Retinal Hemorrhages Research Articles

Increased severity of abusive head trauma during the first year of the COVID-19 pandemic

BackgroundAbusive head trauma (AHT) is the leading cause of death from physical abuse in children. Reports regarding the impact of the COVID-19 pandemic on rates and severity of AHT are limited and with conflicting results. ObjectiveTo determine the number and clinical characteristics of AHT cases presenting to a pediatric tertiary care center during the first year of the COVID-19 pandemic compared to the two prior years. Participants and settingWe performed a retrospective cohort study of patients <5 years old diagnosed with AHT at a single pediatric tertiary care center over a three-year period. MethodsData were obtained for the pandemic year and two years before, including demographics, length of stay, physical and retinal examination findings, radiologic studies, electroencephalogram results, and mortality. ResultsThere were 27 cases of AHT during the first year of the pandemic and 55 during the two pre-pandemic years. Length of stay was similar for the two cohorts. The mortality rate was higher during the pandemic (29.6 % vs. 3.6 %; p < .01), as were the proportion of patients with retinal hemorrhages (84.6 % vs. 41.5 %; p < .01) and abnormal cervical spine imaging (52.6 % vs. 21.2 %; p = .02). There were no differences in age, sex, race, abnormalities on dermatological exam, skeletal surveys, and electroencephalograms. ConclusionsWe did not observe an increase in the number of patients with AHT during the pandemic but did see an increase in mortality, patients with retinal hemorrhages, and patients with abnormalities on cervical spine imaging. These data suggest a higher severity of AHT presenting to a pediatric tertiary care center during the pandemic.

Waldenstrom Macroglobulinemia and the Clinical Implications of Acquired Von Willebrand Syndrome

Introduction Waldenström macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma that can manifest with impairment of hemostasis and platelet dysfunction. Very rarely, patients (pts) with WM can develop acquired von Willebrand syndrome (AVWS), a bleeding disorder generally associated with another systemic process. There is limited literature demonstrating the association of these conditions, and the clinical manifestations and symptomatology associated with treatment remain poorly explored. Our study aimed to assess the prevalence of this condition at our institution and determine the associated clinical manifestations and outcomes. Methodology Consecutive pts with a diagnosis of WM evaluated at Mayo Clinic, MN, FL and AZ who underwent von Willebrand factor (VWF) testing from 01/2002 to 01/2022 were included. Laboratory confirmation was obtained in the Special Coagulation Laboratory at Mayo Clinic, and those with a confirmed diagnosis of WM and AVWS were included in our final cohort. Bleeding symptoms, WM- and AVWS-related treatment, and associated laboratory data were abstracted. Results Of 2210 pts with a diagnosis of WM, 73 (3%) received testing for VWF, and 11 (15% of those tested and 0.5% of all pts) were diagnosed with AVWS. The median follow-up for these 11 pts was 34.0 months (95% CI, 30.1 - 163.6). Baseline testing at time of initial AVWS diagnosis [median (range, normal)] revealed: platelet count 170 (49-281, 135-317), VWF-activity (latex immunoassay) 25% (12-31, 55-200), ristocetin co-factor activity 21% (12-31, 55-200), VWF-antigen 32 (13-44, 55-200), and Factor VIII activity 40% (16-64, 55-200). Multimer analysis available in 6 patients revealed a normal distribution pattern. The most common underlying reason for testing was bleeding symptoms, observed in 9 (82%) pts. Other reasons for testing included pre-surgical (n=1) and routine screening (n=1). Eight (73%) pts were diagnosed with AVWS prior to frontline treatment initiation for WM. Concurrent diagnosis of AVWS and WM was made in 5 (45%) pts, 3 (27%) pts were diagnosed with AVWS before the progression of smoldering WM to WM and WM-directed therapy initiation, 2 (18%) pts were diagnosed during progressive WM after frontline therapy, and 1 (9%) pt was diagnosed during frontline therapy. In the 5 pts with concurrent diagnosis, WM was diagnosed a median of 35 days (range, 4-83) after the diagnosis of AVWS. All pts received WM-directed treatment. Recurrent epistaxis was the most observed bleeding symptom and was seen in 6 (55%) pts. Other observed symptoms included spontaneous hematoma (n=2), gastrointestinal (GI) bleeding (n=2), retinal hemorrhage (n=2), and subarachnoid hemorrhage (n=1). Seven (64%) pts had a major bleeding event leading to hospitalization due to spontaneous hematoma (n=2), GI bleeding (n=2), epistaxis (n=2) and subarachnoid hemorrhage (n=1). Two (18%) pts required surgical embolization due to severe epistaxis. Pharmacologic hemostatic treatments were administered in 6 (55%) pts, including Factor VIII/VWF complex (n=4, 36%), administered due to GI bleed, hematoma, epistaxis, and pre-surgical prophylaxis. Desmopressin was administered to 4 (36%) pts for hematoma, GI bleed, and epistaxis. Three (27%) pts received intravenous immunoglobulin (IVIG) for GI bleed, hematoma and pre-surgical prophylaxis, and 1 (9%) pt received prednisone for hematoma. These therapies led to at least temporary bleeding symptom improvement (<3 months) in all 6 pts. Of the 9 pts who had bleeding symptoms, 6 (67%) had improvement in their symptoms after WM-directed therapy. Three pts who were refractory to WM-directed therapy had no improvement in bleeding symptoms while on WM therapy (Table). Conclusions We found that <1% of pts had an identified diagnosis of AVWS secondary to WM, highlighting the rarity of this diagnosis and its potential under-recognition. The bleeding risk associated with AVWS in combination with WM, a malignancy inherently associated with bleeding, likely underlies the high rates of life-threatening bleeding events. The high morbidity associated, leading to events such as CNS bleeding and retinal hemorrhage, signals that one needs to evaluate pts with WM who are presenting with symptomatic bleeding for AVWS. Additionally, given a fraction of pts had worsening bleeding events after therapy initiation, agents with lower bleeding risk should be considered in pts with this diagnosis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical study of branch retinal vein occlusion (BRVO) in a tertiary eye care center

