DOCSLIB.ORG

A Rare Case of Acute Vitreous Hemorrhage Secondary to Ruptured Retinal Arterial Macroaneurysm During a Period of Inadequate Blood Pressure Control

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Rare Case of Acute Vitreous Hemorrhage Secondary to Ruptured Retinal Arterial Macroaneurysm During a Period of Inadequate Blood Pressure Control A rare case of acute vitreous hemorrhage secondary to ruptured retinal arterial macroaneurysm during a period of inadequate blood pressure control Joseph Kane, O.D. Abstract: Acute vitreous hemorrhage without proliferative retinopathy or trauma is discovered during inadequate BP control. Ruptured retinal arterial macroaneurysm subsequently diagnosed. Serial multimodal ophthalmic imaging and laboratory studies, medical status, and role of co-management are discussed. Case History: • Patient Demographics: 85 y.o. African American Male • Chief Complaint: recent difficulty controlling blood pressure prompting emergency room visit; optometry consulted for associated dramatic increase in floaters OD and mild decrease in vision OD over the past week • Ocular History: o Last BCVA = 20/20 OD and OS o Type 2 DM w/o retinopathy or macular edema OU (at last dilated eye exam 11/14/13) • Medical History: o Type 2 Diabetes Mellitus o Hypertension (recent dramatic fluctuation, as high as 190/100) o Congestive Heart Failure o Hyperlipidemia • Medications: o Amlodipine 2.5 mg QD o ASA 81 mg QD o Hydralazine 50 mg TID o Isosorbide 30 mg QAM o Metformin 500 mg QAM o Simvastatin 20 mg QHS o Terazosin 5 mg QHS • Other Relevant Information: o Recent h/o hospital admission due to bradycardia prompting carvedilol & chlorthalidone discontinuation à patient subsequently notes “high blood pressure readings” during self-checks at home o Denies headache, jaw claudication, shortness of breath, dizziness, chest pain Pertinent Findings • Clinical: o BCVA at presentation = 20/30 OD and OS o Pupils, EOM’s, and CFC all WNL OD/OS o Slit lamp exam: moderate cataracts OU o IOP = normotensive OU o Gonioscopy OD: open anterior chamber angles without neovascularization of the angle o Dilated fundus exam OD: posterior vitreous detachment with extensive vitreous hemorrhage; partially dehemoglobinized blood and fibrin emanating from superior-temporal arcade, difficult to assess exact layer or depth clinically o Dilated fundus exam OS: flame shaped hemorrhage inferior to optic nerve head, otherwise no retinopathy; posterior vitreous detachment w/o hemorrhage o Optic nerves are pink, with sharp/distinct margins OU o Maculae are flat, healthy OU • Ophthalmic Imaging: o Serial SD-OCT scans tracking the clinical course of the lesion in question o B-Scan Ultrasound during the initial presentation: reveals dense vitreal debris and hemorrhaging, no visible retinal break or detachment, sectoral hemorrhage emanating from superior-temporal arcades with spillover into vitreous body • Laboratory Studies: o CRP = 1.22 mg/L o ESR = 35 mm/hr o Glucose = 111 mg/dL o Urea Nitrogen = 23 mg/dL o Creatinine = 1.52 mg/dL o EGFR = 53 mL/min o CBC w/ diff = overall WNL with mild reduction in WBC, RBC, HBG, and HCT o BNP (brain natriuretic peptide, biomarker for CHF) = 493.5 (elevated, >300 indicates at least mild heart failure) o PTT/PT/INR = WNL • Radiology Studies: o Head CT w/o contrast: no acute abnormality (no hemorrhage, infarct, intracranial abnormality) à stable to CT 2 years prior Differential diagnosis • Primary/leading: vitreous hemorrhage OD • Secondary (etiology of vitreous hemorrhage): o Proliferative diabetic retinopathy o Hypertensive retinopathy o Branch retinal vein occlusion o Retinal break/detachment o Sickle cell retinopathy o Hemorrhagic posterior vitreous detachment o Hemorrhagic pigment epithelial detachment o Ruptured choroidal neovascular membrane / peripheral exudative hemorrhagic chorioretinopathy o Ruptured retinal arterial macroaneurysm o Valsalva retinopathy o Malignant melanoma Diagnosis and discussion Diagnosis: vitreous hemorrhage secondary to ruptured retinal arterial macroaneurysm OD • Retinal arterial macroaneurysms (RAM) represent acquired, focal dilatations in the retinal vasculature, most commonly associated with hypertension. Many are discovered upon routine examination and do not cause symptoms, unless the macula or vitreous is involved. RAM are often misdiagnosed at initial presentation and considered by some to be “masqueraders” due to the highly variable nature of its presentation; hemorrhage can be seen at multiple layers of the retina, rarely with spillover into the vitreous. Prognosis is generally favorable, and observation is often a sufficient management strategy. Patients with RAM should be