Preretinal Hemorrhage Research Articles

Ophthalmic artery ischemia in hemophagocytic lymphohistiocytosis: A case report and review of current literature

Introduction: This case report describes the ocular manifestations of hemophagocytic lymphohistiocytosis in a 35-year-old male with suspected Adult-onset Still’s Disease. Documented ocular presentations of hemophagocytic lymphohistiocytosis are variable, and the pathophysiology remains unclear. A complete review of the current literature suggests that posterior segment findings, including retinal and vitreous hemorrhage, are most common. Case Report: Here we describe the first published case of bilateral combined choroidal and retinal ischemia in a patient with ocular hemophagocytic lymphohistiocytosis. This is suggestive of complete ophthalmic artery occlusion driving proliferative retinopathy. Mechanistic hypotheses include anemia, thrombocytopenia, coagulopathy, and histiocytic infiltration. Conclusion: In this case, pre-retinal hemorrhage, retinal hemorrhage, and vitreous hemorrhage were treated with panretinal photocoagulation, pars plana vitrectomy, and bevacizumab at different stages in each eye. Unusually for ocular hemophagocytic lymphohistiocytosis, the patient developed a unilateral tractional retinal detachment, later thought to be due to early administration bevacizumab prior to vitrectomy in the left eye. Final visual acuity in this patient remains poor, and worse in the left eye. We therefore suggest early vitrectomy to maintain adequate views of the fundus before bevacizumab or panretinal photocoagulation in this patient cohort.

Clinical study of ocular manifestations in patients with newly diagnosed and relapsed hematolymphoid malignancies at a tertiary care hospital

Objectives: To estimate the proportion of ocular manifestations in new and relapsed cases of various hematolymphoid malignancies and to determine an association between these ocular manifestations and the hematological parameters of the patients. Materials and Methods: The study was conducted in the department of ophthalmology in association with medical oncology. All patients with newly diagnosed or presenting with a relapse of hematolymphoid malignancies underwent a complete ocular evaluation. Results: A total of 63 patients were included in this study. The mean age of the patients was 34.71 ± 19.80 years. Acute myeloid leukemia and B-ALL accounted for 73% of the cases. At the time of examination, 47.61% of patients (n = 30) were newly diagnosed and 52.38% (n = 33) had relapsed. Acute leukemias had more probability of having ocular manifestations than chronic leukemias (P = 0.01). Subconjunctival hemorrhage was found to be the most common anterior segment finding (n = 10, 15.87%; P = 0.05). The most common posterior segment finding seen in both the right and left eyes was dot blot hemorrhages (n = 20). Those patients who had hemoglobin counts <6.5 mg/dl had the most ophthalmic manifestations (n = 20); of which Roth spots were seen the most (n = 6; P = 0.04). And those who had platelet counts <50,000 cells/cumm presented with Roth spots (n = 6, P = 0.05) followed by subretinal hemorrhages (n = 5, P = 0.05) and preretinal hemorrhages (n = 5, P = 0.05). Conclusion: Screening to detect ocular manifestations is of importance in hematolymphoid malignancy, especially in newly detected and relapsed cases. A complete ocular examination is recommended in these patients, as most patients are asymptomatic and ocular manifestation could be an early sign of worsening of the disease. Among the various blood parameters, low hemoglobin and platelet counts are definite indicators of the presence of intraretinal bleeding manifestations.

Snakebite hemotoxin-induced unilateral retinopathy: Case report and review of the literature

Ocular manifestations of snakebite depend on the nature of envenomation. Neurotoxic venoms usually cause neurological manifestations such as ptosis and external ophthalmoplegia, whereas hemotoxic poisons cause hemorrhagic manifestations such as hemorrhagic retinopathy and arterial occlusions. However, most of the ocular manifestations present bilaterally. We report a unique case of a female in her 5th decade presenting with unilateral snakebite hemotoxin-induced retinopathy in the form of subretinal and preretinal hemorrhages presenting 5 days after the snakebite. She was managed conservatively. Preretinal and subfoveal bleed gradually resolved with fair visual recovery. Anatomical differences in the vasculature between the two eyes along with some degree of venous occlusion in the left eye might have contributed to such an asymmetrical presentation.

