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Purtscher retinopathy as an initial presentation of thrombotic thrombocytopenic purpura

Tajunisah I, Patel DK, Subrayan V

J Thromb Thrombolysis, 2010 Jul;30(1):112-3.
PMID: 19834784 DOI: 10.1007/s11239-009-0399-y
Matched MeSH terms: Retinal Hemorrhage/diagnosis; Retinal Hemorrhage/etiology*; Retinal Hemorrhage/pathology
Fulltext Unilateral ischaemic retinopathy and bilateral subdural haemorrhage in an infant with non-accidental injury: An ophthalmological approach

Ee CL, Mohd Abdullah AA, Samsudin A, Khaliddin N

Ulus Travma Acil Cerrahi Derg, 2019 09;25(5):527-530.
PMID: 31475330 DOI: 10.5505/tjtes.2018.57059

Non-accidental injury (NAI) is not an uncommon problem worldwide, which leads to significant morbidity and mortality in infants. The presence of retinal or subdural haemorrhages, or encephalopathy with injuries inconsistent with the clinical history is highly suggestive of NAI. In this study, we report on a case of a a 3-month-old infant who presented to the casualty department with a very sudden onset of recurrent generalised tonic-clonic seizures. There was no history of trauma or visible external signs. She was found to have bilateral subdural haemorrhages and atypical unilateral ischaemic retinopathy. Retinal photocoagulation was performed with subsequent resolution of vitreous and retinal haemorrhages. However, visual recovery in that eye remained poor. The findings showed that a high index of suspicion of NAI is required in infants with intracranial haemorrhage and unilateral retinal haemorrhages.

Matched MeSH terms: Retinal Hemorrhage*
Valsalva haemorrhagic retinopathy after push-ups

Hassan M, Tajunisah I

Lancet, 2011 Feb 5;377(9764):504.
PMID: 21255827 DOI: 10.1016/S0140-6736(10)60677-0
Matched MeSH terms: Retinal Hemorrhage/diagnosis; Retinal Hemorrhage/etiology*; Retinal Hemorrhage/surgery
An unusual presentation of gestational thrombocytopenia

Lim CC, Patel DK, Bakhtiari A, Subrayan V

Platelets, 2013;24(6):498-9.
PMID: 22994680 DOI: 10.3109/09537104.2012.724484

Thrombocytopenia is classically defined as a platelet count of less than 150 000/µl. Counts from 100 000 to 150 000/µl are considered mildly depressed, 50 000 to 100 000/µl moderately depressed, and less than 50 000/µl severely depressed. Thrombocytopenia occurs in about 10% of pregnant women. Gestational thrombocytopenia (GT) is a diagnosis of exclusion and considered the most prevalent cause of thrombocytopenia in pregnancy. GT accounts for almost 75% of cases of thrombocytopenia in pregnancy. The cause of GT is unclear, although existing studies denote the possibility of accelerated platelet consumption and the increased plasma volume during pregnancy. The presence of antiplatelet antibodies is not specific to GT. The degree of thrombocytopenia in GT is usually mild to moderate, usually remaining greater than 70 000/µl. Patients are asymptomatic with no evidence of bleeding and rarely preconception history of thrombocytopenia. The platelet count returns to normal within 2-12 weeks post partum. We wish to report a unique case of GT presenting as blurred vision due to retinal hemorrhages.

Matched MeSH terms: Retinal Hemorrhage/pathology
Megaloblastic anaemia in Malaysia: a review of 26 cases

Dutt KA, Velathaun T

Med J Malaya, 1971 Sep;26(1):65-7.
PMID: 4258580
Matched MeSH terms: Retinal Hemorrhage/etiology
Fulltext Dengue fever presenting as bilateral dengue maculopathy

Umi Kalthum, M.N.

Medicine & Health, 2012;7(1):57-61.
MyJurnal

Dengue fever is a common pyrexial-viral infection in the Asian region and the incidence is increasing yearly. There are various ocular manifestations of dengue fever such as maculopathy, retinal hemorrhages, retinal lesions and vasculitis. Reduction in visual acuity and other visual disturbances such as metamorphopsia is the most common presentation of dengue-associated maculopathy. We report an interesting case of a young lady with bilateral maculopathy secondary to dengue fever who was managed conservatively with dramatic visual improvements. This case highlights the possibility of bilateral and simultaneous ocular involvements in patients infected with dengue fever. Both ophthalmologists and physicians need to be aware of ocular complications following dengue fever and advice patients regarding the symptoms.

