1/17. Benign idiopathic haemorrhagic retinopathy.PURPOSE: To describe a new condition characterised by an unusual unilateral idiopathic haemorrhagic retinopathy. methods: A review is presented of patient histories from 5 patients with acute-onset unilateral idiopathic haemorrhagic retinopathy, including results of ophthalmological, haematological and fluorescein angiographic examinations. RESULTS: All patients had an extensive deep blot haemorrhagic retinopathy without significant vascular signs or abnormal optic discs. In 4 cases the haemorrhage was sufficiently severe to break through into the vitreous. fluorescein angiography demonstrated normal arteriovenous flow, without capillary non-perfusion, vessel or disc leakage. Disc swelling, macular oedema and cotton wool spots were not seen at any stage in these patients. All patients recovered the visual acuity in the affected eye by 4 months. Systemic examination in all cases was unremarkable. CONCLUSION: This distinct and rare form of retinopathy is important to define since it has a good prognosis without treatment.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
2/17. anemia and papilledema.PURPOSE: To elucidate the relationship between anemia and raised intracranial pressure (ICP). DESIGN: Interventional case series. methods: Retrospective case series and review of the literature. Only patients with documented papilledema, neuroimaging ruling out a space-occupying lesion, and anemia were included. RESULTS: Five women with confirmed idiopathic intracranial hypertension (IIH) (normal brain magnetic resonance imaging, normal cerebrospinal fluid, elevated intracranial pressure), and one man with presumed IIH (normal head computed tomography [CT], no lumbar puncture) were evaluated. All had bilateral papilledema associated with peripapillary hemorrhages. Two had retinal cotton-wool spots (CWS), and two had preretinal hemorrhages. All had severe iron deficiency anemia, which was discovered at the time of their ocular complaints in five of them. Their symptoms and signs improved dramatically after treatment of the anemia. We found 30 well-documented cases in the English and French literature. Among those, 13 were excluded from our analyses (11 had confounding disorders, and two had cerebral venous thrombosis). In the remaining 17 cases, isolated raised ICP associated with anemia was the most likely diagnosis, although in none of these cases was cerebral venous thrombosis excluded. CONCLUSIONS: anemia may play a role in the occurrence of raised ICP and papilledema. Although only a few cases in the literature support this association, it may be more common than previously thought. Because most patients are not known to be anemic when papilledema is discovered, we suggest that a complete blood count be obtained in patients with IIH, especially in the absence of known associated factors such as obesity or medications or when treatment aimed at lowering ICP fails to improve the patient's symptoms. The underlying mechanisms remain unknown, but cerebral venous thrombosis should be carefully excluded.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
3/17. Unilateral Purtscher-like retinopathy after weight-lifting.PURPOSE: To report a case of Purtscher-like retinopathy after weightlifting. methods: A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. RESULTS: Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. CONCLUSIONS: The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinopathy associated with weightlifting.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
4/17. Ocular manifestations in Dengue fever.PURPOSE: To report a case of Dengue fever resulting in permanent visual loss in both eyes due to retinal capillary occlusion. methods: Case report. RESULTS: Severe permanent visual loss occurred in a patient with Dengue fever. Dilated fundus exam showed vascular sheathing with associated retinal hemorrhages at the equator and cotton wool spots in the maculae of both eyes. fluorescein angiography revealed areas of capillary nonperfusion at the equator and in the macula. The diagnosis of Dengue fever was confirmed by serology detecting IgM antibodies to the dengue virus. CONCLUSION: Ocular abnormalities may be seen in patients with Dengue fever, therefore ophthalmoscopy should be performed in patients presenting with severe forms of the disease.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
5/17. Subretinal hemorrhage in cytomegalovirus retinitis.A case of subretinal hemorrhage associated with cytomegalovirus (CMV) retinitis in a human immunodeficiency virus-positive woman is described. The patient was found to have an exudative retinal detachment involving the fovea, subretinal hemorrhage, cotton wool spots, and active CMV retinitis temporal to the exudative detachment. No evidence of systemic coagulopathy was found. Although unusual, subretinal hemorrhage may be observed in association with CMV retinitis in the absence of a systemic coagulopathy.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