New Approaches to Surgical Treatment of Patients with Advanced Stage of Proliferative Diabetic Retinopathy

Purpose. Development and evaluation of the clinical effectiveness and safety of a vitrectomy (VE) technique for patients with advanced stage proliferative diabetic retinopathy (ASPDR).Materials and methods. We observed 132 patients (mean age 62.8 ± 2.4 years) with the following criteria for inclusion in the study, corresponding to the classification criteria of ASPDR: it is impossible to estimate the area of neovascularization; the fundus of the eye is partially ophthalmoscoped or not ophthalmoscoped in the posterior pole; preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs; retinoschisis in the macular zone. All patients were divided into the following two groups, equal in age, gender and visual status of the “healthy” eye: the main group (MG, 69 patients, 69 eyes), who underwent VE was performed according to the developed method and a control group (CG, 63 patients, 63 eyes), in which VE was performed according to the traditional method.Results. The incidence of intraoperative complications in patients in the MG (5.8 %) was 8.1 % (p < 0.05) lower than in the CG (13.9 %). The incidence of postoperative complications in patients from the MG (5.5 ± 0.5 %) was 4.2 % (p < 0.01) lower than in the CG (9.7 ± 1.0 %). The increase in best-corrected visual acuity after surgery in patients from the MG was significantly (by 0.13 rel. units, p < 0.001) higher than in the CG. The value of the average decrease in the developed qualitative criteria for the condition of the fundus in patients in the MG (1.6 ± 0.1) was 23.1 % (p < 0.05), higher than in the CG (1.3 ± 0.1).Conclusion. Surgical treatment of patients with ASPDR using the developed technique provides (compared to the traditional approach) a higher level of safety and clinical effectiveness. The main advantage of the developed technique is an integrated approach to surgical intervention, including the improvement of ophthalmological “techniques” (use of one-stage combined surgery, endolaser coagulation technology, etc.) and drug support (administration of ranibizumab at a dose of 0.05 mg 3–5 days before surgery) and the choice of intravenous sedation as the optimal anesthetic aid.

Quality of life of patients with an advanced stage of proliferative diabetic retinopathy after application of various vitrectomy technologies

Purpose: A comparative assessment of quality of life (QL) after the use of various vitrectomy (VE) technologies in patients with an advanced stage of proliferative diabetic retinopathy (ASPDR).Material and methods. We examined 132 patients aged 42 to 76 (average age 62.8 ± 2.4 years) who met the classification criteria of ASPDR: impossibility to estimate the area of neovascularization; the fundus of the eye in the posterior pole cannot be seen or can only partialy be seen using an ophthalmoscope; evidence of preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs and retinoschisis in the macular zone. All patients were divided into two groups, comparable in age, gender and visual status of the “healthy” eye: the main group (69 eyes), in which VE was performed according to the technique developed by the authors, and the control (63 eyes), in which the traditional VE technique was used. QL was assessed before surgery and 3 months after it using the VFQ-25 and QL-20 questionnaires.Results. QL was found to be higher when the new surgery technique was used: the data of VFA-25 showed a 12.9% increase (p < 0.05) and QL-20 showed a 29.2% increase (p < 0.01), which points to a higher clinical effectiveness of the newly developed surgical treatment technique than that of the traditional technique.Conclusion. The results obtained are related to the ophthalmological features of the developed surgical treatment of ASPDR: combined (phacoemulsification of cataracts + IOL + vitrectomy) one-stage intervention, lack of drainage of subretinal fluid, etc.), medication support (preliminary intravitreal administration of an angiogenesis inhibitor) and anesthesia (intervention under local anesthesia with intravenous sedation). The differences are most effectively identified using the special QL-20 questionnaire.

Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea.

To evaluate the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR). Retrospective non-comparative cross-sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti-VEGF and PRP and have completed a minimum 6-month follow-up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response. In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti-VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months ( P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow-up. The mean area of PRH as measured by Image J analysis was 14.78 mm 2 at baseline, 8.97 mm 2 at 4 weeks, and 1.25 mm 2 at 3 months ( P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow-up. Intravitreal anti-VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long-term studies are warranted to assess the long-term efficacy.

