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PubMed1985

[AIDS and the eye].

The acquired immune deficiency syndrome (AIDS), is a recently described irreversible dysfunction of cell-mediated immunity in homosexuals, intravenous, drug abusers, and hemophiliacs, with subsequent development of potentially lethal opportunistic infections and/or unusual neoplasms, such as Kaposi's sarcoma. A prospective evaluation of ophthalmic findings in 14 patients with AIDS revealed that 8 patients had ophthalmoscopically and biomicroscopically significant ocular abnormalities, including peripapillary cotton-wool spots of changing frequency and diameter, retinal hemorrhages, progressive cytomegaly virus (CMV) retinitis, acute destructive retinal necrosis, periphlebitis, CMV conjunctivitis and keratitis, and in one patient a conjunctival Kaposi's sarcoma. All patients with AIDS and abnormal ocular findings carry a poor prognosis. Early detection of ocular manifestations is important, since most patients with AIDS are visually asymptomatic, and the ophthalmic presentation may be the primary one, and the initiating contact leading to diagnosis and permitting the prognosis to be assessed.

Acquired Immunodeficiency Syndrome↗
PubMed1993

An animal model of focal, subacute, viral retinitis.

To study local intravitreal therapies for retinitis due to herpes viruses, an animal model of focal, subacute, relatively nonlethal herpes family retinitis is needed. Herpes simplex virus type 1 (HSV-1) was injected into the subretinal space of 33 Dutch pigmented rabbit eyes. The animals were observed for up to 42 days after the inoculation. All inoculated eyes developed a focal, enlarging area of retinitis in a predictable manner, showing focal enlarging areas of retinal opacification and necrosis with variable retinal hemorrhage. In the inoculated eyes, retinal detachment developed in all animals within 21 days; 33% of the animals developed focal retinitis in the uninoculated eye. Histologic examination showed encephalitis to be present in 11 (73%) of the 15 animals studied after 1 week. This model may be used to evaluate the therapeutic efficacy of new antiviral agents and modalities in the treatment of herpes family viral retinitis. The model is most similar to herpes simplex or zoster retinitis in humans, but also shares some similarities (and differences) with cytomegalovirus (CMV) retinitis in humans.

Acute Disease↗
PubMed1990

Tolerance of intravitreal povidone-iodine in rabbit eyes.

Povidone-iodine is frequently instilled on to the conjunctival surface prior to intraocular surgery in order to prevent septic endophthalmitis. A small amount of povidone-iodine is inevitably introduced into the eye when it is used in this manner. The toxicity of intravitreal povidone-iodine was assessed in rabbit eyes by injecting 0.1 ml of povidone-iodine in concentrations of 0.05%, 0.5% and 5% into the vitreous cavity. The injected eyes were evaluated by clinical examination, anterior segment and fundus photography, endothelial cell counts, electroretinography and histopathology. Compared to control eyes, no changes were observed in all 6 eyes injected with 0.1 ml of 0.05% povidone-iodine solution. 9 of 10 eyes tolerated a concentration of 0.5% with no detectable adverse changes. One eye developed a temporary mild iritis and mild suppression of the ERG. Intra-retinal hemorrhages, edema, arteriolar narrowing and retinal edema were seen one week following injection. Mild retinal necrosis of the same area was seen on histology. All 4 eyes injected with 5% povidone-iodine developed temporary hypotony and iridocyclitis. A dense cataract developed in all eyes. Full thickness retinal necrosis and a profound lasting reduction in the ERG was produced in all of these eyes. No corneal epithelial or endothelial changes were observed in any eye in this series. Low concentrations of intravitreal povidone-iodine likely to be produced by instillation prior to surgery are tolerated by rabbit eyes. The concentrations tolerated by the studied eyes are near reported bactericidal levels.

Animals↗
PubMed1992

Adhesion molecules in experimental phacoanaphylactic endophthalmitis.

Intraocular accumulation of inflammatory neutrophils is an important feature of experimental phacoanaphylactic endophthalmitis (EPE). Increasing evidence suggests that localization of neutrophils to the site of inflammation requires the participation of neutrophil and endothelial adhesion molecules. These studies were undertaken to determine if blocking of adhesion molecules on neutrophils (CD18) or endothelium (ELAM-1) could attenuate EPE in Lewis rats. Treatment of experimental animals with anti-CD18 or anti-ELAM-1 significantly suppressed intraocular neutrophil accumulation, retinal hemorrhage, and vasculitis, and attenuated retinal edema formation by 48% and 70%, respectively. These observations demonstrate that antibodies directed against adhesion molecules on the neutrophil (CD18) or the vascular endothelial cell (ELAM-1) exhibit potent anti-inflammatory effects, resulting in a striking amelioration of injury in EPE in rats.

