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D.M. Moshfeghi, M.S. Blumenkranz; Posterior Retinal Break as a Cause of Vitreous Hemorrhage in Diabetes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1471.
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To describe posterior retinal breaks as a cause of vitreous hemorrhage in patients with diabetes.
This was a retrospective study. Patients were included if they had a history of diabetes mellitus and presented with vitreous hemorrhage that was ascribed to a posterior retinal break, in the absence of active retinal neovascularization. Data collected included age, gender, symptoms, presence of retinopathy, history of laser photocoagulation, type of retinal break, treatment, and outcomes.
Five patients with diabetes mellitus were identified with posterior retinal breaks presenting as vitreous hemorrhage in the absence of retinal neovascularization. The median duration of diabetes was 20 years, with four patients having Type 1 disease. The average and median age of the patients was 54 years. Four patients were male. The retinal breaks consisted of 4 atrophic breaks with subsensory fluid cuff in 4 patients, and 2 horseshoe tears in one patient. All breaks were located in the macula or just nasal to the optic nerve head. Avulsed retinal vessels were associated with 3 breaks, while a paravascular location was noted in 3 breaks. Three patients had a history of previous pan retinal photocoagulation. Fluorescein angiography demonstrated relative ischemia in the retina surrounding the breaks. Four patients were treated with barrier laser, and 1 patient was treated with panretinal photocoagulation for presumed proliferative retinopathy prior to identification of the break. One patient progressed to retinal detachment.
Posterior retinal breaks may present as a cause of vitreous hemorrhage in patients with diabetes. In the absence of identifiable proliferative retinopathy, a retinal break should be considered, particular in a posterior, paravascular location. Retinal ischemia may be an inciting factor in the development of these breaks.
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