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PubMed1990

[Retinochoroidal changes in toxemia of pregnancy with the relation to hypertensive retinopathy and choroidopathy].

Thirty patients who suffered from ocular involvement caused by toxemia of pregnancy were examined ophthalmologically during the nine-year period between 1980 and 1988 at Osaka Medical Center and Research Institute for Maternal and Child Health. The ophthalmoscopic findings were divided into the following five categories: cotton wool patches (CWP), retinal hemorrhages (RH), hard exudates (HE), yellowish opaque foci (YOF) and serous retinal detachments (SRD). Although the first three types of findings were recognized as hypertensive retinopathy (Keith-Wagener III or IV), the last two were recognized as choroidal vascular damage. Based on the frequency of fundus findings, patients were divided into three types: R-type mainly suffered from retinal vascular occlusion (CWP), C-type mainly suffered from choroidal vascular occlusion (YOF, SRD), and R + C-type consisted of mixed vascular occlusion. The maximum systolic blood pressure of C-type patients was significantly lower than that of R-type. The maximum diastolic blood pressure of C-type patients was also significantly lower than those of R-type and R + C-type. There were five C-type cases with systolic blood pressure of less than 160 mmHg in which the choroidal ischemia was concluded not to be hypertensive choroidopathy but a specific alteration characterized by toxemia of pregnancy (hypercoagulopathy).

Adult↗

PubMed1984

Occlusive retinal vascular disease in systemic lupus erythematosus.

Ocular involvement in patients with systemic lupus erythematosus (SLE) is most commonly noted in the form of retinal hemorrhage, exudates and cotton wool spots resulting from occlusion of small retinal blood vessels. Less frequently, SLE is associated with extensive obliteration of larger retinal vessels, as demonstrated in the 2 cases reported here. In both cases large parts of the retina lost their function due to extensive occlusions of retinal arteries and veins. Marked retinal neovascularizations developed in one of the 2 cases. Awareness and early detection of retinal vascular occlusive disease and its complications are important in averting serious visual loss in SLE.

Adolescent↗

PubMed2000

Vitrectomy for macular hemorrhage associated with retinal arterial macroaneurysm.

OBJECTIVE: To evaluate the safety and efficacy of pars plana vitrectomy to treat massive macular hemorrhage caused by retinal arterial macroaneurysm. DESIGN: Retrospective case series. PARTICIPANTS: Eight eyes of eight patients. METHODS: We retrospectively reviewed the charts for eight eyes of eight patients in which pars plana vitrectomy had been performed to remove a massive macular hemorrhage secondary to a ruptured retinal arterial macroaneurysm. In each case, the preretinal/intralamellar hemorrhage was removed, and in three of the eight eyes a subretinal hemorrhage was removed via a retinotomy after clot lysis using tissue plasminogen activator. MAIN OUTCOME MEASURE: Pars plana vitrectomy to treat macular hemorrhage secondary to retinal arterial macroaneurysm. RESULTS: The duration of symptoms ranged from 10 to 80 days (average, 31 days). The preoperative visual acuities ranged from counting fingers to 0.09. Follow-up ranged from 3 to 36 months (average, 19 months). The postoperative visual acuities improved in seven eyes and remained unchanged in one; vision was better than 0.1 in six eyes and better than 0.4 in five. Postoperative complications included a mild vitreous hemorrhage in two eyes, a macular hole in one, and a cataract in two. CONCLUSIONS: Pars plana vitrectomy appears to be relatively safe and effective in treating massive macular hemorrhage caused by a retinal arterial macroaneurysm.

Aged↗

PubMed2000

Clinical factors related to the aqueous levels of vascular endothelial growth factor and hepatocyte growth factor in proliferative diabetic retinopathy.

