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In this study, we report paracentral acute middle maculopathy (PAMM) and cotton wool spots (CWS) in a patient with ocular migraine. A 74-year-old man presented with persistent paracentral scotoma in the right eye that began a week prior. His visual acuity was 20/25 in the right eye and 20/40 in the left. Dilated fundoscopy revealed CWS in the right eye. Spectral-domain optical coherence tomography (SD-OCT) showed hyper-reflective bands in the inner nuclear layer corresponding to parafoveal lesions seen on near-infrared imaging in the right eye consistent with the diagnosis of PAMM. Further laboratory studies were unremarkable, and a transthoracic echocardiogram and a carotid ultrasound were unrevealing. The patient was started on brimonidine three times daily in both eyes. The patient reported subjective improvement in the paracentral scotoma and the absence of ocular migraine symptoms at two-month follow-up. We conclude from this case that PAMM and CWS can occur simultaneously in ocular migraine, and we suggest that retinal vascular changes associated with ocular migraine may contribute to ischemia underlying both entities. Additionally, we suggest a potential therapy in brimonidine due to its proposed beneficial effects on retinal vasculature and neuroprotection.
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Angiografía con Fluoresceína , Trastornos Migrañosos , Escotoma , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Masculino , Anciano , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/tratamiento farmacológico , Agudeza Visual/fisiología , Escotoma/diagnóstico , Escotoma/fisiopatología , Escotoma/tratamiento farmacológico , Angiografía con Fluoresceína/métodos , Enfermedad Aguda , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/fisiopatología , Mácula Lútea/patología , Mácula Lútea/diagnóstico por imagen , Campos Visuales/fisiología , Tartrato de Brimonidina/uso terapéutico , Síndromes de Puntos Blancos/diagnóstico , Síndromes de Puntos Blancos/tratamiento farmacológico , Fondo de Ojo , Vasos Retinianos/patología , Vasos Retinianos/diagnóstico por imagenRESUMEN
PURPOSE: To evaluate the clinical patterns of retinopathy in patients who received cardiopulmonary resuscitation (CPR) using wide-field fundus photography and slit-lamp fundus examination. METHODS: The medical records of patients aged ≥ 18 years who survived after receiving CPR and underwent wide-field fundus photography and slit-lamp fundus examination within 3 months were retrospectively analyzed. Fundus findings, including retinal hemorrhage and cotton wool spots, were investigated. The subjects were categorized into the retinopathy and non-retinopathy groups based on the presence of fundus findings. Systemic and CPR-related factors were analyzed to compare the two groups. RESULTS: Twenty eyes (10 patients) and 28 eyes (14 patients) were included in the retinopathy and non-retinopathy groups, respectively. The retinopathy group had longer CPR time than the non-retinopathy group (15 ± 11 min vs. 6 ± 5 min, p = 0.027). In the retinopathy group, retinal nerve fiber layer hemorrhage was observed in all eyes, and intraretinal hemorrhage was observed in 55% of the eyes. 80% of hemorrhages were located in the peripapillary or posterior pole. There were no interval changes in visual acuity, intraocular pressure, and central retinal thickness for 6 months. The average remission periods of retinal hemorrhage and cotton wool spots were 6.8 ± 2.6 month and 5.6 ± 2.1 months, respectively. No retinopathy progression was observed. CONCLUSION: The signs of retinopathy, such as retinal hemorrhages and cotton wool spots, which are found after CPR, mainly occur in patients who receive longer time of CPR and improve over time.
