Association between subconjunctival hemorrhage and hemorrhagic disorders: a nationwide population-based study

Subconjunctival hemorrhage (SCH) is a benign eye condition that is often noticeable and leads to medical attention. Despite previous studies investigating the relationship between SCH and cardiovascular diseases, the relationship between SCH and bleeding disorders remains controversial. In order to gain further insight into this association, a nationwide cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort version 2.0 from 2006 to 2015. The study defined SCH using a diagnostic code and compared the incidence and risk factors of intracerebral hemorrhage (ICH) and gastrointestinal (GI) bleeding in 36,772 SCH individuals and 147,088 propensity score (PS)-matched controls without SCH. The results showed that SCH was associated with a lower risk of ICH (HR = 0.76, 95% CI = 0.622-0.894, p = 0.002) and GI bleeding (HR = 0.816, 95% CI = 0.690-0.965, p = 0.018) when compared to the PS-matched control group. This reduced risk was more pronounced in females and in the older age group (≥ 50 years), but not observed in males or younger age groups. In conclusion, SCH dose not increase the risk of ICH and major GI bleeding and is associated with a decreased incidence in females and individuals aged ≥ 50 years.

Conjunctival Perivascular Epithelioid Cell Neoplasm With RBM10-TFE3 Fusion Presenting as Recurrent Subconjunctival Hemorrhage

Subconjunctival hemorrhages commonly present to eye care professionals and are frequently regarded as benign self-limited conditions. In selected cases, subconjunctival hemorrhages can be a harbinger of more severe disease. Perivascular epithelioid cell tumors, or PEComas, are rare mesenchymal neoplasms believed to originate from perivascular myoid cells and are rarely present in ocular structures. We present a rare case of a conjunctival perivascular epithelioid cell tumor that initially presented with recurrent subconjunctival hemorrhage. To our knowledge, this is the first description of a PEComa with a RBM10-TFE3 gene fusion, only previously seen with renal cell carcinoma. Physicians should be aware of this rare condition, its location in the fornix and its presentation as a recurrent subconjunctival hemorrhage.

Prevalence and Causes of Subconjunctival Hemorrhage in Children

OBJECTIVE

Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury, but there are limited published data about SCH during childhood. We sought to determine the prevalence and causes of SCH in children.

METHODS

This is a retrospective cross-sectional study of children seen by pediatric ophthalmologists in an outpatient setting over 4 years. Primary outcomes were prevalence and causes of SCH, based on history, physical ocular and nonocular findings, and laboratory and imaging studies. Subconjunctival hemorrhage prevalence was determined including and excluding eye surgery to reduce bias in the prevalence estimate.

RESULTS

We studied 33,990 children, who underwent 86,277 examinations (median age, 5 years; range, 2 days to 18 years; 9282 younger than 2 years, 13,447 age 2-7 years, 11,261 age 8-18 years). There were 949 cases of SCH (1.1%; 95% confidence interval, 1.0-1.2). When surgery was excluded, there were 313 cases (prevalence, 0.4%; 95% confidence interval, 0.3-0.4), of which 261 (83%) were due to trauma; 40 (13%) ocular surface inflammation, including infectious conjunctivitis; 7 (2%) orbital or conjunctival lesion; 3 (1%) vessel rupture from choking or cough; and 2 (1%) coagulopathy related. Across all ages, including less than 2 years, trauma and inflammation together accounted for 94% to 97% of all cases of SCH.

CONCLUSIONS

Subconjunctival hemorrhage is uncommon in children. The great majority of cases are due to trauma. All children with SCH, including infants and young children, should be closely examined to identify other ocular or nonocular signs of trauma.

Retrolental Hemorrhage in Berger's Space After Intravitreal Bevacizumab Injection for Retinopathy of Prematurity

A preterm neonate with type 1 retinopathy of prematurity in posterior zone II presented with hemorrhage in Berger's space immediately after intravitreal bevacizumab injection. The authors report a rare case of successful self-resolution and discuss the need for proper injection technique to prevent this complication. [J Pediatr Ophthalmol Strabismus. 2020;57:e71-e73.].

