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PubMed2004

[White-centered retinal hemorrhage revealing acute lymphoblastic leukemia].

Retinal involvement during leukemia is frequent (varying from 28% to 50%), can be the result of different mechanisms, and may reveal the disease. We describe two patients, 10 and 50 years old, who consulted for a sudden drop in visual acuity. Fundus examination showed bilateral retinal hemorrhage with a white center in both eyes associated with other hemorrhages in the posterior pole. Acute leukemia was found in both patients and chemotherapy was institgated. The younger patient died of general complications, the other is in remission phase. Retinal hemorrhage with a white center is a rare manifestation of acute leukemia and is exceptionally the first sign of the disease. Through these cases, we detail the physiopathology and clinical aspects. We stress the importance of ocular findings in leukemia in both diagnosis and therapy.

Antineoplastic Agents↗
PubMed1998

Peripheral retinal hemorrhages: a literature review and report on thirty-three patients.

BACKGROUND: Peripheral retinal hemorrhages are often asymptomatic and are detected during routine dilation. The incidence of peripheral retinal hemorrhages is unknown and there is a paucity of information on the subject available in the literature. METHODS: This article reports on 33 patients with peripheral retinal hemorrhage detected during routine fundus examination. The possible etiologies and pathophysiology of peripheral retinal hemorrhages are discussed and a management plan for the primary care clinician is presented. The ophthalmic literature was reviewed and reports of peripheral retinal hemorrhages were included. For each etiology, the ocular and systemic sequelae, symptoms, testing, treatment, and followup are delineated. RESULTS: Various proposed etiologies of peripheral retinal hemorrhages include senescence, systemic and retinal vascular disease, hematologic disorders, infectious disease, hypoxia, and mechanical and iatrogenic causes. CONCLUSION: Despite their asymptomatic nature, peripheral retinal hemorrhages have a variety of potential etiologies and risk factors. Causes associated with serious ocular or systemic complications must be identified so that appropriate treatment and followup can be instituted.

Aged↗
PubMed2001

High altitude retinal hemorrhages in a Colorado skier.

High altitude retinal hemorrhages are commonly seen at altitudes above 4270 m. While these hemorrhages are generally asymptomatic, macular involvement may result in permanent visual acuity deficit. We present the case of a 29-year-old male recreational skier who traveled to a ski resort at 2930 m, ascended to 3470 m, and developed acute mountain sickness, high altitude pulmonary edema, and bilateral retinal hemorrhages. A funduscopic examination to determine if macular retinal hemorrhage is present may be performed by clinicians in the final assessment of patients following altitude illness.

Adult↗
PubMed1993

Obstetric correlates of neonatal retinal hemorrhage.

OBJECTIVE: To determine whether maternal or fetal factors, other than vacuum-assisted delivery, play a role in neonatal retinal hemorrhage, and whether correlates are similar in retinal hemorrhage after spontaneous vaginal delivery. METHODS: A cross-section of assisted deliveries at an urban hospital (n = 156) over 7 months were compared with contemporaneous spontaneous vaginal deliveries (n = 122). A subset of assisted deliveries (n = 87) was prospectively randomized to forceps or vacuum-assisted delivery by sealed envelope. Maternal and neonatal biometric data were collected, and Apgar scores, umbilical artery blood gas analysis, and neonatal ophthalmologic evaluations were performed. RESULTS: Moderate to severe retinal hemorrhage was found in 18% of spontaneous, 13% of forceps, 28% of vacuum-assisted, and 50% of sequential vacuum and forceps-assisted deliveries. Fetal distress (P < .008), vacuum-assisted delivery (P < .02), decreased birth weight for gestation (P < .004), umbilical artery pH less than 7.20 (P < .004), and second stage of labor less than 30 minutes (P < .05) were most closely associated with increased degrees of retinal hemorrhage. Maternal parity, preeclampsia, length of labor, and head circumference were not correlated with retinal hemorrhage. Vacuum-assisted delivery among low birth weight infants (P < .0001), short second stage of labor (P < .006), fetal acidosis (P < .045), and sequential use of vacuum and forceps for assisted delivery (P < .005) formed a logistic model that correctly predicted 81% of moderate to severe retinal hemorrhage cases. Logistic analysis of the randomized assisted deliveries gave similar results. CONCLUSIONS: Maternal and fetal factors other than vacuum-assisted delivery are significant correlates of moderate to severe retinal hemorrhage. Vacuum-assisted delivery among small for gestational age infants is closely correlated with moderate to severe retinal hemorrhage.

