Retinal and Preretinal Hemorrhages in a Patient Receiving Hyper-CVAD Chemotherapy for T-Cell Acute Lymphoblastic Leukemia (original) (raw)
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Pathogenesis of the Vitreous Cloud Emanating From Subretinal Hemorrhage
Archives of Ophthalmology, 2003
To determine the cellular mechanism that allows subretinal hemorrhage to cloud the vitreous. Methods: We simulated subretinal hemorrhage in a rabbit model by injecting autologous blood beneath the retina. At the first appearance of a cloud in the vitreous a vitrectomy was performed and using a surgical microscope, the retina was searched for breaks. After enucleation and fixation, the retina was searched for microscopic breaks using light and electron microscopy. The vitreous was then examined to determine the character of the cell population in the cloud. In a related study, we sampled and examined the vitreous for its cellular content in patients undergoing vitrectomy to clear cloudy vitreous emanating from subretinal hemorrhage. Results: We found no breaks in the living retina of the animal models or the patients. Microscopic examination of serial sections of the rabbit retina revealed necrosis except for the internal limiting membrane. Fragments of the erythrocytes were seen within the damaged retina and on both sides of the internal limiting membrane. Electron microscopy suggested that the erythrocytic fragments had migrated across the internal limiting membrane. The vitreous cloud in both rabbits and patients contained only fragments of erythrocytes. Conclusions: Thick subretinal hemorrhage causes necrosis of the overlying retina. Fragments of the erythrocytes infiltrate the retina and cross an intact internal limiting membrane to cloud the vitreous. Clinical Relevance: Rapid necrosis of the retina occurs over thick subretinal hemorrhage and indicates the need for early displacement of the hemorrhage from the macula if function is to be preserved and breakthrough prevented.
Central Serous retinopathy Complicated by bilateral massive subretinal haemorrhage
EDITOR,-The stroma comprises about 90% of the total corneal thickness 1 and is responsible for most of the corneal tensile strength. Presumably because of its avascularity, healing of corneal stromal wounds is slower than in other connective tissues. Continued histopathological changes in human corneal laceration wounds have been observed years after injury, despite meticulous original suture closure. 2 The wounds appear to undergo perpetual, dynamic remoulding, a fine balance between constructive and destructive processes. We report three cases of late, full thickness corneal wound dehiscence occurring spontaneously or after minor blunt trauma 17-56 years after the original injury.
Flaming Retinal Hemorrhage Revealing Acute Lymphoblastic Leukemia ( About a Case )
2019
The frequency of retinal damage in acute leukemias can range from 28 to 50%. These retinal lesions may be indicative of leukemia. A 51-year-old patient consults for a sharp decrease in bilateral visual acuity and in whom fundus examination shows the presence of multiple retinal hemorrhages disseminated at the posterior pole in both eyes and that some of them are white-centered the rest of the somatic examination is without abnormality. The etiological diagnosis makes it possible to link them to a table of acute lymphoblastic leukemia so that the patient was treated in collaboration with the oncologist. In the medical literature, several cases of retinal hemorrhages are reported as manifestations of acute leukaemias. They are exceptional as the mode of entry of the disease. Finally, from this observation, we show the interest of ophthalmological examination in the case of leukemia both for diagnosis and treatment.
Retinal hemorrhages in intubated pediatric intensive care patients
Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014
PURPOSE To define the diagnoses associated with the presence of retinal hemorrhages, to clarify the association between retinal hemorrhages, cardiopulmonary resuscitation (CPR), and coagulopathy, and to describe the type of retinal hemorrhages found in intubated critically ill patients \4 years of age. METHODS This was a prospective observational study of intubated patients \4 years of age admitted to the pediatric intensive care unit of a tertiary care center from March 2010 to May 2012. The presence and description of retinal hemorrhages was recorded along with diagnoses, international normalized ratio (INR), CPR (in minutes), and mortality. RESULTS A total of 85 intubated, critically ill patients (37 females) were included; average patient age was 8.2 months (range, 0.1-46.8 months). Of the 85 patients, 6 (7%) had retinal hemorrhages (95% CI, 0.029-0.153). Of the 6 patients with RH, abusive head trauma (AHT) was diagnosed in 4 patients, 1 patient had direct head trauma, and 1 had CPR. There were 8 patients with CPR out of the 85. AHT was highly associated with severe multilayered retinal hemorrhages (P 5 0.0001) but coagulopathy (P 5 0.2671) and CPR (P 5 0.5342) were not. CONCLUSIONS Severe multilayered retinal hemorrhages were associated with AHT in this cohort of patients. Without a history of trauma, retinal hemorrhages occurred in only 1 of 85 patients; in this case the hemorrhages were mild, confined to the posterior pole, and found only in the retinal layer.
