Poster 37: Vitreous Hemorrhage Can Be a Red Herring

316 eye. She was perscribed one 250-mg Acetazolamide tablet each day for the macular edema. Conclusion: Visual acuity in this patient has remained stable since her initial evaluation, although she notes that her overall quality of vision seems to be decreasing. She is monitored every 1 to 2 months. After electroretinogram testing, it was confirmed that she had USH1. These individuals have little or no benefit from hearing aids, and most use sign language as their primary form of communication. Electroretinography (ERG) to diagnose RP and electronystagmography (ENG) to detect balance problems are important to help doctors detect Usher syndrome early in its course. Early diagnosis is important in order to begin special training programs to help the individual manage concurrent hearing and vision difficulties. Regarding their vision, these individuals can benefit greatly from orientation and mobility training, independent-living training, Braille instruction, and other low vision services. Because the type of RP seen with Usher syndrome is similar to other forms of RP, it is assumed that any advances in the treatment and management of RP will directly benefit those with Usher syndrome. Poster 37 Vitreous Hemorrhage Can Be a Red Herring Jennifer Jones, O.D., Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: There are 2 categories of vitreous hemorrhage: retrovitreous and intravitreous. Retrovitreous hemorrhages may occur in eyes associated with PVD but are also associated with trauma, diabetic retinopathy, retinal detachment, retinal vein occlusion, or neovascularization. A patient typically presents with a complaint of “red vision” (erythropsia) or loss of vision. It typically presents as bright red blood that shifts with eye movements and is often keel-shaped or boat-shaped when settling. Intravitreous hemorrhages may also have a similar etiology but usually occurs secondary to neovascularization with associated vitreous traction. A combination of retrovitreous and intravitreous hemorrhages is possible and is often associated with trauma. Both categories involve similar management as to determining the underlying cause. B-scan ultrasonography is often necessary to assess the underlying retina depending on the severity of the hemorrhage. The patient should be instructed to sleep with his or her head elevated. Most retrovitreal hemorrhages will resolve through hemolysis and phagocytosis; however, a retinal consult should be considered, especially in patients with intravitreous hemorrhage of diabetic etiology as they may benefit from early vitrectomy intervention. Case Summary: A 45-year-old Hispanic male presented with MRI films in-hand for progressive vision loss over the last 2 months O.S.⬎O.D. His complex medical history included renal and brain carcinoma, diabetes, and hypertension. Best-corrected visual acuity was 20/400 O.D. and hand motion O.S. The slit lamp exam revealed moderate posterior capsular and cortical cataracts O.D., O.S. The dilated fundus

Optometry, Vol 79, No 6, June 2008 examination was remarkable for dense intravitreous hemorrhages O.S.⬎O.D. B-scan ultrasonography and MRI images confirm the diagnosis and will highlight the differential process involved in managing this challenging case. Conclusion: This poster presents a challenging clinical case with a taxing differential diagnosis. Vitreous hemorrhage and its root causes will be discussed in detail to offer the optometric physician a review on how to handle and prioritize the potential diagnoses of this patient. Poster 38 Cyclitic Membrane in a Post–Cataract Surgery Retinitis Pigmentosa Patient Grace Tan, O.D., and Patricia Woo, O.D., Northport VAMC, OPT 123, 79 Middleville Road, Northport, New York 11768 Background: Acute inflammatory, or cyclitic, membrane formation is a rare, but serious postoperative complication found in patients who have undergone intraocular surgery. These fibrous membranes originate from proliferative glial cells and fibroblasts, to cause leukocyte and fibrin accumulation. Most reported cases have documented these findings on the surface of the ciliary body as well as the anterior vitreous. This case describes the diagnosis and treatment of a cyclitic membrane found in the anterior chamber of a patient who also suffers from retinitis pigmentosa (RP). Case Summary: A 35-year-old male with RP underwent extracapsular cataract extraction (ECCE) in both eyes—the right eye followed the left eye operation by 2 weeks. Three days after the second procedure, the patient presented with a sudden loss of vision and severe pain in the right eye. His vision had decreased from an uncorrected projected Snellen acuity of 20/60 to hand motion detection. Biomicroscopy examination revealed grade IV cells and grade IV flare in the anterior chamber and an inflammatory membrane formation. A dilated fundus exam revealed no cells or flare in the vitreous, and the posterior segment was unremarkable except for the classic RP triad, all of which had been noted in exams pre-ECCE. No evidence of infective processes was noted. At the 3-day postoperative visit, the medication regimen for the patient was increased to aggressively target the cyclitic membrane. After only 2 days of treatment, the patient had shown a significant improvement in visual acuity, reduction in his anterior chamber reaction, and deterioration of the inflammatory membrane. The treatment was tapered; however, 2 weeks later the anterior chamber began showing an increased inflammatory reaction. To avoid a recurrence of the membrane and suppress the reaction, the tapering regimen was altered to prolong each dosing step. The affected eye regained 20/60 acuity and showed no evidence of chronic inflammation. Conclusion: The daunting appearance of a cyclitic membrane can deter most practitioners from managing a patient. As with any complicated postsurgical outcome, the surgeon should be notified and consulted. However, if an acute