monitored for secondary complications such as retinal vein occlusion, chronic macular edema, secondary angle closure glaucoma, and hemorrhagic retinal detachment. Depending on the clinical scenario, there are several proposed management strategies for RAM and its sequelae including observation, vitrectomy, focal laser treatment (either directly to the lesion or indirect), and anti-VEGF injections. A systemic work-up is indicated to rule out underlying medical conditions (especially cardiovascular disease) and treat as appropriate. Unique features in this case: • RAM is a relatively rare clinical entity (only 1/9,000 eyes in the Beijing eye study) and even more uncommon as a mechanism for vitreous hemorrhage (~0.6-7%, depending on the study); many vitreous hemorrhage prevalence studies do not even cite RAM as an etiology • We have B-scan ultrasound and serial SD-OCT images capturing the acute bleeding emanating from the area of RAM into the vitreous cavity, which has only been described in a handful of case reports (Tang, et al); to the best of our knowledge, B-scan ultrasound and SD-OCT have not previously been described in conjunction during acute ruptured RAM; this represents a unique means by which to track these lesions both in the acute stage and throughout their clinical course • We have access to serial blood pressure readings and laboratory studies both before and after his retinal presentation, allowing us to track his ocular status in conjunction with his medical status • The patient was subsequently diagnosed with variable degree heart block (with periods of complete heart block) and underwent implantation of a permanent pacemaker, highlighting the importance of co- management in cases of ruptured RAM to uncover underlying medical conditions; there has not yet been a direct correlation established between heart block and RAM, though HTN and arteriosclerosis link both of these conditions Treatment, management • Ocular = the patient is currently being monitored for clearance of his vitreous hemorrhage; the RAM is also being monitored for spontaneous involution with serial SD-OCT scans through the lesion • Medical = the patient reported to the emergency room several times after his initial eye examination complaining of difficulty controlling his blood pressure at home; he has been seen multiple times by primary care, cardiology, and electrophysiology; it was discovered that he also was having varying degrees of heart block and was given Ziopatch to monitor at home; one month after his initial eye exam, he was admitted to the hospital and underwent implantation with a permanent pacemaker; the procedure went well, but unfortunately his blood pressure control remains inadequate; per his last cardiology visit, his physicians are attempting to re-establish optimal blood pressure control medically Conclusion & Clinical Pearls • Ruptured RAM is a rare cause of vitreous hemorrhage; clinicians must consider all possible etiologies for vitreous hemorrhage, especially in the absence of proliferative retinopathy or retinal break • B-scan ultrasound and SD-OCT imaging are of paramount importance in the acute stage of vitreous hemorrhage and may reveal a surprising etiology for the bleed; both imaging modalities provide clinically useful information for RAM cases and allow serial monitoring to determine proper management • RAM is often a sign of underlying systemic disease; co-management with other health care providers (i.e. cardiologists, primary care, endocrinologists) may result in additional medical diagnoses, even in patients with known diabetes or hypertension; proper recognition and timely intervention can be both vision and life saving Bibliography 1. Asao, Kazunobu et al. “Vitreous hemorrhage caused by ruptured retinal macroaneurysm.” Case Reports in Ophthalmology. 5. (2014):44-49. 2. Koinzer S, et al. “Long-term, therapy-related visual outcome of 49 cases with retinal arterial macroaneurysm: a case series and literature review.” Br J Ophthalmol. 0 (2015): 1-9. 3. Ryan, Stephen J. "Acquired Retinal Macroaneurysms." Retina. 5th ed. London: Saunders, 2013. 1026-1028. 4. Speilburg, Ashley M., and Stephanie A. Klemencic. "Ruptured Retinal Arterial Macroaneurysm: Diagnosis and Management." Journal of Optometry. 7 (2014): 131-37. 5. Spraul, Christoph W., and Hans E. Grossniklaus. "Vitreous Hemorrhage." Survey of Ophthalmology. 42.1 (1997): 3-39. 6. Tang, William M., et al. “Echographic characteristics of retinal arterial macroaneurysm.” The Journal of Retinal and Vitreous Diseases. 18.6. (1998): 559-563. 7. Xu L, et al. “Frequency of retinal Macroaneurysms in adult Chinese: the Beijing Eye Study.” Br J Ophthalmol. 91 (2007): 840-841. .