Matched MeSH terms: Retinal Hemorrhage
Fulltext Sudden visual loss in acute leukaemia

Tengku Kamalden, T.A., Nurliza, K., Haris, A.R.

JUMMEC, 2008;11(1):30-32.
MyJurnal

The presenting signs of acute leukaemia occur as a result of bone marrow failure and organ infiltration. Increased bleeding tendencies are seen on the skin, gums and mucosal lining. Bleeding in the posterior segment of the eye, namely the retina and vitreous, may occur, but do not usually cause any visual disturbances. This case demonstrates visual loss as a result of premacular subhyaloid haemorrhage in acute leukaemia.

Matched MeSH terms: Retinal Hemorrhage
Bone in the eye

Jumaat BH, Dahalan A, Mohamad M

Am J Ophthalmol, 2003 Feb;135(2):254-6.
PMID: 12566045

PURPOSE: To report a case of choroidal osteoma presenting with massive subretinal hemorrhage not associated with choroidal neovascularisation (CNV).
DESIGN: Case report.
METHODS: An 18-year-old man presented with sudden loss of vision in the right eye following competitive swimming. He was found to have a massive subretinal hemorrhage involving the macula.
RESULTS: Following resolution of the hemorrhage, the patient was found to have an underlying choroidal osteoma. There was no evidence of choroidal neovascularisation clinically and angiographically. He regained his normal vision.
CONCLUSIONS: Choroidal osteoma presenting with massive subretinal hemorrhage not associated with underlying choroidal neovascularization need not result in poor visual outcome.

Matched MeSH terms: Retinal Hemorrhage/diagnosis; Retinal Hemorrhage/etiology*
Clinical clues for head injuries amongst Malaysian infants: accidental or non-accidental?

Thalayasingam M, Veerakumarasivam A, Kulanthayan S, Khairuddin F, Cheah IG

Injury, 2012 Dec;43(12):2083-7.
PMID: 22424957 DOI: 10.1016/j.injury.2012.02.010

Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not.

Matched MeSH terms: Retinal Hemorrhage/diagnosis*; Retinal Hemorrhage/etiology*; Retinal Hemorrhage/epidemiology
Fulltext Intravitreal injection of recombinant tissue plasminogen activator and pneumatic displacement of submacular haemorrhage

Fadhilah M, Mimiwati Z, Fong KC

Med J Malaysia, 2010 Dec;65(4):271-2.
PMID: 21901943

We report a case of a patient with hypertension and ischaemic heart disease on anti-platelet treatment, who developed uniocular profound visual loss from a submacular haemorrhage secondary to valsalva retinopathy. He was treated with a combination of intravitreal recombinant tissue plasminogen activator (rtPA) and sulphur hexafluoride (SF6) gas followed by strict prone positioning. He demonstrated significant displacement of the haemorrhage and improvement of vision postoperatively.

Matched MeSH terms: Retinal Hemorrhage/therapy*
Prognostic significance of retinopathy at presentation in adult acute leukemia

Reddy SC, Quah SH, Low HC, Jackson N

Ann Hematol, 1998 Jan;76(1):15-8.
PMID: 9486919

Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12-77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50x10(9)/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01). We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia.

Matched MeSH terms: Retinal Hemorrhage/complications*
Retinal findings in adult leukaemia: correlation with leukocytosis

Jackson N, Reddy SC, Hishamuddin M, Low HC

Clin Lab Haematol, 1996 Jun;18(2):105-9.
PMID: 8866143

The associations between retinal findings and haematological parameters in acute leukaemia are controversial. Sixty-three newly-diagnosed acute leukaemia patients, aged 12-77 years, were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton wool spots (CWS) and macular haemorrhages (MH), Thirty-three patients (52.4%) showed at least one retinal abnormality. The prevalence of individual findings was: IRH (30 cases), WCH (20 cases), CWS (5 cases), MH (11 cases). In contrast to previous studies, there was no association between any of these retinal findings and the haemoglobin level or the platelet count. There was a higher median WBC in patients with IRH (68 x 10(9)/l) than in those without IRH (15.4 x 10(9)/l), P = 0.037. When the acute myeloblastic leukaemia cases were considered separately, an association was also found between higher WBC and the presence of WCH and CWS. There was no association between retinal findings and FAB type in the AML cases. We conclude that a high WBC may be at least as important as anaemia and thrombocytopenia in the pathogenesis of the retinopathy of acute leukaemia.

