1/11. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases.The clinical and histopathologic features of 29 eyes from 28 patients with central retinal vein occlusion (CRVO) are reported. A fresh or a recanalized thrombus was observed in each eye. This study considers the temporal aspects of the cases, and it notes the different morphologic features of the occlusion. These observations explain most of the variability of the changes observed in previous reports. We believe these different features representthe various stages in the natural evolution of such a thrombus. The interval between CRVO and histopathologic study in our series ranged from six hours to more than ten years. Local and systemic factors were reviewed and were found to be important in the pathogenesis of thrombus formation. Local diseases with a predisposing effect on CRVO included: glaucoma, papilledema, subdural hemorrhage, optic nerve hemorrhage, and drusen of the optic nerve head. Associated systemic diseases included: hypertension, cardiovascular and cerebrovascular disease, diabetes mellitus, and leukemia with thrombocytopenia. A fresh thrombus in the CRVO was observed in three (10.3%), and a recanalized thrombus in 26 eyes (89.7%). Endothelial-cell proliferation was a conspicuous feature in 14 (48.3%) of the eyes. Chronic inflammation in the area of the thrombus and/or vein wall or perivenular area was observed in 14 (48.3%) of the eyes. Arterial occlusive disease was observed in seven eyes (24.6%). Cystoid macular edema was found in 26 (89.7%) of the eyes.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/11. Combined branch retinal artery and central retinal vein obstruction.We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/11. Massive hemorrhage complicating age-related macular degeneration. Clinicopathologic correlation and role of anticoagulants.Reported are 15 cases of age-related macular degeneration (AMD) complicated by massive subretinal and/or vitreous hemorrhage. Clinicopathologic correlation is presented in four of the seven cases studied histopathologically. Salient histologic findings include: subretinal and subretinal pigment epithelium (sub-RPE) fibrovascular scar in the posterior pole; discontinuities in Bruch's membrane with choroidal neovascularization; extensive hemorrhagic detachment of the RPE and sensory retina; and vitreous hemorrhage. In three cases, a choroidal artery, emerging from breaks in Bruch's membrane, had ruptured walls. The authors have reviewed the previously reported cases of AMD complicated by massive hemorrhage and found that 19% of the patients were taking Coumadin (warfarin) or aspirin treatment when the bleeding occurred. Forty percent had a positive history of systemic hypertension and cardiovascular diseases. Although the occurrence of hypertension is expected in the aged population with AMD, use of anticoagulants or antithrombotics by such patients may predispose them to serious ocular hemorrhagic complications.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/11. Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy.Between 1960 and 1976 117 patients underwent pituitary implantation with yttrium-90 (90Y) for treatment of proliferative retinopathy at the Hammersmith Hospital, london. Mean age at operation was 35 /- 11 years (mean /- SD), and mean duration of diabetes 18.6 /- 10.0 years. Mean insulin dosage prior to implant was 67.2 /- 24 units, falling to 30.4 /- 14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to follow-up. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carried out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35 /- 10.5 years, and mean duration of diabetes 17.2 /- 8.7 years. visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7 /- 1.6 to 0.8 /- 1.2 (p less than 0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/11. Panretinal cryotherapy in neovascular disease.Panretinal cryotherapy (PRC) was used to treat 15 eyes with rubeosis, nine of which had established neovascular glaucoma, and seven eyes with proliferative diabetic retinopathy. The rubeosis regressed, with preservation of vision and return to normal of intraocular pressure, in all but one eye. With one exception all eyes with proliferative retinopathy also showed new vessel regression after treatment. PRC may be considered an effective alternative to retinal photocoagulation in the treatment of advanced rubeosis, early rubeotic glaucoma, and in certain circumstances proliferative diabetic retinopathy.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