PURPOSE: To investigate clinical factors related to the aqueous humor levels of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in patients with proliferative diabetic retinopathy (PDR). METHODS: Undiluted aqueous humor was obtained during ocular surgery from 46 eyes of 46 patients and the levels of growth factors were measured using enzyme-linked immunosorbent assays. VEGF and HGF levels were compared with the number of photocoagulation. VEGF and HGF levels in patient groups stratified according to the existence of vitreous hemorrhage, retinal detachment, and fibrovascular membrane were analyzed. And clinical parameters associated with the growth factors were determined by multiple regression analysis. RESULTS: The levels of VEGF decreased significantly as the extent of photocoagulation increased and showed significant positive correlation with the existence of vitreous hemorrhage. There was no significant correlation between VEGF levels and the existence of fibrovascular membrane and traction retinal detachment. The levels of HGF also decreased significantly as the extent of photocoagulation increased, but increased significantly when fibrovascular membrane existed. There were no significant correlations between HGF levels and the existence of vitreous hemorrhage and traction retinal detachment. Concerning systemic conditions, each growth factor has no significant correlation with duration and type of diabetes mellitus, the treatment regimen, the control of hemoglobin A1C, and the existence of hypertension or renal dysfunction. CONCLUSION: The therapeutic effect of panretinal photocoagulation on PDR might be partly exerted by reduction of the levels of VEGF and HGF in ocular fluid. Since the clinical parameters associated with VEGF were different from those associated with HGF, these growth factors might influence the progression of retinopathy in different ways.

Adult↗

PubMed2000

[New examination methods for macular disorders--application of diagnosis and treatment].

To establish a diagnosis or evaluate the efficacy of treatment for macular disorders, we need methods to evaluate the anatomical and functional changes of these disorders. In this article, we describe several studies that we have conducted for 2 years. In section 1, we report our new methods for making a diagnosis and evaluating visual function in macular disorders. In section 2, we describe our trials of these examination methods in treatment. Here is the summary of our results. In section 1, to examine the structures of the macular area, we used a retinal thickness analyzer (RTA), a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph, HRT), and optical coherence tomography (OCT) to measure retinal thickness and assess retinal microstructures. We compared retinal imaging analysis of various macular diseases obtained with these three instruments. With the RTA, we obtained good three-dimensional macular images displayed on a retinal thickness map, but the retinal thickness map did not demonstrate the thickened retina with dense retinal hemorrhages, and high backscattering from hard exudates might obscure the vitreoretinal interface. The HRT three-dimensional topographic image clearly showed the undulation of the retinal surface. However, it took a relatively long time to obtain the HRT image, and we sometimes could not obtain good topographic images because of fixation movement. Examination with the OCT allows confirmation of the retinal cross-sectional structures, such as retinoschisis or cystoid spaces and the vitreomacular interface, such as vitreous traction, that cannot be detected using other conventional methods with high resolution, but high reflectivity from dense hemorrhages obscured the deeper layers of the retinal structures. Measurement of retinal thickness obtained with both the RTA and OCT is highly reproducible, and there was significant correlation between the retinal thicknesses measured with the two instruments. We believe that these three instruments might contribute significantly to early, accurate diagnosis and better monitoring of the therapeutic effects of vitrectomy for macular diseases. In the future, if these fundus imaging analysis instruments can achieve higher resolution and can analyze three-dimensional retinal images, they will provide better information to clinically evaluate macular diseases. We demonstrated vitreous examination and examination from the retinal surface to the deeper retinal layer at the macular area using a scanning laser ophthalmoscope (SLO). The SLO examination with an argon laser and a large confocal aperture was useful for conducting kinetic examination of the vitreous opacity above the macula. With a diode laser and a ring aperture (dark-field mode), it was possible to examine the retina from the deeper retinal layer to the choroids. On the other hand, the SLO also allows us to conduct a functional examination of fixation. We demonstrated that the referred retinal locus of fixation may change during the follow-up period in patients whose central fixation is impaired due to macular disease, and we showed that the fixation behavior was related to the visual acuity. Therefore, the SLO is an ideal instrument for determining the visual field and the visual acuity before and after treatment in patients with macular disease, because of its precise localization of the examination point by directly observing the fundus and by monitoring fixation behavior. Our new program installed in the SLO allows us to complete the quantitative retinal sensitivity evaluation within 2 minutes, which is difficult to do using a conventional SLO program. Furthermore, we demonstrated for the first time that minute functional changes in the retina can be detected by the SLO under low background illuminance. Such changes cannot be detected under conventional conditions. In addition, the extrafoveal visual acuity of normal subjects and patients with macular disease was studied using this new SLO program. The iso-acuity lines could be illustrated by summarizing these results in normal subjects. The SLO acuity of the horizontal meridian is significantly better than that of the vertical meridian, and even in the nasal area adjacent to the optic disc, an acuity of better than 0.1 could be achieved. To evaluate macular function, we also investigated the blood flow of the choroid (CF), the retina (RF), and the choriocapillaris at the fovea (CCF). We investigated the CF in patients with age-related macular degeneration (AMD) using pulsatile ocular blood flow (POBF) measurements. In patients with exudative AMD, the POBF was significantly lower than in patients with nonexudative AMD or in control subjects. Decreased CF may play a role in the development of choroidal neovascularization in AMD. RF was measured using laser Doppler velocimetry (LDV). (ABSTRACT TRUNCATED)