Branch Retinal Vein Occlusion (BRVO) is a common retinal vascular disorder which involves one of the branch retinal veins. The aim of the study is to analyse epidemiology, risk factors, clinical characteristics in the distribution of different types of BRVO and final visual outcome after treatment and six months follow up. This is a prospective study including 222 patients of BRVO was done from October-2018 to September-2020. Clinical evalution included, detailed history with systemic risk factors, visual acuity testing, Slit-lamp biomicroscopy, Intra occular pressure, detailed fundus evaluation, fundus fluorescein angiography, Optical Coherence Tomography and Gonioscopy. Laboratory test included complete blood count, Erythrocyte sedimention rate, fasting blood sugar, serum lipid profile. Treatment given, observation and follow up, intravitreal (lV) ranibizumab, IV triamcinolone and laser photo coagulation. Out of 222 BRVO patients, 207 (94.1%) were major BRVO (129(58.1%) were suprotemporal BRVO, 66(29.8%) were inferotemporal BRVO) and 15 (5.9%) were macular BRVO. Maximum number of patients 108 (48.6%) in the age group of 61-70 years. Male patients 126 (56.7%) more than females 96 (43.3%). Right eye 117 cases (52.7%) were involved slight more than the left eye 102 cases (45.9%). Blurring of vision 162 (72.9%) is the commonest symptom. Hypertensive patients 113 (50.9%) affected more followed by Diabetic 36 (16.2%) and cardiovascular disease 33 (14.9%). Mean Systolic blood pressure (SBP), Diastolic blood pressure (DBP), ESR &amp; Fasting blood sugar (FBS) are higher in Macular BRVO, cholesterol level is higher in Major BRVO. Retinal haemorrhage was present in all cases. Macular edema was present in 87.4% of patients in whom OCT was done. At the end of six months after treatment in majority of patients i:e 85.1% had BCVA between 6/6-6/18. There was dramatical improvement of vision after receiving intravitreal Ranibizumab (P value 0.041).There is strong association of conventional risk factors with BRVO. Visual prognosis depends on initial status with careful monitoring for macular ischaemia, macular edema, development of neovascularization and subsequent neovascular glaucoma followed by appropriate therapy like IV Ranibizumab, IV Triamcinolone and laser photocoagulation etc wherever required. There is dramatical improvement of vision after receiving intravitreal Ranibizumab (P value 0.041).

