Spontaneous inferior subconjunctival haemorrhages in association with circumferential drainage blebs

AIM

To describe an association of spontaneous inferior subconjunctival haemorrhages in eyes with circumferential drainage blebs following trabeculectomy.

METHODS

Observational case series. Patients with multiple episodes of spontaneous inferior subconjunctival haemorrhage following trabeculectomy (with or without antimetabolite) and circumferential blebs are presented. All patients described had multiple episodes. A possible mechanism is discussed.

RESULTS

The number of spontaneous haemorrhages ranged from two to more than 10. All individual haemorrhages resolved spontaneously without adverse sequelae

CONCLUSIONS

A new clinical presentation of inferior subconjunctival haemorrhage in association with circumferential blebs is described.

Acute Epstein-Barr virus infection causing bilateral conjunctival hemorrhages

The systemic and ocular manifestations of acute Epstein-Barr virus infection are protean. Conjunctival hemorrhage has been described once. This report describes a young male who had bilateral conjunctival hemorrhages in the setting of acute Epstein-Barr virus infection.

[Pavlyuk--antioxidant "Gistochrom" in the complex treatment of intraocular hemorrhages in children]

We studied the efficiency of Russian antioxidant Gistochrom in the treatment of intraocular hemorrhages of different genesis in children. Gistochrom was used in 407 children (449 eyes), aged 1 month to 14 years, with traumatic hyphema, hemophthalmos, hemorrhages in the eye bottom, hemorrhagic retinovasculitis, recurrent hephema, diabetic retinopathy, hemorrhages after reconstruction of the anterior chamber with cataract extraction, neuritis, retinopathy of prematures as well as with uveitis with a pronounced exudative component, with signs of retinal edema and of reactive pappilitis. Gistochrom has an intense action on blood resorption in structures of the eye ball as observed in traumas and lesions of internal eye tunics with hemorrhages. The treatment efficiency is higher when the drug is used at earlier disease stages and when it is administered into the retrobulbar space through the irrigation system. Gistrochrom is recommended for use in ophthalmic practice for the treatment of intraocular hemorrhages of different genesis as well as in retinopathy with a pronounced exudative component and in different-etiology uveitis.

Thrombocytopenia and the risks of intraocular surgery

BACKGROUND AND OBJECTIVE

In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery.

PATIENTS AND METHODS

A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994--1995 and 1998--1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study.

RESULTS

Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail.

CONCLUSIONS

The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia.

[Blunt ocular trauma. Part I: blunt anterior segment trauma]

Blunt ocular traumas include contusions and ruptures of the globe--open and closed globe injuries. Characteristic damage results in anterior and posterior segment trauma. Typical patterns of injuries are combinations of (1) hyphema grade II-IV, iris-lens injury, vitreal bleeding--choroidal rupture and increased risk of rebleeding, (2) angle recession >180 degrees--secondary open-angle glaucoma, and (3) vitreal prolapse and lens dislocation-retinal detachment. Patients with blunt eye trauma should be under steady observation by an ophthalmologist to handle late complications.

Cerebral and conjunctival haemorrhages associated with von Willebrand factor deficiency and canine angiostrongylosis

A case of angiostrongylosis is described in a 14-month-old golden retriever bitch. Conjunctival haemorrhage and neurological signs, referable to a space-occupying cerebral lesion, were associated with defective primary haemostasis caused by low levels of von Willebrand factor. Full clinical recovery followed treatment with desmopressin, fresh whole blood transfusion, fenbendazole and supportive care. The magnetic resonance image of the suspected organising haematoma is described. Similarities to the human condition, acquired von Willebrand syndrome, and a possible role for aberrant larval migration in haematoma formation are suggested.