Animals↗

PubMed1992

Acute laser lesion effects on acuity sweep VEPs.

Q-switched neodymium-YAG (infrared) laser lesions at energies up to and including retinal hemorrhages were placed under visual control in the parafovea and the fovea of anesthetized monkeys. Visual-evoked potential (VEP) data were obtained by parallel analog (vector voltmeter) techniques from scalp electrodes in response to high luminance counterphasing sine wave gratings. The gratings were swept downward in spatial frequency to determine an acuity estimate by recording of the VEP magnitude increase onset. Acuity estimates were determined immediately post-exposure and at 15 sec intervals up to 12 min. These were analyzed as a function of laser exposure site and retinal lesion produced. Significant delays in VEP lock-in were demonstrated in subjects that had parafoveal burns or parafoveal subretinal hemorrhages. Foveal burns caused severe short-term fluctuations before a sustained decrease in acuity. Contained foveal hemorrhages produced sustained acuity losses. Foveal exposures that did not produce an immediately visible lesion did not produce measurable changes in VEP response lock-in time. These results probably are independent of visible flash effects and indicate that there may be a transient neural shock effect from parafoveal lesions that can affect the fovea.

Animals↗

PubMedDate not supplied

Dense vitreous hemorrhages predict poor visual and neurological prognosis in infants with shaken baby syndrome.

OBJECTIVE: A retrospective study was performed to examine the relationship between the severity of vitreous hemorrhages and the severity of neurological injury in infants with shaken baby syndrome, and the result of early vitrectomy in these infants. METHODS: Five infants, ages 3 to 8 months, with confirmed child abuse underwent ocular examination and neurological testing to identify varying degrees of vitreoretinal changes and neurological dysfunction. Pars plana vitrectomy was performed on one or both eyes in each infant to remove the vitreous hemorrhage. RESULTS: The three infants with bilateral dense vitreous hemorrhage and multiple subarachnoid hemorrhage and cerebral contusions had poor postoperative ocular and neurological outcomes including light perception (LP) or no light perception (NLP) vision, large retinal holes or tears, retinal ischemia, and severe encephalopathy. The other two infants presented with bilateral subhyaloid and retinal hemorrhages without dense vitreous involvement, along with mild subarachnoid hemorrhage and minimal neurological findings. Following vitrectomy, visual acuities in these infants improved to or remained at the fix and follow state, and both infants improved neurologically. CONCLUSIONS: The presence of dense vitreous hemorrhage in infants with shaken baby syndrome has a poor visual prognosis, due to the frequent concomitant occurrence of significant retinal and visual cortical pathology. In contrast, infants with only intraretinal or subhyaloid hemorrhage tend to have a much better prognosis, with less disruption of both intraocular and intracranial structures.

Battered Child Syndrome↗

PubMed1995

Systemic lupus erythematosus with choroidopathy and serous retinal detachment.

