PURPOSE: To determine the clinical outcome of anti-vascular endothelial growth factor (anti-VEGF) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma (CCH) with serous retinal detachment. METHODS: The medical records of patients having CCH with serous retinal detachment in macula were retrospectively reviewed. CCH and serous retinal detachment were evaluated via fundus photography, optical coherence tomography, indocyanine green angiography, and ultrasonography. RESULTS: A total of 9 eyes were enrolled in this study. The average follow-up period was 19.2 months. The mean visual acuity was 0.51 ± 0.52 (logMAR) and the mean maximum diameter and thickness of the tumor were 6,154.4 ± 2,019.9 µm and 2,224.4 ± 862.1 µm, respectively. Of the 6 eyes receiving anti-VEGF (mean number of injections: 3.16) as the first treatment for serous retinal detachment, 5 had sustained or recurred intraretinal/subretinal fluid (IRF/SRF) and needed additional PDT and transpupillary thermotherapy. In the 3 eyes that received PDT (mean number of treatments: 1.3) as an initial treatment, IRF/SRF was completely resolved. Finally, 8 eyes achieved complete resolution of SRF and IRF; however visual recovery was limited. CONCLUSIONS: PDT, even with a small number of treatments, can alleviate IRF/SRF in CCH, while anti-VEGF did not.
Angiography ; Choroid* ; Endothelial Growth Factors ; Follow-Up Studies ; Hemangioma* ; Humans ; Hyperthermia, Induced ; Indocyanine Green ; Medical Records ; Photochemotherapy ; Photography ; Retinal Detachment ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome* ; Ultrasonography ; Visual Acuity

PURPOSE: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. CASE SUMMARY: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. CONCLUSIONS: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.
Aged ; Diabetic Nephropathies ; Glaucoma, Angle-Closure* ; Hand ; Hemorrhage* ; Heparin ; Humans ; Intraocular Pressure ; Mydriatics ; Renal Dialysis ; Retinal Detachment ; Ultrasonography ; Visual Acuity

PURPOSE: To measure and compare the ocular blood-flow velocity of ophthalmic artery in patients with central serous chorioretinopathy (CSC); affected eyes, asymptomatic fellow eyes, and CSC resolved eyes using transcranial Doppler ultrasonography. METHODS: A total of 31 patients (age 20-52 years) with CSC were evaluated using power motion mode Doppler 150 digital transcranial Doppler ultrasonography. The peak systolic velocity (PSV), peak diastolic velocity (PDV), and resistance index (RI) were measured in the ophthalmic artery of both affected and asymptomatic fellow eyes. After 2 months, 23 patients with resolved serous retinal detachment underwent repeated measurement of the above hemodynamic indices. RESULTS: The PSV and PDV of the ophthalmic artery were 30.05 ± 5.34 cm/sec and 14.07 ± 2.90 cm/sec in affected eyes and 33.03 ± 2.00 cm/sec and 17.17 ± 2.76 cm/sec in asymptomatic fellow eyes, respectively. Both indices were significantly lower in affected eyes (p = 0.004, p < 0.001, respectively). The RI was 0.52 ± 0.08 in affected eyes and 0.43 ± 0.04 in fellow eyes, a significant difference (p < 0.001). After 2 months, in 23 eyes with resolved CSC, the PSV and PDV were 32.94 ± 6.24 cm/sec and 15.54 ± 2.88 cm/sec, respectively. Both indices were significantly higher than at baseline (p = 0.031, p = 0.045, respectively). However, RI was 0.48 ± 0.04 and was not significantly different (p = 0.073). CONCLUSIONS: The CSC-affected eyes showed lower ocular blood-flow velocity and higher RI than the asymptomatic fellow eyes. The ocular blood-flow velocity was increased as CSC was resolved. These findings provide insights into the ophthalmic arterial vascular factors related to the pathogenesis of CSC.
Central Serous Chorioretinopathy* ; Hemodynamics ; Humans ; Ophthalmic Artery ; Retinal Detachment ; Ultrasonography, Doppler, Transcranial*

