Objective To observe the fundus characteristics and associated factors of retinal hemorrhage (RH) in newborns. Methods A total of 293 healthy newborns (586 eyes) were enrolled in this study. A digital wide-angle retinal imaging device (RetCam Ⅲ) was used to examine the subjects at about 2 days after birth (2.7plusmn;0.9) days. The images of posterior pole, temporal quadrant, superior quadrant, nasal quadrant and inferior quadrant of the fundus of each eye were taken sequentially. Every newborn completed the examination and the mean duration of the procedure was (2.62plusmn;0.55) minutes. Newborns with RH were reexamined after one month. RH was classified according to the location and size of the hemorrhages based on guidelines in the literature. The location and degree of RH was determined in each newborn. The incidence of RH by gender, parity, birth weight, maternal age and delivery method was compared and analyzed. Results RH was present in 87 eyes (14.8%) of 58 newborns (19.8%) and of the 58 newborns with RH, half (29 eyes) had hemorrhages in both eyes, and half (29 eyes) had hemorrhages in only one eye. The site of the hemorrhage was all on the superficial retina. Of the 87 eyes with RH, 72 eyes (82.8%) had hemorrhage in zone Ⅰ, 86 eyes (98.9%) had hemorrhage in zone Ⅱ, and 36 eyes (41.4%) had hemorrhage in zone Ⅲ. Thirty-eight eyes (43.7%) had hemorrhage in zone Ⅰand Ⅱ. Three eyes (3.4%) had hemorrhage in zone Ⅱ and Ⅲ. Thirtythree eyes (37.9%) had hemorrhage in zone Ⅰ, Ⅱ and Ⅲ. One eye (0.4%) had hemorrhage in zoneⅠonly. Twelve eyes (13.8%) had hemorrhage in zone Ⅱ only. None had hemorrhage in zone Ⅲ only. The severity of RH was grade Ⅰ in 13 of 87 eyes (14.9%), grade Ⅱ in 33 of 87eyes (37.9%), and grade Ⅲ in 41 of 87 eyes (47.1%). Fourteen of 58 newborns with RH (24.1%) were lost to follow-up. Forty-four of 58 newborns with RH (75.9%) were reexamined one month after birth and all the RH disappeared entirely. There were no statistically significant differences among the incidences of RH of the different gender (chi;2=0.018,P=0.893), parity（chi;2=0.772,P=0.380）, birth weight（chi;2=1.611,P=0.447）and maternal age (chi;2=0.915,P=0.339). The incidence of RH was higher for vaginal delivery than that for cesarean section delivery (chi;2=3.073,P＜0.05). Conclusions The RH in newborn is located in the superficial retina, mostly located in zone Ⅰor zone Ⅱ, and resolves itself within one month after birth. The RH in newborns is related to the mode of delivery, but not related to gender, parity, birth weight or maternal age.
