Ocular manifestation of vertical transmission of dengue: case report / Manifestação ocular de transmissão vertical de dengue: relato de caso

ABSTRACT A 7-week-old male delivered by cesarean section presented with a positive serology for dengue along with preretinal and retinal hemorrhages, vitreous opacities and cotton wool spots. The patient and his mother had positive serologies for Non Structural Protein 1 (NS1) by ELISA. Retinal and vitreous findings improved over a sixteen-week period. Spectral domain optical coherence tomography (OCT) showed preserved macular architecture. In this case report, we suggest that retinal and vitreous changes may be the ocular presenting features of vertically transmitted dengue in newborns, and that those findings may resolve with no major structural sequelae.

RESUMO Neonato de 7 semanas, do sexo masculino, nascido de parto cesárea, apresentou sorologia positiva para dengue com hemorragias retinianas e pré-retinianas, opacidades vítreas e manchas algodonosas. O paciente e sua mãe haviam apresentado sorologias positivas para Non Structural Protein 1 através de ELISA. Achados na retina e no vítreo melhoraram em um período de dezesseis semanas. O exame de tomografia de coerência óptica de domínio espectral demonstrou arquitetura macular preservada. Neste relato de caso, sugerimos que alterações na retina e no vítreo podem ser os achados oculares aparentes em neonatos com infecção vertical por dengue, e que estes podem se resolver sem maiores sequelas estruturais.

The clinical characteristic of ocular findings secondary to hemophagocytic lymphohistiocytosis / 中国医师杂志

Objective:To describe the characterization of ocular changes secondary to hemophagocytic lymphohistiocytosis (HLH).Methods:The clinical data of 5 patients with HLH complicated with ocular involvement treated in Beijing Friendship Hospital Affiliated to Capital Medical University from September 2020 to May 2021 were retrospectively analyzed, the patients′ systemic examination and treatment were sorted out, and the ocular examination results were analyzed. The relevant literatures on ocular involvement of HLH patients were searched in China National Knowledge Infrastructure (CNKI), Pubmed, WOS, Embase and Medicine databases to summarize the characteristic manifestations of ocular involvement of HLH.Results:Of the 5 patients, 1 had primary HLH, 3 were Epstein-Barr virus-associated HLH (EBV-HLH), and 1 had diffuse large B-cell lymphoma-associated HLH. 4 patients showed unilateral or bilateral focal retinal hemorrhage and exudates. 1 male patient performed bilateral retinal pigment epithelial detachment. The literature search results showed that a total of 1 paper on ocular involvement in HLH patients was retrieved from the Chinese database and 11 papers were retrieved from the foreign database. HLH mainly involved the optic nerve, retina and choroid.Conclusions:The ocular involvement of HLH is easy to be missed or misdiagnosed because of its occult onset and complex and diverse clinical manifestations. Early examination and effective treatment may save vision and avoid missing the opportunity of systemic treatment.

Observation of the effect of autologous retinal pigment epithelium transplantation in the treatment of severe obsolete submacular hemorrhage / 中华眼底病杂志

Objective:To evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD).Methods:A retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age ( t=-0.363), gender composition ratio ( χ2=0.549), course and thickness of SMH ( t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments ( t=0.129), times of PPV ( t=-0.452) between the two groups were not statistically significant ( P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. Results:At the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant ( t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance ( χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant ( χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant ( t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. Conclusions:Both autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.

