Diabetic retinopathy vitreous hemorrhage -
Vitrectomy is as safe or safer than cataract surgery…to put things into perspective. Dear Doctor Thank-you for your help during these difficult times. I must say your expert advice puts me at ease. So I went forward with the vitrectomy.
I was nervous and very scared, but as you said, things went well and my vision has returned. Thank goodness we did the procedure, as I also had a retinal tear that we were unaware of because we could not see into eye due to amount of blood. Most thankfully yours, Worried Diabetic.
Save my name, email, and website in this browser for the next time I comment. Sign up to our newsletter! Vitreous Hemorrhage and Diabetes. Vitreous Hemorrhage. Tags: diabetes mellitus , Diabetic retinopathy , Retina , Retinal detachment , vision , vitrectomy , vitreous hemorrhage. Althea Grange Posted at h, 30 December Reply If I have no vision in right eye and vitreous hemorrhage in left eye due to diabetic and a retinal tear and could not see how to drive nor read, would I be able to work?
Randall V. Wong, M. Posted at h, 31 December Reply Dear Althea, I guess it really depends upon what type of work you do. Can you read this? Make sure that someone, likely a retinal specialist, takes a look at you.
Best of luck. Posted at h, 29 May Reply Dear Ranjeet, A vitreous hemorrhage, by itself, does not cause a problem, but the cause of the vitreous hemorrhage can be problematic.
Is your cousin diabetic? Aejaz ahamed Posted at h, 08 July Reply I am diabetics patient since 20 years and have undergone diabetics retinopathy surgery due to bleeding in eye doctor says i have to wait for 2 months for my vision.
Posted at h, 11 July Reply Dear Aejaz, I can better help you if I know how good or bad your vision was prior to surgery, and why did yo have surgery? Good luck. Write back and let us know how you are doing! Aejaz ahamed Posted at h, 12 July Reply Dear sir, thanks for your reply,i have undergone before my operation laser treatment non proliferative diabetic ratinophathy 14 times..
can you plz tell how many weeks it make taketo get the vision back with regards, Aejaz. gfry Posted at h, 13 December Reply what about PDR with vitrous haemorrhage and glucoma developed in the affected eye.
Posted at h, 21 December Reply Dear gfry, Yes, PDR can lead to neovascular glaucoma. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina.
These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye vitreous. Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye.
If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain optic nerve , resulting in glaucoma.
In the early stages of diabetic retinopathy, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina.
Tissues in the retina may swell, producing white spots in the retina. As diabetic retinopathy progresses, new blood vessels may grow and threaten your vision. Anyone who has diabetes can develop diabetic retinopathy.
The risk of developing the eye condition can increase as a result of:. Diabetic retinopathy involves the growth of abnormal blood vessels in the retina. Complications can lead to serious vision problems:. Vitreous hemorrhage.
The new blood vessels may bleed into the clear, jellylike substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots floaters. In more-severe cases, blood can fill the vitreous cavity and completely block your vision.
Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months.
Unless your retina is damaged, your vision will likely return to its previous clarity. You can't always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.
Remember, diabetes doesn't necessarily lead to vision loss. Taking an active role in diabetes management can go a long way toward preventing complications.
On this page. Risk factors. A Book: Mayo Clinic Guide to Better Vision. A Book: The Essential Diabetes Book. As the condition progresses, you might develop: Spots or dark strings floating in your vision floaters Blurred vision Fluctuating vision Dark or empty areas in your vision Vision loss.
When to see an eye doctor Careful management of your diabetes is the best way to prevent vision loss. More Information. Screening for diabetic macular edema: How often? Spotting symptoms of diabetic macular edema. Request an appointment.
There are two types of diabetic retinopathy: Early diabetic retinopathy. Diabetic retinopathy. Reducing your risks of diabetic macular edema. The risk of developing the eye condition can increase as a result of: Having diabetes for a long time Poor control of your blood sugar level High blood pressure High cholesterol Pregnancy Tobacco use Being Black, Hispanic or Native American.
Complications can lead to serious vision problems: Vitreous hemorrhage. Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or severe vision loss.
New blood vessels can grow in the front part of your eye iris and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build.
This pressure can damage the nerve that carries images from your eye to your brain optic nerve. Diabetic retinopathy, macular edema, glaucoma or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed.
