RESUMO
PURPOSE: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. METHODS: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. RESULTS: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. CONCLUSIONS: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Hemorragia , OlhoRESUMO
BACKGROUND: The most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. OBJECTIVE: To carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. METHOD: Retrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. RESULTS: 1227 files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. 65% presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36)â¯ml/min/1.73â¯m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6 to 15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy. (pâ¯=â¯0.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. CONCLUSION: The results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.
Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Estudos Retrospectivos , Retinopatia Diabética/complicações , Retinopatia Diabética/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Diabetes Mellitus/cirurgiaRESUMO
PURPOSE: We aimed to evaluate the factors influencing the visual gain following pars plana vitrectomy for vitreous hemorrhage in patients with proliferative diabetic retinopathy. METHODS: A retrospective study was conducted on 172 eyes of 143 consecutive patients with diabetes mellitus between January 2012 and January 2018. Demographic data, ophthalmological findings, surgery details, and visual outcomes were gathered after consulting the patients' records. The main outcome measured was the improvement of best corrected visual acuity and the secondary outcomes measured were rebleeding and complications. RESULTS: Best corrected visual acuity improved in 103 eyes (59.88%), worsened in 45 eyes (26.16%), and remained unchanged in 24 eyes (13.95%). Type 2 diabetes mellitus was significantly associated with better final best corrected visual acuity (p=0.0244). Previous treatment by pan-retinal laser photocoagulation or intravitreal bevacizumab determined better final best corrected visual acuity, but not significantly (p>0.05). Preoperative rubeosis iridis and neovascular glaucoma did not influence the outcomes. The lack of fibrovascular proliferation requiring dissection was a significant factor for better final best corrected visual acuity (p=0.0006). Rebleeding occurred in 37.1% of the eyes and it was not influenced by the antiplatelet drugs (p>0.05). Postoperative neovascular glaucoma was a negative prognostic factor (p=0.0037). CONCLUSION: The final best corrected visual acuity was influenced positively by type 2 diabetes mellitus and the absence of preoperative extensive fibrovascular proliferation and negatively by postoperative neovascular glaucoma.
Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Glaucoma Neovascular , Humanos , Retinopatia Diabética/complicações , Vitrectomia/efeitos adversos , Hemorragia Vítrea/cirurgia , Hemorragia Vítrea/complicações , Glaucoma Neovascular/cirurgia , Diabetes Mellitus Tipo 2/complicações , Estudos Retrospectivos , PrognósticoRESUMO
ABSTRACT This report describes a case of retinal racemose hemangioma that first presented as a vitreous hemorrhage. The authors present the case of a 47-year-old woman with a sudden 5-day painless visual loss in her left eye. At the first visit, the best-correct visual acuities were 20/20 in the right eye and hand motions in the left eyes. Ultrasonography showed an attached retina and a massive vitreous hemorrhage. Pars plana vitrectomy was performed and a dilatation of large vessels was detected bulging from the optic disc. The best-correct visual acuities on day 30 postoperatively was 20/25 in the left eye. Fundus angiography and spectral-domain optical coherence tomography angiography showed anomalous arteriovenous communications with no intervening capillaries. The diagnosis was racemose hemangioma, an arteriovenous malformation of group 2 retina based on the Archer classification.
