Macular hemorrhages associated with neonatal polycythemia and thrombocytopenia: A case report.

BACKGROUND: Thrombocytopenia occurs in 51% of neonates with polycythemia and is independently associated with growth restriction. Increased hematocrit is associated with decreased platelet count. The possibility of a hemorrhage should be noted. CASE DESCRIPTION: A Chinese male newborn presented with elevated hemoglobin and hematocrit levels. The platelet count decreased to 10×109/L during the 1st week after birth and remained abnormal at day 12. Vitreous turbidity of the right eye was detected 2 days later and was suspected of stemming from endophthalmitis or ocular inflammation. Two weeks later, vitreous turbidity decreased and a macular hemorrhage became visible. Optical coherence tomography confirmed the diagnosis of a retinal hemorrhage. CONCLUSION: Thrombocytopenia associated with polycythemia can induce a vitreous hemorrhage, which may be confused with ocular infection or inflammation.

Serum interferon-gamma/interleukin-4 imbalance in patients with Eales' disease.

BACKGROUND: Eales' disease (ED) is an idiopathic obliterative vasculopathy that usually affects the peripheral retina of young adults. The aim of this study is to investigate Th1/Th2 serum cytokine profiling in patients with ED. METHODS: This study included 30 male patients with ED and 10 healthy controls. The ED patients were divided into two subgroups: the vitreous haemorrhage (VH) group (n = 18) and non-vitreous haemorrhage (NVH) group (n = 12). Sixteen patients (six from the VH group and 10 from the NVH group) received glucocorticoid treatment for three months and were followed for six months. Levels of six cytokines including interferon-gamma (IFN-gamma), tumour necrosis factor-alpha (TNF-alpha) and four interleukins (IL-2, IL-4, IL-5 and IL-10) in the serum samples were determined by Luminex assays. RESULTS: Compared to controls, ED patients showed significantly higher levels of IL-10 and TNF-alpha, increased IFN-gamma/IL-4 (Th1/Th2) ratio, and lower levels of IL-4 (p < 0.05). Glucocorticoid treatment caused a restoration in the cytokine levels and the IFN-gamma/IL-4 ratio. Multivariate analysis revealed that reduced IL-4 (less than 4 pg/ml) and elevated IL-10 (greater than 4 pg/ml) levels were independent predictors of ED with odds ratios of 0.024 (95% CI, 0.002-0.255; p = 0.002) and 12.108 (95% CI, 1.045-140.233; p = 0.046), respectively. CONCLUSION: The findings demonstrate for the first time that there is an imbalance of Th1/Th2 cytokines in ED patients, which can be reversed by glucocorticoid treatment. Additionally, both IL-4 and IL-10 might represent potential diagnostic markers for the disease.

Interleukin-1 and tumor necrosis factor-alpha: novel targets for immunotherapy in Eales disease.

BACKGROUND: Eales disease is an idiopathic obliterative vasculopathy that primarily affects the peripheral retina of young adults. The authors evaluated interleukin 1 beta (IL-1beta), interleukin-6 (IL-6), Interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha) in the serum of patients with Eales disease stages for the first time. METHODS: The study group consisted of 45 consecutive patients of Eales disease [inflammatory stage (n = 15) and proliferative stage (n = 30)] and 28 healthy controls. Immunoassays for the quantification of the levels of four cytokines including IL-1beta, IL-6, IL-10, and TNF-alpha in the serum samples were performed using ELISA kits. RESULTS: IL-1beta, IL-6, IL-10, and TNF-alpha levels were found to be increased significantly in the inflammatory stage of Eales disease as compared to controls (p < .001). IL-1beta levels decreased significantly during the proliferative stage of the disease as compared to the inflammatory stage (p = .03). TNF-alpha levels increased significantly during the proliferative stage as compared to the inflammatory stage (p = .02). CONCLUSIONS: Raised levels of IL-1beta and TNF-alpha were observed in the inflammatory stage and persisted in the proliferative stage of the disease. The IL-1 system and TNF-alpha represent novel target for immunotherapy for controlling inflammatory activity and/or the associated long-term sequelae related to angiogenesis in Eales disease.

[Contribution of selected cellular adhesion molecules and proinflammatory cytokines in the pathogenesis of proliferative diabetic retinopathy]. / Udzial wybranych molekul adhezyjnych oraz cytokin prozapalnych w patogenezie proliferacyjnej retinopatii cukrzycowej.

UNLABELLED: Proliferative diabetic retinopathy (PDR) is caused by structural and functional disorders of the retinal vessels. Complex pathobiological mechanisms of this process have not been clearly explained so far. PURPOSE: To prove the role of immunological-inflammatory process in the development of the proliferative diabetic retinopathy. MATERIAL AND METHODS: Forty six patients, aged 63.97+/-9 were enrolled in the study, treated for diabetes type 2 for 12.56+/-6,87 years. In 19 patients (12 women and 7 men aged 64.63+/-8.38, treated for diabetes for 12.47+/-6.75 years) a parallel analysis of given parameters was performed in both serum and vitreous body samples. Vitrectomy, in course of which the vitreous body samples were obtained, was performed in these patients because of vitreous haemorrhage, causing traction retinal detachment in some patients. The control group consisted of 15 patients (9 women and 6 men), aged 63.00+/-14.58, who underwent the vitrectomy procedure because of reasons other than diabetic retinopathy. The concentration values of the soluble forms of ICAM-1, VCAM-1, IL-6 and TNF-alpha were estimated both in the serum and vitreous body samples on the basis of the ELISA method. The biochemical tests were performed routinely in the clinical laboratory. RESULTS: Mean concentrations of the investigated parameters were significantly higher in the group of patients suffering from PDR, both in the serum and in the vitreous body samples, in comparison with the values observed in the control group. In the presence of HbAlc at the level of 9.21+/-2.17% a directly proportional correlation between the TNF-alpha either in serum or in the vitreous body samples and VCAM-1 in the vitroeus body samples was found. It is worth mentioning that the increase of the TNF-alpha concentration in the vitreous body was significantly related to the rise of the VCAM-1. CONCLUSIONS: The above mention of findings prove the remarkable role of the immunological and inflammatory response in the pathogenesis of this specific vascular complication of diabetes. The research was a source of evidence which highlighted the necessity of optimal metabolic control of the disease in the prevention of vascular complications of diabetes.

