Pneumatic displacement of submacular hemorrhage due to age-related macular degeneration

PURPOSE

Subretinal hemorrhage is one of the most serious complications of exudative age-related macular degeneration (AMD). Treatment with vitreous surgery with or without plasminogen activator, fluid-gas exchange, or perfluorocarbon yields only a small improvement in visual acuity.

PATIENTS AND METHODS

The files of 24 patients with submacular hemorrhage secondary to AMD who were treated by injection of perfluoropropane gas (C(3)F(8)) (11 patients) or sulfur hexafluoride (SF(6)) (13 patients) were reviewed for visual acuity before and after the procedure and time of treatment from onset of symptoms.

RESULTS

For the whole sample, pneumatic displacement led to a statistically significant improvement in mean visual acuity (p = 0.015). A significant difference between pre- and postoperative visual acuity was found for the patients treated with SF(6) (p = 0.034), but not for the patients treated with C(3)F(8) (p = 0.245).

CONCLUSION

The use of gas injection to displace submacular hemorrhage can significantly improve visual acuity.

Valsalva retinopathy associated with fiberoptic gastroenteroscopy

CASE REPORT

A 45-year-old woman presented with a sudden loss of vision in her left eye, which occurred while she was having a routine upper fiberoptic gastroenteroscopy. According to the gastrointestinal specialist, the patient had performed multiple sustained Valsalva maneuvers during the procedure. Funduscopy showed a preretinal hemorrhage with a half disc diameter in the fovea of the left eye.

COMMENTS

A diagnosis of Valsalva retinopathy was made on the basis of history and fundus finding. The hemorrhage resolved within 2 months without any sequelae. To our knowledge, this is the first report of the occurrence of Valsalva retinopathy following a routine upper fiberoptic gastroenteroscopy.

Hemorheologic Abnormalities Associated with HIV Infection: In Vivo Assessment of Retinal Microvascular Blood Flow

PURPOSE

To evaluate retinal microvascular blood flow in human immunodeficiency virus (HIV)-infected individuals using scanning laser Doppler flowmetry (SLDF) and to seek correlations between flow and various laboratory measures that may predict alterations in flow.

METHODS

The Heidelberg Retina Flowmeter and SLDF software were used to acquire in vivo retinal blood flow data from 24 HIV-infected individuals and 16 HIV-negative control subjects. In each subject, separate scans were performed in each of six retinal regions: nasal parapapillary retina; macula; and the superior, nasal, inferior, and temporal periphery. Erythrocyte aggregation (assessed in vitro by a fully automatic erythrocyte aggregometer and by zeta sedimentation ratio [ZSR, a hematocrit-independent sedimentation rate]), serum fibrinogen level, plasma viscosity, and leukocyte rigidity (assessed in vitro with a cell transit analyzer) were compared with flow in selected regions.

RESULTS

Flow was significantly higher in the periphery (superior, nasal, inferior, temporal) than in the posterior retina (nasal parapapillary retina, macula). Flow was highest in the temporal periphery for both HIV-infected subjects and control subjects. Flow in the posterior retina was significantly lower in HIV-infected subjects than in control subjects (P < 0.0001). Among HIV-infected individuals, flow in the macula correlated negatively with ZSR (r = -0.397, P = 0.0547) and leukocyte rigidity (r = -0.505, P = 0.0119).

CONCLUSIONS

Microvascular blood flow in the posterior retina is reduced in HIV-infected individuals. Both increased erythrocyte aggregation and increased leukocyte rigidity contribute to this hemorheologic abnormality.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AIMS

Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy.

METHODS

Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months.

RESULTS

All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage.

CONCLUSION

Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Pars plana vitrectomy with peripheral retinotomy after injection of preoperative intravitreal tissue plasminogen activator: a modified procedure to drain massive subretinal haemorrhage

AIMS

To report outcome of a modified procedure for draining massive subretinal haemorrhages (SRHs).

METHODS

The charts of eight consecutive eyes from eight patients with massive SRHs extending to the periphery and involving two or more quadrants with haemorrhagic and bullous retinal detachment were reviewed. Tissue plasminogen activator (tPA) was injected intravitreally 12-24 h preoperatively; vitrectomy was carried out with peripheral retinotomy, drainage of the SRH from the retinotomy using perfluorocarbon liquid and gas tamponade with prone positioning postoperatively.