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Reanimación Cardiopulmonar , Enfermedades de la Retina , Humanos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiología , Estudios Retrospectivos , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Retina , Reanimación Cardiopulmonar/efectos adversosRESUMEN
Purtscher's retinopathy is a rare angiopathy reported in patients with a history of severe trauma and other systemic diseases. The diagnosis is made on clinical grounds, and the severity varies. A 41-year-old gentleman with underlying poorly controlled diabetes mellitus and dyslipidemia was referred to the ophthalmology department for diabetic retinopathy screening. He denied visual complaints. Ocular examination revealed a negative relative afferent pupillary defect with a visual acuity of 6/6 bilaterally. The anterior segment examination was unremarkable. Both eye (oculus uterque, OU) fundus revealed a pink disc with a cup-to-disc ratio of 0.4 and peripapillary flame-shaped hemorrhages. Right eye (oculus dexter, OD) also showed multiple cotton wool spots along the superotemporal arcade involving zones 1 and 2 of the retina, while left eye (oculus sinister, OS) showed a single cotton wool spot along the superotemporal arcade at zone 1 of the retina. Otherwise, there were no visible retinal emboli, dot hemorrhages, or hard exudates, and the macula was normal. The retinal features were not characteristic of diabetic retinopathy. It mimicked hypertensive retinopathy, but the patient was normotensive. The absence of inner retinal thickening and hyperreflectivity on optical coherence tomography of the macula ruled out retinal vein occlusion. This prompted us to elicit further history, and the patient disclosed a recent admission for myocardial infarction in which he received cardiopulmonary resuscitation with chest compressions for seven minutes. Hence, the diagnosis of OU Purtscher's retinopathy was made, and the patient was monitored closely in the clinic. Purtscher's retinopathy remains a diagnostic dilemma and should not be neglected in complex clinical contexts.
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Objective:To observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy (AMN) associated with the coronavirus disease 2019 (COVID-19).Methods:A retrospective study. From December 20, 2022 to January 17, 2023, a total of 29 patients (58 eyes) with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital, Shanghai Medical College were included in the study. All the affected eyes underwent the best corrected visual acuity, color fundus photography, infrared fundus photography (IR), short-wavelength autofluorescence (SW-AF), near-infrared autofluorescence (NIL-AF), optical coherence tomography (OCT), and OCT angiography (OCTA). All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy. Follow-ups were conducted 1 to 3 months after the initial diagnosis, with a total of 19 cases (38 eyes) completing the one-month follow-up.Results:Out of the 29 cases, there were 9 males (18 eyes) and 20 females (40 eyes), all of whom experienced bilateral eye involvement. The age of the patients ranged from 12 to 47 years, with an average age of (29.9±9.5) years. The time from the onset of fever to the appearance of ocular symptoms was (2.52±2.01) days. Among the 58 affected eyes, there were 5 cases with retinal cotton wool spots, 2 cases with optic disc edema, and 1 case with parafoveal branch retinal vein occlusion. All affected eyes exhibited deep reddish-brown macular dark spots. IR revealed wedge-shaped, wedge-like, or "petaloid-like" dark areas involving the fovea and parafovea. SW-AF examination showed no obvious abnormality in 39 eyes. Weak autofluorescence dark area were consistent with IR in 19 eyes. NIR-AF examination showed spot-like or flaky self-fluorescent dark areas. OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium (RPE) layer in the macular area in the acute stage, showing typical "bean seedling" sign. OCTA revealed reduced blood flow density in the deep capillary plexus (DCP) of 50 eyes. Enface OCT displayed lesion areas that corresponded to the dark areas seen in IR. One month after the initial diagnosis, the condition improved in 18 eyes (47.4%, 18/38). Among the 5 eyes with cotton wool spots, regression of these spots was accompanied by loss of nerve fiber layer in 4 eyes. In cases with optic disc edema, the edema subsided. The "bean sprout" sign disappeared in all affected eyes, and the lesions became localized. The ellipsoid zone and/or interdigitation zone in the lesion areas were discontinuous.Conclusions:COVID-19-related AMN is characterized by distinctive features. IR fundus reveals wedge-shaped, wedge-like, or petaloid dark areas involving the fovea and parafovea. OCT displays strongly reflective lesions with vertical spread above the RPE. OCTA shows reduced blood flow density in the DCP of the retina.
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A 15-year-old girl presented to the emergency department with a history of bilateral blurred vision for one day, with greater severity in the right eye. Fundus examinations revealed cotton wool spots, dot hemorrhage, and hard exudate. She underwent optical coherence tomography angiography (OCTA), which showed the presence of macula ischemia, decreased vascular density, mild retinal fluid, severe ischemia, some macular edema, and vascular sheathing, indicating active vasculitis in the right eye. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect many organs in the body, including the eye. Ocular involvement is one of the most well-known features. Retinal vasculitis is a rare complication of SLE that is characterized by vascular sheathing that can progress to vaso-occlusion. We report the clinical features of SLE using OCTA.
