the retina vault

OCT of the retina showing fluid leakage at different levels.

vitreous hemorrhage, tractional retinal detachment

Laser retinopexy was successful.

Active at the chorioretinal scar margin.

Large floater in front of the macula

Observation and head of bed elevated is the treatment of choice in this case.

Before and after treatment.

Cleaning cortex after surgery done at the general hospital. cortex behind lens from Roberto Roizenblatt, M.D., Ph.D. on Vimeo.

Dry age-related macular degeneration

Dry age-related macular degeneration

Vitreous hemorrhage in the right eye; patient underwent vitrectomy surgery in the right eye and laser panphotocoagulation in the left eye.

Course initial hyperfluorescence on fluorescein angiography is characteristic. Patient presented with metamorphosia and subretinal fluid on OCT was identified.

Diabetic vitreous hemorrhage and posterior tractional retinal detachment

A case of combined occlusion of the central retinal artery and vein.

This patient had a non-clearing hemorrhage due to diabetes with a small posterior tractional retinal detachment.

Loss of retinal pigment epithelium cells in dry macular degeneration is accompanied by substantial loss of autofluorescent content. Dark areas of geographic atrophy are easier to follow, and that is one of the benefits of fundus autofluorescence.

These white opacities found in the vitreous are more common in both diabetes and hypertension. When it is so dense as to block the view of the posterior fundus and retinal pathology is suspected, fluorescein angiography is usually successful in imaging the abnormalities.

Patient with systolic blood pressure above the 200s. He presents with blurry vision, and on exam it is possible to see blurring of the disc margins, disc edema, linear peripapillary flame-shaped hemorrhages, hard exudates. Treatment of systemic arterial hypertension is essential for reducing or reversing these ocular manifestations of the disease.

Patient with retinitis pigmentosa, severe atrophy was observed.

Seen better under the red-free filters. Note the retinal wrinkling.

The patient presented with flashes of light; lattice degeneration was seen with two small retinal tears at each edge. This vitreoretinal interface abnormality is found in 6-10% of the general population, and is more common – but not limited to – myopic eyes. It may predispose to retinal detachment. Prophylactic treatment of the retinal breaks…

Temporal inferior chorioretinal scar, normal visual acuity, asymptomatic patient.

Vitreomacular adhesion observed through time in a diabetic patient. As soon as macular edema was evident in the OCT, the patient was symptomatic, and a trial of Avastin intravitreal injections turned out to be effective and showed that the edema was mostly due to diabetes, with only a small vitreo-tractional component.

Small choroidal nevus just temporal to the fovea.

  This is a patient with symptomatic floaters, retinal macroaneurysm in involutional stage. Pars plana vitrectomy and air-fluid exchange for floaters from a non-clearing vitreous hemorrhage.

  Advanced cataract with posterior synechia and an old total retinal detachment, proliferative vitreoretinopathy grade B with inferior full-thickness stiff retina fold. Phacoemulsification, intraocular lens implant, vitrectomy with PVR membrane peel, inferior retinectomy followed by air-fluid exchange, endolaser and silicone oil implant was performed.

The more surgeries you perform, the more experienced you get, and as all surgeons know, part of this gain includes identifying and managing adverse outcomes. How to proceed forward? How to discuss them with your patient? I wish there was a great answer, however people respond differently to a doctor presenting an unfortunate scenario. Also,…

Another case of CSCR, which underwent spontaneous resorption of subretinal fluid in 4 months.

  Pars plana vitrectomy with endolaser for non-clearing vitreous hemorrhage due to diabetes. An initial separation of the anterior from the posterior vitreous is important, and one can follow the attachments of the stained vitreous to the neovascular tufts of the peripheral retina.

    Incomplete vitreous separation with persistent posterior vitreous attachment to the perifoveal retina is the hallmark of Vitreomacular Adhesion (VMA), which can be symptomatic. Metamorphopsia (distorted vision), with or without loss of vision, is the symptom I most commonly encounter in clinic.  This entity can lead to vitreomacular traction, epiretinal membrane formation, cystoid macular edema and frank macular hole.  …

  Pars plana vitrectomy and membrane peel for epiretinal membrane, causing low vision due to cystoid macular edema, which resolved after surgery.