Vitreous Hemorrhage: Difference between revisions
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The population at risk for vitreous hemorrhage will have the demographic and clinical characteristics according to its common causes. Poorly controlled diabetics with end-organ damage such as proliferative diabetic retinopathy are at high risk. People younger than 40 with vitreous hemorrhage often have a history of recent ocular trauma whereas older, non-diabetic populations with vitreous hemorrhage likely suffered an acute, posterior vitreous detachment and/or retinal tear. | The population at risk for vitreous hemorrhage will have the demographic and clinical characteristics according to its common causes. Poorly controlled diabetics with end-organ damage such as proliferative diabetic retinopathy are at high risk. People younger than 40 with vitreous hemorrhage often have a history of recent ocular trauma whereas older, non-diabetic populations with vitreous hemorrhage likely suffered an acute, posterior vitreous detachment and/or retinal tear. | ||
There have been reports of vitreous hemorrhage in patients treated with anticoagulation and antiplatelet agents, but these cases are rare and often in patients with significant preexisting retinal pathology (e.g. neovascular age-related degeneration). Systemic coagulation disorders and blood dyscrasia such as leukemia and thrombocytopenia has reportedly increased the risk of vitreous hemorrhage, but these cases are also rare. | There have been reports of vitreous hemorrhage in patients treated with anticoagulation and antiplatelet agents, but these cases are rare and often in patients with significant preexisting retinal pathology (e.g. neovascular age-related degeneration). Systemic coagulation disorders and blood dyscrasia such as leukemia and thrombocytopenia has reportedly increased the risk of vitreous hemorrhage, but these cases are also rare. | ||
Revision as of 17:30, February 16, 2011
Article summary goes here.
Disease Entity
Vitreous Hemorrhage ICD-9 379.23
Disease
Vitreous Hemorrhage is a common cause of acute vision loss having an incidence of approximately 7 cases per 100,000. It is therefore frequently encountered on an emergent basis by ophthalmologists and Emergency Room professionals alike. Although the diagnosis is often straightforward to make on fundoscopic examination or ultrasonography, the underlying etiology may require further investigation to determine.
Etiology
The etiology of vitreous hemorrhage and their frequencies are variable according to the characteristics of the study population. The three most common causes include proliferative diabetic retinopathy, vitreous detachment with or without retinal tear, and ocular trauma which account for 59-88.5% of all cases. Less common causes of vitreous hemorrhage include retinal vein occlusion, proliferative sickle cell retinopathy, retinal macroanuerysm, subarachnoid hemorrhage (Terson's syndrome), and age-related macular degeneration.
Risk Factors
The population at risk for vitreous hemorrhage will have the demographic and clinical characteristics according to its common causes. Poorly controlled diabetics with end-organ damage such as proliferative diabetic retinopathy are at high risk. People younger than 40 with vitreous hemorrhage often have a history of recent ocular trauma whereas older, non-diabetic populations with vitreous hemorrhage likely suffered an acute, posterior vitreous detachment and/or retinal tear.
There have been reports of vitreous hemorrhage in patients treated with anticoagulation and antiplatelet agents, but these cases are rare and often in patients with significant preexisting retinal pathology (e.g. neovascular age-related degeneration). Systemic coagulation disorders and blood dyscrasia such as leukemia and thrombocytopenia has reportedly increased the risk of vitreous hemorrhage, but these cases are also rare.
General Pathology
Extravasation of blood into and around the vitreous cavity is generally cased by three basic mechanisms. Abnormal blood vessels prone to bleeding grow in response to ischemic conditions such as diabetic retinopathy and retinal vein occlusion. The elaboration of angiogenic factors suh as vasucalr endotheilial growth factor (VEGF), basic fibroblast growth factor, and insulinlike growth factor potentiate nevascularization and have recently become popular pharmacotherapeutic targets. The second mechanism involves the rupture of normal vesslels through mechanical force. This can occur from ocular trauma (both blunt or perforating) and in association with posterior vitreous detachment (PVD). Vitreous Hemorrhage in the setting of acute PVD is associated with a retinal tear or break in 70-95% of cases and should invoke consideration of a retinal specialist referral. Extension of hemorrhage from a source adjacent to the vitrous is the third mechanism. Retinal macroaneursms, tumors, or choroidal neovascularations secondary to conditions such as age-related macular degeneration can cause "break-through" bleeding into the vitreous. Add text here
Pathophysiology
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Primary prevention
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Diagnosis
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History
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Physical examination
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Signs
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Symptoms
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Clinical diagnosis
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Diagnostic procedures
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Laboratory test
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Differential diagnosis
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Management
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General treatment
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Medical therapy
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Medical follow up
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Surgery
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Surgical follow up
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Complications
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Prognosis
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Additional Resources
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References
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