RESUMO
Case Description: A 16-year-old male patient presented with a 12-days sudden painless loss of vision in his left eye after diving in a lake. Best corrected visual acuity (BCVA) in the left eye was counting fingers. Anterior segment was unremarkable. Fundoscopy in the left eye revealed a pre-retinal hemorrhage in the macular region and swept-source ocular coherence tomography (SS-OCT) confirmed the location in the sub-inner limiting membrane (ILM) space. An Neodymium:YAG (Nd:YAG) laser membranotomy was performed the next day in order to drain the hemorrhage into the vitreous cavity. A couple of days after, the BCVA in the left eye improved to 20/ 25, at fundoscopy the blood being almost reabsorbed and the SS-OCT showing a resolution of the sub-ILM hemorrhage. Discussion: Due to Valsalva retinopathy, sub-ILM hemorrhage may lead to a sudden painless vision loss. Spontaneous resolution of the hemorrhage is possible but absorption may take a long time. During this period, intraretinal tissue migration and proliferation may lead to permanent structural damage. Posterior vitrectomy is a treatment option but the fact that it is an invasive procedure fuels the search for less invasive treatment methods and Nd:YAG laser membranotomy fits this place. Conclusion: Given the excellent results and low complication rates, Nd:YAG laser membranotomy is highly recommended to treat this condition as it offers a simple, relatively safe and a non-invasive treatment option for drainage of sub-ILM hemorrhages.
Assuntos
Membrana Basal/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Hemorragia Retiniana/cirurgia , Acuidade Visual , Adolescente , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Hemorragia Retiniana/diagnósticoRESUMO
PURPOSE: To describe the first case of a combined sub-hyaloid and sub-internal limiting membrane macular hemorrhage after recreational laser exposure. METHODS: A 23-year-old patient presented with an acute loss of vision in his right eye (OD) immediately after a brief exposure to a laser beam at a music festival. Color photography, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinogram (mfERG) were performed for diagnosis and follow-up. RESULTS: On presentation, visual acuity was 20/400 in the OD and 20/20 in the left eye. Posterior segment examination of his OD revealed a preretinal hemorrhage at the macula. SD-OCT images exposed a combined sub-hyaloid and sub-internal limiting membrane localization. Successful VPP with ILM peeling was carried out. Although sequential mfERG displayed almost complete restoration of the P1 amplitude 6 months posterior to VPP, SD-OCT demonstrated permanent damage to outer retinal layers. Final BCVA on OD was 20/30. CONCLUSION: The expanding and unregulated use of lasers in everyday life has created an increasing amount of cases of laser-induced retinopathy in recent years. Much more attention should be addressed in laser safety and awareness to prevent future ocular injuries. In acute phases of sub-hyaloid hemorrhages blocking direct visualization of the posterior pole, mfERG is a valuable tool to address initial macular pathology.
Assuntos
Traumatismos Oculares/etiologia , Lasers/efeitos adversos , Retina/lesões , Hemorragia Retiniana/etiologia , Corpo Vítreo/lesões , Hemorragia Vítrea/etiologia , Eletrorretinografia , Traumatismos Oculares/diagnóstico por imagem , Traumatismos Oculares/cirurgia , Férias e Feriados , Humanos , Masculino , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/cirurgia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Vitrectomia , Hemorragia Vítrea/diagnóstico por imagem , Hemorragia Vítrea/cirurgia , Adulto JovemRESUMO
We describe the case of a 23-month-old female infant with a diagnosis of hemolytic uremic syndrome (HUS) and hemorrhagic retinopathy. The patient had a past history of abdominal pain, bloody diarrhea, and acute renal failure. On ophthalmologic examination, indirect ophthalmoscopy revealed extensive areas of flame-shaped hemorrhage, cotton wool spots, macular edema and optic nerve head neovascularization in both eyes. Fluorescein angiography showed severe bilateral retinal ischemia and neovascularization leakage in disk. The patient, who had the visual acuity of 20/1000 in the right eye (OD) and 20/540 in the left eye (OS) at the first examination, was treated with panretinal photocoagulation (PRP) and presented at the end of the 6th month of follow-up improvement to 20/540 in OD and 20/270 in OS. There was also a regression of disc neovascularization, hemorrhages and macular edema. Despite intense retinal ischemia, there were no complications related to angiogenesis such as vitreous hemorrhage and/or neovascular glaucoma. We describe, in this report, the association between hemorrhagic retinopathy with features of Purtscher-like disease and HUS.