Animals↗
PubMed1990

[Vitreolysis with Nd:YAG laser].

From 1985 to 1987, the authors performed Nd:YAG laser vitreolysis in 20 eyes with vitreous membranes. The average power used was 27 mJ, and the maximum was 65 mJ. 18 eyes with vitreous strands were relieved or partially relieved. 2 eyes with floating vitreous membranes were not helped. Vision was improved in 11 eyes, unchanged in 8 eyes, and worsened in 1 eye. The complications included local opacification of the crystalline lens in 2 eyes, retinal hemorrhage in 2 eyes, and retinal hole in 1 eye. It was concluded that YAG laser was useful for lysis of organized vitreous membranes near the optical axis of the eye, and the effect should be good with appropriate contact lenses and proper selection of candidates for the operation.

Adolescent↗
PubMed1991

External argon laser drainage of subretinal fluid using the endolaser probe.

The results of 200 consecutive scleral buckling procedures in which the argon endolaser probe was used to create a choroidotomy for drainage of subretinal fluid are reported. This technique was used in any case requiring drainage and was specifically employed in cases in which needle drainage was contraindicated because the detachment was shallow. The argon laser was set at 0.2 seconds, 1.25 watts, and was used with the endolaser probe held adjacent to, but not touching, the choroid. Drainage was successfully accomplished in 98% of cases. Rates of subretinal hemorrhage, retinal incarceration, and perforation related to laser drainage were 5.5%, 2.5%, and 1%, respectively. No large or submacular subretinal hemorrhages occurred. This technique appears to be particularly promising for drainage of shallow retinal detachments.

Choroid↗
PubMed2002

[Traction retinal detachment, optic atrophy, apallic syndrome after shaking trauma in an infant].

INTRODUCTION: Ophthalmological examinations are important in children with suspected shaken baby and/or battered child syndrome. Retinal and epiretinal haemorrhages can indicate non-accidental injuries. We observed a case of extensive retinal hemorrhages, edema of the optic disc followed by development of optic atrophy, neovascularisation and tractional retinal detachment over the course of months. CASE REPORT: A 6-week-old infant with no history of systemic disease or trauma was admitted to the children's hospital because of a disorder of consciousness, respiratory insufficiency, taut fontanel and dilated pupils with sluggish reaction to light. A subdural haematoma was diagnosed. Ophthalmological examination showed no signs of trauma in the anterior segment. Ophthalmoscopy revealed extensive retinal haemorrhages and swollen optic nerve heads. During the next months optic atrophy, subretinal fibrosis at the posterior pole, neovascularisation at the optic disc and non-rhegmatogenous retinal detachment developed. The child is in a persistent vegetative state. DISCUSSION: Non-accidental injuries can cause direct trauma and indirect traumatic sequelae. Retinal haemorrhages, especially in conjunction with unexplained trauma or changes of consciousness should arouse suspicion of shaken baby syndrome. The ophthalmologist should emphasize this and strongly recommend further investigation if not previously undertaken.

Battered Child Syndrome↗
PubMed1985

Multiple recurrent serosanguineous retinal pigment epithelial detachments in black women.

Three middle-aged black women suffered recurrent, multiple, bilateral, asymmetric, serosanguineous retinal pigment epithelial detachments. These involved the posterior fundus with resolution and recurrences producing subretinal hemorrhages, vitreous hemorrhages, retinal pigment epithelial pigmentary mottling, and chorioretinal scars. Fluorescein angiography showed evidence of choroidal neovascular membranes, choroidal serosanguineous leaks, or both. Ocular inflammation was not evident. Systemic laboratory tests were noncontributory. The clinical pattern was not characteristic of any other entity producing serosanguineous retinal pigment epithelial detachments. The origin remains to be defined.

Black People↗
PubMed1998

Retinopathy in older persons without diabetes and its relationship to hypertension.

OBJECTIVE: To assess the prevalence and relationship of retinopathy lesions in older subjects without diabetes to systemic hypertension. METHODS: Three thousand six hundred fifty-four people aged 49 years or older attending the Blue Mountains Eye Study underwent a detailed eye examination, including medical history, blood pressure measurement, and fasting blood collection. Retinopathy lesions (hemorrhages and microaneurysms) were assessed from masked grading of stereoretinal photographs. Subjects with a history of diabetes or an elevated blood glucose level were excluded. Hypertension was defined as the current use of antihypertensive medications or an elevated blood pressure measurement on examination. RESULTS: Retinopathy was present in 325 subjects without diabetes, a prevalence of 9.8% (95% confidence interval [CI], 8.9%-10.9%), which increased with age. An increased age-adjusted relative risk (RR) for retinopathy was found for women (RR, 1.67; 95% CI, 1.26-2.21) and men (RR, 1.47; 95% CI, 1.07-2.00) with hypertension. In people using antihypertensive medications, retinopathy prevalence was higher for uncontrolled compared with controlled blood pressure but was not related to hypertension duration. Significant (P=.02 to P=.001) trends were found between increasing blood pressure quartiles and age-adjusted retinopathy prevalence, a relationship that was maintained after adjusting for fasting plasma glucose level at 3 diagnostic cut points for diabetes. CONCLUSIONS: This study supports the Beaver Dam Eye Study findings that retinal hemorrhages and microaneurysms are relatively frequent lesions in older people without diabetes and are significantly related to the presence and severity of hypertension.

