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Background: Heatstroke is a life-threatening disease clinically characterized by central nervous system dysfunction, multiorgan failure, and extreme hyperthermia. There are no reports about eye involvement in heat stroke. Here, we report a rare case of multilayered retinal hemorrhages in a patient with heatstroke. Case presentation: A 55-year-old male with a one-month history of blurry vision in both eyes presented at our department after suffering from heatstroke. His visual acuity was 5/20 OD and 10/20 OS. Fundus examination revealed retinal hemorrhages in both eyes. Fundus autofluorescence images and near-infrared reflectance images revealed well-defined retinal lesions. Optical coherence tomography helped to accurately locate the different layers of the lesions, including the nerve fiber layer, sub-inner limiting membrane, outer plexiform layer, ellipsoid zone and Henle fiber layer hemorrhages. We followed up with the patient for 8 months. At the last follow-up, his visual acuity was 20/20 in both eyes, and fundus examination showed that retinal hemorrhages were almost completely absorbed. Conclusion: To our knowledge, this is the first report on multilayered retinal hemorrhages secondary to heat stroke. Intraretinal and preretinal hemorrhages can gradually resolve, and the patient's vision will improve with the absorption of the retinal hemorrhages. Multimodal imaging may help to reveal additional details about retinal lesions and monitor the course of the disease.

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Purpose: To report a case of bilateral vitreous hemorrhage (VH) resulting in postoperative vision loss (POVL) after robot-assisted laparoscopic hysterectomy in a 71-year-old female patient. Observations: At initial presentation, best-corrected visual acuity was hand motion at 20 cm in the right eye and 20/666 in the left eye. VH in both eyes and preretinal hemorrhage in the left eye was observed. As the hemorrhage gradually resolved, a full-thickness macular hole was discovered in the right eye, for which the patient did not agree with a surgical treatment. Conclusions and importance: This report describes a rare incidence of bilateral VH as a cause of POVL after non-ophthalmic surgery, which may be related to Trendelenburg positioning, CO2 pneumoperitoneum, and a long surgical duration. Given that POVL can cause severe visual impairment, consultation with ophthalmologists is crucial.

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Valsalva retinopathy is a preretinal hemorrhage caused by a sudden increase in intrathoracic or intra-abdominal pressure, which generally happens after sudden and intense physical effort. This case report describes a case of Valsalva preretinal hemorrhage first treated with laser membranotomy, which subsequently recurred and was retreated with a pars plana vitrectomy. An 18-year-old male was admitted due to complaints of decreased visual acuity in his right eye for three days. He had been practicing strength training in the gymnasium before the complaints started but denied trauma or other precipitating factors. Fundoscopy revealed a central preretinal hemorrhage, and he underwent laser membranotomy, which successfully released the blood from the sub-hyaloid space into the vitreous cavity. However, the following night, he went to a nightclub party and then returned with the same initial symptoms of decreased visual acuity in his right eye. Fundoscopy revealed a relapse of the hemorrhage, which was now too central for membranotomy. He was proposed for a pars plana vitrectomy, with an aspiration of the blood, which was found to be under the inner limiting membrane. The patient achieved complete functional recovery after two weeks, with visual acuities of 20/20 on his right eye. Valsalva retinopathy may be treated with a conservative non-interventional approach, but laser membranotomy and surgery may be beneficial in selected cases, promoting faster visual rehabilitation and avoiding potential long-term toxicity effects of the prolonged presence of preretinal blood. Compliance with the postoperative rest period is essential after a laser membranotomy is performed, and failure to do it may result in the recurrence of the hemorrhage.

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BACKGROUND: To report four cases with interesting anatomical presentations of multilayer macular hemorrhages with preretinal hemorrhage possibly preventing subretinal involvement of the macular area. CASES PRESENTATION: Observational study of four patients presenting with macular hemorrhages. RESULTS: Four patients with multilayer macular hemorrhage due to different causes, presented with a halo-shaped submacular hemorrhage coincident with the preretinal hemorrhage borders. After resolution, in all cases, the macular area underneath the preretinal hemorrhage was found to be spared. CONCLUSION: We hypothesized that an extensive preretinal hemorrhage can exert a mechanical force pushing the subretinal hemorrhage towards the periphery, consequently protecting the macular area.

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PURPOSE: To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy. METHODS: Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes. RESULTS: There were 15 females and nine males with mean age of 41.08 ± 12.72 (21-65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12-116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities. CONCLUSIONS: Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.

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@#AIM: To compare the therapeutic effect of Ranibizumab on retinopathy of prematurity(ROP)with or without preretinal hemorrhage(PRH). <p>METHODS: From April 2017 to January 2018, a retrospective study was carried out on the diagnosed and treated ROP cases 66 eyes of 34 in the Affiliated Eye Hospital of Nanchang University. All the infants were divided into two groups according to PRH or not. All patients were treated with intravitreal Ranibizumab under tropical anesthesia. The infants were followed up, and the cure and retreatment rate between the two groups after initial treatment were compared. <p>RESULTS: After the initial treatment of intravitreal Ranibizumab, the cure rate was 65%(17)and 98%(39), and the retreatment rate was 35%(9)and 2%(1)in bleeding and non-bleeding group, respectively. 9 eyes with PRH needed retreatment; however, only 1 eye retreatment in the non-bleeding group. Notably, all the retreatment cases were cured by once more intravitreal Ranibizumab. The cure rate between two groups was statistically significant. <p>CONCLUSION: The curative effect with initial treatment of ROP with PRH was significantly lower than that without PRH. The retreatment cases were attenuated by repeated intravitreal Ranibizumab treatment.

