Multiple Intraretinal Hemorrhages Research Articles

Beaten to Blindness: Battered Baby Syndrome

Introduction: A battered child is one who sustains repetitive physical injuries due to non-accidental violence inflicted by a parent or guardian. Child abuse encompasses behaviors exposing the child to various forms of physical or sexual abuse, neglect, or emotional misconduct. Typically, battered child syndrome is diagnosed through a disparity between the history provided by the child's caregivers and the findings of clinical examination. Case details: An 18-month-old girl child was admitted to a tertiary care hospital, presenting with a four-day history of fever, vomiting for two days and a seizure episode. The child had a history of head injury one week ago, resulting in transient unconsciousness. Upon examination, multiple healed and fresh injuries were observed on the face, hands, and right thigh. CT brain revealed hypodensity areas with a mildly displaced fracture of the left frontal bone. Fundus examination identified bilateral multiple intraretinal hemorrhages and papilledema. X-ray showed a fracture of the right proximal tibia. The child required ventilator support during the hospital stay, and subsequently, developed retinal blindness. The child was managed accordingly. Discussion: The classical feature of Battered Baby Syndrome is the discrepancy between the nature of injuries and the history provided, and the delay between the injury and medical attention. The parental risk factors for child abuse are poverty, social isolation, drug addiction, violent environment, family history of abuse, communication skills deficit and the child related risk factors are children with special needs, children with behavior problems, bonding deficit. etc. Conclusion: The current case sheds light on the unfortunate prevalence of this condition within the Indian context, urging point-of-care health providers to stay vigilant and informed about child abuse patterns in the community. It serves as a crucial reminder of the responsibility we all share in safeguarding the well-being of children.

ROLLER COASTER RETINOPATHY

Traumatic head injuries not involving the eye have been known to cause retinal injury through multiple mechanisms. Abusive head trauma remains the prototypical example. We propose to demonstrate the first case of bilateral multiple retinal hemorrhages in a young healthy adult related to riding multiple theme park roller coasters. The patient was evaluated with a complete ophthalmic examination including dilated extended ophthalmoscopy, fluorescein angiography, optical coherence tomography, and fundus photography. The patient was found to have a bilateral symptomatic macular retinopathy characterized by multiple intraretinal hemorrhages. Given the lack of other systemic findings and negative medical workup, her signs and symptoms were thought to be attributed to the same day attendance of a theme park and riding of multiple roller coasters. Theme park roller coasters, as well as other attractions, may affect the eye at the vitreoretinal interface. This type of acceleration-deceleration injury should be considered in the differential of an adolescent or adult patient with retinal hemorrhage in the absence of other pathologic processes to explain clinical findings.

Increased choroidal thickness in patient with high-altitude retinopathy

We report a case of high-altitude retinopathy with increased choroidal thickness detected by spectral-domain optical coherence tomography (SD-OCT). A 36-year-old Japanese man developed an acute vision decrease in his left eye after he had trekked at an altitude of 4600 m in Tibet for 1 week. His visual acuity was 20/20 OD and 20/200 OS with refractive errors of − 0.25 diopters (D) OD and − 0.50 D OS 3 weeks after the onset of the visual decrease. Funduscopic examinations revealed multiple intraretinal hemorrhages bilaterally and a macular hemorrhage in the left eye. SD-OCT showed that the thickness of choroidal layer at the fovea was 530 μm OD and 490 μm OS which is thicker than that in normal subjects of approximately 300 μm. We suggest that the increase in the retinal blood flow under hypoxic conditions may be associated with an increase in the choroidal blood flow resulting in an increase in choroidal thickness.