Usefulness of post-mortem ophthalmological endoscopy during forensic autopsy: a case report

Post-mortem intraocular findings in two autopsy cases with traumatic intracranial haemorrhage were obtained using an ophthalmological endoscope. The endoscopy results clearly revealed the presence of intraocular haemorrhages and papilledema caused by intracranial haemorrhage. Post-mortem ophthalmological endoscopy offers several benefits. First, post-mortem intraocular findings can be directly observed in corpses with post-mortem clouding of the cornea. Secondly, the endoscopy only requires a 0.9 mm incision in the sclera and does not require the removal of the eye from the corpse, a procedure that should be avoided for ethical and cosmetic reasons. Thus, post-mortem opthalmological endoscopy is a useful method for obtaining intraocular findings in autopsies.

Funduscopic findings following cataract extraction by means of phacoemulsification in diabetic dogs: 52 cases (1993-2003)

OBJECTIVE

To determine prevalence of retinal hemorrhages and microaneurysms in dogs with diabetes mellitus following cataract extraction by means of phacoemulsification and identify potential risk factors.

DESIGN

Retrospective study.

PROCEDURE

Medical records of dogs undergoing phacoemulsification between 1993 and 2003 were reviewed, and information was recorded on signalment, history, physical examination findings, ophthalmic examination findings, results of laboratory testing, electroretinographic findings, and surgical findings. Glycemic control was classified as poor, intermediate, or good on the basis of baseline blood glucose concentration, perioperative body weight loss, daily insulin dosage, and presence of glucosuria and ketonuria. Data from diabetic and nondiabetic dogs were analyzed to determine prevalence and risk factors for development of retinal hemorrhages or microaneurysms following phacoemulsification.

RESULTS

11 of the 52 (21%) dogs with diabetes mellitus developed ophthalmoscopic signs of retinal hemorrhages or microaneurysms, compared with 1 of the 174 (0.6%) nondiabetic dogs. Median time from onset of diabetes mellitus to diagnosis of retinopathy was 1.4 years (range, 0.5 to 3.2 years). No risk factors for development of retinopathy were identified.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that retinal hemorrhages and microaneurysms may be more common and develop earlier in diabetic dogs than previously reported. This may affect treatment, as diabetic dogs survive longer with improved glycemic control.

[Systemic ALlambda amyloidosis associated with vascular fragility]

A 63-year-old patient had experienced bilateral spontaneous periorbital hemorrhage for one year. After hospitalization because of recurring hemoptysis, biopsies of skin and colon revealed systemic ALlambda amyloidosis. In addition, the heart and lungs appeared to be involved. Monoclonal gammopathy was excluded by a normal plasma cell count and a polyclonal expression pattern in a bone marrow sample and by radiographic examination. The patient was treated with a relatively non-aggressive regimen of melphalan and prednisolone monthly with careful hematologic monitoring. This approach led to a significant improvement in relevant parameters. Recent advances in diagnosis, monitoring and therapy have made it easier to manage patients with amyloidosis with their poor prognosis.

Kataraktoperation in topischer Anästhesie unter oraler Antikoagulation

BACKGROUND

Approximately 14 % of cataract surgery patients receive blood-thinning agents. In a prospective study, the influence of oral anticoagulants on intraoperative and postoperative hemorrhages in patients undergoing cataract surgery in topical anesthesia was investigated.

PATIENTS AND METHODS

128 patients presenting for cataract surgery under oral anticoagulation were included. The mean preoperative prothrombin time was 39 +/- 18 %. Most patients (81 %) continued their oral anticoagulation (prothrombin time 34 +/- 13 %). All surgeries were performed in topical anesthesia.

RESULTS

In 9 patients (7 %) an ocular hemorrhagic event was observed. These were not sight-threatening and resorbed spontaneously within a few days. Only one patient (0.8 %) had a slight hemorrhage in the anterior chamber. There were no differences (P > 0.05) between patients with or without hemorrhagic complications in the postoperative visual acuity, the intraocular pressure, the prothrombin time or the discontinuation of oral anticoagulants.

