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Retinal hemorrhage and vacuum extraction delivery.

The purpose of this prospective study was to investigate whether there is an increased risk of retinal hemorrhage in those infants delivered with the assistance of the silastic vacuum extractor from mothers who were low-risk and who had normal labors. Ocular fundi of 38 term newborns (19 vacuum assisted deliveries, 19 spontaneous deliveries) were examined for retinal hemorrhage within 72 hours after delivery. The overall frequency of retinal hemorrhage was 21.1%, 31.6% with the vacuum extractor and 10.5% with a spontaneous delivery. The mode of delivery did influence the number of infants with hemorrhages in each category, however this was only statistically significant in primiparous patients. The prognostic significance of the degree of retinal hemorrhage was not assessed.

Extraction, Obstetrical↗

Retinal hemorrhages in newborn.

Two hundred and fifty eight newborn babies were studied for the presence of retinal hemorrhages between 1-3 days of birth. The overall incidence of retinal hemorrhages was found to be 18.9%. It was observed that the incidence of retinal hemorrhages was higher in unassisted vaginal deliveries than in assisted births. Also, a two fold higher incidence was noted in term infants as compared to preterm babies. No association was seen with birth asphyxia.

Asphyxia Neonatorum↗

Multiple retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma.

PURPOSE: We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. METHODS: A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The lOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP. RESULTS: Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye. CONCLUSIONS: It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.

Adult↗

Retinal hemorrhages in newborn piglets following cardiopulmonary resuscitation.

OBJECTIVE: To determine whether conventional cardiopulmonary resuscitation causes retinal hemorrhages in piglets. DESIGN: Nonrandomized observations. SETTING: Animal physiology laboratory. PARTICIPANTS: Six 3.5- to 4.5-kg piglets. INTERVENTIONS: Fifty minutes of conventional, closed chest cardiopulmonary resuscitation. MEASUREMENTS/MAIN RESULTS: Intrathoracic venous pressure (right atrium) and intracranial venous pressure (sagittal sinus) were directly measured. At 5 minutes of cardiopulmonary resuscitation, the mean (+/- SEM) sagittal sinus pressure was 41 +/- 8 mm Hg and the mean right atrial pressure was 58 +/- 9 mm Hg. The pressures were sustained throughout the 50 minutes of cardiopulmonary resuscitation. At autopsy, there was no gross or microscopic evidence of retinal hemorrhages. CONCLUSION: These results support the conclusion that cardiopulmonary resuscitation does not cause retinal hemorrhages.

Animals↗

Dye laser photocoagulation through experimentally induced retinal hemorrhage.

The histological effects of photocoagulation obtained by using each of 4 wavelengths of the dye laser (577, 590, 610, and 630 nm) on experimentally induced retinal hemorrhage in cat eyes were examined. Energy from 577, 590, and 610 nm laser was directly absorbed by red blood cells in the retinal hemorrhage and destroyed the inner layers of the retina. Red blood cells were not directly coagulated with the use of 630 nm laser, and the retinal pigment epithelial cells (RPE cells) and choroidal melanocytes were coagulated. These results suggest that the use of yellow or orange dye lasers for photocoagulative therapy in a retinal hemorrhage is dangerous, because of the risk for destruction of the inner layers of the retina. A 630 nm dye laser is useful for photocoagulation of a retinal hemorrhage, while the laser energy is unable to reach the RPE cells and the choroid with the use of other wavelengths.

Animals↗

Focal inner retinal hemorrhages in patients with drusen: an early sign of occult choroidal neovascularization and chorioretinal anastomosis.

