Vitreous hemorrhage

Retinal or vitreous hemorrhage, retinal detachment, transient or permanent visual loss central retinal vein occlusion... 

Intra-ocular insertion occasionally results in visual acuity loss, vitreous hemorrhage, and retinal detachment. 

Spaide RF, Fisher YL. Intravitreal hevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina 2006, 26, 275-278. 

Vitrase Ovine sodium hyaluronidase Ista Pharmaceuticals Off-label use Vitreous hemorrhage Intravitreal injection... 

The Vitrasert has proved to be safe and effective for treatment of CMV retinitis as an adjimct to continued systemic therapy. Although use of the Vitrasert is relatively safe, it is not free of complications. Adverse events can occur in 10% to 20% of patients and can result in significant loss of vision. Acute and long-term complications associated with the Vitrasert or its surgical procedure include retinal detachment, vitreous hemorrhage, and endophthalmitis. 

May also have macular edema, venous engorgement, flame-shaped hemorrhages, arterial occlusions (usually asymptomatic) neovascular fronds at the edge of perfused and nonperfused retina may lead to vitreous hemorrhage and RD. 

If i.v. drug abuse has ceased, then close monitoring may not be necessary. Treat neovascular changes with laser photocoagulation vitreous hemorrhage with vitrectomy. 

Factors that mimic glaucomatous visual field loss include branch retinal artery occlusion chorioretinal scars retinal areas treated by photocoagulafion or cryotherapy demyelin-afing disorders cerebrovascular accidents, tumors, or other lesions affecting the optic nerve, chiasm, optic tract, optic radiation, ancPor the remaining course of nerve fibers to the occipital cortex. Other abnormalities that could account for pseudo-glaucomatous visual field defects or vision loss include vitreous hemorrhage, proliferative retinopathy or other retinal disorders. 

Severe retinal hemorrhage with a slowly reversible loss of visual acuity, and massive vitreous hemorrhage recurring after further G-CSF treatment and resulting in irreversible loss of vision in the affected eye have each been reported in single patients (SEDA-21, 378) (SEDA-22, 408). Concomitant hyperleukocytosis was suggested as a possible cause in the first patient, whereas G-CSF-induced reactivation of primary ocular inflammation (probably infectious in origin) was advanced as an explanation in the second case. 

Two cases of vitreous hemorrhage have been observed after retrobulbar block in patients with severe diabetic retinopathy (303). 

Labelle PF, Lapointe A, Boucher MC. Vitreous hemorrhage following retrobulbar anesthesia. Can J Ophthalmol 1996 31(1) 21. ... 

A heavier-than-water fluorinated silicone oil was used in the treatment of 30 selected cases of complicated retinal detachment due to proliferative vitreoretinopathy (n = 19), proliferative diabetic retinopathy with traction detachment (n = 2), giant retinal tears (n = 5), ruptured globe with retinal detachment (n = 2), massive choroidal effusion with retinal detachment (n = 1), and acute retinal necrosis with retinal detachment (n = 1) (13). Initial retinal reattachment was achieved in all cases. Complications included redetachment (n = l), cataract (n = 6), raised intraocular pressure (n = 4), hypotony (n = 4), keratopathy (n = 3), uveitis sjme-chia formation (n = 3), phthisis (n = 2), choroidal hemorrhage (n — 1), and vitreous hemorrhage n = 1). 

Ocular problems seen in patients with SCD inclnde hansient monocnlar blindness, visual field defects from retinal hemorrhage, retinal detachment, vitreous hemorrhage, venous microaneurysms, and neovascnlarization. The incidence of proliferative retinopathy in SCD patients varies from 5% to 10%. Vaso-occlusion in the eye can occnr as early as 20 months and clinically detectable retinal diseases nsnally occnr during adolescence and early adulthood. Despite the less systemic manifestations, patients with HbSC develop serious retinal complications more often and earlier. Annual examination with retinal evalnation is recommended for patients with SCD to prevent blindness from retinopathy and other complications. ... 

LTO could also be applied to retinal neovascularization which occurs in diseases such as diabetes and sickle cell disease. Most of these new vessels which proliferate into the preretinal space and vitreous can be made to regress by pan-retinal thermal photocoagulation. However, in cases of persistent neovascularization, which results in recurrent vitreous hemorrhage, LTO may potentially be used. 

However, complications particularly associated with removal of nondegradable devices include loss of the device into the vitreous cavity, separation of the pellet from the support strut, vitreous hemorrhage, particularly with repeated same site exchanges, and thinning of the sclera resulting in wound leakage... 

Intravitreal injections to deliver corticosteroids minimize systemic side effects however, they may be associated with complications such as retinal detachment, retinal tears, vitreous hemorrhage, endophthalmitis, increased intraocular pressure (IOP), cataract formation, and, with repeated use (required for successful treatment), fibrosis and ptosis. The most common side effect is increased IOP, which has been found on rare occasion to increase drastically (up to 50mmHg in one case report by Detry-Morel et al.) (16,34,35). Close IOP monitoring is crucial following intravitreal injection. 

It was noted, however, that 3 of the 20 treated patients developed sudden severe vitreous hemorrhage, which led to functional blindness and therefore the authors advised caution with use of this treatment. Vitreoretinal surgical techniques have improved significantly since this report and it is possible that such adverse events could be more easily managed at this time. 

Lahey et al. (48) reported on 26 eyes (23 with CRVO, 3 with BRVO) treated with 65-110 pg of intravitreal tPA within 21 days of the onset of CRVO. There was no control group. This trial had a short follow-up of six weeks. At six weeks, the visual acuity was stable or improved in 16 of 23 eyes (69.6%). One eye developed vitreous hemorrhage and two others were found to have an increase in macular edema and a subsequent decrease in visual acuity. The short follow-up precludes making substantive conclusions. 

The potential complications with this procedure include vitreous hemorrhage, nerve fiber layer defect, retinal detachment, accelerated cataract formation, and increased retinal nonperfusion. The rates of these complications have been low in the reported studies. 

The rate of anastomosis formation was similarly low in a series of 24 eyes collected by Fekrat et al. (74). Nine eyes (38%) had successful anastomosis formation. Of these nine, visual acuity improved in four and the remainder had no change. Forty-two percent of eyes developed a transient vitreous hemorrhage and 21% developed localized choroidal neovascularization at the site of the laser treatment. Overall, visual acuity decreased by at least one line in 63%. 

Some other uncommon complications include macular edema, vitreous hemorrhage, hypotony, cataract (Fig. 6), temporary reduced vision secondary to astigmatism, implant malposition, and retinal detachment, which is more likely if the CMV infection involves over 25% of the retina (100). Lim and colleagues evaluated a series of 110 ganciclovir implant procedures and noted posterior segment complications in 12% (111). Some of these eyes had undergone multiple prior implant procedures and... 

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