1/55. Retinal findings in Takayasu's arteritis.PURPOSE: To describe unusual as well as typical ocular findings in eight patients with Takayasu's disease. methods: The ophthalmic manifestations and clinical courses of eight patients with Takayasu's disease were evaluated. RESULTS: All patients had clinical and angiographic evidence of pulseless disease. Typical findings included retinal venous congestion, fluorescein staining, capillary drop-out, microaneurysms and arteriovenous shunting. Unusual findings included cotton wool spots, anterior ischemic neuropathy and retinal emboli. In one case microaneurysms disappeared after carotid bypass surgery. Several patients had profound, transient, visual loss with changes in head posture. CONCLUSION: Takayasu's disease can cause a variety of retinal manifestations. Less common findings include cotton wool spots, anterior ischemic optic neuropathy and retinal emboli.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
2/55. association of antiphospholipid antibodies with retinal vascular disease in systemic lupus erythematosus.OBJECTIVES: To study the prevalence and characteristics of retinal vascular disease in patients with systemic lupus erythematosus (SLE) and to analyze their relationship with antiphospholipid antibodies (aPL) and other serological markers. patients AND methods: Eighty-two consecutive patients (77 women and 5 men; mean age, 36 years) were studied. All patients fulfilled the 1982 revised criteria of the American College of rheumatology for the classification of SLE. Ophthalmologic examination included assessment of best corrected visual acuity, tonometry, slit-lamp biomicroscopy, and fundus examination. Serologic studies included determination of anticardiolipin antibodies (aCL) (ELISA), lupus anticoagulant (LA) (coagulation tests), antinuclear antibodies (indirect immunofluorescence), anti-dna (Farr's test), and anti-ENA antibodies (counterimmunoelectrophoresis). RESULTS: Retinal vascular disease was detected in 13 (15%) of 82 SLE patients. The retinal lesions consisted of retinal vascular occlusions in six patients (five arterial and one venous), cotton-wool spots in three, optic disc edema in three, retinal hemorrhages in three, and ischemic optic neuropathy in one. Antiphospholipid antibodies were detected in 10 (77%) of these 13 patients: nine had aCL and two had the LA. When compared with patients without retinal vascular disease, patients with retinopathy had a higher prevalence of aPL (77% v. 29%, P = .005). CONCLUSIONS: Retinal vascular disease is frequent in patients with SLE. The presence of aPL is associated with a higher prevalence of retinal abnormalities in SLE patients.- - - - - - - - - - ranking = 0.5keywords = cotton (Clic here for more details about this article) |
3/55. Retinal cotton-wool spots as the first sign of systemic sarcoidosis.Isolated retinal cotton-spots have not yet been reported as the sign of ocular sarcoidosis. We describe three patients with retinal cotton-wool spots of initially unknown etiology in whom systemic sarcoidosis was diagnosed 6-16 months later. The diagnosis was confirmed by conjunctival biopsy. These observations indicate that sarcoidosis should be included in the differential diagnosis of retinal cotton-wool spots and patients with these lesions should be followed for the development of this disease.- - - - - - - - - - ranking = 3.5keywords = cotton (Clic here for more details about this article) |
4/55. Retinopathy in a patient with thrombotic thrombocytopenic purpura complicated by polymyositis.BACKGROUND: Cotton wool spots are known to be a complication in patients with thrombotic thrombocytopenic purpura or with polymyositis. CASE: A 53-year-old woman developed numerous cotton wool spots around the optic disc of both eyes. OBSERVATIONS: fluorescein angiography disclosed capillary obstruction and microaneurysms in the early phase, followed by dye leakage in the late phase. Systemically, she showed fever, hemolytic anemia, fragmented red blood cells, thrombocytopenia, proximal muscle weakness, and elevation of serum muscle enzymes. This led to a diagnosis of thrombotic thrombocytopenic purpura complicated by polymyositis. CONCLUSION: We believe that this is the first case of thrombotic thrombocytopenic purpura complicated by polymyositis to develop cotton wool spots.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
5/55. Single isolated cotton-wool spots.The presence of isolated cotton-wool spots in normal fundi may indicate serious systemic disease. In this presentation 4 patients were examined for blurred vision or scotomas with sudden onset. Two of them were pregnant. Funduscopic examination revealed soft-appearing white spots in the temporal arcades in 3 patients and in the papillomacular bundle in 1 patient. Due to the lack of other fundus lesions 3 of the patients were initially treated for toxoplasmosis. The patients were seronegative for typical viral (hiv), antinuclear antibodies, bacterial infections, or toxoplasmosis. Blood pressures, glycosylated hemoglobin and blood counts were in the normal range. At the follow-up examinations subjective symptoms had improved and the spots disappeared or were smaller and showed more distinct borders, and no new lesions were detected. These cases suggest that isolated cotton-wool spots may occur without serious systemic disease in otherwise healthy subjects and the spots may be misinterpreted as acute inflammatory retinochoroidal lesions.- - - - - - - - - - ranking = 3keywords = cotton (Clic here for more details about this article) |
