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PubMed1993

Ocular manifestations in Japanese patients with human immunodeficiency virus infection.

The ocular manifestations in 65 Japanese human immunodeficiency virus (HIV)-seropositive patients were examined. Based on the cumulative totals, 22 of the cases had acquired immunodeficiency syndrome (AIDS), 17 had AIDS-related complex (ARC), and 35 were asymptomatic carriers (AC), including 4 AIDS cases who had progressed from ARC and 5 ARC cases from AC. Seventy-seven percent of the AIDS cases had ocular manifestations, including cotton-wool spots (50%), retinal hemorrhages (59%), cytomegalovirus retinitis (46%) and pupil abnormalities (14%). The ocular signs were also seen in 71% of the ARC cases and 37% of the AC cases. In Japanese HIV-seropositive patients, ocular manifestations are also as common as in Western HIV-seropositive patients.

AIDS-Related Complex↗
PubMed1994

[Vitreous hemorrhage after accidental head injury with chest compression--case report].

Vitreous hemorrhage is relatively common following subarachnoid hemorrhage, but rarely occurs after accidental head injury. In this paper, we report a rare case of vitreous hemorrhage after an accidental head injury with chest compression. A 4-month-old girl was held in her father's arms. After he fell down, she struck her head and her chest was compressed by her father's body. She soon became pale and was immediately transported to our center complaining of disturbance of consciousness on February 6, 1993. On admission, she was semicomatose and had a generalized convulsion. Computed tomography (CT) scan showed a subdural hematoma, although no fracture was detected on the plain X-ray film. Bilateral vitreous hemorrhage was also observed. The anterior fontanelle pressure was a high 330 mmH2O. The patient was treated conservatively with agents to promote hemostasis and reduce the intracranial hypertension. She was discharged after one month with normal consciousness and improved vision. The follow-up CT scan revealed subdural hematoma, hemorrhagic infarction (suggesting rupture of the pontine veins), and cerebral atrophy, corresponding to those of the shaken baby syndrome. Her chest was compressed by her father's body. The anterior fontanelle pressure was a high 330 mmH2O. These findings suggest that shaking or abrupt deceleration, acute intrathoracic hypertension and acute intracranial hypertension, caused retinal hemorrhage, and that extensive retinal hemorrhage possibly resulted in vitreous hemorrhage.

Craniocerebral Trauma↗
PubMed1997

Ophthalmic findings in a case of hemophagocytic syndrome.

PURPOSE: To report a case of hemophagocytic syndrome, which is characterized by hemophagocytosis of histiocytes; optic nerve involvement, and unusual retinal white patches. METHOD: Case report. A 10-year-old boy had repeated relapses of hemophagocytic syndrome. He complained of swelling of the right upper eyelid and bilateral visual disturbance. RESULTS: Ophthalmoscopic examination disclosed bilateral optic disk edema, retinal hemorrhages, and multiple perivenous white patches in the retina. Magnetic resonance imaging demonstrated enlargement of both optic nerves. After chemotherapy and bone marrow transplantation, his visual acuity improved in both eyes, and retinal patches changed to inactive-appearing scars. CONCLUSION: Hemophagocytic syndrome may manifest with ophthalmic findings such as optic nerve involvement, retinal hemorrhages, and multiple white perivenous retinal patches.

Child↗
PubMed1985

Cohort study of silastic obstetric vacuum cup deliveries: I. Safety of the instrument.

A prospective study was undertaken to determine the safety of the Silastic vacuum extractor. Between November 1982 and July 1983, a cohort of 84 successful vacuum extractor deliveries was examined, using the next sequential forceps delivery and spontaneous vaginal delivery as controls. In addition to routine neonatal morbidity measures, Scanlon early neonatal neurobehavioral scale and a modified Sarnat encephalopathy staging examination were used to critically assess neurologic functioning; a cranial ultrasound scan was performed to look for intracerebral hemorrhage, and an indirect ophthalmologic examination was done to assess the incidence of retinal hemorrhage. The study yielded no significant increase in maternal vaginal trauma for vacuum extractor versus spontaneous vaginal delivery, but there was a significantly greater incidence for forceps delivery (60%) versus vacuum extractor (25%) and more associated blood loss for forceps delivery (P less than .01). There was no significant increase in neonatal morbidity for vacuum extractor compared with forceps delivery nor in serious morbidity compared with spontaneous vaginal delivery. Specifically, for vacuum extractor versus forceps delivery there was no difference in one- and five-minute Apgar scores, extent of resuscitation, cosmetic injury, jaundice, mean neonatal intensive care unit stay, or incidence of retinal hemorrhage. Notably, there was no mortality related to delivery method, but there were two unrelated deaths. There were no cases of intraventricular or subgaleal hemorrhage on clinical or ultrasound examination, but one stillborn infant, who succumbed to a generalized coagulation defect, had a subarachnoid hemorrhage. Finally, there was no significant difference in Sarnat encephalopathy staging or Scanlon neurobehavioral assessment between spontaneous vaginal, forceps, and vacuum extractor deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1995

Central retinal vein occlusion in a patient with anorexia nervosa.