Adult↗
PubMed1988

Retinal hemorrhages in malignant arterial hypertension.

We conducted a detailed investigation into retinal hemorrhages in renovascular malignant arterial hypertension experimentally produced in rhesus monkeys. The hypertension was produced by modified Goldblatt's procedures in 60 rhesus monkeys and hypertensive fundus changes were studied by ophthalmoscopy, stereoscopic color fundus photography and fluorescein fundus angiography. Our study revealed that, in hypertensive retinopathy due to malignant hypertension, retinal hemorrhages usually did not constitute either one of the earliest or one of the most conspicuous retinal lesions, but, on the contrary, were a minor feature of the retinopathy. Neither the time of onset of retinal hemorrhages nor their peak severity showed any significant correlation with the level of the arterial hypertension. The hemorrhages were usually situated in the nerve fiber layer, and could be located anywhere in the fundus but were usually found in the distribution of the radial peripapillary retinal capillaries. There was no association between the presence of retinal hemorrhages and retinal venous changes; the latter were seen only in a minority of animals and consisted of retinal venous stasis, venous collaterals and arteriovenous shunts.

Animals↗
PubMed1990

Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy.

Traumatic hemorrhagic retinal detachment may prevent successful visual rehabilitation of eyes with severe posterior segment injury. We managed 19 consecutive cases of traumatic hemorrhagic retinal detachment with pars plana vitrectomy, scleral buckling, and fluid-gas exchange, with or without internal drainage of subretinal hemorrhage. We based our approach on the amount of subretinal hemorrhage present and the location of associated retinal breaks. Internal drainage of subretinal hemorrhage was performed in 16 eyes to allow adequate retinopexy to hemorrhagically elevated retinal breaks (9 eyes), to remove massive subretinal hemorrhage (4 eyes), and to allow intraoperative reattachment when the retina exhibited bullous retinal detachment (3 eyes). Overall, with a minimum of 6 months of follow-up, anatomic reattachment was achieved in 13 (68%) of 19 eyes, and functional success (visual acuity 5/200 or better) was achieved in 6 (32%) of 19 eyes. Anatomic failure resulted from proliferative vitreoretinopathy (4 eyes) and globe atrophy (2 eyes). Drainage of subretinal blood appeared to be beneficial for hemorrhagically elevated retinal tears to allow adequate retinopexy and may help to accomplish long-term anatomic attachment in eyes with massive subretinal hemorrhage or bullous retinal detachment.

Adolescent↗
PubMed1981

Effect of instrumental delivery on the frequency and severity of retinal hemorrhages in the newborn.

The frequency and severity of retinal hemorrhages were studied in 200 newborns within the first 72 hours of life. One hundred of the neonates were delivered instrumentally by either forceps (49 cases) or vacuum extraction (51 cases). Another hundred neonates were delivered spontaneously and served as controls. Both the highest and the lowest frequency of retinal hemorrhages were found among the babies delivered by instrumentation. The actual values were 50 per cent in the vacuum groups and only 16 per cent in the forceps group (p less than 0.01). The spontaneously delivered babies, who served as controls, showed retinal hemorrhages in 41 per cent of the cases. The frequency of severe retinal hemorrhages was five times higher in the vacuum group compared to both the forceps group and the control group (p less than 0.01, p less than 0.001).

Extraction, Obstetrical↗
PubMed1993

[Retinal hemorrhage in newborn infants].

