Efficacy of Intravitreal Triamcinolone Acetonide for Eyes with Postvitrectomy Diabetic Vitreous Hemorrhage

( Sun Young Lee ),( Hee Gyung Lee ),( Hyewon Chung ),( Young Hee Yoon ),( June Gone Kim ) 대한안과학회 2007 Korean Journal of Ophthalmology Vol.21 No.4

Purpose: To evaluate the efficacy of intravitreal triamcinolone acetonide (IVT) for the management of postvitrectomy diabetic vitreous hemorrhage. Methods: The authors conducted a retrospective study of patients with postvitrectomy diabetic vitreous hemorrhage who were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. Ocular history, adverse events, BCVA, intraocular pressure, external eye examination, slit-lamp biomicroscopy, fundus examination, B-scan ultrasonography, and fundus photography were assessed on day 1, weeks 1, 2, and 4 and months 2 and 3. Results: There were 19 eyes of 18 consecutive patients with mean follow-up after IVT injection of 28 weeks. Of the 19 eyes, 17 eyes (89%) experienced clearing of vitreous hemorrhage within 1 to 5 weeks (mean, 1.7 weeks) with visible triamcinolone precipitates along with blood clot in the inferior aspect of fundus. Of these 17 eyes, 12 eyes (63%) maintained vitreous hemorrhage-free condition at last follow-up with a mean visual acuity of 20/63 (range, 20/320 20/25), whereas 5 (29%) developed recurrent vitreous hemorrhage after clearing of vitreous hemorrhage. Vitreous hemorrhage was not cleared in 2 eyes, which required surgical procedures. Conclusions: IVT injection may be beneficial for clearing recurrent postvitrectomy Diabetic Vitreous Hemorrhage.

유리체절제술과 동시에 시행한 베바시주맙 주사 후 발생한 유리체 그물망

김모세,채주병.Moses Kim. MD. Ju Byung Chae. MD 대한안과학회 2014 대한안과학회지 Vol.55 No.5

Purpose: To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying pars plana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage. Case summary: A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presented with decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV with intravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in the anterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosed with non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance of the vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumab injection cleared the vitreous hemorrhage with no evidence of vitreous web. Conclusions: Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatment of DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anterior chamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections. J Korean Ophthalmol Soc 2014;55(5):780-784

유리체출혈의 원인으로서의 망막열공과 열공망막박리의 비교 분석

신광훈,남동흔,이대영,Kwang Hoon Shin,Dong Heun Nam,Dae Yeong Lee 대한안과학회 2011 대한안과학회지 Vol.52 No.4

Purpose: To analyze retinal tears and to compare the clinical outcomes between retinal tear and rhegmatogenous retinal detachment (RRD) as the cause of dense non-diabetic vitreous hemorrhage in patients who underwent vitreoretinal surgery. Methods: In a retrospective case series, the medical records of patients who presented dense non-diabetic vitreous hemorrhage and who underwent vitreoretinal surgery between January 2005 and June 2009 were reviewed. Among the 134 patients, 27 patients had dense vitreous hemorrhage caused by retinal tears. The first group had retinal tears only and the second group had accompanying RRD. A comparison of clinical features and postoperative prognoses between the two groups was performed. Results: Among the 27 eyes with non-traumatic retinal tear and RRD, 18 were categorized into the retinal tear group and 9 to the RRD group. The demographic findings between the two studied groups exhibited no significant differences except for time between onset of symptoms and diagnosis. However, the time to diagnosis was significantly delayed in the group with RRD (22.67 ± 37.47 days) compared to the retinal tear group (5.00 ± 3.41 days) (p = 0.035). The amount of visual improvement was also greater in the retinal tear group than the RRD group (p = 0.002). Conclusions: Retinal tears are a major cause of non-diabetic vitreous hemorrhage. Vitreous hemorrhage caused by retinal detachment may result in delayed diagnosis and poor visual recovery. Therefore, early examinations in suspicion of RRD and appropriate treatments are needed in non-diabetic vitreous hemorrhage. J Korean Ophthalmol Soc 2011;52(4):448-453

