Ultrasonic fragmentation for removing thick organized clots during diabetic vitrectomy – A novel technique

A 65?year?old male with proliferative diabetic retinopathy (PDR) and non?clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.

Pneumatic displacement without tissue plasminogen activator in premacular subhyaloid hemorrhage.

To assess the efficacy and safety of intravitreal injection of Sulfur Hexafluoride (SF6) gas without the use of tissue Plasminogen Activator (tPA) in premacular Subhyaloid Hemorrhage (SHH), 5 eyes of 5 patients with premacular SHH were enrolled. After performing paracentesis of the anterior chamber, 0.3 ml pure SF6 gas was injected through pars plana with a 30 gauge needle. Facedown position was maintained for 5 days. Subhyaloid Hemorrhage was displaced in 4/5 (80%) eyes with a duration of SHH less than 2 weeks. The pre-injection visual acuity of all 5 eyes was finger counting and improved in 4/5 ( 80% ) eyes within 3 days to 7 days post-injection to 6/20 - 6/6. The underlying disease was hypercoagulation in 1 patient, diabetes mellitus in 2 patients, hypertension in 1 patient and unknown in 1 patient. No complications were encountered. In conclusion, SF6 gas injected into the vitreous without the use of tPA, can displace SHH if performed within 14 days of duration, and results in rapid visual recovery. This procedure is proven to be safe.

A Case of Subhyaloid Hemorrhage due to Bungee Jumping

PURPOSE: To report a case of subhyaloid hemorrhage which resulted from bungee jumping and to describe the clinical course. METHODS: A 21-year-old man who presented with acute diminution in vision following bungee jumping from a height of approximately 64m visited our ophthalmologic department 3 days after the jump. RESULTS: Best uncorrected visual acuity (UCVA) was right eye 1.0 and left eye F.C 10cm initially. He demonstrated a periocular contusion of about 1cm in the left lateral eyebrow. A full examination of the anterior segment was normal but his left fundus showed a subhyaloid hemorrhage of about 7 disc-diameters in size. There were surrounding superficial retinal hemorrhages and peripheral retinal edema. At 54 days follow-up, subhyaloid hemorrhage of about 5 disc-diameters in size remained and visual acuity was not improved. Trans pars plana vitrectomy was performed in his left eye and improved his vision. One month after the operation, the vision was 1.0 unaided in the left eye. The visual acuity remained as 1.0 eight months after the operation. CONCLUSIONS: It is important that the public should be educated about the potential hazard of bungee jumping and we recommend the use of safety glasses during the bungee jump.

Bilateral Subhyaloid Hemorrhage in Acute Myeloid Leukemia: One Case Report of Treatment

The ocular manifestations of leukemia include leukemic infiltration in optic nerve, retina, choroid, iris, ciliary body and anterior chamber, as well as retinal vascular change and hemorrhage due to systemic hemodynamic abnormalities.Occasionaly, subhyaloid hemorrhage involving the macula may cause acute loss of central visual acuity. We observed dense bilateral macular subhyaloid hemorrhage in 19-year-old man who had been diagnosed to have acute myeloid leukemia.Trans pars plana vitrectomy was performed in his both eyes, resulting in improvement of vision.