Successful Desensitization of Severe Alloimmune Platelet Refractoriness and Provision of Permissive Platelet Transfusions with a Novel IgG-Targeted Enzyme Therapeutic

AK and JCS contributed equallyBACKGROUND Alloimmune platelet refractoriness (APR), inadequate response to platelet transfusion secondary to alloantibodies targeting Human Leukocyte Antigens (HLA), affects ~25% of acute myeloid leukemia (AML) patients. For profoundly sensitized thrombocytopenic patients, HLA- or crossmatch-compatible platelet units may be unavailable, increasing the risk of thrombocytopenic hemorrhage. Imlifidase cleaves systemic IgG precluding complement fixation/phagocytosis and has been used to desensitize renal allograft recipients.1 Here we show that desensitization with imlifidase can significantly improve compatible platelet availability in APR and post-hematopoietic stem cell transplant platelet nadir. PATIENT CASE A 43-year-old woman with AML treated with cytarabine and daunorubicin was referred for matched-unrelated donor allogeneic hematopoietic progenitor cell transplantation. Her induction, at an outside institution, was complicated by bilateral retinal and mucosal hemorrhage secondary to APR and profound thrombocytopenia (platelet count to 0/µL). On presentation, her panel reactive antibody (PRA) showed exquisite sensitization (99.9%, i.e. ~99.9% of all donor platelet units predicted incompatible), precluding identification of HLA-compatible platelet units to support the patient through her anticipated platelet nadir. Desensitization included rituximab 375 mg/m2 (transplant D-13 and -6), therapeutic plasma exchange (TPE, D-2 and -1) and FDA-emergency-use-authorized imlifidase 0.25 mg/kg IV (D-1 and D+1). Following imlifidase administration, the number of unacceptable antigens and PRA decreased significantly (Figure) allowing sufficient compatible platelets to be identified and procured. During admission, the patient received 7 total platelet transfusions and experienced no hemorrhage (Table). She was discharged stable, post-platelet engraftment on D+19. STUDY DESIGN With IRB approval, the number of predicted clinically significant alloantibodies (antibodies with ≥ 3000 mean fluorescence intensity, MFI) and PRA (LABScreen single antigen and PRA Class I, One Lambda/ThermoFisher, West Hills, California) were compared at baseline, after rituximab/TPE, and after imlifidase administration. Corrected count increment (CCI) to platelet transfusions administered following imlifidase desensitization was calculated. CCI > 5000 was judged a permissive transfusion. Categorical variables were compared with Chi-squared followed by Fisher's Exact. P < .05 was significant. RESULTS AND CONCLUSION Compared to the baseline, unacceptable antigens (antigens targeted by antibodies at clinically significant levels) decreased significantly after rituximab/TPE (N=53/55 to 44/55 antigens, P = .015) and imlifidase (N = 44/55 to 16/55, P < .0001). PRA did not decrease significantly with rituximab/TPE (99.9 to 99.5%, P = .22) but did following imlifidase (99.5 to 87.2%, P < .0001). Of 7 transfusions given post imlifidase, the median CCI was 6000 (interquartile range: 500-7500), N=5/7 were judged permissive. In summary, the imlifidase-mediated decrease in PRA significantly aided the identification of numerous compatible platelet units for this patient and prevented further thrombocytopenic hemorrhage. Our limited data suggest a potentially novel application of imlifidase for desensitization of highly platelet allo-refractory patients requiring multiple platelet transfusions over a short period. We will perform western blot analysis of antibodies from in vivo samples collected over the treatment course to compare antibody fragmentation over time, as partially cleaved immunoglobulin detected by our microbead-based assays may not be pathologic.2 Additionally, as the patient's initial antibody levels exceeded the range of linearity of the bead-based assay, serial dilution studies of patient serum over the treatment course will more precisely semi-quantitate the true peak antibody levels. REFERENCES 1. Jordan SC, Legendre C, Desai NM, et al. Imlifidase desensitization in crossmatch-positive, highly sensitized kidney transplant recipients: results of an international phase 2 trial (Highdes). Transplantation. 2021;105(8):1808-1817. 2. Bockermann R, Järnum S, Runström A, et al. Imlifidase-generated single-cleaved IgG: implications for transplantation. Transplantation. 2022;106(7):1485-1496. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Laser Treatment for Retinal Arterial Macroaneurysm

