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PubMed1984

Ophthalmologic findings in acquired immune deficiency syndrome (AIDS).

Forty-one homosexually active men had ophthalmologic and immunologic evaluations. Four of eight with acquired immune deficiency syndrome (AIDS) had abnormal ocular findings that included cotton-wool spots, retinal hemorrhages, cytomegalovirus, retinitis and conjunctivitis due to cytomegalovirus, and keratoconjunctivitis sicca. The other four patients with AIDS and 33 homosexual male controls had normal ocular examinations. Patients with AIDS and abnormal eye findings had a notably lower total leukocyte count, absolute lymphocyte count, percentage T-helper lymphocytes, helper-suppressor lymphocyte ratio, hematocrit level, and platelet count than patients with AIDS and normal results on eye examination or controls. All patients with AIDS and abnormal eye examination results died; the four other patients with AIDS and normal eye findings remain alive. These observations suggest that ophthalmologic abnormalities are common in patients with AIDS, are associated with severe immunoregulatory abnormalities, and carry a poor prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Cerebral white matter lesions, retinopathy, and incident clinical stroke.

CONTEXT: White matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to have a microvascular etiology and to precede the development of clinical stroke. However, few clinical data are available to support these hypotheses. OBJECTIVE: To examine the relationship of WMLs, retinal microvascular abnormalities, and incident clinical stroke in healthy, middle-aged men and women. DESIGN AND SETTING: The Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort study conducted in 4 US communities and initiated in 1987-1989. PARTICIPANTS: A total of 1684 persons aged 51 to 72 years who had cerebral magnetic resonance imaging (MRI) and retinal photography at the third examination (1993-1995). MAIN OUTCOME MEASURES: Odds of WMLs, defined by standardized methods from MRI, by presence or absence of specific retinal microvascular abnormality (eg, microaneurysm, retinal hemorrhage) on retinal photograph; incident clinical stroke, ascertained after a median follow-up of 4.7 years, according to presence or absence of WMLs and retinopathy. RESULTS: Persons with retinopathy were more likely to have WMLs than those without retinopathy (22.9% vs 9.9%; odds ratio, 2.5; 95% confidence interval [CI], 1.5-4.0, adjusted for age, sex, race, and vascular risk factors). The 5-year cumulative incidence of clinical stroke was higher in persons with vs without WMLs (6.8% vs 1.4%; adjusted relative risk [RR], 3.4; 95% CI, 1.5-7.7) and in persons with vs without retinopathy (8.0% vs 1.4%; adjusted RR, 4.9; 95% CI, 2.0-11.9). Persons with both WMLs and retinopathy had a significantly higher 5-year cumulative incidence of stroke than those without either WMLs or retinopathy (20.0% vs 1.4%; adjusted RR, 18.1; 95% CI, 5.9-55.4). CONCLUSIONS: In this cohort, middle-aged persons with cerebral WMLs detected on MRI were more likely to have retinal microvascular abnormalities and to have an increased risk of clinical stroke than people without WMLs. The risk of stroke was higher when retinopathy was simultaneously present in persons with WMLs.

Aged↗
PubMed1976

The retina in type 5 hyperlipoproteinemia.

Of two patients with type 5 hyperlipoproteinemia, one exhibited lipemia retinalis with multiple retinal hemorrhages and intraretinal lipid extravasations. Postmortem examination showed hemorrhages in the inner retinal layers and lipid deposits largely in the outer plexiform layer. Lipid within the walls of the retinal vessels was demonstrated by light and electron microscopy. The second patient exhibited visual loss due to progressive obstruction of retinal vessels with white material presumed to be lipid. Findings were confined to one eye.

Adult↗
PubMed1990

Quadrantic venous-stasis retinopathy secondary to an embolic branch retinal artery obstruction.