Systemic lupus erythematosus associated ocular manifestations usually consist of cotton-wool spots and retinal hemorrhages. The authors report one case of lupus choroidopathy revealed by bilateral serous retinal detachment, occurring 4 months after a systemic flare-up of the disease. An immune complexes-mediated phenomenon is involved in these manifestations, which are usually controlled by systemic corticosteroids and immunosuppressive agents. Plasma exchanges were successfully applied in this case, resulting in a disappearance of the retinal detachment in one month.

Adult↗

PubMed1999

[Two cases of frosted retinal angiitis with central retinal vein occlusion].

BACKGROUND: Frosted retinal angiitis usually occurs in children, and has a good prognosis. We report two cases of unilateral frosted retinal angiitis in adults. They resulted in visual degradation because of associated central retinal vein occlusion and neovascular glaucoma. CASES: Case 1 was a 36-year-old female. Almost all retinal veins and some retinal arteries had vasculitis in her right eye, and the veins were slightly dilated and sheathed. Case 2 was a 23-year-old female. Angle hypopyon was observed in her left eye. Retinal veins were dilated, meandered, and sheathed. Retinal hemorrhages were also observed. In both cases, systemic steroid therapy gradually improved the retinal vasculitis, but central retinal vein occlusions gradually developed, and in spite of systemic administration of urokinase and panretinal photocoagulation, neovascular glaucoma developed, and visual acuity became degraded in both cases. CONCLUSION: Two cases of frosted retinal angiitis complicated by retinal vein occlusion were reported. Careful observation of retinal blood flow is necessary in frosted retinal angiitis in adults.

Adult↗

PubMed1986

Subdural hematomas in abused children: report of six cases from Japan.

In abused children, subdural hematoma is one of the most common causes of damage to the central nervous system. We report six Japanese cases of child abuse with subdural hematoma and discuss differences from those in the United States. The majority of abused children with subdural hematomas in Japan have suffered direct violence to the face and head, resulting in external signs of trauma. Failure to detect these external traces of trauma, however, might result in an incorrect diagnosis of infantile acute subdural hematoma attributed to accidental trivial head injury. Child abuse with subdural hematoma in the United States is frequently caused by whiplash shaking injury in which external signs of trauma may not be evident. In the United States, retinal hemorrhage and subdural hematoma together suggest child abuse; some cases of infantile acute subdural hematoma might be mistakenly diagnosed as child abuse. Thus, the constellation of retinal bleeding and subdural hematoma combined with the absence of visible signs of trauma is differently interpreted in the United States and Japan.

Child Abuse↗

PubMed2004

Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis.

OBJECTIVE: Retinal hemorrhages (RHs) are 1 manifestation of child abuse, and although they often are considered to be diagnostic of abuse in a young child, there are other potential causes. RHs have been described in association with valsalva maneuver, such as forceful vomiting or coughing. Our aim was to describe the incidence of RH in infants with vomiting caused by pyloric stenosis. METHODS: A prospective, descriptive study was conducted of infants who underwent pyloromyotomy for hypertrophic pyloric stenosis (HPS). Dilated retinal examinations were performed, and the findings were documented. RESULTS: A total of 100 infants with HPS were evaluated. Eighty-four infants were male, 92 were white, and 21 had a family history of pyloric stenosis. Thirty-seven examinations were performed in the operating room. Eighteen examinations were confirmed by a second investigator, and 3 children had dilated eye examinations documented independently by a pediatric ophthalmologist. No RHs were identified (0 of 100; 95% confidence interval: 0%-3%). One patient had facial petechiae, and 2 had subconjunctival hemorrhage. Electrolyte levels were abnormal in 63 patients. In 89 cases, the emesis was described as projectile. Patients varied in the number of episodes of emesis, with 30% of patients having >100 episodes of emesis before diagnosis. One patient had a respiratory arrest associated with vomiting in the emergency department and required bag-valve mask ventilation. CONCLUSIONS: No RHs were identified in 100 infants with vomiting caused by HPS. These results suggest that RHs do not result from forceful vomiting in infants.

