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PubMed1999

[Timing of vitrectomy for proliferative diabetic retinopathy in cases with type II diabetes mellitus].

OBJECTIVE: To determine the timing of vitrectomy for proliferative diabetic retinopathy with severe vitreous hemorrhage, retinal traction and even tractional detachment resulted from fibrovascular membranes in type II diabetes mellitus. METHODS: According to the preoperative duration of vitreous hemorrhage and severity of diabetic retinopathy, 78 eyes of 64 cases having undergone vitrectomy were divided into 2 groups for the comparison of postoperative visual acuity. RESULTS: After 9 months of follow-up, in the group with preoperative vitreous hemorrhage of or= 0.3, while in the group with preoperative vitreous hemorrhage of > 6 months' duration 5.3% of cases reached such a level (P < 0.01). After one year, in the group with preoperative vitreous hemorrhage of or= 0.5, while in the group with preoperative vitreous hemorrhages of > 6 months' duration, 7.1% (P < 0.05). In the group of vitreous hemorrhage with or without local tractional retinal detachment, 35.7% had visual acuity of >or= 0.5, while in the group with large area of tractional retinal detachment, 16.7% (P < 0.05). CONCLUSION: Earlier vitrectomy is preferable for type II diabetes mellitus with vitreous hemorrhage, and the operative treatment should not be abandoned for the patients with vitreous hemorrhage of longer duration and severe tractional retinal detachment.

Diabetes Mellitus, Type 2↗
PubMed1989

Diagnosis and management of massive vitreous hemorrhage caused by retinal tear.

Fourteen cases of massive vitreous hemorrhage caused by a retinal tear, the cause having been confirmed during closed vitrectomy, were studied retrospectively. In the 3 cases with no retinal detachment and in the 6 cases with partial but not extensive retinal detachment at the time of surgery, the electroretinogram (ERG), visual evoked response (VER) and electrically evoked response (EER) were recordable preoperatively. After surgery the retina was attached in all 9 cases, but later redetached in one case. The visual acuity improved in 8 of the 9 cases. In the 5 cases with subtotal or total retinal detachment at the time of surgery, the ERG was nonrecordable preoperatively in all 5 cases, while the VER and EER were recordable in 4 cases. After surgery the retina was reattached in 3 of the 5 cases, but later redetached in one case. Visual acuity improved in only 2 of the 5 cases. When a retinal tear is suspected to be present, surgical intervention should not be delayed in cases of massive vitreous hemorrhage which does not clear after initial bilateral patching and bed rest. Ultrasonographic and electrophysiological tests help establish the diagnosis and prognosis.

Adult↗
PubMed2005

Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the Atherosclerosis Risk in Communities Study.

BACKGROUND AND PURPOSE: Retinal microvascular abnormalities reflect cumulative small vessel damage from elevated blood pressure and may reflect subclinical cerebral microvascular changes. We examined their associations with MRI-defined cerebral infarcts. METHODS: Population-based, cross-sectional study of 1684 persons 55 to 74 years of age without a history of clinical stroke, sampled from 2 US southeastern communities. Retinal photographs were obtained and graded for presence of retinal microvascular abnormalities, including arteriovenous nicking, focal arteriolar narrowing, retinal hemorrhages, soft exudates and microaneurysms. Photographs were also digitized, and retinal vessel diameters were measured and summarized as the arteriole-to-venule ratio (AVR). Cerebral MRI scans were graded for presence of cerebral infarct, defined as a lesion > or =3 mm diameter in a vascular distribution with typical imaging characteristics. RESULTS: There were a total of 183 MRI cerebral infarcts. After adjustment for age, gender, race, 6-year mean arterial blood pressure, diabetes, and other stroke risk factors, cerebral infarcts were associated with retinal microvascular abnormalities, with odds ratios 1.90 (95% CI, 1.25 to 2.88) for arteriovenous nicking, 1.89 (95% CI, 1.22 to 2.92) for focal arteriolar narrowing, 2.95 (95% CI, 1.30 to 6.71) for blot hemorrhages, 2.08 (95% CI, 0.69, 6.31) for soft exudates, 3.17 (95% CI, 1.05 to 9.64) for microaneurysms, and 1.74 (95% CI, 0.95 to 3.21) for smallest compared with largest AVR. In stratified analyses, these associations were only present in persons with hypertension. CONCLUSIONS: Retinal microvascular abnormalities are associated with MRI-defined subclinical cerebral infarcts independent of stroke risk factors. These data suggest that retinal photography may be useful for studying subclinical cerebrovascular disease in population-based studies.