RESULTS

The preoperative visual acuities ranged from light perception to 20/200. Most of the subretinal haematomas moved postoperatively to the vitreous cavity through the peripheral retinotomy using perfluorocarbon liquid. Residual SRHs were drained from the anterior chamber at the bedside after prone positioning overnight. SRH recurred in one eye 14 months postoperatively and was successfully retreated. No other serious complications developed. The final visual acuity improved in seven eyes (range 20/1000-20/60). Polypoidal lesions in choroidal vasculatures were present in three of seven patients.

CONCLUSIONS

The technique seems safe and effective for treating massive SRH. However, visual recovery is limited by the underlying macular pathology. Polypoidal choroidal vasculopathy, other than age-related macular degeneration, may be another cause of massive SRHs.

Management of subretinal macular haemorrhage by direct administration of tissue plasminogen activator

BACKGROUND/AIMS

Recent studies on the treatment of acute subretinal macular haemorrhage have shown that the volume of the clot and the time to evacuation have strong prognostic factors for visual outcome. A novel technique for surgical evacuation of these lesions involves direct injection of tissue plasminogen activator (t-PA) into the haematoma using pars plana vitrectomy. The aim of this study was to evaluate the clinical outcomes of this recently described procedure.

METHODS

17 consecutive patients with subretinal macular haemorrhages caused by age related macular degeneration were enrolled. Patient demographics, acuities, and fluorescein angiograms were obtained for all evaluations. All patients underwent complete three port pars plana vitrectomy to enable direct cannulation of the subretinal space and injection of 48 mug of t-PA, partial fluid-air exchange, 1 hour face up supine positioning postoperatively, followed by upright positioning overnight.

RESULTS

88% of patients within the study had stabilisation or improvement of visual acuity. Nine patients had total clearing of the macular haemorrhage and eight patients had subtotal clearing. Two patients had recurrence of the haemorrhage after the procedure and one patient underwent repair for retinal detachment. Occult lesions demonstrated similar outcomes to classic or predominately classic lesions. Nine patients required no therapy after the study to treat subfoveal neovascularisation.

CONCLUSIONS

This study represents one of the largest case series to date showing that direct injection of subretinal t-PA with air-fluid exchange only and no intraoperative clot lysis period can have favourable results.

The Relationship between Recurrent Optic Disc Hemorrhage and Glaucoma Progression

OBJECTIVE

To compare the clinical characteristics and progression rates of glaucoma in patients with recurrent and single disc hemorrhages (DHs).

DESIGN

Retrospective comparative case series.

PARTICIPANTS

Patients with DH.

METHODS

The medical records of 57 eyes of 54 patients with DH were reviewed retrospectively. These patients had been regularly followed up at 1- to 3-month intervals, between 1991 and 2003, for at least 1 year after the initial DH. The recurrent DH group was composed of patients who had experienced > or =2 episodes of hemorrhage, whereas the single DH group was composed of those who had experienced a single DH episode. These 2 patient groups were compared with respect to clinical courses after initial DH and their clinical characteristics.

MAIN OUTCOME MEASURES

Progression of optic disc and visual field (VF) deterioration.

RESULTS

Twenty-six of the eyes in this study (45.6%) exhibited recurrent DH, and 31 eyes (54.4%) single DH. The average total follow-up period in the recurrent DH group was 67.5 months, whereas single DH patients were followed up for an average of 54.7 months. There were no differences between the groups with regard to age, diagnosis, follow-up period, associated disease, or mean deviation in automated perimetry. Normal-tension glaucoma was the most commonly encountered glaucoma type, and the inferotemporal area was the most common location of DH in both groups. The cumulative probability of optic disc deterioration, including retinal nerve fiber layer change after DH, was found to be significantly greater in patients with recurrent DH (P = 0.004, log rank test). However, no significant differences were found between the 2 groups with regard to rate of VF deterioration (P = 0.10, log rank test).

CONCLUSIONS

No differences were found between the recurrent and single DH groups in terms of clinical characteristics. Recurrent DH in cases of glaucoma may reflect more rapid optic nerve head damage progression than single DH.

[Pulsation in polypoidal choroidal vasculopathy]

PURPOSE

To evaluate the relationship between pulsation and the fundus lesion in polypoidal choroidal vasculopathy (PCV).

