1/8. Bilateral optic disk edema and blindness as initial presentation of acute lymphocytic leukemia.PURPOSE: To report bilateral optic disk edema and blindness as the unusual initial presentation of acute lymphocytic leukemia (ALL) in an adult. methods: A 19-year-old man presented with a history of headaches, back pain, and 10 days of worsening vision that progressed to blindness. Ocular examination revealed light perception acuity in the right eye and no light perception in the left eye. Fundus examination revealed bilateral profound optic disk edema, tortuous vessels, and retinal hemorrhages. Acute lymphocytic leukemia was diagnosed with complete blood count and bone marrow biopsy. head computed tomography and magnetic resonance imaging, were normal. Lumbar puncture revealed normal opening pressure. Ocular ultrasonography showed bilateral optic nerve enlargement. DESIGN: Interventional case report and literature review. ESULTS: The presumptive diagnosis of leukemic infiltration of the optic nerves was made, and urgent radiotherapy, intrathecal methotrexate, and intravenous daunorubicin were instituted. visual acuity improved to hand motions in the right eye. CONCLUSIONS: Acute lymphocytic leukemia can rarely present in adults as visual changes due to leukemic optic nerve infiltration. radiation treatment should be considered as an urgent treatment modality for this rare condition.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/8. Laser eye injuries in military occupations.INTRODUCTION: lasers (light amplification by stimulated emission of radiation) play an important role in our world and their use is increasing. They are powerful tools for good, but can also cause tragedy, especially in an aviation environment. Information about injuries associated with lasers is limited. This study highlights several laser eye injuries in the U.S. military and discusses issues pertaining to them. methods: We gathered data from the U.S. Army safety Center, the U.S. Army Center for health promotion and preventive medicine, and the Walter Reed Army Institute of research. This paper describes ten representative cases of laser eye injury that occurred in the U.S. military between 1984 and 2000. RESULTS: patients suffered retinal damage, though no corneal injury occurred. Most were caused by accidental exposure to a Q-switched, Neodynium:YAG (Nd:YAG) laser at 1064 nm wavelength. The incidents occurred both on and off duty, indoors and outdoors, and from close and long ranges. None of the victims were wearing eye protection. Inadequate training and poor equipment design were major factors in at least six of the nine unintentional cases. The tenth occurred during military operations in the Persian Gulf. All of the victims needed several months medical care and follow up. Two received medical discharges as a result of their injuries. DISCUSSION: As illustrated by these cases, human and societal costs from unintentional laser eye injuries can be reduced by improving operator training, safety procedure compliance, and equipment design. In addition, intentional laser eye injuries are a growing concern and further research is needed to design appropriate protection, treatment and countermeasures.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/8. Subhyaloid hemorrhage treated with SF6 gas injection.A 72-year old woman with a premacular subhyaloid hemorrhage could not be treated by laser photodisruption due to a thick posterior cortical vitreous. Pure sulfur hexafluoride (SF6, 0.3 mL) gas was injected intravitreally without recombinant tissue plasminogen activator, and facedown positioning was recommended for 5 days. Posterior vitreous detachment was induced and the hemorrhage dispersed into the vitreous cavity. Eight weeks later, her visual acuity had recovered from hand motions to 20/40. fluorescein angiography revealed an arterial macroaneurysm in the inferotemporal retina. Intravitreal SF6 gas injection without recombinant tissue plasminogen activator may be an alternative method for treating a relatively new subhyaloid hemorrhage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/8. Massive bilateral vitreoretinal hemorrhage in patient with chronic refractory idiopathic thrombocytopenic purpura.BACKGROUND: We describe a patient with chronic, refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. methods: A 49-year-old woman complained of an acute decrease of vision, and ophthalmoscopy revealed bilateral preretinal and subretinal hemorrhages around the optic disc. Her platelet counts were less than 5000/mul in spite of repetitive administration of corticosteroids and immunoglobulins with splenectomy for the chronic refractory ITP. One month later, she developed massive vitreoretinal hemorrhages bilaterally, and vision decreased to hand-motion. RESULTS: vitrectomy was performed on both eyes after medical treatment to increase platelet counts. The intraretinal hemorrhages were absorbed from the area around the disc and vision recovered to 20/100 in the right eye and 20/2000 in the left after one month. CONCLUSION: Massive vitreoretinal hemorrhages can develop in patients with chronic refractory ITP, and vitrectomy can be beneficial for this condition.