Aged↗
PubMed2002

Side effects after radiotherapy of age-related macular degeneration with the Nijmegen technique.

BACKGROUND: In a randomized trial concerning radiotherapy for age-related macular degeneration, fluorescein angiograms were taken of controls and patients. In this study the frequency of side effects in eyes receiving radiotherapy with the Nijmegen technique is compared with the findings in the eyes of controls. METHODS: Patients receiving treatment were irradiated by two isocentric photon beams in four fractions of 6 Gy that were directed to the macular area at 30 degrees and -30 degrees with regard to the optical axis. The most recent fluorescein angiograms of the randomized eyes (32 treated and 31 control eyes) were scored by two independent researchers, using a scoring form with nine features of radiation retinopathy: nonperfusion, macular edema, microaneurysms, retinal hemorrhages, cotton-wool spots, perifoveal telangiectasis, vascular sheathing, retinal neovascularization, and radiation-associated choroidal neovasculopathy. The results were graded as: no retinopathy (grade 0), mild retinopathy (grade 1), moderate retinopathy (grade 2), and severe retinopathy (grade 3). RESULTS: In the treated group 6 patients (18.8%) were grade 1, 10 patients (31.2%) were grade 2 and 7 patients (21.9%) were grade 3. In the control group 9 patients (29.0%) were grade 1, 11 patients (35.5%)were grade 2 and 2 patients (6.5%) were grade 3. There were no patients with retinal neovascularization. CONCLUSION: With the Nijmegen technique a relatively high dose of radiation can be applied to a small retinal area. In only a minority of cases does some evidence of radiation retinopathy occur.

Aged↗
PubMed1984

Raccoon ascarid larvae (Baylisascaris procyonis) as a cause of ocular larva migrans.

Larvae of the common raccoon roundworm, Baylisascaris procyonis, are known causes of visceral larva migrans and CNS disease in animals and human beings. In the present experiments we examined the ability of B. procyonis to cause ocular larva migrans (OLM) in subhuman primates, as an indication of its possible ocular zoonotic importance. Squirrel monkeys given 5,000 or 10,000 infective B. procyonis eggs per os and cynomolgus monkeys given 20,000 eggs had clinical and histologic evidence of OLM, beginning 7 days after inoculation. Clinically, multifocal retinal hemorrhages, white spots, chorioretinitis, inflammatory tracks, vascular sheathing, diffuse retinal degeneration, and motile intraretinal larvae were seen. Histologically, primarily subretinal larvae caused varying degrees of retinal disruption, degeneration and necrosis, retinitis, vasculitis, and perivascular sheathing, primarily with eosinophils. Larvae were also present in choroidal granulomas. It was concluded that B. procyonis larvae have marked ability to produce OLM in subhuman primates following oral infection and should be considered as a possible etiology in human ocular disease.

Animals↗
PubMed2002

Comparison of nonmydriatic digitized video fundus images with standard 35-mm slides to screen for and identify specific lesions of age-related macular degeneration.