Venous-stasis retinopathy is a term used to describe the posterior segment findings of the ocular ischemic syndrome. These include midperipheral blot retinal hemorrhages, dilated retinal veins, attenuated arterioles, peripheral retinal microaneurysms, macular edema, as well as retinal and optic disc neovascularization. The authors recently evaluated a 71-year-old woman who presented with an asymptomatic calcific embolus in her right infero-temporal branch retinal artery. Classic venous-stasis retinopathy that was limited to the territory of the obstructed arteriole was present concurrently. This case appears to demonstrate that chronic retinal hypoperfusion and resultant venous-stasis retinopathy can be produced by not only high-grade, fixed stenosis but also by embolic disease.

Aged↗
PubMed2004

The effect of prinomastat (AG3340), a potent inhibitor of matrix metalloproteinase, on a new animal model of epiretinal membrane.

PURPOSE: To develop a simple epiretinal membrane (ERM) animal model and evaluate the efficacy of prinomastat (AG3340), a synthetic inhibitor of matrix metalloproteinase. METHODS: This experiment was carried out on 18 eyes of nine Brown Norway rats. Preretinal hemorrhage was induced bilaterally using diode laser focused deeply on choroidal blood vessels. One day later, AG3340 was injected intravitreally in the right eyes while the left eyes received equal amounts of vehicle. The developed epiretinal membrane was measured in disk areas and compared between groups. RESULTS: Clinically, preretinal hemorrhage showed a slow clearance persisting for 8 to 10 weeks. ERM was well established around 12 weeks. Histologically, ERMs consist of fibroblast and glial cells embedded in collagen-rich extracellular matrix infiltrated by macrophages. Seventy-five percent of the hemorrhagic laser burns in the control group developed ERM, whereas only 25% of the hemorrhagic laser burns in treated group developed ERM (P = 0.01). The total surface area of developed ERM was 3.66 DD in treated eyes versus 25.45 DD in control eyes (P = 0.049). The mean surface area of ERM per eye was 0.52 disk areas +/- 1.05 in treated eyes versus 3.18 +/- 3.07 in control eyes. CONCLUSION: We demonstrated that ERM can be induced on rat retina by simple hemorrhagic retinal laser coagulation. This new animal model could be used for future evaluation of different medical treatment modalities for proliferating ERM. Furthermore, AG3340 demonstrated an inhibitory effect on ERM formation in this new rat model.

Animals↗
PubMed2003

Rocky Mountain Spotted Fever as a cause of macular star figure.

An 86-year-old woman with a history of tick bites in the previous months developed subnormal visual acuity in both eyes, keratic precipitates, anterior chamber and vitreous cells, optic disc edema, retinal hemorrhages, and retinal arteriolar sheathing. She had no fever or skin rash. Three weeks later, binocular macular star figures appeared. Brain imaging was negative; cerebrospinal fluid disclosed a lymphocytic pleocytosis and elevated protein. The serum Rickettsia rickettsii antibody test was markedly positive, establishing a diagnosis of Rocky Mountain Spotted Fever (RMSF) as the cause of the ophthalmic findings. Despite treatment with oral doxycycline, these findings improved only modestly. Although neuroretinitis has been previously described in RMSF, macular star has not been documented.

Administration, Oral↗
PubMed1998

Ocular manifestations of systemic hypertension.

Recent population-based studies suggest that the fundus lesions of hypertension also occur in people without hypertension. In experimental studies, hypertensive lesions, which used to be the backbone of older classifications of the severity of hypertension, did not correlate sufficiently with severity to allow reliable grading. Hypertensive retinopathy, choroidopathy, and optic neuropathy are independent processes. Vascular narrowing appears to occur early in the disease process, whereas retinal hemorrhages and retinal lipid may occur later. Branch vein occlusion is a complication of hypertension, whereas open-angle glaucoma may not be. Choroidal neovascularization in the fellow eyes of patients with macular degeneration is associated with high blood pressure. Laser treatment for this disorder is less effective in patients with high blood pressure than it is in normotensive individuals, which suggests that choroidal neovascularization may be an expression of chronic hypertensive choroidopathy. Hypertensive optic neuropathy, a variant of ischemic optic neuropathy, has delayed onset compared with retinopathy and, in experimental studies, has not been linked to the severity of hypertension. Given these findings, it may be better to describe than to grade fundus lesions. In either event, it is important to take blood pressures accurately. Fundus lesions suggest high blood pressure. Sphygmomanometry is more specific and reliable than funduscopy in making that diagnosis.

