[EALES DISEASE AND RICKETTSIOSIS].
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Serum hyperviscosity syndrome was diagnosed in 2 cats with multiple myeloma. Clinical signs included pale mucous membranes, dehydration, retinal hemorrhages, dilated and tortuous retinal vessels, seizures, head-tilt, nystagmus, systolic murmur, and gallop rhythm. Laboratory abnormalities included hyperglobulinemia, azotemia, hyperphosphatemia, nonregenerative anemia, and thrombocytopenia. Both cats had IgG monoclonal gammopathy, Bence Jones proteinuria, increased numbers of bone marrow plasma cells, and high values for relative serum viscosity. Renal disease was suspected in both cats. Cardiac hypertrophy was documented in 1 cat and was suspected in the other cat. Chemotherapy, using melphalan, prednisone, and vincristine, caused short-term remission in both cats, and plasmapheresis was used to lower serum protein concentration in 1 cat. Serum hyperviscosity syndrome rarely develops in cats, but should be suspected when monoclonal gammopathy exists with signs of neurologic, cardiac, or retinal disease.
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A case of optic disc drusen complicated by retinal hemorrhages similar to those seen in central retinal vein occlusion is presented. While haemorrhagic complications of optic disc drusen are rare, three types have been described: small disk haemorrhages, vitreous haemorrhages and deep peripapillary haemorrhages. This clinical aspect of the haemorrhagic retinopathy presented in this paper has rarely been described; the pathogenesis of this lesion can be attributed to a progressive compression by the drusen on the central vein in the optic disk, causing a venous stasis retinopathy. Since it is impossible to remove the cause of the venous compression, the prognosis of this clinical form is always poor. Finally, the author emphasizes the need to consider this rare complication of drusen of the optic disk, especially in young patients with no systemic pathology who present this ophthalmoscopic picture, in order to avoid useless, time consuming tests and ineffective therapies.
A 66-year-old man presented with a gray-yellow mass on the optic disk associated with retinal hemorrhage and a branch retinal artery obstruction. Follow-up over a several-month period disclosed the disappearance of the yellow tissue and the presence of a retinal arterial macroaneurysm. Such a lesion should be considered in the differential diagnosis of tumors of the optic nerve head.
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A retrospective study of 36 second eyes with cataract, who have undergone prophylactic retinocryocoagulation prior to cataract extraction, is presented. All 36 patients suffered an aphakic retinal detachment in the first eye in the past. Postoperative complications included iritis, transient cycloplegia and retinal hemorrhages; two patients developed retinal tears following cataract surgery. During the average followup period of 8.4 years, no retinal detachment occurred among this group of patients. This study strongly supports the value of preventive treatment (retinocryocoagulation) of the second eyes prior to cataract extraction, which have a high risk of aphakic retinal detachment.
A 69-year-old man (Patient 1) complained of anorexia, lumbago, and seeing floaters OS. The results of laboratory tests showed immunoglobulin (Ig) G lambda-type multiple myeloma associated with blood hyperviscosity. Retinal hemorrhages OD and central retinal vein occlusion OS were found. A 71-year-old woman (Patient 2) with IgG kappa-type multiple myeloma had blood hyperviscosity. Retinal microaneurysms OD and central retinal vein occlusion OS were found. We believe that our patients represent rare cases of IgG multiple myeloma associated with blood hyperviscosity and central retinal vein occlusion.
A case of vitreo retinal hemorrhages following a hemolytic crisis by fava beans in a G-6-DP-deficient patient is reported. Intravascular coagulation due to thromboplastin-like substances liberated by the diseased RBC could be the cause. The possibility of vitreoretinal hemorrhages of this nature in young subjects from the areas where G-6-PD deficiency is endemic is stressed.
A 21-year-old woman with a history of chronic lung disease secondary to cystic fibrosis (CF) developed an acute hemorrhagic retinopathy during exposure to moderately high altitude. Although retinal hemorrhages are known to occur in patients with CF, we speculate that the retinopathy in this case was partially related to altitudinal change and that patients with chronic hypoxemia may be predisposed to high-altitude retinopathy at much lower altitudes.
A 81-year-old woman developed central retinal vein occlusion (CRVO) in her left eye subsequent to central retinal artery occlusion (CRAO). She noticed sudden visual loss in the left eye. At initial examination, her left visual acuity was 0.03, and only a small visual field was preserved at temporal area. The left fundus showed findings of mild non-ischemic CRVO. In addition white clouded retina was recognized at the left posterior pole which indicated CRAO. FAG showed remarkably prolonged arterial circulation, but no retinal capillary obliteration. Then retinal hemorrhage increased rapidly and her left eye developed hemorrhagic retinopathy. Two weeks after initial examination, FAG showed extensive retinal capillary obliteration. In this case it was supposed that central retinal artery occlusion due to arteriosclerosis produced ischemic capillaropathy and venous thrombosis, after which restoration of arterial circulation caused hemorrhagic retinopathy.