HEMORRHAGIC VASCULITIS AND RETINOPATHY HERALDING AS AN EARLY SIGN OF BACTERIAL ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION

PURPOSE

To describe a case series of postintravitreal injection, bacterial endophthalmitis heralded by hemorrhagic retinal vasculitis.

METHODS

Observational case series of three patients with a history of intravitreal injections for age-related macular degeneration at a tertiary referral center who presented with vision changes and eye pain that were eventually found to have bacterial endophthalmitis. Clinical course was then followed.

RESULTS

All patients developed bacterial endophthalmitis and hemorrhagic retinal vasculitis.

CONCLUSION

These three cases highlight the importance of hemorrhagic retinal vasculitis as the presenting fundus finding of bacterial endophthalmitis and that this finding in a postinjection patient should be treated as endophthalmitis until proven otherwise.

Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis

PURPOSE

To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs).

DESIGN

Systematic review and network meta-analysis.

METHODS

The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches.

RESULTS

A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF.

CONCLUSIONS

Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.

Delayed suprachoroidal hemorrhage after cataract surgery: A case report and brief review of literature

RATIONALE

To report a case of 44-year-old man with delayed suprachoroidal hemorrhage (DSCH) 2 days after cataract surgery.

PATIENT CONCERNS

The patient developed sudden onset of ocular pain and reduction of visual acuity on his left eye 2 days after receiving conventional cataract operation.

DIAGNOSES

The ocular conditions were accessed by best-corrected visual acuity, intraocular pressure, slit lamp examination, fundus photography, and B-scan ultrasound. Fundus color photograph revealed a raised choroidal mass and extensive subretinal hemorrhage. B-scan ultrasound also confirmed features of choroidal hemorrhage. Thus, he was diagnosed as DSCH.

INTERVENTIONS

He received conservative treatments for 1 month.

OUTCOMES

The involved eye recovered well.

LESSONS

DSCH is a rare but dreaded complication occurring in intraocular operations. Conservative managements or surgeries may be beneficial for the recovery of visual acuity.

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report

BACKGROUND

Herpes uveitis has been previously reported to present with hyphema, but hemorrhagic hypopyon is rarely reported as a herpetic uveitis manifestation. We report a case of herpes simplex virus (HSV) presenting with hemorrhagic hypopyon, and speculate on the underlying pathophysiology with relation to an intravascular lymphoma which was subsequently diagnosed as a result.

CASE PRESENTATION

We present a case wherein a 62-year-old Japanese rheumatoid arthritis woman, with HSV uveitis, presented with hemorrhagic hypopyon in the anterior chamber and a fever with photophobia. Patient was treated with antiviral drugs which improved the hyphema and corneal lesions, but lesions recurred 3 months later. This rare presentation of HSV induced uveitis, and its subsequent recurrence, aroused suspicion of an additional hypopyon-inducing pathology. On account of previous history of lung opacities and elevated LDH, intravascular lymphoma was eventually diagnosed via lung biopsy. She was treated for the lymphoma which also completely resolved all ocular symptoms without any recurrence as of 1.5 years later.

CONCLUSION

The exceedingly rare presentation of hemorrhagic hypopyon may have been enabled by an interaction of the HSV with the intravascular lymphoma. HSV involvement was indicated by the dendritic lesions, IgG assay, and response to anti-viral drugs. The ocular involvement of the intravascular lymphoma seems to be indicated by virtue of the anti-tumor drugs completely resolving all ocular symptoms.

Bloody tears and recurrent nasolacrimal duct obstruction due to a retained silicone stent

A 6-year-old girl with a history of bilateral nasolacrimal duct obstruction presented with recurrent tearing, discharge, and bloody tears from the right eye. The patient had a history of multiple prior probing and stenting procedures on the right nasolacrimal system. Endoscopic dacryocystorhinotomy revealed a retained portion of a prior stent and accompanying pyogenic granuloma, removal of which resolved her symptoms.

[Morphologically reasonable application of 1.44 microm Nd:YAG laser in ocular surgery for distant hemostasis in conjunctival and episcleral vessels]

The article discusses morphological changes in bulbar conjunctiva and episclera after experimental exposure to Nd:YAG laser radiation at 1.44 pm in comparison to the effect of diathermal coagulator Mira TR4000. The results proved the use of 1.44 microm Nd:YAG laser in ocular surgery for distant hemostasis morphologically reasonable. Non-contact and directional laser treatment is more delicate as it produces smaller irradiated area. The depth of penetration and tissue heating is very limited. Neither excessive reparation, nor scarring is found in the exposed area. On the contrary, diathermy is a contact procedure associated with irregular distribution of heat, which causes large tissue burns and necrosis with subsequent adherent scar formation.

