Retinal metastasis presenting as a retinal hemorrhage in a patient with adenocarcinoma of the cecum.
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BACKGROUND: With the development of new imaging technologies indocyanine green (ICG) angiography allows better visualization of choroidal and retinal vasculature and their pathology. Due to its high protein bound ICG leaks very slowly from fenestrated normal and abnormal vessels. With its absorption and emission peak in the near infrared spectrum ICG penetrates hemorrhage to a greater degree than does blue light with shorter wavelength used for fluorescein angiography. METHODS: We report the clinical and fluoresceinangiographical findings of three patients with a sudden macular hemorrhage of unknown origin. RESULTS: In all patients conventional fluoresceinangiography revealed a similar appearance with little characteristic signs early ill-defined hyperfluoroescence and late exudation of dye. ICG angiography clearly demonstrated the underlying pathology as a pulsatile retinal artery macroaneurysm, a choroidal neovascularization secondary to age-related macular degeneration, and a retinal angioma. CONCLUSION: ICG videoangiography with its absorption and emission peak in the near infrared light seems to be an additive tool to identify and delineate more precisely fluoresceinangiographically ill-defined hyperfluorescence and exudations in patients with retinal hemorrhage of unknown origin.
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Thresholds for retinal vitreal and contained hemorrhages were determined for 1064 nm laser light at 30-nsec and 4-nsec pulsewidths. Rhesus monkeys received graded exposures from a neodymium-yag laser onto either the macular or extramacular region of the retina. Contained hemorrhages appeared as concentric ring structures with white punctate centers. The vitreal hemorrhage was characterized by the presence of choroidal blood in the vitreal chamber at the exposure site. The 30-nsec contained hemorrhage threshold (ED50) was 1.7 mJ on the macula and 2.1 mJ for an extramacular exposure. The 30-nsec vitreal hemorrhage macular threshold was 2.3 mJ, and the extramacular threshold was 6.6 mJ. The threshold for the 4-nsec pulsewidths to produce a hemorrhage (vitreal or contained) on the retina (macula or extramacular) was 340 microJ.
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PURPOSE: To check the effects of intravitreally injected dispase in the vitreo-retinal region. METHODS: Dispase, 0.05 to 2.5 units dissolved in 100 microl of phosphate-buffered saline, was injected into the midvitreous of rabbits which were killed from 15 to 120 min afterwards. The enzyme was also injected into four human eyes of patients with orbital tumors 15 min before enucleation during orbital exenteration surgery. The eyes were examined in vivo as well as by light and electron microscopy. RESULTS: Hemorrhages were detected by fundus observations and confirmed by microscopical analysis in nearly all rabbits and in half of the human eyes. The red blood cells were observed in the vitreous and retina. Breaches in the inner limiting membrane were visualized in human eyes and ruptures of small blood vessels in rabbit eyes. In spite of that, vitreous detachment was not verified. In fact, the cortical-vitreous collagen-fibril network was conspicuous on scanning electron micrographs. CONCLUSIONS: Retinal hemorrhages were evident as early as 11 min after injection. It is suggested that this enzyme degraded selectively basement membrane components without affecting other proteins involved in the vitreous-retinal junction.
External hydrocephalus has been associated with subdural hematomas in infancy, and the hematomas have been noted to be secondary to minor trauma or have even been described as spontaneous. The author reports the case of an infant with external hydrocephalus who developed retinal as well as subdural hemorrhages after sustaining a minor head injury. Although retinal hemorrhage in infancy has been considered virtually pathognomonic of child abuse, in the setting of external hydrocephalus a more cautious interpretation may be appropriate.
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A 74-year-old woman with a history of systemic hypertension presented with a slowly resolving superficial hemorrhage in the posterior pole of her left eye. With retinal fluorescein angiography, this hemorrhage appeared to be related to an arteriolar aneurysm (macroaneurysm). This area was successfully treated with laser application.
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