CONCLUSIONS

Cataract surgery in topical anesthesia under oral anticoagulation did not increase the risk of sight-threatening hemorrhages. The continuation of oral anticoagulation seems particularly indicated for ambulatory cataract surgery.

RISKS OF INTRAVITREOUS INJECTION: A COMPREHENSIVE REVIEW

PURPOSE

To evaluate the prevalence of the most common serious adverse events associated with intravitreous (IVT) injection.

METHODS

A systematic search of the literature via PubMed from 1966 to March 1, 2004, was conducted to identify studies evaluating the safety of IVT injection. Data submitted in New Drug Applications to the U.S. Food and Drug Administration for drugs administered into the vitreous were included where available. Serious adverse events reported in each study were recorded, and risk per eye and risk per injection were calculated for the following serious adverse events: endophthalmitis, retinal detachment, iritis/uveitis, intraocular hemorrhage, ocular hypertension, cataract, and hypotony. Rare complications also were noted.

RESULTS

Data from 14,866 IVT injections in 4,382 eyes were analyzed. There were 38 cases of endophthalmitis (including those reported as pseudoendophthalmitis) for a prevalence of 0.3% per injection and 0.9% per eye. Excluding cases reported specifically as pseudoendophthalmitis, the prevalence of endophthalmitis was 0.2% per injection and 0.5% per eye. Retinal detachment, iritis/uveitis, ocular hypertension, cataract, intraocular hemorrhage, and hypotony were generally associated with IVT injection of specific compounds and were infrequently attributed by the investigators to the injection procedure itself. Retinal vascular occlusions were described rarely in patients after IVT injection, and it was unclear in most cases whether these represented true injection-related complications or chance associations.

CONCLUSION

The risk of serious adverse events reported after IVT injection is low. Nevertheless, careful attention to injection technique and appropriate postinjection monitoring are essential because uncommon injection-related complications may be associated with permanent vision loss.

[The enzyme therapy within a complex treatment of hemophthalmos in patients with diabetes mellitus]

The efficiency of the enzyme therapy was studied in patients with hemophthalmos concurrent with diabetes mellitus of different types. Sixty-eight patients received parabulbar injections of the hemase and collelizin enzymes and another 25 patients underwent the routine therapy comprising injections of dicynone, emoxipin and heparinum. The method of ultrasound B-scanning was used to determine the area of hemorrhage spread into the vitreous body. A high efficiency of the enzyme therapy, as used within the complex treatment of hemophthalmos in patients with diabetes mellitus, was demonstrated. Ultrasound B-scanning is a highly informative technique in evaluating the enzyme-therapy efficiency. The enzyme therapy can be recommended as the most effective method for the treatment of hemophthalmos in patients with diabetes mellitus.

Subepithelial Intracorneal Hemorrhage in a Soft Contact Lens User

PURPOSE

To describe a case of spontaneous subepithelial hemorrhage in a soft contact lens user.

METHODS

A 45-year-old man with irritation and decreased vision had four-quadrant pannus and corneal subepithelial hemorrhage in an annular pattern.

RESULTS

The subepithelial hemorrhage was drained and the feeder vessel coagulated. The hemorrhage subsequently absorbed with time.

CONCLUSIONS

Soft contact lens users should be monitored for the development of significant neovascularization.

[Clinicopathological study on suprachoroidal and supraciliary hemorrhage during enucleation]

PURPOSE

To investigate the pathogenesis of suprachoroidal and supraciliary hemorrhage that might have been induced during enucleation.

METHODS

A histopathological examination of 392 enucleated eyeballs was carried out and 8 eyeballs with suprachoroidal and supraciliary hemorrhage were selected for further clinicopathological examination.

