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Maria Bretana, Eric Kegley, Amy Schefler; Ultrasonographic differentiation of avulsed retinal vessels presenting with vitreous hemorrhage after trauma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2302. doi: https://doi.org/.
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To demonstrate the ultrasonographic features of avulsed retinal vessel which are critical to making this challenging diagnosis and pursuing conservative (nonsurgical) treatment.
A retrospective review was conducted of patients at Retina Consultants of Houston who were diagnosed with vitreous hemorrhage due to an avulsed retinal vessel after trauma. Three patients were identified. All patients were evaluated with 10/20 MHz contact B-scan. Longitudinal and transverse ultrasound sections of the eye were recorded at multiple clock hours. Critical features of avulsed retinal vessels which distinguished this entity from masquerading syndromes were identified. These features were identified even in cases with dense vitreous hemorrhage. Patients were managed conservatively and underwent observation only or observation followed by laser.
Patients with a history of vitreous hemorrhage after trauma should undergo ophthalmic ultrasound. The longitudinal image to the temporal oblique quadrants demonstrates an elevated tissue adherent to the hyaloid. A transverse view of the same area demonstrates a single point, confirming this tissue as a linear band rather than a sheet-like membrane. This band can present with discontinuous features. The more elevated this band is, the more motility will be captured on dynamic imaging. If the vitreous hemorrhage is moderately dense, a 20MHz contact B-scan posterior segment can be performed, providing better resolution in cases in which good images are difficult to obtain with the 10MHz ultrasound probe.
Avulsed retinal vessel is a rare condition which can present with vitreous hemorrhage after trauma. This is the first series to demonstrate high resolution posterior ultrasound features of this disease. Attention to the ultrasound features identified in this study will improve the accuracy of diagnosis and early detection of avulsed retinal vessels. Furthermore, knowledge of these features will help to avoid confusion with other etiologies which can appear similar such tractional retinal detachments or retinal tears that can require emergent treatment. In contrast, patients with retinal vessel avulsion can undergo conservative management and avoid surgery.
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