vitreous hemorrhage

玻璃体出血
  • 文章类型: Journal Article
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  • 文章类型: Case Reports
    严重的镰状视网膜病变在成人中很常见,但在儿童中却不常见。因此,儿童镰状视网膜病变的相关治疗方法没有得到很好的描述.我们报告了2名儿童镰状患者(12岁和13岁)出现严重镰状视网膜病变,并描述了他们2-3年的疾病进展和治疗细节。以及在管理这一组年轻的镰状细胞患者时面临的挑战。我们的病例报告还证明了激光光凝治疗对早期镰刀增生性疾病的益处。以及晚期严重视网膜病变的并发症如何阻碍了有效的治疗。
    Severe sickle retinopathy is commonly known in adults but not in children, hence any related treatment for sickle retinopathy in children was not well described. We reported 2 paediatric sickle patients (aged 12 and 13) presented with severe sickle retinopathy and described details of their disease progression and treatments over 2-3 years, along with the challenges faced when managing this particular group of young age sickle cell patients. Our case reports also demonstrated the benefits of laser photocoagulation treatment to early sickle proliferative disease, and how complications from advanced severe retinopathy hindered effective treatments.
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  • 文章类型: Case Reports
    背景技术Terson综合征(TS)是一种以眼内出血为特征的医学病症,其可导致视觉障碍并且与蛛网膜下腔出血(SAH)相关。病理生理学和自然史在目前的文献中还没有很好地确定。该报告描述了一名52岁的动脉瘤性SAH患者的成功治疗方法,该患者使用球囊辅助卷绕和玻璃体切除术发展了迟发性TS,以提高对动脉瘤性SAH这一重要并发症的认识。病例报告一名52岁的吸烟者,没有已知的既往病史,突然出现在急诊科,严重头痛,伴有畏光和畏音。患者患有弥漫性SAH,并接受了栓塞手术。经过48小时密切的重症监护病房监测,病人的生命体征稳定,GCS评分始终为15/15。然而,住院3周后,患者出现视力模糊和右上正交视。进一步检查显示为TS,患者接受了1眼玻璃体切除术。手术成功,眼睛恢复到20/20,无并发症。然而,另一只眼睛显示出血吸收缓慢,还计划对那只眼睛进行玻璃体切除术。结论TS是动脉瘤性SAH的并发症,可导致视力丧失和发病率增加。它经常得不到诊断,和眼科医生没有定期咨询。这种情况的晚期表现以本案为例。早期发现和干预对于更好的患者预后至关重要。
    BACKGROUND Terson\'s syndrome (TS) is a medical condition characterized by intraocular bleeding that can lead to visual impairment and is associated to subarachnoid hemorrhage (SAH). The pathophysiology and natural history are not well established in the current literature. This report describes successful treatment of a 52-year-old man with aneurysmal SAH who developed late-onset TS using balloon-assisted coiling and vitrectomy to raise awareness of this important complication of aneurysmal SAH. CASE REPORT A 52-year-old smoker with no known past medical history presented to the emergency department with a sudden, severe headache that worsened with photophobia and phonophobia. The patient had a diffuse SAH and underwent an embolization procedure. After 48 hours of close Intensive Care Unit monitoring, the patient\'s vital signs were stable, and the GCS score was consistently 15/15. However, after 3 weeks in the hospital, the patient experienced blurred vision and a right upper quadrantanopia. Further examination revealed TS and the patient underwent a vitrectomy in 1 eye. The surgery was successful and the eye recovered to 20/20 with no complications. However, the other eye showed slow absorption of the hemorrhage, and a vitrectomy was scheduled for that eye as well. CONCLUSIONS TS is a complication of aneurysmal SAH that can lead to vision loss and increased morbidity. It often goes undiagnosed, and ophthalmologists are not regularly consulted. Late manifestation of the condition is exemplified by the present case. Early detection and intervention are crucial for better patient outcomes.