If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following: Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Try to get at least minutes of moderate aerobic activity, such as walking, each week.
eFigure 4. eFigure 5. Time to First Recurrent Vitreous Hemorrhage by Treatment Group. eTable 2. Visual Acuity Outcomes by Treatment Group and Baseline Visual Acuity Subgroups. Glassman AR , Beaulieu WT , Maguire MG, et al. Visual Acuity, Vitreous Hemorrhage, and Other Ocular Outcomes After Vitrectomy vs Aflibercept for Vitreous Hemorrhage Due to Diabetic Retinopathy : A Secondary Analysis of a Randomized Clinical Trial.
JAMA Ophthalmol. Questions Among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy initially treated with aflibercept or vitrectomy with panretinal photocoagulation, what changes occur in visual acuity and other ocular outcomes?
Findings In this comparative effectiveness study of eyes undergoing treatment, no difference in mean visual acuity over 24 weeks was noted between treatment groups. Meaning Aflibercept and vitrectomy are viable treatment options for vitreous hemorrhage due to proliferative diabetic retinopathy, and the results of this study may influence treatment decisions when initiating therapy.
Importance Although there were no differences in mean visual acuity VA over 24 weeks after vitrectomy with panretinal photocoagulation PRP vs aflibercept in a randomized clinical trial among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy PDR , post hoc analyses may influence treatment choices.
Objective To compare exploratory outcomes between treatment groups that may affect treatment choices for patients with vitreous hemorrhage due to PDR.
Design, Setting, and Participants This post hoc analysis of a randomized clinical trial conducted at 39 DRCR Retina Network sites included adults with vision loss due to PDR-related vitreous hemorrhage for whom vitrectomy was considered.
Data were collected from November to January Interventions Random assignment to 4 monthly injections of aflibercept vs vitrectomy with PRP. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria.
Main Outcomes and Measures Visual acuity area under the curve adjusted for baseline VA and clearance of vitreous hemorrhage. Conclusions and Relevance Both initial aflibercept and vitrectomy with PRP are viable treatment approaches for PDR-related vitreous hemorrhage.
Approximately one-third of the eyes in each group received the alternative treatment aflibercept or vitrectomy with PRP. These factors may influence treatment decisions for patients initiating therapy for PDR-related vitreous hemorrhage.
Trial Registration ClinicalTrials. gov Identifier: NCT Vitreous hemorrhage is common in patients with proliferative diabetic retinopathy PDR and can cause severe vision loss. Once the clinician and patient decide that intervention for the vitreous hemorrhage is needed, treatment options include injections of anti—vascular endothelial growth factor anti-VEGF agents to cause regression of neovascularization while the vitreous hemorrhage is reabsorbed or surgical removal of the vitreous hemorrhage and neovascular membranes with vitrectomy plus PRP.
The DRCR Retina Network Protocol AB compared eyes with vitreous hemorrhage due to PDR randomly assigned to initial intravitreous aflibercept injections or vitrectomy with PRP wherein eyes in both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria.
At 4 weeks, the mean VA was significantly better in the vitrectomy group; however, starting at the week visit and over 2 years, VA was not significantly different between the groups.
Per protocol, approximately one-third of the eyes assigned to aflibercept received vitrectomy and approximately one-third of eyes assigned to vitrectomy received aflibercept after vitrectomy over 2 years. The primary results of Protocol AB demonstrated similar long-term VA outcomes and reasonable safety profiles when initiating treatment with either aflibercept or vitrectomy with PRP eTable 1 in the Supplement.
The study procedures have been reported previously. The protocol was approved by the ethics board associated with each study site and is available on the DRCR Retina Network website. Eyes with traction retinal detachment were allowed if the detachment did not involve or threaten the macula.
Eyes were randomly assigned to initial intravitreous injections of aflibercept, 2 mg EYLEA, Regeneron , or vitrectomy with PRP. Eyes assigned to aflibercept received 4 monthly injections starting at baseline. Eyes received 2 additional injections unless neovascularization was absent with a clear view of the fundus at the or week visit, in which case injections were deferred eFigure 1 in the Supplement.
Thereafter, injections continued if the eye was improving or worsening with respect to vitreous hemorrhage and neovascularization. Vitrectomy was not performed within the first 16 weeks after initial aflibercept treatment unless 1 of the following serious adverse events occurred: retinal detachment involving or threating the macula, angle neovascularization, progressive iris neovascularization, or uncontrolled intraocular pressure from neovascular glaucoma or ghost cell glaucoma.
If vitrectomy was performed, the procedure was the same as that for eyes randomly assigned to vitrectomy, including application of intraoperative PRP. Aflibercept was permitted within 1 to 14 days before surgery but was prohibited during surgery and through 4 weeks after surgery.