Retinal arterial macroaneurysm (RAM) can be defined as an acquired round or fusiform dilation of a retinal artery. RAMs frequently remain stable but, in some cases, can complicate with macular exudation or hemorrhage, resulting in symptomatic disease. While a watch-and-wait approach is the standard option in asymptomatic RAMs, there is no universal agreement regarding treatment of symptomatic cases and randomized clinical trials are warranted. Anti-VEGF intravitreal injections can reduce exudation, albeit multiple treatments may be necessary. Hence, laser treatment may be a better choice to provide a durable control of symptoms while anti-VEGF therapy should be preferred for lesions adjacent to the fovea. Indirect laser is recommended because there is a decreased danger of RAM rupture and hemorrhage. Furthermore, subthreshold laser seems to be comparable to conventional laser in terms of efficacy outcomes.

Terson’s Syndrome: Never Let It Slide! (A Case Report)

Terson's syndrome is defined by an intraocular (vitreous, retinal or retrohyaloid) hemorrhage, consequent to an acute intracranial bleeding or a sudden elevated intracranial pressure. Undiagnosed early, Terson's syndrome can be responsible for serious ocular complication that can leads to complete vision loss. We report a 57 year old patient representing Terson's syndrome after an acute rupture of an aneurysm of the right sylvian artery. The rapid diagnosis and management of Terson's syndrome in our patient’s case allowed for a quick recovery and a better prognosis. Therefore, the importance of always thinking of Terson's syndrome a a possible diagnosis upon such clinical presentation.

COVID-19 Vaccine-Associated Ocular Adverse Effects: An Overview.

To address the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccination efforts were initiated across the globe in December 2020 and are continuing. We report the onset interval and clinical presentations of ocular adverse effects following SARS-CoV-2 vaccination. For this narrative review, articles in the English language, published between 1 January 2020 to 1 September 2022, were included to formulate a list of the reported ocular adverse effects of different COVID-19 vaccines. During this period, ocular adverse effects have been reported with BNT162b2 (Pfizer), mRNA-1273 (Moderna), AZD-1222 (AstraZeneca), and Ad26.COV2.S (Johnson & Johnson) vaccines. Endothelial graft rejection, herpes simplex virus keratitis, herpes zoster ophthalmicus, anterior uveitis, eyelid edema, purpuric rashes, ischemic optic neuropathy, and cranial nerve palsies were the most reported with BNT163b2. Retinal hemorrhages, vascular occlusions, and angle closure glaucoma were the most reported with AZD-1222. Most of the ocular adverse effects reported in the literature had a good to fair prognosis with appropriate management. Evidence regarding the ocular adverse effects does not outweigh the benefits of SARS-CoV-2 vaccination in patients with pre-existing systemic or ophthalmic diseases. This review provides insights into the possible temporal association between reported ocular adverse events and SARS-CoV-2 vaccines; however, further investigations are required to identify the link between potential causality and pathological mechanisms.

BNT162b2 (Pfizer/BioNTech) COVID-19 Vaccination Was Not Associated with the Progression of Activity of the Exudative Form of Age-Related Macular Degeneration during Anti-VEGF Therapy.

Evaluation of the activity of the exudative form of age-related macular degeneration (AMD) during anti-vascular endothelial growth factor (anti-VEGF) therapy before and after administration of BNT162b2 (Pfizer/BioNTech) vaccination. The optical coherence tomography and best corrected visual acuity (BCVA) records of the two previous visits before the first dose of BNT162b2 (first pre-vaccination visit marked as "V-1", the previous pre-vaccination "V-2"), and two subsequent visits after the second dose of vaccination (first visit after the second dose marked as "V1", second visit after the second dose marked as "V2") were collected for 63 eyes of 59 patients. The difference in the average retinal thickness was observed between the last and each other checkpoint for the aflibercept group and in the overall outcome. The maximum thickness from the inner retinal surface to the inner border of RPE decreased during the observation; differences were observed comparing visits -2 and 1. Subretinal complex thickness decreased during follow-up, and the differences were observed between visits -2 and 2. There were no statistically significant differences in the BCVA and the occurrence of intraretinal cystoid fluid, serous PED, subretinal hyperreflective material, and retinal hemorrhage. In the present study, the activity of the exudative form of AMD did not deteriorate after the administration of the BNT162b2 vaccine.

