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[Terson's syndrome. Apropos of 7 cases].

We studied seven cases of Terson's syndrome, in association with bleeding in the subarachnoid space caused by rupture of vascular malformation or cranial traumatism. The association of rapid increase of intracranial pressure with subarachnoid hemorrhage could explain the development of a Terson's syndrome. The retinal hemorrhages associated with the vitreous hemorrhage are variable in morphology and topography. Pars plana vitrectomy has been performed in eight eyes with most often good results.

Adolescent↗

Retinopathy of prematurity and other ocular problems in premature infants weighing less than 1500 g at birth.

PURPOSE: To estimate the incidence of retinopathy of prematurity and other ocular problems in a population of preterm infants. METHODS: This retrospective study included all infants with gestational age (GA) <32 weeks and birth weight (BW) <1500 g cared for in the neonatal intensive care unit (NICU) over a period of nine years (1992-2000). Ophthalmological examination was started the 4th week of life and included refractive examination, examination of the cornea and funduscopy under mydriasis. An ocular motility test was done after the 2nd month. RESULTS: The study included 194 infants. Stage I and II retinopathy occurred in 51 infants but regressed spontaneously. Five of the 194 (2.5%) had to undergo cryopexy. Optic disc atrophy was observed in association with peri-intraventricular hemorrhage (PIIVH) (grade IV) in seven infants. Fifteen infants (7.7%) had retinal hemorrhages which were absorbed by three months of age. Almost 20% of the study infants developed high refractive errors and 13.4% strabismus. CONCLUSIONS: Not only retinopathy of prematurity, but other serious ocular problems were observed in this population of preterm infants. The role of PIIVH III-IV in the pathogenesis of certain ocular problems needs further elucidation.

Cryosurgery↗

Altitude retinopathy on Mount Everest, 1989.

The authors studied prospectively the incidence of and risk factors for high altitude retinal hemorrhages among 14 members of the 1989 American Everest Expedition. All subjects had comprehensive eye examinations and fundus photography performed at sea level before the expedition and again at the Mt. Everest Base Camp after 6 weeks of exposure to altitudes between 5300 and 8200 meters. Asymptomatic intraretinal hemorrhages were found in five eyes of four climbers. An additional eye of one of these climbers had a central retinal vein occlusion with vitreous hemorrhage, which reduced visual acuity to counting fingers. Higher baseline intraocular pressure and use of nonsteroidal anti-inflammatory drugs were found to be significant risk factors for development of altitude retinopathy.

Acclimatization↗

Vitreous hemorrhage secondary to presumed ocular histoplasmosis syndrome.

Hemorrhagic retinal pigment epithelium detachment caused by choroidal neovascular membrane progressed to massive vitreous hemorrhage in two patients with presumed ocular histoplasmosis syndrome. When the hemorrhage cleared, a diskiform mass became visible. In one patient, this was located near the midnasal periphery. In endemic areas of histoplasmosis, presumed ocular histoplasmosis syndrome should be considered as a possible cause of spontaneous vitreous hemorrhage.

Eye Diseases↗

Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage.

BACKGROUND: Vitreous hemorrhage (Terson's syndrome) and other intraocular hemorrhages have been reported in up to 40% of patients with subarachnoidal hemorrhage (SAH). Our objective was to determine prospectively the frequency of intraocular involvement and its relationship to the grade of SAH. METHODS: Seventy-four consecutive patients with SAH were prospectively examined. The patients were classified according to Hunt and Hess and ophthalmological examination was performed by an ophthalmologist. RESULTS: In all patients SAH was caused by a ruptured cerebral aneurysm. Intraocular hemorrhages were present in 28% of the patients, all of whom had retinal hemorrhages, which were detectable unilaterally in 45%, while 15% of these patients exhibited typical retrohyaloidal or vitreal hemorrhages. Ocular involvement was statistically more frequent in patients with a higher grade of SAH according to Hunt and Hess. CONCLUSIONS: Due to ocular involvement in more than a quarter of the patients with SAH and due to the fact that ocular involvement is related to the severity of SAH, screening of patients with SAH is recommended, especially when no reliable data about visual function are available. Early vitrectomy of vitreous hemorrhages provides a more effective rehabilitation.