PURPOSE/METHODS: We evaluated a unilateral retinal vascular abnormality in a 21-year-old woman with anorexia nervosa. RESULTS/CONCLUSION: The patient had weight loss, amenorrhea, and anemia. The left eye had a nonischemic central retinal vein occlusion and a visual acuity of 20/200. With treatment, the retinal hemorrhages disappeared and visual acuity in the left eye improved to 20/20. Central retinal vein occlusion may be a rare complication of anorexia nervosa.

Adult↗
PubMed1991

Spontaneous ophthalmic lesions in young Sprague-Dawley rats.

Eight hundred eight Sprague-Dawley rats were examined for ophthalmic abnormalities during a pretest period in various preclinical safety assessment studies. Persistent pupillary membrane, corneal crystal, healed minor trauma, synechia, coloboma of the iris, lens luxation, cataract, persistent hyperplastic primary vitreous, vitreous hemorrhage, coloboma of the optic disc or choroid, remnant of hyaloid arterial system, retinal hemorrhage, retinal detachment, retinal folding and choroidal defect were observed. The incidences of corneal crystal, synechia, and nuclear cataract in this survey were higher than those reported previously. On the other hand, retinal folding in this survey was less common than that reported previously. These results suggest that background data of eye problems in albino rats should be accumulated in each own laboratory colony. In addition, since spontaneous eye problems are common in young albino rats, elimination of rats with ophthalmic abnormalities from study groups by an ophthalmic examination during a pretest period would facilitate to evaluate toxicity potential of test compounds in safety assessment studies.

Animals↗
PubMed1984

A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome.

A prospective evaluation of ophthalmologic findings in 26 patients (25 men and one woman) with the acquired immune deficiency syndrome disclosed that 19 patients had significant ocular abnormalities. These included isolated retinal hemorrhages, cotton-wool spots, cytomegalovirus retinitis, acute retinal necrosis, cranial nerve palsies, and orbital Kaposi's sarcoma. Hemorrhages and cotton-wool spots appeared and disappeared spontaneously. Cytomegalovirus retinitis and acute retinal necrosis were progressive and destructive. The fundus findings did not correlate with the patient's general clinical status.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Carbon monoxide retinopathy.

A 26-year-old man who had become comatose after having inhaled carbon monoxide developed retinal venous engorgement and peripillary hemorrhages. Retinal changes closely resembled those that accompany hypoxemia.

Adult↗
PubMed1993

Fatal falls in childhood. How far must children fall to sustain fatal head injury? Report of cases and review of the literature.

The question of whether fatal head injuries may occur from short-distance falls is one that continues to cause controversy. The records of the Sacramento County Coroner's Office from 1983 to 1991 were reviewed for cases of fatal head injury in children aged < or = 5 years, where a history of a fall was initially given. During this 9-year period, three cases of witnessed falls from heights of > 10 ft (3 m) were found. At autopsy, all children had multiple complex calvarial skull fractures, basal fractures, or both; subdural and subarachnoid hemorrhage was found in all cases, and two showed severe cerebral contusion. None had retinal hemorrhage or axonal injury. These are compared with 19 fatalities initially alleged to have occurred from short falls of < or = 5-6 ft (1.5-1.8 m). As others have found, most of these "minor fall" fatalities occurred under circumstances where there were no unrelated witnesses to corroborate the initial history. Autopsy findings in these cases tended to be of unexpected severity for the initially proposed mechanism of injury, and a number of cases showed evidence of accelerative injury (retinal hemorrhage and/or diffuse axonal injury) where no such mechanism was accounted for by initial history. After sufficient investigation, most of these cases (74%) have ultimately been proven to represent inflicted trauma. A thorough literature review on the subject identifies two major viewpoints. One is that short falls have a significant potential for fatality. The other, more widely espoused view is that short falls rarely, if ever, cause serious injury or death.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed2004

Chorioretinal involvement in patients with West Nile virus infection.