Diferentes abordajes en el manejo de las hemorragias maculares: reporte de casos y revisión de literatura / Different approaches in the management of macular hemorrhage: case reports and a literature review

INTRODUCCIÓN: Las hemorragias maculares producen una pérdida de la visión súbita y profunda. Las principales modalidades de tratamiento incluyen observación, inyección intravítrea de fármacos antiangiogénicos, hialoidotomía con láser neodymium-doped yttrium aluminium garnet, inyección intravítrea de gas y/o activador de plasminógeno tisular, en monoterapia o combinadas con cirugía. En el presente trabajo reportamos cuatro casos de hemorragias maculares de distintas causas, tratadas con diferentes abordajes, y realizamos una revisión de la literatura al respecto. PRESENTACIÓN DE CASOS: Los cuatro pacientes mostrados presentaron diferentes causas de hemorragias maculares. El primer caso tuvo una hemorragia prerretiniana debido a retinopatía de Valsalva y fue tratado con cirugía, el Caso 2 tuvo una hemorragia macular multinivel debido a una rotura de un macroaneurisma arteriolar retiniano y fue manejado con desplazamiento neumático, láser y ranibizumab intravítreo, el Caso 3 presentó una hemorragia subretiniana extensa debido a rotura coroidea posterior a un trauma ocular cerrado de alta energía y fue tratado exitosamente con cirugía. El último caso presentó una hemorragia prerretiniana debido a retinopatía diabética, manejada con láser neodymium-doped yttrium aluminium garnet. Los diferentes tratamientos fueron realizados exitosamente con buenos resultados. CONCLUSIÓN: Existen amplias opciones disponibles para el manejo de las hemorragias maculares y la mejor opción depende de las características de cada caso en particular. El manejo apropiado y oportuno de éstas puede lograr un resultado visual bueno, especialmente si la localización de la hemorragia es prerretiniana.

INTRODUCTION: Macular hemorrhages result in a sudden and profound loss of vision. The primary treatment modalities include observation, intravitreal injection of antiangiogenic drugs, neodymium-doped yttrium aluminum garnet hialoidotomy, intravitreal injection of gas with or without tissue plasminogen activator, as monotherapy or combined with surgery. In this paper, we report four cases of macular hemorrhages of different causes treated with different approaches, and we review the literature in this regard. CASE PRESENTATION: All four patients presented different causes of macular hemorrhage. The first case had a preretinal hemorrhage due to a Valsalva retinopathy and was treated with surgery. Case 2 had a multilevel macular hemorrhage due to a rupture of a retinal arteriolar macroaneurysm and was treated with pneumatic displacement, laser, and intravitreal ranibizumab. Case 3 presented an extensive subretinal hemorrhage due to a choroidal rupture after high-energy ocular trauma that was also successfully treated with surgery. The last case was a preretinal hemorrhage due to diabetic retinopathy managed with neodymium-doped yttrium aluminum garnet laser. Different treatment approaches were successfully performed in all cases with good outcomes. CONCLUSION: There is an extensive range of options available for the management of macular hemorrhages, and the best option depends on the characteristics of each particular case. Proper and timely management of these diseases can achieve an excellent visual outcome, especially if the location of the hemorrhage is preretinal.

The relationship between the retinal macular hemorrhage and refractive abnormalities in high-rask neonates / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the relationship between the macular hemorrhage and refractive abnormalities,and analyze the occurrence probability and the factors of refractive abnormalities in high-risk neonates. <p>METHODS: From January 2017 to January 2018, a total of 1 229 neonates with high-risk factors invided into 3 groups, according to the different parts of retinal hemorrhage, examined by RetCamⅢ device. All the subjects were checked the refractive status by autorefractor when they were 1 to 1.5 years old. The abnormalities were checked their refractive status under using of 1% atropine oculentum after 7d. The relationship between the macular hemorrhage and refractive abnormalities, and the occurrence probability and the factors of refractive abnormalities were analyzed.<p>RESULTS: Among 205 eyes which were retinal hemorrhage irrelated macula 6 eyes had refractive abnormality(2.93%)in group A. 57 eyes which were macular hemorrhage 17 eyes had refractive abnormality(29.82%)in group B. 2 196 eyes which were no retinal hemorrhage 40 eyes had refractive abnormality(1.82%)in group C. It had significant difference between groups A and B, groups B and C(<i>P</i><0.001), but had no significant difference between groups A and C(<i>P</i>=0.27). Multivariate Logistic regression analysis showed that macular hemorrhage and neonatal hypoxic ischemic encephalopathy were the independent risk factors for refractive status.<p>CONCLUSION: The incidence of refractive abnormality was high in macular hemorrhage. Macular hemorrhage and neonatal hypoxic ischemic encephalopathy were the independent risk factors for refractive abnormality,and we should strengthen the observation and intervention of such new-borns.