Aneurysm, Ruptured↗

Resolution of leukemic retinopathy following treatment with imatinib mesylate for chronic myelogenous leukemia.

PURPOSE: To report a case of leukemic retinopathy before and after treatment with imatinib mesylate (formerly STI-571) for chronic myelogenous leukemia (CML). DESIGN: Interventional case report. METHODS: A 58-year-old man diagnosed with stable phase CML (SP-CML) presented with blurry vision. Fundoscopy revealed several flame-shaped hemorrhages in the macular region in both eyes. One month after this initial visit, imatinib therapy was initiated. RESULTS: : The patient noticed improvement in his visual as well as his medical symptoms; on repeat examination 6 months after the initial visit, the retinal hemorrhages had resolved and remained so after 18 months. CONCLUSIONS: Imatinib appears to be an effective treatment for SP-CML, and the improvement in visual and medical symptoms in our case report correlates with this.

Antineoplastic Agents↗

Adenosine and its agonists cause retinal vasodilation and hemorrhages. Implications for ischemic retinopathies.

Animals were given a 0.1-mL intravitreous injection of various agents and followed up with frequent ophthalmoscopic examinations. Fundus photographs were performed before injection and at six and 24 hours after injection. Vascular caliber was assessed by a previously described technique of performing measurements on fundus photographs taken and projected in a standardized fashion. No significant vascular dilation was identified for vehicle alone, carbachol, histamine, isoproterenol hydrochloride, or bradykinin. Mild dilation within one hour, but not persisting for 24 hours, was noted for dibutyryl cyclic adenosine monophosphate. Prominent dilation within one hour, becoming maximal by five hours but not persisting for 24 hours, was noted for adenosine, dipyridamole, and sodium nitroprusside. The adenosine-induced vasodilation was effectively blocked by an adenosine receptor antagonist, BW-A1433U. N-ethylcarboxamidoadenosine (NECA), a nonspecific adenosine selective agonist, was a much more potent vasodilator than two relatively selective A1 adenosine agonists, N6-cyclopentyladenosine and N6-phenylisopropyladenosine, suggesting that A2 receptors are involved. The vascular dilation caused by adenosine, dipyridamole, and particularly NECA, but not nitroprusside or dibutyryl cyclic adenosine monophosphate, was accompanied by retinal hemorrhages, producing a picture reminiscent of some features of ischemic retinopathies. This study suggests that adenosine may be an important mediator of vasodilation, and therefore blood flow, in the retina.

Adenosine↗

Three types of retinal bleeding as a complication of hypotony after trabeculectomy.

Although small retinal bleeding has been evaluated as a complication of filtering surgery, long-standing retinal bleeding is rare. We report 3 rare cases of young patients with massive retinal hemorrhages following trabeculectomy with 5-fluorouracil or mitomycin C. The bleeding in 1 case resolved spontaneously, whereas the bleeding in the other 2 cases did not resolve and the visual acuity remained poor. Every patient showed markedly delayed retinal circulation. Possible dysfunction of the retinal blood vessels may be responsible for the development of the other two types of massive bleeding, especially in advanced glaucoma with a total cup disk: one is decompression retinopathy and another central retinal vein occlusion or hemorrhagic retinopathy.

Adolescent↗

Tissue plasminogen activator in the treatment of vitreoretinal diseases.

Tissue plasminogen activator (tPA) is a thrombolytic agent that activates plasminogen into plasmin almost exclusively in the presence of fibrin. Intraocular injection of tPA has been proposed for the treatment of vitreoretinal diseases, such as vitreous hemorrhage, postvitrectomy fibrin formation, submacular hemorrhage, retinal vascular occlusive disorders, suprachoroidal hemorrhage and endophthalmitis. Currently, intraocular tPA is only used in the treatment of postvitrectomy fibrin formation and submacular hemorrhage. For other indications, tPA has not been shown to be safe or effective. This article reviews the use of tPA in the treatment of vitreoretinal disorders.