Load more

Recommended publications
  • The Acute and Long-Term Ocular Effects of Accelerated Hypertension: a Clinical and Electrophysiological Study
    THE ACUTE AND LONG-TERM OCULAR EFFECTS OF ACCELERATED HYPERTENSION: A CLINICAL AND ELECTROPHYSIOLOGICAL STUDY 1 2 2 3 3 L2 S. J. TALKS , , P. GOOD , C. G. CLOUGH , D. G. BEEVERS and P. M. DODSON Birmingham SUMMARY the invention of the ophthalmoscope in 1851 the Thirty-four patients with accelerated hypertension were causes of this disturbance could be described? clinically examined. The visual evoked potential (VEP) Leibreich,4 in 1859, was the first to describe and electroretinogram (ERG) were recorded: acutely 'albuminuric retinitis' in Bright's disease. However, in 12 patients, being repeated in 7 patients up to 6 it was not until 1914, after the invention of the Riva­ months later. In the remaining 22 patients these tests Rocci sphygmomanometer at the end of the nine­ were performed 2-4 years after presentation. Visual teenth century, that Volhard and Fahr6 related the acuity was 5.6/12 in 22 of 68 (32 %) eyes at presentation retinopathy to arterial hypertension. and 5.6/12 in 10 of 58 (19%) eyes at follow-up. The It was then realised that the fundal appearance cause of severest loss of vision appeared to be anterior was associated with the severity of the hypertension ischaemic optic neuropathy, found in 3 cases. During and with the prognosis of the patient. In 1939 Keith the acute stage 11 patients (92%) had abnormal VEPs et aC drew up a four-group grading system. Grade 3 and all had abnormal ERGs. The group mean PI00 (more recently called accelerated hypertensionS) latency, of the 7 patients (14 eyes) seen acutely and consisted of 'angiospastic retinitis', 'characterised followed up at 6 months, was 123.8 ms with significant especially by oedema, cotton wool patches, and recovery of latency (p<0.005) to 110.9 ms.
    [Show full text]
  • MOC PORT/DOCK Practice Core Modules Content Outline
    MOC PORT/DOCK Practice Core Modules Content Outline 1 Cataract and Anterior Segment (10%) 1.1 Basic Anatomical and Scientific Aspects 1.1.1 The Normal Lens 1.1.1.1 Anatomy 1.2 Assessment Techniques 1.2.1 History-Taking and Preoperative Examination of Ocular Structures 1.2.1.1 Take patient history 1.2.1.2 Examine ocular structures 1.2.1.3 Signs and symptoms 1.2.1.4 Indications for surgery 1.2.1.6 External examination 1.2.1.7 Slit-lamp examination 1.2.1.8 Fundus evaluation 1.2.1.9 Impact on visual functioning and quality of life 1.2.2 Measurement of Visual and Macular Function 1.2.2.1 Visual acuity testing 1.2.2.2 Test visual acuity 1.2.2.5 Visual field testing 1.2.2.6 Test visual field 1.2.2.7 Cataract's effect on visual acuity 1.2.2.8 Estimate cataract's effect on visual acuity 1.2.2.10 Measure visual (and macular) function 1.2.4.3 Evaluate glare disability: subjective and objective 1.3 Clinical Disease Conditions and Manifestations 1.3.1 Types of Cataract 1.3.1.1 Identify types of cataracts 1.3.2 Anterior Segment Disorders 1.3.2.1 Diagnose anterior segment disorders 1.3.2.2 Cataract associated with uveitis 1.3.2.3 Diabetes mellitus and cataract formation 1.3.2.4 Lens-induced glaucoma 1.3.2.4.1 Lens particle 1.3.2.4.2 Phacolytic 1.3.2.4.3 Phacomorphic Copyright and Use Policy for ABO Content Outlines © 2017 – American Board of Ophthalmology.
