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PubMedDate not supplied

The challenge of preventing vision loss from diabetic retinopathy.

Diabetes is present in 7% of Missourians. Another 52% are at risk. Periodic eye examinations are key to averting vision loss from diabetic retinopathy. Signs of diabetic retinopathy are evident long before vision loss and include microaneurysms, retinal hemorrhage, microvascular and venous caliber abnormalities and neovascularization. Loss of vascular integrity can lead to retinal edema and neovascular growth. Laser ablation of the peripheral retina can curb neovascular growth. It can also help stabilize macular edema.

Blindness↗

PubMed1998

Nd:YAG laser photodisruption for preretinal hemorrhage due to retinal macroaneurysm.

PURPOSE: To document the clinical course of Nd:YAG laser photodisruption for eyes with preretinal hemorrhage following rupture of a retinal macroaneurysm. METHODS: We reviewed six eyes of five patients with preretinal hemorrhage due to retinal macroaneurysm that received Nd:YAG laser photodisruption. Nd:YAG laser created a focal opening in the anterior surface of the preretinal hemorrhage, permitting the blood to enter the vitreous cavity where it would be absorbed more rapidly. RESULTS: Three eyes showed both subhyaloid hemorrhage, which was resorbed without treatment within 2 months, and hemorrhagic detachment of the internal limiting membrane (ILM), which required Nd:YAG laser photodisruption. All eyes showed disappearance of the preretinal hemorrhage and improvement of vision within 1 week of Nd:YAG laser photodisruption. Visual recovery was less prominent in eyes associated with subretinal macular hemorrhage. CONCLUSION: Preretinal hemorrhage due to a ruptured retinal macroaneurysm could be dispersed into the vitreous cavity with Nd:YAG laser photodisruption. It should be considered in the decision of Nd:YAG laser photodisruption that the visual increment may be limited in eyes that also have subretinal hemorrhage in the macula and that the hemorrhage beneath the ILM tends to remain longer than the subhyaloid hemorrhage.

Aged↗

PubMed1991

Ocular injuries caused by elastic cords.

Five patients with ocular trauma due to elastic cords with attached metal or plastic hooks were evaluated over a 13-month period. Injuries included hyphema, angle recession, lens subluxation, choroidal rupture, vitreous hemorrhage, retinal detachment, and scleral rupture. Two patients suffered penetrating ocular injuries, and three patients had final visual acuities of 20/200 or less. This series emphasizes the potential severity of ocular injury due to these commonly used devices and reiterates a modification in design that might decrease the likelihood of accidental trauma from elastic cords.

Adult↗

PubMed1989

[Intermediate uveitis].

Intermediate uveitis is diagnosed in about 10% of the patients seen at the "Uveitis Clinic" of the Second Department of Ophthalmology of Vienna University. Forty-nine patients (with 83 eyes showing signs of the disease) were followed up for between six months and 12 years. Bilateral involvement was seen in 34 patients. The average age of the 27 female patients at the time of diagnosis was 26.2 years, that of the 22 male patients 24.6 years. All the eyes affected showed distinct vitreous opacities; 80% developed exudates overlying the pars plana and 70% showed a mild anterior chamber reaction. Posterior synechiae were found in 10% of the eyes, swelling of the optic disk in 15%, retinal vaso-proliferation in 10%, and dense intravitreal membranes in 6%. Posterior subcapsular cataract, vitreous hemorrhage, retinal detachment, band keratopathy, and atrophy of the eye were rarely seen. The complication most frequently and severely reducing central visual acuity was cystoid macular edema (30%). Whereas 31 patients did not require any treatment over the course of the observation period, it was found that oral corticosteroid therapy led to a significant improvement in vision in 14 patients (20 eyes) with CME. Only few patients required a combination of corticosteroids and Ciclosporin-A as long-term therapy. Vitrectomy and scleral buckling operations were rarely performed.

Adolescent↗

PubMed1976

Use of conjugated estrogens in eye diseases.

