Vitreous humor analytes in assessing the postmortem interval and the antemortem clinical status

Various body fluids have been used in the diagnosis of diseases. Rapid changes occur in the blood and cerebrospinal fluid after death. Vitreous humor, being well protected, shows a more gradual change. It has been found to be a useful adjunct in determining the time of death in an individual and in diagnosing certain antemortem clinical conditions (AU)

Sickle cell retinopathy in young children in Jamaica

Ophthalmological examinations were performed on 59 of the 74 (80 percent) children with homozygous sickle cell (SS) disease and on 37 of the 54 (69 percent) children with sickle cell-haemoglobin C(SC) disease, aged 5-7.5 years, within the cohort study of sickle cell disease. Arteriolar sheathing was the commonest retinal vessel abnormality, occurring in 30/59 (51 percent) SS children and in 11/37 (30 percent) SC children. Peripheral arteriolar closure was observed in 14 (24 percent) SS children and in 6 (16 percent) SC children. Arteriovenous anastomoses were seen in 3 children, but proliferative retinopathy was not identified. Capillary changes often occurred in patients without confluent closure, suggesting that complex remodelling of the capillary bed may precede retinal nonperfusion. Discrete retinal patches similar to schisis cavities resulting from intraretinal haemorrhages were found in 22 (37 percent) SS children and in 9 (24 percent) SC children, but haemorrhages were observed in only 2 patients (1 SS, 1SC). Vitreous opacities were common and were generally associated with retinal vessel disease. Retinal changes were consistently more common in children with SS disease, though the differences failed to reach statistical significance. The prevalence of peripheral vascular closure and retinal patches showed a significant upward trend with age. These observations contrast with the greater prevalence of proliferative retinopathy characterising SC disease in adults.(AU)

Photocoagulation and diathermy in the treatment of proliferative sickle retinopathy

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)