Incidence and rate of disappearance of retinal hemorrhage in newborns.

OBJECTIVE: To determine the prevalance, associated biometric factors, and rate of disappearance of neonatal retinal hemorrhage. DESIGN: Cross-sectional and natural history study. METHODS: Healthy newborns (n = 149) at an urban hospital were examined using indirect ophthalmoscopy within 30 hours of birth. Newborns with retinal hemorrhage were reexamined biweekly until hemorrhage resolved. MAIN OUTCOME MEASURES: Neonatal and maternal biometric factors, and incidence and rate of resolution of retinal hemorrhage. RESULTS: Intraretinal hemorrhage was present in 34% of newborns and varied from a single dot hemorrhage in one eye to bilateral widespread hemorrhages, occasionally with white centers. The incidence of hemorrhage was higher for vacuum-assisted (75%) than for spontaneous vaginal deliveries (33%) and was least for infants delivered by cesarean section (7%). The mean maternal age was greater for infants with retinal hemorrhage. By 2 weeks after birth, retinal hemorrhage resolved in 86% of eyes, and at 4 weeks no intraretinal hemorrhage was detected, although a single subretinal hemorrhage persisted until 6 weeks after birth. CONCLUSIONS: Intraretinal hemorrhages are common in the immediate postnatal period and resolve by 1 month of age. Retinal hemorrhage in infants older than 1 month should heighten suspicion that the hemorrhage is associated with factors other than birth.

Hyperleukocytosis and retinal hemorrhages after chemotherapy and Filgrastim administration for peripheral blood progenitor cell mobilization.

A 49-year-old man with mantle cell lymphoma received 2.5 g/m2 of cyclophosphamide and 900 mg/m2 of etoposide followed by 10 microg/kg/day of Filgrastim for PBPC mobilization. This was complicated by marked hyperleukocytosis and retinal hemorrhages. The patient's symptoms improved gradually following leukopheresis. To the best of our knowledge, this is the first report describing this complication in patients undergoing PBPC mobilization. Early recognition of symptoms is important in order to stop Filgrastim and initiate immediate leukapheresis.

Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome.

OBJECTIVE: This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome. METHODS: Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection. RESULTS: Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery. CONCLUSIONS: Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

An analysis of the effect of intravitreal blood on visual acuity.

We investigated the effect of diffuse hemorrhage on Snellen visual acuity in a model of vitreous hemorrhage in phakic and aphakic eyes. Two cylindrical test chambers with optical paths of 17 mm and 23 mm were constructed to simulate the effect of vitreous hemorrhage in phakic and aphakic eyes. The visual acuity was measured in two subjects in a double-masked fashion for 17 dilutions of whole blood between 1/100 and 1/12,800. The visual acuity decreased approximately linearly between the 1/800 and 1/4,800 dilutions of blood. The visual acuity was 20/20 in all dilutions of blood higher than 1/4,800. The visual acuity was reduced to hand motions or worse with 12.5 microliter of blood in the 5-ml test chamber under all test conditions. The visual acuity was 20/20 in all tests with 1.04 microliter of blood in the test chamber. The visual acuity decreased from 20/20 to hand motions with only a twelve-fold change in concentration of blood in the test chamber.

Pars planitis and autoimmune endotheliopathy.

A migrating endothelial rejection line is the clinical criterion of specific immune reaction in corneal allotransplantation. This line when seen in otherwise intact corneas has been presumed to be an autoimmune endotheliopathy. We have recorded corneal changes similar to autoimmune endotheliopathy in four of ten patients with the diagnosis of pars planitis. These observations suggest that pars planitis may be an autoimmune process directed against the vitreous humor.