PANUVEITIS AS A MANIFESTATION OF OCULAR SYPHILIS IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS : A CASE SERIES

Introduction : Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum. Syphilis can result in multiple organ involvement, including the eyes, and demonstrates various clinical findings. Ocular syphilis is an important cause of uveitis in the new era of co-infection with the human immunodeficiency virus (HIV).&#x0D; Case Illustration : Case 1: A 29-year-old male HIV-positive with 5 months of blurred vision, pain, and redness in left eye (LE) with skin rashes on the palms and foots (Figure 1). The visual acuity was 1/300 in LE, anterior segment showed flare cell (Figure 2). Fundus examination (Figure 3) revealed multiple exudative lesion of right eye (RE) and vitreus opacity of LE due to inflammation. VDRL and TPHA tests were positive. Case 2: 38-year-old male, HIV-positive and tuberculosis-positive, with 2 months of blurred vision,pain and redness in both eyes with skin rashes on the palms and foots (Figure 1). The visual acuity of the RE was 1/60 and 1,5/60 in the LE on the initial visit. Anterior segment eye examination revealed flare and cell (Figure 2). Fundus examination revealed (Figure 3) preretinal hemorrhage and exudate of both eyes. VDRL and TPHA testing were positive, CD4 count showed severe immunodeficiency.&#x0D; Discussion : This study depicts clinical features and outcomes of two cases of ocular syphilis with HIV co- infection. Poor visual outcome was associated with posterior segment-involving uveitis at presentation.&#x0D; Conclusion : An accurate diagnosis is crucial, treatment is adjusted according to the clinical stage. Comprehensive education is needed for patients and their families.

When Retinal Vasculitis Wears a Mask: Unveiling Retinal Vasculitis Presented as Branch Retinal Vein Occlusion in a Young Male Patient

Introduction : Retinal vasculitis can present with a range of clinical features. Correct diagnosis and prompt treatment are essential to prevent permanent visual loss. We describe a case of retinal vasculitis with branch retinal vein occlusion (BRVO) as initial diagnosis, which is a rare manifestation in a young individual without any vascular risk factors.&#x0D; Case Illustration : A 24-year-old male was referred to our center with a sudden onset of blurry vision of his left eye. He was previously diagnosed with BRVO. The patient denied having any chronic diseases, fever, or sore throat. Visual acuity was 6/18 on the left eye and 6/6 on the right eye, respectively. The anterior segment showed no abnormalities. However, fundus examination revealed prominent retinal sheathing, retinal whitening at the inferior quadrant, and macular star. Systemic diseases, such as Bechet disease, sarcoidosis, and systemic lupus erythematosus were excluded by ancillary tests. One month after the initial examination, the patient reported worsening of vision. Funduscopic examination revealed preretinal hemorrhages and macular star. The patient then received intravitreal injection of anti-vascular endothelial growth factor (VEGF), which helped to resolve the hemorrhage and improve vision.&#x0D; Discussion : Further investigations, such as fundus fluorescein angiogram, may aid in the diagnosis and management of this condition. Anti-VEGF therapy may be a useful treatment option for retinal vasculitis-associated hemorrhages.&#x0D; Conclusion : Our case highlights the importance of considering retinal vasculitis as a differential diagnosis in young patients presenting with BRVO, even in the absence of traditional risk factors.