Descrevemos o caso de um lactente do sexo feminino de 23 meses com diagnóstico de síndrome hemolítico-urêmica (SHU) e retinopatia hemorrágica. A paciente apresentou história clínica prévia de dor abdominal, diarréia sanguinolenta e insuficiência renal aguda. Ao exame oftalmológico, a oftalmoscopia indireta evidenciou, em ambos os olhos, extensas áreas de hemorragia em chama de vela, exsudatos algodonosos, edema macular e neovasos na cabeça do nervo óptico. A angiofluoresceinografia mostrou intensa isquemia retiniana bilateral e vazamento na neovascularização de disco. A paciente, a qual apresentava acuidade visual de 20/1000 no olho direito (OD) e 20/540 no olho esquerdo (OE) no primeiro exame, foi tratada com panfotocoagulação retiniana e apresentou no final do 6º mês de acompanhamento a acuidade visual de 20/540 no OD e 20/270 no OE. Observou-se ainda a regressão dos neovasos, das hemorragias retininanas e do edema. Apesar da intensa isquemia retiniana não houve complicações relacionadas à angiogênese como hemorragia vítrea e/ou glaucoma neovascular. Descreve-se, neste relato, a associação entre retinopatia hemorrágicas com características de Purtscher-like e síndrome hemolítico-urêmica.
Assuntos
Feminino , Humanos , Lactente , Síndrome Hemolítico-Urêmica/complicações , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/patologia , Angiofluoresceinografia , Fotocoagulação a Laser/métodos , Neovascularização Patológica/cirurgia , Hemorragia Retiniana/cirurgia , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
We describe the case of a 23-month-old female infant with a diagnosis of hemolytic uremic syndrome (HUS) and hemorrhagic retinopathy. The patient had a past history of abdominal pain, bloody diarrhea, and acute renal failure. On ophthalmologic examination, indirect ophthalmoscopy revealed extensive areas of flame-shaped hemorrhage, cotton wool spots, macular edema and optic nerve head neovascularization in both eyes. Fluorescein angiography showed severe bilateral retinal ischemia and neovascularization leakage in disk. The patient, who had the visual acuity of 20/1000 in the right eye (OD) and 20/540 in the left eye (OS) at the first examination, was treated with panretinal photocoagulation (PRP) and presented at the end of the 6th month of follow-up improvement to 20/540 in OD and 20/270 in OS. There was also a regression of disc neovascularization, hemorrhages and macular edema. Despite intense retinal ischemia, there were no complications related to angiogenesis such as vitreous hemorrhage and/or neovascular glaucoma. We describe, in this report, the association between hemorrhagic retinopathy with features of Purtscher-like disease and HUS.
Assuntos
Síndrome Hemolítico-Urêmica/complicações , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/patologia , Feminino , Angiofluoresceinografia , Humanos , Lactente , Fotocoagulação a Laser/métodos , Neovascularização Patológica/cirurgia , Hemorragia Retiniana/cirurgia , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
Relatar o caso de uma paciente com retinopatia por Valsalva que evoluiu com hemorragia submembrana limitante interna e foi submetida à vitrectomia via pars plana, tendo tido melhora da acuidade visual. Paciente hígida de 35 anos evoluiu com redução súbita e indolor da acuidade visual do olho direito, após crise de tosse. Ao exame oftalmológico, apresentava hemorragia pré-macular, sem outras alterações. Inicialmente, optou-se pela conduta expectante, porém não houve regressão completa da hemorragia. Então, foi indicada a vitrectomia via pars plana associada à remoção da membrana limitante interna, havendo melhora considerável da acuidade visual, sem complicações peri-operatórias e sem alterações significativas à tomografia de coerência óptica, autofluorescência ou eletrorretinograma multifocal. Neste caso, o tratamento da hemorragia sub-membrana limitante interna com a cirurgia vitreorretiniana resultou em melhora da acuidade visual e regressão da hemorragia.
To report a case of a patient with Valsalva retinopathy that developed sub-internal limiting membrane hemorrhage, underwent pars plana vitrectomy and had visual acuity improvement after that. A 35-year-old healthy patient presented with sudden and painless vision loss of her right eye, after coughing. During the ophthalmologic evaluation, she had a pre-macular hemorrhage and no other abnormalities. Initially, we chose for expectant management, but the hemorrhage did not clear totally. Thus, pars plana vitrectomy associated with internal limiting membrane peeling was indicated, with considerable improvement of her visual acuity, without perioperative complications or significant findings in the optical coherence tomography, autofluorescence and multifocal electroretinogram. In this case, sub-internal limiting membrane hemorrhage treatment with vitreoretinal surgery was relatively useful, with visual acuity improvement and resolution of sub-internal limiting membrane hemorrhage.