Effect of Antiplatelet Drugs on the Development of Vitreous Hemorrhage in Patients with Atrial Fibrillation

Yoon-Jung Choy 대한시과학회 2022 대한시과학회지 Vol.24 No.1

목적: 항혈소판제를 사용했던 심방세동 환자들을 장기적으로 추적 관찰하여 유리체 출혈의 발생률 및 위험요인을 연구하였다. 방법 : 2002년도부터 2006년까지 건강보험공단 자료에서 심방세동으로 진단받은 환자들을 2007년부터 2013 년 12월까지 유리체 출혈의 발생을 경과 관찰하였다. 아스피린, 실로스타졸 사용과 유리체 출혈과의 관계를 알아 보기 위해 투여 기간을 1년 이하 복용, 1년 이상 4년 이하 복용, 4년 이상 복용으로 나누어 검토하였다. 결과 : 총 7,471명의 환자가 선택되었다. 유리체 출혈은 98명이 발생하였다. 아스피린을 먹고 있던 총 25명 중 1년 이하로 복용한 환자는 9명(36%), 1년 이상~4년 이하로 복용한 환자는 9명(36%), 4년 이상 복용한 환자 는 7명(28%)이었다. 아스피린을 1년 이상~4년 이하로 복용 후 유리체 출혈 발생의 위험도는 0.799(p=0.634), 4 년 이상은 0.489(p=0.158)이었다. 실로스타졸을 먹고 있던 총 13명 중 1년 이하로 복용한 환자는 7명(53.8%), 1 년 이상~4년 이하로 복용한 환자는 4명(30.8%), 4년 이상 복용한 환자는 2명(15.4%)이었다. 실로스타졸을 1년 이상~4년 이하로 복용 후 유리체 출혈 발생의 위험도는 0.757(p=0.657), 4년 이상은 1.202(p=0.819)이었다. 12년간 추적관찰한 유리체 출혈은 4.6%의 누적 발생률을 보였다. 결론 : 심방세동 환자를 장기간 추적 관찰한 결과, 아스피린과 실로스타졸의 사용이 유리체 출혈의 위험을 증 가시킬 수 있음을 알 수 있었다. 유리체 출혈이 있는 환자에서는 당뇨병과 고혈압의 빈도가 높기 때문에 유리체 출혈은 다인성인 것으로 나타났다. Purpose : This study aimed to investigate the incidence and risk factors of vitreous hemorrhage in patients with atrial fibrillation (AF) using thrombolytic agents with long-term follow-up. Methods : Patients diagnosed with AF between 2002 and 2006 were selected from the National Health Insurance Corporation database and followed-up from 2007 to 2013. To investigate the relationship between the use of antiplatelets (aspirin and cilostazol) and vitreous hemorrhage, patients were divided based on length of antiplatelet use (<1 year, 1~4 years, and ≥4 years). Results : A total of 7,471 patients were enrolled. Ninety-eight patients developed vitreous hemorrhage, of which 25 patients were taking aspirin (<1 year: 9[36%] patients, 1~4 years: 9[36%] patients, and ≥4 years: 7[28%] patients). The hazard ratio for developing vitreous hemorrhage after taking aspirin for 1~4 years was 0.799 and for ≥4 years was 0.489. In addition, 13 patients who developed vitreous hemorrhage were taking cilostazol (<1 year: 7[53.8%] patients, 1~4 years: 4[30.8%] patients, and ≥4 years: 2[15.4%] patients). The hazard ratios for developing vitreous hemorrhage after taking cilostazol for 1~4 years and for ≥4 years were 0.757 and 1.202, respectively. The cumulative incidence of vitreous hemorrhage at 12-years follow-up was 4.6%. Conclusion : Long-term follow-up of patients with AF revealed that the use of aspirin and cilostazol may increase the risk of vitreous hemorrhage. However, vitreous hemorrhage was found to be multifactorial because the frequency of diabetic mellitus and hypertension was high in patients with vitreous hemorrhage.