Blood Pressure↗
PubMed2000

Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome.

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.

Cause of Death↗
PubMed1992

Ocular and visual side effects of systemic cyclosporine.

In this study, we investigated the ocular and visual side effects of systemic cyclosporine used as an immunosuppressant in 51 renal transplant recipients during the postoperative period. Three different treatment schemes were used. The patients in the first group received cyclosporine and a corticosteroid. The second group was given azathioprine and a corticosteroid. Those in the third group were treated with azathioprine, a corticosteroid, and cyclosporine. Cotton-wool exudates, retinal hemorrhages, and retinal artery branch occlusion were observed only in one patient each in the second group, and these patients were excluded from the statistical evaluation. Macular hyperpigmentation was observed as a new finding in each group, but there was no statistical difference between the groups. The same results were found for cataract; this probably was related to the use of steroids. Trichomegaly, visual hallucinations, and cerebral blindness were not observed by contrast with previous studies. We suggest that systemic cyclosporine does not have significant ocular and visual side effects.

Adolescent↗
PubMed1978

[Photocoagulation for central vein occlusion (author's transl)].

27 patients with fully developed central vein occlusion were treated by means of photocoagulation. In all cases, a relatively quick regression of retinal hemorrhage and retinal edema occurred, as well as an extensive nomalisation of the caliber of the veins. In over 1/3 of cases, improvement of visual acuity could be achieved; acuity decreased in 1/3 of cases because of macula alterations (fibrosis, cystic edema, pigmentary dystrophy). The results, however, showed a general improvement as compared to disease courses left untreated. None of the patients developed secondary glaucoma during case control which can be assessed as the most significant result of photocoagulation.

Adult↗
PubMed2004

[Prognosis and differential diagnosis of Purtscher's retinopathy].

BACKGROUND: Purtscher's retinopathy is accompanied by a distinct loss of vision as a result of severe trauma to the chest or skull. Reports on visual prognosis in the literature are not uniform. PATIENTS: The data of 10 patients with Purtscher's retinopathy from the department of Ophthalmology in Freiburg, published data from 55 patients with Purtscher's retinopathy and 20 patients with traumatic retinal hemorrhages taken from the literature were evaluated. RESULTS: The average visual acuity of the 10 patients from Freiburg was 0.3 within a short period after the accident and the final average visual acuity was 0.46. The average visual acuity of the 55 patients with Purtscher's retinopathy was 0.21 within a short period after the accident with an average final visual acuity of 0.61. The average visual acuity of the 20 patients with traumatic retinal hemorrhages from the literature was 0.45 within a short period after the accident with an average final visual acuity of 0.74. Therefore the initial and the final visual acuity were better in patients with traumatic retinal hemorrhages compared to patients with Purtscher's retinopathy. CONCLUSION: In spite of severe initial retinal findings, the visual prognosis is usually not disappointing. Prognosis of visual acuity was better in patients with traumatic retinal hemorrhages compared to patients with Purtscher's retinopathy.

Adolescent↗
PubMed1994

[Interferon-induced retinal changes].

Fifty patients treated with interferon for chronic type C hepatitis, chronic type B hepatitis and renal cell carcinoma were examined for retinal complications. Retinal hemorrhages or cotton wool spots were observed in 23 (46%) of the patients. Retinal hemorrhages without cotton wool spots were found in 14 patients, cotton wool spots without retinal hemorrhages in 5 patients, and both hemorrhages and cotton wool spots in four patients. These findings were potentially reversible. There was one case of branch retinal artery occlusion and one case with microaneurysm. Red blood cell count decreased significantly in the patients with retinopathy compared with those without retinopathy (p < 0.05%). Patients with diabetes, hypertension, retinal arterial sclerosis, and anemia were at risk for retinopathy.

Carcinoma, Renal Cell↗
PubMed1983

Pars plana vitrectomy for vitreous hemorrhage and retinal vein occlusion.