Presomen, a preparation of natural conjugated estrogen has been applied to 81 ophthalmologic patients. Some patients received it as a preoperative measure for the prevention of hemorrhages, others were treated with the drug in order to facilitate the absorption of vitreous and retinal hemorrhages. The effect of the preparation on capillary fragility has likewise been studied. The literature contains contradictory reports on the mode of action of conjugated estrogens. Clinical observations show conjugated estrogens suitable for the prevention of hemorrhages in connection with surgical interventions.

Capillary Fragility↗

PubMed1988

[Eales' disease with neurologic disorders].

Two cases of Eale's disease, with neurological involvement have been studied with magnetic resonance imaging (MRI). In the first case the ophthalmological disease had been diagnosed ten years before the onset of a cerebellar ataxia. In the second case the characteristic ocular changes were followed eight years later by a myelopathy. MRI in both cases showed multifocal white matter abnormalities. The nosological interpretation of such cases remains uncertain: association of Eale's disease with multiple sclerosis or vasculopathy involving the central nervous system and the retina?

Adult↗

PubMed1982

Cardiovascular toxic effects of VM26 in the treatment of acute lymphatic leukemia. Presentation of two cases.

Two cases of acute lymphatic leukemia treated with VM 26 underwent a severe cardiovascular syndrome with hypertension and cardiac failure. The first patient, a 9-year-old boy, after the appearance of hypertension suffered from serious cerebral hemorrhages which were lethal. The second patient, a 12-year-old boy, also developed hypertension with retinal hemorrhages and cardiac failure. Hypertension was, however, controlled, the patient recovered, and at present he is in remission. Although cardiovascular toxic effects are not frequent after administration of VM 26, they should be known to the medical oncologist so that treatment of this side effect may be introduced at the first appearance of the symptoms.

Cardiovascular System↗

PubMedDate not supplied

[Ophthalmologic manifestations of acquired immunodeficiency syndrome (AIDS) in central Africa].

In central Africa, the authors have performed an ophthalmological examination of 77 adult patients (18-55 years) with AIDS: 33.7% had ocular abnormalities. Frequent manifestations included cotton-wool patches and retinal hemorrhages, while lacrymal hyposecretion, palpebral and conjunctival kaposi sarcoma, ocular palsy, ptosis, herpes zoster, papillar oedema, cytomegalovirus retinitis and periphlebitis were less frequent. The authors underline the necessity to perform an ocular examination for each patient with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1997

[High altitude retinopathy after Himalayan ascent].

BACKGROUND: Visual disturbances after high altitude exposure were first reported in 1969. Later, the term "High Altitude Retinal Hemorrhage-HARH" has been used for the ensuing retinal hemorrhages and vascular engorgement. CASE REPORT: A 31-year-old Caucasian male presented to our outpatient department 1 week after climbing Mt. Gosainthan in the Himalayas. He had spent 25 days without oxygen supply above 5000 meters, with a maximum of 8046 meters. He now complained of glare and decreased vision in twilight. Visual acuity was 20/25 OD and 20/20 OS. Ophthalmoscopy revealed intraretinal hemorrhages and tortuosity of dilated arterioles and venoles. After 6 weeks of gradual improvement, visual acuity was 20/20 OD and 20/16 OS with normal visual fields. DISCUSSION: The hypoxia at high altitude causes increased retinal blood flow and blood volume possibly via autoregulatory mechanisms. Furthermore, retinal venous pressure can be increased by extreme physical exertion and Valsalva maneuvers during mountain climbing. A hypoxic retinal capillary bed exposed to increased retinal venous pressure predisposes to intraretinal hemorrhage. Retinal changes include marked increase of retinal vessel diameter with tortuosity of arterioles and venoles and hyperemia or edema of the optic disc. The intra- or preretinal hemorrhages often spare the macular area. These patients do not experience debilitating symptoms unless vitreous hemorrhage occurs. This may be potentially hazardous when the patient is still in the high mountains. Clinically, all these retinal changes are reversible within weeks. To prevent high altitude retinopathy, ascending slowly and use of supplemental oxygen is recommended.