OBJECTIVE AND METHODS

We studied 26 eyes with PCV by indocyanine green angiography (IA) with a heidelberg retina angiograph(HRA). The 26 eyes were classified into two groups; pulsatile PCV and non-pulsatile PCV. We evaluated the strength and the amplitude of the pulsation, and the frequency of subretinal hemorrhage within one year after the first IA. Seven eyes in the pulsatile PCV group were tested by HRA twice or more to evaluate the relationship between the fundus lesion and the change in the strength and the amplitude of pulsation.

RESULTS

Subretinal hemorrhage occurred in 9 of 14 eyes with pulsatile PCV and in 2 of 12 eyes with non-pulsatile PCV (odds ratio : 12.5). The possibility of subretinal hemorrhage was significantly higher in pulsatile PCV than in non-pulsatile PCV. In 3 of the 7 eyes tested twice or more, the fundus lesion worsened as the pulsation strengthened and the area of pulsation enlarged. In 1 of the 7 eyes, the fundus lesion improved as the pulsation weakened and the area of pulsation decreased.

CONCLUSION

There is a good possibility that strengthened and extended pulsation is related to increasing subretinal hemorrhage in PCV patients.

Retinal microvascular signs and risk of stroke and stroke mortality

OBJECTIVE

The purpose of this study was to assess the relation of retinal microvascular signs and incident stroke and stroke mortality in an older population.

METHODS

The authors took retinal photographs on baseline participants (3,654 patients aged 49+ years) of the Blue Mountains Eye Study (1992 to 1994). They assessed the presence of retinopathy (microaneurysms, retinal hemorrhages) in participants without diabetes and retinal arteriolar signs in all participants using standardized grading protocols. Incident stroke/TIA/cerebrovascular death (combined stroke events) were identified at follow-up examinations during 1997 to 1999.

RESULTS

During a 7-year period, 859 participants died, 97 (11.3%) of which died of cerebrovascular causes. Of survivors, 24 had confirmed incident stroke, and 11 had incident TIA. Combined stroke events were more frequent in participants with retinopathy (5.7%), with moderate/severe arteriovenous nicking (4.2%), or with focal arteriolar narrowing (7.2%) compared with those without (1.9%). After controlling for age, sex, systolic blood pressure, smoking, and self-rated health, retinopathy was significantly associated with combined stroke events (relative risk [RR] 1.7, 95% CI 1.0 to 2.8) in persons without diabetes. This association was stronger in those without severe hypertension (RR 2.7, CI 1.2 to 6.2) or in persons with two or more retinal microvascular signs (RR 2.7, CI 1.5 to 5.2). Generalized or focal arteriolar narrowing or arteriovenous nicking was not independently associated with combined stroke events after multivariate adjustment.

CONCLUSIONS

In older Australians without diabetes, retinopathy signs predict stroke or stroke-related death independent of traditional stroke risk factors.

Development of multiple subretinal hemorrhages during diode laser supplementation for retinopathy of prematurity

A premature infant had subretinal hemorrhages in one eye after laser ablation for threshold retinopathy of prematurity. We postulate that subretinal hemorrhages occur from trauma to the microvasculature secondary to globe manipulation during scleral depression at the time of laser treatment.

The pathogenesis of optic disc splinter haemorrhages: a new hypothesis

PURPOSE

To describe a hypothesized relationship between optic disc haemorrhages (ODHs) and primary vascular dysregulation (PVD).

METHODS

Observational case report of a patient with classical PVD and five bilateral recurrent ODHs

RESULTS

The ODHs were superotemporal in the right eye and inferotemporal in the left; the eyes were otherwise normal. Intraocular pressure (IOP) never exceeded 17 mmHg. Visual fields were normal. Increased blood flow resistivity, a reduced blood flow of the extraocular vessels, a low systemic blood pressure, a cold-induced flow stop of the nailfold capillaries, and elevated endothelin-1 plasma levels were found, all confirming the diagnosis of vascular dysregulation.

CONCLUSIONS

Optic disc haemorrhages may be due to a disturbed blood-retina barrier rather than to a mechanical rupture of the vessel. This barrier dysfunction may occur in the context of PVD.

Premacular haemorrhage associated with arteriovenous communications of the retina induced by a valsalva-like mechanism: an observational case report

A 26-year-old woman presented with sudden defective vision in the right eye following lifting a heavy bucket of water. Examination showed a dense premacular subhyaloid haemorrhage associated with arteriovenous communications of the retina (AVCRs). Spontaneous absorption of the premacular haemorrhage with consequent improvement in the visual acuity was seen after two months. The possible aetiopathogenesis of the case is also discussed.