Incidence of Postoperative Epiretinal Membrane Development Following 23-Gauge Pars Plana Vitrectomy for Complex Diabetic Tractional Retinal Detachment: A Comparative Study of Silicone Oil and Balanced Salt Solution Tamponade

BACKGROUND: Tractional retinal detachment (TRD) poses a significant threat to vision in diabetic patients, necessitating surgical intervention. However, the choice of tamponade agent (silicone oil vs. balanced salt solution [BSS]) and the presence of incomplete hemostasis during surgery can influence postoperative complications, specifically the development of epiretinal membranes (ERMs). METHODS: This prospective study involved 235 patients undergoing 23-Gauge pars plana vitrectomy for diabetic TRD with incomplete hemostasis. Patients were categorized into two groups based on tamponade agent used. ERM development was assessed clinically and through optical coherence tomography (OCT). RESULTS: Among the cases with incomplete hemostasis and residual preretinal hemorrhage, 71.80% of those in the silicone oil group developed ERMs, in contrast to 11.76% in the BSS. Notably, 46.2% of silicone oil cases with ERMs required reoperation, whereas 47.4% remained ERM-free. DISCUSSION: The choice of tamponade agent was a crucial determinant in ERM development, with silicone oil exhibiting a significantly higher incidence. Moreover, silicone oil cases with macular tractional effects had a substantial proportion of ERMs necessitating reoperation. These findings underscore the importance of vigilant postoperative monitoring. CONCLUSION: In cases involving incomplete hemostasis during vitrectomy for diabetic TRD, the use of silicone oil as a tamponade agent is associated with a substantially increased risk of postoperative ERM development. Clinically, this highlights the need for meticulous patient management. Further research is warranted to validate these results and explore long-term outcomes.

Self-Inflicted Laser-Induced Retinopathy.

This photo essay details a patient with self-inflicted laser-induced retinal injury progressing to full-thickness macular holes in both eyes. A 40-year-old patient presented after a self-inflicted injury by a handheld class 3 blue laser (450 nm) he purchased on the internet. The patient reported shining the laser through a window, which reflected the beam back into his eyes. Visual acuity was measured at 20/400 in both eyes. The initial fundus photographs revealed vitreous and preretinal hemorrhages in the right eye, and multiple yellow-white fresh laser burns in the macula of the left eye. Optical coherence tomography (OCT) showed preretinal hemorrhage in the right eye and retinal disruption with preretinal hyper-reflective lesion in the left eye. After one month, his vision deteriorated to finger counting in each eye. He developed a full-thickness macular hole and hyperfluorescent curvilinear streaks in the superior maculae in both eyes. OCT images showed retinal pigment epithelium clumping and outer retinal atrophy in curvilinear streak areas in both eyes, which point to self-inflicted injury. This case illustrates laser-pointer-induced retinopathy and reinforces the necessity of public education on the dangers of utilizing handheld lasers without eye protection.

Fundoscopic changes in preeclampsia and eclampsia and their association with fetal outcome

Abstract Introduction: Hypertensive disorder is a major cause of maternal and perinatal mortality and morbidity, with preeclampsia and eclampsia being the most common. Preeclampsia is characterized by endothelial dysfunction and vasospasm of vessels, which can be observed by an ocular fundus examination. The fundus usually develops changes such as hypertensive retinopathy, papilledema, exudative retinal detachment, and vitreous and preretinal hemorrhages. Retinopathy is associated with placental insufficiency and intrauterine growth retardation. Therefore, this study has been undertaken to assess the prevalence of retinal changes in preeclampsia and their association with fetal parameters. Objective: To study the fundus changes in preeclampsia. To study the relationship between fundus changes and fetal outcome with respect to various parameters like birth weight, APGAR score, stillbirth, and perinatal death. To study the relationship between fundus changes with respect to proteinuria and serum uric acid. Study Design: Observational study. Methodology: One hundred patients presenting to the department of obstetrics and gynecology diagnosed with preeclampsia at a tertiary care center were included in the study. The patient recruited underwent an ocular examination using Snellen’s chart, a pupillary examination, a slit lamp examination, and a dilated fundus examination. The retinopathy was graded according to Keith and Wagner’s classification. The fetal parameters considered were birth weight, APGAR score, stillbirth, and neonatal death. Results: Patients ages ranged from 25 to 30 years old, with an average of 23.28 ± 3.37. Average systolic and diastolic blood pressures were 156.9 ± 17.961 and 104.88 ± 13.58, respectively. All patients had normal anterior segments. Visual acuity was6/6 in most of the patients. Fundus changes were noted in 48% of patients. Based on retinopathy classification, we found 66.7% patients with Grade 1 and 27.1% patients with Grade 2 hypertensive retinopathy. Only 6.3% of patients presented with Grade 3 hypertensive retinopathy. There was a significant association between retinopathy and proteinuria (P = 0.003), serum uric acid (P = 0.002), and the fetal birth weight (P = 0.001). Conclusion: Our findings suggest that progressive fundal changes in preeclampsia indicate worsening of the pathophysiological status of pregnancy-induced hypertension (PIH) and help in management. The degree of hypertensive retinopathy in women with preeclampsia is a valid and reliable prognostic factor that serves as an indirect marker of the severity of PIH and fetal outcome. Fundus examination is a simple, noninvasive, and cost-effective procedure that could be the initial finding in an asymptomatic patient who may require immediate management, which may help in saving the lives of both the mother and the baby. Fundus evaluation is essential for all patients with PIH.