Assuntos
Adulto , Feminino , Humanos , Membrana Basal , Tosse/complicações , Hemorragia Retiniana/etiologia , Manobra de Valsalva , Vitrectomia , Membrana Basal/cirurgia , Eletrorretinografia , Hemorragia Retiniana/cirurgia , Tomografia de Coerência Óptica , Acuidade VisualRESUMO
To report a case of a patient with Valsalva retinopathy that developed sub-internal limiting membrane hemorrhage, underwent pars plana vitrectomy and had visual acuity improvement after that. A 35-year-old healthy patient presented with sudden and painless vision loss of her right eye, after coughing. During the ophthalmologic evaluation, she had a pre-macular hemorrhage and no other abnormalities. Initially, we chose for expectant management, but the hemorrhage did not clear totally. Thus, pars plana vitrectomy associated with internal limiting membrane peeling was indicated, with considerable improvement of her visual acuity, without perioperative complications or significant findings in the optical coherence tomography, autofluorescence and multifocal electroretinogram. In this case, sub-internal limiting membrane hemorrhage treatment with vitreoretinal surgery was relatively useful, with visual acuity improvement and resolution of sub-internal limiting membrane hemorrhage.
Assuntos
Membrana Basal , Tosse/complicações , Hemorragia Retiniana/etiologia , Manobra de Valsalva , Vitrectomia , Adulto , Membrana Basal/cirurgia , Eletrorretinografia , Feminino , Humanos , Hemorragia Retiniana/cirurgia , Tomografia de Coerência Óptica , Acuidade VisualRESUMO
Os autores apresentam dois casos de hemorragia sub-retiniana e dois casos de hemorragia subhialoidea. Justificam o tratamento pelo Nd-YAG laser, com drenagem dos hematomas pré e sub-retinianos, por possibilitar a melhora quase imediata da acuidade visual. Discutem também os prejuízos provocados pela presença de sangue na regiäo macular
Assuntos
Humanos , Masculino , Adulto , Feminino , Idoso , Drenagem , Hematoma/cirurgia , Lasers/uso terapêutico , Hemorragia Retiniana/cirurgiaRESUMO
The records of fifty-two consecutive patients with the ocular ischemic syndrome seen between 1978 and 1985 were reviewed with the purpose of investigating the visual prognosis and effects of treatment. On initial presentation, 43% of affected eyes had a visual acuity of 20/20-20/50, whereas 37% were counting fingers or worse. By the end of one year, only 24% remained in the 20/20-20/50 group, while 58% were counting fingers or worse. The presence of rubeosis iridis was an indicator of poor visual prognosis. Ninety-seven percent of eyes with rubeosis had vision of counting fingers or worse at the end of one year. We were unable to demonstrate convincingly that carotid endarterectomy and superficial temporal artery to middle cerebral artery bypass were of benefit in stabilizing or improving vision in persons with the ocular ischemic syndrome.
Assuntos
Olho/irrigação sanguínea , Isquemia/cirurgia , Oclusão da Artéria Retiniana/cirurgia , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Endarterectomia , Feminino , Humanos , Doenças da Íris/etiologia , Isquemia/etiologia , Fotocoagulação , Masculino , Pessoa de Meia-Idade , Prognóstico , Hemorragia Retiniana/cirurgia , Estudos Retrospectivos , SíndromeRESUMO
The O'Malley Log II portable photocoagulator was used to treat the worse eye of 36 patients with proliferative sickle cell retinopathy flat on the retinal surface. The technique involved direct coagulation of the feeder arterioles before treatment of the new vessels themselves. The photocoagulator was most successful in treating the lesions and 131 of 137 retinitis proliferans (RP) lesions were occluded. In only one RP lesion did the photocoagulator have insufficient power to occlude the lesion. Vitreous haemorrhage occurred in only one patient and small round localized retinal haemorrhages in five. The Manchester portable diathermy machine successfully occluded all 29 raised RP lesions and fifty feeder arterioles in thirteen patients. Anterior segment ischaemia occurred in only one patient who had advanced traction retinopathy involving 360 degrees of arc of the retinal circumference before treatment. No recurrence of retinopathy over a 2-year follow-up period was seen in seven patients and in the remainder there was no recurrence in the 2 months after treatment. (Summary)