Child Abuse↗

PubMedDate not supplied

[Intravitreous hemorrhage caused by retinal tear with a bridge vessel. Discussion on management of 4 cases].

The authors report 4 cases of recurrent vitreous hemorrhage related to retinal breaks without detachment, bridged by a retinal vessel. Clinical and evolutive features of this type of breaks are emphasized according to a review of available literature. Fluoroscopic evaluation of vascular permeability appears as a promising prognostic tool. Management should be directed to the prevention of both retinal detachment and vitreous hemorrhage recurrence. Cryoapplication and scleral buckling is far more effective than photocoagulation.

Aged↗

PubMed1984

Intraretinal neovascularization in diabetic retinopathy.

Nonperfused retinal areas were evaluated in 60 eyes (42 cases) with diabetic retinopathy through repeated fluorescein angiography. Revascularization occurred in the nonperfused area in 40 eyes, due to recanalization in 3 and to intraretinal neovascularization (IRNV) in 39 eyes. Recanalization and IRNV developed in the same fundus in 2 eyes. IRNVs occurred during the nonproliferative state in 11 eyes, concomitant with retinal neovascularization in 14 and after manifestation of proliferative changes in 14. Typically, IRNVs originated from and drained into a retinal venule, showed hairpin-loop at their tips and manifested minimum tendency of dye leakage. No retinal hemorrhage occurred from the IRNVs. Their unexpectedly high incidence and their timely association with retinal neovascularizations point to the importance of IRNVs in the diagnosis of preproliferative diabetic retinopathy.

Adult↗

PubMed2004

Associations between the metabolic syndrome and retinal microvascular signs: the Atherosclerosis Risk In Communities study.

PURPOSE: To examine the cross-sectional relationship of the metabolic syndrome (hypertension, hyperglycemia, central obesity, and dyslipidemia) and retinal microvascular abnormalities in middle-aged men and women. METHODS: A population-based, cross-sectional study involving 11,265 persons aged 49 to 73 years who had retinal photography from 1993 through 1995. Photographs were graded for presence of retinal microvascular signs (microaneurysms, retinal hemorrhages, arteriovenous nicking, and focal arteriolar narrowing) according to a standardized protocol. To quantify retinal vessel diameters, photographs were digitized and individual arteriolar and venular diameters were measured and summarized. The metabolic syndrome was defined according to the Third Report of the National Cholesterol Education Program Adult Treatment Panel. RESULTS: After adjustment for age, gender, race, education, cigarette smoking and alcohol consumption, persons with the metabolic syndrome were more likely to have retinopathy (odds ratio [OR] 1.68, 95% confidence interval [CI], 1.45-1.96), arteriovenous nicking (OR 1.30, 95% CI, 1.16-1.45), focal arteriolar narrowing (OR 1.24, 95% CI, 1.10-1.38), generalized retinal arteriolar narrowing (OR 1.23, 95% CI, 1.12-1.35), and generalized retinal venular dilatation (OR 1.30, 95% CI, 1.18-1.48) than persons without the metabolic syndrome. Associations for arteriovenous nicking, focal arteriolar narrowing, generalized arteriolar narrowing, and venular dilatation were noted, even in people without diabetes or hypertension. CONCLUSIONS: These data suggest that the metabolic syndrome is associated with microvascular changes in the retina. This finding reflects, in part, the associations of individual syndrome components with retinal microvascular abnormalities.

Aged↗

PubMed1988

The diagnosis of cytomegalovirus retinitis.