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/8. Massive subhyaloidal hemorrhage associated with severe PAI-1 deficiency.PURPOSE: To report an association between spontaneous subhyaloidal hemorrhage and severe plasminogen activator inhibitor-1 (PAI-1) deficiency. methods: Case report. RESULTS: A 29-year-old woman presented with sudden, painless visual loss to hand motion in her right eye. ophthalmoscopy showed a massive subhyaloidal hemorrhage. The patients' medical history was negative for cardiovascular risk factors, trauma, infections or bleeding complications. Further investigation into possible causes revealed hyperfibrinolysis secondary to severe PAI-1 deficiency. The non-clearing subhyaloidal hemorrhage was successfully treated by pars plana vitrectomy, and her visual acuity improved to 20/20. CONCLUSION: When ordering laboratory tests in patients with spontaneous subhyaloidal hemorrhage to rule out fibrinolytic disorders, severe PAI-1 deficiency should be considered in the differential diagnosis. Selective screening may be helpful in identifying ophthalmologic patients with hyperfibrinolysis, especially in young individuals with subhyaloidal hemorrhages in the absence of other recognized risk factors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/8. Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy.PURPOSE: To report a case of recurrent bleeding after photodynamic therapy (PDT) in an eye with polypoidal choroidal vasculopathy (PCV). DESIGN: Interventional case report. methods: A 73-year-old man was treated in the left eye for PCV with PDT. RESULTS: Two weeks after PDT, his left eye showed extensive subretinal hemorrhage, with a slight vision loss. Three months after PDT, subretinal hemorrhage was almost absorbed. He received a second session of PDT to the remaining choroidal neovascularization. Two weeks thereafter, his left eye showed massive suprachoroidal hemorrhage with further vision loss. One month after the second PDT, visual acuity was decreased to no light perception as a result of massive vitreous hemorrhage. Although the patient underwent pars plana vitrectomy, visual acuity in the left eye remained hand motion as a result of massive suprachoroidal hemorrhage. CONCLUSIONS: Ophthalmologists and patients should be aware of the risk of massive bleeding after PDT in eyes with PCV.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/8. The posterior uveal bleeding syndrome.Eight patients were observed who suffered varying degrees of visual loss secondary to multiple recurrent hemorrhages or serous fluid beneath the retinal pigment epithelium and neurosensory retina in the posterior fundus. vitreous hemorrhage occurred in two patients. In all patients, hemorrhages or exudates were associated with orange subretinal lesions of which the clinical and fluorescein angiographic appearances were not previously familiar to the authors. Six of the eight patients were female, and all but one was black. Ages ranged from 40 to 79 years (median, 57 years). Final visual acuities ranged from 20/40 to hand motions. The term "posterior uveal bleeding syndrome" is proposed to describe these findings.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/8. Idiopathic polypoidal choroidal vasculopathy of the macula.OBJECTIVE: The authors evaluated the clinical, fluorescein, and indocyanine green (ICG) angiographic characteristics of the macular variant of idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Observational case series. PARTICIPANTS: The records, photographs, and fluorescein and ICG angiograms of eight eyes of seven patients with IPCV lesions confined to the macula were reviewed. MAIN OUTCOME MEASURES: The visual acuity, fundus examination, fluorescein and ICG angiographic characteristics, and clinical course were compared. RESULTS: All patients demonstrated polypoidal lesions arising from macular choroidal vessels on ICG angiography. One patient had bilateral lesions. These lesions appeared hyperfluorescent in the early phases of both fluorescein and ICG angiography. Late-phase leakage was seen in cases associated with subretinal fluid or exudate. None of these patients demonstrated polypoidal lesions arising from the peripapillary choroidal circulation or peripapillary choroidal neovascularization. Three eyes with polypoidal lesions that were associated with subretinal fluid and exudates were treated with photocoagulation. Five eyes were not treated. Final visual acuity ranged from 20/20 to hand motions. Severe visual loss was associated with vitreous and subretinal hemorrhage, but this resolved without permanent severe visual loss in several cases. CONCLUSIONS: In the macular variant of IPCV, ICG and fluorescein angiography demonstrate characteristic macular polypoidal lesions without evidence of peripapillary lesions. The vascular origin of these polypoidal lesions appears to be the macular choroidal circulation. This is distinguished from classic IPCV, in which lesions appear to arise from the peripapillary choroidal circulation. Visual prognosis appears to be good, with most patients retaining visual acuity of 20/80 or better. If subretinal fluid or exudates reduce visual acuity, photocoagulation should be considered.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |