Proliferative Retinopathy Associated with Repeated High-Altitude Exposure in a Patient with Sickle Cell Trait.

Broadhead Geoffrey K., Henry E. Wiley, David Peprah, Kenneth Olumba, and Alisa T. Thavikulwat. Proliferative retinopathy associated with repeated high-altitude exposure in a patient with sickle cell trait. High Alt Med Biol. 23:369-371, 2022.-Sickle cell trait (SCT), a carrier state characterized by one normal copy of the beta-globin gene (producing hemoglobin A) and one abnormal variant (producing hemoglobin S), is typically asymptomatic and very low risk for manifestations of hemoglobinopathy, including development of retinopathy. Reported cases of proliferative retinopathy in patients with SCT have occurred in the context of concurrent ocular or systemic disease. We report a case of an otherwise healthy patient with SCT who developed proliferative retinopathy requiring surgical intervention in the setting of significant exposure to high altitude through increased work hours as a flight attendant in the month leading to her presentation. Significant high-altitude exposure may contribute to development of retinopathy in patients with sickle trait. Practitioners should consider the possibility of sickle cell retinopathy in patients with sickle trait in these circumstances.

Fiberglass intraocular foreign body with no initial ocular symptoms.

PURPOSE: To report a case of an occult intraocular foreign body missed on initial presentation. To our knowledge, this is the first reported case of fiberglass as an intraocular foreign body. METHODS: A case report in which the clinical presentation of the patient was documented by color anterior segment and fundus photographs, optical coherence tomography (OCT), and computed topography (CT) of the orbit. RESULTS: A 34-year-old male was referred for the evaluation of an acute unilateral preretinal hemorrhage of undetermined origin. Three months before his presentation, he had a foreign body sensation while cutting fiberglass, which lasted for several hours. He denied having any visual complaints until his presentation 3 months later. On anterior examination, a small paracentral corneal scar was noticed. There was no cell or flare. A small iris defect inferior nasal with an adjacent area of broad based peripheral anterior synechia on gonioscopy was noted. On funduscopy, a large subretinal elevation with an underlying hemorrhage adjacent to the disk with a white foreign body partially imbedded in the retina was seen. A vitreous hemorrhage was overlying the macula. Because there were no signs of infection or inflammation, surgical intervention was avoided. Barrier laser was performed around the subretinal elevation. CONCLUSION: Occurrence of intraocular foreign bodies, although not uncommon, has a varying presentation. Most often devastating and dramatic, clinical signs may not be obvious or appreciated on thorough examination, especially when the offending object is very small. Intraocular foreign bodies composed of inert material (i.e., glass/fiberglass) can leave the eye without inflammation, further making the diagnosis difficult.

Central retinal artery occlusion in a patient with tetralogy of Fallot.

A 17-year-old Caribbean male presented with painless acute vision loss in the left eye. The patient was found to have a central retinal artery occlusion and an underlying uncorrected tetralogy of Fallot. To our knowledge, this is the first such reported case. One week after presentation visual acuity in the left eye spontaneously improved to 20/200.