Archive for November 2015

Early Vitrectomy for Spontaneous Fundus-Obscuring Vitreous Hemorrhage

Acute, Spontaneous Posterior Vitreous Detachment (PVD) has been associated with a reported 10%–15% incidence of retinal tears.1 However, when acute PVD is associated with vitreous hemorrhage, the incidence of retinal tears rises to reported rates of 54%–91%.2–8

In the setting of a dense fundus-obscuring vitreous hemorrhage, the clinical examination is made more difficult by an inability to visualize the fundus. In these cases, B-scan ophthalmic ultrasonography is used to rule out an underlying retinal tear or detachment. Studies looking at the accuracy of ultrasonography in determining the presence of retinal tears have demonstrated variable results.9,10

Given the high risk of underlying retinal pathology, an important consideration becomes whether early surgical intervention with pars plana vitrectomy (PPV) results in improved visual and anatomic outcomes as compared to careful monitoring. The decision to intervene must balance the risks of vitrectomy vs the risk of missing an underlying tear and not responding in a timely fashion.11–13

Several noncomparative studies have looked at the question of appropriate patient management in patients with an acute dense vitreous hemorrhage in the setting of PVD. One retrospective observational case series concluded that the incidence of underlying pathology is high but close observation is appropriate in many cases, except in those individuals who have a history of retinal detachment in the contralateral eye.14 Two studies analyzed patients treated with early vitrectomy and concluded that surgical management is both safe and effective.15,16 A gap in the literature has been a study comparing 2 management approaches in a similar setting. We set out to design a comparative analysis to determine whether, in patients presenting with a dense, fundus-obscuring vitreous hemorrhage from presumed PVD, early surgical intervention results in improved patient outcomes.

Full Paper: Early Vitrectomy for Spontaneous Fundus-Obscuring Vitreous Hemorrhage
(406K PDF)

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The Effects of Cataract Surgery on Patients With Wet Macular Degeneration

Age-related Macular Degeneration (AMD) and cataract are common causes of vision loss in our aging population. Recent advances in the treatment of wet AMD have succeeded to either stabilize or improve vision in a large proportion of cases.1–4 It is therefore not uncommon for wet AMD patients to develop visually significant cataracts. However, there is concern about proceeding with cataract surgery in patients with wet AMD, as there may be a risk of exacerbating choroidal neovascularization (CNV) or progressing geographic atrophy.

There is little evidence in the current literature to aid the decision to proceed with cataract surgery in patients undergoing active treatment for wet AMD. Concern exists that intraocular pressure fluctuations and increased inflammatory mediators associated with uncomplicated cataract surgery may disrupt or further stimulate delicate neovascular vessels. Adverse events related to worsening wet AMD may lead to poorer visual outcome or increased AMD treatment demands, requiring further cost and clinic visits for the patient.

Our study aims to evaluate the visual outcomes and possible complications of cataract surgery in patients with wet AMD. This is the first study to include a control arm and an examination of specific optical coherence tomography (OCT) features.

Full Paper: The Effects of Cataract Surgery on Patients With Wet Macular Degeneration
(464K PDF)

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