Vitreous hemorrhage as the presenting feature of peripheral exudative hemorrhagic chorioretinopathy in Indian eyes

Five Indian patients presenting with unilateral vitreous hemorrhage (VH) underwent pars plana vitrectomy (PPV) and were found to have lesions suggestive of peripheral exudative hemorrhagic chorioretinopathy (PEHCR). All eyes had extensive sub-retinal hemorrhage; three also showed an elevated mass lesion. The temporal retina anterior to the equator was the most commonly affected site. Exudative manifestations were absent in all. No recurrences occurred over a mean follow-up of 17.5 months. Although PEHCR is reported to be rare in Asians, this series demonstrates that it can present as VH in Indians as well. Unless the macula has irreversible damage, a favorable outcome can be obtained with PPV alone.

Clinic analysis of fundus screening and the risk factors of retinal hemorrhage in neonates / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To understand the basic conditions of neonatal fundus lesions and analyze the influencing factors of retinal hemorrhage.<p>METHODS: Totally 289 neonates from our hospital in the department of obstetric ward and neonatal intensive care unit from January 1, 2016 to May 31, 2018 were screened for fundus oculi disease by Retcam Ⅲ. The following information were collected such as gender, gestational age, history of asphyxia, maternal pregnancy and delivery way.<p>RESULTS: Among the 289 infants, there were 97 premature infants and 192 term infants. Sixty-four(22.1%)were detected with fundus lesions. Among which, 34(11.8%)were detected with retinal hemorrhage and 23(8.0%)retinopathy of prematurity. Single factor analysis showed that the rate of retinal hemorrhage in premature infants was higher than term(<i>P</i><0.05). The rate of retinal hemorrhage in neonates with perineal delivery was higher than cesarean section(<i>P</i><0.05). The rate of retinal hemorrhage in neonates with a history of asphyxiation was higher than that without(<i>P</i><0.05). The rate of retinal hemorrhage in neonates with high blood pressure during pregnancy was higher than that without(<i>P</i><0.05). After adjusting for the effects of risk factors, preterm infants, perineal births, history of asphyxiation, and high blood pressure during pregnancy were the high risk factors for neonatal retinal hemorrhage(<i>P</i><0.05).<p>CONCLUSION: The incidence of neonatal retinal hemorrhage is relatively high, which is related to factors such as gestational age, mode of delivery, history of asphyxia and history of maternal pregnancy hypertension.

Research progress of ocular decompressive retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular decompression retinopathy(ODR)is defined as multiple hemorrhagic retinopathy following abrupt lowering of intraocular pressure(IOP)that is not explained by another process. It is frequently associated with glaucoma surgeries, but also occurs in conjunction with other ocular surgical or medical procedures. Most patients are asymptomatic, so it may be difficult to detect clinically. We review the recent articles to better understand the risk factors, pathogenesis, clinical characteristics, imaging, differential diagnoses, management and prognosis of ODR.

Evaluation of a birth-related foveal hemorrhage in an infant using optical coherence tomography / Avaliação de uma hemorragia foveal relacionada ao nascimento de uma criança usando tomografia de coerência óptica

ABSTRACT During the routine ophthalmologic examination of a 38-day old female infant, indirect ophthalmoscopy revealed a dense hemorrhage on the fovea and a couple of superficial hemorrhages in the nasal retina of the left eye. No hemorrhage was observed in the right eye. A hand-held spectral domain optical coherence tomography (SD-OCT) was used at the time of diagnosis. The hemorrhage at the nasal retina resolved in the first week of follow-up, and the foveal hemorrhage resolved 12 weeks after birth. Spectral domain optical coherence tomography was repeated once the foveal hemorrhage had resorbed, and it showed that the foveal contour had reformed without any sequelae. This case suggests that birth-related foveal hemorrhages do not cause any disturbance in the foveal architecture.