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  • 文章类型: Journal Article
    背景:增殖性糖尿病视网膜病变是糖尿病患者失明的主要原因。该研究旨在评估增生性糖尿病视网膜病变的临床特征和增生性糖尿病视网膜病变的平坦部玻璃体切除术的结果。
    方法:一项前瞻性研究于2019年9月至2021年12月在三级眼科护理中心接受了玻璃体切割手术的连续增殖性糖尿病视网膜病变患者中进行。在机构审查委员会的伦理批准后进行研究。详细的全身和眼部病史,视敏度,散瞳下的眼部发现,外科手术,并记录平坦部玻璃体切除术后的结果。定期随访病例,直至玻璃体切除术后一年。
    结果:共83例(89只眼)增殖性糖尿病视网膜病变纳入研究。平均年龄为53岁±9.7标准差,从26年到72年不等。男性占62.7%。2型糖尿病占病例的94%。平坦部玻璃体切除术的适应症为;混合性玻璃体出血和牵引性视网膜脱离(38.2%),非清除性玻璃体积血(38.1%),仅牵拉性视网膜脱离(24.7%)。78.65%的眼给予术前玻璃体内抗血管内皮生长因子,58.42%的眼给予全视网膜光凝。在95.5%的眼睛中实现了解剖学成功,视力改善68.54%,14.6%的眼睛出现静态,16.86%的眼睛出现恶化。约15.7%的眼睛有某种形式的术后并发症。
    结论:玻璃体出血伴牵引性视网膜脱离,在增生性糖尿病性视网膜病变病例中,持续性玻璃体出血和牵拉性视网膜脱离是平坦部玻璃体切除术的常见指征。在增生性糖尿病性视网膜病变的PPV后,大多数眼睛可以实现解剖学成功和视力改善。
    BACKGROUND: Proliferative diabetic retinopathy is a leading cause of blindness among people with diabetes. The study aimed to assess the clinical characteristics of proliferative diabetic retinopathy and outcome of pars plana vitrectomy in Proliferative diabetic retinopathy.
    METHODS: A prospective study was conducted from September 2019 to December 2021 among consecutive cases of proliferative diabetic retinopathy who underwent pars plana vitrectomy at a tertiary eye care center. Study was conducted after ethical approval from Institutional Review Committee. Detailed systemic and ocular history, visual acuity, ocular findings under mydriasis, surgical procedures, and outcome following pars plana vitrectomy were recorded. Cases were followed up regularly until one year after the pars plana vitrectomy.
    RESULTS: Total of 83 cases (89 eyes) of proliferative diabetic retinopathy were enrolled in the study. The mean age was 53 years ±9.7 SD, ranging from 26 years to 72 years. Males comprised of 62.7% cases. Type two diabetes comprised of 94% of cases. Indications for pars plana vitrectomy were; mixed vitreous hemorrhage and tractional retinal detachment (38.2%), non-clearing vitreous hemorrhage (38.1%), and tractional retinal detachment only (24.7%). Pre-operative intra-vitreal anti-vascular endothelial growth factor was given in 78.65% eyes and pan retinal photocoagulation in 58.42% eyes. The anatomical success was achieved in 95.5% eyes, visual improvement in 68.54%, static in 14.6% and worsened in 16.86% of eyes. About 15.7% of eyes had some form of post- operative complications.
    CONCLUSIONS: Vitreous hemorrhage with tractional retinal detachment, persistent vitreous hemorrhage and tractional retinal detachment involving macula were the common indication of pars plana vitrectomy among cases of Proliferative diabetic retinopathy. Anatomical success and visual acuity improvement can be achieved in majority of the eyes following PPV in Proliferative diabetic retinopathy.
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  • 文章类型: Case Reports
    染色体3q的末端缺失与异质性临床表型有关,其中包括增长限制,发育迟缓,智力残疾。然而,关于3q染色体缺失的眼科影响的报道很少。我们报告了一个9岁男孩,其1.4兆碱基缺失3q27.1q27.2,其眼部疾病包括一只眼睛的视网膜脱离,另一只眼睛的玻璃体出血,和需要急性护理和连续眼科随访的双眼中央凹发育不全。
    Terminal deletions of chromosome 3q are associated with a heterogenous clinical phenotype, which includes growth restriction, developmental delay, and intellectual disability. However, little has been published on the ophthalmic impacts of chromosome 3q deletions. We report a 9-year-old boy with a 1.4 megabase deletion of 3q27.1q27.2 whose ocular morbidities included retinal detachment in one eye, vitreous hemorrhage in the other eye, and foveal hypoplasia in both eyes that required acute care and continuous ophthalmologic follow-up.