A Case of Purtscher Retinopathy Associated with Stent-Assisted Coil Embolization of a Middle Cerebral Artery Aneurysm

This article reports a case of Purtscher retinopathy following therapeutic coil embolization of a middle cerebral artery (MCA) aneurysm. METHODS. Case report. A 53-year-old woman with a history of stent-assisted coil embolization in her left MCA unruptured aneurysm presented with a visual disturbance about 3 hours after the procedure. Her left eye vision was 20/40. Fundus examination of the left eye showed an intraretinal hemorrhage and multiple whitish retinal lesions. The spectral-domain optical coherence tomography (OCT) examination showed focal thickness around the whitish lesions and a hemorrhage site. Three weeks later, the retinal whitish lesions decreased but new multiple intraretinal hemorrhages were found near the previous whitish lesions. Fluorescein angiography revealed the obstruction of an arteriole at the posterior pole. After 5 weeks, all lesions in the fundus photography and OCT were almost gone and her left visual acuity was 20/20. A thorough understanding of clinical findings and mechanism of this disorder, including the possibility of direct emboli during coil embolization rather than secondary emboli from the postoperative coil-thrombus complex formed in the aneurysm after the procedure, is therefore necessary to prevent unwanted ocular complications after coil embolization.

Ocular decompression retinopathy after bleb needling in a patient with extremely high intraocular pressure.

To report a case of ocular decompression retinopathy after bleb needling in a patient with extremely high intraocular pressure. Case report of a 55-year-old man who had undergone trabeculectomy for neovascular glaucoma and bleb needling to lower intraocular pressure. During the procedure, the anterior chamber collapsed suddenly as a result of overdrainage, and the intraocular pressure decreased rapidly from 60 mmHg to 2 mmHg. Funduscopy performed the next day showed multiple intraretinal hemorrhages in all quadrants. Fluorescein angiography showed no evidence of occluded retinal vessels. He had no history of any bleeding disorder. Decompression retinopathy was diagnosed. Decompression retinopathy can occur after bleb needling, which is often required after trabeculectomy to restore bleb function.

Marathon Runner’s Retinopathy

Purpose: To report a case of an unusual retinopathy in an otherwise healthy 25-year-old marathon runner.Methods: Case report.Results: A 25-year-old female marathon runner developed sudden onset of monocular vision loss during a routine training run. The retinal features included a large, central, subhyaloid hemorrhage, multiple intraretinal hemorrhages, disc edema and venous dilation and tortuosity resembling characteristics of both valsalva retinopathy and nonischemic central retinal vein occlusion. Work up for underlying systemic cause was negative. However, the patient did participate in endurance exercise.Conclusion: Strenuous exercise increases activated platelets and other clotting factor elements. During exercise, this increase in clotting factors in the coagulation cascade is usually balanced by activation of key elements in the fibrinolysis cascade as well. However, certain individuals, especially those who already have a predisposition to clotting or other thrombogenic risk factors may disrupt the balance between coagulation and fibrinolysis during strenuous exercise favoring coagulation which places them at risk for thrombus formation.

Retinal angiomatous proliferation: clinical characteristics and treatment options

A new form of exudative age-related macular degeneration (ARMD), retinal angiomatous proliferation (RAP), has been described in which neovascularization begins in the deep retina, extends through the subretinal space, and eventually communicates with choroidal neovascularization. Case series. Common clinical features of RAP include small multiple intra-retinal hemorrhages, intra-retinal edema, vascularized pigment epithelial detachments (PEDs), and retinal choroidal anastomosis (RCA). Fluorescein angiography (FA) reveals ill-defined, occult choroidal neovascularization. Indocyanine green (ICG) angiography is useful in early stages because 'hot spots' can be detected before clinical or FA characteristics are present. Optical coherence tomography (OCT) is useful in illustrating some of the clinical and FA characteristics. The use of photodynamic therapy (POT), combined with intravitreal triamcinolone injection, was successful in stabilizing the RAP lesion in one case discussed in this report. Retinal angiomatous proliferation is a newly recognized entity of exudative age-related macular degeneration with its own set of clinical, FA, ICG angiography, and OCT features. Experimental treatments such as the use of PDT combined with intravitreal triamcinolone injection demonstrate potential success with this entity. The biggest hope appears to be anti-angiogenic factors currently in clinical trials for the treatment of exudative ARMD.

Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection

PURPOSE: To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema.DESIGN: Interventional case report.METHODS: Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage.RESULTS: Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100.CONCLUSION: Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.