The fundi of the 527 infants born within one week were investigated. The results showed that 54 cases (78 eyes) had retinal hemorrhage. Among them, 23 cases (28 eyes) accompanied macular hemorrhage. The retinal hemorrhage in newborn infants was higher in vaginal delivery than in cesarean section, and the incidence of the fetal distress was higher in the newborn infants with macular hemorrhage. The essential causes of the retinal hemorrhage in newborn infants, development of infant macular and the mechanism of amblyopia induced by macular hemorrhage were discussed.

Adult↗
PubMed1990

Retinal hemorrhage in an infant after cardiopulmonary resuscitation.

Unexplained retinal hemorrhages in infants are usually indicative of child abuse. We present the case of an infant with retinal hemorrhages following cardiopulmonary resuscitation, who had not been abused. Cardiopulmonary resuscitation should be added to the list of causes of retinal hemorrhages in infants and children.

Child Abuse↗
PubMed1986

Two Japanese cases of battered child syndrome with retinal hemorrhage.

We present 2 cases of battered child syndrome with retinal hemorrhage. Case 1 is a 6-year-old boy who was blinded in both eyes following abuse by his mother's common-law husband. Retinal hemorrhages and optic atrophy were found in both eyes. Case 2 is a 6-month-old boy who developed dyspnea following episodes of abuse by his mother's common-law husband. Retinal hemorrhages were visible in both fundi. We believe that retinal hemorrhage is the most frequent clinical finding in abused children and its presence should alert the ophthalmologist to suspect battered child syndrome.

Battered Child Syndrome↗
PubMed1979

Retinal hemorrhage in the battered child.

The presence of retinal hemorrhage in head-injured children under 3 years of age is believed to be pathognomonic of battering. When a group of battered children was compared to head-injured children due to other causes, the high incidence of retinal hemorrhage in the battered children was contrasted with the absence of retinal hemorrhage produced by other causes of head injury.

Age Factors↗
PubMed1996

Prevalence of retinal hemorrhages in infants after extracorporeal membrane oxygenation.

PURPOSE: To determine the prevalence of vision-threatening retinal hemorrhages in infants after venoarterial extracorporeal membrane oxygenation, and possible correlation between retinal hemorrhages and brain hemorrhages, thrombocytopenia, carotid reanastomosis, or death after extracorporeal membrane oxygenation. METHODS: We reviewed the findings of dilated ophthalmoscopic examinations performed on 37 children an average of 16 days after extracorporeal membrane oxygenation (35 neonates and two 1-year-old children). RESULTS: Five (13%) of the 37 children examined had small (< or = 1 disk diameter) intraretinal hemorrhages. Presence or absence of retinal hemorrhages did not correlate with presence of cerebral hemorrhage, mean platelet count during extracorporeal membrane oxygenation, a history of reanastomosis of the carotid artery, or subsequent death. CONCLUSION: Retinal hemorrhages observed after extracorporeal membrane oxygenation are not necessarily caused by extracorporeal membrane oxygenation; some hemorrhages may be benign and related to parturition. Children who undergo venoarterial extracorporeal membrane oxygenation are at low risk for vision-threatening retinal hemorrhage.

Cerebral Hemorrhage↗
PubMed1997

Prevalence of retinal hemorrhages in pediatric patients after in-hospital cardiopulmonary resuscitation: a prospective study.

