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PubMed2002

Cardiovascular and thrombophilic risk factors for central retinal vein occlusion.

Retinal vein occlusion (RVO) is a relatively common disease that is often associated with a variety of systemic disorders including arterial hypertension, diabetes mellitus, dyslipidemia, and systemic vasculitis. There are various types of RVO, categorized on the basis of the site of occlusion and on the type of consequent vascular damage. Central retinal vein occlusion (CRVO) is the most frequently occurring and clinically relevant type of RVO. In addition to the well-known classical risk factors, new hemostasis-related ones have been investigated in patients affected by CRVO. The data concerning a number of parameters remain contradictory; yet, high levels of type 1 plasminogen activator inhibitor (PAI-1) and hyperhomocysteinemia appear to play a significant role in the pathogenesis of this disease. Although based on a limited number of studies, this new knowledge could eventually provide important indications regarding prognosis and therapeutic strategies.

Journal Article↗
PubMed1980

Optic disk vasculitis.

A 44-year-old woman developed progressive loss of vision associated initially with a swollen optic disk, and later with optic atrophy and a diffuse retinal vasculopathy, which caused extensive retinal hemorrhagagic. Histopathologic examination showed hemorrhagagic infarction of the retina, as well as infarction of the anterior optic nerve. In the optic nerve, the central retinal vessels showed extensive phlebitis and occlusion of many small arterioles.

Adult↗
PubMed2006

Treatment of cytomegalovirus retinitis with oral valganciclovir in an acquired immunodeficiency syndrome patient unresponsive to combination antiretroviral therapy.

BACKGROUND: Cytomegalovirus (CMV) retinitis was a much-feared visual complication of late-stage acquired immunodeficiency syndrome (AIDS) in the past. Its incidence has waned significantly owing to the benefits of potent antiretroviral combination therapy, which for many individuals has provided some degree of immune reconstitution and avoidance of opportunistic infections, particularly this blinding disease. CASE REPORT: A 45-year-old white man with long-standing, multidrug-resistant human immunodeficiency virus (HIV) infection and severe immunodeficiency despite multiple antiretroviral drug regimens, presented to the eye clinic reporting decreased vision and spider web patterns in his left eye for the past week. Best-corrected visual acuity was 20/20 in the right (O.D.) and 20/25 in the left eye (O.S.). Dilated funduscopic examination of the left eye found vasculitis of the midperipheral inferonasal arcade in the midperiphery, with surrounding intraretinal hemorrhage and granular retinal necrosis. Diagnosis of cytomegalovirus retinitis was made, and the patient began induction therapy with oral valganciclovir 900 mg twice a day for 3 weeks. Maintenance therapy after retinitis stabilization was 900 mg every day until any observed recurrence of infection. Three months after complete resolution of the active retinitis, the patient returned to the clinic reporting new floaters of recent onset. A reactivation of the CMV retinitis warranted a reinduction with valganciclovir 900 mg orally twice a day for 3 weeks. CONCLUSION: This case is illustrative of the efficacy and relative ease of administration of valganciclovir, the newest medication approved for treatment and maintenance of CMV retinitis. Despite his severe immunodeficiency, our patient tolerated the induction and maintenance therapy of oral valganciclovir well, and the CMV retinitis was stabilized and resolved with full recovery of visual acuity.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis.

Two vaso-occlusive events, branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO), were observed in the retina of an HIV-infected patient with cytomegalovirus (CMV) retinitis who developed neovascularization of the disc (NVD). Although BRVO and reversible NVD have been reported in association with CMV retinitis, we have seen no reports of concomitant BRAO. CMV damages endothelial cells and causes an occlusive vasculitis. In HIV-infected individuals, damaged endothelial cells and rheologic problems result in increased blood viscosity. HIV infection has also been associated systemically with elevated levels of cytokines, including tumor necrosis factor alpha (TNF-alpha). In vitro, TNF-alpha exerts effects that decrease fibrinolytic potential; this activity in the circulation of a patient with AIDS may lead to vascular occlusive events. In the patient reported here, the retinal changes were not reversed by induction therapy with ganciclovir and the NVD did not regress.