Adult↗

PubMed1989

Retinal macroaneurysms treated with the yellow dye laser.

Retinal macroaneurysms, and their sequelae of retinal hemorrhage, exudate, edema, and serous detachment of the macula, may lead to decreased central visual acuity. We studied twelve patients with retinal macroaneurysms and decreased or threatened central vision who underwent laser photocoagulation of the macroaneurysm using the yellow (577 nm) wavelength of an ophthalmic tunable dye laser. In all cases, the macroaneurysm was "obliterated", with resolution of hemorrhage, exudate, edema, or serous macular detachment; in eight of the twelve cases, the visual acuity improved following treatment. There were no complications due to the photocoagulation.

Aged↗

PubMed1994

Ocular and optic nerve hemorrhages in abused infants with intracranial injuries.

PURPOSE: To ascertain whether the pathology of the eye and optic nerve might be useful in determining the manner of death in infants who died after sustaining apparent nonaccidental intracranial injury. METHODS: Complete autopsies were performed on 13 infants who died of acute intracranial injuries after nonaccidental trauma. The infants were divided into two groups: nine with physical evidence of blunt trauma to the head, and four without detectable scalp or skull injury whose intracranial injuries were attributed to violent shaking (shaken baby syndrome). Six infants with no intracranial injuries who died suddenly from unidentifiable causes (the so-called sudden infant death syndrome) served as controls. RESULTS: Optic nerve sheath hemorrhage, most prominent in the subdural space, was present in all 13 infants with nonaccidental intracranial injury. Multilayered retinal hemorrhage was present in at least one eye of 11 of these 13 infants. The location and quantity of the intraocular and optic nerve sheath hemorrhages did not differ in those with external head trauma and those without scalp or skull lesions. A single control infant had a few erythrocytes in the nerve fiber layer of the anterior optic nerve of one eye. The remainder of the control infants did not have evidence of hemorrhage in the eye or optic nerve sheath. CONCLUSION: Histopathologic analysis of optic nerve sheath and intraocular hemorrhages may be helpful in distinguishing traumatic from non-traumatic causes of death in infants.

Battered Child Syndrome↗

PubMed2002

[Ocular complications in systemic lupus erythematosus--choroidal and retinal pigment epithelial changes].

PURPOSE: Cotton wool patch and retinal hemorrhage are common ocular findings in systemic lupus erythematosus(SLE). Immunosuppressive treatment with corticosteroids may modify choroidal and retinal findings. We examined ocular complications, mainly choroidal and retinal pigment epithelium (RPE) changes in patients with SLE. MATERIALS AND METHODS: Fifty SLE cases[3 males, 47 females, 41 +/- 15 (mean +/- standard deviation) year-old] were examined and treated in the departments of Internal Medicine and Ophthalmology of Osaka University Medical Hospital. RESULTS: Complications included cataract in 16 cases, glaucoma or ocular hypertension in 9 cases, and choroidal and retinal changes in 15 cases. Occlusive retinal vasculitis, retinal pigment epithelial dysfunction, such as pigment epithelial detachment, choroidal neovascularization and multiple posterior pigment epitheliopathy, in 6 cases, and branch retinal vein occlusion in 2 cases were detected as fundus complications. Average time period from the first detection of SLE was 13 years in patients with RPE changes. CONCLUSION: Long term corticosteroid therapy is probably responsible for the RPE complications.

Adult↗

PubMed1991

[Retinochoroidopathy and systemic state in toxemia of pregnancy].

We carried out a retrospective study of 74 patients with toxemia of pregnancy with reference to retinochoroidal complications. Thirty-two patients (43.2%) had overt retinochoroidal disease; 23 cases (group A) showed retinal hemorrhages and cotton-wool spots compatible with hypertensive retinopathy, while 9 cases (Group B) had widespread serous retinal detachment associated with choroidal vasculopathy. There was no significant difference between the two groups in the severity of toxemia of pregnancy, in the hematologic examinations or in the fetal prognosis, although Group A showed a higher rate of fetal mortality, and Group B had a more significantly decreased platelet count and lower concentration of fibrinogen that may indicate a mild form of chronic disseminated intravascular coagulopathy.