Ocular structure and function in an aged monkey with spontaneous diabetes mellitus

Diabetes mellitus develops spontaneously in middle-aged, obese rhesus monkeys, thus making them a good model for examining the effects of co-morbid factors on the development of end-organ damage. Changes in structure and function in the eyes of one monkey who spontaneously developed type 2 diabetes are reported here. This animal had concomitant hypertension, high levels of triglycerides and serum cholesterol, and a low fraction of high-density lipoprotein. The eyes showed intraretinal hemorrhages and large areas of retinal capillary nonperfusion. Indo-cyanin green (ICG) angiography revealed a large area of non- or poorly perfused choriocapillaris in one eye, and immunohistochemistry showed loss of viable choriocapillaries in this region. Both basal laminar deposits and hard drusen were present on areas of Bruch's membrane adjacent to nonviable choriocapillaris. Blood flow via the nasal posterior ciliary arteries to this section of choroid was not detectable by color duplex Doppler ultrasound, indicating contribution of extraocular vascular disease to ischemia in this eye. There was a severe decline in number of photoreceptor inner and outer segments, and corresponding reductions in the multifocal electroretinogram (ERG), in the areas of choriocapillaris loss. The ganzfeld ERG indicated loss in both inner and outer retinal function. Much of the ganglion cell layer was absent throughout the retina, possibly reflecting the effect of diabetes as well as chronic open angle glaucoma; the latter diagnosis supported by elevated intraocular pressures and excavated optic disks. In summary, high resolution, enzyme histochemical and histopathological analyses of a diabetic hypertensive monkey retina and choroid after serial functional in vivo analyses have demonstrated the relationship between vascular dysfunction and visual function loss. Choroidal vascular dysfunction in both large and small vessels was associated with age-related macular degeneration-like changes in Bruch's membrane and photoreceptor degeneration.

Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months

AIM

To compare the visual acuity (VA), spherical equivalent refractive error, motility, and anatomical outcomes in children with treated regressed threshold stage 3 retinopathy of prematurity (ROP) and those with spontaneously regressed subthreshold stage 3 ROP.

METHOD

6 month and 3 year data collected from infants examined between 1989 and 1999 with regressed stage 3 ROP, with or without treatment were retrospectively reviewed.

RESULTS

85 infants were included in this study. 40 eyes received cryotherapy, 81 eyes laser photocoagulation, and 34 eyes had spontaneously regressed subthreshold stage 3 ROP. Grating acuity score > or =2 cycles/degree (c/d) at 6 months was predictive of optotype acuity > or =6/9 in 69% of eyes and a score <2 c/d at 6 months was predictive of acuity < 6/9 in 88% of eyes. Eyes with subthreshold stage 3 ROP were twice as likely to have VA of 6/9 or better at 36 months than the treated eyes. The mean spherical equivalent refractive error at 36 months was -6.5 dioptres (D) (-21.5D to +1.38D) in cryotherapy treated eyes, -2.4D (-13D to +4D) in the laser group, and -0.22D (-9D to +2.25D) in the subthreshold group. Eyes within the treated groups were more myopic than the eyes within the spontaneously regressed group (p = 0.005). At 36 months, 42 out of the 85 infants (that is, 49%) had strabismus (44% in the cryotherapy group, 26% in the laser group, and 25% in the subthreshold group). There was a statistically significant association between the presence of strabismus and anisometropia (p = 0.016) and strabismus and intraventricular haemorrhage (IVH) (p = 0.005). There was a statistically significant difference in the incidence of strabismus between mild and moderate and severe grade IVH (p = 0.01). Eight out of 40 eyes in the cryotherapy group and six out of the 81 eyes in the laser group developed macular ectopia. None of the eyes in the spontaneously regressed group had macular dragging.

CONCLUSIONS

In this study, the grating acuity at 6 months was a good predictor of the 3 year optotype acuity in all groups. Eyes with spontaneously regressed subthreshold stage 3 ROP were associated with better vision at 3 years of age and a lesser degree of myopia compared to the treated groups. Strabismus developed predominantly in the treated groups and was frequently associated with neurological damage and/or anisometropia. The spontaneously regressed subthreshold stage 3 group had a better anatomical outcome compared to the groups in which the retinopathy regressed following treatment.