PURPOSE: The purpose of this study was to compare nonmydriatic digitized images obtained using a digital imaging system (resolution of 640 x 480 pixels) with 35-mm slide images for detecting specific findings of age-related macular degeneration (AMD) and to evaluate its usefulness as a screening tool in detecting signs of AMD. METHODS: Seventeen consecutive patients (33 eyes) underwent digital color imaging (with a nonmydriatic, 45-degree, fundus camera attached to a digital back) and standard 35-mm, 30-degree retinal color photography of the fundus: posterior pole, nasal retina, and temporal retina. The images were later reviewed for the presence or absence of specific retinal findings. The images were not compressed. Primary outcome measures included the presence or absence of drusen, hard exudate, choroidal neovascularization (CNV), subretinal hemorrhage, retinal pigment epithelial (RPE) changes, subretinal fibrosis, pigment epithelial detachment (PED), and subretinal fluid. Presence of drusen, with or without any one of the other findings, and presence of disciform scar or geographic atrophy were positive indications in screening for AMD. RESULTS: Agreement between image type was highest for PED (97%), CNV (91%), and subretinal fibrosis (91%); and lowest for RPE changes (63%). Sensitivity, specificity, positive predictive value, and negative predictive values were determined using the 35 mm-slide images as the reference for comparison. Sensitivity ranged from 40% (hard exudates) to 75% (subretinal hemorrhage). Specificity ranged from 88% (drusen) to 100% (hard exudate, CNV, RPE changes, PED). Positive predictive value ranged from 67% (subretinal hemorrhage) to 100% (hard exudate, CNV, RPE changes, PED). Negative predictive value ranged from 44% (drusen) to 97% (PED). For the purposes of screening for any evidence of AMD, the system was 70% sensitive. CONCLUSION: This digital fundus imaging system with 640 x 480 pixel resolution has low sensitivity and high specificity, as compared with 35-mm slide images, for detection of early AMD, but higher sensitivity for late findings (CNV, scar, atrophy) of AMD. Because of sensitivity for detecting any AMD coupled with the low sensitivity for detecting CNV, the system is not useful for evaluating AMD patients who require close follow-up and who are at risk for more severe visual loss.

Aged↗
PubMed1989

Multinucleated giant cells on Bruch's membrane late in recurrent retinal and subretinal hemorrhaging.

Two cases with a history of recurrent subretinal hemorrhaging are reported. Multinucleated giant cells of macrophage origin were demonstrated on Bruch's membrane in a few stages of their functions of phagocytosis of old blood and storage of blood remnants. Their classification as foreign-body giant cells fails to recognize the important purification, disposal and storage functions of these cells in situations with extensive intraocular hemorrhage, exudation or necrosis.

Choroid↗
PubMed1980

Results and complications of surgery of retinal detachment with a macular hole.

About 96% of retinal detachments with a macular hole were cured by surgery. The most effective surgical procedure was diathermy with a macular buckling method and scleral infolding at the temporal part of the equatorial region, the rate of success being 100%. Only diathermy or diathermy plus scleral infolding at the temporal part of the equatorial region could reattach all detached retinas. Since macular buckling procedures made visual acuity worse, techniques without macular buckling should be used in cases without macular atrophy or degeneration of myopia. Retinal hemorrhage during or after operation was the most frequent complication (50%) of surgery for retinal detachment with a macular hole and occurred more frequently when macular buckling procedures were used. Macular hemorrhage caused deterioration of postoperative visual acuity.

Adolescent↗
PubMed1992

[A case of metastatic carcinoma to the retina].

The authors report a case of metastatic carcinoma to the retina. The patient was a 61-year-old man who had an operation for a well-differentiated adenocarcinoma of the rectum. Ophthalmoscopic examination disclosed a single, white, elevated mass lesion surrounded by serous retinal detachment located in the upper part of the macula of the right eye. A few retinal hemorrhages existed around the lesion. Fluorescein angiography revealed partially obscured retinal vessels due to compression by the tumor and arteriovenous anastomosis. Postmortem pathologic examination confirmed metastases to the brain, lung and retina. Microscopic examination showed a retinal lesion and tumor cells in the right eye. Tumor cells, similar to the carcinoma of the rectum, were present only in the neurosensory retina and did not invade the pigmented epithelium or choroid.

Adenocarcinoma↗
PubMed1989

Retinal arterial macroaneurysms.

Retinal arterial macroaneurysm is a distinct, infrequently occurring fundus sign usually found in older patients with systemic vascular disease. The lesion arises on a main branch of the retinal artery within the first three orders of bifurcation. Visual disturbance is uncommon, although it may occur as a result of vitreous or retinal hemorrhage or macular edema. This paper presents two cases of retinal arterial macroaneurysm and discusses the diagnosis, etiology, and management of this condition.

Aged↗
PubMedDate not supplied

[Extra-scleral balloon catheterization. Report 3. New ways of its use--prevention of hypotonia and intraocular hemorrhages in vitreo- retinal surgery].