OBJECTIVE: Child abuse occurs in 1% of children in the United States every year; 10% of the traumatic injuries suffered by children under 5 years old are nonaccidental, and 5% to 20% of these nonaccidental injuries are lethal. Rapid characterization of the injury as nonaccidental is of considerable benefit to child protection workers and police investigators seeking to safeguard the child care environment and apprehend and prosecute those who have committed the crime of child abuse. Physically abused children present with a variety of well-described injuries that are usually easily identifiable. In some cases, however, particularly those involving children with the shaken baby syndrome, obvious signs of physical injury may not exist. Although external signs of such an injury are infrequent, the rapid acceleration-deceleration forces involved often cause subdural hematomas and retinal hemorrhages, hallmarks of the syndrome. Frequently, retinal hemorrhages may be the only presenting sign that child abuse has occurred. Complicating the interpretation of the finding of retinal hemorrhages is the belief by some physicians that retinal hemorrhages may be the result of chest compressions given during resuscitative efforts. The objective of this study is to determine the prevalence of retinal hemorrhages after inpatient cardiopulmonary resuscitation (CPR) in pediatric patients hospitalized for nontraumatic illnesses in an intensive care unit. DESIGN: Prospective clinical study. SETTING: Pediatric intensive care unit. PATIENTS: Forty-three pediatric patients receiving at least 1 minute of chest compressions as inpatients and surviving long enough for a retinal examination. Patients were excluded if they were admitted with evidence of trauma, documented retinal hemorrhages before the arrest, suspicion of child abuse, or diagnosis of near-drowning or seizures. All of the precipitating events leading to cardiopulmonary arrest occurred in our intensive care unit, eliminating the possibility of physical abuse as an etiology. INTERVENTIONS: None. MEASUREMENTS: Examination of the retina was performed by one of two pediatric ophthalmologists within 96 hours of CPR. The chart was reviewed for pertinent demographic information; the platelet count, prothrombin time, and partial thromboplastin time proximate to the CPR were recorded if they had been determined. RESULTS: A total of 43 pediatric patients hospitalized with nontraumatic illnesses survived 45 episodes of inpatient CPR. The mean age was 23 months (range, 1 month to 15.8 years), and 84% of the patients were under 2 years old. The majority of the patients (44%) were admitted to the intensive care unit after surgery for congenital heart disease, and another 21% were admitted for respiratory failure. The mean duration of chest compressions was 16.4 minutes +/- 17 minutes with 58% lasting between 1 and 10 minutes. Five patients had chest compressions lasting >40 minutes, and two patients had open chest cardiac massage. All patients survived their resuscitative efforts. Ninety-three percent of patients had an elevated prothrombin time and/or partial thromboplastin time while 49% were thrombocytopenic. Sixty-two percent of the patients had low platelet counts and an elevated prothrombin time and/or partial thromboplastin time. Small punctate retinal hemorrhages were found in only one patient. CONCLUSIONS: Retinal hemorrhages are rarely found after chest compressions in pediatric patients with nontraumatic illnesses, and those retinal hemorrhages that are found appear to be different from the hemorrhages found in the shaken baby syndrome. Despite the small number of patients in this prospective study, we believe that these data support the idea that chest compressions do not result in retinal hemorrhages in children with a normal coagulation profile and platelet count. A larger number of patients should be evaluated in a prospective multi-institutional study to achieve statistical significance

Adolescent↗
PubMed1992

Spontaneous resolution of hemorrhagic retinal pigment epithelial detachment.

Large hemorrhagic retinal pigment epithelial detachments (RPEDs) with presumed subretinal neovascularization (SRN) generally have a poor visual prognosis. We report the case of a 70-year-old woman who initially had a large serous hemorrhagic RPED associated with lipid exudation and juxtafoveal SRN. Without treatment, spontaneous resolution occurred with subsequent visual improvement.

Aged↗
PubMed1982

High altitude retinal hemorrhage: a clinical and pathological case report.

Retinal hemorrhages may occur at high altitudes. They occur more commonly in association with acute mountain sickness and particularly with high-altitude cerebral edema. We describe a 27-year-old man who experienced retinal hemorrhages as well as papilledema and coma at 5,330-m altitude and who died four days later, one day after evacuation to 1,300-m altitude. At autopsy, we found papilledema and hemorrhages in the nerve fiber layer. These were sometimes distant from areas where there were arterioles and venules. There was perivascular red cell infiltration. Deeper layers of the retina were intact. We conclude that the hemorrhages were form both retinal capillaries and veins and we speculate that hypoxia, with or without the Valsalva effect, was the cause of the endothelial damage.

Adult↗
PubMed1999

Retinal hemorrhages caused by accidental household trauma.

Traumatic retinal hemorrhages in young children are considered pathognomonic of child abuse. We identified 3 children with unilateral retinal hemorrhages caused by accidental household trauma. The hemorrhages were ipsilateral to intracranial hemorrhage and isolated to the posterior retinal pole.

Accidental Falls↗