Objective To evaluate the effective method for treatment of premacular hemorrhage. Methods In 36 cases (36 eyes) of premacular hemorrhage (2PD),25 cases were treated with medicine, and 11 cases were treated with laser surgery and medicine. Results In 25 patients treated with medicine, the average time of vision recovery was 24 days and the average time of clearance of vitreous hemorrhage was 40 days; in the other 11 patients treated with laser surgery and medicine,10 were treated successfully, and in these 10 patients, the average time of vision recovery were 5 days and the average time of clearance of premacular hemorrhage were 11 days in 10 cases which were operated successfully with laser in 11 cases. Conclusions Laser surgery of inducing preretinal hemorrhage to vitreous body is an effective method for treatment of premacular hemorrhage to relieve the impaired central vision. (Chin J Ocul Fundus Dis, 2002, 18: 199-201)
PURPOSE:To search for the occult choroidal neovascularization(CNV)of age-related macular degeneration (AMD)with macular hemorrhage using indocyanine green angiography(ICGA). METHODS:FFA and ICGA were performed in a series of 22 cases(24 eyes)of AMD with macular hemorrhage,and the findings of both angiograms were compared each other. RESULTS :ICGA was found to be superior than FFA in evaluating the occult CNV of AMD with hemorrhage owing to the following outstanding findings in this series,i.e,in judging the presence,position,number and range of the occult CNV. CONCLUSION:ICGA is an important technique in diagnosing the subretinal occult CNV in AMD with macular hemorrhage,and useful in selecting therapeutic measures including photocoagulation and surgical treatment. （Chin J Ocul Fundus Dis,1997,13: 146-149）
PURPOSE:To discuss the clinical characteristics and differential diagnosis of peripapillary subretinal hemorrhage(PPSRH). METHOD:Retrospective analysis of the clinical documents including mainly the ocular manifestations and the findings of fundus fluorescein angiography(FFA)of 37 patients (38 eyes)with PPSRH. RESULTS:In all of these 37 patients,36 were myopes, 31 were young persons ,the average age was 21 years old,and 36 were affected unilaterally. The subretinal hemorrhage revealed itself in 4 types :PPSRH (5 eyes),PPSRH with disc iaemorrhage (21 eyes),PPSRH with vitreous hemorrhage (2 eyes), and PPSRH with disc hemorrhage and vitreous hemorrhage (10 eyes). In the FFA, the hemorrhages showed blocked fluorescence and the optic discs showed irregular hyperfluorescence at the late phase. All of the hemorrhages were absorbed within 3 weeks to 3 months without any treatment. CONCLUSIONS:According to the manifestation of the optic discs in FFA PPSRH might be complicatton of the buried optic disc drusen. （Chin J Ocul Fundus Dis,1997,13: 143-145 ）
PURPOSE:To observe the clinical features of the macular hemorrhage in myopes. METHOD:Twenty-four patients(30 eyes)with myopic macular hemorrhage were examined with slitlamp biomicroscopy,funduscope,A/B ultrasonography,and fundus fluorecein angiography(FFA). The patients were followed up for 3~18 months(average 12 months). RESULTS: Four of 26 eyes with macular hemorrhage examined with FFA were found to be due to choroidal neovaseulature,and they were associated with posterior staphyloma. The other 22 eyes without neovascular change were thought to be simple type,and 19 of them were associated with lacquer cracks. The hemorrhage in simple type cases deminished usually within 1~3 months. CONCLUSION:Myopic macular hemorrhagic eyes of neovascular type resulted usually in recurrent hemorrhage and worse prognosis in visual acuity than those of simple type. （Chin J Ocul Fundus Dis,1996,12: 220-222）
ObjectiveTo investigate the related factors of the retina1 hemorrhage in newborns. Methods9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCamⅢat 0-4 days after born. According to the literature, retinal hemorrhage was classified into degreeⅠ, ⅡandⅢ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intracranial hemorrhage, maternal age, first-time mom, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy-induced hypertension, gestational diabetes, oxytocin, prenatal body mass index (BMI). Multivariate logistic regression analysis was used. ResultsIn 9558 cases of newborns, retinal hemorrhages were found in 2753 infants (28.8%), including 1137 degreeⅠ(41.3%), 895 degreeⅡ(32.5%) and 721 degreeⅢ(26.2%). Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage (r=0.146, 5.841, 1.847, 0.071, 0.246, 0.965;P < 0.05). The degree of fundus hemorrhage was not related to birth weight and BMI (P > 0.05). ConclusionsThe neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.