PURPOSE: In this study we evaluated and analyzed the causes and prognosis of spontaneous vitreous hemorrhage except direct ocular trauma and diabetic retinopathy-induced vitreous hemorrhage confirmed after therapeutic vitrectomy. METHODS: The present study included Non-traumatic, non-diabetic vitreous hemorrhage patients who underwent vitrectomy in our hospital from March 2010 to December 2013 and were followed up for more than 1 year. Past history, preoperative visual acuity and intraocular pressure were evaluated postoperatively at 1, 3, 6 and 12 months. RESULTS: A total of 157 patients (157 eyes) were included in the study. Common causes of vitreous hemorrhage were branch retinal vein occlusion, retinal tear and age-related macular degeneration. Age-related macular degeneration and central retinal vein occlusion patients showed a poor visual prognosis. Lattice retinal degeneration or retinal tear in the opposite eye was observed in 27 patients and therefore, barrier laser was performed. CONCLUSIONS: The most common cause of spontaneous vitreous hemorrhage was retinal vein occlusion. Visual prognosis varied depending on the cause of disease, but significant vision improvement can be expected if the macula is not involved. Additionally, in some patients without evidence of retinal detachment on ultrasound, a possible retinal tear accompanied by localized retinal detachment should be considered.
Humans ; Intraocular Pressure ; Macular Degeneration ; Prognosis ; Retinal Degeneration ; Retinal Detachment ; Retinal Perforations ; Retinal Vein ; Retinal Vein Occlusion ; Ultrasonography ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage*

PURPOSE: This study aimed to determine the accuracy of ultrasonography (US) in detecting retinal detachment in vitreous hemorrhage (V-HEMO). METHODS: A chart review of 81 patients (86 eyes) who have undergone pars plana vitrectomy in the treatment of V-HEMO between June 1996 and June 2004 was done. RESULTS: The most common cause of vitreous hemorrhaging was proliferative diabetic retinopathy (PDR) (39 eyes, 45.3%), followed by ocular trauma (22 eyes, 25.6%). the correct anatomic position of the retina was identified with US in 72 of 86 eyes (83.7%), with eight false positives (9.3%) and six false negatives(7.9%). The sensitivity of US was calculated as 73% and specificity was 88%. US within the PDR group correctly identified 29 of 39 eyes (74.4%), and had a sensitivity of 62% and a specificity of 81%. US within the non-PDR group correctly identified 43 of 47 eyes (91.5%), and had a sensitivity of 89% and a specificity of 92%. CONCLUSIONS: It has been reported that US is an effective diagnostic tool in patients with media opacity, however physicians should bear in mind that US can be unreliable in some patients with PDR. Thus, caution is warranted in making diagnoses and determining the appropriated surgical procedure.
Diabetic Retinopathy ; Diagnosis ; Humans ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Sensitivity and Specificity ; Ultrasonography* ; Vitrectomy ; Vitreous Hemorrhage*

PURPOSE: To evaluate the postoperative surgical outcome of vitreous surgery with removal of the internal limiting membrane assisted by indocyanine green (ICG) and the epiretinal membrane assisted by triamcinolone acetonide (TA.) METHODS: We examined the posterior vitreous state with ultrasound and OCT. The procedures performed included pars plana vitrectomy with internal limiting membrane removal assisted by ICG and epiretinal membrane peeling assisted by TA. We prospectively examined 9 eyes with retinal detachment resulting from a macular hole and with follow-up periods longer than 12 months. The main outcome was evaluated by the anatomical success rate, functional success rate, and postoperative complications. RESULTS: In the 7 of 9 eyes, the retina was reattached with closure of the macular hole and without closure of the macular hole in 1 of 9 eyes. Successful retinal reattachment was achieved in 8 eyes (88%) after the initial surgery and in one eye after an additional operation. Visual acuity was improved in 7 eyes, was unchanged in one eye, and decreased in one eye. The functional success rate was 78%. CONCLUSIONS: In retinal detachment resulting from a macular hole, removal of the internal limiting membrane by ICG, and the posterior hyaloid membrane and epiretinal membrane by TA typically results in anatomical and functional success.
Epiretinal Membrane* ; Follow-Up Studies ; Indocyanine Green ; Membranes* ; Postoperative Complications ; Prospective Studies ; Retina ; Retinal Detachment* ; Retinal Perforations* ; Retinaldehyde* ; Triamcinolone Acetonide ; Ultrasonography ; Visual Acuity ; Vitrectomy