Congestion bleeding of the head and neck following myocardial infarction

We present an unusual case of congestion bleeding of the head and neck following myocardial infarction. A 51-year-old man presented with widespread facial petechiae and subconjunctival haemorrhages following a collapse associated with evolving electrocardiographic changes. Emergency coronary artery stent placement was undertaken. No cardiopulmonary resuscitation (CPR) was performed. We hypothesise that the presence of facial petechiae in our case following transient loss of consciousness due to a presumed ventricular arrhythmia in the setting of acute myocardial ischaemia, may have been precipitated by a Valsalva manoeuvre on regaining consciousness with sudden acute increase in venous pressure and consequent venous congestion of the head and neck, and that congestion bleeding of the face may occur in acute cardiac events without a history of CPR.

Skin rash and subconjunctival haemorrhage in an adult with pandemic H1N1 influenza

A young man presented with erythematous rash that appeared 3 days following upper respiratory symptoms and fever. Diffuse exanthematous rash was seen over whole body, most pronounced over the trunk. A subconjunctival haemorrhage also appeared in the left eye following incessant cough. Reverse transcription-PCR of the nasopharyngeal secretions revealed influenza A (2009 pandemic H1N1). The patient responded to oseltamivir therapy. Influenza should be considered in patients presenting with exanthematous skin rash.

Comparing the effects of three different intravitreal injection techniques on vitreous reflux and intraocular pressure

PURPOSE

To compare the effects of straight, oblique, and double-plane tunnel scleral intravitreal injection techniques, on short-term intraocular pressure (IOP) changes, occurrence of vitreous reflux (VR), and/or other complications.

METHODS

A total of 105 patients were included in this prospective study. Patients were assigned randomly to one of the straight injection group (SI; n=35), oblique injection group (OI; n=35), or double-plane tunnel injection group (DPTI; n=35). The occurrence of VR and preinjection and postinjection IOP at 2 and 6 h were compared between groups, and complications were assessed.

RESULTS

The mean patient age was 71.1±6.6 years (range 58 to 86 years; 50 women and 55 men). In the SI, OI, and DPTI groups, VR occurred in 18 (51.4%), 12 (34.3%), and 6 patients (17.1%), respectively. Mean preinjection IOPs were 15.4, 14.8, and 15.6 mmHg, and changed to 17.3, 18.0, and 20.0 mmHg at the second hour, and 15.7, 16.2, and 16.1 mmHg at the sixth hour, respectively. No significant differences among the groups were found in terms of complications such as transient mild uveitis or subconjunctival hemorrhage.

CONCLUSION

Double-plane tunnel injection prevents VR from the injection site and has no additional complications than other techniques.

Fugo blade-assisted lens aspiration in a case of intra- and retro-lenticular hemorrhage

Hemorrhage into the crystalline lens is exceedingly rare but has been described following ocular trauma [1, 2], glaucoma surgery [3-5], laser iridotomy [6], pediatric cataract surgery [7], and also in the absence of an obvious pathology [8]. We describe a case of intra- and retro-lenticular organised bleed which presented 9 years following repair of open globe injury and which was treated using fugo blade-assisted lens aspiration. The fugo blade provided adequate endocoagulation of retrolenticular blood during posterior capsulotomy and prevented undue anterior segment hemorrhage.

A lacrimal sac mass with bloody discharge

We report a 38-year-old man who presented with a 7-year history of a mass in the right medial canthal region. He had several episodes of dacryocystitis, epiphora and bloody discharge. A cystic lesion was defined on MRI. Lacrimal sac excision was performed and a dark red mass was extirpated. External dacryocystorhinostomy and bicanalicular silicone tube intubation was performed. The polypoid lesion was diagnosed as an inflammatory polyp. Benign and malignant tumors of the lacrimal sac may have similar clinical findings on presentation. Preoperative ancillary testing may help us to have an idea of the nature of the lesion but histopathological examination is still the gold standard. Ophthalmologists should remember this similarity and be careful especially while performing endoscopic or laser-assisted dacryocystorhinostomy.