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PURPOSE: To report a case of Terson syndrome who developed dissociated optic nerve fiber layer appearance after pars plana vitrectomy. CASE REPORT: The author reports a young male patient with Terson syndrome who developed bilateral vitreous hemorrhage and sub-internal limiting membrane hemorrhage after road traffic accident. He underwent pars plana vitrectomy and removal of the already detached internal limiting membrane and the sub-internal limiting membrane hemorrhage in both eyes. In both eyes, dissociated optic nerve fiber layer was appreciated and left eye had a peculiar resemblance to the appearance of cystoid macular edema. CONCLUSIONS: Dissociated optic nerve fiber layer appearance may be noted following vitrectomy and removal of detached internal limiting membrane in patients with vitreous hemorrhage and sub-internal limiting membrane bleed due to Terson syndrome.

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PURPOSE: To report a case of a new complication following complementary and alternative medicine chiropractor neck manipulation with multiple preretinal hemorrhages. OBSERVATIONS: A 59-year-old Caucasian female presented with the acute, painless constant appearance of 3 spots in her vision immediately after a chiropractor performed cervical spinal manipulation using the high-velocity, low-amplitude technique. Examination multiple unilateral preretinal hemorrhages with no retinal tears. The preretinal hemorrhages were self-limited and resolved by 2 months later. CONCLUSIONS: Chiropractor neck manipulation has previously been reported leading to complications related to the carotid artery and arterial plaques. This presents the first case of multiple unilateral preretinal hemorrhages immediately following chiropractic neck manipulation. This suggests that chiropractor spinal adjustment can not only affect the carotid artery, but also could lead to preretinal hemorrhages.

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PURPOSE: To present fundus images of a case with severe preretinal hemorrhage in diabetic retinopathy that was treated with posterior hyaloidotomy with an Nd:YAG laser. OBSERVATIONS: A 35-year-old diabetic patient presented with sudden painless loss of vision due to severe preretinal hemorrhage over the macular area and high risk proliferative diabetic retinopathy. Her visual acuity was counting fingers. Posterior hyaloid face was treated with Nd:YAG laser (posterior hyaloidotomy). Panretinal laser photocoagulation was first performed to control the proliferative diabetic retinopathy. Blood drained inferiorly into the vitreous cavity with clearance of the premacular area. CONCLUSIONS AND IMPORTANCE: Prompt treatment with Panretinal laser photocoagulation followed by posterior hyaloidotomy with the YAG laser is a viable option in order to avoid further proliferative diabetic retinopathy complications and vision loss. The current image clearly depicts treatment efficacy.

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OBJECTIVE: To assess whether preretinal hemorrhage (PRH) is associated with the presence and severity of retinopathy of prematurity (ROP) in high-risk patients. METHOD: Prospective cohort study, patients referred to the Department of Ophthalmology for ROP screening during October-November 2016 were evaluated weekly on 4 occasions to assess the relationship with PRH and the development of ROP as well as degree of severity associated. We used absolute, median frequencies with minimum and maximum values, χ2 test and Mann-Whitney U-test, as well as relative risk with 95% confidence interval. RESULTS: A total of 30 patients, in the first week 11 females (36%) and 4 males (13%) had PRH; in the 2nd week 13 patients (43%) presented PRH and 14 (46%) developed ROP; on the 3rd week there were no changes; in the last week 8 presented HPR (26%) and 11 patients (36%) with ROP. Stage I severity occurred more frequently. Statistical significance (p = 0.040) was found in the presence of PRH and the development of ROP in the first week with. CONCLUSIONS: HPR is a risk factor for the development of ROP during the first weeks of life and is associated with stages of mild severity.

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We report three cases of idiopathic macular telangiectasia type 2 with temporally decentered preretinal hemorrhage as the presenting sign. The preretinal blood obscured the telangiectatic vessels such that the diagnosis was only evident by fluorescein angiography of the fellow eyes, which had near-normal vision. The preretinal hemorrhage was associated with Valsalva maneuver in one patient and with type 3 subretinal neovascularization in one patient. We speculate that the vascular dilations in idiopathic macular telangiectasia type 2 may increase patients' susceptibility to rupture and hemorrhage with increased venous pressure.

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The Valsalva maneuver is described as an expiratory effort against a closed glottis or airway. It leads to elevation of retinal venous pressure and may result in retinal hemorrhage. A fifty two-year-old man presented with an acute reduction of central visual acuity in his right eye which occurred after considerable straining at stool. Detailed past medical history revealed that he suffered from chronic constipation and hypertension. There were one disc sized subhyaloid hemorrhage and three small intraretinal hemorrhages around the fovea at the dilated fundus examination. After three months of follow-up without any treatment, the retinal hemorrhages resolved without any sequelae. Here we report a patient with sudden visual loss and retinal hemorrhage.

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PURPOSE: To evaluate the visual prognosis of retinal arterial macroaneurysm with various treatment. METHODS: We did retrospective study in 16 patients(16 eyes) of retinal arterial macroaneurysm diagnosed at our hospital from March 1996 to January 2003. RESULTS: The range of patient's age was from 26 to 92 year-old, and 10 patients were female and 6 patients were male. In 6 eyes without treatment, spontaneous absorption of hemorrhage or edema occurred in 4 eyes. In 2 eyes with preretinal hemorrhage involving the macular area, vision was improved 2 lines or more as hemorrhage was subsided. Two eyes with Nd: YAG laser photodisruption obtained visual improvement of 4 lines or more. In 2 eyes misdiagnosed as CNV, argon laser photocoagulation was performed. In 6 eyes treated surgically with tPA injection or pars plana vitrectomy, 5 eyes showed visual improvement of 4 lines or more. CONCLUSIONS: Laser therapy or vitrectomy seems to be an effective method for the treatment of retinal arterial macroaneurysm involving the macular area.

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