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Abstract: Peripapillary retinal veinitis can repeatedly lead to vision loss that recovers after a few days and may lead to blindness if not treated promptly. As in this case, the patient came to the clinic because of sudden vision loss in the right eye with recurrent symptoms. After retinal angiography and ocular ultrasound examination, the patient was diagnosed with retinal perivasculitis with secondary vitreous hemorrhage, which is a type of retinal lesion, and was given medication + retinal laser photocoagulation treatment. After a period of time, the patient’s vision recovered and the lesion did not progress, and all indicators improved.
Basic information】Male, 24 years old
Disease Type】Peripapillary retinal veinitis, secondary vitreous hemorrhage
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】August 2021
Treatment plan】Medication (blood and eye tablets) + retinal laser photocoagulation treatment
Treatment Period】1 month of outpatient treatment
Results】Vision restored, no progression of lesion, all indexes improved
I. Initial consultation
Three months ago, the patient experienced a sudden loss of vision in the right eye, initially he could distinguish the outline of an object and a large black shadow floated in front of his eyes. The patient told me that this time he had lost his vision and had rested on his own for 3 days, but he did not return to normal, and the black shadow in front of his eyes was larger. The patient did not have hypertension, diabetes and other systemic diseases. The patient was then scheduled for retinal angiography, which revealed a large non-perfused area around the retina and a neovascularization. The patient was then given an ultrasound examination of the eye, which confirmed that the patient had retinal perivasculitis with secondary vitreous hemorrhage.
II. Treatment history
After 1 week, the patient’s vitreous hemorrhage was absorbed and his visual acuity improved, and the patient’s psychological stress was significantly reduced. However, the cause of hemorrhage was not controlled, and vitreous hemorrhage would occur again in the future. Retinal laser photocoagulation treatment was needed as soon as possible, while the cause of retinal perivasculitis was actively sought, and the result was negative by screening for infectious factors such as tuberculosis infection. Subsequently, retinal laser photocoagulation treatment was started once a week for 4 times over a period of 1 month.
III. Treatment results
After using a 1-month treatment cycle, the patient’s visual acuity was 1.0 in both eyes, and the patient’s self-perceived visual acuity returned to normal. Retinal angiography was arranged again, and neovascular atrophy was found, and a large number of laser spots were seen at the location of the non-perfused area. Six months later, the patient’s retinal angiography was repeated, and a large number of laser spots were seen in the peripheral retina, and the retinal neovascularization was atrophic, with no progression of the lesion. The patient did not experience any further vitreous blood accumulation leading to vision loss for nearly 1 year afterwards. In conclusion, the patient’s visual acuity was restored, the lesion did not progress, and all indexes were improved.
IV. Precautions
The patient recovered after a period of active and effective treatment and was truly happy for him. Since the patient does not have the supervision of a doctor, self-examination and daily care are relatively important. After laser treatment, if abnormalities such as eye swelling and pain, vision loss again occur, it is recommended to promptly communicate with the doctor to confirm the situation. Avoid excessive emotions and physical work on a daily basis, and pay attention to recuperation. Diet, avoid spicy and stimulating food, raw and cold food, and focus on light and nutritious to promote the recovery of the disease. If the lesion occurs unilaterally, patients are advised to focus on observing the other eye to avoid the occurrence of the lesion.
V. Personal insight
Retinal perivasculitis is one of the more common retinal lesions, and vision loss due to retinal perivasculitis can initially recover on its own after a few days, so some people, like this patient, rest on their own and wait for their vision to recover without paying attention to it. However, the absorption time of the blood accumulation after many repeated vitreous accumulations can be prolonged or incomplete, and some patients may miss the best time for retinal laser photocoagulation when they are seen during this time. If not detected in time, intravitreal blood accumulation mechanization can lead to retinal detachment by traction and eventually lead to blindness. Therefore, early detection and treatment are needed to effectively prevent the incidence of blindness.