[Posterior approach for foreign body removal from optic nerve head. Case report]

A technique of foreign body removal from optic nerve head performing an external approach and optic nerve transection is described. After 3 months of follow-up cosmetic result is satisfactory and there are no surgery related complications.

A very rare case of bloody tears with enigmatic epistaxis and haematuria

BACKGROUND

Bloody tears are a rare symptom that can be caused by local or systemic pathology.

METHODS

We describe a very rare case of bloody tears that resulted from hyperthyroidism.

RESULTS

A 15-year-old female patient presented with a 6-month history of bloody tears and epistaxis. Examination excluded local ocular and nasal pathology, including neoplasm and coagulopathy. Systemic investigations identified elevated thyroid function and following treatment her symptoms resolved. We discuss the mechanism by which hyperthyroidism may induce haemostatic dysfunction.

CONCLUSION

We present the first case of bloody tears secondary to thyroid dysfunction.

Malignant hemophtalmus as a first sign of orbital rhabdomyosarcoma in adult

We report on a rare case of an adult patient with rhabdomyosarcoma treated at the Dpt Ophthalmology, Comenius University, Medical School in Bratislava as a single case since 1968 (Fig. 2, Ref. 5). Full Text in free PDF www.bmj.sk.

[Clinical rationale for the efficiency of using the domestic antioxidant agent Histochrome]

The objective of the study was to evaluate the efficacy of the Russian drug Histochrome in the treatment of 554 children at different ages who had intraocular hemorrhages of various degrees and sites in relation to the route and time of its administration. Histochrome therapy was shown to reduce the time of resorption of hyphemas and hemophthalmos by two times and retinal hemorrhages to 2 weeks. There was a positive effect in increasing visual acuity by 0.2 or more in 70.3% of cases.

[Hemorrhagic Descemet's membrane detachment after viscocanalostomy]

INTRODUCTION

Viscocanalostomy is an option in the surgical treatment of glaucoma. This non-penetrating technique favours aqueous drainage through the Schlemm channel while avoiding filtering blebs and their related pathologies. Complications associated to this surgery are unusual, one of which is Decemet's membrane detachment (DMD) CLINICAL CASE: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose had undergone a viscocanalostomy of the left eye. In the immediate postoperative period we noticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and see attitude, we did not find improvement 15 days after surgery and corneal edema was established with vision decrease. We proceeded to a surgical reapplication by means of Descemet's membrane micropuncture and SF6 injection into the anterior chamber and achieving an anatomical and functional improvement

DISCUSSION

We believe that the intrusion of viscoelastic material into the supradescemetic was a consequence of the high-pressure during the high-density hyaluronate injection. Hemorrhagic DMD management is mainly determined by its location, size and evolution. In our case, the posterior endothelial micropuncture and descematopexy by means of 20% SF6 injection into the anterior chamber was useful in resolving this complication.

Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma

PURPOSE

This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG).

METHODS

Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were > or = 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 +/- 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan-Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups.

RESULTS

Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group.

CONCLUSIONS

This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG.

Fine-needle aspiration biopsy and other biopsies in suspected intraocular malignant disease: a review

