Choroideal hemorrhage

Optic neuropathy has only rarely been reported in association with penicillamine (73). In one patient, blurred vision occurred as a result of the development of bilateral choroidal hemorrhage complicating penicillamine-induced thrombocytopenia (123). 

A heavier-than-water fluorinated silicone oil was used in the treatment of 30 selected cases of complicated retinal detachment due to proliferative vitreoretinopathy (n = 19), proliferative diabetic retinopathy with traction detachment (n = 2), giant retinal tears (n = 5), ruptured globe with retinal detachment (n = 2), massive choroidal effusion with retinal detachment (n = 1), and acute retinal necrosis with retinal detachment (n = 1) (13). Initial retinal reattachment was achieved in all cases. Complications included redetachment (n = l), cataract (n = 6), raised intraocular pressure (n = 4), hypotony (n = 4), keratopathy (n = 3), uveitis sjme-chia formation (n = 3), phthisis (n = 2), choroidal hemorrhage (n — 1), and vitreous hemorrhage n = 1). 

The intravitreal injection of Healon is also recommended in severe postoperative hypotonia and choroidal hemorrhage (Baldwin et al., 1989 Cadera et al., 1993). 

AB) 20 4 Miscoding of gut (2), microencephaly (1), general hemorrhage (1), edema AO (1), edema AOF (1), eyes with irregular shape and failure (fthe choroid (1), blister dorsal (1)... 

Retinal hemorrhage occurred in four women after they had received epidural methylprednisolone for chronic back and hip pain (SEDA-20, 373 77). Retinal and choroidal vascular occlusions are a serious and sometimes lasting complication of periocular and facial injections of glucocorticoids (SEDA-21, 416). 

Other rare complications that may lead to reduced visual acuity are subretinal pigment epithelial neovascularization, choroidal folds, preretinal macular hemorrhage, choroidal and subretinal hemorrhages, macular star formation, and retinal pigment epithelial disease. 

The patient may report episodes of watering or tenderness. When reduced lOP is fc>imd by applanation tonometry, a careful examination of the woimd is necessary.This inspection is achieved by painting sodium fluorescein over the cataract incision to observe for Seidel s sign. Occasionally, the auxiliary incisions can leak, so they should also be examined. The clinician should note the appearance of the cornea, which often shows endothelial folds. After the instillation of sodium fluorescein, a waffled appearance of the cornea is generally apparent if the lOP is markedly reduced (Figure 30-3). In addition, the anterior chamber depth should be assessed as well as the presence of inflammation. The pupils should be dilated and a retinal examination should be performed to rule out serous or hemorrhagic choroidal separations or a retinal break or detachment. 

ICGA is most valuable for evaluation of choroidal neovascularization. Fluorescein angiography of early choroidal fluorescence is potentially inhibited by media opacities, fundus pigmentation, xanthophyll, RPE, hemorrhage, or serous exudate in the retina. Rapid leakage from the fenestrated choroidal capillaries is sometimes not easily appreciated with fluorescein angiography in attempting to identify subretinal CNVMs. 

Of the cases in the VIP trial, the visual loss was attributed to the development of extensive subretinal fluid with choroidal hypofluorescence in one case and sub-retinal pigment epithelial hemorrhage in three cases. No obvious cause was detected in six cases. Vision recovered to < 20 letters lost in five of the 10 patients at three months after the events. Although preclinical studies demonstrated some damage to the RPE with PDT, the Phase III data did not suggest any increase in RPE atrophy in verte-porfin-treated patients. For both groups in the TAP study, the distribution of lesion sizes with the inclusion of surrounding atrophy did not differ from the distribution of lesion sizes without atrophy. 

The rate of anastomosis formation was similarly low in a series of 24 eyes collected by Fekrat et al. (74). Nine eyes (38%) had successful anastomosis formation. Of these nine, visual acuity improved in four and the remainder had no change. Forty-two percent of eyes developed a transient vitreous hemorrhage and 21% developed localized choroidal neovascularization at the site of the laser treatment. Overall, visual acuity decreased by at least one line in 63%. 

Subretinal hemorrhage - A collection of blood between the retina and the choroid. 

A 60-year-old man with diabetes mellitus, hypertension, and renal insufficiency requiring dialysis developed loss of vision in his right eye. Both eyes had retinal microaneurysms and punctate hemorrhages due to diabetic retinopathy. There was polypoidal choroidal... 

AVM location hemispheric location of the AVM was correlated to better OR (Pollock et al. 1998). There is more risk of clinical complications with radiosurgery of brain-stem AVMs than of superficial AVMs (Karlsson et al. 1996). A recent series reported the results in 45 patients with brain-stem AVMs (Regis et al. 2001). The overall OR was 82%. Complications were neurological deficit in three patients (two permanent) and recurrent hemorrhage in two. Choroidal and cisternal AVMs seem to be less radiosensitive, with an OR of 47.6% (Nataf et al. 2001d). 

Sensory systems Eyes In 138 patients with subfoveal choroidal neovascular age-related macular degeneration who received ranibizumab 0.5 mg the observed adverse events were vitreous hemorrhage (n = 1), extrafoveal tears in the retinal pigment epithelium (n = 13 9%), conjunctival hemorrhages n = 33 24%), small floaters... 

The most common sign is pallor, which is present in up to 90% of cases (23,58). Between one-third and half of patients have crackles or rhonchi present on chest auscultation (58). Lower extremity edema occurs in 25% to 32% of patients (23,58). Other physical examination findings include tachycardia, tachypnea, and hepatosplenomegaly. Ophthalmic findings occur infrequently and include retinal hemorrhage and detachment with IgG deposition in Burch s membrane and the basement membranes of the choroidal vessels (63,64). 

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