The family of crooked arteries

Familial retinal arterial tortuosity syndrome (fRATs) is an autosomal dominant condition characterized by Tortuosity of second‐ and third‐order retinal arterioles but no retinal hemorrhages. We present a case series of a family of three affected members with fRATS. The 47-year-old father presented with diminution of vision, and we found preretinal and intraretinal hemorrhages in the macula. Retinal arterioles of the second‐ and third‐order were tortuous. We examined his children and found similar retinal findings. Clinical exome sequencing revealed a heterozygous c.1501G&gt;A (p.Gly501Ser) mutation involving the COL4A1 gene. To our knowledge, this is the first case report of fRATS from India.

An Unusual Case of Anaemic Retinopathy Secondary to Iron Deficiency Anaemia

Anaemia has varied ocular presentations, ranging from simple conjunctival pallor to retinal abnormalities. Anaemic Retinopathy (AR) is a secondary retinal pathological symptom that can range from asymptomatic to developing retinal abnormalities. The increase in the severity of anaemia will ultimately increase the risk of retinopathy. While the outcomes might be similar to hypertensive or diabetic retinopathy, further comprehensive systemic and clinical evaluation is warranted. The incidence of AR, its associations with varying degrees of anaemia severity, and other haematological variables is still debated. Visual loss due to retinal abnormalities in anaemia is a rare clinical entity, despite its long-standing existence. Hereby, the authors present a case of a patient presenting with AR. A 19-year-old woman with a history of heavy menstrual bleeding was admitted for a sudden, painless, non progressive loss of vision in her left eye. Upon examination, her fundus revealed several Roth spots affecting all four quadrants and the macula, alongside a large and small preretinal haemorrhage in the nasal region and in the macula. Blood investigations revealed a Haemoglobin (Hb) of 2.4 g/dL and other reports suggestive of iron deficiency. She was diagnosed with iron-deficiency anaemia, with retinopathy as the most remarkable feature. She was treated with blood transfusion and Iron-folic Acid (IFA) supplementation, which showed a prompt response in the resolution of haemorrhage. She was discharged on IFA supplementation with planned follow-up for Ophthalmology and Gynaecology visits along with dietary advice.

Characterization of Ocular Injuries Caused by Orbeez Hydrated Gel Pellet Projectiles: Clinical Insights and Implications

To examine the clinical characteristics of patients who have experienced blunt ocular injuries from "Orbeez" hydrated gel pellets (Spin Master Corp.), and to describe ocular morbidity, visual acuity (VA), and intraocular pressure (IOP) after Orbeez-related ocular trauma. Retrospective, institutional, observational case series. Patients sustaining Orbeez-related ocular trauma at a single institution over a 13-month period were identified. Clinical parameters including VA, IOP, and anterior and fundus examination findings were assessed upon initial and final presentation. Basic statistical testing was performed to compare differences within this cohort. A total of 17 eyes from 17 patients with Orbeez-related trauma were identified. Orbeez-related blunt ocular injuries included corneal abrasion (n=7), hyphema (n=9), commotio retinae (n=5), intraretinal hemorrhage (n=3), preretinal hemorrhage (n=1), vitreous hemorrhage (n=2), and retinal tear (n=1). Adolescents (14-18 years of age) showed higher rates of posterior segment complications compared to other ages (P=.0152). The presence of elevated IOP and hyphema upon initial examination correlated with increased likelihood of requiring invasive treatment following Orbeez impact (P=.0275). Orbeez-related ocular trauma may be associated with severe visual morbidity and varied anterior and posterior segment intraocular sequelae. Adolescents could be at increased risk for posterior segment complications following these injuries. Initial findings of elevated IOP and hyphema may indicate a need for more aggressive interventions. Prevention remains paramount in managing Orbeez-related ocular trauma; it is critical to raise awareness regarding the importance of wearing eye protection meeting high-impact standards and minimizing exposure to such projectiles.

