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Sub?macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub?macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r?tPA) followed by air/SF6 injection into the sub?retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub?macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub?retinal space prior to the r?tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self?sealing properties. An air injection prior to r?tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.
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@#AIM:To observe the imaging features of optical coherence tomography angiography(OCTA)in the macular hemorrhage of pathologic myopia.METHODS:Designing a retrospective analysis collected clinical data of 100 patients(108 eyes)diagnosed as macular hemorrhage of pathological myopic in Nanjing Medical University Affiliated Eye Hospital from June 2016 to December 2020. All patients underwent refraction, eye axis,fundus photography, spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA)and OCTA examination. All patients were divided into macular hemorrhage only with lacquer cracks and macular hemorrhage with choroidal neovascularization(CNV). All patients followed-up for more than 3mo by OCTA. RESULTS:There were 40 patients(42 eyes)diagnosed as macular hemorrhage only with lacquer cracks, OCTA showed bleed obscured by choroidal capillaries. After hemorrhage was being absorbed, lacquer cracks showed linear or stellate reflection completely in the choroidal capillary layer. B-scan image showed discontinuous retinal pigment epithelium(RPE), thinner choroid and an increased light. Penetrance into deeper tissues. After all macular hemorrhage only with lacquer cracks were absorbed, follow-up mode of OCTA found that 2 eyes(4.8%)without lacquer cracks, 28 eyes(66.7%)were linear and 12 eyes(28.6%)were stellate under the original hemorrhage. Follow-up mode also showed that 8 eyes of 8 patients(19.0%)relapsed macular hemorrhage only with lacquer cracks, and 4 eyes of 4 patients(9.5%)suffered secondary macular hemorrhage with CNV. There were 60 patients(66 eyes)diagnosed as macular hemorrhage with CNV,OCTA showed bleed obscured choroidal capillaries, the outer retinal and choroidal capillary layer also showed the shape of CNV around hemorrhage. B-scan showed CNV breaked through the RPE layer and blood flow signal in it. The area of CNV decreased after anti-vascular endothelial growth factor(VEGF)intravitreal injection treatment. Around all macular hemorrhage with CNV, OCTA found that 48 eyes(72.7%)had lacquer cracks, 28 eyes(42.4%)were linear and 20 eyes(30.3%)were stellate.CONCLUSION:OCTA has a great significance in the diagnosis of macular hemorrhage of pathological myopia, fast and non-invasive is the biggest advantage. Choroidal capillary layer can clearly observe the shape and location of hemorrhage,lacquer cracks and CNV. The follow-up mode can intuitively comprehend the changes of disease. To some extent, it can replace fundus angiography to directly judge the classification, and time to treat in the clinic.
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AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA)in macular-involved branch retinal vein occlusion(BRVO)and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA)and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.
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@#AIM: To investigate the relationship between the macular hemorrhage and refractive abnormalities,and analyze the occurrence probability and the factors of refractive abnormalities in high-risk neonates. <p>METHODS: From January 2017 to January 2018, a total of 1 229 neonates with high-risk factors invided into 3 groups, according to the different parts of retinal hemorrhage, examined by RetCamⅢ device. All the subjects were checked the refractive status by autorefractor when they were 1 to 1.5 years old. The abnormalities were checked their refractive status under using of 1% atropine oculentum after 7d. The relationship between the macular hemorrhage and refractive abnormalities, and the occurrence probability and the factors of refractive abnormalities were analyzed.<p>RESULTS: Among 205 eyes which were retinal hemorrhage irrelated macula 6 eyes had refractive abnormality(2.93%)in group A. 57 eyes which were macular hemorrhage 17 eyes had refractive abnormality(29.82%)in group B. 2 196 eyes which were no retinal hemorrhage 40 eyes had refractive abnormality(1.82%)in group C. It had significant difference between groups A and B, groups B and C(<i>P</i><0.001), but had no significant difference between groups A and C(<i>P</i>=0.27). Multivariate Logistic regression analysis showed that macular hemorrhage and neonatal hypoxic ischemic encephalopathy were the independent risk factors for refractive status.<p>CONCLUSION: The incidence of refractive abnormality was high in macular hemorrhage. Macular hemorrhage and neonatal hypoxic ischemic encephalopathy were the independent risk factors for refractive abnormality,and we should strengthen the observation and intervention of such new-borns.