Immunosuppressed patients are at risk for developing cytomegalovirus retinitis. This disorder is the most common cause of vision loss in patients with the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus retinitis is probably the result of hematogenous spread of the virus to the retina after systemic reactivation of a latent cytomegalovirus infection. Although the ophthalmic infection may initially be asymptomatic, the retinal necrosis it produces may result in both loss of visual field and decreased visual acuity. Routine screening of these patients is required for early diagnosis. The retinitis is detected with ophthalmoscopy as either a perivascular yellow-white retinal lesion frequently associated with retinal hemorrhage or as a focal white granular infiltrate, often without hemorrhage. Both lesions enlarge in a progressively expanding "brushfire" pattern. The diagnosis of cytomegalovirus retinitis, as well as the evaluation of its response to therapy, is determined primarily by clinical criteria. Serial retinal photography is an objective method to assess the changing appearance of these lesions. Ganciclovir and foscarnet are investigational antiviral drugs that appear to be effective in treating cytomegalovirus retinitis. However, maintenance therapy with these medications is required after initial treatment because the disease often relapses. The combined expertise of the internist and the ophthalmologist is needed to diagnose and treat these patients.

Acquired Immunodeficiency Syndrome↗

PubMed1976

Acute glaucoma in hemorrhagic fever with renal syndrome (nephropathia epidemica).

Bilateral eyelid edema, chemosis, conjunctival injection and hemorrhages, shallowing of the anterior chamber with transitory myopia, and acute glaucoma were observed in three patients with hemorrhagic fever with renal syndrome (nephropathia epidemica). One patient had anterior uveitis with posterior synechiae. Two patients had congestion of retinal venules and retinal edema, and one patient had small retinal hemorrhages. Fluorescein angiography revealed early leakage of the conjunctival capillaries and delayed filling of the lower retinal arterioles with retinal edema. The acute glaucoma subsided rapidly. The myopia disappeared slowly with a gradual deepening of the anterior chamber after onset of the diuretic phase of the illness. In nephropathia epidemica, the transitory shallowing of the anterior chamber, myopia, and acute glaucoma are due to lesions in the small blood vessels of the ciliary body, resulting in its swelling, with relaxation of the zonules and forward movement of the lens.

Acute Disease↗

PubMedDate not supplied

Posterior segment involvement in ocular Behçet's disease.

PURPOSE: Posterior segment involvement, which can lead to blindness with recurrent inflammatory attacks, has a very important prognostic value in ocular Behçet's disease (BD). This study evaluated the frequency and characteristics of posterior segment involvement and the causes of visual impairment in patients with ocular BD. METHODS: We retrospectively evaluated 257 eyes of the 131 patients who were followed from 1993 to 2001 in the Uveitis and BD division of SSK Ankara Eye Hospital, Turkey. RESULTS: The mean follow-up was 49.2 +/- 27.4 months. Thirty-one of the palents were female (23.6%) and 100 male (76.4%). The mean age was 25.1 +/- 7.9. Fundus changes were observed in 213 (82.9%) eyes and were bilateral in 87%, and vitritis was present in 239 (93%) eyes. The most frequent fundus changes were vascular sheathing in 61 eyes (23.7%), optic atrophy in 46 (17.9%), macular edema in 29 (11.3%), retinal hemorrhage in 23 (9%), macular scar in 21 (8.2%), optic disc paleness in 19 (7.4%), retinal edema in 17 (6.6%), branch retinal vein occlusion in 15 (5.8%). The most common fluorescein angiography findings were diffuse vascular leakage in 98 (38%), hyperfluorescence of the optic disc in 38 (14.8%) and hyperfluorescence of the macula in 29 eyes (11.3%). Visual acuity was <1/10 in 85 (33%) of the eyes. Optic atrophy was the main cause (54.1%) of permanent visual impairment. CONCLUSIONS: Posterior segment involvement is the most serious ocular complication of BD, leading to blindness with recurrent attacks. Following patients closely, performing fluorescein angiography in all patients diagnosed as BD even they have no clinical ocular involvement, and early treatment are very important in the prognosis of the disease.

Adolescent↗

PubMedDate not supplied

Comparison of a digital retinal imaging system and seven-field stereo color fundus photography to detect diabetic retinopathy in the primary care environment.

BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician regularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologist was evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 11 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on "no retinopathy" versus "any retinopathy" was excellent (Kappa = 0.96). Agreement based on "microaneurysms or less retinopathy" versus "retinal hemorrhages or worse retinopathy" was very good (Kappa = 0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.

Adolescent↗