Adult↗

PubMedDate not supplied

[Surgical treatment of post-contusion orbital hematoma in the late phase].

OBJECTIVE: The object of the study was to present successfully performed decompression of the orbit in orbital hematoma. MATERIAL AND METHODS: Male, 51 years of age sustained the contusion injury of the right eye during his fall on the bath tap. It caused the development of a large orbital hematoma with protrusion, restricted movement of the eyeball, pain, diplopia, folding of the retina due to hemtoma compression to bulbus oculi and retinal hemorrhages, higher intraocular pressure and impaired visual acuity to 2/60. He was treated by medicaments for a month, but the results were not favorable. After one month from the injury, anterior-inferior transcutaneous orbitotomy was performed. During the surgical intervention, hematoma and a part of orbital fat tissue were removed. RESULTS: The globe of the eye was retracted and the exophthalmos disappeared immediately after the surgery, while the mobility of the eyeball, disappearance of retinal folds with gradual receding of hemorrhage, normal intraocular pressure, abatement of pain and diplopia as well as the restoration of visual acuity to normal ensued in a few subsequent days. CONCLUSION: This study illustrated that decompression of the orbit in orbital hematoma might be successful even in the late phase, e.g., one month following the injury. It is assumed that surgical intervention would be performed by experienced orbital surgeon.

Contusions↗

PubMed2006

[Preliminary report of Nd: YAG laser embolysis for branch retinal artery occlusion].

OBJECTIVE: In this study, the clinical effect of the Nd: YAG laser embolysis on branch retinal artery occlusion was evaluated. METHODS: A fundus contact lens was used to focus the Nd: YAG laser on the embolus within the retinal arteriole. 0.8 to 0.9 mJ of laser pulse was delivered directly to the embolus. Fundus photographs were taken before and immediately after the treatment. Follow-up time ranged from 2 weeks to 4 months, average about 7 weeks. Seven cases received the treatment, including 5 male and 2 female patients. Age of those cases ranged from 49 to 73, average 61 years. The duration of the disease ranged from 1 to 60 days, average 13 days. RESULTS: Before treatment, visual acuity ranged from 0.06 to 0.8. Embolus can be detected in all the 7 cases. After treatment, all the cases showed immediate recovery of blood flow in the occluded arteriole both in fundus examination and fundus fluorescein angiography. The vision in the patients was improved in the follow-up. Visual acuity ranged from 0.2 approximately 1.0. In most cases, visual field defect still existed in the ischemic area. Complications included local retinal hemorrhages in some cases and vitreous hemorrhage, but those hemorrhages were gradually absorbed and did not affect the final visual prognosis. CONCLUSIONS: Nd: YAG laser embolysis for branch retinal artery occlusion is an effective treatment and the treatment is relatively safe.

Aged↗

PubMed1983

Retinitis pigmentosa: clinical observations and correlations.

