Purpose: To evaluate real-world visual acuity (VA) outcomes in a socioeconomically disadvantaged population of patients with vitreous hemorrhage (VH) resulting from proliferative diabetic retinopathy (PDR) who received primary treatment with either intravitreal antivascular endothelial growth factor (anti-VEGF) injections, pars plana vitrectomy (PPV), or panretinal photocoagulation (PRP). Methods: This retrospective cohort study included patients with newly diagnosed VH resulting from PDR at Eskenazi Hospital (Indianapolis, IN). VA outcomes were compared in patients before and during the COVID-19 pandemic, between race/ethnicity groups, and between initial treatment groups of intravitreal anti-VEGF injections, PPV, or PRP. Results: Of the 100 patients included in the study, mean VA was 1.44 logMAR at baseline (Snellen equivalent, 20/550; n = 100), which improved to 0.79 logMAR (Snellen equivalent, 20/125; n = 45), 0.80 logMAR (Snellen equivalent, 20/125; n = 41), and 0.87 logMAR (Snellen equivalent, 20/150; n = 38) at 6 months, 1 year, and 2 years following diagnosis, respectively. VA outcomes between the time periods prior to and during the pandemic, race/ethnicity groups, and initial treatment groups were similar, with the exception of significantly better VA at 2 years in the PRP group compared with the anti-VEGF group (P < .01). Conclusions: Long-term VA outcomes in a socioeconomically disadvantaged population with VH resulting from PDR at a county hospital were worse than those observed in a randomized control trial, influenced by worse presenting VA and poor follow-up rate.

Legal blindness due to proliferative diabetic retinopathy (PDR) in patients with diabetes mellitus can be preventable if detected and treated in a timely manner. Although vitrectomy has traditionally been reserved for complicated cases, advances in surgical techniques and a better understanding of pathophysiology have driven its evaluation as an early or preventive strategy in selected patients. This article presents a systematic review in PubMed (2020-2025), with an emphasis on classic studies, on the safety and efficacy of vitrectomy as an early intervention in patients with PDR, before the onset of major complications, using the keywords "diabetic vitrectomy," "proliferative diabetic retinopathy," "retinal diseases," and "vitreous hemorrhage". Most of the specific evidence in Mexican or Latin American populations is limited, which is why general evidence used as a reference in the region was also included. Studies published in English and in open-access were included. The reviewed studies consistently report that early vitrectomy helps maintain or improve visual acuity during follow-up, reduces progression to severe complications, and shows low rates of intraoperative adverse events. It is concluded that early vitrectomy in selected patients with PDR represents a safe and effective strategy with the potential to preserve vision and alter the natural history of the disease. However, prospective multicenter clinical trials are needed to establish standardized selection criteria and validate its long-term impact.

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare entity consisting of lesions similar to those of age-related macular degeneration (AMD) and type 1 aneurysmal neovascularization (N1a), but located outside the macular region in the peripheral retina. We present the case of an 89-year-old woman who presented to the emergency department with loss of visual acuity (VA) in both eyes (OU) due to a massive macular subretinal hemorrhage in the right eye (OD) and a vitreous hemorrhage in her left eye (OS), accompanied in both eyes by peripheral hemorrhagic retinal pigment epithelium detachments (hPED). Ophthalmological examination and multimodal imaging led to the diagnosis of PEHCR. This case highlights the importance of the differential diagnosis of PEHCR from other vascular and neoplastic pathologies in order to avoid unnecessary tests and treatments. Early recognition and diagnosis are essential for establishing appropriate management, with intravitreal injections of anti-vascular endotelial groth factors (anti-VEGF) being recommended in cases with loss of VA or threat thereof. This case also contributes to the limited published literature on bilateral PEHCR, reinforcing the need to consider this pathology in elderly patients with peripheral hemorrhagic lesions.

Purpose: To report a case of high-altitude cerebral edema and high-altitude retinopathy resulting in persistent neurologic and long-term visual sequelae following inadequate acclimatization. Methods: A single case was reviewed. Results: A 32-year-old man developed high-altitude sickness during a hike in the Andes, most likely due to inadequate acclimatization during ascent. He was diagnosed with high-altitude cerebral edema and high-altitude retinopathy. Neurologic deficits persisted during the 4-day stay at high altitude but resolved immediately after descent below 4300 m; however, multiple cerebral hemorrhages remained visible on magnetic resonance imaging. Severe bilateral macular hemorrhage led to prolonged vision loss lasting several months. Both eyes subsequently developed macular epiretinal membranes, with a macular hole in the right eye requiring vitrectomy. Although intraretinal hemorrhages in the posterior pole resolved, multifocal electroretinography demonstrated numerous persistent areas of reduced retinal response density for several months. Conclusions: Adequate acclimatization is essential for preventing high-altitude sickness, even in experienced climbers. High-altitude retinopathy may result in permanent vision loss; therefore, long-term ophthalmologic monitoring is recommended.