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  • 文章类型: Journal Article
    目的:玻璃体切除术是治疗非创伤性和非糖尿病性视网膜疾病的关键干预措施之一。然而,接受此手术的患者的预后和影响预后的因素仍有待澄清。本研究旨在分析非创伤性和非糖尿病性视网膜病变并发玻璃体积血的预后因素。
    方法:对352例患者进行了回顾性研究,包括152名(43.18%)女性,2018年3月至2022年12月在我院行玻璃体切割手术患者,根据术后随访期间是否发生并发症分为A组(术后并发症)和B组(无并发症).收集并比较两组患者的一般情况和临床资料。采用二元Logistic回归分析影响预后的主要因素。
    结果:所有患者均随访12个月。共有87例患者出现术后并发症,占24.72%(87/352),共265例患者无术后并发症,占75.28%(265/352),术前视力差异有统计学意义。手术干预的时间,术前眼底情况,视网膜病变的阶段,两组患者术前眼压和年龄比较(p<0.05),这些指标被确定为影响患者预后的独立危险因素(比值比>1)。
    结论:术前视力,手术干预的时间,术前眼底情况,视网膜病变的阶段,术前眼压和年龄都是影响非创伤性和非糖尿病性视网膜病变患者在接受玻璃体切除术时预后的因素。需要个性化护理以改善这些患者的手术结果。
    OBJECTIVE: Vitrectomy is one of the crucial therapeutic interventions for non-traumatic and non-diabetic retinal diseases. However, the prognosis of patients undergoing this procedure and the factors affecting prognosis remain to be clarified. The aim of this study was to analyze the prognostic factors of non-traumatic and non-diabetic retinopathy complicated by vitreous hemorrhage.
    METHODS: A retrospective study was conducted on 352 patients, including 152 (43.18%) females, who underwent vitrectomy in our hospital from March 2018 to December 2022, divided into Group A (postoperative complications) and Group B (no complications) according to whether complications occurred during postoperative follow-up. General and clinical data of the two groups were collected and compared. Binary logistic regression was used to analyze the main factors affecting prognosis.
    RESULTS: All patients were followed up for 12 months. A total of 87 patients had postoperative complications, accounting for 24.72% (87/352), and were classified as Group A. A total of 265 patients who had no postoperative complications, accounting for 75.28% (265/352), were classified as Group B. There were significant differences in preoperative visual acuity, time of surgical intervention, preoperative fundus condition, stage of retinopathy, preoperative intraocular pressure and age between the two groups (p < 0.05), and these indices were identified as independent risk factors affecting the prognosis of patients (odds ratio >1).
    CONCLUSIONS: Preoperative visual acuity, time of surgical intervention, preoperative fundus condition, stage of retinopathy, preoperative intraocular pressure and age are all factors affecting the prognosis of patients with non-traumatic and non-diabetic retinopathy while undergoing vitrectomy. Personalized care is required to improve the surgical outcome for these patients.
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  • 文章类型: Journal Article
    目的:评估全视网膜光凝(PRP)联合玻璃体腔康柏西普(IVC)注射治疗高危增生性糖尿病视网膜病变(HR-PDR)合并轻度或中度玻璃体积血(VH)的临床疗效和安全性。伴或不伴糖尿病性黄斑水肿(DME)。
    方法:这项回顾性研究招募了诊断为VH伴或不伴HR-PDR继发DME并接受PRP联合IVC注射的患者。在确定患者的诊断后,最初进行了IVC,其次是PRP的迅速管理。在大量出血持续并阻碍激光手术的情况下,在补充PRP之前维持IVC。PRP完成后,对患者进行至少6个月的精心监测.根据荧光素眼底血管造影(FFA)结果,对激光治疗和IVC注射进行了合理调整。观察治疗效果及不良事件发生率。
    结果:在42例患者(74只眼)中,男性29人,女性13人,平均年龄59.17±12.74y(33-84y)。糖尿病病史在1wk到26y之间,视觉症状发作与HR-PDR诊断之间的间隔为1wk-1y。受影响的眼睛接受了2.59±1.87(1-10)次IVC注射,并接受了5.5±1.02(4-8)次PRP。其中,68只眼睛在1次IVC注射后接受了PRP,2次IVC注射后5只眼,3次IVC注射后1眼。初始治疗后5-50周,所有74只眼均观察到VH完全吸收,初始治疗后3-48wk,51只眼的DME消退。一只眼睛中发现了新开发的视网膜前膜。25只眼视力明显提高。无青光眼等并发症,视网膜脱离,或报告眼内炎。
    结论:该研究表明,PRP与IVC注射联合使用是治疗HR-PDR患者的糖尿病VH的有效且安全的方式。
    OBJECTIVE: To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME).
    METHODS: Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient\'s diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed.
    RESULTS: Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported.
    CONCLUSIONS: The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.