Vitrectomy for the treatment of submacular hemorrhages from macular degeneration: a comparison of submacular hemorrhage/membrane removal and submacular tissue plasminogen activator-assisted pneumatic displacement

PURPOSE

To evaluate two techniques for treatment of large submacular hemorrhages resulting from choroidal neovascularization associated with age-related macular degeneration.

METHODS

Retrospective consecutive case series of 42 eyes of 42 patients who presented with submacular hemorrhages of at least 12 disc areas associated with visual loss of 3 months or less duration. One of two treatments was performed: (1) vitrectomy with removal of the submacular hemorrhage/neovascular membrane complex using subretinal forceps (SRH group), or (2) vitrectomy with injection of subretinal tissue plasminogen activator (TPA) followed by air-fluid exchange to achieve pneumatic displacement of the hemorrhage (TPA group).

RESULTS

The mean visual acuity in the SRH group improved from 20/1000 -1 to 20/640 -2 at 3 months and 20/640 at 1 year and at the final examination at a mean of 2.92 years (P = .048). The mean visual acuity in the TPA group remained stable initially with a visual acuity of 20/500 preoperatively and 20/640 +2 at 3 months. The visual acuity in the TPA group deteriorated to 20/1000 -2 at 1 year and 20/1000 +2 at the final examination at a mean of 2.3 years (P = .031). Visual acuity improved by at least .3 logMAR units (3 lines) in 44% of the SRH group at 3 months and in 48% at 1 year and at the final examination compared with 20% of the TPA group at 3 months and 13% at 1 year and at the final examination (P = .042 comparing SRH and TPA groups at 1 year and final examination).

CONCLUSIONS

Vitrectomy with removal of the subretinal neovascular membrane/hemorrhage complex resulted in better visual results than displacement of the subretinal hemorrhage primarily due to continuing declines in the TPA group.

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

PURPOSE

To describe whether quantitative assessment of early changes in the morphology of retinopathy lesions can predict development of vision-threatening diabetic maculopathy.

METHODS

We used a nested case-control study, and we studied 11 type 2 diabetes patients who had developed visual loss secondary to diabetic maculopathy. For each diabetes patient, we also studied three matched control patients who had been followed for a comparable period of time without developing visual loss. Fundus photographs describing the early development of retinopathy were digitized and subjected to a full manual quantitative grading on a computer monitor. Differences in the early development of retinal morphology were compared between the two groups. The outcome parameters were changes in the number and area of haemorrhages and exudates in different regions of the fundus, and the weighted distance of these lesions from the fovea and the optic disc.

RESULTS

In patients who developed visual loss secondary to diabetic maculopathy there was significant early progression in the total area and number of haemorrhages and exudates. The haemorrhages had progressed in all retinal areas except the area around the optic disc and the temporal vascular arcades. The exudates had progressed temporally from the fovea and in the retinal periphery.

CONCLUSIONS

The results suggest that a quantitative description of the regional development of early diabetic retinopathy may help in identifying patients who will later develop vision-threatening maculopathy.

Impaired Cerebral Autoregulation in Patients With Malignant Hypertension

Background— In patients with a malignant hypertension, immediate parenteral treatment with blood pressure–lowering agents such as intravenous sodium nitroprusside (SNP) is indicated. In this study, we evaluated static and dynamic cerebral autoregulation (CA) during acute blood pressure lowering with SNP in these patients.

Methods and Results— In 8 patients with mean arterial pressure (MAP) >140 mm Hg and grade III or IV hypertensive retinopathy at hospital admission, middle cerebral artery blood velocity (MCA V) and blood pressure were monitored. Dynamic CA was expressed as the 0.1-Hz MCA V mean to MAP phase lead and static CA as the MCA V mean to MAP relationship during SNP treatment. Eight normotensive subjects served as a reference group. In the patients, the MCA V mean to MAP phase lead was lower (30±8° versus 58±5°, mean±SEM; P <0.05), whereas the transfer gain tended to be higher. During SNP treatment, target MAP was reached within 90 minutes in all patients. The MCA V mean decrease was 22±4%, along with a 27±3% reduction in MAP (from 166±4 to 121±6 mm Hg; P <0.05) in a linear fashion (averaged slope, 0.82±0.15% cm · s −1 · % mm Hg −1 ; r =0.70±0.07).

Conclusions— In patients with malignant hypertension, dynamic CA is impaired. An MCA V mean plateau was not detected during the whole SNP treatment, indicating loss of static CA as well. This study showed that during the whole rapid reduction in blood pressure with SNP, MCA V mean decreases almost one on one with MAP.

