Poor Prognosis in Idiopathic Thrombocytopenic Purpura-associated Retinopathy

PURPOSE: To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis. CASE SUMMARY: A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient's platelet count was 38,000/µL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient's visual acuity was 0.1 in both eyes, and her platelet count was 7,000/µL. For 2 years, the patient's platelet count was not controlled, and remained between 12,000–19,000/µL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye. CONCLUSIONS: ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.

Multiple Subretinal and Intraretinal Hemorrhages as a First Sign of Infective Endocarditis

PURPOSE: To report a patient with multiple subretinal and intraretinal hemorrhages in the absence of retinal/choroidal lesions, diagnosed with infective endocarditis (IE). CASE SUMMARY: We describe the case of a 44-year-old male with an acute decrease of vision in his right eye. Ophthalmic evaluation revealed multiple subretinal and intraretinal hemorrhages, but no choroidal or other retinal lesions. A systemic examination revealed a pansystolic murmur and blood cultures with echocardiography were suggestive of IE. CONCLUSIONS: Thorough systemic evaluations are important when patients present with subretinal and intraretinal hemorrhages in the absence of other retinal/choroidal lesions.

A Case of White-centered Retinal Hemorrhage in Infective Endocarditis

PURPOSE: To report a case of white-centered retinal hemorrhage in infective endocarditis. CASE SUMMARY: A 45-year-old patient complained of acute visual loss. The patient had a history of epidural anesthesia for the relief of back pain. On the day of admission the patient showed no light perception and had a white-centered retinal hemorrhage and cotton wool spot in the left eye upon fundus examination. Other ocular manifestations were not specific and there were no specific findings on a brain MRI and visual evoked potential. The patient was diagnosed with pyogenic spondylitis and was treated by abscess drainage and systemic antibiotics therapy. The patient's near vision improved up to 0.4/0.5. He was diagnosed with infective endocarditis based on the echocardiogram with epidural and subarachnoid hemorrhage. CONCLUSIONS: Roth spot can occur in many diseases such as diabetes, leukemia, anemia, and trauma, but most commonly in sepsis due to infective endocarditis. Therefore, medical evaluation and an echocardiogram for patients with white-centered retinal hemorrhage should be considered.

Cerebral Malaria Associated with Retinal Hemorrhage on Macular Area

PURPOSE: Cerebral malaria is caused by Plasmodium falciparum. The reports about cerebral malaria are very rare because Korea is not endemic area of P. falciparum. Additionally, macular hemorrhage and decreased vision associated with cerebral malaria was not reported ever in Korea, we report one case of cerebral malaria associated with retinal hemorrhage on macular area and review of literature. METHODS: Ophthalmology was consulted with about 19-year-old woman in cerebral malaria, tropical endemic disease caused by Plasmodium falciparum, with decresed visual acuity. RESULTS: 1250 mg/day of Mefloquine was injected into patient for cerebral malaria for 18 days. After awareness, the patient complained of decreased visual acuity in left eye, then the best corrected visual acuity(BCVA) in left eye was 20/800, BCVA in right eye was 20/20, retinal hemorrhage and Roth's spot were found on fundus examination in left eye, and finding in fluorescein angiography was not specific. After 8 months, retinal hemorrhage in left eye was absorbed, but BCVA in left eye was not changed.