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@#AIM:To analyze the treatment of macular hemorrhage caused by rupture of retinal aortic aneurysm and its effect. <p>METHODS:Totally 7 case(7 eyes)of macular hemorrhage caused by rupture of retinal aortic aneurysm in our hospital from January 2012 to January 2016 were collected. Three cases of hemorrhage were pre-retina, in which 1 eye was observed(without treatment)and 2 eyes were treated with 532nm laser vitreous cortex incision drainage. In 3 eyes with hemorrhage in the retinal, all were given anti- vascular endothelial growth factor(VEGF)treatment. In 1 eye with both pre-retinal and in the retinal hemorrhage, combined treatment was given as the intravitreal injection + laser vitreous cortex incision and drainage and anti-VEGF therapy. <p>RESULTS: All 7 cases of pre-retinal and retinal hemorrhage were absorbed, visual acuity improved to varying degrees. <p>CONCLUSION: The treatment of macular hemorrhage caused by rupture of retinal aortic aneurysm should be treated according to the scope and location of bleeding, so as to achieve better prognosis.
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We report a case of a 17‑year‑old female patient who presented with sudden, painless, nonprogressive diminished vision in both eyes (best corrected visual acuity in right eye ‑ 6/60 and left eye ‑ 6/36). An ophthalmological evaluation revealed bilateral pale tarsal conjunctiva and bilateral macular hemorrhage. Hematological evaluation revealed the presence of megalocytic anemia (with hemoglobin ‑ 4.9 g%). General examination showed severe pallor. On systemic examination, no abnormality was detected, confirmed by ultrasonography abdomen. Other causes of severe anemia have been ruled out. Intraocular pressure in both eyes was 12 mmHg. This case documents the rare occurrence of bilateral subinternal limiting membrane macular hemorrhage with megaloblastic anemia without thrombocytopenia and other retinal features of anemic retinopathy.
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AlM:To study the treatment effect of traditional Chinese medicine in the treatment of high myopia macular hemorrhage, using Chinese medicine etiology and pathogenesis, syndrome differentiation treatment, and provide the basis for the clinical treatment. METHODS: Eighty patients ( 135 eyes ) with high myopia macular hemorrhage were selected in the hospital from January 2012 to september 2014 as treatment group, and applied traditional Chinese medicine treatment. Forty-five patients (64 eyes) with the same period, as the control group, received routine western medicine treatment. After 1mo treatement, the treatment effect and vision improvement situation of two groups were observed, and after 6mo follow-up, the relapse was observed.RESULTS: The total effective rate of treatment group was 85. 19% (115/135), higher than the control group 78. 13% (50/64) (P<0. 05). The average corrected visual acuity of treatment group was 0. 48±0. 11, higher than the control group 0. 36 ± 0. 09, the difference was statistically significant (P<0. 05). The average diopter and macular bleeding scope of the treatment group were -9. 81±0. 85D and 0. 51 ± 0. 27PD, lower than the control group -10. 76 ± 0. 91D and 0. 78 ± 0. 23PD, the differences were statistically significant ( P < 0. 05 ). The eye ground hemorrhage absorption time of treatment group was 25. 34±2. 28d, less than the control group 29. 72 ± 2. 13d, the difference was statistically significant (P<0. 05). The bleeding again of the control group 7. 81% ( 5/64 ), higher than the treatment group was 5. 19% (7/135), the difference was statistically significant (P<0. 05).CONCLUSlON: Evidence-based treatment of traditional Chinese medicine for high myopia macular hemorrhage has good clinical effect, can shorten the treatment time, and is beneficial to the recovery of postoperative vision, worthy of clinical popularization and application.
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PURPOSE: To evaluate the relationship between postoperative optical coherence tomography (OCT) findings and visual acuity in patients who underwent vitrectomy for macular hemorrhage related to the rupture of a retinal artery macroaneurysm. METHODS: A retrospective case review was conducted for patients who underwent vitrectomy for macular hemorrhage caused by a retinal arterial macroaneurysm. The relationship between postoperative OCT findings and visual acuity was analyzed. RESULTS: This study included 12 patients whose preoperative mean best corrected visual acuity (BCVA) (logMAR) was 1.7+/-0.8 and whose mean final BCVA was 0.6+/-0.5. These values were statistically different (p=0.004). Mean foveal thickness by OCT was 437.5+/-161.5 micrometer at the preoperative period and 252.8+/-84.9 micrometer three months postoperative, and this difference was statistically significant (p=0.017). As the foveal thickness decreased after removal of the remnant organized retinal hemorrhage in the postoperative period, BCVA improved at the final follow-up (p=0.048). According to the postoperative OCT, the photoreceptor disruption group presented a lower BCVA than that of the photoreceptor preservation group at the final follow-up (logMAR: 1.4+/-0.4 vs. 0.3+/-0.2, p=0.009). CONCLUSIONS: Photoreceptor preservation as observed by OCT was significantly associated with better visual outcome after vitrectomy in patients with macular hemorrhage caused by rupture of a retinal arterial macroaneurysm.