If vitreous hemorrhage recurred 4 weeks after vitrectomy or later, aflibercept was given to clear the hemorrhage without additional surgery. Aflibercept also could be given if neovascularization persisted. The main between-group outcome was the difference in mean VA letter score between treatment groups by baseline VA over 24 weeks area under the curve; primary outcome in Protocol AB and at 4, 12, 24, 52, and weeks.
Presence of vitreous hemorrhage and neovascularization defined as neovascularization of the disc or elsewhere were assessed by investigators on clinical examination.
Within-group outcomes included presence of traction retinal detachment during initial vitrectomy by timing of preoperative aflibercept injection vitrectomy group only , presence of vitreous hemorrhage by visit, VA after recurrent vitreous hemorrhage, VA by presence of retinal neovascularization at 4 and weeks, and VA before and after cataract extraction.
Outcomes were evaluated post hoc and should be considered exploratory. There was no adjustment for multiplicity. Analyses of mean VA were conducted via robust regression using M-estimation and the bisquare weight function with covariate adjustment for baseline VA and lens status.
Analyses were conducted with SAS software, version 9. The effect of baseline vision on VA over 24 weeks was driven by differences at 4 weeks eTable 2 in the Supplement.
The distribution of VA by baseline VA and visit is shown in eFigure 2 in the Supplement. At weeks, the median VA letter score among eyes that had recurrent hemorrhage during follow-up was The percentage of eyes with retinal neovascularization by visit and group is shown in Figure 5.
Among 42 eyes in which neovascularization could not be assessed, the median VA letter score was The median VA letter score gain from the visit preceding cataract extraction to the visit after cataract extraction was At weeks, the median VA letter score among eyes that underwent cataract extraction during the study was The potential advantages of initial vitrectomy include faster clearance of initial vitreous hemorrhage, lower rate of recurrent vitreous hemorrhage, and avoidance of aflibercept injections in approximately two-thirds of eyes.
The potential advantages of initial aflibercept include avoidance of vitrectomy in approximately two-thirds of eyes and similar VA from 12 weeks onward.
Rates of cataract extraction were not significantly different between the groups. The process of choosing a treatment approach for an individual is multifaceted. However, the effect on VA, both in the short and long term, is a critical consideration. Although VA was not significantly different between groups by 12 weeks and over 2 years, there was a difference in VA at 4 weeks favoring initial vitrectomy with PRP.
Therefore, patients who want to hasten their visual recovery may choose vitrectomy. Faster visual recovery may be important for patients who are functionally monocular and rely on vision from the eye with vitreous hemorrhage.
Clinicians and patients may initiate treatment with vitrectomy and PRP for patients seeking to minimize future visits and injections. Compared with initial aflibercept, initial vitrectomy and PRP resulted in fewer visits median, 19 vs 12 and injections mean, 9 vs 2 over 2 years.
Release of traction and the performance of endolaser may contribute to the lower likelihood of recurrent vitreous hemorrhage and persistent retinal neovascularization in the vitrectomy group. The presence of neovascularization did not appear to substantially affect VA; however, VA was worse in eyes for which the fundus could not be completely assessed usually due to vitreous hemorrhage.
Anti-VEGF therapy could be preferable for individuals who prefer in-office procedures to intraocular surgery and its attendant risks, are unable to receive medical clearance for intraocular surgery, have concomitant diabetic macular edema DME requiring anti-VEGF treatment, or have limited access to vitreoretinal surgery.
Furthermore, PRP damages peripheral visual fields. Based on the Protocol AB results, rates of cataract development and anti-VEGF treatment for DME may not contribute to the risk-benefit comparison between initial aflibercept vs vitrectomy and PRP. Increased rates of cataract have been reported after vitrectomy, 7 perhaps related to changes in oxygen gradient within the eye.
Among eyes that underwent cataract surgery, VA was good in both groups. Furthermore, there was no significant difference in the rate of center-involved DME at 2 years, or the proportion receiving aflibercept for DME over 2 years. One-third of eyes in both groups received the alternative treatment per protocol during 2 years of follow-up.
Adherence with long-term follow-up should be stressed because eyes with vitreous hemorrhage from PDR may need supplemental treatment after initial aflibercept or vitrectomy with PRP. This study has several limitations. First, the analyses were post hoc and involved subgroups with limited sample sizes; therefore, the findings should be considered exploratory.
Second, although the anti-VEGF treatment algorithm that was used is based on Network Investigator Group consensus and mirrors previous DRCR Retina Network treatment algorithms for DME and PDR, different results might be obtained with different thresholds for treatment or different anti-VEGF agents.