Ocular oncologists require a strong indication for intraocular biopsy before the procedure can be performed because it carries a risk for serious eye complications and the dissemination of malignant cells. The purpose of this review is to evaluate the extent to which this restricted practice is supported by evidence from previous reports and to outline our main indications and contraindications. The different intraocular biopsy techniques in the anterior and posterior segment are discussed with a focus on our preferred method, fine-needle aspiration biopsy (FNAB). In the literature, complications are typically under-reported, which reduces the possibilities of evaluating the risks correctly and of making fair comparisons with other biopsy methods. In FNAB, the exact placement of the needle is critical, as is an accurate assessment of the size of the lesion. Fine-needle aspiration biopsy is usually not a reliable diagnostic tool in lesions < 2 mm in thickness. It is very advantageous to have a cytopathologist present in the operating theatre or close by. This ensures adequate sampling and encourages repeated biopsy attempts if necessary. This approach reduces false negative results to < 3%. Adjunct immunocytochemistry is documented to increase specificity and is essential for diagnosis and management in about 10% of cases. In some rare pathological processes the diagnosis depends ultimately on the identification of specific cell markers. An accurate diagnosis may have a decisive influence on prognosis. The cytogenetic prognostications made possible after FNAB are reliable. Biopsy by FNA has a low complication rate. The calculated risk for retinal detachment is < 4%. Intraocular haemorrhage is frequently observed, but clears spontaneously in nearly all cases. Only a single case of epibulbar seeding of malignant cells at the scleral pars plana puncture site of transvitreal FNAB has been documented. Endophthalmitis has been reported and adequate standard preoperative preparation is obligatory. An open biopsy is still an option in the anterior segment, but has been abandoned in the posterior segment. Although vitrectomy-based procedures are becoming increasingly popular, we recommend using FNAB as part of a stepwise approach. A vitrectomy-assisted biopsy should be considered in cases where FNAB fails. In any adult patient with suspected intraocular malignancy in which enucleation is not the obvious treatment, the clinician should strive for a diagnosis based on biopsy. When the lesion is too small for biopsy or the risks related to the procedure are too great, it is reasonable to be reluctant to biopsy. The standards applied in the treatment of intraocular malignant diseases should be equivalent to those in other fields of oncology. Our view is controversial and contrary to opinion that supports current standards of care for this group of patients.

Risk factors and complications of subconjunctival hemorrhages in patients taking warfarin

OBJECTIVES

The aim of this study was to identify patients with subconjunctival hemorrhage (SCH) on warfarin therapy, to describe risk factors that may contribute to SCH development, and to identify complications related to SCH.

METHODS

A retrospective chart review was conducted including patients treated at a university anticoagulation clinic over 2 years (4,334 patient visits). Data collection included patient demographics; international normalized ratios (INRs) before, at time of, and after SCH; risk factors for increased risk of bleeding; patient-reported complications related to SCH; recent changes in medication use; and warfarin dosage adjustments made in response to the event. The data were summarized using descriptive statistics and frequencies described as percentages.

RESULTS

Fifteen SCH events were identified at an event rate of 0.35%. Two were excluded because of related surgeries near the time of SCH events. The average patient age was 67.3 years (range, 51 to 82). A total of 76.9% (n = 10) of patients had INRs within the goal range at the appointment before reporting the SCH. A total of 46.2% (n = 6) of patients reported alterations in medication regimens during the month preceding SCH. Various patient conditions were documented that may increase the risk of SCH development. No ophthalmic complications were associated with SCHs.

CONCLUSIONS

An SCH event rate of 0.35% was identified. Many factors may have precipitated SCH; however, ophthalmic complications were uncommon.

Intra-ocular haemorrhage, a frequent complication of acute promyelocytic leukaemia

We have found a high incidence of ocular haemorrhage in patients with acute promyelocytic leukaemia (APL). We describe a series of seven consecutive cases of APL, five of which developed ocular haemorrhage. There were no consistent detectable abnormalities in coagulation predictive of ocular damage. Ocular haemorrhage occurred despite the use of aggressive blood product support and its incidence was not altered by the use of the anti fibrinolytic agent tranexamic acid or by the use of heparin. Complete spontaneous resolution of the ocular pathology occurred in three of the five cases of ocular haemorrhage and partial recovery occurred in one. The fifth patient required surgical intervention. The mechanisms underlying the coagulopathy associated with APL are poorly understood. We discuss the evidence in support of primary disseminated intravascular coagulation and primary fibrinolysis. A logical approach to the management of the bleeding complications in APL can only follow greater understanding of the underlying pathophysiology.

Iatrogenic lateral rectus transection secondary to dental implantation surgery

A 48-year-old patient noted right subconjunctival hemorrhage and double vision immediately following dental implant surgery. CT scan confirmed implant screw misplaced into the right orbit, and exploration revealed transection of right lateral rectus muscle belly. Diagnostic and management challenges are discussed.

Phacoemulsification of cataract in patients receiving Coumadin therapy: ocular and hematologic risk assessment

PURPOSE

To assess the risks of intra- and postoperative bleeding tendency associated with uncomplicated cataract surgery by phacoemulsification in patients receiving Coumadin treatment.