Aged↗
PubMed2001

Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions.

OBJECTIVE: To investigate the efficacy and safety of treating submacular hemorrhages secondary to age-related macular degeneration (ARMD) with intravitreous recombinant tissue plasminogen activator (rt-PA) and gas under various conditions. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Forty-three consecutive eyes of 42 patients with recent (range, 2-28 days) subfoveal hemorrhage secondary to ARMD were included in this study. The size of subretinal hemorrhage ranged from 0.25 to 30 disc areas. METHODS: All patients were treated with intravitreous injections of rt-PA (50 microg) and sulfur hexafluoride (0.5 ml). Postoperative prone positioning was maintained for 24 to 72 hours. Patient follow-up ranged from 4 to 18 months (mean, 6 months). MAIN OUTCOME MEASURES: Best and final postoperative visual acuity in relation to size and onset of hemorrhage, displacement of subretinal blood, and surgical complications. RESULTS: Best postoperative visual acuity compared with preoperative visual acuity was improved two or more Snellen lines in 19 eyes (44%) and stable in 24 eyes (56%). Final visual acuity was improved two or more lines in 13 eyes (30%), stable in 26 (61%), and two or more lines worse in 4 eyes (9%). Duration of hemorrhage <or=14 days was associated with a better gain of lines of vision (P = 0.0058). Best postoperative acuity was maintained for an average of 4.2 months (range, 0.5-12 months). Overall, complete displacement of blood from under the fovea was achieved in 35 eyes (81%). Nine eyes (21%) developed recurrent hemorrhage, which required repeat treatment. In three patients (7%), a mild breakthrough vitreous hemorrhage was observed. CONCLUSIONS: Our findings suggest that intravitreous injections of rt-PA and gas are of value for an improved and accelerated visual recovery in ARMD patients with submacular hemorrhage, although final visual outcome is often limited by the progression of the underlying ARMD. Patients with retinal hemorrhages of recent onset (<or=14 days) seem to have the most favorable results. A rapid displacement of submacular blood may reveal discrete choroidal neovascular membranes amenable to further treatment. The complication rate of this minimally invasive technique seems to be low.

Aged↗
PubMed2001

Retinal and intraventricular cerebral hemorrhages in the preterm infant born at or before 30 weeks' gestation.

PURPOSE: To determine the prevalence of retinal hemorrhages and their association with cerebral intraventricular hemorrhages (IVH) in low-birth-weight preterm neonates born at or before 32 weeks' gestation. METHODS: We prospectively studied a consecutive series of 22 neonates (24-30 weeks' gestation; mean gestational age, 27 weeks; mean weight, 1065 g) admitted to the neonatal intensive care unit. Anterior segment and indirect ophthalmoscopic examination, as well as cranial ultrasonographic examination, were performed on day 1 and day 10 of life. The prevalence of retinal and intraventricular hemorrhage was tested statistically for association with obstetric and neonatal clinical variables. RESULTS: The prevalence of retinal hemorrhage was 9% (2/22; 95% CI, 3%-21%) on day 1 and 2% (1/22) on day 10. The prevalence of IVH was 27% (6/22; 95% CI, 9%-46%): 14% (3/22) on day 1 and 23% (5/22) on day 10. Retinal hemorrhages occurred with greater frequency in neonates born to women who had intrauterine infection (chorioamnionitis, P =.043) and low umbilical cord pH levels (P =.027). No association was found between the presence of retinal hemorrhage and IVH (P = 1.000), mode of delivery (ie, vaginal vs cesarean section, P = 1.000), birth weight (P =.476), or gestational age (P = 1.000). The presence of subconjunctival hemorrhage was associated with IVH (P =.046). CONCLUSIONS: Retinal hemorrhages occur in less than 10% of low-birth-weight neonates, ie, a prevalence one half that observed in term neonates (22%). The hemorrhages tend to resolve without sequelae in the first 10 days of life and occur more commonly in infants born to women with uterine infection. Retinal hemorrhages in very premature neonates are not predictive of IVH-related brain damage.

Cerebral Hemorrhage↗
PubMed1975

Symptomatic floaters as a clue to vitreoretinal disease.