HLA typing in patients of Eales disease.

OBJECTIVE: To determine any predisposition of haplotypes with Eales disease. DESIGN: A case control study. PLACE AND DURATION OF STUDY: This study was started in February 2002 and data collected till April 2003 at Eye Department of Military Hospital, Rawalpindi. PATIENTS AND METHODS: The frequency of HLA antigens both class-I and II by complement dependent standard lymphocytotoxicity test was studied in 32 patients of Eales disease (group-I) and 32 age and gender matched normal persons as controls (group-II). Both patients and controls underwent complete ocular and clinical examination and were followed up for one year. RESULTS: Mean age was 30.8 years. HLA DR3 was found in 20 patients of group-I and none in group-II. HLA types A1, B8, B5 (51) and DR 15 (2) were found in 12 out of 32 patients of eales disease and none in controls. HLA DQ2 and DR52 was found in 28 cases of group-I as compared to 18 cases of group-II (p = .005). CONCLUSION: HLA phenotypes HLA DR3, A1, B8, B5 (51) and DR 15 (2) occurred in majority of cases of Eales disease, whereas these were not found in controls which was statistically significant. Similarly, HLA DQ2, DR52 and Bw6 was found in higher frequency in Eales patients and thus strongly associated with it. We conclude that certain HLA haplotypes have a possible predilection for Eales disease.

Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage.

PURPOSE: To investigate the hemostatic effects of SF6 gas in preventing postoperative vitreous hemorrhage in diabetic vitrectomy. METHODS: A prospective, randomized study of 33 diabetic eyes with vitreous hemorrhage, treated by vitrectomy. In 17 of our cases SF6 20% was injected into the eye at the end of the operation, while in 16 cases BSS remained in the vitreous cavity. RESULTS: The incidence of vitreous hemorrhage recurrence was 17.6% for the SF6 group and 12.5% for the BSS group (statistically not significant). Progression of lens opacities was observed in 23.5% of the SF6 group, and in 18.8% of the BSS group (statistically not significant, with a higher incidence in the SF6 group). CONCLUSIONS: SF6 gas did not show hemostatic effects in the cases studied. Furthermore, it may have contributed to cataract progression. Therefore we suggest that the use of SF6 is not recommended as a treatment modality in preventing new vitreous hemorrhage after diabetic vitrectomy.

Bilateral vitreous hemorrhages in an infant with low fibrinogen levels.

The finding of retinal or vitreous hemorrhage in a child under age 3 years may cause significant controversy with regard to the etiology, because it raises the suspicion of nonaccidental injury. Blood dyscrasias have been documented to cause retinal and vitreous hemorrhages in adults and children, but they have rarely been reported to be the cause of retinal hemorrhages in neonates. We report on a patient with a low plasma fibrinogen level who had bilateral retinal hemorrhage that proceeded to vitreous hemorrhage. This subtle abnormality of the blood clotting cascade caused significant retinal and vitreous hemorrhage in a child without risk factors for abuse.

[Parameters of blood proteinase inhibitor balance and hyperlipoproteinemia in patients with proliferative diabetic retinopathy with vitreous hemorrhage]. / Pokazateli proteinazno-ingibitornogo balansa krovi i giperlipoproteidemii u bol'nykh proliferativnoi diabeticheskoi retinopatiei s krovoizliianiem v steklovidnoe telo.

The parameters of proteinase-inhibitor balance and lipid metabolism were studied in the blood of patients with proliferative diabetic retinopathy. Metabolic disorders in patients with proliferative diabetic retinopathy with hemophthalmia are characterized by a notable increase in the activities of trypsin-like enzymes and alpha 2-macroglobulin level and normal activity of alpha 1-antitrypsin and shifted lipid metabolism parameters characteristic of types IIb and IV hyperlipoproteinemia. These data indicate a necessity of monitoring lipid metabolism and proteinase-inhibitor balance in patients with diabetic retinopathy in order to detect subjects at a high risk of hemophthalmia and timely start drug correction for preventing this complication.

Serum alpha-1 acid glycoprotein levels in patients with idiopathic peripheral retinal vasculitis (Eales' disease).

Serum alpha-1 acid glycoprotein levels were measured in 27 patients with idiopathic peripheral retinal vasculitis (Eales' disease) and 31 healthy subjects by single radial immunodiffusion technique. The levels were found to be significantly increased in both moderate and severe types of the disease. The serum levels of this protein paralleled the severity of the disease. The increased alpha-1 acid glycoprotein in serum showed a significant fall to near normal levels during the quiescent stage. Our observations support the hypothesis that idiopathic peripheral retinal vasculitis is an immune mediated disease. It is proposed that serum alpha-1 acid glycoprotein may be considered as a reliable parameter of the activity and the degree of severity of the disease, as well as an useful tool for monitoring the efficacy of treatment.