RESUMO Este relato descreve um caso de hemangioma racemoso da retina que se apresentou inicialmente como hemorragia vítrea. Os autores apresentam o caso de uma mulher de 47 anos com perda visual súbita e indolor 5 dias antes no olho esquerdo. Na primeira visita, a melhor acuidade visual corrigida foi de 20/20 no olho direito e movimentos das mãos no olho esquerdo. A ultrassonografia mostrou uma retina aderida e uma hemorragia vítrea maciça. Foi realizada vitrectomia pars plana, sendo detectada proliferação de grandes vasos salientes do disco óptico. A acuidade visual no dia 30 de pós-operatório foi de 20/25 no olho esquerdo. A angiografia de retina e a angiotomografia de coerência óptica de domínio espectral mostraram comunicações arteriovenosas anômalas sem capilares intermediários. O diagnóstico foi hemangioma racemoso, uma malformação arteriovenosa da retina do grupo 2 com base na classificação de Archer.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Malformações Arteriovenosas/complicações , Vasos Retinianos/anormalidades , Hemorragia Vítrea/etiologia , Angiografia , Hemangioma/complicações , Malformações Arteriovenosas/cirurgia , Malformações Arteriovenosas/diagnóstico , Doenças Retinianas , Vasos Retinianos/diagnóstico por imagem , Vitrectomia , Hemorragia Vítrea/cirurgia , Hemorragia Vítrea/diagnóstico , Ultrassonografia , Tomografia de Coerência Óptica , Hemangioma/cirurgia , Hemangioma/diagnósticoRESUMO
PURPOSE: To describe the first case of a combined sub-hyaloid and sub-internal limiting membrane macular hemorrhage after recreational laser exposure. METHODS: A 23-year-old patient presented with an acute loss of vision in his right eye (OD) immediately after a brief exposure to a laser beam at a music festival. Color photography, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinogram (mfERG) were performed for diagnosis and follow-up. RESULTS: On presentation, visual acuity was 20/400 in the OD and 20/20 in the left eye. Posterior segment examination of his OD revealed a preretinal hemorrhage at the macula. SD-OCT images exposed a combined sub-hyaloid and sub-internal limiting membrane localization. Successful VPP with ILM peeling was carried out. Although sequential mfERG displayed almost complete restoration of the P1 amplitude 6 months posterior to VPP, SD-OCT demonstrated permanent damage to outer retinal layers. Final BCVA on OD was 20/30. CONCLUSION: The expanding and unregulated use of lasers in everyday life has created an increasing amount of cases of laser-induced retinopathy in recent years. Much more attention should be addressed in laser safety and awareness to prevent future ocular injuries. In acute phases of sub-hyaloid hemorrhages blocking direct visualization of the posterior pole, mfERG is a valuable tool to address initial macular pathology.
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Traumatismos Oculares/etiologia , Lasers/efeitos adversos , Retina/lesões , Hemorragia Retiniana/etiologia , Corpo Vítreo/lesões , Hemorragia Vítrea/etiologia , Eletrorretinografia , Traumatismos Oculares/diagnóstico por imagem , Traumatismos Oculares/cirurgia , Férias e Feriados , Humanos , Masculino , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/cirurgia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Vitrectomia , Hemorragia Vítrea/diagnóstico por imagem , Hemorragia Vítrea/cirurgia , Adulto JovemRESUMO
Spontaneous vitreous hemorrhage is a rare entity, present in 7 out of 100,000 inhabitants. It is associated with different pathologies; however, it is rarely reported to be caused by retinal vessel avulsion syndrome. In the present manuscript, we report a case of avulsion of retinal vessels associated with recurrent vitreous hemorrhage managed, at first, by photocoagulation, but due to the several recurrence of bleeding, the patient went into surgical management.
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Fotocoagulação/métodos , Perfurações Retinianas/complicações , Vasos Retinianos/diagnóstico por imagem , Hemorragia Vítrea/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Vasos Retinianos/cirurgia , Tomografia de Coerência Óptica , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/cirurgiaRESUMO
BACKGROUND: Usual retinal surgery (vitrectomy or surgery for retinal detachment) may require additional procedures to deal with complex cases, which increase time and resource use and delay access to treatment. We undertook this study to identify the proportion of primary retinal surgeries that required complex procedures and the associated causes. METHODS: We carried out an observational, descriptive, cross-sectional, retrospective study. Patients with primary retinal surgery were evaluated (January 2007-December 2010). The proportion and 95% confidence intervals (CI) of preoperative diagnosis and cause of the disease requiring retinal surgery as well as the causes for complex retinal surgery were identified. Complex retinal surgery was defined as that requiring lens extraction, intraocular lens implantation, heavy perfluorocarbon liquids, silicone oil tamponade or intravitreal drugs, in addition to the usual surgical retinal procedure. The proportion of complex retinal surgeries was compared among preoperative diagnoses and among causes (χ(2), odds ratio [OR]). RESULTS: We studied 338 eyes. Mean age of subjects was 53.7 years, and there were 49% females. The most common diagnoses were vitreous hemorrhage (27.2%) and rhegmatogenous retinal detachment (24.6%). The most common cause was diabetes (50.6%); 273 eyes required complex surgery (80.8%, 95% CI: 76.6-85). The proportion did not differ among diagnoses but was higher in diabetic retinopathy (89%, p <0.001, OR 3.04, 95% CI: 1.63-5.7). CONCLUSIONS: Of the total sample, 80.8% of eyes required complex surgical procedures; diabetic retinopathy increased by 3-fold the probability of requiring these complex procedures. Early treatment of diabetic retinopathy may reduce the proportion of complex retinal surgery by 56%.