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The recent outbreak of the Coronavirus SARS-CoV-2 has been declared a worldwide pandemic. Within various multi-organ involvement, several ocular manifestations have been described, such as conjunctivitis and retinopathy. The prevalence and severity of retinal lesions and their relation to the severity of the systemic disease are unknown. We performed a prospective, observational study on 172 consecutively hospitalized patients with acute confirmed COVID-19 infection. All patients underwent screening widefield fundus photography at the time of hospital admission. Despite no ocular or vision-related symptoms, we found cotton wool spots (CWS) and/or hemorrhages in 19/172 patients (11%). Diabetes history, overweight, and elevated C-reactive protein were more frequently observed among patients with retinal abnormalities, while a history of systemic hypertension was more frequently observed among patients without retinal findings. At a 3-month follow-up visit, CWS had subsided in all patients.
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La retinopatía de Purtscher es una microangiopatía oclusiva asociada a causas traumáticas que suele cursar con disminución visual. Cuando la etiología no es traumática se denomina retinopatía Purtscher-like (RPL). Un varón de 26años refirió pérdida de visión en el ojo izquierdo tras el implante de un stent telescopado para el tratamiento de un aneurisma carotídeo intracraneal. El fondo de ojo mostró numerosos exudados algodonosos y hemorragias superficiales. La evolución espontánea fue favorable, con una resolución casi completa salvo por un escotoma residual inferior. La aparición de RPL se puede asociar al implante de un stent endovascular para el tratamiento de aneurismas intracraneales (Au)
Purtscher retinopathy is an occlusive microangiopathy associated with traumatic causes and usually causes visual impairment. For non-traumatic origins, it is called Purtscher-like retinopathy (PLR). A 26-year-old man reported loss of vision in his left eye after the implantation of a telescoping stent for the treatment of an intracranial carotid aneurysm. The fundus of the eye showed numerous cotton-wool spots and superficial haemorrhages. The spontaneous evolution was favourable, with almost complete resolution, except for an inferior residual scotoma. The appearance of PLR may be associated with the implantation of an endovascular stent for the treatment of intracranial aneurysms (AU)
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Humanos , Masculino , Adulto , Aneurisma Intracraneal/cirugía , Stents/efectos adversos , Oclusión de la Arteria Retiniana/diagnóstico por imagen , Oclusión de la Arteria Retiniana/etiología , AngiografíaRESUMEN
Purtscher retinopathy is an occlusive microangiopathy associated with traumatic causes and usually causes visual impairment. For non-traumatic origins, it is called Purtscher-like retinopathy (PLR). A 26-year-old man reported loss of vision in his left eye after the implantation of a telescoping stent for the treatment of an intracranial carotid aneurysm. The fundus of the eye showed numerous cotton-wool spots and superficial haemorrhages. The spontaneous evolution was favourable, with almost complete resolution, except for an inferior residual scotoma. The appearance of PLR may be associated with the implantation of an endovascular stent for the treatment of intracranial aneurysms.
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Aneurisma Intracraneal , Papiledema , Enfermedades de la Retina , Adulto , Fondo de Ojo , Humanos , Aneurisma Intracraneal/cirugía , Masculino , StentsRESUMEN
A 33-year-old male presented with history of blurring of vision in the left eye for two months. He was seen by the local ophthalmologist and diagnosed as nongranulomatous anterior uveitis in the left eye with normal fundus. He had history of fever 20 days back and was diagnosed positive for COVID-19 by RT-PCR. He presented with acute anterior uveitis in the left eye. Fundus examination revealed a cotton wool spot close to the fovea, which was confirmed by swept-source optical coherence tomography (SS-OCT) of the macula. The patient after two months' follow-up showed resolution of the cotton wool spot, which was confirmed by SS-OCT. Our case indicates that cotton wool spot can be an ocular manifestation of COVID-19 infection, and swept-source optical coherence tomography can precisely document the resolution of the lesion.