PURPOSE: To characterize and analyze the chorioretinal manifestations of West Nile virus (WNV) infection. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Twenty-nine consecutive patients with serologically confirmed WNV infection in the setting of an outbreak of the disease. METHODS: The average duration of systemic symptoms before ophthalmic examination was 10 days (range, 2-30 days). All participants underwent a detailed ophthalmic examination at presentation and regularly throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, and fluorescein angiography. RESULTS: A typical multifocal chorioretinitis was observed in 20 of 29 patients (69%) bilaterally at presentation and developed later during follow-up in 3 patients (10.3%), bilaterally (n = 1) or unilaterally (n = 2). Multifocal chorioretinitis was associated with mild vitreous inflammatory reaction in all cases. Other findings included intraretinal hemorrhages (21 patients [72.4%]), white-centered retinal hemorrhages (7 patients [24.1%]), focal retinal vascular sheathing (3 patients [10.4%]), marked diffuse retinal arterial sheathing (1 patient [3.4%]), retinal vascular leakage (5 patients [17.2%]), optic disc swelling (2 patients [6.9%]), optic disc staining (6 patients [20.7%]), segmental zones of retinal pigment epithelium changes (1 patient [3.4%]), and nonproliferative diabetic retinopathy (7 patients [24.1%]). The posterior segment findings related to WNV disease had a self-limited course in all patients. CONCLUSIONS: Chorioretinal involvement, frequently asymptomatic and self-limited, is common in patients with acute WNV infection. The unique pattern of multifocal chorioretinitis in patients with systemic symptoms suggestive of WNV can help to establish the diagnosis while serologic testing is pending. Therefore, a systematic ocular evaluation, including dilated fundus examination and fluorescein angiography in selected cases, is recommended in patients with clinically suspected WNV infection.

Adult↗
PubMed1993

A randomized comparison of vacuum extraction delivery with a rigid and a pliable cup.

OBJECTIVE: To compare the effectiveness and complications of obstetric vacuum extraction with a rigid and a pliable cup, with a focus on neonatal retinal hemorrhage. METHODS: One hundred women requiring assisted delivery who met predefined criteria for vacuum extraction were randomly assigned to be delivered by the classic rigid Malmström cup or the pliable Silastic cup. RESULTS: Because of the faster induction of vacuum, delivery occurred more rapidly with the pliable cup, but the pliable cup detached significantly more often than the rigid cup. The overall failure rate was not significantly different between the cups. There were no significant differences between the groups with regard to Apgar scores, umbilical artery pH, birth canal trauma, or maternal blood loss, but scalp injury occurred less frequently with the soft than with the rigid cup. Retinal hemorrhage in the newborns showed a similar incidence of about 50%, and neonatal neurologic examination showed no significant differences between the groups. CONCLUSION: In comparison with the rigid cup, the advantage of the pliable cup is limited to a smaller incidence of neonatal scalp injury.

Adult↗
PubMed2001

Pharmacological inhibition of diabetic retinopathy: aminoguanidine and aspirin.

Effects of aminoguanidine and aspirin on the development of retinopathy have been examined in 5-year studies of diabetic dogs. Either agent was administered daily in doses of 20-25 mg. kg(-1). day(-1). Because severity of hyperglycemia greatly influences development of the retinopathy, special effort was devoted to maintaining comparable glycemia in experimental and control groups. The retinal vasculature was isolated by the trypsin digest method, and retinopathy was assessed by light microscopy. Diabetes for 5 years resulted, as expected, in saccular capillary aneurysms, pericyte ghosts, acellular capillaries, retinal hemorrhages, and other lesions. Administration of aminoguanidine essentially prevented the retinopathy, significantly inhibiting the development of retinal microaneurysms, acellular capillaries, and pericyte ghosts compared with diabetic controls. Aspirin significantly inhibited the development of retinal hemorrhages and acellular capillaries over the 5 years of study, but had less effect on other lesions. Although diabetes resulted in significantly increased levels of advanced glycation end products (AGEs) (namely, pentosidine in tail collagen and aorta, and Hb-AGE), aminoguanidine had no significant influence on these parameters of glycation. Nitration of a retinal protein was significantly increased in diabetes and inhibited by aminoguanidine. The biochemical mechanism by which aminoguanidine has inhibited retinopathy thus is not clear. Aminoguanidine (but not aspirin) inhibited a diabetes-induced defect in ulnar nerve conduction velocity, but neither agent was found to influence kidney structure or albumen excretion.

Albumins↗
PubMed2005

Accidental and nonaccidental head injuries in infants: a prospective study.