Hypotonia and ex vacuo hemorrhages are the most grave complications of vitreoretinal surgery; the known methods of their prevention are altogether inadequate. The authors have developed extra-scleral ballooning (ESB) methods that improve the efficacy of surgery and reduce the rate and severity of complications in subretinal fluid draining during surgery for detachment of the retina and in arresting intraocular hemorrhages during closed vitrectomy. ESB application helped elevate intraocular pressure in the patients with drastic hypotonia, permitting a reliable and easy-to-perform monitoring of intraocular pressure over the course of surgery. This was conducive to complete evacuation of subretinal fluid, thus preventing the development of hypotonia and its complications, as well as to a rapid arrest of intraocular hemorrhage due to rapid elevation of intraocular pressure up to the values essential for the bleeding vessel collapse. Surgical methods are described and their results analyzed in 65 cases. The developed ESB methods for the prevention of hypotonia and intraocular hemorrhages in vitreoretinal surgery are effective, low traumatic, and may be recommended as alternative ones.

Catheterization↗
PubMed1992

Central subretinal hemorrhage from a retinal arterial macroaneurysm--two-step treatment with laser and vitreoretinal surgery.

Central subretinal hemorrhage can be a complication of arterial retinal macroaneurysm. Subretinal bleeding may lead to mechanical and toxic damage of photoreceptors, causing persisting central scotomas. Prophylactically, we perform a two-step therapy using an argon laser and vitreoretinal surgery to achieve coagulation of the bleeding source and drainage of subretinal blood.

Adult↗
PubMed1999

Diltiazem reduces retinal neovascularization in a mouse model of oxygen induced retinopathy.

PURPOSE: To assess the effect of diltiazem, a calcium channel blocking agent, on oxygen induced retinopathy (OIR) in a mouse model using neovascular nuclei quantitation and a quantitative scoring system based on examining fluorescein perfused retinal whole mount preparations. METHODS: The mouse model of oxygen induced retinopathy consisting of a 5 day exposure to 75% oxygen from postnatal day 7 to 12 was used to produce retinal neovascularization. Fluorescein conjugated dextran angiography of retinal vasculature was performed and retinal whole mounts were prepared to score features of retinopathy. The parameters that were scored in a masked fashion included blood vessel growth, blood vessel tuft formation, extra retinal neovascularization, degree of central vasoconstriction, retinal hemorrhage, and tortuosity of vessels. Diltiazem (0.05-0.5 mg/kg/day subcutaneously for five days) was administered to mice pups during exposure to oxygen to determine if calcium channel blockade altered retinopathy. In addition, quantification of retinal neovascular nuclei was performed in a masked fashion with periodic acid Schiff (PAS) staining of frozen eye sections. RESULTS: Animals that were exposed to hyperoxia for five days had a median (25th, 75th quartile) retinopathy score of 9 (8,11) versus control animals that had a retinopathy score of 1 (0,1) with p<0.001. Subscores for blood vessel growth, blood vessel tufts, extra-retinal neovascularization, central vasoconstriction, hemorrhage, and blood vessel tortuosity were all significantly different between control and treated animals. In addition, quantification of neovascular nuclei showed a significant increase in the number of nuclei extending beyond the inner limiting membrane into the vitreous in hyperoxic treated animals. Diltiazem at doses of 0.2 and 0.5 mg/kg/day improved the retinopathy as measured by the total retinopathy score [5 (4,6) and 4 (3.75,5.25), respectively]. The average number of extraretinal neovascular nuclei per retinal section (mean +/-standard deviation) was significantly decreased by diltiazem at doses of 0.2 and 0.5 mg/kg/day (31.4+/-18.8 and 20.9+/-6.9, respectively) when compared to hyperoxic treated animals (56.1+/-21.5). CONCLUSIONS: Diltiazem reduces oxygen induced retinopathy in the mouse as measured by a scoring system based on a retinal whole mount method of retinal neovascularization and by quantification of extra retinal neovascular nuclei.

Animals↗
PubMed1981

Salmon-patch hemorrhages after central retinal artery occlusion in sickle cell disease.

In two patients with sickle cell disease (one hemoglobin SC and one hemoglobin SS), central retinal artery occlusions developed. In one case, the occlusion followed a retrobulbar injection of lidocaine hydrochloride. Although the central retinal artery reperfused in each patient, many secondary peripheral retinal arteriolar occlusions remained. During the subsequent days, multiple salmon-patch hemorrhages developed in the distribution of these occluded arterioles. In one patient, the salmon-patch hemorrhages evolved into atrophic schisis cavities. These unusual cases allowed us to document the origin of salmon-patch hemorrhages after peripheral retinal arteriolar occlusions. The development of the hemorrhages was a delayed phenomenon that occurred hours to days after the initial vascular occlusion. Reperfusion of the damaged ischemic vessels with a blowout of the wall of the vessels seems the most likely explanation for this phenomenon.