Matched MeSH terms: Retinal Hemorrhage/etiology*; Retinal Hemorrhage/pathology
A prospective study of ocular manifestations in childhood acute leukaemia

Reddy SC, Menon BS

Acta Ophthalmol Scand, 1998 Dec;76(6):700-3.
PMID: 9881556

PURPOSE: To determine the prevalence of ocular manifestations in childhood acute leukaemia at the time of presentation.
METHODS: Eighty-two children with acute leukaemia were examined for ocular lesions within two days of diagnosis before starting chemotherapy. The detailed ocular examination of both eyes was carried out by the ophthalmologist irrespective of the presence or absence of eye symptoms in all cases.
RESULTS: Only 3 out of 82 children presented with eye symptoms (3.6%). However, ocular changes were found in 14 children (17%); ten with lymphoblastic and four with myeloid leukaemia. The ocular lesions observed were proptosis, intraretinal haemorrhages, white centered haemorrhages, cotton wool spots, macular haemorrhage, subhyaloid haemorrhage, vitreous haemorrhage, papilloedema, cortical blindness, sixth nerve palsy, and exudative retinal detachment with choroidal infiltration.
CONCLUSION: In view of the high prevalence of asymptomatic ocular lesions in childhood acute leukaemia, routine ophthalmic examination should be included as a part of evaluation at the time of diagnosis.

Matched MeSH terms: Retinal Hemorrhage/diagnosis; Retinal Hemorrhage/etiology
Fulltext Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Abdul-Salim I, Embong Z, Khairy-Shamel ST, Raja-Azmi MN

Clin Ophthalmol, 2013;7:703-6.
PMID: 23589678 DOI: 10.2147/OPTH.S42208

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Matched MeSH terms: Retinal Hemorrhage
Fulltext Bilateral profound visual loss as a consequence of leukaemia – a case report

Raajini, Devi K., Safinaz, M.K., Hazlita, M.I.

Journal of Surgical Academia, 2015;5(1):61-63.
MyJurnal

An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.

Matched MeSH terms: Retinal Hemorrhage
Fulltext Wernicke's Encephalopthy Associated with Hyperemesis Gravidarum - A Case Report

Sulaiman W, Othman A, Mohamad M, Salleh HR, Mushahar L

Malays J Med Sci, 2002 Jul;9(2):43-6.
PMID: 22844223 MyJurnal

Two cases of Wernicke's encephalopathy due to hyperemesis gravidarum are described. The first patient presented with bilateral papilloedema, altered sensorium and the second with bilateral retinal haemorrhages, ophthalmoplegia and nystagmus. Both patients were diagnosed with Wernicke's encephalopathy on clinical ground since there were no laboratory facilities to measure red cell transketolase and thiamine pyrophosphate levels. This is a rare but treatable complication of hyperemesis gravidarum (HG) and due to lack of diagnostic tools, there is often diagnostic uncertainty, delay in commencing appropriate treatment, as well as irreversible damage to the upper brain stem and death.

Matched MeSH terms: Retinal Hemorrhage
Macular haemorrhage in adult acute leukaemia patients at presentation and the risk of subsequent intracranial haemorrhage

Jackson N, Reddy SC, Harun MH, Quah SH, Low HC

Br J Haematol, 1997 Jul;98(1):204-9.
PMID: 9233585

Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4-year study has been carried out in 82 newly-diagnosed acute leukaemia patients, aged 12-77 years, who were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton-wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra-cranial haemorrhage (ICH) within the first 30 d following diagnosis. There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5.0, CI 95% [2.03-12.33], P=0.003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3-AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.