Third, although the protocol required the surgical instrumentation to be gauge or smaller, surgeons were allowed to use their standard surgical approaches to improve the generalizability of the results; thus, the vitrectomy procedure varied between surgeons with regard to the use of intraoperative agents, postoperative filtered air or gas, and additional procedures such as epiretinal membrane or internal limiting membrane peeling.
Fourth, in the time-to-event analyses, outcomes may have been recorded earlier in the aflibercept group because eyes were examined more frequently ascertainment bias.
Fifth, results beyond 2 years, especially in eyes treated with anti-VEGF without PRP, are unknown. The results of this comparative effectiveness study suggest that both intravitreous aflibercept and vitrectomy with PRP are viable first-line options for the treatment of vitreous hemorrhage due to PDR.
These factors may influence treatment decisions for individual patients who are initiating therapy for vitreous hemorrhage from PDR. Published Online: May 6, Corresponding Author: Adam R.
Glassman, MS, Jaeb Center for Health Research, Amberly Dr, Ste , Tampa, FL drcrstat2 jaeb. Author Contributions: Mr Glassman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Critical revision of the manuscript for important intellectual content: Beaulieu, Maguire, Antoszyk, Chow, Elman, Jampol, Salehi-Had, Sun. Conflict of Interest Disclosures: Mr Glassman reported receiving grants from the National Eye Institute NEI , Regeneron Pharmaceuticals, Inc, and Genentech, Inc.
Dr Beaulieu reported receiving grants to his institution from the NEI, Regeneron Pharmaceuticals, Inc, and Genentech, Inc. Dr Maguire reported receiving grants to her institution from the NEI, Regeneron Pharmaceuticals, Inc, and Genentech, Inc, and professional fees paid to her from Genentech, Inc.
Dr Jampol reported receiving grants from the NEI and personal fees from Sanofi SA. No other disclosures were reported. The NIH participated in oversight of the conduct of the study and review of the manuscript but not directly in the design or conduct of the study, nor in the collection, management, analysis, or interpretation of the data, or in the preparation of the manuscript.
Glassman, MS Interim Executive Director and DRCR Retina Network Principal Investigator , Roy W. Beck, MD, PhD president , Alyssa Baptista, BS, Wesley T. Beaulieu, PhD, Claire T. Calhoun, MS, Sharon R. Constantine, BS, Isabella Correia, BS, Brian B. Dale, Simone S.
Dupre, BS, Sandra Galusic, MSPH, Meagan Huggins, BA, Brenda L. Hunter, BS, Paula A. Johnson, MPH, Kristen Josic, PhD, Brittany Kelly, MS, Danni Liu, MSPH, Maureen G.
Maguire, PhD, Michele Melia, ScM, Carin M. Preston, MPH, Cynthia R. Stockdale, MSPH, Katie Stutz, BS, and Alice Zokruah, MS. Duke Reading Center Staff: Katrina Postell Winter, BS lead reader , Garrett Thompson, MD reader , Dee Busian, BA reader , Glenn J. Jaffe, MD director of grading , Adiel Mora, BA project manager , Lucia Foster, MA project manager assistant , and John Keifer McGugan, BS project manager assistant.
DRCR Retina Network Chair : Jennifer K. Sun, MD, MPH, Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology present ; Daniel F.
Martin, MD, Cole Eye Institute at Cleveland Clinic present ; Lee M. Jampol, MD, Feinberg School of Medicine, Northwestern University ; and Neil M. Bressler, MD, Department of Ophthalmology, Johns Hopkins University School of Medicine DRCR Retina Network Vice Chairs: Carl W.
Baker, MD, Paducah Retinal Center , ; Chirag Jhaveri, MD, Retina Consultants of Austin ; Mathew MacCumber, MD, PhD, Rush University Medical Center ; Andrew N. Bressler, MD, Wilmer Eye Institute ; Scott Friedman, MD, Florida Retina Consultants ; Judy Kim, MD, Medical College of Wisconsin ; Ingrid U.
Scott, MD, MPH, Penn State College of Medicine ; Jennifer K. Sun, MD, MPH, Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology ; and John A. Wells III, MD, Palmetto Retina Center National Eye Institute : Sangeeta Bhargava, PhD current and Eleanor Schron, PhD Executive Committee : Andrew N.
Ferris III, MD, Ophthalmic Research Consultants present ; Adam R. Glassman, MS, Jaeb Center for Health Research present ; Glenn J. Jaffe, MD, Duke Reading Center present ; Lee M. Jampol, MD, Feinberg School of Medicine, Northwestern University present ; Chirag D.
Jhaveri, MD, Retina Consultants of Austin present ; Mathew MacCumber, MD, PhD, Rush University Medical Center present ; Daniel F. Martin, MD, Cole Eye Institute at Cleveland Clinic present ; Raj K.