    [Show full text]
  • Ophthalmology July 10-11, 2018 Bangkok, Thailand
    J Clin Exp Ophthalmol 2018, Volume 9 conferenceseries.com DOI: 10.4172/2155-9570-C4-088 3rd International Conference on Ophthalmology July 10-11, 2018 Bangkok, Thailand Stage of Hypertensive Retinopathy among Patients who undergone Cataract Surgery in Zamboanga City Medical Center Jerne Kaz Niels B. Paber Dr.evangelista st, sta. Catalina Background: Individuals who are not known hypertensive are noted to have blurring of vision as an initial presentation. Preventable co- morbidity such as hypertension is essential in saving sight in patients with cataract. Objective: To determine the prevalence of hypertension and stage of hypertensive retinopathy among individuals who undergone cataract surgery and to identify the association between the stage of hypertension and the risk factors for hypertension and the stage of hypertensive retinopathy. Methods: This prospective study included 203 individuals. All of the participants were noted to have mature cataract surgery done and was noted to have followed up at Tzu Chi Eye center from July 1 2017 to March 30, 2018. The nature, significance and procedure of the study were explained to every identified respondent. There was only one ophthalmologist who saw the participants who enrolled in the study. Once they understood the study, a written informed consent was taken. They were asked to answer questions provided by the researcher and their laboratory results were recorded. A follow up after 2 weeks was done in order to determine the stage of retinopathy of the patients. Demographic variables, hypertensive retinopathy, history of hypertension, medication usage, compliance, ECG changes, proteinuria, creatinine, and cardiomegaly on chest x-ray, radiographic identification of Atheromatous aorta and fundoscopic examination were analyzed.
    [Show full text]
  • Ocular Co-Morbidity in Patients with Refractive Errors in Nigeria
    N igerian Journal of Ophthalmology 2011; 19(1): 19-24 Ocular Co-morbidity in Patients with Refractive Errors in Nigeria BO Adegbehingbe FWA CS, O Adeoye FWA CS, BA Adewara M BBS Ophthalmology Unit, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife 1-4 ABSTRACT a high proportion of patients attend ing ophthalm ic clinics. Refractive errors can be easily d iagnosed , m easured and Purpose: To d eterm ine the pattern and prevalence of other corrected w ith spectacles or other refractive corrections to ocular problem s seen in patients w ith refractive errors attain normal vision. H ow ever, non correction or inad equate in a N igerian teaching hospital. correction of refractive errors becom es a m ajor cause of low Methods: A retrospective hospital-based review of all vision and even blind ness. Globally, there are 8 m illion consecutive patients w ho presented w ith signs and people w ho are blind and 153 m illion w ith visual sym ptom s of refractive errors at the Obafem i Aw olow o im pairm ent (presenting visual acuity <6/ 18 in the better University Teaching H ospitals Com plex betw een 1st eye) d ue to uncorrected refractive errors; this exclud es January 2007 and 31st August 2007. Patients w ho had a presbyopia.5 Poor visual outcom e in patients w ith refractive d iagnosis of refractive error and su bsequently had errors could be in part d ue to other associated ocular d etailed eye exam ination w ere includ ed in this stud y.
    [Show full text]
  • Clinical Findings and Management of Posterior Vitreous Detachment
    American Academy of Optometry: Case Report 5 Clinical Findings and Management of Posterior Vitreous Detachment Candidate’s Name, O.D. Candidate’s Address Candidate’s Phone number Candidate’s email Abstract: A posterior vitreous detachment is a degenerative process associated with aging that affects the vitreous when the posterior vitreous cortex separates from the internal limiting membrane of the retina. The composition of the vitreous gel can degenerate two collective ways, including synchysis or liquefaction, and syneresis or shrinking. Commonly, this process of separation occurs with the posterior hyaloid resulting in a Weiss ring overlying the optic nerve. Complications of a posterior vitreous detachment may include retinal breaks or detachments, retinal or vitreous hemorrhages, or vitreomacular traction. This case presentation summarizes the etiology of this ocular condition as well as treatment and management approaches. Key Words: Posterior Vitreous Detachment, Weiss Ring, Vitreous Degeneration, Scleral Depression, Nd:YAG Laser 1 Introduction The vitreous humor encompasses the posterior segment of the eye and fills approximately three quarters of the ocular space.1 The vitreous is a transparent, hydrophilic, “gel-like” substance that is described as a dilute solution of collagen, and hyaluronic acid.2,3,4 It is composed of 98% to 99.7% water.4 As the eye matures, changes may occur regarding the structure and composition of the vitreous. The vitreous functions to provide support to the retina against the choroid, to store nutrients and metabolites for the retina and lens, to protect the retinal tissue by acting as a “shock absorber,” to transmit and refract light, and to help regulate eye growth during fetal development.3,4 Case Report Initial Visit (03/23/2018) A 59-year-old Asian female presented as a new patient for examination with a complaint of a new onset of floaters and flashes of light in her right eye.
