Long term outcome of early vitrectomy in non-diabetic, non-traumatic patients with acute posterior vitreous detachment (PVD) and vitreous hemorrhage

Objective: Evaluate the etiologies for dense vitreous hemorrhage in pseudophakic, non-diabetic and non-traumatic adults with acute PVD and the efficiency of early vitrectomy treatment.Methods: The study included 93 eyes of 93 patients and it consisted in the evaluation of etiologies of vitreous hemorrhage: retinal tears, retinal occlusion (RVO), choroidal neovascularization (CNV) and acute posterior vitreous detachment (PVD). A comparison of initial visual acuity versus final visual acuity post vitrectomy is performed.Results: The mean time between symptom onset and surgery was 6.9 days. The most common etiologies observed during this study were: retinal tear (63.4%), vein occlusion (18.3%), CNV (9.7%) and PVD (8.6%). Following early vitrectomy treatement, VA significantly improved from 1.673 LogMAR to 0.220 LogMAR. In addition, the incidence of retinal tears identified preoperatively by ocular ecography were 13, but it improved to 46 during surgery.Conclusion: Retinal tears, RVO, CNV and PVD were the most common causes of dense vitreous hemorrhage. Early vitrectomy has a good outcome with improvement on visual acuity and we also observed during surgery retinal tears not efficiently identified by ultrasound preoperatively.

A Rare Case of an Ophthalmologic Emergency: Idiopathic Central Retinal Artery Occlusion

Central retinal artery occlusion is a form of an acute stroke in the eye and is regarded as an ophthalmic emergency.[1,2] This paper presents a case of Central retinal artery occlusion in an 18-year-old pregnant female who presented with sudden loss of vision in her right eye and was diagnosed with central retinal artery occlusion. The aim of this paper is to illustrate the clinical presentation, diagnosis and treatment but mainly focusing on the underlying etiologies. Recent literature shows no reported cases explaining the possibility of retinal artery occlusion occurring in a young pregnant female who is otherwise free of any medical conditions.[3] Due to the serious consequence, limited knowledge and treatment in the field of unexplained retinal occlusion in pregnancy; it’s encouraged that more efforts are invested in research and reporting cases for a better understanding of the possible and future management options and preventative strategies of central retinal occlusions.

Current Treatment of Retinal Vein Occlusion

Retinal vein occlusion (RVO) was first described more than 150 years ago. Even though much has been written about this frequent condition, the aetiopathology appears to be multifactorial with many unclear aspects and varied expression, making it difficult to define treatment guidelines. The management of the patient with RVO is complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. In the past, laser therapy was the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Current multicentre studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are attractive options to halt disease progression and achieve a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow better patient management.