Macular hemorrhage after laser in situ keratomileusis (LASIK) with femtosecond laser flap creation

PURPOSE

To report the first case of macular hemorrhage following laser in situ keratomileusis (LASIK) with femtosecond laser flap creation.

DESIGN

Observational case report.

METHODS

A 36-year-old woman underwent uncomplicated, bilateral, simultaneous LASIK procedures for correction of moderate myopia (-5.00 diopters OD and -6.00 diopters OS). LASIK flap creation was performed using the IntraLase femtosecond laser.

RESULTS

On postoperative day 1, the patient's uncorrected and best-corrected visual acuities were 20/20 OD and 20/40 OS. A dilated fundoscopic examination revealed a one-third disk diameter macular hemorrhage OS. An intravenous fluorescein angoiogram ruled out the presence of predisposing macular pathology. Two months after LASIK, the macular hemorrhage had cleared, and 6 months later, the BCVA improved to 20/25 OS.

CONCLUSIONS

Macular hemorrhage may occur after LASIK, even in the absence of previously identified risk factors, such as high myopia, pre-existing choroidal neovasculaization, lacquer cracks, and sudden changes in intraocular pressure associated with microkeratome-assisted flap creation.

Subfoveal hemorrhage after verteporfin photodynamic therapy in treatment of choroidal neovascularization

BACKGROUND

To identify the frequency of new subfoveal hemorrhage and its impact on visual acuity 2 weeks following verteporfin photodynamic therapy (PDT) in the treatment of predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

METHODS

Retrospective, noncomparative, consecutive, interventional case series. At a tertiary retinal referral center, 104 eyes of 97 consecutive patients with predominantly classic subfoveal CNV were treated by PDT. Morphological outcomes include new subfoveal hemorrhage assessed on the photo review (pretreatment, 2 and 12 weeks after PDT). Visual acuity outcomes include moderate (3-5 ETDRS lines) and severe (6 and more ETDRS lines) loss of visual acuity at 2 weeks after PDT.

RESULTS

In this study, 104 eyes of 97 patients were analyzed. CNV in all eyes was secondary to AMD. New subfoveal hemorrhage was found in 22% (23/104) of the eyes 2 weeks following PDT. 17.4% (4/23) of the eyes with new subfoveal hemorrhage had moderate or severe loss of visual acuity. In such eyes the 12-week examination revealed considerable resorption of the new subfoveal hemorrhage with some improvement of visual acuity.

CONCLUSIONS

In 3.8% of the eyes that underwent PDT for predominantly classic subfoveal CNV secondary to AMD, new subfoveal hemorrhage may result in moderate or severe loss of visual acuity within 2 weeks. In all eyes with new subfoveal hemorrhage, considerable resorption of the hemorrhage and some improvement of the visual acuity were seen at 12 weeks. Candidates for PDT should be informed about the low risk of this complication.

Decompression retinopathy after Ahmed glaucoma valve implantation in a patient with congenital aniridia and pseudophakia

We present the case of a 16-year-old adolescent boy with congenital aniridia and pseudophakia who developed decompression retinopathy in a glaucomatous eye after Ahmed glaucoma valve implantation combined with anterior vitrectomy. On the first postoperative day, dot and blot-shaped hemorrhages scattered in the posterior pole were observed. The hemorrhages resolved over 6 months, and the visual acuity returned to the preoperative level. Severe deterioration of the visual field was not observed in the late postoperative period. Despite the sudden visual acuity decrease postoperatively, decompression retinopathy is a benign condition and resolution of hemorrhages without sequelae is the natural course.

[White-centered retinal hemorrhage revealing acute lymphoblastic leukemia]

Retinal involvement during leukemia is frequent (varying from 28% to 50%), can be the result of different mechanisms, and may reveal the disease. We describe two patients, 10 and 50 years old, who consulted for a sudden drop in visual acuity. Fundus examination showed bilateral retinal hemorrhage with a white center in both eyes associated with other hemorrhages in the posterior pole. Acute leukemia was found in both patients and chemotherapy was institgated. The younger patient died of general complications, the other is in remission phase. Retinal hemorrhage with a white center is a rare manifestation of acute leukemia and is exceptionally the first sign of the disease. Through these cases, we detail the physiopathology and clinical aspects. We stress the importance of ocular findings in leukemia in both diagnosis and therapy.