PURPOSE: To present evidence that superficial retinal hemorrhage in the macula of patients with age-related macular degeneration (ARMD) may be an early sign of occult chorioretinal anastomosis (OCRA) and type 1 occult choroidal neovascularization (OCNV). METHODS: Retrospective follow-up study of 16 patients presenting with a small focal area of superficial retinal hemorrhages and drusen in the juxtafoveolar area in 24 eyes. RESULTS: OCRA and OCNV occurred in an older subset of patients with ARMD (mean age, 75 years). Of 22 eyes with the early stages of chorioretinal anastomosis (CRA), 18 had evidence of a piggyback neovascular complex, with the smaller subsensory retinal type 2 complex lying anterior to the larger subretinal pigment epithelial type 1 complex. At initial presentation, three patients had OCRA and OCNV bilaterally, and three patients had large disciform cicatricial lesions with overt CRA in the fellow eye. Nine patients had one or more laser photocoagulation treatments for early stages of CRA. Only one patient maintained visual acuity of better than 20/200 for >1 year. At the last follow-up, 24 of 26 eyes with CRA had visual acuity of 20/200 or less. CONCLUSION: Superficial retinal hemorrhage in the paracentral area of patients with drusen is the earliest sign of OCRA and OCNV. Fluorescein angiography and indocyanine green angiography are important in detecting the dual nature of the subretinal neovascular network. Photocoagulation and photodynamic treatment is usually unsuccessful in preserving central vision.

Aged↗

Retinal hemorrhage following lensectomy and anterior vitrectomy in children.

Lensectomy and anterior vitrectomy were performed on 13 eyes of 10 consecutive children, aged 10 years or less, with congenital or acquired nontraumatic cataracts or subluxed lenses. Operative eyes were examined prospectively to determine the incidence and natural course of hemorrhagic retinopathy following lens extraction. Flame-shaped retinal hemorrhages occurred in five eyes of four patients within 24 hours of surgery. In addition, a small vitreous hemorrhage was seen in one of these patients. All hemorrhages cleared within 3 weeks postoperatively. No statistically significant correlation was found between the occurrence of hemorrhage and patient age, race, sex, or duration of surgery. We conclude that retinal hemorrhage following lensectomy and anterior vitrectomy in children may occur more commonly than previously recognized.

Cataract↗

Retinal hemorrhages in 4 patients with dengue fever.

We report 4 patients with retinal hemorrhages that developed during hospitalization for dengue fever. Onset of symptoms coincided with resolution of fever and the nadir of thrombocytopenia. Retinal hemorrhages may reflect the rising incidence of dengue in Singapore or may be caused by changes in the predominant serotype of the dengue virus.

Adult↗

Retinal hemorrhages in newborn--fetal causative factors.

Two hundred and eight alive newborns examined within 2 hours of birth showed 37.50% incidence of retinal hemorrhage (RH). Out of these, 38.59% were full term and 29.17% were preterm. Head circumference had a significant correlation (p less than 0.05) with retinal hemorrhage, while sex of the newborn, birth weight, gestational age and fetal distress showed no significant correlation. Birth injuries especially ocular and periocular injuries showed a significantly higher incidence of retinal hemorrhage (83.33%).

Birth Injuries↗

Diagnostic and prognostic value of retinal hemorrhages in the neonate.

Ocular fundi of 410 newborns were examined for retinal hemorrhages within 24 hours after delivery. The purpose of this study was to investigate whether the course of pregnancy and management of delivery influence the incidence of neonatal retinal hemorrhage (RH) and whether this incidence could be reduced by electronic monitoring of delivery. To assess the prognostic value of neonatal RH for future development of the child, the physical, motor, and psychologic states of 252 infants were examined 6 to 18 months following delivery. The incidence of RH was 37.3% and was not influenced by maternal age, parity, gestational age, course of pregnancy, birth weight, or electronic monitoring of delivery. The mode of delivery did influence the incidence of RH. Gesell developmental schedule showed no correlation between ocular findings and later development of the child.

Delivery, Obstetric↗

Hemorrhagic retinal macrocysts in advanced Coats disease.