Matched MeSH terms: Retinal Hemorrhage/etiology*
Retinopathy in acute leukaemia at initial diagnosis: correlation of fundus lesions and haematological parameters

Reddy SC, Jackson N

Acta Ophthalmol Scand, 2004 Feb;82(1):81-5.
PMID: 14738490

PURPOSE: To determine the prevalence of retinal changes in newly diagnosed acute leukaemia patients, and to establish the relationship between retinal lesions and haematological parameters in these patients.
METHODS: A total of 127 patients with acute leukaemia (myeloid and lymphoid), of both genders, aged between 13 and 77 years, were examined by an ophthalmologist for retinal changes using direct/indirect ophthalmoscopy within 2 days of diagnosis before starting chemotherapy.
RESULTS: Retinal lesions were seen in 62 cases (49%), with intraretinal haemorrhages being the most common lesion (42%). A high white blood cell count was significantly associated with intraretinal haemorrhages (p = 0.04) and white-centred haemorrhages (p = 0.001), while a low platelet count was significantly associated with intraretinal haemorrhages (p = 0.03) in acute myeloid leukaemia patients.
CONCLUSIONS: A high white blood cell count may be considered as important as a low platelet count in the pathogenesis of leukaemic retinopathy.

Matched MeSH terms: Retinal Hemorrhage/diagnosis*
Fulltext Ocular Tuberculosis Initially Presenting as Central Retinal Vein Occlusion

Mahyudin M, Choo MM, Ramli NM, Omar SS

Case Rep Ophthalmol, 2010 Aug 02;1(1):30-35.
PMID: 21116342

A 23-year-old man presented with central retinal vein occlusion. The retinal haemorrhages worsened and signs of retinal vasculitis appeared later as vision dropped from 6/60 to Counting Fingers. No signs of systemic disease were observed. Routine Mantoux test and chest radiograph were negative for tuberculosis. Fundus flourescein angiogram confirmed presence of retinal vasculitis. Both systemic and topical corticosteroid therapy were ineffective. Polymerase chain reaction analysis of vitreous fluid showed presence of Mycobacterium tuberculosis. A full 6-month course of antituberculosis therapy was given and inflammation subsided. Vision improved to 3/60. This is a rare case of ocular tuberculosis without evidence of systemic infection, presenting first as a central retinal vein occlusion.

Matched MeSH terms: Retinal Hemorrhage
Fulltext Central scotoma at near top of Mount Everest – a case report of bilateral high altitude retinopathy

Nazrina Hassan, Yong Meng Hsien, Wan Haslina Wan Abdul Halim, Norshamsiah Md Din

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):94-94.
MyJurnal

Introduction: High altitude retinopathy (HAR) is part of high altitude illness (HAI) which includes acute mountain sickness, high altitude cerebral oedema and pulmonary oedema. We present a case of bilateral HAR with right eye central scotoma during Mount Everest expedition. Case description: A 37-year-old lady presented with decreased right eye (OD) vision and central scotoma during ascending to the top of Mount Everest at 5100m. She developed respiratory symptoms with shortness of breath at the same time and warranted her a rapid descend on day eight of her excursion. Ocular examination revealed visual acuity of 6/36 OD and 6/6 left eye (OS). Both pupils were normal without relative afferent pupillary defect. Anterior segment and intraocular pressure were unremarkable. Fundus examination revealed bilateral multiple retinal haemorrhages along vascular arcades, with macula involvement in the right eye only. Otherwise there was no sign of optic disc swelling, vascular sheathing or choroidal involvement. Optical coherence tomography (OCT) of the macula showed hyperreflectivity changes on the right fovea at the level of superficial nerve fiber layer. Diagnosis of bilateral HAR was made and treated conservatively. She was also diag-nosed with HAI with acute pulmonary oedema and pneumonia by the treating physician. The retinal haemorrhages started to resolve after two weeks with full recovery of vision in ten weeks. Conclusion: With increasing popularity of mountaineering, ophthalmologists should be prepared to recognise HAR as part of HAI. Visual impairment depends on the location and extent of the lesions. HAR is self-limiting with good prognosis but can be associated with poten-tially fatal conditions of HAI e.g. pulmonary oedema in our case.

Matched MeSH terms: Retinal Hemorrhage

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