6/17. Course of diabetic retinopathy following cataract surgery.Five patients with mild to moderate retinopathy to both eyes underwent complication-free cataract surgery in one eye. Within three months of surgery deterioration of the retinopathy was observed in the operated eye only. In four patients there was an increase of intraretinal haemorrhages and hard exudates, accompanied by clinically significant macular oedema manifested as retinal thickening and extensive fluorescein leakage from both the macular and the peripapillary capillary networks. Of these four patients one also developed retinal ischaemia, evident ophthalmoscopically by flame-shaped haemorrhages and cotton-wool spots and angiographically by areas of capillary non-perfusion. The fifth patient showed proliferation of new blood vessels and vitreous haemorrhage. Diabetic patients scheduled for cataract surgery should undergo a thorough preoperative evaluation of any existing retinopathy. Postoperatively they should be followed up at close intervals so that any progression of retinopathy can be promptly detected and considered for laser treatment.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
7/17. Retinopathy associated with acute pancreatitis.Two patients (a 28-year-old woman and a 23-year-old man) with acute pancreatitis developed severe visual loss. The acute stage of retinopathy consisted of retinal edema, cotton-wool patches, and retinal hemorrhages, predominantly in the posterior pole of both eyes. During the five-year follow-up period, visual acuity improved and sequential fluorescein angiography of both patients demonstrated reperfusion of previously occluded retinal vessels. After resolution of the cotton-wool patches, the previously edematous areas were replaced by foci of retinal thinning which created irregularities in the internal limiting membrane light reflex. visual fields demonstrated scotomas corresponding to the areas of the previous cotton-wool patches.- - - - - - - - - - ranking = 3keywords = cotton (Clic here for more details about this article) |
8/17. Obstructed axoplasmic transport in Purtscher's traumatic retinopathy.2 cases of unilateral traumatic Purtscher's retinopathy are reported. The postraumatic increase of the cephalic venous pressure may cause subconjunctival hemorrhages and retinal venous stasis followed by hemorrhages and ischaemic changes, like capillary nonperfusion and cotton-wool spots. Correlation of the fundus picture with fluorescein angiograms suggests that the cotton-wool spots found in association with capillary non-perfusion result from the obstruction of both the orthograde and the retrograde axonal flow in the retinal ganglion cell axons. After recovery, funduscopic and perimetric evidence of nerve fibre bundle defect was found.- - - - - - - - - - ranking = 2keywords = cotton (Clic here for more details about this article) |
9/17. Renal cortical necrosis and Purtscher's retinopathy in hemorrhagic pancreatitis.A patient presented with acute hemorrhagic pancreatitis complicated by both renal cortical necrosis and Purtscher's retinopathy. Either of these two complications is rare and never before have both been reported in the same patient. The patient's renal insufficiency required hemodialysis; it gradually improved over two years when dialysis could be discontinued. The patient's retinopathy included bilateral hemorrhages and cotton wool spots; visual fields and acuity remained normal. Funduscopic lesions disappeared by three months after the acute event. These two rare vasculo-occlusive complications of pancreatitis simultaneously occurring in one individual might suggest complement-mediated leukostatic mechanisms.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
10/17. subacute sclerosing panencephalitis.A 17-year-old white woman had an acute left maculopathy of unknown etiology. She was in excellent health and had only had rubeola at 3 years of age. Hruby lens examination of the left eye, visual acuity of 6/60 (20/200), revealed a normal vitreous, macular edema, intraretinal hemorrhage, and cotton-wool exudates. xenon photo-coagulation was performed on the left eye. The visual acuity remained 6/60 (20/200) with drying of the retina. The patient remained in excellent health until 22 months after the initial ocular problem when she developed a left homonymous hemianopia. Then her mind deteriorated, and she became demented. We diagnosed subacute sclerosing panencephalitis after finding an increased spinal fluid gamma globulin, raised serum and spinal fluid titers of measles antibodies, and an electroencephalogram pathognomonic for this condition.- - - - - - - - - - ranking = 1keywords = cotton (Clic here for more details about this article) |
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