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JAMA Ophthalmology Clinical Challenge
August 2016

An Unexpected Postvitrectomy Course

Author Affiliations
  • 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2016;134(8):937-938. doi:10.1001/jamaophthalmol.2015.6117

A man in his 50s with a history of ‎poorly controlled type 2 diabetes reported decreased vision in both eyes. On examination, visual acuity was counting fingers OD and 20/200 OS. Anterior segment examination was unremarkable. Dense vitreous hemorrhage precluded fundus examination of the right eye, and B-scan ultrasonography did not reveal any additional pathology. The left fundus examination exhibited diabetic macular edema with central subfield thickness of 425 μm on optical coherence tomography and severe nonproliferative diabetic retinopathy, for which he had laser surgery for diabetic macular edema and panretinal photocoagulation. He subsequently underwent vitrectomy in the right eye for nonclearing vitreous hemorrhage with an uneventful postoperative course and improvement of his visual acuity to 20/100. The patient was lost to follow-up and returned 4 months later with visual acuity 20/125 OD and counting fingers OS, with a vitreous hemorrhage in the left eye for which he underwent vitrectomy with thorough panretinal photocoagulation (1200 spots). On postoperative day 1, visual acuity was 20/200 and intraocular pressure was elevated to 35 mm Hg. The conjunctiva had mild hyperemia with foci of subconjunctival hemorrhage, the anterior chamber was deep and quiet, the anterior vitreous contained no cells, and a few cobweblike, tan strands were present throughout the vitreous cavity. Topical timolol/acetazolamide and brimonidine were started twice daily, together with prednisolone acetate and moxifloxacin every 6 hours. On postoperative day 3, the patient noted decreased visual acuity OS but he denied pain or discharge. Visual acuity was hand motion, and intraocular pressure was 17 mm Hg. The anterior chamber had minimal inflammation. Extensive strands and veils were noted throughout the vitreous cavity (Figure 1).

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