DESIGN

Prospective, nonrandomized, interventional, consecutive case series.

METHODS

Sixty-three consecutive patients underwent cataract extraction with lens implantation in 75 eyes. All patients were receiving Coumadin therapy at the time of surgery, and nine patients (14.3%) were also taking antiaggregants. The operations were performed by phacoemulsification technique under topical anesthesia. All patients underwent a hemostatic work-up before intervention. Structured questionnaires were completed by the surgeon immediately after the operation. In 18 (24%) eyes, the surgery was videotaped, and the tapes were reviewed subsequently for any bleedings by an independent observer.

RESULTS

Twelve patients (19%) underwent surgery in both eyes, not simultaneously. The mean prothrombin time international normalized ratio (INR) was 2.03 at the time of the surgery. No significant intraoperative bleeding occurred. Four (6.3%) patients had minor postoperative ocular bleeding. A microscopic hyphema and a dot retinal hemorrhage were each seen in one eye on the first postoperative day, and small iris hemorrhages were identified in two additional eyes at the one-week visit. All bleedings disappeared within one week without affecting the visual acuity. The mean INR of the four patients with minor bleedings was 2.1.

CONCLUSIONS

Cataract surgery by phacoemulsification in uncomplicated eyes can be performed safely in patients receiving Coumadin treatment. However, a large clinical trial is required to assess the safety of continuous Coumadin treatment associated with phacoemulsification in eyes with complicated cataract.

Primary Cardiac Amyloidosis Mimicking Interstitial Lung Disease and Bleeding Diathesis: A Case Report

Primary amyloidosis is a rare systemic disease due to various organ involvements that can lead to atypical clinical findings. In this article, we discuss a case of primary cardiac amyloidosis in a patient presenting with bleeding eyelids and interstitial lung disease.

Ocular manifestations of dengue fever in an East Indian epidemic

BACKGROUND

The incidence and geographic distribution of dengue has increased dramatically in recent years. Previously, ocular findings in dengue fever were considered rare. We report a spectrum of ocular manifestations of this potentially fatal disease and its association with laboratory parameters.

METHODS

134 patients hospitalized with a diagnosis of dengue fever during an epidemic were included. Systemic and ophthalmic examinations were completed on all patients.

RESULTS

The mean age was 31.3 years and 63.4% were males. All patients presented with fever. Six (4.5%) patients had retrobulbar pain and none of the patients presented with any visual complaints. Ocular findings were present in 54 (40.3%) patients. Subconjunctival haemorrhage was the commonest eye finding seen in 50 patients, of whom 84% had characteristic petechial type of haemorrhages. Fundus findings present in 10 (7.5%) patients included dilatation and tortuosity of vessels, superficial retinal haemorrhages, cotton-wool spots, and hard exudates; the macula, however, was spared in all patients. Only 6 of the patients with posterior segment involvement returned for follow-up examination and it was found that retinal changes had resolved without any specific treatment within 2 to 8 weeks time. Of all laboratory parameters evaluated, marked thrombocytopenia (platelet count <50,000/microL) emerged to be significantly associated with ocular haemorrhage.

INTERPRETATION

Multiple subconjunctival haemorrhages, especially petechial type, are a common manifestation of dengue infection. Dengue fever patients with marked thrombocytopenia are predisposed to spontaneous ocular haemorrhages.

[YAG-laser treatment for traumatic hemophthalmia]

The paper deals with noninvasive YAG-laser surgery that is used in the treatment of hemophthalmia, particularly hemophthalmia of posttraumatic genesis. A Visulas YAG laser unit ("Karl Zeiss") was used for YAG laser radiation. Its energy parameters were 0.8 to 9.2 mJ; 2-10 impulses; 1-30 laser treatment sessions. YAG-laser radiation affected the altered part of vitreous body: from fresh blood to the emergence of hemophthalmia as adhesions and conglomerates. YAG-laser applied to pathological vitreous body changes in hemophthalmia is effective and causes their elimination with subsequent lysis. YAG-laser vitreolysis is the operation of choice in traumatic hemophthalmia and may be used not only as an independent surgical technique, but also an additional one in the surgical and medical treatment of hemophthalmia. YAG-laser application to the vitreous body reduces the time of treatment for traumatic hemophthalmia.