AIDS-Related Opportunistic Infections↗
PubMed1992

Viral infections of the choroid and retina.

DNA (herpes viruses) and RNA (rubella, rubeola) group viruses are recognized causes of viral retinitis. Severe damage is often the result, not only because the viruses have a cytologic effect but also because the antigens may cause immune complex deposition that results in vasculitis. Most of the viral retinitides are associated with systemic disease; immune-compromised individuals are more susceptible than healthy individuals. A distinct clinical entity, acute retinal necrosis, affects the eye only in healthy individuals and is associated with the herpes family of viruses.

Chorioretinitis↗
PubMed2001

[Central retinal artery occlusion--etiology, clinical picture, therapeutic possibilities].

An occlusion of the central retinal artery (CRAO) leads to a unilateral acute painless loss of vision. The individual etiology remains unclear in many cases. Potential pathomechanisms are embolism, vasoobliteration and vascular compression. Emboli (calcified, thrombotic, myxomatous, bacterial or cholesterol) are of carotid or cardiac origin. Atherosclerotic plaques, giant-cell arteritis and other types of vasculitis may cause vasoobliteration. A retrobulbar mass (hematoma, neoplasms, retrobulbar injections) may lead to an optic nerve and central retinal artery compression. Funduscopic signs of CRAO are described. Late development of iris neovascularization and neovascular secondary glaucoma may occur in up to 15 percent of cases. The prognosis of CRAO has been poor. A spontaneous remission and recovery of visual function is rare. It has been shown experimentally that the retinal damage is irreversible after 100 minutes of non-perfusion. The initial treatment should include an immediate paracentesis of the anterior chamber, digital massage of the globe, and i.v. administration of 500 mg azetazolamide in order to stimulate retinal reperfusion by lowering the intraocular pressure. This procedure is recommended for the first 6 (up to 24) hours after onset of CRAO. More promising success rates have recently be reported by a selective intra-arterial fibrinolysis with Urokinase (100,000-1,000,000 IU) or recombinant plasminogen activator (rtPA). In a personal series of 18 cases, intra-arterial fibrinolysis with Urokinase was performed. A final visual acuity of 6/10 to 6/6 was achieved in 30 percent of the cases.

Acetazolamide↗
PubMed1989

Transvitreal retinochoroidal biopsy.

Biopsies from retina and/or choroid were performed through a transvitreal approach in 14 patients during the 2-year period 1984-1986. A 20-gauge fine needle was used. The transvitreal approach was chosen because exact location of the biopsy could be documented by video recording and/or by photography. The needle was guided either by a stereotactic micromanipulator or by hand. Immediately after biopsy laser burns were placed around the biopsy hole. Light microscopical and, in selected cases, transmission electron microscopical examination of the material obtained showed malignant melanoma, choroidal haemorrhage, leukaemic infiltration of the choroid, intraretinal fibrosis in detached retina, atrophic retina after vasculitis and malignant lymphoma of the uvea. More than 2 years after biopsy, no retinal detachment due to the biopsy or any tumour-seeding has been observed. Two cases of vitreous haemorrhage cleared spontaneously. No visual impairment was related to the biopsies.

Adolescent↗
PubMed2006

A comparative study of epiretinal membranes associated with Eales' disease: a clinicopathologic evaluation.

AIM: To study the histopathologic features and clinical correlation of epiretinal membranes (ERM) obtained from patients of Eales' disease and compare with other vasoproliferative disorders. METHODS: Retrospective analysis of epiretinal membranes submitted for histological evaluation between January 1995 and June 2001, from the patients of diabetic retinopathy and vascular occlusions (Group 1; vaso-occlusive disorders) and of Eales' disease (Group 2; vasoinflammatory disorders). Demographics, pre and postoperative visual acuity, and anatomic and histologic characteristics of membranes were studied. Histopathologic features and clinical outcomes were correlated between the groups. The results were analysed statistically by Student's t-test, Fisher's exact test and Kruskal-Wallis test. RESULTS: This study consisted of 42 patients, 24 in Group 1 and 18 in Group 2. Patients in Group 2 (33.0+/-9.2 years) were significantly younger than the patients in Group 1 (49.9+/-7.6 years) (P< or =0.0001). Final visual acuity of >20/400 was attained in 79.2% (19/24) patients in Group 1 and 83.3% (15/18) in Group 2 (P=1.0). Inflammatory membranes were significantly associated with presumed Eales' disease (94.4 vs 0%) (P< or =0.0001) and fibrovascular membranes with Group 1 (70.8% vs 33.3%) (P=0.028). Mast cells and eosinophils were observed as special features in epiretinal membranes of patients with Eales' disease. CONCLUSIONS: Histological features of ERM in Eales' disease are comparable to other vasoproliferative disorders except for features of inflammation. Presence of mast cells and eosinophils in epiretinal membranes of Eales' disease needs further investigation.