유리체 절제술로 치료한 코우츠 유사 망막색소변성증에 합병된 유리체 출혈 1예

이지현(Ji Hyun Lee),김태경(Tai Kyong Kim),김수영(Su Young Kim),이영춘(Young Chun Lee),이미연(Mee Yon Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.4

목적: 코우츠 유사 망막색소변성증에 합병된 유리체 출혈에 대해 유리체 절제술 및 안내 레이저 광응고술로 치료한 사례를 경험하였기에 이를 보고하고자 한다. 증례요약: 6년 전 망막색소변성증으로 진단 받은 24세 남자가 7개월 전부터 시작된 좌안의 시력저하를 주소로 내원하였다. 망막색소 변성증 가족력 및 기저 질환은 없었다. 내원 시 좌안 교정시력은 0.06으로 측정되었으며 안저검사에서 좌안의 유리체 출혈 소견이 관찰되었고 우안 주변부 망막에서 삼출성 병변 소견을 보였다. 이에 좌안의 코우츠 유사 망막색소변성증에 합병된 유리체 출혈을 의심하여 유리체절제술을 시행하였고 유리체 출혈을 제거한 후 주변부 망막에서 출혈을 야기한 모세혈관 확장 및 삼출성 병변이 관찰되어 안내 레이저 광응고술을 시행하였다. 수술 1개월 후 최대교정시력 좌안 0.2로 개선되었으며 유리체 출혈 및 삼출성 병변은 호전되었다. 결론: 코우츠 유사 망막색소변성증에 합병된 유리체 출혈에서 유리체절제술 및 안내 레이저 광응고술은 유용한 치료 수단으로 고려될 수 있다. Purpose: For vitreous hemorrhage induced by coats-types retinitis pigmentosa, we report a case treated with pars plana vitrectomy and endolaser photocoagulation. Case summary: A 24-year-old male who was diagnosed with retinitis pigmentosa in both eyes 6 years earlier presented with decreased visual acuity in his left eye for the last 7 months. Corrected visual acuity was measured at 0.06 in the left eye and fundus examination revealed a vitreous hemorrhage in the left eye as well as an exudative lesion in the right eye's peripheral retina, which suggested Coats-type retinitis pigmentosa. The left eye was treated with pars plana vitrectomy. After removal of the vitreous hemorrhage, endolaser photocoagulation was performed around the peripheral exudative lesion that caused the vitreous hemorrhage. One month later, the best-corrected visual acuity increased to 0.20 in the left eye, and there was an improvement in the vitreous hemorrhage and the exudative lesion. Conclusions: Pars plana vitrectomy and endolaser can be helpful in vitreous hemorrhage induced by coats-type retinitis pigmentosa.

뇌동맥류 파열로 인한 뇌지주막하 출혈에서 Terson

박정운,김무성,이선일,정용태,김수천,심재흥,윤일한 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.8

Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke −A Case Report−

변하영,정호연,최혜정,이중훈,오민균,윤철호,신희석,이은신 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.2

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.

Infantile Vitreous Hemorrhage as the Initial Presentation of X-linked Juvenile Retinoschisis

이종주,김소연,박성섭,유영석,김정훈 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.2

The authors report two cases of X-linked juvenile retinoschisis (XLRS) manifested as bilateral vitreous hemorrhage as early as in an 1-month-old infant and in a 3-month-old infant. The one-month-old male infant showed massive bilateral vitreous hemorrhage. During vitrectomy, thin membrane representing an inner part of schisis cavity was excised and intraschisis hemorrhage was evacuated. As intraschisis cavities were cleared, the stump of inner layer appeared as the demarcation line between the outer layer of the schisis retina and non-schisis retina. The other three-month-old male infant presenting with esodeviation also showed bilateral vitreous hemorrhage. Typical bilateral retinoschisis involving maculae could be seen through vitreous hemorrhage in both eyes on fundus examination. Spontaneous absorption of hemorrhage was observed on regular follow-up. XLRS could be manifested as massive hemorrhage inside or outside of the schisis cavity early in infancy.

