What’s behind door number 1?

Author: Ilias Papandreou (Greece)

Co-authors:

Purpose

To present a case of vitreous haemorrhage with a surprise cause in a diabetic patient.

Setting/Venue

A 70-year-old mildly controlled diabetic on oral anticoagulants presented as an emergency with a dense vitreous haemorrhage after lifting weight.

Methods

His visual acuity was cc 6/9 in the right eye and hand movements in the left eye. Fundoscopy showed mild background retinopathy in the right eye and was not possible in the left eye due to dense vitreous haemorrhage. Ultrasound examination of the left eye showed a posterior vitreous detachment and dense intravitreal and retrohyaloidal haemorrhage. After 3 weeks of review, the patient decided to proceed with surgery.

Results

A 3 port 23G pars plana vitrectomy was performed. After initial clearing of the intravitreal haemorrhage an organised fibrin plate corresponding to organized haemorrhage on the posterior hyaloid plane was carefully entered and gradually removed to reveal fine subretinal haemorrhage centrally and extensive peripheral organized subretinal haemorrhage. A gas endotamponade and anti-VEGF injection were used to complete the case.

Conlusions

Vitreous haemorrhages in diabetic patients, when not accompanied by tractional detachment, are often benign and self limiting. In cases of very dense haemorrhage where adequate fundoscopy is not possible an early vitrectomy should be considered as different pathologies can coexist and ultrasound examination can sometimes not exclude vision threatening pathology.

Financial Disclosure

none

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