A retrospective study on demographic profile and etiology of vitreous hemorrhage

Vitreous haemorrhage(VH) is due to blood leak from ruptured vessels into the vitreous cavity. It results in painless loss of vision. Visual acuity depends on degree and location of haemorrhage.To study the demographic profile and etiology of all patients with vitreous hemorrhage in tertiary care eye hospital. Medical records of patients who presented with VH between Jan 2017 to July 2018 were retrospectively reviewed. A detailed analysis of records will be noted. Out of 47 patients, 35 were males and 12 were females. Common age group affected were more than 60 years with 22 cases followed by that among 40 to 60 years involving 15 eyes. 46 cases were unilateral and 1 was bilateral. Majority of cases was noted from the rural areas with low socioeconomic status. Among the etiological causes proliferative diabetic retinopathy was the major cause (41.6%), followed by retinal vein occlusion (14.5%), rhegmatogenous retinal detachment(RRD) (12.5%), blunt trauma (10.41%) which was major cause among children presenting with vitreous haemorrhage, hypertension (4.16%), Eales disease (4.16%), AMD (4.16%), open globe injury (4.16%), retinal artery microaneurysm (2.08%), and PVD with tear (2.08%).Most common age groups affected were greater than 60 years. Among the 47 cases majority were males. 46 were unilateral and 1 was bilateral. More cases were from the rural areas having lower socioeconomic status. Among the etiological causes proliferative diabetic retinopathy formed the major cause.

A 27 - Gauge Microincision Vitrectomy Surgery for Posterior Segment Diseases in a Tertiary Centre, Nepal

Introduction: Transconjunctival micro incision vitrectomy surgery (MIVS) with 23 or 25 gauge instrumentation is more advantageous than traditional 20 gauge surgery. We intended to evaluate the visual outcome, complications and indication of various vitreoretinal diseases using 27 Gauge vitrectomy systems. Methods: This study was a prospective, interventional, non-comparative study conducted in Nepal Eye Hospital from June 2017 to July 2018. Fifty-two patients with various vitreoretinal diseases were recruited. The main outcome measures included corrected distance visual acuity (CDVA) preoperative and postoperative, intraocular pressure (IOP) preoperative and postoperative, indication for vitreoretinal surgery, intraoperative complications, and postoperative complications. Results: Fifty two eyes of 52 patients (26 men and 26 women; mean age, 59 years) underwent 27-gauge pars planavitrectomy. Surgical indications included epiretinal membrane (n = 11), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment [n = 14 (12 vitrectomy only and two vitrectomy with scleral buckle)], vitreous haemorrhage (n = 3), vitreous opacities (n = 3), silicon oil removal (n = 3), proliferative diabetic retinopathy [n = 6 (5 vitreous haemorrhage and one tractional retinal detachment)], posterior IOL dislocation (n = 1). Postoperative complications included transient ocular hypertension in eight eyes (15.39%), transient hypotony in five eyes (9.62%) and vitreous haemorrhage in five eyes (9.62%). No cases of postoperative endophthalmitis, sclerotomy - related tears, or choroidal detachments were encountered in the follow-up period. Mean corrected distance visual acuity improved from 20 / 796 (logarithm of the minimum angle of resolution, 1.60 ± 0.64) preoperatively to 20 / 49 (logarithm of the minimum angle of resolution, 0.42 ± 0.26) postoperatively (p = 0.000,) at final follow up. Conclusions: 27-gauge micro-incision vitrectomy surgery was found to be a safe and effective suture-less surgery with favourable outcomes, in terms of vision.

A case of air pollution-induced Valsalva retinopathy

This is a case of Valsalva retinopathy during the season of annual transboundary haze pollution in Sarawak. A 22-year-old man with no known medical illness developed sudden onset of painless visual acuity loss preceded by persistent cough. Left eye fundus showed dense preretinal haemorrhage covering optic disc extendinginferiorly with breakthrough vitreous haemorrhage. The patient underwent pars plana vitrectomy, endolaser, and fluid gas exchange in view of persistent dense vitreous haemorrhage after a month of conservative management. In conclusion, pars plana vitrectomy can be considered as a safe and effective treatment option for patients with Valsalva retinopathy developing extensive premacular haemorrhage.

Red herring unmasked: the trail leading to retinoblastoma

This case series highlights the possibility of retinoblastoma in children with a history of trauma. Retinoblastoma commonly presents with leukocoria. In our series, the history of blunt trauma led to a misdiagnosis. The delay in correctly diagnosing retinoblastoma was made more difficult with hyphaema and vitreous haemorrhage obscuring the fundus view. Hyperdensities in imaging tests were mistaken for intraocular foreign bodies and post-trauma insult rather than calcification of an intraocular tumour. Both patients underwent anterior chamber washout. The patients were referred to our centre when their condition worsened. Retinoblastoma was highly suspected and confirmed from histopathological examination after enucleation. An accurate diagnosis can only be achieved by exercising a high index of suspicion. Misdiagnosis and mismanagement will lead to poor prognosis.

Eye: the door to undiagnosed chronic myeloid leukaemia

Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that can present in varied ways from incidental finding on haemogram to symptomatic presentation such as splenomegaly. We report an interesting case of a 22-year-old man who presented with loss of vision in right eye for 1 month. There were no pre-existing ocular or systemic diseases. On detailed ocular examination, a diagnosis of right eye rubeosis iridis, hyphaema, cataract and vitreous haemorrhage with left eye suspected leukaemic retinopathy was made. Routine haemogram revealed high leucocytosis. Systemic evaluation with investigations confirmed the diagnosis of CML and the patient was started on appropriate therapy.

Plaque brachytherapy for choroidal melanoma with vitreous haemorrhage: a therapeutic challenge

A 47-year-old man presented with profound loss of vision in right eye and relative afferent pupillary defect. On fundus examination, posterior pole details were obscured due to dense vitreous haemorrhage. B-scan ultrasonography was performed that revealed a mushroom-shaped hyperechoic lesion with medium internal reflectivity on A-scan ultrasonography. After performing contrast-enhanced MRI of the orbit, a diagnosis of choroidal melanoma was established. Patient was managed using plaque brachytherapy based on multiplanar MRI. This was followed 10 months later by pars plana vitrectomy and cataract extraction. Vision postoperatively improved to 20/60. A systematic clinical assessment along with supportive ancillary investigations augments diagnostic accuracy and reduces delay in definitive management.

Optic nerve avulsion: A case report

A case of a 13-year-old girl after being injured on the left eyeball by a stick from a cage, is presented. Along vitreous haemorrhage, retinal oedema and ischaemia, the disc was replaced by a cavity. Multimodal imaging was performed, which confirmed the optic nerve damage. The eye had no light perception anymore. Our case is a demonstration for complete avulsion of the optic nerve after blunt injury.