Underestimating isolated bilateral hygroma as non-accidental head injury with dramatic consequences: a case presentation

ObjectiveAbusive head injury (AHI) in infancy is associated with significantly worse outcomes compared to accidental traumatic brain injury. The decision-making of the diagnosis of AHI is challenging especially if the clinical signs are not presenting as a multifactorial pattern.MethodWe present a case of isolated bilateral hygroma in which this differential diagnosis of AHI was evaluated but primarily not seen as such leading subsequently to extensive secondary AHI with fatal brain injury.ResultsThe case of an 8-week-old infant with apparently isolated bilateral hygroma without any external signs of abuse and no retinal hemorrhages was interpreted in causative correlation to the perinatal complex course of delivery. At a second readmission of the case, severe brain injury with bilateral cortical hypoxia, subarachnoid and subdural hemorrhages, and skull and extremity fractures led to severe disability of the affected infant.ConclusionAny early suspicion of AHI with at least one factor possibly being associated with abusive trauma should be discussed in multidisciplinary team conferences to find the best strategy to protect the child. Beside clinical factors, social factors within the family household may additionally be evaluated to determine stress-related risk for traumatic child abuse. In general, prevention programs will be essential in future perspective.

Intraocular Tuberculosis with Extraocular Growth

A 24-year-old man presented with a 1-month history of deterioration in the vision of his left eye. Visual acuity was measured at 8/20 in the left eye and 20/20 in the right eye. In the left eye, a hemispherical subretinal mass with retinal hemorrhage was noted in the superotemporal quadrant (Figure 1 A). Interferon-gamma (IFN-gamma) release assay showed significantly elevated level of IFN-gamma. A diagnosis of intraocular tuberculosis was suspected. Physical examination showed no other abnormalities and chest radiograph was normal, so the patient refused to receive antituberculosis medications.

Accuracy and feasibility with AI-assisted OCT in retinal disorder community screening.

Objective: To evaluate the accuracy and feasibility of the auto-detection of 15 retinal disorders with artificial intelligence (AI)-assisted optical coherence tomography (OCT) in community screening. Methods: A total of 954 eyes of 477 subjects from four local communities were enrolled in this study from September to December 2021. They received OCT scans covering an area of 12 mm × 9mm at the posterior pole retina involving the macular and optic disc, as well as other ophthalmic examinations performed using their demographic information recorded. The OCT images were analyzed using integrated software with the previously established algorithm based on the deep-learning method and trained to detect 15 kinds of retinal disorders, namely, pigment epithelial detachment (PED), posterior vitreous detachment (PVD), epiretinal membranes (ERMs), sub-retinal fluid (SRF), choroidal neovascularization (CNV), drusen, retinoschisis, cystoid macular edema (CME), exudation, macular hole (MH), retinal detachment (RD), ellipsoid zone disruption, focal choroidal excavation (FCE), choroid atrophy, and retinal hemorrhage. Meanwhile, the diagnosis was also generated from three groups of individual ophthalmologists (group of retina specialists, senior ophthalmologists, and junior ophthalmologists) and compared with those by the AI. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated, and kappa statistics were performed. Results: A total of 878 eyes were finally enrolled, with 76 excluded due to poor image quality. In the detection of 15 retinal disorders, the ROC curve comparison between AI and professors' presented relatively large AUC (0.891-0.997), high sensitivity (87.65-100%), and high specificity (80.12-99.41%). Among the ROC curve comparisons with those by the retina specialists, AI was the closest one to the professors' compared to senior and junior ophthalmologists (p < 0.05). Conclusion: AI-assisted OCT is highly accurate, sensitive, and specific in auto-detection of 15 kinds of retinal disorders, certifying its feasibility and effectiveness in community ophthalmic screening.

The Roles of Vitamins in Diabetic Retinopathy: A Narrative Review.