RESUMO Durante o exame oftalmológico de rotina de uma criança do sexo feminino de 38 dias, a oftalmoscopia indireta revelou uma hemorragia densa na fóvea e algumas hemorragias superficiais na retina nasal do olho esquerdo. Nenhuma hemorragia foi observada no olho direito. Foi utilizada uma tomografia de coerência óptica de domínio espectral no momento do diagnóstico. A hemorragia na retina nasal foi resolvida na primeira semana de acompanhamento e a hemorragia foveal foi resolvida em 12 semanas após o nascimento. A tomografia de coerência óptica de domínio espectral foi repetida uma vez que a hemorragia foveal foi reabsorvida, e mostrou que o contorno foveal havia se reformado sem sequelas. Este caso sugere que as hemorragias foveais relacionadas ao nascimento não causam qualquer distúrbio na arquitetura foveal.

Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.

Effects of intravitreal injection Conbercept combined with 23G minimally invasive vitrectomy on PDR / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To explore the effect of intravitreal injection of Conbercept combined with 23G minimally invasive vitrectomy on retinal hemorrhage, retinal proliferation and visual prognosis in patients with proliferative diabetic retinopathy (PDR). ·METHODS: Totally 56 cases of PDR patients (56 eyes) admitted to our hospital were randomly divided into the conbercept group ( n=28) and the pars plana vitrectomy (PPV) group ( n=28). The conbercept group was given intravitreal injection of Conbercept and 23G minimally invasive vitrectomy, and the PPV group was given the 23G minimally invasive vitrectomy only. The operative time, retinal hemorrhage, retinal proliferation and visual acuity were compared between the two groups. ·RESULTS: The operative time and intraoperative blood loss in the conbercept group were significantly lower than those in the PPV group (P<0. 05). The visual acuity and macula thickness in the conbercept group were significantly better than those in the PPV group (P<0. 05). The postoperative retinal hemorrhage score, retinal proliferative score, vitreous rebleeding rate and vascular endothelial growth factor ( VEGF) level in the conbercept group were significantly lower than those in the PPV group (P<0. 05). · CONCLUSION: Intravitreal injection conbercept combined with 23G minimally invasive vitrectomy for PDR can not only shorten the operative time, reduce the intraoperative retinal hemorrhage and postoperative rebleeding and the retinal proliferation, but also help patients with postoperative visual acuity recovery.

Effect of retinal hemorrhage on laser photocoagulation in patients with retinopathy of prematurity / 中华眼底病杂志

Objective To observe the effect of retinal hemorrhage on the treatment of retinopathy of prematurity (ROP) by laser photocoagulation.Methods Retrospective case analysis.Screening and diagnosis of 134 eyes in 67 patients with ROP in Zone IⅡ Stage 3+ were included in the study.Among them,32 patients were male and 35 patients were female.The average birth gestational age was 27.80 ± 2.55 weeks.The average birth weight was 1060± 320 g.All children underwent binocular indirect ophthalmoscopy and RetCam Ⅲ.Of the 134 eyes,38 eyes (28％) with anterior,ridge or vitreous hemorrhage (group A);96 eyes (72％) without hemorrhage.Retinal avascular photocoagulation was performed within 72 hours after diagnosis by intravenous sedative combined with ocular surface anesthesia with 810 nm laser.Follow-up was performed at 1,4,8 and 12 weeks after treatment,and then every 6 months thereafter.The same equipment and methods before treatment were used to examine and document the regression and progression of ROP.The number of eyes with lesions after photocoagulation in the two groups was compared by x2 test.The t-test was used to compare the gestational age and birth weight.Results Among 134 eyes,lesions completely resolved in 125 eyes (93.3％),progressed in 9 eyes (6.7％).In group A,7 eyes were progressive (18.4％).In group B,2 eyes were progressive (2.1％).There was a statistically significant difference in the number of eyes with lesions after laser treatment in group A and B (x2=9.14,P=0.003).There was no significant difference in birth gestational age and birth weight (t=0.85,0.25;P=0.40,0.80).Conclusion The laser photocoagulation is safe and effective in the treatment of ROP.The preretinal,ridge or vitreous hemorrhage is related to the progression of the lesion after laser photocoagulation.