ObjectiveTo observe the effect of retinal hemorrhage on the treatment of retinopathy of prematurity (ROP) by laser photocoagulation.MethodsRetrospective case analysis. Screening and diagnosis of 134 eyes in 67 patients with ROP in Zone Ⅱ Stage 3+ were included in the study. Among them, 32 patients were male and 35 patients were female. The average birth gestational age was 27.80±2.55 weeks. The average birth weight was 1060±320 g. All children underwent binocular indirect ophthalmoscopy and RetCam Ⅲ. Of the 134 eyes, 38 eyes (28%) with anterior, ridge or vitreous hemorrhage (group A); 96 eyes (72%) without hemorrhage. Retinal avascular photocoagulation was performed within 72 hours after diagnosis by intravenous sedative combined with ocular surface anesthesia with 810 nm laser. Follow-up was performed at 1, 4, 8 and 12 weeks after treatment, and then every 6 months thereafter. The same equipment and methods before treatment were used to examine and document the regression and progression of ROP. The number of eyes with lesions after photocoagulation in the two groups was compared by χ2 test. The t-test was used to compare the gestational age and birth weight.ResultsAmong 134 eyes, lesions completely resolved in 125 eyes (93.3%), progressed in 9 eyes (6.7%). In group A, 7 eyes were progressive (18.4%). In group B, 2 eyes were progressive (2.1%). There was a statistically significant difference in the number of eyes with lesions after laser treatment in group A and B (χ2=9.14, P=0.003). There was no significant difference in birth gestational age and birth weight (t=0.85, 0.25; P=0.40, 0.80).ConclusionThe laser photocoagulation is safe and effective in the treatment of ROP. The preretinal, ridge or vitreous hemorrhage is related to the progression of the lesion after laser photocoagulation.
ObjectiveTo observe the efficacy and safety of vitrectomy combined with submacular injection of tissue-type plasminogen activator (t-PA), gas filling and anti-VEGF drugs (multiple therapy) for thick submacular hemorrhage.MethodsA retrospective case study. From January 2014 to June 2018, 24 patients (24 eyes) with thick submacular hemorrhage who received multiple therapy at the Department of Ophthalmology of Peking University Third Hospital were included in the study. Among them, there were 15 males and 9 females with the average age of 69.05±8.86 years. The average submacular bleeding time was 17.15±10.30 days, the average bleeding area was 13.85±8.63 DD. Seventeen eyes showed hemorrhagic RPE detachment. The international standard visual acuity chart was used to BCVA examination, which was converted to logMAR visual acuity in statistics. The frequency domain OCT was used to measure the height of the foveal elevation. The average logMAR BCVA of the affected eye was 1.37±0.38. The average height of the macular fovea was 824.94±294.38 μm. All eyes underwent 23G or 25G vitrectomy. During the operation, 0.1-0.5 ml t-PA (10 μg/0.1 ml) was injected under the macula. The vitreous cavity was filled with 15% C3F8 after gas-liquid exchange in 13 eyes, and 11 eyes were filled with sterilized air. Eleven eyes were injected with anti-VEGF drugs at the end of the operation, and anti-VEGF drugs were given PRN treatment according to the activity of the lesion. The average follow-up time after treatment was 27.90±22.21 months. The absorption of bleeding under the macula, the improvement of vision, the occurrence of rebleeding and treatment-related complications were observed and recorded. The Wilcoxon rank sum test was performed to compare the BCVA and the height of foveal elevation before and after treatment.ResultsOne month after the treatment, the blood in the fovea of all affected eyes was cleared. At the last follow-up, the logMAR BCVA and macular foveal elevation were 0.82±0.28 and 253.88±71.75 μm, respectively. Compared with those before treatment, the difference was statistically significant (Z=－3.727, －3.234; P＜0.001, ＜0.001). The average intravitreal injection of anti-VEGF drugs was 1.08 times. During the operation, a tiny hole was formed in the center of the macula when t-PA was injected under the retina. Two eyes showed mild vitreous hemorrhage early after the operation. During the follow-up period, bleeding recurred in 2 eyes.ConclusionsVitrectomy combined with submacular injection of t-PA, gas filling, and anti-VEGF drugs is an optimal combination for the treatment of thick submacular hemorrhage. It can effectively remove submacular hemorrhage, improve vision, reduce foveal elevation with good safety.
ObjectiveTo evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD). MethodsA retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age (t=－0.363), gender composition ratio (χ2=0.549), course and thickness of SMH (t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments (t=0.129), times of PPV (t=－0.452) between the two groups were not statistically significant (P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. ResultsAt the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant (t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance (χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant (χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant (t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. ConclusionsBoth autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.