There have been attempts to evaluate the roles of vitamins for the prevention or treatment of eye conditions, such as glaucoma, age-related macular degeneration, and diabetic retinopathy (DR). Regarding DR, two main groups of studies can be identified. The first group focuses on the association between serum levels of an individual vitamin and DR. Many studies have found that lower serum levels of vitamins, particularly vitamin D, are significantly associated with the development, or severity, of DR, while some studies have not supported this trend. The second group evaluates dietary vitamin intakes and DR. A small, randomized placebo-controlled trial did not show any benefit of vitamin E intake on improving the area of retinal hemorrhage or diabetic macular edema at 12 months. A pilot study of patients with mild-to-moderate non-proliferative DR received tablets of combined vitamins B6, B9, and B12 for 6 months and significant improvement in retinal sensitivity and retinal thickness resulted. Two large prospective cohorts showed that high dietary intake of vitamin B6, and fruit rich in vitamin C and E, could significantly lower the risk of DR by 50% after an eight-year follow-up. Properly designed, randomized controlled trials are needed to support the results.

Diagnostic Accuracy of Vitreous Cytology in Patients with Vitreoretinal Lymphoma.

(1) Background: To determine the diagnostic value of vitreous cytology in patients with vitreoretinal lymphoma (VRL) and evaluate its diagnostic accuracy relative to that of other diagnostic tests. (2) Methods: In total, 38 eyes from 38 patients with VRL who underwent diagnostic vitrectomy and were followed up for at least 6 months were analyzed. The clinical manifestations and VRL diagnostic rates for all diagnostic tests were determined. (3) Results: The presence of vitreous cells/opacity was the most common ophthalmic finding (97.4%), followed by sub-retinal pigment epithelial infiltration (65.8%) and retinal hemorrhage (21.1%). The VRL diagnostic rates were 89.3% for interleukin (IL)-10 levels &gt; 50 pg/mL; 82.1% for IL-10/IL-6 ratios &gt; 1; 60.0% and 63.3% for immunoglobulin heavy chain and kappa light chain clonality assays, respectively; and 44.4% for vitreous cytology. The VRL diagnostic rate for vitreous cytology was significantly lower in the steroid pretreatment group than in the non-steroid pretreatment group (p = 0.007). (4) Conclusions: The VRL detection rate for vitreous cytology was lower than that for the other tests, especially in patients who received steroid pretreatment. These findings suggest that even if vitreous cytology findings are negative, other tests and characteristic fundus findings should be evaluated to confirm VRL diagnosis.

STUDY OF OPHTHALMIC MANIFESTATIONS IN PATIENTS WITH HAEMATOLOGICAL DYSCRASIAS

BackgroundAndObjectives:Haematologicaldyscrasiasreferstodisorders of the cellular elements of the blood, indicating a pathologicalcondition.Tostudythetypesofophthalmicmanifestationsinhaematological dyscrasias. Methods: This was a Descriptive cross-sectional study of 200cases admitted and diagnosed with various haematological dyscrasias inMedicine, Paediatrics wardsof the hospital betweenDecember 2020 toNovember2022.Allpatientsunderwentastandardisedandcomprehensiveophthalmic evaluation. Results:Outof200cases,152caseswereofnonmalignantdiseases,and 48 cases were of malignant diseases.Male cases were predominantly higherthan female cases. Conjunctival pallor was the most common anteriorsegment manifestation observed, and Retinal haemorrhage was the mostcommon posterior segmentmanifestation observedduring the studyperiod. Conclusion: It is essential to examine all patients with haematologicaldisordersforocularmanifestationsasithelpsindiagnosisandprognosis. Early recognition of the ocular manifestations is of greatimportance as an early treatment institution may prevent or alleviatebothocularandsystemic complications.

Optical and Physical Properties of Silicone Oil Extracted from the Vitreous of Patients Who Underwent Vitrectomy for Retinal Detachment.