Diagnostic value of conventional ultrasound, color Doppler ultrasonography and contrast-enhanced ultrasound in sub-retinal hemorrhage / 中华医学超声杂志（电子版）

Objective To explore the value of conventional ultrasound, color Doppler ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of sub-retinal hemorrhage. Methods A total of 26 patients with sub-retinal hemorrhage were examined by conventional ultrasound, color Doppler ultrasound and CEUS. The results of medical history, ultrasound, color Doppler ultrasound and CEUS were recorded and analyzed.And the difference of the detection rate between the three methods was analyzed by χ2test. Results The mean fundus diameter of the sub-retinal hemorrhage was (5.31±2.21) mm, and the mean height was (1.97±0.98) mm. In twenty-two eyes (84.6%) the lesions were located in the posterior pole of the ocular wall, while in two eyes (7.7%) the lesions were located in the equator and peripheral of the ocular wall. Seven eyes (26.9%) had dome-shaped mass, ten eyes (38.5%) had flat-shaped mass, and nine eyes (34.9%) had irregular-shaped mass. The echogenecity of the lesions was homogeneous in twelve eyes (46.2%), and heterogeneous in fourteen eyes (53.8%). The lesions showed clear margin in seventeen eyes (65.4%). Blood flow signals can be detected in twenty-three eyes (88.5%). The surface of the lesions was filled by contrast-medium in all cases. The detection rate of sub-retinal hemorrhage with color Doppler and contrast-enhanced ultrasound was higher than that of conventional ultrasound, and the difference was statistically significant. Conclusion Color Doppler ultrasonography and CEUS can provide a powerful basis for the clinical diagnosis of sub-retinal hemorrhage, while CEUS has higher application value.

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 Retinal Hemorrhage Following a Dexamethasone Intravitreal Implant

PURPOSE: To report a case of retinal hemorrhage after a dexamethasone (Ozurdex®, Allergan, Irvine, CA, USA) intravitreal implant injection in macular edema (ME) secondary to central retinal vein occlusion (CRVO). CASE SUMMARY: A 60-year-old woman visited our hospital for ME secondary to CRVO in the right eye. Intravitreal bevacizumab injection and vitrectomy was conducted three times, but ME did not improve. Then, dexamethasone intravitreal implant was injected without any problems. Right after the dexamethasone intravitreal implant injection, retinal hemorrhage (2 disc diopter size) was observed in the infero-temporal area on fundus examination. Retinal hemorrhage completely disappeared 1 month after injection without other treatment. CONCLUSIONS: A case of dexamethasone intravitreal implant associated with retinal hemorrhage has not been previously reported in Korea. Althrough retinal hemorrhage was observed, it resolved spontaneously without treatment.

Retinal Hemorrhage Incidence of Newborn with Intra-uterine Growth Retardation in Korea

PURPOSE: We report 3 cases of patients with retinal hemorrhage among 27 newborns with intrauterine growth retardation. CASE SUMMARY: Twenty-seven newborns with intrauterine growth retardation were examined using the indirect ophthalmoscope for confirming retinal hemorrhage which was observed in 3 patients. The mean gestational age and birth weight (g) of the 3 patients were 37⁺⁶ weeks and 2,086.7 g, respectively. Among the 3 newborns, 1 patient's mother had oligohydramnios. Two patients were delivered vaginally and 1 by cesarean section. All 3 patients had no birth trauma and the retinal hemorrhage was resolved within 2 weeks after the first eye examination. CONCLUSIONS: We observed 3 cases with retinal hemorrhage in neonates with intrauterine growth retardation which improved within 2 weeks.