Adult↗
PubMed1999

Microangiopathy of the brain and retina with hearing loss in a 50 year old woman: extending the spectrum of Susac's syndrome.

A 50 year old woman presented with a subacute onset of vertigo and diplopia followed by an encephalopathy with confusion, spasticity, ataxia, myoclonus, and multiple branch retinal arteriolar occlusions and unilateral sensorineural deafness. Brain biopsy confirmed multiple microinfarcts with no vasculitis. After the procedure she had a right iliofemoral deep vein thrombosis and was found to be heterozygous for the factor V Leiden mutation. She was treated with anticoagulants and made a marked recovery with no relapses 6 months after presentation. This case extends the age range at which Susac's syndrome can present, and raises the possibility that the condition may be associated with abnormalities of coagulation.

Brain↗
PubMed1997

Evaluation of lymphocyte proliferation assay to purified protein derivative, enzyme linked immunosorbant assay, and tuberculin hypersensitivity in Eales' disease.

The purpose of this study was to evaluate the immunological responses against mycobacterial antigens in Eales' disease. Fifty six patients with Eales' disease and fifty age-and-sex-matched healthy volunteers with normal fundus findings taken as controls, were subjected to Mantoux test, using 2 TU/0.1 ml of purified protein derivative (PPD), lymphocyte proliferation assay to PPD, and ELISA to detect IgM and IgG antibodies against mycobacterial A-60 antigen. The results of Mantoux test and lymphocytes proliferation assay did not differ significantly in the two groups suggesting a similar cellular immune response. The number of individuals with recent exposure/reexposure to tuberculosis (IgM+) was significantly higher among patients. However the number of people with past exposure (IgM-IgG+) was significantly higher among controls. Our study indicates that there are no statistically significant differences in the humoral and cellular immune responses to mycobacterial antigens between the patients with Eales' disease and controls, except for a significantly higher IgM positivity among the patients.

Adolescent↗
PubMed1995

Choroidal and retinal detachment in antineutrophil cytoplasmic antibody-positive scleritis.

PURPOSE/METHODS: A 72-year-old woman with antineutrophil cytoplasmic antibody-positive vasculitis had a combined detachment of the choroid and retina. This unique initial manifestation was also associated with systemic and orbital manifestations, including brow ptosis, dacryoadenitis, and pneumonitis. RESULTS/CONCLUSIONS: This patient underwent vitrectomy for removal of a dense vitreitis and responded well to systemic cyclophosphamide. This case demonstrates that antineutrophil cytoplasmic antibody testing is useful for the diagnosis and treatment of Wegener's granulomatosis and microscopic polyarteritis-associated scleritis. The distinction between these two entities is often difficult to make.

Aged↗
PubMed1999

New animal model for human ocular toxocariasis: ophthalmoscopic observation.

BACKGROUND/AIMS: Although human ocular toxocariasis causes severe vision defect, little is known about its aetiology, diagnosis, and treatment. To develop a new animal model for human ocular toxocariasis, ophthalmological findings of fundi in Mongolian gerbils, Meriones unguiculatus, and BALB/c mice were investigated following infection with Toxocara canis. METHODS: Using an ophthalmoscope, which was specifically developed to observe the fundi of small animals, ocular changes of fundi of 20 gerbils and 11 mice were monitored after oral infection with embryonated eggs of T canis. RESULTS: Vitreous, choroidal, and retinal haemorrhages were consistently observed in Mongolian gerbils, but rarely in mice. Severe exudative lesions and vasculitis were often present in gerbils but not in mice. Migrating larvae were also frequently observed in gerbils. CONCLUSION: Mongolian gerbils are more appropriate animal model for human ocular toxocariasis than previously used experimental animal such as mice, guinea pigs, rabbits, and monkeys because of its high susceptibility of ocular infection.