    [Show full text]
  • Floaters-Survey-Ophthalmol-2016.Pdf
    survey of ophthalmology 61 (2016) 211e227 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/survophthal Major review Vitreous floaters: Etiology, diagnostics, and management Rebecca Milston, MOptoma, Michele C. Madigan, PhDb,c, J. Sebag, MD, FACS, FRCOphth, FARVOd,* a Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia b School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia c Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney Medical School, University of Sydney, New South Wales, Australia d VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA article info abstract Article history: Vitreous is a hydrated extracellular matrix comprised primarily of water, collagens, and Received 3 July 2015 hyaluronan organized into a homogeneously transparent gel. Gel liquefaction results from Received in revised form 25 molecular alterations with dissociation of collagen from hyaluronan and aggregation of November 2015 collagen fibrils forming fibers that cause light scattering and hence symptomatic floaters, Accepted 25 November 2015 especially in myopia. With aging, gel liquefaction and weakened vitreoretinal adhesion Available online 8 December 2015 result in posterior vitreous detachment, the most common cause of primary symptomatic floaters arising from the dense collagen matrix of the posterior vitreous cortex. Recent Keywords: studies indicate that symptomatic floaters are not only more prevalent, but also have a vitreous negative impact on the quality of life that is greater than previously appreciated. We review collagen the literature concerning management of symptomatic vitreous floaters, currently either myopia with observation, vitrectomy, or Nd:YAG laser.
    [Show full text]
  • Hypertensive Retinopathycourse # 40048
    Hypertensive Retinopathy Course # 40048 Instructor: Amiee Ho OD Section: Systemic Disease COPE Course ID: 5119251192----SDSDSDSD Expiration Date: October 10, 2019 Qualified Credits: 1.00 credits --- $39.00 COURSE DESCRIPTION: This course focuses on the clinical features, diagnosis and management of hypertensive retinopathy. Additionally, some background and statistics on systemic hypertension is also presented. LEARNING OBJECTIVES: • Know the retinal signs of hypertension • Understand importance of checking blood pressure and knowing when to refer immediately • Understand general background and current statistics of systemic hypertension • Know how to manage and co-manage these types of patients • Understand early detection and proper referrals can save lives Hello, I am Dr. Aimee Ho, and welcome to Pacific University’s online CE course on Hypertensive Retinopathy. For this course, we will be reviewing systemic hypertension, ocular manifestations of hypertension, and the management of these patients. Without further ado, let’s get started. I would like to start with presenting a case. This is a 45 Table 1 year old Caucasian male. He presents for his 1 st eye exam back in 2005. He complains of blurry vision at near without an Rx. His ocular history and medical history is unremarkable, and he’s not on any medications. For his occupation, he reports being an attorney in a very high stress environment. BCVA is 20/20 in the right eye, and 20/20 in the left. Pupils, EOM’s and confrontation visual fields were all unremarkable at that visit. The anterior segment was also unremarkable. Table 2 After dilation, looking at the posterior segment, the optic nerves looked healthy with pink rims, distinct margins, and a small C/D ratio.
    [Show full text]
  • Acute Visual Loss 5 Cédric Lamirel , Nancy J
    Acute Visual Loss 5 Cédric Lamirel , Nancy J. Newman , and Valérie Biousse Abstract Visual loss is a common symptom in neurologic emergencies. Although ocular causes of visual loss are usually identifi ed by eye care specialists, many patients appear in an emergency department or a neurologist’s offi ce when the ocular examination is normal or when it suggests a neurologic disorder. Indeed, many causes of monocular or binocular acute visual loss may reveal or precede a neurologic process. In this situation, a quick and simple clinical examination done at bedside in the emergency department allows the neurologist to localize the lesion and determine whether an urgent neurologic workup or further ophthalmologic consultation is necessary. Keywords Central retinal artery occlusion • Funduscopic examination • Optic neuropathy • Retinal emboli • Visual fi eld • Visual loss Acute vision changes typically precipitate emer- gency consultation. Although ocular causes are usually identifi ed by eye care specialists, many patients appear in an emergency department or a C. Lamirel , MD neurologist’s offi ce when the ocular examination Service d’ophtalmologie , Fondation Ophtalmologique is normal or when it suggests a neurologic disor- Adolphe Rothschild , Paris , France der. Indeed, many causes of monocular or binoc- e-mail: [email protected] ular acute visual loss may reveal or precede a N. J. Newman , MD • V. Biousse, MD () neurologic process. In this situation, a quick and Neuro-Ophthalmology Unit , simple clinical examination done at bedside in Emory University School of Medicine , Atlanta , GA , USA the emergency department allows the neurologist e-mail: [email protected]; [email protected] to localize the lesion and determine whether an K.L.