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  • 文章类型: Journal Article
    糖尿病视网膜病变临床研究网络协议S表明,玻璃体切除术治疗玻璃体出血(VH)或牵拉性视网膜脱离(TRD)在最初分配给全视网膜光凝(PRP)的眼睛中更为常见,而抗血管内皮生长因子(抗VEGF)治疗增生性糖尿病视网膜病变(PDR)。这些临床意义值得在临床实践中进一步评估。
    探讨PRP单药治疗的PDR与抗VEGF单药治疗的匹配患者相比的结果。
    使用聚合电子健康记录研究网络的回顾性队列研究。在2023年1月至9月期间接受PRP或抗VEGF单药治疗的PDR患者在倾向评分匹配之前被纳入。单药治疗或PRP和抗VEGF联合治疗后随访6个月或更少的患者被排除在外。数据在2023年9月进行了分析。
    使用当前程序术语代码,通过PRP或抗VEGF药物的单一疗法对患有新PDR诊断的患者进行分层。
    平坦部玻璃体切除术(PPV)的发生率,VH,或TRD。
    在6020名患者中(PRP队列:平均[SD]年龄,64.8[13.4];6424[50.88%]女性;3562[28.21%]黑人,6180[48.95%]白色,2716[21.51%]未知种族;抗VEGF队列:平均[SD]年龄,66.1[13.2];5399[50.52%]男性;2859[26.75%]黑人,5377[50.31%]白色,和2382[22.29%]未知种族)接受治疗的人,与5年抗VEGF单药治疗的患者相比,PRP单药治疗与较高的PPV发生率相关(RR,1.18;95%CI,1.05-1.36;RD,1.37%;95%CI,0.39%-2.37%;P<.001),在1年和3年有类似的关联。PRP单药治疗与5年时VH发生率较高相关(相对危险度[RR],1.72;95%CI,1.52-1.95;风险差异[RD],7.05;95%CI,5.41%-8.69%;P<.001)和更高的5年TRD率(RR,2.76;95%CI,2.26-3.37;RD,4.25%;95%CI,3.45%-5.05%;P<.001),在6个月时有相似程度的关联,1年,3年,与使用抗VEGF单药治疗的患者相比。
    这些发现支持以下假设:用PRP单药治疗的PDR患者更有可能发生VH,TRD,与接受抗VEGF单药治疗的匹配患者相比,接受PPV治疗。然而,考虑到相对风险的广泛范围,混杂因素可能解释了PRP和抗VEGF单药治疗与所评估结局之间的某些关联.
    UNASSIGNED: The Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti-vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.
    UNASSIGNED: To explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.
    UNASSIGNED: Retrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months\' follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.
    UNASSIGNED: Patients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.
    UNASSIGNED: Incidence of pars plana vitrectomy (PPV), VH, or TRD.
    UNASSIGNED: Among 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P < .001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P < .001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P < .001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.
    UNASSIGNED: These findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    目的:报告首次出现各种眼部表现并最终确定患有潜在登革热的患者。方法:2012年至2022年在印度多个三级眼部护理中心进行了一项前瞻性研究。选择最初报告具有眼部特征以及过去两周的发烧/过去的发烧史或具有登革热临床特征的病例。眼科检查后,对患者进行完整的血清学和生化分析,并对血小板计数降低的患者进行登革热评估.结果:564例中,最终证实15名患者患有登革热。每年有15例病例呈上升趋势,在新冠肺炎大流行期间(从2020年到2022年)报告了8例病例,但COVID阴性。9例出现急性发红,视力减退。在过去的几天中,有7例患者有发烧史,其中1例来自登革热流行区。各种眼部表现包括结膜下出血,病毒性角膜炎,前葡萄膜炎,第六神经麻痹,和玻璃体出血.在血清学检查中,所有15例患者均检测到低血小板.所有病例在支持治疗后反应良好,眼部特征在几周内全部消退,视力恢复良好。结论:在一个热带国家,比如印度,随着登革热的流行区和最近登革热的增加,眼科医生必须在各种眼部表现如结膜下出血的鉴别诊断中包括登革热,病毒性角膜炎,前葡萄膜炎,第六神经麻痹,和玻璃体出血.缩写:DHF=登革出血热,PCR=聚合酶链反应,RT-PCR=实时自动化逆转录酶(RT-PCR),SD=标准偏差,MAC-ELIS=IgM抗体捕获酶联免疫吸附测定,RE=右眼,LE=左眼,CECT=对比增强计算机断层扫描。
    Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.
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