Preretinal Hemorrhage in Myelin Oligodendrocyte Glycoprotein–Associated Disease

Preretinal Hemorrhage in Myelin Oligodendrocyte Glycoprotein–Associated Disease

A study on the mediation effect of insulin use on diabetic retinopathy in a community population

Objective: To explore the risk factors for diabetic retinopathy (DR) in patients with diabetes and the mediating effect of insulin use on the relationship between glycated hemoglobin (HbA1c) and DR. Methods: Cross-sectional study. Random cluster sampling was conducted using a random number table method. A total of 84 sampling points (including 2 pilot points) were selected from the registered population of patients with type 2 diabetes aged 50 years and above at the Disease Prevention and Control Center in Funing County, Jiangsu Province. Questionnaires and biochemical tests were performed to obtain information on the general characteristics of the participants, medical history, insulin use, and glycated hemoglobin (HbA1c) levels. Ocular examinations, including anterior segment and fundus examinations, were conducted. The participants were divided into two groups, DR (diabetic retinopathy) and non-DR, based on the presence or absence of retinal hemorrhages, hard exudates, cotton wool spots, neovascularization, preretinal or vitreous hemorrhage. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors for DR. The Karlson-Holm-Breen analysis method was used for mediation effect analysis. Results: A total of 2 067 diabetic patients were enrolled, of whom 1 965 completed the survey and 1 802 were included in the statistical analysis, resulting in a response rate of 87.2%. Among them, 660 patients were diagnosed with DR, with a detection rate of 36.63%. The results of multivariate analysis showed that diabetes duration (OR=1.166, 95%CI: 1.138-1.196), family history of diabetes (OR=1.325, 95%CI: 1.001-1.755), insulin therapy (OR=1.995, 95%CI: 1.434-2.777), HbA1c level (OR=1.513, 95%CI: 1.189-1.925), and alcohol consumption (OR=0.712, 95%CI: 0.514-0.985) were independent risk factors for DR. The mediating effect of insulin use accounted for 13.67% of the total effect of HbA1c on DR (P<0.001). Conclusions: The risk factors for DR in patients with diabetes include a history of insulin therapy, longer duration of diabetes, family history of diabetes, alcohol consumption, and high HbA1c levels. Insulin use increases the impact of HbA1c on DR and has a partial mediating effect on DR.

Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment

ObjectivesTo compare the diabetic retinopathy (DR) severity level determined when considering only the ETDRS 7-field region versus the entire ultrawidefield (UWF) image.MethodsIn this retrospective, cross-sectional study, UWF pseudocolor images were graded on the Eyenuk image viewing, grading, and annotation platform for the severity of DR considering only the regions within the ETDRS 7-fields as well as the entire UWF image using two different protocols: 1) the simple International Classification of Diabetic Retinopathy (ICDR) scale and 2) the more complex DRCR.net Protocol AA grading scale.ResultsA total of 250 eyes from 157 patients were included in this analysis. Six eyes (2.4%) demonstrated a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ICDR classification system. The discrepancies were due to the presence of lesions [intraretinal haemorrhage (n = 2), neovascular disease (n = 4)] in the peripheral fields which were not identified in the ETDRS 7-fields. Fourteen eyes (5.6%) had a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ETDRS DRSS Protocol AA grading scale. The discrepancies were due to the presence of a higher level of disease [intraretinal haemorrhage (n = 4), neovascularization (n = 4), preretinal haemorrhage (n = 2), scatter laser scars (n = 4)] in the peripheral fields.ConclusionAlthough considering regions outside of the ETDRS 7-fields altered the DR severity level assessment in <5% of cases in this cohort, significant and potentially vision-threatening lesions including neovascularization and preretinal haemorrhage were identified in these peripheral regions. This highlights the importance of evaluating the entire UWF region when assessing patients with diabetic retinopathy.