    [Show full text]
  • 27 Cardiovascular Disorders
    27 Cardiovascular Disorders ◆ Systemic Hypertension Effects of Systemic Hypertension on the Eye and Vision ◆ Hypertensive retinopathy ◆ Hypertensive choroidopathy ◆ Hypertensive optic neuropathy ◆ Central and branch retinal vein occlusion ◆ Retinal macroaneurysm ◆ Vitreous hemorrhage ◆ Subconjunctival hemorrhage ◆ Secondary effects ° Carotid disease—retinal arterial emboli ° Cerebrovascular accident—visual field loss ° Ischemic optic neuropathy ° Oculomotor cranial nerve palsies ° Cataract, glaucoma, age-related macular degeneration Hypertensive Retinopathy Hypertensive retinopathy is usually asymptomatic. In severe hypertension, how- ever, painless loss of vision may occur due to the development of vitreous or reti- nal hemorrhages, retinal edema, retinal vascular occlusion, serous retinal detach- ment, choroidal ischemia, or optic neuropathy. Fundus Features ◆ Focal or diffuse narrowing of retinal arterioles ◆ Increased vascular tortuosity ( Fig. 27.1 ) ◆ Arteriovenous nicking (nipping) ( Fig. 27.2 ) ◆ Retinal hemorrhages ( Fig. 27.3 ) ° Flame-shaped hemorrhage ° Dot and blot hemorrhage ° Preretinal hemorrhage ◆ Microaneurysms ◆ Hard exudates, macular star ◆ Cotton-wool spots (F igs. 27.4 and 27.5 ) ◆ Abnormality of vascular reflex ° Copper-wire reflex ( Fig. 27.6 ) ° Silver-wire reflex ( Fig. 27.7 ) ◆ Intraretinal microvascular abnormalities ◆ Retinal edema ( Fig. 27.8 ) ◆ Serous retinal detachment—occurs secondary to hypertensive choroidopathy in patients with very severe hypertension or eclampsia ( Fig. 27.9 ) ◆ Elschnig spots—small to medium-size hyper- and hypopigmented patches rep- resenting chorioretinal scarring due to prior choroidal infarction ( Figs. 27.10 and 27.11 ) 111 14585C27.indd 111 7/8/09 3:44:46 PM 112 III The Retina in Systemic Disease ◆ Siegrist streaks—linear configurations of hyperpigmentation that have a patho- genesis similar to that of Elschnig spots. ◆ Optic disc edema ( Fig. 27.12 ) ◆ Optic atrophy ◆ Vitreous hemorrhage Fig.
    [Show full text]
  • Hypertension and the Eye
    rnib.org.uk/gp [email protected] Hypertension and the eye This factsheet was produced under a collaboration between the UK Vision Strategy, RNIB, and the Royal College of General Practitioners. Key learning points • Hypertensive retinopathy is a clinical diagnosis made when characteristic fundus findings are seen in a patient with or who has had systemic arterial hypertension. • Mild hypertensive retinal features are seen commonly and are of limited relevance, advanced changes represent important signs of accelerated hypertension. • The main complications from hypertension are retinal artery and retinal vein occlusions, and these cause considerable visual morbidity. • Treatment of hypertension may resolve ocular features, but does not improve established vision loss. • Other vascular risk factors eg hyperglycaemia, dyslipidaemia, smoking and abnormal circulation compound the risk and effect of hypertension in the eye. Evidence base: common eye diseases are commoner if the patient is hypertensive • Cataract: In a meta-analysis of 25 studies across the world, risk of cataract was found to be increased in populations with hypertension independent of glycaemic risk, obesity or lipids [1]. We don’t know how generalisable this finding is. • Glaucoma: Nocturnal hypotension is also found to be associated with progression of visual field defects in glaucoma. • Late stage AMD: Some population studies show increased incidence with high © 2016 RNIB Reg charity nos 226227, SC039316 rnib.org.uk/gp [email protected] systolic BP [2], others show incidence associated with the metabolic syndrome but not specifically with hypertension [3]. • Other: Incidental retinal detachment in non-myopic eyes has been found to be more common [4] but again we don’t know how generalisable this is.