Assuntos
Retinopatia Diabética/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Doenças Retinianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Retinopatia Diabética/diagnóstico , Diagnóstico Precoce , Feminino , Hospitais Gerais , Humanos , Injeções Intraoculares/estatística & dados numéricos , Implante de Lente Intraocular/estatística & dados numéricos , Subluxação do Cristalino/cirurgia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Vitrectomia/estatística & dados numéricos , Hemorragia Vítrea/cirurgia , Adulto JovemRESUMO
BACKGROUND: To determine the alterations in the corneal topography after pars planavitrectomy with the system of 20- and 25-gauge. METHODS: A total of 29 patients with vitreous hemorrhage. The first group (17 patients) had to undergo a pars planavitrectomy with the 20-gauge system, whereas the second (12 patients) had the pars planavitrectomy with the 25-gauge system. The corneal topography was analyzed in the pre-operation, in the first, third, and sixth months in the post-operation. RESULTS: the group which underwent the standartvitrectomy registered a statistically significant difference in the keratometric difference (dK) in the first month compared to the pre-operation (p < 0,000), first month with the third month (p < 0,020), first month and sixth month (p < 0,008). In the 25-gauge system group significant statistical alterations did not occur. CONCLUSION: astigmatism occurs in the first month post vitrectomy standard. The 25-gauge systemis notinducedastigmatism.
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Astigmatismo/etiologia , Topografia da Córnea , Microcirurgia/métodos , Complicações Pós-Operatórias , Vitrectomia/métodos , Hemorragia Vítrea/cirurgia , Adulto , Idoso , Astigmatismo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Técnicas de Sutura , Vitrectomia/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: complications of proliferative diabetic retinopathy require surgical treatment. In 2007 Flaxel reported visual improvement after vitreoretinal surgery in 37% of Latino diabetics; in our country it is estimated that a higher proportion of patients improves, but this has not been documented. AIM: to identify the efficacy of vitreoretinal surgery for improving best corrected visual acuity, in diabetic patients treated at a hospital in Mexico City. METHODS: an observational, longitudinal, retrospective, descriptive study was conducted in diabetics who underwent vitreoretinal surgery (2007-2010) with one year follow-up. Visual acuity was measured before surgery and one year after, and it was registered when the retinopexy orphacoemulsification was performed, or silicone tamponade wasused. The proportions and 95% confidence intervals (CI) of patients whose visual acuity improved, did not change or worsened, were compared with those reported by Flaxel in Latino patients (χ(2), relative risk [RR]). RESULTS: 63 patients, mean age 58.5 ± 11.6 years, 26 with retinal detachment (41.3%), phacoemulsification was performed in 50 (79.4%), and silicone was used in 27 (42.9%). BCVA worsened in 12 patients (19%), did not change in 5 (8%) and improved in 46 (73%, 95% CI 62-84); the latter proportion exceeded that reported by Flaxel (p = 0.0005, RR 1.97, 95% CI 1.25-3.1). DISCUSSION: although the difference was not clinically significant, the efficacy of vitreoretinal surgery to improve visual acuity in the sample was consistently higher than that reported by Flaxel in Latinos, and did not vary from other studies. These results do not support an association between an ethnic group and a lower surgical efficacy.