Adult↗
PubMed1992

Vascular occlusion of the retina: an experimental model. I. Leukocyte aggregates.

A new technique was developed to study the pathogenesis of retinal arteriolar occlusion in the pig. Using a catheter with its tip in front of the exit of the ophthalmic artery, autologous microparticles could be injected directly into the retinal arterial system. These microparticles were C5a-des-Arg stimulated leukocytes, which were aggregated to pellets of different sizes ranging from 0.26 to 1.0 mm. For better adhesion of the aggregates to the endothelium, endothelial damage was induced by the injection of additional substances, including methomidate and endothelial antibodies. In a further series of experiments systemic hypoxemic conditions were created over several hours prior to injection of the leukocyte aggregates. This resulted in cotton-wool spots and arterial branch occlusions with retinal edema. Furthermore, retinal hemorrhages occurred. This experimental model seems to be appropriate for mimicking retinal arteriolar occlusion syndromes.

Animals↗
PubMed2000

Idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy.

PURPOSE: To report a patient who had concomitant idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy. METHOD: Case report. A 46-year-old black woman presented with sudden onset of "blurring" in the left eye. Her ocular history was unremarkable, and her medical history was relevant for sickle cell disease with yearly episodes of sickle cell crises. RESULTS: Both eyes had evidence of idiopathic polypoidal choroidal vasculopathy and peripheral retinal neovascularization secondary to sickle cell disease. The left eye had hemorrhagic retinal pigment epithelial detachments secondary to idiopathic polypoidal choroidal vasculopathy. CONCLUSION: We present this case as an example of concomitant sickle cell retinopathy and idiopathic polypoidal choroidal vasculopathy. We are unaware of previous reports with these findings.

Anemia, Sickle Cell↗
PubMed2003

The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study.

PURPOSE: To describe the prevalence of retinal microvascular characteristics and their associations with atherosclerosis in elderly, nondiabetic persons. DESIGN AND PARTICIPANTS: Population-based, cross-sectional study comprising 2050 men and women aged 69 to 97 years without diabetes, living in four communities. METHODS: Participants underwent retinal photography and standardized grading of retinal microvascular characteristics, including retinopathy (e.g., microaneurysms, retinal hemorrhages), focal arteriolar narrowing, and arteriovenous nicking. In addition, calibers of retinal arterioles and venules were measured on digitized photographs to obtain an estimate of generalized arteriolar narrowing. Atherosclerosis and its risk factors were obtained from clinical examination and laboratory investigations. MAIN OUTCOME MEASURES: Prevalence of retinal microvascular abnormalities and their associations with measures of atherosclerosis. RESULTS: The prevalence of retinal microvascular abnormalities was 8.3% for retinopathy, 9.6% for focal arteriolar narrowing, and 7.7% for arteriovenous nicking. All retinal lesions were associated with hypertension (odds ratios [OR] were 1.8 for retinopathy, 2.1 for focal arteriolar narrowing, 1.5 for arteriovenous nicking, and 1.7 for generalized arteriolar narrowing). After controlling for age, gender, race, mean arterial blood pressure, and antihypertensive medication use, retinopathy was associated with prevalent coronary heart disease (OR, 1.7), prevalent myocardial infarction (OR, 1.7), prevalent stroke (OR, 2.0), presence of carotid artery plaque (OR, 1.9), and increased intima-media thickness of the common carotid (OR, 2.3; fourth vs. first quartile) and internal carotid (OR, 1.8; fourth vs. first quartile) arteries. In contrast, focal arteriolar narrowing, arteriovenous nicking, and generalized arteriolar narrowing were not associated with any measures of atherosclerosis. CONCLUSIONS: Retinal microvascular abnormalities are common in older persons without diabetes and are related to hypertension. Retinopathy is associated with prevalent coronary heart disease, stroke, and carotid artery thickening, but focal and generalized arteriolar narrowing and arteriovenous nicking are not related to most measures of atherosclerosis. These data suggest that retinal microvascular abnormalities reflect processes associated with hypertension but distinct from atherosclerosis.

Aged↗