vitreous hemorrhage

WordNet

1. relating to or resembling or derived from or containing glass; "vitreous rocks"; "vitreous silica"
2. of or relating to or constituting the vitreous humor of the eye; "the vitreous chamber"

PrepTutorEJDIC

1. ガラスの;ガラス製の;ガラス状の
2. 出血,(特に)大量出血 / 多量に出血する

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/16 11:47:04」(JST)

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Vitreous hemorrhage
Slit lamp photograph showing retinal detachment with visible vitreous hemorrhage.
Classification and external resources
Specialty	ophthalmology
ICD-10	H43.1
ICD-9-CM	379.23

Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.

Causes

There are many factors known to cause vitreous hemorrhage.

Diabetic retinopathy

The most common cause found in adults is diabetic retinopathy. Abnormal blood vessels can form in the back of the eye of a person with diabetes. These new blood vessels are weaker and prone to breaking and causing hemorrhage. Diabetic retinopathy accounts for 31.5-54% of all cases of vitreous hemorrhage in adults in the United States.

Trauma

Some injuries can cause blood vessels in the back of the eye to bleed. Trauma is the leading cause of vitreous hemorrhage in young people, and accounts for 12–18.8% of cases in adults.

Retinal tear or detachment

A tear in the retina can allow fluids from the eye to leak in behind the retina, which causes retinal detachment. When this occurs, blood from the retinal blood vessels can bleed into the vitreous. Retinal tear accounts for 11.4–44% of vitreous hemorrhage cases.

Posterior vitreous detachment

As one gets older, pockets of fluid can develop in the vitreous. When these pockets develop near the back of the eye, the vitreous can pull away from the retina and possibly tear it. Posterior vitreous detachment accounts for 3.7–11.7% of vitreous hemorrhage cases.

Other causes

Less common causes of vitreous hemorrhage make up 6.4–18% of cases, and include:

• Proliferative sickle cell retinopathy
• Macroaneurysm
• Age-related macular degeneration
• Terson syndrome
• Retinal neovascularization as a result of branch or central retinal vein occlusion
• Other – about 7 cases in 100,000 have no known cause attributed to them.

Symptoms and diagnosis

Common symptoms of vitreous hemorrhage include:

• Blurry vision
• Floaters- faint cobweb-like apparitions floating through the field of vision
• Reddish tint to vision
• Photopsia – brief flashes of light in the peripheral vision

Small vitreous hemorrhage often manifests itself as "floaters". A moderate case will often result in dark streaks in the vision, while dense vitreous hemorrhage can significantly inhibit vision.

Vitreous hemorrhage is diagnosed by identifying symptoms, examining the eye, and performing tests to identify cause. Some common tests include:

• Examination of the eye with a microscope
• Pupil dilation and examination
• An ultrasound examination may be used if the doctor does not have a clear view of the back of the eye
• Blood tests to check for specific causes such as diabetes
• A CT scan to check for injury around the eye
• Referral to a retinal specialist

Treatments

The treatment method used depends on the cause of the hemorrhage. In most cases, the patient is advised to rest with the head elevated 30–45°, and sometimes to put patches over the eyes to limit movement prior to treatment in order to allow the blood to settle. The patient is also advised to avoid taking medications that cause blood thinning (such as aspirin or similar medications).

The goal of the treatment is to fix the cause of the hemorrhage as quickly as possible. Retinal tears are closed by Laser treatment or cryotherapy, and detached retinas are reattached surgically.

Even after treatment, it can take months for the body to clear all of the blood from the vitreous. In cases of vitreous hemorrhage due to detached retina,long-standing vitreous hemorrhage with a duration of more than 2–3 months, or cases associated with rubeosis iridis or glaucoma, a vitrectomy may be necessary to remove the standing blood in the vitreous.

References

UpToDate Contents

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• 1. 急性持続性視力喪失が認められた成人に対するアプローチ approach to the adult with acute persistent visual loss
• 2. 網膜剥離 retinal detachment
• 3. 眼内出血リスクの高い患者における抗凝固療法、抗血小板療法、および線維素溶解（
  血栓溶解）療法 anticoagulant antiplatelet and fibrinolytic thrombolytic therapy in patients at high risk for ocular hemorrhage
• 4. 小児における急性視力低下へのアプローチ approach to acute vision loss in children
• 5. 糖尿病性網膜症の予防及び治療 prevention and treatment of diabetic retinopathy

English Journal

• Therapeutic Monoclonal Antibodies and Fragments: Bevacizumab.