OBJECT: Head injury is a major cause of morbidity and death in infants, and child abuse is among its chief causes. Retinal hemorrhages (RHs) are of paramount importance for the diagnosis of child abuse; however, their sensitivity and specificity are poorly estimated. Subdural hematoma (SDH) is a common feature; however, its incidence and causative factors are poorly documented. METHODS: To study the epidemiology of head injuries in infants, factors predisposing to SDH, value of RH for the diagnosis of child abuse, and prognostic factors, the authors prospectively collected data from cases of head injury in infants who were hospitalized at their institution over a 3-year period. One hundred fifty cases were collected, 57 of which were due to child abuse. This prospective study allows the comparison of clinical, radiological, and ophthalmological features in accidental and nonaccidental trauma in infants. CONCLUSIONS: Subdural hematomas were significantly correlated with RH and with child abuse but not with idiopathic macrocranium. The sensitivity and specificity of RH for the diagnosis of child abuse were 75 and 93.2%, respectively. Retinal hemorrhages associated with accidental trauma were always mild, and the specificity of more severe RH for the diagnosis of child abuse was 100%. The grading of RH requires the expertise of a trained neuroophthalmologist. Child abuse was also significantly associated with antecedents of perinatal illness, absence of signs of impact, and seizures on presentation. Although child abuse represented just 38% of traumas, it was the cause of 71% of deaths and 90% of severe disability in this series. Abuse and the clinical severity on presentation were two significant and independent factors conditioning outcome.

Child Abuse↗
PubMedDate not supplied

Neovascular glaucoma associated with cilioretinal artery occlusion combined with perfused central retinal vein occlusion.

BACKGROUND: Cilioretinal artery occlusion rarely results in neovascular glaucoma, especially in cases of extensive cilioretinal infarction and combined retinal vascular occlusion. CASE: A 62-year-old man with diabetes mellitus and essential hypertension showed a visual acuity of counting fingers, retinal whitening temporal to the optic disc with mild dilation and tortuosity of the retinal veins, and retinal hemorrhages in four quadrants of his right eye. Fluorescein angiography demonstrated a delayed filling of the central retinal vein and cilioretinal artery. OBSERVATIONS: Two months later, neovascular glaucoma developed and retinal ablation was performed using an argon laser. Trabeculectomy was also performed due to the intractability of the glaucoma, and central artery occlusion was found. On magnetic resonance angiography, the right distal common carotid artery was irregularly narrowed and the right ophthalmic artery was almost entirely occluded. CONCLUSIONS: In cases of cilioretinal artery occlusion and perfused central retinal vein occlusion with multiple risk factors, close follow-up is advised.

Ciliary Arteries↗
PubMedDate not supplied

Toxicity of the photosensitizer NPe6 following intravitreal injection.

BACKGROUND AND OBJECTIVE: To determine the retinal toxicity of mono-L-aspartyl chlorin e6 (NPe6) following intravitreal injection. METHODS: Twelve Dutch-belted rabbits divided into 5 experimental groups (n=2 each) were injected intravitreally with 6.25, 12.5, 25, 50, or 100 microg of NPe6; one control group (n=2) was injected with intravitreal normal saline. One eye in each rabbit was sutured shut to test the effect of light exposure. Fundus photography and electroretinograms were performed before treatment and 2 days, 1 week, and 2 weeks after injection. Animals were euthanized and the eyes enucleated for histopathologic analysis. RESULTS: After 1 week, 4 uncovered eyes given 50 and 100 microg had central retinal vein occlusion and varying degrees of retinal hemorrhage. RPE proliferation was seen in the covered eyes given 50 or 100 microg. Electroretinograms revealed absent retinal response at 100 microg and mild toxicity at 50 microg, but no change from normal at doses of < or = 25 microg of NPe6. CONCLUSIONS: Intravitreal doses of < or = 25 microg NPe6 caused little or no apparent toxicity; however, toxicity was significant at doses of 50 microg and 100 microg.

Animals↗
PubMed1988

Autopsy findings in the eyes of fourteen fatally abused children.

The eyes of fourteen fatally abused children and sixteen control cases were examined histopathologically. Ten of the abused children showed intraocular change. The most common ocular changes were subdural hemorrhage of the optic nerve and retinal hemorrhage which involved all the layers of the retina, but most commonly the nerve fiber layer, ganglion cell layer and inner nuclear layer. The presence of blood cavities within the retina partially supported the hypothesis of traumatic retinoschisis. The control cases of non-abused children rarely showed intraocular hemorrhage.

Child Abuse↗