Animals↗

An unusual macular lesion associated with malaria.

A case of a young man afflicted with falciparum malaria is presented in which the primary ocular finding was a subpigment epithelial hemorrhage involving the macula. Previous reports in the literature concentrate on peripheral and central retinal hemorrhages, almost to the exclusion of choroidal vascular abnormalities. The value of this case lies in the recognition that the choroid can assume an important role in fundus abnormalities associated with malaria, probably on the basis of obstructive phenomena with subsequent ischemic degenerative changes, similar to the process which involves the retinal vessels and central nervous system.

Adult↗

Hemorrhagic valsalva retinopathy in Leber's optic neuropathy.

A patient with acute Leber's optic neuropathy had a large splinter retinal hemorrhage noted after he had strained to install fire hydrants. The hemorrhage occurred at a site of peripapillary telangiectasia, which is a feature of this condition. The pathogenesis of the process is discussed.

Adult↗

Vitreous fluorophotometry in patients with hypertension.

Vitreous fluorophotometry performed on 22 patients with moderate to severe hypertension showed that patients with active retinopathy, as manifested by retinal hemorrhages, cotton-wool spots, retinal exudates and edema, or disc edema, generally had elevated values (20/28 eyes). Control of the BP resulted in a decrease in the values toward the normal range. Patients with only arteriolar sclerosis, even some with particularly high BP, generally had normal fluorophotometric values (14/16 eyes). The two exceptions showed minimal elevations. Vitreous fluorophotometry is a useful tool to quantitate the blood-retinal barrier in patients with moderate to severe hypertension and may be a sensitive indicator of treatment efficacy.

Adult↗

Toxocara canis infection of the eye. Correlation of clinical observations with developing pathology in the primate model.

A primate model for the study of Toxocara canis infection was created by intravitreal, periocular, systemic, and intracarotid injection of viable larvae in cynomolgus monkeys. The results were as follows: (1) Intravitreal larvae caused retinal hemorrhages, perivasculitis, mild vitritis, and retinal nodules. (2) Apparently viable larvae without inflammatory reaction were found in the vitreous, retina, and optic nerves up to nine months after intravitreal inoculation. (3) Other larvae were surrounded by an acute inflammatory granuloma or a chronic fibrotic granuloma, but they did not appear to be necrotic. (4) Toxocara canis larvae apparently had the ability to move through ocular tissue, to leave the site of tissue reaction, and to exit via the optic nerve. Viable larvae were found in the retina up to 15 months after inoculation. (5) Culture fluid containing Toxocara proteins stimulated a severe retinal vasculitis. Dead larvae caused little reaction. (6) Positive aqueous and vitreous enzyme-linked immunosorbent assay titers were found in the most severely inflamed eyes, which often harbored live larvae.

Animals↗

Leukemic involvement of the optic nerve.

We studied five cases of leukemia with invasion of the optic disk and optic nerve. Two patients had acute lymphoblastic leukemia and three had acute myelogenous leukemia. All patients received intrathecal injections of chemotherapeutic drugs including methotrexate, cytarabine, and prednisolone. Three patients underwent irradiation therapy of the whole brain and optic nerve. While initial improvement in the ophthalmic abnormalities, such as optic disk edema, flame-shaped retinal hemorrhages, and dilation of the retinal vein, was noted, optic atrophy was later found in all eyes.

Adolescent↗

Episcleral plaque thermoradiotherapy in patients with choroidal melanoma.