Purpose: Silicone oil (SO) is a crucial tool in vitreoretinal surgery. SO has the tendency to emulsify depending on certain factors. In this work, detailed analyses have been conducted to understand changes that occurred to the physical, optical, and chemical characteristics of the oil after removal from the vitreous cavity. Methods: Five samples of SO were collected from patients who underwent vitrectomy for rhegmatogenous retinal detachment. The fourier-transform infrared (FTIR) spectroscopy, ultraviolet-visible spectrometer, and contact angle analysis were utilized to determine the changes in its chemical bondings, transmittance, absorbance, viscosity, buoyance, and specific gravity. Results: FTIR analysis showed significant changes in the chemical bonding that might be related to the age of the patient, lens status, the presence of retinal hemorrhages, and the exposure to laser after implantation of SO. In addition, contact angle analysis revealed that the viscosity might be affected by duration of implantation and the age of the patient. Moreover, transmittance and absorbance were largely affected by the exposure to laser retinopexy after implantation. Conclusion: This study showed that certain factors such as the age of the patient, the exposure to laser, lens status, and the presence of retinal hemorrhages may contribute to the emulsification process.

Clinical characteristics, risk factors and short-term prognosis of retinopathy of prematurity complicated with retinal hemorrhage.

To investigate the incidence, clinical characteristics and short-term prognosis of retinal hemorrhage (RH) in premature infants with retinopathy of prematurity (ROP). From July 2015 to December 2021, the incidence and clinical characteristics of RH in premature infants with ROP diagnosed in a NICU of China before treatment were retrospectively analyzed. A total of 670 premature infants were diagnosed with ROP, including 406 males and 254 females, with a mean gestational age (GA) of 29.51 ± 2.15w and a mean birth weight of 1240.56 ± 292.97g, excluding 10 premature infants who had progressed to stage 4 or 5 at the time of transfer and receiving vitrectomy. Of them, 322 (48.8%) premature infants had Type 1 ROP and received laser or anti-VEGF therapy, and 142 (21.3%) premature infants developed RH before treatment. The GA and birth weight of RH group were lower than those of non-RH group (29.19 ± 2.19w vs. 29.60 ± 2.13w; 1178.11 ± 282.01g vs. 1257.69 ± 293.85g, both P < 0.05), and the proportion of premature infants receiving treatment was also higher than that of non-RH group (97/142, 68.3% vs. 225/518, 43.4%). The lower the GA and the birth weight, the higher the incidence of RH. The incidence of RH was 45.5% in GA <26w and 30.5% in birth weight <1000g. After treatment, 7 eyes (2.6%) of 5 cases (3.5%) in RH group developed retinal detachment vs. 4 eyes (0.4%) of 3 cases (0.6%) in non-RH group, showing a significant difference between the two groups (χ2 = 8.043, P < 0.01). Regression analysis showed that RH, Zone I lesions, plus lesions, and the postnatal time of ocular lesions were independent risk factors for Type 1 ROP. The lower the GA and the birth weight, the higher the incidence of ROP complicated with RH. RH is an indicator of severe ROP associated with poor retinal prognosis.

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases.

Retinal occlusive diseases are common diseases that can lead to visual impairment. Retinal artery occlusion and retinal vein occlusion are included in the clinical entity, but they have quite different pathophysiologies. Retinal artery occlusion is an emergent eye disorder. Retinal artery occlusion is mainly caused by thromboembolism, which frequently occurs in conjunction with life-threatening stroke and cardiovascular diseases. Therefore, prompt examinations and interventions for systemic vascular diseases are often necessary for these patients. Retinal vein occlusion is characterized by retinal hemorrhage and ischemia, which may impair visual function via several complications such as macular edema, macular ischemia, vitreous hemorrhage, and neovascular glaucoma. Even though anti-vascular endothelial growth factor therapy is the current established first-line of treatment for retinal vein occlusion, several clinical studies have been performed to identify better treatment protocols and new therapeutic options. In this review, we summarize the current findings and advances in knowledge regarding retinal occlusive diseases, particularly focusing on recent studies, in order to provide an update for a better understanding of its pathogenesis.

Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China.