Quick Response Code: Purpose: To evaluate the incidence, outcomes, and risk factors for hemorrhagic complications in eyes with polypoidal choroidal vasculopathy (PCV) following photodynamic therapy (PDT). Methods: Medical records of 94 eyes of 86 consecutive patients with PCV who underwent PDT between January 2007 and December 2014 were retrospectively reviewed. The diagnosis of PCV was based on clinical features and indocyanine green angiography. Eyes were treated with PDT monotherapy or a combination of PDT plus anti‑vascular endothelial growth factor. PDT was performed at (standard [SFPDT] or reduced fluence RFPDT). Results: Ninety‑four eyes had 119 PDT treatment sessions (mean: 1.3 sessions). Mean presenting vision was 0.46 ± 0.44 logarithm of the minimum angle of resolution (logMAR). Following PDT, ten eyes (11%) of nine patients had hemorrhagic complications such as subretinal hemorrhage (SRH; n = 5), subretinal pigment epithelium (RPE) hemorrhage (n = 1), breakthrough vitreous hemorrhage (BVH; n = 3), and SRH with sub‑RPE hemorrhage and BVH (n = 1). Median interval to hemorrhage following PDT was 2 months. Age (P = 0.842), duration of symptoms (P = 0.352), number of laser spots (P = 0.219), and laser spot size (LSS) (P = 0.096) were not significantly associated with increased risk of hemorrhagic complications. Female gender was associated with reduced risk of hemorrhage (P = 0.045). SFPDT was significantly associated with increased risk of hemorrhage (P = 0.026). The probability of developing hemorrhagic complications in SFPDT group was 0.24 compared to 0.07 in RFPDT group (P = 0.039). Multivariate logistic regression analysis showed SFPDT as the only significant risk factor for hemorrhage following PDT (odds ratio 5.3, 95% confidence interval 1.1–24.8, P = 0.03). Mean final vision was 0.61 ± 0.53 logMAR at mean follow‑up of 33 months (median = 22 months; range = 2–157 months). Conclusion: Age, LSS, number of laser spots, preexisting hemorrhages, or use of anticoagulants were not associated with increased risk of hemorrhagic complications. SFPDT was significantly associated with increased risk of hemorrhagic complications in such eyes.
Evaluation of surgical and non-surgical approaches in patients with vitreous hemorrhage
Journal of Retina-Vitreous, 2020
To assess and compare the results of surgical and non-surgical approaches in patients with vitreous hemorrhage during the follow-up period. Materials and Methods: The patients with vitreous hemorrhage were divided into 2 groups: those who did not undergo vitreoretinal surgery (Group 1) and those who underwent surgery (Group 2). A detailed ophthalmic examination was performed, including an assessment of the best corrected visual acuity (BCVA) and intraocular pressure, as well as anterior segment and fundus biomicroscopic examination. The patients demographic information, the causes of vitreous hemorrhage, the length of the follow-up period (months) and visual acuity at the fi rst and last visits were examined for statistical analyses. Results: The mean age was 58 ± 12 and 59 ± 12 years while number of eyes included was 140 and 52 and mean follow-up period was 3.5 ± 6.1 and 11.4 ± 13.3 months in Groups 1 and 2, respectively. In Group 1, BCVA was 0.690 ± 0.55 logMAR at baseline and 0.55 ± 0.49 logMAR (p = 0.024) at the fi nal visit. In Group 2, BCVA was 1.17 ± 0.88 logMAR at baseline and 0.62 ± 0.51 logMAR in the postoperative period (p = 0.001). The most commonly observed causes of vitreous hemorrhage were diabetic retinopathy, retinal tears, retinal vein occlusion and posterior vitreous detachment. Conclusion: A signifi cant increase in BCVA was observed during the follow-up period of groups treated for vitreous hemorrhage in surgical and non-surgical manner. The increase was greater in patients underwent surgical intervention.