6/55. Retinopathy associated with high-dose interferon alfa-2b therapy.PURPOSE: To present seven patients who developed retinopathy while receiving high-dose interferon alfa-2b therapy for adjuvant treatment of high-risk melanoma. methods: Retrospective case series. RESULTS: Seven patients developed a retinopathy while receiving high-dose interferon alfa-2b therapy for adjuvant treatment of high-risk melanoma. Five patients had normal visual acuity, but retinopathy with cotton- wool spots and/or retinal hemorrhages with the retinopathy resolved after stopping treatment after detection. Two patients developed severe retinopathy with vision loss to counting fingers and hand motions without resolution of the retinopathy. The duration of the maintenance treatment before detection of the retinopathy for all patients ranged from 6 to 26 weeks. The total dose received at time of detection of retinopathy ranged from 816 to 1770 million units. Confounding factors included hypertension, thrombocytopenia, anemia, and a history of prior chemotherapy in one patient. Also, one patient received an investigational ganglioside vaccine, one had a history of radiation treatment to the brain, and six received paroxetine. CONCLUSIONS: patients receiving interferon alfa-2b are at risk for developing an associated retinopathy. The risk appears to be greater with higher dosage therapy. In addition, severe vision loss can be seen with interferon alfa-2b-associated retinopathy. The effect of treatment with selective serotonin reuptake inhibitors, such as paroxetine, in increasing the incidence of this complication is unknown. patients need to be monitored until the retinopathy is resolved to screen for sequelae, including retinal neovascularization.- - - - - - - - - - ranking = 0.5keywords = cotton (Clic here for more details about this article) |
7/55. cryoglobulinemia associated with Purtscher-like retinopathy.PURPOSE: To report a case of Purtscher-like retinopathy in a young man with chronic hepatitis c--associated cryoglobulinemia. methods: Case report. RESULTS: A 44-year-old Caucasian man with chronic hepatitis c developed sudden loss of vision in the left eye and abdominal pain. Ocular fundus examination revealed peripapillary cotton-wool spots and superficial retinal whitening in the macula. Systemic evaluation revealed markedly elevated rheumatoid factor, hypertension, and acute renal insufficiency. A renal biopsy demonstrated intravascular deposition of immunoglobulins IgG and IgM and complement consistent with type II mixed cryoglobulinemia. CONCLUSION: Clinicians should consider cryoglobulinemia in the differential diagnosis of a patient with Purtscher-like retinopathy and history of infection with hepatitis c.- - - - - - - - - - ranking = 0.5keywords = cotton (Clic here for more details about this article) |
8/55. True, true and related?Several chorioretinal lesions have been observed that are associated with bone marrow transplantation (BMT), such as cotton-wool spots, macular stars, ischemic changes due to microangiopathy, "BMT retinopathy" and choroidal infiltration. Central serous retinopathy (CSR) has rarely been described in the BMT setting. We present a patient who underwent allogeneic BMT and subsequently developed severe chronic graft versus host disease (CGvHD) complicated with CSR.- - - - - - - - - - ranking = 0.5keywords = cotton (Clic here for more details about this article) |
9/55. Atypical retinal microvasculopathy after bone marrow transplantation.OBJECTIVE: Typical early ischaemic retinal microvascular changes with cotton wool spots after allogeneic bone marrow transplantation (BMT) are well recognised. In the study an atypical non-ischaemic late retinopathy is described. methods: Sequential cases of late retinal microvasculopathy following allogeneic BMT were reviewed. Demographic features and clinical and angiographic data were collected. RESULTS: Of 399 patients undergoing allogeneic BMT between 1992 and 1999, eight eyes of four patients developed atypical retinopathy. All patients were male and the age range was 27-50 (mean 37.5) years.The indications for BMT were acute lymphoblastic leukaemia (two patients), chronic myeloid leukaemia (one patient) and chronic lymphocytic leukaemia (one patient).Two patients had conditioning regimens including irradiation. All had cyclosporine and methotrexate as graft-versus-host disease prophylaxis. All but one had cyclophosphamide and busulphan as conditioning treatment. One had interferon. No patients had sustained hypertension or diabetes mellitus. Atypical retinopathy was identified 13-62 (mean 50) months after BMT and clinical features consisted of microaneurysms (MA; 4/4), hard exudates (1/4) and macular oedema (1/4). No patient had cotton wool spots.The median acuity was 6/5. Angiographic features were MA (4/4), late leak (2/4) and peripheral (1/4) or central (1/4) ischaemia. One patient underwent focal photocoagulation for macular oedema. CONCLUSION: Retinal microvascular incompetence (without cotton wool spots) with good vision may occur in a small number of patients as a late complication of allogeneic BMT- - - - - - - - - - ranking = 1.5keywords = cotton (Clic here for more details about this article) |
10/55. Nerve fiber bundle visual field defect resulting from a giant peripapillary cotton-wool spot.Cotton-wool spots are the clinical manifestation of focal infarcts of the retinal nerve fiber layer. They rarely cause significant visual field loss. A large idiopathic cotton-wool spot in a 34-year-old healthy woman caused a nerve fiber bundle visual field defect and an afferent pupillary defect that remained after the cotton-wool spot had disappeared and the retina and optic nerve appeared normal.- - - - - - - - - - ranking = 3keywords = cotton (Clic here for more details about this article) |
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