Animals↗
PubMed2002

Embolic central retinal artery occlusion detected by orbital color Doppler imaging.

OBJECTIVE: To describe the detection of emboli to the retrobulbar circulation using orbital color Doppler imaging in patients with central retinal artery occlusions (CRAO) without visible retinal emboli. DESIGN: Noncomparative, retrospective, observational case series. PATIENTS AND METHODS: Twenty-nine patients with CRAO, without funduscopic evidence of embolic material within the retinal arterioles, underwent neuroophthalmic examination and evaluation with orbital color Doppler imaging. MAIN OUTCOME MEASURES: The detection of retrobulbar plaques using orbital color Doppler imaging. RESULTS: Nine of 29 (31%) patients with CRAO demonstrated hyperechoic retrobulbar plaques. All nine patients had visual acuity of counting fingers or worse at presentation. Six of the nine patients (67%) had a history of hypertension, and seven (78%) had coronary artery disease as vascular risk factors for arterial occlusive disease. Two of the nine patients (22%) subsequently died from cardiac-related events. CONCLUSIONS: This study demonstrates that orbital color Doppler imaging is an important diagnostic procedure for establishing embolism as the cause of CRAO when no emboli are visible in the retinal circulation. This noninvasive technology enables prompt differentiation of embolic disease from arterial occlusion caused by intrinsic atherosclerosis, vasospasm, or vasculitis from giant cell arteritis. Recognition of emboli has important management implications for these patients.

Aged↗
PubMed1999

Eales' disease: increased oxidation and peroxidation products of membrane constituents chiefly lipids and decreased antioxidant enzymes and reduced glutathione in vitreous.

PURPOSE: To measure the levels of oxidation and peroxidation products of membrane constituents chiefly lipids produced by oxygen and lipid free radicals as thiobarbituric acid reacting substances (TBARS), reduced glutathione (GSH) and the antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GP) in vitreous samples from patients with Eales' disease and estimate GSH, SOD, GP in the erythrocytes of patients with Eales' disease with active perivasculitis and healed perivasculitis. METHODS: Vitreous samples on vitrectomy from 11 patients with Eales' disease and 11 patients with diabetic vitreous hemorrhage were used for comparison. For study on erythrocytes, 30 patients of Eales' disease at the active vasculitis stage (group-I), 33 of healed vasculitis stage (group-II) and 25 controls (group-III) were used. The male female ratio was kept the same among the patients and the controls. Oxidation and peroxidation products of membrane constituents chiefly lipids were estimated as TBARS, SOD by its activity to inhibit auto-oxidation of epinephrine, GP by estimating the reduction in the level of GSH and GSH by its colour reaction with 5,5'-dithio bis (2-nitro) benzoic acid (DTNB). RESULTS: TBARS were increased 6 fold in the vitreous of Eales' patients compared to the samples from those with diabetic vitreous hemorrhage while there was a reduction of 95.9% of SOD and 84.2% of GSH. Activity of SOD, GP and the levels of GSH in the erythrocytes were reduced (%) by 81.6, 65 and 56.5 respectively in group I and 22,46.4 and 29.2% respectively in group II. The values are statistically significant. CONCLUSIONS: Increased levels of TBARS and decreased levels of SOD and GSH in the vitreous could explain inflammation, retinal damage and neovascularization in patients with Eales' disease. Decrease of SOD, GP and GSH is found in erythrocytes both in the active perivasculitis stage and the healed perivasculitis stage. Treatment of Eales' disease with antioxidants vitamin E, C as also vitamin A may have a beneficial effect.

Adult↗
PubMed2003

Blood supply to the retina and the lens in the gerbil (Meriones unguiculatus).