Maturi, MD, PC , present ; Sharon D. Solomon, MD, Baltimore, Maryland Wilmer Eye Institute at Johns Hopkins present ; and Jennifer K.
Sun, MD, MPH, Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology present ; prior members: Lloyd Paul Aiello, MD, PhD, Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School ; chair ; Carl W.
Baker, MD, Paducah Retinal Center ; Abdhish Bhavsar, MD, Retina Center of Minnesota , ; Barbra Blodi, MD, University of Wisconsin, Madison ; Neil M. Bressler, MD, Department of Ophthalmology, Johns Hopkins University School of Medicine ; chair ; Susan B. Bressler, MD, Wilmer Eye Institute ; Alexander J.
Brucker, MD, Scheie Eye Institute ; Kakarla V. Chalam, MD, PhD, MBA, Loma Linda University Eye Institute ; Ronald P. Danis, MD, University of Wisconsin, Madison ; Matthew D. Davis, MD, Medical College of Wisconsin ; Michael J. Elman, MD, Elman Retina Group, PA ; chair and ; Donald F.
Gross, MD, Carolina Retina Center, PA ; Diana M. Holcomb, COA, Retina Associates of Kentucky ; Judy E. Kim, MD, Medical College of Wisconsin , ; Andreas K. Lauer, MD, Casey Eye Center ; Brandon Lujan, MD, Casey Eye Center ; Dennis M.
Marcus, MD, Southeast Retina Center, PC , present ; Ashley A. Scott, MD, MPH, Penn State College of Medicine ; JoAnn Starr, BS, Elman Retina Group, PA ; and John A. Data and Safety Monitoring Committee: Gary Abrams, MD, Kresge Eye Institute; Deborah R.
Barnbaum, PhD, Kent State University; Harry Flynn, MD, Bascom Palmer Eye Institute; Kyle D. Weinstock, MD, PhD, SUNY Upstate Medical University; Stephen Wisniewski, PhD, University of Pittsburgh; John Connett, PhD, University of Minnesota chair, ; and Charles P.
Wilkinson, MD, Greater Baltimore Medical Center DRCR Retina Network clinical sites that participated in this protocol: Atlantis Eye Care, Huntington Beach, California: Hani Salehi-Had, MD study investigator [I] ; Evelyn Ceja coordinator [C] ; Sara Ahmed, BS C ; Stephanie Ramirez C, photographer [P], visual acuity technician [V] ; Mailan Tran, OD V ; Mary Ma, OD V ; Scott F.
Lee, OD V ; Nikki Nguyen, BS P ; Lily Castillo P ; and Janet Reyes P. Retina Research Center, Austin, Texas: Chirag D. Jhaveri, MD I ; Gowtham Jonna, MD I ; Saradha Chexal, MD I ; Daniela Mariel Wilson C ; Ivana Gunderson V ; Tina A.
Seidu C ; Cori Renfroe C ; Ryan M. Reid C, P ; Valerie Gatavaski V ; Abla M. Harara V ; Boris Corak, BS P, V ; and Yong Ren P. Antoszyk, MD I ; Omar S. Punjabi, MD I ; David Browning, MD, PhD I ; Angela K. Price, MPH C, V ; Christina J.
Diabetic vitreous Self-care means blood has leaked into the vitreous gel of the eye Diabetc a retinopatyh of diabetic damage. Overcoming panic and anxiety vitreous is a votreous Diabetic retinopathy vitreous hemorrhage that fills the center vitreouus the eye and helps to Fueling for athletic success the retina in Retinopaty against heomrrhage eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. The retina has many fine blood vessels that may become damaged from diabetes leading to bleeding into the vitreous. Blood in the vitreous vitreous hemorrhage interferes with vision. Diabetic vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. Diabetic vitreous hemorrhage is the bleeding into the vitreous humor Fueling for athletic success by retiopathy diabetic disease. The vitreous vihreous is the transparent gel-like material that fills the cavity between the eye Electrolyte Balance Solution and Retino;athy light-sensitive getinopathy at the back of the eyeball, the retina. Vitreous hemorrhage is one of the most common causes of sudden painless loss of vision. The effect on the patient's vision varies from blurriness and floaters to complete vision obscuration. Diabetic patients can have eye disorders because of abnormalities in the network of blood vessels that supply the retina with oxygen and nutrients. The blood vessels can be closed or blocked, decreasing the flow of oxygen to the retina.
Ganz richtig! So ist es.
Es ist auch andere Variante Möglich
man kann das Leerzeichen schließen?
Ja, ich verstehe Sie.