당뇨망막병증성 유리체출혈 환자 치험 1례 보고

이득주,이마음,권강,서형식,Lee, Deuk-Joo,Lee, Ma-Eum,Kwon, Kang,Seo, Hyung-Sik 대한한방안이비인후피부과학회 2018 한방안이비인후피부과학회지 Vol.31 No.2

Objectives : The aim of this study is to report the effect of Korean medicine treatment on diabetic retinopathy vitreous hemorrhage. Methods : A 66-year-old female who had diabetes for over 20 years showed vitreous hemorrhage of Grade 4 at initial visit. For about 2 months, acupuncture, moxibustion and herbal medicine treatment were performed. Prognosis was confirmed by funduscopic examination, automatic refractive examination and visual acuity test. Results : In the fundus photographs, we can observe the recovery of turbidity in Grade 4, which decreases to Grade 1, and the result of refraction in the right eye and visual acuity that was not measured when the turbidity is severe. Conclusions : This study was a case of a patient with diabetic retinopathy vitreous hemorrhage complaining of decreased visual acuity. Patients were given herbal medication, acupuncture and moxibustion. Through the funduscopic examination, the treatment effect on the absorption of vitreous hemorrhage was confirmed.

비당뇨성 유리체출혈에 대한 임상분석

김재우(Jae Woo Kim),김보윤(Boyun Kim),박영근(Young-Gun Park),송민혜(Min Hye Song),노영정(Young Jung Roh) 대한검안학회 2011 Annals of optometry and contact lens Vol.10 No.2

목적: 비당뇨성 유리체출혈 환자에서 유리체절제술의 수술시기와 시력예후와의 상관관계 및 추정되는 원인질환을 알아보고자 하였다. 대상과 방법: 유리체출혈로 유리체절제술을 시행받은 환자 97안을 대상으로 의무기록을 바탕으로 추정되는 원인질환을 조사하였다. 또한 출혈 후 6주를 기준으로 조기와 후기 수술군으로 나누어 수술 전 후 최대교정시력 및 시력 향상 정도, 유리체출혈 후 유리체절제술까지의 기간과 시력과의 상관관계 등에 대해 비교하였다. 결과: 망막정맥분지폐쇄, 망막열공, 외상이 원인인 경우 조기 수술군과 후기 수술군의 수술 전 평균시력, 수술 1년 후 시력평균, 시력향상치의 평균은 통계적으로 유의한 차이를 보이지 않았으나(p>0.05)망막중심정맥폐쇄의 경우는 조기수술군이 후기수술군에 비해 시력향상치의 평균이 유의하게 높았다(p=0.005). 결론: 망막중심정맥폐쇄 이외의 비당뇨성 유리체출혈이 있는 환자에서 수술의 시기가 통계학적으로 유의한 시력 차이를 가져오지는 않았으나 조기 수술로 시력회복을 도모하고 유리체출혈의 원인 질환을 규명하여 합병증을 줄이는 방향으로 치료 계획을 세우는 것이 중요할 것으로 사료된다. Purpose: To investigate the correlation between the time of vitrectomy and visual prognosis and possible causes of vitreous hemorrhage in non-diabetic patients diagnosed with vitreous hemorrhage. Methods: This study investigated the possible causes of vitreous hemorrhages based on the medical records of 97 eyes that underwent vitrectomy. Subjects were divided into early (within 6 weeks) and late (after 6 weeks) groups based on the time of surgery, and the best corrected visual acuity, visual acuity improvement, and the correlation between the time of surgery and the visual acuity were analyzed. Results: There was no significant difference in average visual acuity before a vitrectomy, average visual acuity 1 year after the surgery, mean visual acuity improvement between the two groups when the underlying cause was branch retinal vein occlusion, retinal tear, or trauma (p>0.05). However, when the underlying cause was central retinal vein occlusion, the mean visual acuity improvement was significantly higher in the early surgery group (p=0.005). Conclusions: The timing of vitrectomy in non-diabetic patients with vitreous hemorrhages caused by diseases other than central retinal vein occlusion did not significantly increase the visual acuity. However, it is important to promote early visual recovery and find out underlying disease of vitreous hemorrhage by early vitrectomy in order to prevent complications.