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Humans , Follow-Up Studies , Hemorrhage , Postoperative Period , Preoperative Period , Retinal Artery , Retinal Hemorrhage , Retinaldehyde , Retrospective Studies , Rupture , Tomography, Optical Coherence , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To evaluate the indocyanine green angiographic (ICGA) characteristics of the patients who had recurrent macular hemorrhage. METHODS: Medical records and ICGA were reviewed on 22 eyes of the 22 patients who had recurrent macular hemorrhage without retinal vasculopathy, drusen, and high myopia from March, 1998 to December, 2000. RESULTS: The early hyperfluorescent lesion of ICGA were located in the macula in 16 eyes (72.7%), multiple in 16 eyes (72.7%), and the shape of the lesions were polypoid in 13 eyes (59.1%). The other shapes were tubular in 6 eyes (27.3%), single hotspot in 2 eyes (9.1%), and finger-like in 1 eye (4.5%). The lesion showed late leaking in 17 eyes (77.3%), washout in 2 eyes (9.1%), and mixed type in 3 eyes (13.6%). CONCLUSIONS: The reasons of the difficulty in showing the typical ICGA characteristics of idiopathic polypoidal choroidal vasculopathy (IPCV) by OIS(ophthalmic imaging system) type angiography in the patients who had recurrent macular hemorrhage were insufficient early pictures and the display of that type of ICGA. To diagnose IPCV correctly in the patients who had recurrent macular hemorrhage, early pictures, the changes of the fluorescence through the mid and late phase, and the variable ICGA characteristics should be taken into consideration.
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Humans , Angiography , Choroid , Fluorescence , Hemorrhage , Indocyanine Green , Medical Records , Myopia , RetinaldehydeABSTRACT
PURPOSE: Cerebral malaria is caused by Plasmodium falciparum. The reports about cerebral malaria are very rare because Korea is not endemic area of P. falciparum. Additionally, macular hemorrhage and decreased vision associated with cerebral malaria was not reported ever in Korea, we report one case of cerebral malaria associated with retinal hemorrhage on macular area and review of literature. METHODS: Ophthalmology was consulted with about 19-year-old woman in cerebral malaria, tropical endemic disease caused by Plasmodium falciparum, with decresed visual acuity. RESULTS: 1250 mg/day of Mefloquine was injected into patient for cerebral malaria for 18 days. After awareness, the patient complained of decreased visual acuity in left eye, then the best corrected visual acuity(BCVA) in left eye was 20/800, BCVA in right eye was 20/20, retinal hemorrhage and Roth's spot were found on fundus examination in left eye, and finding in fluorescein angiography was not specific. After 8 months, retinal hemorrhage in left eye was absorbed, but BCVA in left eye was not changed.
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Female , Humans , Young Adult , Endemic Diseases , Fluorescein Angiography , Hemorrhage , Korea , Malaria, Cerebral , Mefloquine , Ophthalmology , Plasmodium falciparum , Retinal Hemorrhage , Retinaldehyde , Visual AcuityABSTRACT
PURPOSE: Valsalva retinopathy is very uncommon disease, but can cause sudden reduction of visual acuity by unilateral macular hemorrhage due to a rapid rise in intrathoracic or intraabdominal pressure. It resolves usually within 1-3 months without specific treatment. We report a case associated with blowing up of a rubber glove. METHODS: A healthy young adult with normal visual acuity experienced visual blurring in one eye. At first visit, visual acuity was 0.06 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up. RESULT: Two weeks after first visit, the size of preretinal hemorrhage decreased. Three weeks after first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity was not improved. Six weeks after first visit, the preretinal hemorrhage resolved completely and visual acuity returned to normal. DISCUSSION: Valsalva retinopathy associated with blowing up of a rubber glove resolved within 6 weeks without no specific treatment.
Subject(s)
Humans , Young Adult , Fluorescein Angiography , Fluorescence , Hemorrhage , Membranes , Rubber , Visual AcuityABSTRACT
Macular hemorrhage which result from breaks of Bruch's membrane or from choroidal neovascularization can develop in high degenerative myopia, but its occurrence after photorefractive surgery has rarely been reported. We experienced a case of macular hemorrhage after laser in situ keratomileusis[LASIK]:A 28-year-old female patient with high myopia of -16.5 diopters, who had received successful LASIK operation on her left eye.complained of a sudden drop in vision 20 days postoperatively.On fundus examination, macular hemorrhages were detected on her left eye.Eventually the hemorrhages resolved, but more than 2 lines of her best corrected visual acuity were lost.During follow-up, a new hemorrhagic lesion was incidently found on the other eye. This case demonstrates that macular hemorrhages may develop after LASIK in eyes with high degenerative myopia, and lead to a permanent reduction in visual acuity.We should be alert to any potential retinal pathology in patients having refractive surgery.