[Retinal vein occlusion followed by ischemic optic neuropathy with anticardiolipin IgG antibody: a case report].

BACKGROUND: Anticardiolipin antibodies in the autoimmune mechanism can cause vasculitis, leading to hypercoagulability-related thrombosis. We report a case of retinal vein occlusion followed by ischemic optic neuropathy in a young woman with anticardiolipin IgG antibody. CASE: A 17-year-old woman with dilatation and tortuosity of the retinal veins and retinal hemorrhage in the superior quadrant of the retina OS. Fluorescein retinal angiography showed a delay of filling time in the upper quadrant of the retina and a 3mm-continuous stain along the superior retinal vein. Laboratory tests were repeatedly positive for anticardiolipin IgG antibodies. Although the retinal hemorrhage disappeared 2 months after subtennon injection of 20 mg triamcinolone acetonide (TA), ischemic optic neuropathy occurred 9 months later. CONCLUSIONS: The staining of the vessel wall and the effectiveness of TA suggest that vasculitis may be associated with the pathology of this condition. The presence of anticardiolipin IgG antibodies suggests that autoimmune mechanism is involved in the vasculitis.

Tractography to depict three layers of visual field trajectories to the calcarine gyri.

PURPOSE: Fiber-tracking by diffusion tensor magnetic resonance imaging (DT-MRI) is currently the only noninvasive in vivo method for white matter fiber-tracking in the human brain. We used this method in attempts to visualize the optic radiation and to examine the clinical applicability of this technique. DESIGN: Observational case series. METHODS: DT-MRI scans for fiber-tracking were obtained in five healthy volunteers by use of a whole-body, 1.5 Tesla imager. DT-MRI data were transferred to an off-line workstation; PRIDE software was used for image analysis. We constructed 3 diopters fiber trajectories by tracking the direction of the fastest diffusion from the lateral geniculate nucleus, and then selected tracts on the basis of anatomical knowledge of the optic radiation. RESULTS: Our method successfully reconstructed the macroscopic 3 diopters architecture of the three major groups of optic radiation in all subjects. Meyer's loop depicted by tractography was located more posterior than the known anatomical locations, although our results on the central and posterior bundles were in good agreement with them. DT-MRI scanning required 7 minutes; preliminary images of the optic radiation could be obtained in approximately 20 minutes. CONCLUSIONS: Fiber-tracking enabled us to obtain information quickly on the 3 diopters course of the optic radiation in vivo. The finding that the fiber-tracking method underestimates the anterior extent of the optic radiations could prove to be an important limitation in the utility of this technique for preoperative planning. The time required for data acquisition and processing makes this method acceptable for routine clinical use.

Platelet aggregates in various stages of diabetic retinopathy: evaluation using the particle-counting light-scattering method.

AIMS: To investigate the possible correlation between platelet aggregation and the severity of diabetic retinopathy using the light-scattering method. METHODS: Using a light-scattering platelet aggregometer, we measured spontaneous platelet aggregation in 86 diabetics with retinopathy of varying severity and 30 healthy volunteers (controls). Platelet aggregates were classified as small, medium, and large according to their light intensity; patients were grouped based on the severity of retinopathy. In each patient group, we recorded for 10 min the total light intensities emitted by each aggregate size in the area under the curve (AUC). Then, we compared the AUC of each level of retinopathy severity with the controls and determined the correlation between the AUC of each aggregate size and each severity level. RESULTS: Of the 86 diabetics, 22 had no apparent retinopathy (NAR), 13 had mild nonproliferative diabetic retinopathy (NPDR), 17 had moderate NPDR, 12 had severe NPDR, and 22 had proliferative diabetic retinopathy (PDR). While the NAR group manifested significantly more small aggregates than the controls (20.5 x 10(6) versus 8.3 x 10(6) a.u., p=0.024), none of the other groups showed a significant increase in aggregates of any size. In the AUC of large aggregates, there was a weak-positive correlation with the severity of retinopathy (r=0.255, p=0.018); in the AUC of small and medium aggregates, there was no correlation. CONCLUSION: Although we did not find a significant correlation between platelet aggregation and the severity of diabetic retinopathy, our pilot study did detect some tendencies. Further studies on larger populations are underway to determine whether these tendencies are real.

Comparative effect of antiplatelet therapy in retinal vein occlusion evaluated by the particle-counting method using light scattering.

PURPOSE: To evaluate platelet aggregation in patients with retinal vein occlusion (RVO) by the light-scattering method and compare the effects of three antiplatelet drugs on aggregate formation. DESIGN: Prospective, nonrandomized, interventional clinical trial. METHODS: (1) Platelet aggregation was measured in 42 patients with untreated branch RVO (BRVO), 26 patients with central RVO (CRVO), and 30 healthy control subjects using a light-scattering platelet aggregometer. Platelet aggregates were classified as small, medium, and large according to light intensity. Total light intensities of each aggregate size were compared between BRVO, CRVO, and control subjects. (2) In 33 patients with RVO, platelet aggregation before and 2 weeks after the administration of ticlopidine, beraprost, or aspirin were compared. RESULTS: (1) There was a statistically significant difference (P = 0.0073) between the control subjects (8.3 x 10(6) a.u.) and CRVO patients (22.9 x 10(6) a.u.) with respect to small aggregates. There was no statistically significant difference with respect to medium and large aggregate formation between the control subjects and either patient group. (2) Compared with aggregates formed in the absence of antiplatelet drugs, ticlopidine significantly inhibited only the formation of small aggregates and beraprost that of all sizes; aspirin did not significantly inhibit the formation of any aggregate sizes. CONCLUSIONS: Increase in small platelet aggregates may be attributable to RVO pathogenesis. Beraprost and ticlopidine appear to inhibit small aggregate formation in RVO patients and may represent effective antiplatelet treatments. The light-scattering method is useful to investigate the pathogenesis of RVO and the effects of antiplatelet drugs.

Intentional complete interruption of a retinal vein after vitrectomy might improve the rate of successful chorioretinal venous anastomosis formation in central retinal vein occlusion.

BACKGROUND: Laser or surgical chorioretinal venous anastomosis has not become widespread as suitable treatment for central retinal vein occlusion (CRVO). We report here the effectiveness of cutting off a retinal vein with vitrectomy in making a chorioretinal venous anastomosis in CRVO. METHODS: We performed a vitrectomy accompanied by a chorioretinal venous anastomosis procedure for seven consecutive patients with CRVO. These patients had shown no improvement in their visual acuity in the month following their first visit to our hospital and had a visual acuity of less than 20/200. Their preoperative visual acuity ranged from counting fingers to 20/300. The procedure included the complete cutting of the affected retinal vein, and the making of a small incision at both sides of the vein interruption through the full thickness of the retina, the retinal pigment epithelium and Bruch's membrane. RESULTS: In five of the seven patients, successful chorioretinal venous anastomosis was observed. All five patients showed an improvement of two or more lines in visual acuity 6 months postoperatively. In three of the five, visual acuity was 20/100 or better. A postoperative complication of recurrent vitreous hemorrhage and fibrous proliferation was observed in one patient, and a second operation was necessary. CONCLUSIONS: Surgical interruption of an affected vein was a feasible procedure and could raise the rate of successful chorioretinal venous anastomosis in CRVO.