OBJECTIVE: To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect. MATERIALS AND METHODS: In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures. RESULTS: Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement. The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5). CONCLUSION: Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.
Adolescent ; Aged ; Comparative Study ; *Contrast Media/administration & dosage ; Diagnosis, Differential ; Female ; Human ; Image Enhancement ; Male ; Middle Age ; Polysaccharides/administration & dosage/*diagnostic use ; Retinal Detachment/*ultrasonography ; Sensitivity and Specificity ; Ultrasonography, Doppler, Color/*methods ; Vitreous Detachment/*ultrasonography

Forty three eyes with vitreous hemorrhage caused by branch retinal vein occlusion had been underwent pars plana vitrectomy and followed-up over 6 months. The eyes were classified into 4 groups according to intraoperative fundus findings-group 1; vitreous hemorrhage only, group 2; vitreous hemorrhage with fibrovascular proliferation, group 3; vitreous hemorrhage with traction retinal detachments, group 4; vitreous hemorrhage with rhegmatogenous retinal detachments. Analysis was focused on the clinical characteristics and postoperative outcome in each group. The durations of vitreous hemorrhage were longer significantly in group 2 and group 3. The vision improved postoperatively in 35 of 43 eyes(81.3%). The percentage of postoperative visual improvements was 100%(18 of 18 eyes) in group 1, 85.7%(12 of 14 eyes) in group 2, 66.6%(4 of 6 eyes) in group 3, and 20$(1 of 5 eyes) in group 4. The preoperative ultrasono-graphic findings of retinal status were accorded with intraoperative retinal findings in 74.4% of eyes.
Retinal Detachment ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Traction ; Ultrasonography ; Vitrectomy ; Vitreous Hemorrhage*

In eyes with media opacity and equivocal ultrasonographic findings, we can differenciate retinal detachment from vitreous membrane using color doppler imaging(CDI), which allows the display of blood flow characteristics on conventional ultrasonography. The authors performed high resolution Bscan ultrasonography and color doppler imaging simultaneously in 31 eyes with opacity of ocular media, and their intraoperative characteristics and post operative results were evaluated. In 30 eyes with retinal detachment or vitreous membrane, 7 eyes(23%) had equivocal ultrasonographic findings and needed color doppler imaging. Nine eyes(75%) had positive color signal in 12 eyes with retinal detachment, whereas 3 eyes negative. 17 eyes(94%) had negative color signal in 18 eyes with vitreous membrane, 1 eye with proliferative diabetic retinopathy had positive. In conclusion, color doppler imaging is a useful diagnostic method in differentiating retinal detachment from vitreous membrane.
Diabetic Retinopathy ; Membranes* ; Retinal Detachment* ; Retinaldehyde* ; Ultrasonography

We analyzed 33 patients (39 eyes) who were surgically diagnosed as persistent hyperplastic primary vitreous (PHPV) with standardized B-scan ultrasonography. The eyes were evaluated for vitreous stalk or membrane, retrolental proliferation, retinal fold, vitreous opacity, and retinal detachment (64.1 %, 48.7 %, 15.4 %, 15.4 %, and 5.1 %, respectively) with the results. We classified these findings of PHPV into 5 types as follows, type 1: simple retinal fold or preretinal fold alone; type 2: retrolental proliferation alone; type 3: vitreous stalk or membrane; type 4: retrolental proliferation connected with vitreous stalk or membrane; type 5: complicated retinal detachment. The incidence of these types were 15.4%, 15.4%, 28.2 %, 33.3 %, and 5.1 %, respectively. Ultrasonographic findings would be used as a useful parameters to evaluate, document, and plan the management in PHPV.
Classification ; Humans ; Incidence ; Membranes ; Persistent Hyperplastic Primary Vitreous* ; Retinal Detachment ; Retinaldehyde ; Ultrasonography