Neonatal retinal hemorrhage (RH) is the most common ocular fundus disease among newborns. Early detection and timely intervention are vital for reducing the risk of visual impairment caused by RH. However, little is known about the prevalence, characteristics, and risk factors of RH in southern China. Full-term infants born in Qingyuan City during the first 10 days of each month in 2021 were included in this study. All infants underwent RetCam III retinal examinations. Detailed information on retinal hemorrhage, including involved eyes, bleeding severity, and affected area (extrafoveal macula, fovea, or optic disc), and clinical information on the neonates and their mothers was collected. The results showed that among the 1072 eligible neonates, 266 (24.8%) had neonatal retinal hemorrhage. Consistent bilateral retinal hemorrhage severity was observed in 83.2% of the cases. The prevalence of optic disc involved RH, extrafoveal macular involved RH and foveal involved RH were 23.7%, 81.2% and 2.63%, respectively. Multivariate logistic regression analysis showed that lower birth weight (OR, 0.63; 95% CI, 0.40-0.99; p < 0.05) and vaginal delivery (OR, 20.6; 95% CI, 9.10-46.5; p < 0.001) were risk factors of neonatal RH. The area under the ROC curve of vaginal delivery, combined with birth weight, as predictors of neonatal RH was 0.73, with 85.3% sensitivity and 23.9% specificity. The birth weight cutoff was 3460 g. Our results suggested that neonatal RH is common in full-term neonates in southern China. It usually has the same severity in both eyes and mostly involves the extrafoveal macular region. Vaginal delivery and low birth weight are risk factors for neonatal RH.

The association of subcortical brain injury and abusive head trauma

BackgroundAbusive head trauma (AHT) remains a major pediatric problem with diagnostic challenges. A small pilot study previously associated subcortical brain injury with AHT. ObjectivesTo investigate the association of subcortical injury on neuroimaging with the diagnosis of AHT. Participants and settingChildren <3 years with acute TBI admitted to 18 PICUs between 2011 and 2021. MethodsSecondary analysis of existing, combined, de-identified, cross-sectional dataset. ResultsDeepest location of visible injury was characterized as scalp/skull/epidural (n = 170), subarachnoid/subdural (n = 386), cortical brain (n = 170), or subcortical brain (n = 247) (total n = 973). Subcortical injury was significantly associated with AHT using both physicians' diagnostic impression (OR: 8.41 [95 % CI: 5.82–12.44]) and a priori definitional criteria (OR: 5.99 [95 % CI: 4.31–8.43]). Caregiver reports consistent with the child's gross motor skills and historically consistent with repetition decreased as deepest location of injury increased, p < 0.001. Patients with subcortical injuries were significantly more likely to have traumatic extracranial injuries such as rib fractures (OR 3.36, 95 % CI 2.30–4.92) or retinal hemorrhages (OR 5.97, 95 % CI 4.35–8.24), respiratory compromise (OR 12.12, 95 % CI 8.49–17.62), circulatory compromise (OR 6.71, 95 % CI 4.87–9.29), seizures (OR 3.18, 95 % CI 2.35–4.29), and acute encephalopathy (OR 12.44, 95 % CI 8.16–19.68). ConclusionsSubcortical injury is associated with a diagnosis of AHT, historical inaccuracies concerning for abuse, traumatic extracranial injuries, and increased severity of illness including respiratory and circulatory compromise, seizures, and prolonged loss of consciousness. Presence of subcortical injury should be considered as one component of the complex AHT diagnostic process.

Effect of triamcinolone acetonide on retinal inflammation and angiogenesis induced by pericyte depletion in mouse

Triamcinolone acetonide (TA) has been shown to improve morphological and functional outcome in diabetic macular edema (DME) patients. However, the functional mechanism of TA has not been elucidated yet. In this study we investigated the detailed functional mechanism of TA using culture cells and retinopathy mouse models in which retinal inflammation and abnormal angiogenesis were induced by pericyte depletion. TA significantly prevented retinal hemorrhage, edema and partially improved abnormal angiogenesis. TA decreased retinal vascular endothelial growth factor (VEGF) concentration, presumably by preventing recruitment of macrophages into retina and TA also inhibited expression of inflammatory cytokines in retina. TA inhibited proliferation/migration of vascular endothelial cells and vessel sprouting. No direct inhibition of VEGF receptor 2 (VEGFR2) autophosphorylation was observed by TA. These results suggested that TA improved inflammatory retinal events which were induced in pericyte-deleted mice by mainly decreasing macrophage-derived VEGF and expression of inflammatory cytokines followed by attenuation of vascular permeability and proliferation/migration of endothelial cells. Furthermore, in these processes, translocation of glucocorticoid receptor (GR) was partially involved.