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At least 109 records · Page 6Linked to original sources

Neonatal retinal hemorrhages and influence of perinatal factors.

We studied fundus oculi in 234 newborns, divided into two groups of mothers and neonates with or without disease. The overall frequency or retinal hemorrhages was 30.3% (71 neonates). In each group, we studied the association between retinal hemorrhage and several variables of labor and the newborn infant. Statistically significant differences were found in the incidence of hemorrhage in one (2.6%) neonate born by cesarean section, as compared with 61 (38%) spontaneous or 9 (25%) forceps delivery.

Birth Injuries↗

Sequential cranial computed tomography in infants with retinal hemorrhages.

Five whiplash-shaken infants presented initially with lethargy, vomiting, irritability, and intraocular hemorrhage and had sequential cranial computed tomography (CT). In three of the five infants, results of the initial CT scans of the head were either normal or demonstrated subtle abnormalities. However, significant subdural hemorrhages which were demonstrated by subdural aspiration developed subsequently in all three infants. Results of repeat CTs of the head showed progressive ventricular dilation and symmetrical bilateral fronto-parietal subdural hematomas. The retinal hemorrhages preceded both the clinical and radiologic recognition of subdural hematoma. Results of the initial head CT of the remaining two children showed intracerebral hemorrhages, cerebral edema and subsequently subdural hematoma. The finding of unexplained retinal hemorrhages in some infants, even though the initial CT head scan may show only minimal changes, warrants monitoring of the head circumference, fundus, and repeat head CT as indicated.

Brain↗

Retinal hemorrhage in retinopathy of prematurity associated with tocopherol treatment.

Two hundred eighty-seven infants were enrolled in a double masked, randomized, placebo controlled trial of early parenteral tocopherol given from day one. Among the 232 survivors with ophthalmologic follow-up, retinal hemorrhages occurred more frequently in the tocopherol group (16/111; 14.4%) than in the placebo group (8/121; 6.6%). The development of retinal hemorrhages correlated strongly with plasma tocopherol levels from three weeks to three months (P less than 0.05). Future studies of tocopherol should be aware of potential bleeding diatheses, and study this prospectively.

Cerebral Hemorrhage↗

Bilateral papilledema with retinal hemorrhages in association with cerebral venous sinus thrombosis and paroxysmal nocturnal hemoglobinuria.

PURPOSE: To report a patient with paroxysmal nocturnal hemoglobinuria who complained of transient obscurations of vision and exhibited bilateral papilledema with retinal hemorrhages. METHODS: Case report. Computed tomography did not demonstrate any abnormality but magnetic resonance imaging disclosed signs of cerebral venous sinus thrombosis. RESULTS: The patient was treated with subcutaneous low molecular weight heparin and intravenous corticosteroids. Symptoms improved within one week and ophthalmoscopic signs resolved within four months. CONCLUSION: Bilateral papilledema with extensive retinal hemorrhages may be a sign of cerebral venous sinus thrombosis, a reported devastating complication of paroxysmal nocturnal hemoglobinuria. Thus, any patient with suspected cerebral venous sinus thrombosis should undergo magnetic resonance imaging, even when results of computed tomography are normal.

Anticoagulants↗

Cerebral computed tomography in newborn children with large retinal hemorrhages.

Cerebral computed tomography was performed in 10 neonates with large retinal hemorrhages compared with a control group of 10 full-term neonates without such hemorrhage. No signs of intra-cranial hemorrhage were found. The cerebral ventricles were poorly visualized in both groups. Periventricular low attenuation areas was a frequent finding in both groups.

Brain↗

Retinal hemorrhages associated with ocular decompression after glaucoma surgery.

Two cases of retinal hemorrhages in glaucomatous eyes associated with ocular decompression following glaucoma filtration surgery are presented. Both patients were young, healthy men with markedly elevated preoperative intraocular pressures (IOPs). The hemorrhages were blot shaped and scattered throughout the macula (including the fovea) in each eye that underwent surgery. One eye had hemorrhages with distinct white centers. Each eye that underwent surgery experienced a permanent decrease in visual acuity after resolution of the hemorrhages. A gradual decrease of IOP preoperatively and intraoperatively is recommended in order to avoid this complication.

Adult↗

Retinal hemorrhages in the preterm neonate. A prospective randomized study comparing the occurrence of hemorrhages after spontaneous versus forceps delivery.

The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29-35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28-35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.

Delivery, Obstetric↗

Retinal hemorrhages from septic emboli in a patient with a ventricular false chorda.

PURPOSE: To demonstrate ophthalmic findings of bacterial endocarditis in a patient with a cardiac structural anomaly and to illustrate the potential usefulness of transesophageal echocardiography in the examination of such patients. METHODS: We examined a patient with bacteremia who had white-centered retinal hemorrhages. Complete clinical, laboratory, and echocardiographic evaluations were performed. RESULTS: Streptococcal bacteremia was proven and, by using transesophageal echocardiography, a ventricular false chorda was demonstrated. CONCLUSIONS: Patients with white-centered retinal hemorrhages should undergo thorough systemic examinations. In this unusual case of such hemorrhages caused by bacteremia in a patient with a ventricular false chorda, modern, high-resolution transesophageal echocardiography played an important role in confirming the diagnosis.

Adult↗

Lack of correlation between umbilical artery pH, retinal hemorrhages and Apgar score in the newborn.

