ABSTRACT
We describe the case of a 23-month-old female infant with a diagnosis of hemolytic uremic syndrome (HUS) and hemorrhagic retinopathy. The patient had a past history of abdominal pain, bloody diarrhea, and acute renal failure. On ophthalmologic examination, indirect ophthalmoscopy revealed extensive areas of flame-shaped hemorrhage, cotton wool spots, macular edema and optic nerve head neovascularization in both eyes. Fluorescein angiography showed severe bilateral retinal ischemia and neovascularization leakage in disk. The patient, who had the visual acuity of 20/1000 in the right eye (OD) and 20/540 in the left eye (OS) at the first examination, was treated with panretinal photocoagulation (PRP) and presented at the end of the 6th month of follow-up improvement to 20/540 in OD and 20/270 in OS. There was also a regression of disc neovascularization, hemorrhages and macular edema. Despite intense retinal ischemia, there were no complications related to angiogenesis such as vitreous hemorrhage and/or neovascular glaucoma. We describe, in this report, the association between hemorrhagic retinopathy with features of Purtscher-like disease and HUS.
Descrevemos o caso de um lactente do sexo feminino de 23 meses com diagnóstico de síndrome hemolítico-urêmica (SHU) e retinopatia hemorrágica. A paciente apresentou história clínica prévia de dor abdominal, diarréia sanguinolenta e insuficiência renal aguda. Ao exame oftalmológico, a oftalmoscopia indireta evidenciou, em ambos os olhos, extensas áreas de hemorragia em chama de vela, exsudatos algodonosos, edema macular e neovasos na cabeça do nervo óptico. A angiofluoresceinografia mostrou intensa isquemia retiniana bilateral e vazamento na neovascularização de disco. A paciente, a qual apresentava acuidade visual de 20/1000 no olho direito (OD) e 20/540 no olho esquerdo (OE) no primeiro exame, foi tratada com panfotocoagulação retiniana e apresentou no final do 6º mês de acompanhamento a acuidade visual de 20/540 no OD e 20/270 no OE. Observou-se ainda a regressão dos neovasos, das hemorragias retininanas e do edema. Apesar da intensa isquemia retiniana não houve complicações relacionadas à angiogênese como hemorragia vítrea e/ou glaucoma neovascular. Descreve-se, neste relato, a associação entre retinopatia hemorrágicas com características de Purtscher-like e síndrome hemolítico-urêmica.
Subject(s)
Female , Humans , Infant , Hemolytic-Uremic Syndrome/complications , Retinal Hemorrhage/etiology , Retinal Hemorrhage/pathology , Fluorescein Angiography , Laser Coagulation/methods , Neovascularization, Pathologic/surgery , Retinal Hemorrhage/surgery , Treatment Outcome , Visual Acuity/physiologyABSTRACT
We report the case of a patient with congenital toxoplasmosis and submacular hemorrhage caused by a neovascular membrane who underwent an intravitreal injection of C3F8 and bevacizumab, and had a good visual recovery.
Relatamos o caso de uma paciente com toxoplasmose congênita e hemorragia submacular por uma membrana neovascular submetida à injeção intravítrea de C3F8 e bevacizumabe, com boa recuperação visual.
Subject(s)
Adolescent , Female , Humans , Intravitreal Injections/methods , Retinal Hemorrhage/drug therapy , Retinal Hemorrhage/etiology , Toxoplasmosis, Congenital/complications , Toxoplasmosis, Congenital/drug therapy , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , Contrast Media , Fluorocarbons , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
Objective To investigate the related factors of the retinal hemorrhage in high-risk infants (HRI).Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1-5 days of birth were enrolled in this study.In 860 cases of HRI,498 infants were vaginal delivery and 362 infants were delivered through cesarean sections.Among 498 vaginal delivered infants,407infants were eutocia and 91 infants were with forceps delivery; 298 infants were born following normal labor,102 infants experienced prolonged labor,and 98 infants were urgent birth.The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ,Ⅱ,and Ⅲ.Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score.The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared,and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed.Results In 860 cases of HRI,retinal hemorrhages were found in 202 infants (23.5％).Within these 202 infants,75 infants (37.1％) were Ⅰdegree retinal hemorrhage,75 infants (37.1％) were Ⅱ degree retinal hemorrhage,and 52 infants (25.8％)were Ⅲ degree retinal hemorrhage.In these 202 infants of retinal hemorrhage,172 infants (85.1 ％) had histories of asphyxia; 119 infants (69.2％) were graded as mild asphyxia-risk,and 53 infants (30.8％)were graded as severe asphyxia-risk.There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants (x2 =34.61,P＜0.01).The incidence of retinal hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference (x2 =30.73,P＜ 0.01).The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference (x2 =62.78,P＜0.01).Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery (x2＝45.86,71.51; P＜0.01).Asphyxia,types of delivery,prolonged and urgent labors were risk factors of retinal hemorrhage for HRI (r=7.46,4.87,15.03,6.47;P＜ 0.01).Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5％.And,asphyxia,types of delivery,prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.