This thesis presents the results of a study of 384 eyes of 192 patients with a mean age of 39.1 years who presented with typical retinitis pigmentosa. The major findings are outlined below, together with suggested hypotheses: Cataract was found in 46.4% of the eyes. Among these, 93.6% showed posterior subcapsular opacification. The incidence of cataract increased with age. The vitreous degeneration that is characteristic of the RP syndrome and begins in childhood was described as showing dust-like, particulate matter throughout the gel; posterior vitreous separation; formation of a posterior matrix of coarse, white, interconnected strands and opacities; and final collapse of the residual gel. Ultrastructural studies of vitreous material from eight eyes revealed that the particles were isolated pigment granules and the coarse strands were composed of condensed collagen fibers. Notwithstanding the vitreous degeneration and prevalence of myopia in RP, neurosensory retinal breaks and/or rhegmatogenous detachment were found in only 7 (1.8%) of the 384 eyes studied. Premature separation of the vitreous from the retina, absence of lattice retinal degeneration, and perhaps a stronger than normal RPE-neurosensory retinal bond are thought to be possible protective factors. Rather than searching for a "toxin," elaborated by diseased retina, that causes vitreous degeneration and cataract formation, it is suggested that the ocular media be studied for an absence of moieties that are normally produced by healthy retina for vitreous and lens maintenance. The classic criteria for diagnosis of RP were met by 96.3% of eyes that showed retinal vascular attenuation and by 52.0% that showed pallor of the optic disc. Less frequent manifestations included solitary retinal hemorrhage, peripheral microaneurysms, telangiectasia, and fluorescein leakage at the macula and disc. Seven additional cases with a Coats'-like retinal detachment were added to the 14 already presented in the literature. Two of the seven had autosomal dominant RP, the first such cases reported. The vascular malformations and detachments were most often inferior. Unlike typical Coats' syndrome, the condition was usually bilateral, showed no sex preference, and appeared to affect older individuals.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2002

Combined central retinal arterial and venous obstruction: emergency ophthalmic arterial fibrinolysis.

PURPOSE: To investigate the role of urokinase selectively perfused into the ophthalmic artery as an emergency treatment for combined central retinal arterial obstruction (CRAO) and central retinal venous obstruction (CRVO). MATERIALS AND METHODS: Over a 6-year period, 11 consecutive patients presented with recent combined CRAO and CRVO (< or =72 hours). Urokinase (300,000 IU) was selectively perfused via the femoral artery into the ophthalmic artery for 40 minutes. Evaluation criteria were Snellen visual acuity with best correction, funduscopic results, and retinal arteriovenous transit time assessed over a mean 3.5-year follow-up. Mean vision and retinal perfusion were tested by means of repeated-measures analysis of variance. The correlation between visual improvement and retinal perfusion improvement was evaluated by means of Spearman rank correlation. RESULTS: Substantial improvement in vision and retinal perfusion was noted in seven of the 11 patients treated. Mean vision improvement was significant (P =.009) within 24-48 hours after fibrinolysis, increased until 1 month after (P =.006), then remained stable throughout the follow-up (P >.10). Visual improvement correlated with retinal perfusion improvement during the period from before fibrinolysis to 24-48 hours after (P =.028). In all patients with improved results, retinal hemorrhages transiently increased. One patient had intravitreal hemorrhage shortly after fibrinolysis. CONCLUSION: For this uncommon clinical entity, which typically has a poor visual outcome, these results suggest that ophthalmic arterial fibrinolysis may restore retinal perfusion, which leads to rapid substantial visual improvement in many cases of combined CRAO and CRVO, without systemic complications, but it may be responsible for intravitreal hemorrhage.

Adult↗

PubMedDate not supplied

Central retinal vein occlusion in young adults.

Central retinal vein occlusion (CRVO) is usually seen in older adults and is often associated with systemic vascular disease. CRVO can be seen in young adults, and although it is occasionally associated with a systemic disease, in the majority of cases it occurs in an otherwise healthy patient with no known systemic disease or ocular problem. Inflammation of the central retinal vein has been proposed as a cause of the occlusion in young adults and for that reason it has been called papillophlebitis. The appearance of unilateral optic disc edema, dilatation, and tortuosity of the major retinal veins with a variable amount of retinal hemorrhage in young, healthy adults with complaints of blurred vision or photopsias has been called, in addition to papillophlebitis, benign retinal vasculitis, optic disc vasculitis, nonischemic CRVO, big blind spot syndrome, and presumed phlebitis of the optic disc. An approach to the diagnostic evaluation of the young adult with CRVO is presented. Although most eyes recover vision to better than 20/40, about one-fifth have significant visual loss, and many suffer ocular sequelae. Many treatment modalities have been tried for this entity, but no conclusive evidence exists that any treatment alters its natural history.

Adolescent↗