The authors report a case of advanced unilateral Coats disease with associated hemorrhagic retinal macrocysts. Fluorescein angiography showed the macrocysts to be intensely hypofluorescent due to absence of perfused retinal blood vessels in the inner wall and presence of intracavitary blood blocking outer wall and choroidal fluorescence. Around the cystic lesions and in other areas of the peripheral retina, characteristic telangiectatic retinal blood vessels were evident. The mechanism responsible for the development of hemorrhagic retinal macrocysts in Coats disease appears to be coalescence of microcystic spaces in edematous and degenerated chronically detached retina.

Cryosurgery↗

Neonatal retinal hemorrhages and neurobehavior related to tractive force in vacuum extraction.

Fifty clinically indicated vacuum extractions were studied to evaluate a possible relationship between neurobehavioral abnormality, retinal hemorrhages and the tractive force used for delivery. A Vacuum Extractor Recorder (Type SF 30, Knick), was used to measure the forces necessary for delivery of the head. Infants delivered by the use of extensive tractive force showed no greater incidence of neuropathology than those delivered with less tractive force. The retinal hemorrhages were equally distributed among the infants, irrespective of the tractive force applied or the neurobehavioral assessment. The implication is that retinal hemorrhages cannot be used to evaluate the extent of cerebral influence after birth and that the main cause of neurobehavioral abnormality is the condition leading to the use of the vacuum extractor (VE).

Adult↗

Retinal hemorrhages in the newborn.

There were 100 babies examined within 24 hours of birth. Retinal hemorrhages were found in 35% of newborns. Birth trauma from forceps delivery and prolonged labor were thought to be significant. Babies born by cesarean section were less likely to have retinal hemorrhages. Asphyxia was also found to be significant. The role of low plasma prothrombin levels, the vacuum extractor and increased intracranial pressure were discussed as etiologic agents. According to Von Noorden in 1973 there appears to be no positive correlation between hemorrhage of the macula and the occurrence of strabismus.

Birth Injuries↗

Acute bilateral vitreo-retinal hemorrhages following oxygen-ozone therapy for lumbar disk herniation.

PURPOSE: To describe a case of acute bilateral intraocular hemorrhages occurring after injection of oxygen-ozone (O(2)O(3)) mixture. DESIGN: Observational case report. METHODS: A 45-year-old woman complained about acute bilateral visual loss after intradiscal and periganglionic injection of gas mixture (O(2)O(3)) for lumbar disk herniation. Detailed ophthalmologic examination; magnetic resonance imaging (MRI) of brain and spinal cord; and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser membranotomy in the left eye was performed. RESULTS: Ophthalmoscopy revealed a premacular hemorrhage involving the left macula. In the right eye multiple, flat, retinal hemorrhages around the optic disk and the posterior pole were observed. The MRI scan for intracranial hemorrhage was unremarkable. Drainage of the left premacular hemorrhage by pulsed Nd:YAG laser was obtained a few weeks later. CONCLUSIONS: Retinal hemorrhages seem to be an uncommon but significant complication of intradiscal O(2)O(3) infiltration, and we suggest that it should be carefully considered when recommending this procedure.

Acute Disease↗

Whiplash shaking syndrome: retinal hemorrhages and computerized axial tomography of the brain.

Three cases of whiplash shaking injury of infants are presented. All children presented with seizures and had minimal signs of external injury. Examination of the retina revealed extensive retinal hemorrhages. These were missed on initial examination and were only discovered after pupillary dilatation. The presence of these palecentered retinal hemorrhages suggested the diagnosis of child abuse and skeletal surveys and thorough social histories confirmed the diagnosis. Despite extensive retinal hemorrhages, computerized axial tomography (C.T.) scan showed minimal inter-hemispheric bleeding. In contrast to the "Battered Child Syndrome," all the findings in whiplash shaking syndrome of infants are subtle and demand an awareness, an index of suspicion and a thorough examination which may include extensive retinal examination following dilatation of the pupils. This latter examination is frequently not performed by family physicians and residents so that the syndrome may be missed. A fourth case is also discussed where shaking is admitted on initial presentation but said to be done for resuscitation. This poses an immense diagnostic dilemma to the pediatrician since in this case the child presented later with all the signs of physical abuse.

Brain↗