ABSTRACT
Five Indian patients presenting with unilateral vitreous hemorrhage (VH) underwent pars plana vitrectomy (PPV) and were found to have lesions suggestive of peripheral exudative hemorrhagic chorioretinopathy (PEHCR). All eyes had extensive sub-retinal hemorrhage; three also showed an elevated mass lesion. The temporal retina anterior to the equator was the most commonly affected site. Exudative manifestations were absent in all. No recurrences occurred over a mean follow-up of 17.5 months. Although PEHCR is reported to be rare in Asians, this series demonstrates that it can present as VH in Indians as well. Unless the macula has irreversible damage, a favorable outcome can be obtained with PPV alone.
ABSTRACT
Objective To explore the value of conventional ultrasound, color Doppler ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of sub-retinal hemorrhage. Methods A total of 26 patients with sub-retinal hemorrhage were examined by conventional ultrasound, color Doppler ultrasound and CEUS. The results of medical history, ultrasound, color Doppler ultrasound and CEUS were recorded and analyzed.And the difference of the detection rate between the three methods was analyzed by χ2test. Results The mean fundus diameter of the sub-retinal hemorrhage was (5.31±2.21) mm, and the mean height was (1.97±0.98) mm. In twenty-two eyes (84.6%) the lesions were located in the posterior pole of the ocular wall, while in two eyes (7.7%) the lesions were located in the equator and peripheral of the ocular wall. Seven eyes (26.9%) had dome-shaped mass, ten eyes (38.5%) had flat-shaped mass, and nine eyes (34.9%) had irregular-shaped mass. The echogenecity of the lesions was homogeneous in twelve eyes (46.2%), and heterogeneous in fourteen eyes (53.8%). The lesions showed clear margin in seventeen eyes (65.4%). Blood flow signals can be detected in twenty-three eyes (88.5%). The surface of the lesions was filled by contrast-medium in all cases. The detection rate of sub-retinal hemorrhage with color Doppler and contrast-enhanced ultrasound was higher than that of conventional ultrasound, and the difference was statistically significant. Conclusion Color Doppler ultrasonography and CEUS can provide a powerful basis for the clinical diagnosis of sub-retinal hemorrhage, while CEUS has higher application value.
ABSTRACT
Massive subretinal hemorrhage may develop secondary to choroidal neovascularization. The poor visual prognosis associated with submacular hemorrhage can be explained by preexisting abnormality of photoreceptorretinal pigment epithelium-Bruch's membrane complex and fibrin-mediated injury to the outer segment of photoreceptor. An animal experiment showed that subretinal fibrin induced irreversible damage to the retina within 24 hours. We use recombinant tissue plasminogen activator(rt-PA), at doses(3 microgram substantially lower than previously reported, to aid in the surgical evacuation of massive subretinal hemorrhage within 2 days of its development. The subretinal hemorrhage in both patients developed in association with age-related macular degeneration. Postoperative corrected visual acuity improved from counting fingers to 0.3 in one patient and from hand motion to 0.04 in the other. There has been no complication except ocular hypertension which is medically controllable. Subfoveal neovascularization explains poor postoperative vision in one case. It seems that visual recovery is facilitated by early evacuation of massive subretinal hemorrhage and by using low-dose rt-PA. Low-dose rt-PA may minimize the risks of intraocular hemorrhage and retinal toxicity.