    [Show full text]
  • And Pneumatic Displacement of Submacular Hemorrhage
    5. Ross R, Gitter K, Cohen G, Schomaker K. Idiopathic polypoi- subretinal blood through a retinotomy.4 To move the dal choroidal vasculopathy associated with retinal arterial blood out of the central macula without the need for a pars macroaneurysm and hypertensive retinopathy. Retina 1996; plana vitrectomy and retinotomy, Heriot (American 16:105–111. Academy of Ophthalmology Annual Vitreoretinal Update presentations, 1996–1997, unpublished data) reported the use of an intravitreal injection of tissue plasminogen Vitreous Hemorrhage After activator and gas with postoperative face down positioning Intravitreal Tissue Plasminogen to lyse the blood clot and then displace the blood periph- Activator (t-PA) and Pneumatic erally from the submacular space. Intravitreal injection of tissue plasminogen activator and gas was performed in two Displacement of Submacular cases of sudden submacular hemorrhage associated with Hemorrhage retinal arterial macroaneurysm. Dense vitreous hemor- Gregg T. Kokame, MD rhage was noted after intravitreal injection of tissue plas- minogen activator and intraocular gas. PURPOSE: To report the immediate complication of dense ● vitreous hemorrhage after intravitreal injection of tissue CASE 1: A 92-year-old man developed sudden vision plasminogen activator and gas for treatment of two cases loss in his left pseudophakic eye for 1 day before of sudden submacular hemorrhage associated with retinal presentation. His visual acuity was RE: 20/20, LE: arterial macroaneurysm. 20/400. A thick subfoveal hemorrhage and subinternal METHODS: Case reports. limiting membrane hemorrhage in the central macula RESULTS: Two patients, a 67-year-old woman and a were noted. Two days after symptom onset, an intra- ␮ 92-year-old man, presented with sudden vision loss vitreal 50- g injection of tissue plasminogen activator related to submacular hemorrhage from a retinal macro- and 0.55 ml of sulfur hexafluoride (SF6) gas were given aneurysm.
    [Show full text]
  • Branch Retinal Vein Occlusion with Vitreous
    International Journal of Retina (IJRETINA) 2018, Volume 1, Number 1. P-ISSN. 2614-8684, E-ISSN.2614-8536 BRANCH RETINAL VEIN OCCLUSION WITH VITREOUS HEMORRHAGE IDENTIFIED DURING INTRAOPERATIVE VITRECTOMY Nafila Mahida Sukmono1, Ramzi Amin1,2 1Ophthalmology Department, Universitas Sriwijaya 2Mohammad Hoesin Hospital Palembang ABSTRACT Introduction Retinal vein occlusion is the largest group of retinal blood vessels after diabetic retinopathy. Occlusion occurring in the retinal vein is divided into central retinal vein occlusion (CRVO) occlusion and branch retinal vein occlusion (BRVO) occlusion. The Beijing Eye Study, reported a higher incidence of BRVO than CRVO, where 10-year incidents for BRVO were 1.6 per 100 subjects, and CRVO was only 0.3% 100 subjects.1 To report a case of Branch Retinal Vein Occlusion with vitreous hemorrhage identified during intraoperative vitrectomy Method: A 49-year-old woman with a history of 15 years of hypertension had right eye vision complaints, increasingly blurred since last 2 months. The right eye visual acuity 2/60 cannot be corrected and left eye 6/30 cannot be corrected. The posterior segment on right eye is difficult to assess. USG B-Scan right eye found vitreous echospike appearance of vitreous bleeding. We manage with vitrectomy and during intraoperative we identified bleeding and ghost vessel in superotemporal area. Bleeding in the superotemporal quadrant is done by photocoagulation laser action. Results: First day postoperative there was increased in visual acuity to 6/60 with a posterior segment that could be assessed, obtained tortous blood vessels, slight bleeding and ghost vessel in the superotemporal area with laser injury. Conclusion: In this case report, patients with BRVO with complications of vitreous hemorrhage performed vitrectomy with additional endolaser in the ischemic area.
    [Show full text]