We studied 16 cases of retinal vein occlusion and vitreous hemorrhage treated by pars plana vitrectomy. The visual acuity in all nine eyes suffering from branch vein occlusion was improved postoperatively, reaching an acuity of 6/6 to 6/12 in 33% of the patients. In the seven eyes suffering from central vein occlusion, however, the postoperative visual acuity results were poor. The incidence of postoperative complications was higher also in the central vein occlusion group.

Eye Diseases↗
PubMed2004

Beta-amyloid precursor protein immunohistochemistry in the evaluation of pediatric traumatic optic nerve injury.

OBJECTIVE: The pathologic markers of nonaccidental injury (NAI) of the central nervous system (CNS) of infants and young children include subdural, subarachnoid, and retinal hemorrhages. Immunohistochemical staining for beta-amyloid precursor protein (betaAPP) has been used to investigate traumatic axonal injury of the brain, brain stem, and spinal cord injuries, and has potential as an additional indicator of traumatic head injury. A single study has reported that betaAPP immunostaining of the optic nerve in CNS NAI reveals axonal damage. The purpose of our study was to explore further the utility of betaAPP immunostaining of optic nerves for the detection of traumatic axonal injury. METHODS: We used hematoxylin-eosin and betaAPP immunostaining to evaluate the eyes and optic nerves in 18 cases of CNS nonaccidental blunt force head injury, 4 cases of homicidal blunt force abdominal injury (BFAI), 1 homicidal suffocation, 1 case of sudden infant death syndrome, 1 near-drowning, 1 overlay (clinical history: "found under sleeping mother in bed"), 1 motor vehicle accident, and 6 natural deaths in children < or =5 years of age. RESULTS: Evaluation of the cases of CNS NAI revealed 17 of 18 (94%) with subdural hemorrhage; 15 of 18 (83%), subarachnoid hemorrhage; 17 of 18 (94%), retinal hemorrhage; 16 of 18 (88%), perioptic nerve hemorrhage; and 6 of 18 (33%), optic nerve betaAPP immunoreactive axonal swellings. The only nontraumatic case that demonstrated betaAPP immunoreactive axonal swellings was the near-drowning. No cases of BFAI, suffocation, overlay, or natural deaths revealed any retinal or perioptic nerve hemorrhage or significant optic nerve betaAPP immunoreactivity. Global hypoxic-ischemic injury was present in 21 cases, of which 19 had evidence of brain swelling, and 7 demonstrated betaAPP immunoreactive axonal swellings. CONCLUSIONS: These findings confirm the presence of optic nerve axonal injury in some cases of fatal pediatric CNS NAI.

Amyloid beta-Protein Precursor↗
PubMed1992

Retinal findings after head trauma in infants and young children.

BACKGROUND: Many authorities believe that the finding of retinal hemorrhages in a child younger than 3 years of age with a history of head trauma, in the absence of an obvious cause for the injury, is pathognomonic of child abuse. To date, no studies have examined the prospective retinal examination of children who have had head trauma. The authors undertook such a study because the presence of retinal hemorrhage from any head trauma in children may have medicolegal diagnostic significance in differentiating accidental from nonaccidental trauma. METHODS: Seventy-nine children younger than 3 years of age, each of whom experienced head injury, underwent an ophthalmologic assessment, which included a dilated funduscopic examination. RESULTS: Seventy-five children sustained accidental head injuries and had normal funduscopic examinations. Three children had nonaccidental head injuries and all were found to have varying degrees of retinal hemorrhages. One child, with a normal fundus examination, had injuries that were of indeterminate cause. CONCLUSION: The finding of retinal hemorrhages in a child with a head injury suggests a nonaccidental cause.

Battered Child Syndrome↗
PubMed1998

Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children.

OBJECTIVE: To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI. METHODS AND PATIENTS: Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups. OUTCOME MEASURES: Acute computed tomography/magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. chi2 analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups. RESULTS: Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups. CONCLUSIONS: Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.

Brain Damage, Chronic↗