From 1988 to 1991, 21 patients with uveal melanoma were treated in a Phase I study with episcleral plaque radiotherapy (EPRT). This irradiation was combined with localized current field episcleral hyperthermia (LCFHT). Tumor stage was: T3 = 15 (71%) and T2 = 6 (29%). Follow-up ranged from 2 to 42 months (mean 9.2 months). EPRT was given using custom built I-125 gold plaques. Radiation doses to the tumor apex ranged from 13 to 123 Gy (mean dose 70.0 Gy) given at a mean dose rate of 55 cGy/hr. LCFHT was given with 500 KHz frequency for 45 min immediately before EPRT. The temperature was controlled on the scleral surface using four thermocouples. T mean ranged from 42.5 degrees C to 45 degrees C +/- 0.5 degrees C (mean 43.4 degrees C). The study patients showed rapid tumor necrosis. A 25% mean decrease of apical tumor dimension was noted, p = 0.0007. At least ambulatory vision (greater than 5/200) was maintained by 17/21 (81%) patients. Visual acuity was seen to improve greater than 6 months post-plaque therapy in 10 (48%) study patients. This was following an intermediate decrease in visual acuity. Severe complications, including large hemorrhagic retinal detachment and large vitreous hemorrhage, were seen in two (9.5%) of the early study patients. A mean scleral temperature reduction to less than or equal to 44 degrees C +/- 0.5 degrees C resulted in good treatment tolerance and a lack of serious complications in subsequently treated patients. A Phase II prospective randomized trial comparing LCFHT with 60 versus 80 Gy EPRT dose to the tumor apex is currently being activated for patients with choroidal melanoma.

Adolescent↗

Perimetric sensitivity and retinal thickness in eyes with macular edema resulting from branch retinal vein occlusion.

PURPOSE: To document and study the relationship between perimetric sensitivity and retinal thickness at the foveal and parafoveal points in eyes with macular edema associated with branch retinal vein occlusion. METHODS: A prospective study was performed using the central 10-2 Humphrey perimetry program and optical coherence tomography. Seventeen eyes with branch retinal vein occlusion were eligible showing macular edema without macular nonperfusion or massive retinal hemorrhage. RESULTS: The sensitivity and retinal thickness were significantly correlated at the fovea (r = -0.629, P =.006) as well as 1 (r = -0.656, P <.0001) and 3 (r = -0.885, P <.0001) degrees apart from the fovea. The visual acuity that is expressed as a logarithm of the minimum angle of resolution (LogMAR) also correlated with retinal thickness (r = 0.591, P =.011). CONCLUSION: The increased retinal thickness resulting from macular edema is closely correlated with retinal sensitivity as measured by automated static perimetry both at the fovea and parafovea. Measuring the retinal thickness using optical coherence tomography may be useful in monitoring macular edema in eyes with branch retinal vein occlusion.

Adult↗

The formation and involution of optociliary veins during the course of central retinal vein occlusion.

BACKGROUND: Formation of collateral pathways by veins on the optic nerve head is sometimes observed during the resolution of a central retinal vein occlusion (CRVO). However, no cases have been reported in which the formation and involution of these collateral pathways were documented during the resolution of a CRVO. CASE: A 56-year-old man with a nonischemic CRVO was followed over a 10-year period by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (IA). OBSERVATIONS: Initial examination revealed only mild arteriosclerosis and the absence of optociliary veins (OCV) in the right eye. Approximately 9 years later, the patient returned with a nonischemic CRVO, and FA demonstrated a prolongation of the retinal circulation time to 12.1 seconds (normal < 11.0 seconds). Monitoring of this patient while undergoing treatment disclosed the development of OCV on the optic nerve head and gradual decrease in the retinal hemorrhage. FA showed that the retinal circulation time was shortening and recovering to normal. IA verified an outflow through the OCV into choroidal veins. Later, ophthalmoscopy showed a narrowing of the diameter of the OCV. CONCLUSIONS: We suggest that the OCV developed to drain blood from the retinal veins into the vortex veins through choroidal veins to compensate for the slowing of retinal blood outflow. The reperfusion of the central retinal vein was accompanied by the narrowing of the OCV.

Blood Flow Velocity↗