RESULTS

Among 14 eyeballs with severe acute intraocular inflammation, 7 eyeballs with suprachoroidal and supraciliary hemorrhage were found and one other such eyeball was seen among 53 with neovascular glaucoma. Among these 8, there was one case of prolapse of intraocular tissue with severe hemorrhage into the suprachoroidal and supraciliary spaces; 4 cases of severe hemorrhage into the suprachoroidal and supraciliary spaces without prolapse of intraocular tissue; and 3 cases of mild hemorrhage into the suprachoroidal or supraciliary spaces.

CONCLUSIONS

In the eyeballs with severe acute intraocular inflammation, intraocular pressure was elevated and the blood vessels were weakened by inflammatory cell infiltration. During enucleation external forces affected the blood vessel wall of the ciliary arteries and vortex veins, and the breakdown of vessel walls might have been the cause of the suprachoroidal and supraciliary hemorrhage.

[A follow-up of patients operated on for acute arterial aneurysmal rupture]

The paper analyzes the long-term results of treatment and assesses the quality of life in patients admitted to the N. N. Burdenko Research Institute of Neurosurgery, Academy of Medical Sciences, for acute subarachnoidal hemorrhage (ASH) from arterial aneurysms. The study was based on the questioning survey of 168 patients and/or their relatives in the periods of 1 to 7 years after ASH and surgery. The findings have indicated that the pattern of outcomes in the late periods after ASH and surgery differs from that in the early periods after the onset of the disease. These differences concern all types of outcome. Recovery of cerebral functions continues for a long period of time. As the rehabilitative period passes, neurological disorders are absent or mild in 55% of the patients. The patients with significant neurological defects reduced in number by three times as compared with that on discharge and accounted for 9.7%. At the same time the death caused by the underlying disease occurred in the late postoperative periods in 7 cases. In this connection, the outcomes of the disease should be finally assessed in the periods of not earlier than half a year after surgery. 80.7% of the patients operated on are completely adapted in everyday life; 9% need an occasional aid; 7.1% entirely depend on other people; 42% of the patients work; however, only 27.1% of the patients returned to their former work and 23.2% cannot work due to their prior disease. The highest disability rates and hence a low life quality are observed in patients operated on at Hunt-Hess stages IV-V. The findings suggest that the brain is highly plastic and that efforts and material costs on the nursing and rehabilitation of patients with ASH yield good results.

A comparison of three sub-Tenon's cannulae

PURPOSE

To compare the quality of anaesthesia and complication rates between three sub-Tenon cannula of increasing length (anterior Greenbaum, mid Kumar-Dodds, and posterior Steven's sub-Tenon's cannulae).

METHODS

A total of 150 patients undergoing cataract extraction were randomised to receive a sub-Tenon injection of 5 ml of 2% lidocaine with hyaluronidase with one of the three cannulae. The development of akinesia was assessed every 2 min over a 6-min period. Complications were also recorded.

RESULTS

There was no difference in the onset of akinesia, with 46, 50, and 46 patients achieving adequate akinesia within 6 min for the anterior, mid, and posterior groups respectively (P>0.05). There was an increase in retained lid opening with anterior compared to mid and posterior cannulae (P=0.0001). There was significantly less retained lid closure with the posterior compared to the mid or anterior cannulae (P<00001). The mean (range, SD) scores for pain during injection were 0.4 (0-5, 0.83), 1.2 (0-9, 1.96), and 1.1 (0-6, 1.19) for the anterior, mid, and posterior groups, respectively. These were not significantly different between the anterior and mid groups, or the mid and posterior groups (P>0.05), but there was significantly more pain on injection with the posterior compared to the anterior groups (P<0.01). All patients scored intraoperative pain as zero. There was significantly more chemosis in the anterior group (76%) compared to the mid (20%) and posterior (32%) groups (P<0.0001). There were significantly (P=0.0004) more conjunctival haemorrhages in the anterior group (56%) than the mid (20%) or posterior (20%) groups.

CONCLUSIONS

We have shown that all three cannulae provide high-quality anaesthesia with minor differences in retained muscle activity, chemosis, and haemorrhage rates.