• Klein A, Loewenstein A.
• Developments in ophthalmology.Dev Ophthalmol.2016;55:232-45. doi: 10.1159/000431199. Epub 2015 Oct 26.
• Bevacizumab (Avastin) is a recombinant humanized monoclonal immunoglobulin antibody that has two antigen-binding domains and blocks all active forms of vascular endothelial growth factor-A. It was originally designed and is still in use as antitumor agent (for colorectal and non-small cell lung canc
• PMID 26502311

• Recurrent Vitreous Hemorrhage Despite Pars Plana Vitrectomy, Laser, and Injections.

• Chung A1, Chin EK1, Almeida DR1.
• JAMA ophthalmology.JAMA Ophthalmol.2015 Dec 3:1-2. doi: 10.1001/jamaophthalmol.2015.2136. [Epub ahead of print]
• PMID 26633845

• Intraocular surgery with melphalan irrigation for vitreous hemorrhage in an only eye with retinoblastoma.

• Yarovoy AA1, Ushakova TL2, Gorshkov IM3, Polyakov VG2, Golubeva OV1, Gorovtsova OV2, Krivovyaz OS1.
• European journal of ophthalmology.Eur J Ophthalmol.2015 Dec 1;26(1):e17-9. doi: 10.5301/ejo.5000683.
• PURPOSE: To illustrate the successful outcome of pars plana vitrectomy (PPV) with melphalan irrigation for vitreous hemorrhage (VH) with suspected viable retinoblastoma. Despite the high risk of intraocular surgery, it was performed to preserve the only potentially seeing eye with treated retinoblas
• PMID 26428220

Japanese Journal

• 硝子体出血,血管新生緑内障の予防とEBM (特集 網膜静脈閉塞症の病態と治療)

• 近藤 峰生
• 眼科 55(13), 1603-1610, 2013-12
• NAID 40019921952

• 角膜染血を伴う硝子体出血に広角観察システム併用25G手術が奏効した1例 (特集 第66回日本臨床眼科学会講演集(6))

• 雪田 昌克,國方 彦志,小林 航 [他]
• 臨床眼科 67(8), 1331-1336, 2013-08
• NAID 40019765252

Related Links

• Vitreous hemorrhage - Wikipedia, the free encyclopedia

Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions ...

Related Pictures

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★リンクテーブル★

リンク元	「眼底出血」「硝子体出血」
関連記事	「vitreous」「hemorrhage」

「眼底出血」

　　[★]

英

fundal hemorrhage, hemorrhage in ocular fundus

関

硝子体出血

• 網膜前出血 preretinal hemorrhage

• 後部硝子体下出血(網膜内境界膜と後部硝子体の間の出血)　←本当はこれだけを指して言う
• 内境界膜下出血(内境界膜と神経線維層との間の出血)

黄斑部に後発。凝固していない血液が黄斑を覆い、にボーを形成する。

原因：血管疾患、網膜細動脈瘤破裂など網膜浅層の病変、増殖性糖尿病網膜症など網膜症死体新生血管の硝子体牽引

→硝子体出血 vitreous hemorrhage

後部硝子体から硝子体内に血液が拡散した場合

• 網膜浅層出血 superficial retinal hemorrhage

神経線維層に出血

原因：急激な静脈のうっ滞(網膜静脈閉塞症、乳頭浮腫)白血病

　→火炎状出血

• 網膜深層出血 deep retinal hemorrhage

内顆粒層に分布する毛細血管網からの出血で、外網状層に貯留

原因：糖尿病

→点状出血

• 網膜下出血 subretinal hemorrhage

視細胞層と網膜色素層の間

原因：網膜下の新生血管、鈍的外傷

• 網膜色素上皮下出血 subpigment epithelial hemorrhage

脈絡叢から色素上皮下に進入した新生血管の破綻性出血

• 脈絡膜出血

原因：外傷

「硝子体出血」

　　[★]

英

vitreous hemorrhage

ラ

haemorrhagia corporis vitrei

関

眼底出血、網膜前出血

原因

• 裂孔原性網膜剥離(網膜裂孔)、糖尿病網膜症、網膜静脈閉塞症(網膜中心静脈閉塞症)、加齢黄斑変性、網膜細動脈瘤、ぶどう膜炎、イールズ病、後部硝子体剥離、眼内腫瘍、眼外傷など

出典不明

• 網膜新生血管：糖尿病網膜症、未熟児網膜症、網膜中心静脈閉塞症、イールズ病
• 網膜の破綻：網膜剥離・網膜裂孔
• クモ膜下出血：テルソン症候群

「vitreous」

　　[★]

• adj.

• ガラス質の、硝子体の

関

corpus vitreum、hyaloid body、vitreal、vitreous body

　 　 　

「hemorrhage」

　　[★]

• n.

• 出血

関

bleeding