Unilateral pigmented paravenous retinochoroidal atrophy with acute angle-closure glaucoma: a case report

BackgroundPigmented paravenous retinochoroidal atrophy (PPRCA) is an uncommon fundus disease characterized by perivenous aggregations of pigment clumps and retinochoroidal atrophy distributed along the retinal veins. We report a Chinese female case of unilateral PPRCA with acute angle-closure glaucoma (AACG).Case presentationA 50-year-old Chinese female presented with vision loss and elevated intraocular pressure (IOP) in the right eye and then underwent trabeculectomy. She referred to our clinic for further evaluation and treatment. The funduscopic examination revealed grayish retinochoroidal atrophy and osteocyte-like pigment clumping lesions along the retinal veins and peripapillary preretinal hemorrhage in the right eye. The patient also presented with AACG in the same eye on the basis of past medical history of acute attack, shallow anterior chamber depth (ACD), narrow angle showed by ultrasound biomicroscopy (UBM) and glaucomatous neuropathy identified by optical coherence tomography (OCT). Other examinations like fluorescein fundus angiography (FFA), electroretinogram (ERG) and electrooculography (EOG) all confirmed the aforementioned diagnose.ConclusionPPRCA is a rare disease, uncommon in females and symmetrical in both eyes. We present a rare case of unilateral PPRCA accompanied with AACG.

Chorioretinitis sclopetaria and orbital emphysema caused by a high-velocity liquid missile.

To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer. A 19-year-old male presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Left eye visual acuity was 20/40. Dilated fundus exam showed inferior vitreous hemorrhage, retinal whitening, and pre-, intra-, and sub-retinal hemorrhages, consistent with chorioretinitis sclopetaria. Optical coherence tomography revealed a full-thickness macular hole. Computed tomography scan of the orbits showed subcutaneous and post-septal orbital emphysema. Two months following injury, vitreous and retinal hemorrhages and macular hole resolved. Five months following injury, visual acuity improved to 20/20. Chorioretinitis sclopetaria is defined as a full-thickness chorioretinal disruption resulting from a high-velocity projectile passing adjacent to or into the orbit without penetrating the globe. Chorioretinal deformation and ocular comorbidities are influenced by the velocity of the missile and its spatial relationship to the orbit. While this pattern of injury is typically associated with indirect trauma to the globe by a BB or a bullet, this is the first report of chorioretinitis sclopetaria precipitated by a high-velocity liquid missile.

Trauma-Related Acute Macular Neuroretinopathy. A Case Report

To introduce a case report and review the literature on trauma-related acute macular neuroretinopathy as an unusual etiology of acute macular neuroretinopathy. A 24-year-old man presented with unilateral paracentral scotoma following non-ocular trauma in a car accident. The relative afferent pupillary defect was negative and the best corrected visual acuities of both eyes were 10/10 (by the Snellen chart scale). Retinoscopy revealed a reduced foveal reflex, along with a small pre-retinal hemorrhage over the mid-pathway of the supranasal arteriole. OCT images showed an obvious ellipsoid zone (EZ) layer disruption in the macula of the left eye. The infrared fundus photograph of the same eye revealed a distinct hyporeflective area involving the macula. On fundus angiography, no macular vascular lesion was detected. The scotoma persisted after 3 months follow-up. Non-ocular trauma including head or chest trauma without direct ocular injury accounts for most cases of trauma-related acute macular neuroretinopathy. It is important to distinguish this entity, given that there are also unremarkable findings in the retinal examination of these patients. Indeed, proper clinical suspicion leads to further suitable investigations and impedes other extraordinary images, which are the basic rules in the management of traumatic patients suffering multiple injuries and incurring medical expenses.