Anterior retinal cryotherapy in diabetic vitreous hemorrhage.
ABSTRACT Recurrent vitreous hemorrhage associated with proliferative retinopathy can occur in eyes that do not satisfactorily respond to argon laser pantretinal photocoagulation. To evaluate the effect of relatively low-risk surgical intervention, we performed peripheral retinal cryopexy on 24 eyes of 23 diabetic patients with proliferative diabetic retinopathy and vitreous hemorrhage. In most cases, cryopexy followed complete or nearly complete panretinal photocoagulation which did not prevent subsequent vitreous hemorrhage. Existing vitreous hemorrhage cleared postoperatively in 23 of 24 eyes. The best corrected visual acuity improved in 15 eyes, remained unchanged in five, and worsened in four. Four postoperative anterior segment complications resolved completely within a short time. One patient, a 68-year-old woman who had had diabetes for 18 years, postoperatively had a macular hole in one eye and macular edema with tractional retinal detachment in the other.
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Chapter: Eales’ Disease[show abstract] [hide abstract]
ABSTRACT: Eales’ disease was first described by Henry Eales in 1880 (1). The patient presents with retinal perivasculitis predominantly affecting the peripheral retina (inflammatory stage), then sclerosis of retinal veins indicating retinal ischemia (ischemic stage), and finally retinal or optic disk neovascularization, recurrent vitreous hemorrhage with or without retinal detachment (proliferative stage) (2–4).12/2005: pages 149-159;
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ABSTRACT: To evaluate the efficacy of intravitreal bevacizumab with panretinal photocoagulation (PRP) in the treatment of proliferate diabetic retinopathy (PDR) with vitreous hemorrhage (VH). Forty cases (40 patients) with PDR and persistent VH were prospectively enrolled, with a follow-up period of 12 months or more. Intravitreal bevacizumab injection (1.25 mg) was given, followed by PRP when visualization of peripheral fundus could be obtained. A second injection was administered 4 weeks to 6 weeks after the first injection if no signs of VH decrease were noted. Vitrectomy was performed if VH persisted >12 weeks. The vitreous clear-up time (VCUT) and the rate of vitrectomy were compared with those in a historical control group (40 eyes in 40 patients) who were treated with conventional methods. Thirty-one eyes had 1 injection and 9 eyes (22.5%) received 2 injections. Vitreous clear-up time in the study and control groups were 11.9 +/- 9.5 weeks and 18.1 +/- 12.7 weeks (P = 0.02), respectively. Rates of required vitrectomy were 10% in the study group and 45% in the control group (P = 0.01). One or 2 intravitreal injections of 1.25 mg bevacizumab with PRP are associated with rapid regression of VH and may reduce the need for vitrectomy.Retina (Philadelphia, Pa.) 09/2009; 29(8):1134-40. · 2.93 Impact Factor
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ABSTRACT: To evaluate the role of cryotherapy of the anterior retina and sclerotomy sites in the prevention of fibrovascular ingrowth (FVIG) at sclerotomy sites and postoperative recurrent vitreous hemorrhage in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Retrospective, nonrandomized, observational case series. Eighty-one eyes in 71 patients who had undergone PPV for complications of PDR in the previous 2 years, with postoperative retinal reattachment for at least 3 months. Cases were divided into 3 groups: (1) having panretinal or supplementary endophotocoagulation; (2) having anterior peripheral retinal cryotherapy (ARC) in addition to panretinal endolaser treatment; and (3) having endophotocoagulation, ARC, and cryotherapy on the 3 sclerotomy sites added. Ultrasound biomicroscopy (UBM) examination of the 3 sclerotomy sites was performed > or =2 months after surgery. The UBM findings were separated into 4 categories: well-healed, gap, vitreous incarceration, and FVIG. History and management of recurrent vitreous hemorrhage were recorded. Ultrasound biomicroscopy findings and the percentage of recurrent vitreous hemorrhage in the 3 groups were compared to determine the effectiveness of the adjunct cryotherapy in inhibiting FVIG and preventing recurrent vitreous hemorrhage. The recurrent vitreous hemorrhage rates in groups 1, 2, and 3 were 12 of 32 (37.5%), 3 of 26 (11.5%), and 1 of 23 (4.3%), respectively (P = 0.0004). In each group, different sclerotomy sites had similar distributions of the 4 UBM categories. Among the 3 groups, gap was found in 9.4%, 20.5%, and 52.2% of eyes, respectively (P<0.001), whereas FVIG was found in 36.5%, 15.4%, and 0% of eyes (P<0.001). Fibrovascular ingrowth was noted in 87.5% (14/16) of all eyes experiencing recurrent vitreous hemorrhage. Of those with rebleeding but no FVIG (2 eyes), 1 had vitreous lavage combined with additional cryotherapy, and 1 had no treatment. Of those with FVIG (14 eyes), 5 needed > or =2 operations. The presence of FVIG had good correlation with the development of recurrent postoperative vitreous hemorrhage. Anterior peripheral retinal cryotherapy combined with cryotherapy of sclerotomy sites might be helpful adjunct procedures in diabetic vitrectomy for inhibition of FVIG and prevention of recurrent vitreous hemorrhage.Ophthalmology 01/2006; 112(12):2095-102. · 5.56 Impact Factor