Measurement of pH was carried out in blood from the umbilical artery in 100 uncomplicated deliveries immediately after birth. The data were correlated with the results of fundoscopic examination carried out on the same infants within the subsequent 24 h. No relationship could be demonstrated between the grade of retinal hemorrhages and the cord blood pH measurements. Similarly, none of the neonatal birth parameters, including Apgar scores, could be related to individual differences in umbilical blood pH or the incidence or grade of retinal bleedings. The duration of bearing down was significantly and positively correlated (p less than 0.001) to the degree of acidosis in the umbilical blood. It is concluded that the presence of retinal hemorrhages provides little or no information about neonatal wellbeing or the impact of spontaneous birth on the fetus.

Acidosis↗

Senile disciform macular degeneration complicated by massive hemorrhagic retinal detachment and angle closure glaucoma.

Six eyes developed angle-closure glaucoma secondary to total hemorrhagic retinal detachment that occurred as a rare complication of senile disciform macular degeneration. The patients were all elderly with known senile macular choroidal degeneration. They had no history of eye surgery and experienced sudden loss of vision followed by pain. Balloons of retinal detachment were pushed tightly against the lens in a characteristic "Y suture" appearance causing shallowing of the anterior chamber and glaucoma. Pathologic examination of three eyes revealed that the choroid was not detached but that a massive subretinal hemorrhage was present. Neovascular tissue in macular disciform lesions was found in every case and was the probable source of hemorrhage. Sheets of avulsed retinal outer segments were seen incarcerated in subretinal blood in two cases, and drainage of this subretinal blood in three cases did not restore useful vision.

Aged↗

Diffuse retinal hemorrhages (ocular decompression syndrome) after trabeculectomy with mitomycin C for neovascular glaucoma.

PURPOSE: To describe a case of ocular decompression syndrome in a patient after trabeculectomy with mitomycin C for neovascular glaucoma. RESULTS: Diffuse retinal hemorrhages developed in the posterior pole of a patient with neovascular glaucoma after he underwent trabeculectomy with mitomycin C. The hemorrhages persisted for less than 9 months. CONCLUSIONS: Acute decompression of the eye in patients with high intraocular pressure can lead to the development of posterior pole hemorrhages. The course of this rare syndrome is relatively benign.

Aged↗

Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse.

The presence and location of ocular hemorrhages were prospectively studied in 169 randomly selected child deaths referred to a medical examiner. Causes of death in the study group included natural diseases and various injuries involving the head, trunk, and asphyxia. Retinal hemorrhages were identified in 70 cases: 62 head injuries, four central nervous system diseases (but not other natural diseases), and four deaths of undetermined cause. The presence of retinal, peripheral retinal, optic nerve sheath, and intrascleral hemorrhages were strongly associated with head injury as compared to other injuries and natural diseases (Yates corrected P-values < 0.001). Among the head-injured with retinal hemorrhages, nine had a history of severe traumatic event (e.g., an unrestrained rear-seat passenger in high-speed collision) and 53 were victims of inflicted injury (e.g. violent shaking). In the absence of a verifiable history of a severe head injury or life-threatening central nervous system disease, retinal and ocular hemorrhages were diagnostic of child abuse.

Asphyxia↗

Acute angle-closure glaucoma from spontaneous massive hemorrhagic retinal or choroidal detachment. An updated diagnostic and therapeutic approach.

Acute angle-closure glaucoma from a spontaneous massive hemorrhagic retinal or choroidal detachment occurred in five eyes. The source of the hemorrhagic detachment was a disciform macular lesion in all instances. The mechanism for the angle closure is the abrupt forward displacement of the lens-iris diaphragm resulting from the massively detached choroid and retina. Four of the five patients had either systemic hypertension or a primary or anticoagulant-induced clotting disorder. All patients underwent ultrasonographic studies, and one patient had magnetic resonance imaging (MRI) to rule out melanoma. Only one eye required enucleation for pain relief. Glaucoma medication, cyclophotocoagulation, or retrobulbar alcohol controlled the other four eyes. The clinical, ultrasonographic, MRI, and histopathologic features of this rare condition are described, and an updated therapeutic approach is discussed.

Acute Disease↗

[Retinal hemorrhages after ivermectin treatment for onchocerciasis in a patient with Loa loa microfilaremia].

A case of retinal hemorrhages with special features and degradation of the general condition is reported in a 27-year-old female patient, following the ingestion of ivermectin for the treatment of onchocerciasis. The patient was infested by both Onchocerca volvulus and Loa loa. A bilateral peripheral temporal location of the retinal lesions was observed. The role of L. loa microfilarial load in the occurrence of the retinal lesions as well as the transient character of the lesions are discussed, based on the clinical observation and with reference to the literature. The authors call for setting up a rapid therapeutic system to take care of serious adverse reactions following treatment with ivermectin in areas with a high prevalence of L. loa infestation.

Adult↗

[Matas procedure in the treatment of spontaneous carotid cavernous sinus fistula: a complication of retinal hemorrhage].

We herein report three cases of the dural internal type of spontaneous carotid cavernous sinus fistula (SCCF) which seemed to be improved by the Matas procedure. Sequential cerebral angiography revealed that thrombosis formation in the peripheral side of the draining vein resulted in a closure of the fistula. During this course of spontaneous regression, retinal findings were transiently exacerbated in some cases. The retinal hemorrhage seemed to be induced by central retinal vein occlusion and hypoxic retinopathy which preceded the spontaneous regression of SCCF. It was confirmed that the Matas procedure should be tried as the first choice for the treatment of SCCF, particularly in the dural internal type. However, fundus findings must be carefully monitored.

Arteriovenous Fistula↗