Association between Metabolic Syndrome and Retinal Vascular Changes in Koreans based on Health Check-ups

PURPOSE: To evaluate the associations between components of metabolic syndrome and retinal vascular changes in a Korean population based on data collected at health check-ups. METHODS: Fundus photographs of 381 patients participating in a health check-up were examined to identify central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriovenous ratio (AVR) by IVAN software. Retinal hemorrhage, arteriovenous nicking, and retinal exudate were also noted. The association between metabolic syndrome and each component was then analyzed. RESULTS: Significant associations were shown between metabolic syndrome and CRAE (p = 0.032), central obesity and CRAE (p = 0.037), triglyceride and CRAE (p = 0.011), and triglyceride and AVR (p = 0.005), in addition to central obesity and arteriovenous nicking (odds ratio [OR] = 2.68, p = 0.013), central obesity and retinal exudate (OR = 2.30, p = 0.038), serum glucose and retinal hemorrhage (OR = 8.06, p = 0.030), and blood pressure and arteriovenous nicking (OR = 2.78, p = 0.007). CONCLUSIONS: Metabolic syndrome showed a significant relationship with retinal artery diameter. Central obesity showed the greatest relationship with retinal vascular changes among each of the components of metabolic syndrome.

The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). METHODS: This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. RESULTS: The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm² at baseline to 1.8 ± 6.5 mm² at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. CONCLUSIONS: Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.

Intraretinal hemorrhage associated with visceral leishmaniasis / Hemorragia intrarretiniana associada à leishmaniose visceral

ABSTRACT Visceral Leishmaniasis, also know as Kala-azar, is a parasitic tropical disease caused by protozoa of the genus Leishmania donovani. It is an endemic disease in many countries. It affects approximately 1,5 million people every year, and when associated with mal-nutrition and co-infection it may be fatal. Fever, hepatosplenomegaly, and pancytopenia is its typical clinical picture. Ocular manifestations of Kalaazar are relatively rare and can affect either anterior or posterior segment of the eye. We report a patient with kala-azar presenting intraretinal hemorrhages that regress completely after the successful treatment for visceral leishmaniasis.

RESUMO Leishmaniose visceral, também conhecida como calazar é uma doença tropical parasitária, causada pelo protozoário do gênero Leishmania donovan uma doença endêmica em muitos países. Afeta aproximadamente 1,5 milhões de pessoas durante todo ano e quando associada à desnutrição e coinfecção pode ser fatal. Febre, hepatoesplenomegalia e pancitopenia e o quadro típico. Manifestações oculares são raras e podem afetar tanto o segmento anterior como o posterior do olho. Relatamos o caso de um paciente com calazar e hemorragia intrarretiniana que regrediu após tratamento para leishmaniose visceral.

A Case of Bilateral Retinal Hemorrhage with Cotton Wool Spot Following Viper Bite.

A 38 years male, admitted in the department of Internal Medicine with a history of snake bite in his left lower leg during agriculture work. He was treated with anti snake venom after admission. He had history of dimness of vision in both eyes. On examination, swelling and subcutaneous hemorrhage was noted in his left leg. His best corrected visual acuity (BCVA) was 6/60 in the both eyes. Fundus examination with 90 D lens and Indirect Ophthalmoscopy of both eyes showed retinal hemorrhage with cotton wool spots. Blood tests revealed increased titers of D-dimer and fibrin degradation products. The patient was followed up regularly at 2 weeks interval and BCVA and Fundus examination was carried out. At the end of 10 weeks, retinal hemorrhages had significantly cleared in both eyes with improvement of vision in both eyes (BCVA of right eye at last follow-up 6/6 and left eye 6/9).