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O'Riordan MM, McCabe GA, Kennelly KP. Early vitrectomy is indicated for both diffuse and dense vitreous haemorrhages of unknown aetiology. Ir J Med Sci 2023:10.1007/s11845-023-03573-6. [PMID: 37975994 DOI: 10.1007/s11845-023-03573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Early vitrectomy for complete fundus-obscuring vitreous haemorrhage (VH) allows for prompt diagnosis and treatment of the cause. AIMS To analyse the causes of VH of unknown aetiology, whether partially fundus-obscuring or dense, and to determine the outcomes of early vitrectomy. METHODS A retrospective review of patients who underwent early vitrectomy within 10 days of symptom-onset for partially fundus-obscuring or dense VH of unknown origin. Patients with evidence of proliferative diabetic retinopathy in either eye or any other preoperatively diagnosed aetiology of VH were excluded. RESULTS 19 patients were included. Intraoperative diagnoses were: retinal tears without rhegmatogenous retinal detachment (RRD) (53%); peripheral localised RRD (32%); neovascularisation secondary to retinal vein occlusion (11%) and posterior vitreous detachment without a retinal break (5%). Patients with diffuse VH were as likely to have a retinal tear diagnosed as those with dense VH (88% vs 82%, respectively; p = 0.7). Mean VA improved from 1.26 LogMAR to 0.23 LogMAR postoperatively (p = 0.001). 1 patient (5%) developed a RRD one-year postoperatively. CONCLUSIONS In cases of diffuse or dense VH of unknown aetiology, an occult retinal tear should be suspected. Early vitrectomy should be strongly considered regardless of whether the fundal view is partially or completely obscured, to prevent progression to visually significant RRDs.
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Affiliation(s)
- Matthew M O'Riordan
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland.
| | - Grace A McCabe
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
| | - Kevin P Kennelly
- Department of Ophthalmology, University Hospital Limerick, Limerick, Ireland
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Jindachomthong KK, Cabral H, Subramanian ML, Ness S, Siegel NH, Chhablani J, Hsu SX, Chen X. Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment. Ophthalmol Retina 2023; 7:318-324. [PMID: 36307014 DOI: 10.1016/j.oret.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. DESIGN Retrospective, observational case series. SUBJECTS Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018. METHODS This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. MAIN OUTCOME MEASURES Time to the development of a delayed retinal tear. RESULTS A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. CONCLUSIONS This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L Subramanian
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Steven Ness
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Nicole H Siegel
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel X Hsu
- Boston University School of Medicine, Boston, Massachusetts
| | - Xuejing Chen
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts.
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Ren Q, Han N, Zhang R, Chen RF, Yu P. Combined hamartoma of the retina and retinal pigment epithelium: A case report. World J Clin Cases 2023; 11:1788-1793. [PMID: 36970010 PMCID: PMC10037282 DOI: 10.12998/wjcc.v11.i8.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/19/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) is a rare congenital benign tumor which is commonly monocular. Typical CHRRPE comprises slightly raised lesions at the posterior pole, with proliferation membrane often leading to vascular distortion. In severe cases, macular edema, macular hole, retinal detachment or vitreous hemorrhage may occur. Patients with atypical clinical manifestations are prone to misdiagnosis by inexperienced ophthalmologists.
CASE SUMMARY A 33-year-old man reported onset of right eye blurred vision for one week prior. Anterior segment and intraocular pressure were normal in both eyes. Left eye fundus photography was normal. Right eye ophthalmoscopy showed vitreous hemorrhage and off-white raised retinal lesions below the optic disc. Proliferative membranes on the lesion surfaces resulted in superficial retinal detachment and tortuosity and occlusion of peripheral blood vessels. A horseshoe-like tear in the temporal periphery was surrounded by retinal detachment. Optical coherence tomography revealed retinal thickening at the focal site with structural disturbance indicated by high reflectance. Right eye ultrasound showed retinal thickening at the lesion, stretching and uplifting of the proliferative membrane, with moderately patchy echo at the optic disc edge. Cytokines and antibodies were detected in vitreous fluids during the operation to rule out other diseases. Fundus fluorescein angiography (FFA) at postoperative follow-up led to final diagnosis of CHRRPE.
CONCLUSION FFA is helpful in diagnosing retinal and retinal pigment epithelial combined hamartoma. In addition, other cytokine and etiological tests facilitate further differential diagnosis to rule out other suspected diseases.
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Affiliation(s)
- Qing Ren
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Ning Han
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Rui Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Ruo-Fan Chen
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
| | - Peng Yu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun 130022, Jilin Province, China
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Karahan E, Karti O, Er D, Cam D, Aydın R, Zengin MO, Kaynak S. Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. Int Ophthalmol 2017; 38:257-263. [PMID: 28160191 DOI: 10.1007/s10792-017-0455-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. MATERIALS AND METHODS Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. RESULTS Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. CONCLUSION Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.