INTRODUCTION: The combination of subarachnoid hemorrhage (SAH) and subhyaloid hemorrhage is known as 'Terson syndrome'. Retinal hemorrhage is commonly observed clinically in the optic fundi of patients with SAH, however, subhyaloid hemorrhage of the globe in the setting of SAH has been rarely on CT of the brain. Several mechanisms of subhyaloid hemorrhage have been proposed: a. A sudden increase in intracranial pressure (ICP) forces blood from the subarachnoid space directly into the preretinal space. b. A sudden rise in ICP is thought to decrease venous return to the cavernous sinus from the veins draining the globe. The increased retinal venous pressure results in stasis followed by vessel rupture. c. A sudden rise in ICP obstructs both the retinochoroidal anastomoses and the central retinal vein due to a rapid effusion of CSF through the communication of the subarachnoid space with the optic nerve sheat. This produces an acute decrease in venous drainage from the retina and results in stasis and hemorrhage. CLINICAL CASE: A 35 year old man, with a history of a non controlled arterial hypertension, dilated cardiopathy and 'agitation episodes'. He had a spontaneous intracranial hemorrhage, consistent in a parenchymal hematoma ruptured into ventricles and subarachnoid space. The CT showed through optic nerve sheath this hemorrhage extended to subhyaloid space. The patient came in coma 'dépassé' and brain death. CONCLUSIONS: We report a case of Terson syndrome demonstrated by CT. This CT allow see the blood from the subarachnoid space erupt directly into the preretinal space through optic nerve sheath, confirming one the proposed mechanism for this syndrome.
PURPOSE: To discuss the usage and effectiveness of endolaser in vitrectomy for retinal vascular disease. METHODS: Twenty-four cases (28 eyes) of vitrectomy for retinal vascular disease were treated with endolaser. The methods of endolaser: 21 eyes were treated with panretinal scatter therapy; 2 eyes with endolaser ring-intercepting around retinal and sealing retinal breaks; 5 eye with focal therapy. RESULTS: After follow-up for 1-24 months (mean 9 months), retinal hemorrhage recurred in 3 eyes; the other 25 eyes, retinas were totally reattached, retinal breaks were sealed, and vision had considerable recovery, no hemorrhage. The ratio of recovery is up to 89.2%. CONCLUSIONS: Endolaser is an important adjuvant in vitreous operation nowadays and an effective procedure in vitrectomy for the cases of retinal hemorrhage.
There are a number of conditions which can be grouped together as ARI. Many represent potentially fatal pathophysiological states that are rapidly reversible if identified and treated properly. Physiological alterations that result from the hypobaric hypoxia of altitude include cerebral vasodilatation, altered ventilatory patterns, pulmonary vasoconstriction, decreased cardiac output, and altered fluid and electrolyte balance. The various altitude-related illnesses represent a spectrum of conditions with overlapping presentations. The symptoms of AMS and HACE represent a continuum of disease that appears to be related to alterations in cerebrovascular autoregulation. High-altitude retinal hemorrhage may be related to similar vascular events in the retinal circulation. Although the etiology of HAPE remains unclear, it is likely that alterations of pulmonary vascular tone and flow play an important roles in its production. Knowledge regarding ARI is important in planning prophylaxis and instituting therapy. Gradual ascent and acclimatization are the mainstays of prophylaxis. Pharmacological prophylaxis is available for those who are prone to severe AMS. Prompt recognition, descent, and administration of oxygen constitute the major therapies for severe ARI. The ability to perform these three tasks can rapidly reverse a potentially fatal illness.
Retinal arterial macroaneurysms are a relatively rare clinical entity that occur most frequently in the elder female population. They are strongly associated with systemic hypertension. Variable clinical presentations may occur, which may often lead to misdiagnosis. Correct diagnosis is essential for proper follow-up care and potential treatment. Differential diagnosis includes Coats' disease, angiomatosis retinae, Leber's miliary aneurysm, diabetic retinopathy, ectopic neovascular membrane, and malignant melanoma. The importance of the differential diagnosis is exemplified in a case report of a macroaneurysm which, upon initial ophthalmoscopic presentation, was concealed by surrounding retinal hemorrhage. The clinical features, differential diagnosis, management, and treatment of retinal macroaneurysms are discussed.
One hundred consecutive eyes underwent vitrectomy with the disposable vitrophage via a pars plana approach. Eyes were divided into two main categories based on opacity location-in the anterior or posterior segment. Patients with posterior segment opacities had diabetic retinopathy, nondiabetic vitreous hemorrhages, retinal detachments associated with vitreous hemorrhage, bands, or membranes, and intraocular foreign bodies or silicone oil. Patients with anterior segment opacities were treated for pupillary membranes resulting from surgical trauma or perforating injuries, and for complications following cataract extraction, such as capsule breakage and vitreous loss. Postoperatively, visual acuity improved in 68% of eyes with posterior segment opacities and in 85% of eyes with anterior segment opacities. Overall, visual acuity was 20/300 or better in 45% of eyes. There were only two intraoperative retinal tears and one postoperative rhegmatogenous retinal detachment.
PURPOSE: To describe bilateral hemorrhage of the posterior segment and secondary angle-closure glaucoma as sequelae of anticoagulation therapy in a nanophthalmic patient. METHODS: An 80-year-old man who was nanophthalmic and was undergoing anticoagulation therapy presented with declining visual acuity in left eye. Six months later, he experienced declining visual acuity in his right eye. RESULTS: In the LE and six months later in the RE, ocular examination disclosed angle-closure glaucoma and a hemorrhagic retinal detachment. Peripheral iridoplasty successfully treated the initial attack. The subretinal hemorrhage was successfully drained by pars plana vitrectomy, retinotomy, and air-fluid exchange in the left eye. Anatomic success and intraocular pressure control were obtained, but visual recovery was limited. CONCLUSION: Intraocular hemorrhage and angle-closure glaucoma are potential complications of anticoagulation therapy in a patient with nanophthalmos.