One hundred consecutive patients with symptomatic floaters without previous ocular trauma or surgery are analyzed as to the underlying cause. The most common findings were posterior vitreous detachment with and without vitreous hemorrhage, vitreous syneresis with collagen fibril clumping, diabetic retinopathy with vitreous hemorrhage, retinal tears without retinal separation, and retinal separation. Significant vitreoretinal disease occurred in 36% of the patients.

Adult↗
PubMed1995

Intraocular intrusion of sutures after retinal detachment buckling surgery.

BACKGROUND: Intraocular intrusion of tight encircling silicone band is a major complication of retinal detachment surgery leading to subretinal and vitreous hemorrhage, retinal detachment, and phthisis bulbi. Intrusion of the sutures into the eye has only been reported as an adjunct to buckle intrusion. METHODS: Seven patients (9 eyes) are presented in whom intrusion of sutures occurred as a late complication of retinal detachment surgery using the extrascleral buckling technique. Their complications and treatments are discussed. RESULTS: Eleven anchoring sutures were observed under the retina and two sutures penetrated into vitreous cavity. In five eyes (55.5%), small subretinal or vitreous hemorrhages were noted and in one of them perforation with total detachment occurred. In four eyes, no complications were detected. In four eyes, the silicone band was cut and left in place and the hemorrhages were spontaneously absorbed. The perforated eye underwent replacement of the silicone band with a wide silicone sponge, followed by vitrectomy and silicone oil injection. CONCLUSIONS: Intrusion of sutures into the eye can rarely be seen years after retinal detachment surgery and usually do not require surgical intervention. When hemorrhage occurs, cutting of the silicone band only, with no attempt to remove the band or the sutures, is recommended.

Foreign-Body Migration↗
PubMed2006

Malignant hypertension: ocular manifestations.

Malignant hypertension may be the first manifestation of systemic hypertension. We report a clinical case of a Caucasian 41-year-old man with no previous history of blood hypertension seen at casualty because of blurred vision. Fundus examination disclosed optic disk swelling, retinal hemorrhages and infarcts. The blood pressure was 220/130 mmHg. After the appropriate management of hypertension, optic disk and retinal edema resolved, leaving minor changes as mild optic disk pallor and hard exudates.

Adult↗
PubMed1991

[General causes of retinal and vitreous hemorrhages in Mali].

Sixty four cases of retinal and vitreous hemorrhages are reported during a 15 months prospective study in Bamako. Main diseases associated with hemorrhages are high blood pressure (56% of cases), hemoglobinopathies (33%) and diabetes mellitus (23%). In 28% of cases several aetiologies are connected. SC hemoglobin is a frequent aetiology of vitreous hemorrhage (40%). Hemoglobin AS and AC, generally asymptomatic, are also liable to hemorrhages. Terson and Eales syndromes, Werlhof disease, hemophilia and AIDS are most uncommon. In 8% of cases there is not any aetiology.

Adolescent↗
PubMed2004

Shaken baby syndrome without intracranial hemorrhage on initial computed tomography.

OBJECTIVE: We sought to describe the unique characteristics of children diagnosed with shaken baby syndrome (SBS) despite the absence of intracranial hemorrhage on cranial computerized tomography (CT) on hospital admission. METHODS: Using an international e-mail-based listserv for professionals with an interest in child abuse, we identified and reviewed the charts of children hospitalized in different medical centers who were diagnosed with SBS although CT disclosed no signs of intracranial bleeding. Children with normal imaging were not included. RESULTS: Eight cases were identified. All children had cerebral edema in CT, which was severe on 7/8 cases (88%). All of these children had extensive retinal hemorrhage. The prognosis was poor; 5/8 infants died (63% mortality), and the rest had permanent neurologic damage. CONCLUSION: The diagnosis of SBS can be established even when CT at presentation does not demonstrate intracranial hemorrhage. We hypothesize that rapidly developing cerebral edema may cause increased intracranial pressure and tamponade that prevents the accumulation of intracranial blood. The prognosis in these cases is grave.

Brain Edema↗
PubMed1986

Traumatic retinoschisis in battered babies.

Five infants who were victims of physical abuse had extensive bilateral retinal hemorrhages on initial evaluation and subsequently developed signs of permanent retinal damage. None showed external evidence of trauma to the eyes. Vitreous hemorrhage developed after a delay of several days or more in three cases that were followed closely from the time of the traumatic incident. In several eyes, apparent intraretinal blood-filled cavities were seen acutely in the macular region and elsewhere. Late scarring of the macula typically had a cystic or crater-like configuration. Electroretinography showed loss or reduction of the positive B-wave with preservation of the negative A-wave in every case. We propose that splitting of the retina resulting from the direct mechanical effects of violent shaking was responsible for all of these findings.

Child Abuse↗