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Affiliation(s)
- Eyyup Karahan
- Department of Ophthalmology, Van Training and Research Hospital, Van, Turkey
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı Caddesi No:59, Izmir, Turkey.
| | - Duygu Er
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Duygu Cam
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Rukiye Aydın
- Department of Ophthalmology, Medipol University, Istanbul, Turkey
| | - Mehmet Ozgur Zengin
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Saim Cıkrıkcı Caddesi No:59, Izmir, Turkey
| | - Suleyman Kaynak
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Madi HA, Haynes RJ, Depla D, de la Cour MD, Lesnik-Oberstein S, Muqit MMK, Patton N, Price N, Steel DHW. Rhegmatogenous retinal detachment following intravitreal ocriplasmin. Graefes Arch Clin Exp Ophthalmol 2016; 254:2333-2338. [PMID: 27278373 PMCID: PMC5116307 DOI: 10.1007/s00417-016-3398-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection. Methods Retrospective, multi-centre, observational case series with case note review. Results Eight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3–131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40–20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines. Conclusions RRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.
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Affiliation(s)
- Haifa A Madi
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
| | | | - Diana Depla
- Ophthalmology Department, Cumberland Infirmary, Carlisle, UK
| | - Morten D de la Cour
- Eye Department, Rigshospitalet, Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - Sarit Lesnik-Oberstein
- Department of Ophthalmology, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Mahi M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, City Road, London, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
| | - Nick Price
- Royal Wolverhampton NHS Trust, Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton, UK
| | - David H W Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK. .,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
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Abdolrahimzadeh S, Piraino DC, Scavella V, Abdolrahimzadeh B, Cruciani F, Gharbiya M, Recupero SM. Spectral domain optical coherence tomography and B-scan ultrasonography in the evaluation of retinal tears in acute, incomplete posterior vitreous detachment. BMC Ophthalmol 2016; 16:60. [PMID: 27215604 PMCID: PMC4878030 DOI: 10.1186/s12886-016-0242-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to evaluate the extension and traction effects of posterior vitreous detachment (PVD) complicated with retinal tears using spectral domain optical coherence tomography (OCT) and B-scan ultrasonography. Methods Complete ophthalmological examination, B-scan ultrasonography and spectral domain OCT were performed in patients with acute PVD and retinal tears. Vitreous detachment was classified as complete or incomplete, based on extent of posterior pole or peripheral vitreous detachment. Retinal tear location and persistent traction on the retinal flap was evaluated with B-scan ultrasonography and OCT. Categorical data were evaluated with Fisher’s exact test. Statistical significance was considered as P < 0.05. Results Twenty-six eyes of 25 patients were assessed. Four eyes (15 %) presented complete PVD with detachment at the posterior pole and periphery. 22 eyes (85 %) presented incomplete PVD with detachment in the periphery. Twenty eyes presented retinal tears in the superior quadrants with respect to only 6 in the inferior quadrants (p = 0.006). There was a higher incidence of retinal tears in the pre with respect to post-equatorial areas (19 vs 7 eyes, p = 0.019). B-scan ultrasonography and OCT revealed persistent traction on the retinal tear flap in 19 and 15 eyes, respectively. Conclusions In acute PVD, retinal tears are prevalently associated with peripheral vitreous detachment. The impact of complete or incomplete PVD can be of clinical value when evaluating patients with retinal tears.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, DAI Head/Neck, Azienda Policlinico Umberto I, University of Rome "Sapienza", viale del Policlinico 155, Rome, 00161, Italy.
| | - Domenica Carmen Piraino
- Ophthalmology Unit, Department of Sense Organs, University of Rome "Sapienza", viale del Policlinico 155, Rome, 00161, Italy
| | - Vittorio Scavella
- Ophthalmology Unit, Department of Sense Organs, University of Rome "Sapienza", viale del Policlinico 155, Rome, 00161, Italy
| | | | - Filippo Cruciani
- Ophthalmology Unit, Department of Sense Organs, University of Rome "Sapienza", viale del Policlinico 155, Rome, 00161, Italy
| | - Magda Gharbiya
- Ophthalmology Unit, Department of Sense Organs, University of Rome "Sapienza", viale del Policlinico 155, Rome, 00161, Italy
| | - Santi Maria Recupero
- Opthalmology Unit, NESMOS Department, University of Rome "Sapienza", St. Andrea Hospital, via di Grottarossa 1035-1039, Rome, 00189, Italy
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