The blood supply to the retina and the lens in 32 gerbils (Meriones unguiculatus) of both sexes from infancy to maturity was studied under light and stereoscopic microscopes, and a scanning electron microscope. Mercox (CL-2R; Dai Nippon Ink, Tokyo, Japan) was injected into the left ventricle of 30 animals in order to visualize the blood supply to the retina and the lens from the ophthalmic artery. The central retinal artery arises from the ophthalmic artery, passes through the papilla of the optic nerve together with the central retinal vein and penetrates the vitreous space (cavity of the eye) between the lens and the internal limiting membrane of the retina, where it divides into the central branches covering the lens and the parietal branches to supply the retina. The former passes through the hyaloid space after branching several arterioles and then covers the lens like a network from its medial and marginal sides. Different from small experimental animals, the parietal branches, just after separating from the central one, divides into the nasal, dorsal and temporal branches in the vitreous space, each of which then subdivides to distribute across the retina on the inner limiting membrane, then delineates the membrana vasculosa retinae. This basal pattern of vasculization 1 day after birth continues to death. Both the central and parietal branches of the central retinal artery correspond to the branches of the hyaloid artery in embryo and the latter is preserved in adult gerbils.

Animals↗
PubMed2004

[Vitreoretinal traction syndrome in multiple sclerosis].

METHODS: From January to December 2001, 89 patients with multiple sclerosis (MS) were treated in our hospital; 24 of them were diagnosed for the first time. All patients underwent a complete ophthalmologic examination including a three-mirror contact lens examination when photopsias were found or the disease was diagnosed primarily. RESULTS: Two patients showed vitreoretinal tractions with signs of periphlebitis before clinical-neurological manifestation of multiple sclerosis. The third patient, in whom the disease had been known for years, showed distinct neovascularizations, vasculitis, and recurrent vitreous hemorrhages. High-dose steroid therapy resulted in stabilization of the retinal situation in one patient, but the tractions remained unchanged. Additional laser coagulation in the second patient achieved stabilization and reduction of the tractions. A pars plana vitrectomy led to stabilization of the retinal proliferation in the third patient. CONCLUSIONS: The vitreoretinal traction syndrome is associated with MS and can precede its clinical-neurological manifestation. The good results after argon laser coagulation and vitreoretinal surgery suggest a vascular pathogenesis of these tractions.

Adult↗
PubMed1994

Persistent choroidopathy in systemic lupus erythematosus.

We report a case of a rare entity, choroidopathy in association with systemic lupus erythematosus (SLE), previously described in only twelve patients to our knowledge. It manifested by multiple focal serous elevations of the sensory retina and/or serous detachments of the retinal pigment epithelium bilaterally. No retinal vascular changes were observed. The probable pathogenesis is related to choroidal vascular disease due to systemic hypertension secondary to lupus nephritis, vasculitis, or a combination of these.

Choroid Diseases↗
PubMed1985

Sulfadiazine-induced allergy in six Doberman pinschers.

Treatment with sulfadiazine-trimethoprim caused serious, but reversible, allergic drug reactions in 6 Doberman Pinschers 10 to 21 days after the first drug exposure and/or within 1 hour to 10 days after reexposure. Nonseptic polyarthritis was found in all dogs. Glomerulonephropathy, focal retinitis, polymyositis, skin rash, fever, anemia, leukopenia, and thrombocytopenia were found in some dogs. These clinical abnormalities were typical of an immune-mediated vasculitis and mimicked other immune-mediated disorders. In a drug challenge study, 1 dog was given sulfadiazine and trimethoprim separately. Administration of trimethoprim alone did not result in any abnormalities; however, exposure to sulfadiazine caused recurrence of the polyarthritis, glomerulonephropathy, and focal retinitis within 5 days, suggesting that sulfadiazine likely was the offending agent in all cases. In addition, during the sulfadiazine reexposure, marked complement activation was documented at the time clinical signs were apparent, supporting the suggestion that sulfadiazine caused an immune complex disease (type-III hypersensitivity reaction). Since all dogs were of the same breed, a genetic predisposition of some Doberman Pinschers to react adversely to sulfadiazine was suspected.

Animals↗