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Anterior Retinal Cryotherapy in Diabetic Vitreous Hemorrhage: Reply
AMERICAN JOURNAL OF OPHTHALMOLOGY
256
follow-ups of more than six months. Sixty (75%) had not had laser treatment before cryotherapy; In 46 (45%) of these eyes the vitreous hemorrhage cleared enough after cryopexy to perform laser photocoagulation. Eight to nine spots were applied in each quadrant and indirect ophthalmoscopy was used when possible. We found that eyes with some fundus reflex responded better than eyes with a dense vitreous hemorrhage without fundus reflex. Another important point is the timing of the laser treatment. In our cases the vitreous cleared during the first 48 hours after cryotherapy. If laser treatment is not performed during the third or fourth days after retinal cryopexy, a new vitreous hemorrhage is not uncommon. HUGO QUIROZ, FRANCISCO ACRDENAS, ARMANDO MEZA, ALEJANDRO DALMA,
M.D. M.D. M.D. M.D.
Mexico City, Mexico
_ _ _ _ _ _ _ Reply EDITOR:
_
Drs. Quiroz, Acrdenas, Meza, and Dalma applied anterior retinal cryotherapy in diabetic eyes with vitreous hemorrhage and achieved a 45% success rate. Their series was
February, 1986
essentially different from ours in that only 25% of their patients had received previous retinal photocoagulation, whereas all patients in our series had been so treated. Previous treatment with photocoagulation, and the consequent lowered risk of rebleeding, probably explains the greater proportion of eyes with resolution in our series (23 of 24 eyes). Of special interest is the statement of Dr. Quiroz and associates that vitreous clearing occurred within 48 hours of cryotherapy. We have not observed resolution that promptly. In our experience, the rate varies but can take many months. We agree that eyes containing smaller amounts of blood respond better than those with dense hemorrhage. The age of the hemorrhage appears to be even more important, with recent blood (red) clearing more rapidly and completely than older blood (white). The findings of Dr. Quiroz and associates are consistent with our conclusion that anterior retinal cryotherapy is beneficial in hemorrhaging diabetic eyes. We find that better results are achieved if partial or panretinal photocoagulation is performed before hemorrhaging occurs. However, if it has not been or cannot be done, retinal cryotherapy alone offers significant protection.
MARJORIE A. MOSIER, M.D.
Irvine, California
Correction In the letter, "Traumatic laceration of the inferior rectus muscle," by S. Ullman, L.B. Nelson, and J. J. Martin (Am. J. Ophthalmol. 100:855, Dec. 1985), there was a misprint in the third sentence of the first paragraph. The sentence should read: "Laceration of an isolated extraocular muscle without significant involvement of the globe or adnexa is rare." We apologize for the error.
256
follow-ups of more than six months. Sixty (75%) had not had laser treatment before cryotherapy; In 46 (45%) of these eyes the vitreous hemorrhage cleared enough after cryopexy to perform laser photocoagulation. Eight to nine spots were applied in each quadrant and indirect ophthalmoscopy was used when possible. We found that eyes with some fundus reflex responded better than eyes with a dense vitreous hemorrhage without fundus reflex. Another important point is the timing of the laser treatment. In our cases the vitreous cleared during the first 48 hours after cryotherapy. If laser treatment is not performed during the third or fourth days after retinal cryopexy, a new vitreous hemorrhage is not uncommon. HUGO QUIROZ, FRANCISCO ACRDENAS, ARMANDO MEZA, ALEJANDRO DALMA,
M.D. M.D. M.D. M.D.
Mexico City, Mexico
_ _ _ _ _ _ _ Reply EDITOR:
_
Drs. Quiroz, Acrdenas, Meza, and Dalma applied anterior retinal cryotherapy in diabetic eyes with vitreous hemorrhage and achieved a 45% success rate. Their series was
February, 1986
essentially different from ours in that only 25% of their patients had received previous retinal photocoagulation, whereas all patients in our series had been so treated. Previous treatment with photocoagulation, and the consequent lowered risk of rebleeding, probably explains the greater proportion of eyes with resolution in our series (23 of 24 eyes). Of special interest is the statement of Dr. Quiroz and associates that vitreous clearing occurred within 48 hours of cryotherapy. We have not observed resolution that promptly. In our experience, the rate varies but can take many months. We agree that eyes containing smaller amounts of blood respond better than those with dense hemorrhage. The age of the hemorrhage appears to be even more important, with recent blood (red) clearing more rapidly and completely than older blood (white). The findings of Dr. Quiroz and associates are consistent with our conclusion that anterior retinal cryotherapy is beneficial in hemorrhaging diabetic eyes. We find that better results are achieved if partial or panretinal photocoagulation is performed before hemorrhaging occurs. However, if it has not been or cannot be done, retinal cryotherapy alone offers significant protection.
MARJORIE A. MOSIER, M.D.
Irvine, California
Correction In the letter, "Traumatic laceration of the inferior rectus muscle," by S. Ullman, L.B. Nelson, and J. J. Martin (Am. J. Ophthalmol. 100:855, Dec. 1985), there was a misprint in the third sentence of the first paragraph. The sentence should read: "Laceration of an isolated extraocular muscle without significant involvement of the globe or adnexa is rare." We apologize for the error.