6/11. Central retinal vein occlusion and iris neovascularization hemorrhage.Although there have been few direct observations, the etiology of spontaneous hyphema in patients with retinal or ocular hypoxia is assumed to be hemorrhage from a neovascular iris vessel. This paper reports observed hemorrhage from such a rubeotic iris in a patient with central retinal vein occlusion, diabetes, hypertension, peripheral vascular disease and chronic open-angle glaucoma. Bleeding was spontaneous with dilation, but stopped within 24 hours without treatment, leaving only traces of inferior angle blood staining. The two types of central retinal vein occlusion, and suggestions for their management, are also discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/11. Neovascular glaucoma in systemic occlusive vascular disease.A 58-year-old woman was seen with a red inflamed right eye with rubeosis iridis and neovascular glaucoma with closure of the angle. There was no evidence of the diabetes and no evidence of occlusion of the central retinal vein. physical examination was normal except for an absent carotid pulse on the right side, a carotid bruit on the left side, and absence of the pulse in all extremities. Further evaluation revealed severe arteriosclerosis involving many major branches of the aorta, including both carotid arteries. This patient had neovascular glaucoma as the only presenting sign of severely arteriosclerotic stenosis of both carotid arteries. This case demonstrates the need for emphasis on this rare but occult life-threatening cause of neovascular glaucoma. Ophthalmologists should be alert to the possible presence of carotid occlusive disease as a causative factor when cases of neovascular glaucoma are encountered.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
8/11. Exudative retinal detachment in hemoglobin sc disease.A 21-year-old black man with hemoglobin sc disease had a unilateral exudative retinal detachment. A large area of sea fan neovascularization was identified in this eye at the superotemporal border of the detachment; no retinal holes were present. Following closure of the neovascularization by argon laser photocoagulation using feeder vessel technique, the retina flattened and the exudation cleared. However, multiple holes developed in thin ischemic retina at foci of vitreoretinal traction. Although many retinal vascular diseases may cause exudative detachments, to the authors' knowledge, this is the first definite case of exudative retinal detachment in a patient with a sickling hemoglobinopathy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/11. Digital subtraction angiography in the diagnosis of retinal vascular disease.Digital subtraction angiography is a safe, inexpensive method of investigating systemic vascular disease in patients for whom conventional carotid angiography is too risky. We used this technique in five patients with a variety of retinal vascular conditions--a 55-year-old woman with occlusion of the right internal carotid artery, a 63-year-old man with bilateral occlusion of the internal carotid arteries, a 72-year-old man with occlusion of the stem of the left subclavian artery and an irregularity of the proximal portion of the innominate artery, a 77-year-old man with optic nerve head neovascularization and stenosis of the left internal and external and right internal carotid arteries, and a 74-year-old man with recurrent stenosis of the left internal carotid artery. In all five cases, digital subtraction angiography was helpful in determining the diagnosis and course of treatment.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
10/11. Antiphospholipid antibodies and retinal vascular disease.BACKGROUND: Antiphospholipid antibody retinopathy is a rare and poorly defined clinical entity in which the proper diagnosis has important ocular and systemic implications. The clinical course of five patients with antiphospholipid antibody retinopathy is described and the role of such antibodies in idiopathic retinal venous occlusive disease is investigated. methods: Five case reports are presented highlighting the presentation, course, therapy, associations and outcomes of patients with antiphospholipid antibody retinopathy. In addition, twenty additional patients presenting with idiopathic retinal venous occlusive disease were tested for the presence of antiphospholipid antibodies. RESULTS: All five patients with antiphospholipid antibody retinopathy had diffuse retinal vascular occlusion. All five patients presented with associated rheumatologic disease, including three with lupus or lupus-like disease. antibodies to antiphospholipid were not detected in any of the twenty patients with idiopathic retinal venous occlusive disease. Prompt panretinal photocoagulation together with varying regimens of corticosteroids, immunosuppressives, or warfarin was partially successful in stabilizing the ocular and systemic disease. CONCLUSION: The diagnosis of antiphospholipid antibody retinopathy should be suspected in patients with diffuse retinal vaso-occlusion, particularly when characterized by involvement of both arteries and veins, neovascularization at presentation, and symptoms of symptoms of systemic rheumatologic disease. Antiphospholipid antibodies do not appear to play an important role in idiopathic retinal vein occlusions.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
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