Vitreous hemorrhage - Causes, diagnosis, and management.

Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Retinal neovascularization in a patient with chronic central serous chorioretinopathy.

A 45-year-old male presented with diminution of vision in both eyes since the last 2 years. The best-corrected visual acuity was 20/200 in his right eye and 20/600 in left eye. BE fundi had changes of chronic CSCR with PED and NSD in the RE and subretinal fibrosis in the left eye. Both eyes had peripheral pigmentary changes. Multimodal imaging showed peripheral avascular retina in both eyes with neovascularization at disc in the right eye which promptly resolved with a single injection of anti-VEGF. Retinal neovascularization is an unusual finding in the setting of CSCR and has not been reported in the literature.

Pediatric idiopathic macular hole - A case report and review of literature.

Macular hole in the pediatric age group is usually post-traumatic unlike, the adult counterpart. Herein we describe a case of idiopathic macular hole occurring in a 9-year-old male who presented to us with complaints of diminution of vision in OD (oculus dextrus) for 2 months. The child underwent 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. On follow-up his best-corrected visual acuity improved with type 1 closure of macular hole.

Comparison of topical anesthesia and peribulbar anesthesia for 23-gauge vitrectomy without sedation.

PURPOSE: To compare the safety and efficacy of topical anesthesia versus peribulbar anesthesia for 23-gauge vitrectomy without sedation. METHODS: Selected group of 60 patients with vitreous hemorrhage were divided into 2 groups and underwent 23-gauge vitrectomy. Group 1 used topical anesthesia, whereas Group 2 used peribulbar anesthesia. A 5-point Visual Analogue Scale was used to assess patients' pain score and surgeon's ease while operating. Any complications thereof were made note of. RESULTS: Mean overall patients' pain scores were 1.77 ± 0.50 in Group 1 and 1.77 ± 0.43 in Group 2. Surgeon's comfort score was recorded as 0.3 ± 0.53 and 0.17 ± 0.38 in Groups 1 and 2, respectively. Mean surgical time was 33.7 ± 7.1 minutes and 30.1 ± 6.2 minutes in Groups 1 and 2, respectively. These means were not statistically significant (P > 0.05). No patient required sedation or anesthesia supplementation. Group 1 patients reported maximum pain during trocar entry, whereas Group 2 reported maximum pain during block. Group 2 patients also reported significant conjunctival chemosis and lid edema postblock. CONCLUSION: Topical anesthesia without any sedation is a viable option, comparable to peribulbar block, for performing vitrectomy in selected group of patients requiring vitrectomy and thus avoiding complication of injection anesthesia and quicker postoperative recovery.