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Bilateral retinal hemorrhages from megaloblastic anemia: case report and review of literature.

A 33-year-old woman who was a chronic alcohol abuser and had bilateral visual loss was found to have megaloblastic anemia with thrombocytopenia. Both fundi showed retinal venular dilatation and tortuosity, superficial and deep intraretinal hemorrhages, white-centered retinal hemorrhages, and optic disc edema. Her megaloblastic anemia was caused by vitamin B12 and folate deficiencies, resulting from an inadequate diet and alcohol abuse. The retinal changes were believed to be the result of the severe anemia and thrombocytopenia. Both the megaloblastic anemia and retinal changes resolved promptly after she received vitamin B12 and folate supplements. This case shows that megaloblastic anemia should be suspected as a cause of bilateral retinal hemorrhages.

Adult↗

Indocyanine green videoangiography of hemorrhagic retinal arterial macroaneurysms.

We examined 3 patients with isolated retinal macroaneurysms and secondary hemorrhage by standard fluorescein angiography (FA) and indocyanine green (ICG) angiography. In contrast to standard FA, ICG videoangiography clearly demonstrated the lesion to be pulsatile, contiguous with the arterial wall and pathognomonic of an isolated retinal artery macroaneurysm. ICG with its absorption and emission peak in the near-infrared range penetrates hemorrhage to a greater degree than does blue or green light of conventional FA. ICG can be essential in delineating the specific cause of the bleeding and allow the physician to choose the correct specific form of treatment needed.

Aged↗

Progressive renal failure and blindness due to retinal hemorrhage after interferon therapy for hepatitis C virus-associated membranoproliferative glomerulonephritis.

We treated a 67-year-old Japanese woman with membranoproliferative glomerulonephritis (MPGN) and chronic active hepatitis associated with hepatitis C virus (HCV) infection. Treatment commenced with a daily dose of 6 MU IFN alpha-2b for 2 weeks, which was changed to three times weekly thereafter. After 2 weeks, HCV RNA in the serum was undetectable and there was a concomitant reduction in proteinuria. Treatment with IFN alpha-2b was discontinued because of severe headache and fever. Five weeks after the discontinuation of IFN alpha-2b, the patient experienced the sudden onset of visual loss due to retinal hemorrhage. Subsequently, proteinuria and renal function progressively deteriorated though HCV RNA was undetectable. This case exemplifies the need for careful monitoring of renal function and retinal lesions not only in patients receiving IFN but also in those following the discontinuation of IFN treatment.

Aged↗

Retinal hemorrhages: replicating the clinician's view of the eye.

The authors describe a technique for the gross examination of postmortem eyes of children who are suspected to have been the victims of deliberate trauma. By removing the anterior segment (cornea, iris, lens and pars plicata of the ciliary body) en bloc by a coronal incision through the pars plana just anterior to the ora serrata, the pathologist may view and photograph the fundus exactly as it would have been seen clinically. The photographs obtained with this technique correlate more closely with antemortem clinical examinations and photographs than conventional gross examination procedures and have been introduced as evidence in trials concerning the issue of retinal hemorrhages in injured children. The anterior segment and optic nerve are also examined to facilitate a comprehensive description of ocular findings.

Child↗

Age of retinal hemorrhages by iron detection: an animal model.

Intraretinal hemorrhages have been found in some abusively injured infants and children. Intraretinal hemosiderin has been proposed as an indication of previous injury. The limits of the accuracy of the proposal have not been established. Experimental central retinal vein occlusion (CRVO) was produced in 20 eyes of adult rhesus monkeys as part of ongoing research by one of the authors (SSH). The animal experiments were conducted in accordance with a research protocol approved by the Animal Care Committee, University of Iowa. CRVO produced diffuse intraretinal hemorrhages. Clinical ocular examinations assessed the onset and time course of retinal hemorrhages. Enucleation specimens were used to assess hemosiderin in the retinas. Hemosiderin was detected within 2 days of induction of retinal hemorrhages. It was detected in only 4 of 11 eyes (36%) studied more than 1 week following induction of hemorrhages. In 2 eyes, hemosiderin was found 9 and 16.8 months after development of hemorrhages. Hemosiderin can represent organization of current hemorrhage rather than evidence of prior hemorrhage. This study does not allow specifying the duration of hemorrhages with greater precision than "more than 2 days prior to death," and that, only if there is no survival interval. Failure to detect hemosiderin does not exclude prior retinal hemorrhages.

Animals↗