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COVID-19 , Tomografía de Coherencia Óptica , Adulto , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Masculino , SARS-CoV-2RESUMEN
The purpose of this study was to evaluate the presence of retinal and microvascular alterations in COVID-19 patients with bilateral pneumonia due to SARS-COV-2 that required hospital admission and compare this with a cohort of age- and sex-matched controls. COVID-19 bilateral pneumonia patients underwent retinal imaging 14 days after hospital discharge with structural optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) measurements. Vessel density (VD) and foveal avascular zone (FAZ) area were evaluated in the superficial, deep capillary plexus (SCP, DCP), and choriocapillaris (CC). After exclusion criteria, only one eye per patient was selected, and 50 eyes (25 patients and 25 controls) were included in the analysis. COVID-19 patients presented significantly thinner ganglion cell layer (GCL) (p = 0.003) and thicker retinal nerve fiber layer (RNFL) compared to controls (p = 0.048), and this RNFL thickening was greater in COVID-19 cases with cotton wool spots (CWS), when compared with patients without CWS (p = 0.032). In both SCP and DCP, COVID-19 patients presented lower VD in the foveal region (p < 0.001) and a greater FAZ area than controls (p = 0.007). These findings suggest that thrombotic and inflammatory phenomena could be happening in the retina of COVID-19 patients. Further research is warranted to analyze the longitudinal evolution of these changes over time as well as their correlation with disease severity.
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Diabetic retinopathy (DR) is one of the most prevalent genetic diseases in human and it is caused by damage to the blood vessels in the eye retina. If it is undetected and untreated at right time, it can lead to vision loss. There are many medical imaging and processing technologies to improve the diagnostic process of DR to overcome the lack of human experts. In the existing image processing methods, there are issues such as lack of noise removal, improper clustering segmentation and less classification accuracy. This can be accomplished by automatic diagnosis of DR using advanced image processing method. The cotton wool spot (CWS), hard exudates (HE) contains a common manifestation of many diseases in retina including DR and acquired immunodeficiency syndrome. In the present work, super iterative clustering algorithm (SICA) is proposed to identify the CWS, HE on retinal image. Feature-based medical image retrieval (FBMIR) datasets are utilized for this purpose. Noises present on the images and histogram-filtering technique is used to convert red, green, and blue (RGB) images into a perfect greyscale image without noise. After pre-processing, SICA is used to identify the CWS, HE detection on retinal images and eliminates unnecessary areas of interest. In the third stage, after detecting CWS and HE, various statistical features are extracted for further classification using deep assimilation learning algorithm (DALA). The performance of DALA technique is examined with various classification parameters like recall, precision, and F-measure. Finally, the false classification ratios are computed to compare the performance of the trained networks. The proposed method produces accurate detection of affected regions with an accuracy ratio of 98.5% and it is higher than the other conventional methods. This method may improve the accuracy of automatic detection and classification of eye diseases.
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Algoritmos , Retinopatía Diabética , Genómica , Humanos , Interpretación de Imagen Asistida por Computador , RetinaRESUMEN
A 76-year old African American female with a history of arteritic ischemic optic neuropathy (AION) secondary to biopsy-proven giant cell arteritis (GCA) presented with unilateral vision loss in her contralateral eye despite high-dose oral steroid treatment. Dilated fundus examination revealed three cotton wool spots. Fluorescein angiography showed slowed arteriolar filling with late staining of small peripheral arteries, consistent with small vessel arteritis. Laboratory tests for alternative vasculitides were negative. Review of her temporal artery biopsy specimen confirmed lymphoplasmacytic inflammation around small adventitial vessels with no destructive granulomatous or leukocytoclastic small vessel vasculitis, consistent with GCA. Our unique case demonstrates peripheral small vessel retinal arteriolar leakage in GCA, which is a rare finding. This association is of interest because GCA is commonly associated with medium to large vessel pathology without small vessel involvement.
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PURPOSE: To present a case of a single isolated cotton-wool spot in a healthy patient. CASE SUMMARY: A 43-year-old woman with no systemic disease complained of sudden inferior field defect of the right eye. On fundoscopic examination of the right eye, a single soft white spot was observed in the superotemporal vascular arcade. An elevated hyper-reflective area in the inner retina corresponding to a white spot was observed on optical coherence tomography. Automated perimetry revealed an arcuate field defect which was wider than the cotton-wool spot. A complete workup for systemic diseases was within normal range except a positive rheumatoid factor. At the 2-week follow-up, the patient's subjective symptom improved and the white spot decreased. After 6 months, the cotton-wool spot disappeared and slit-like retinal nerve fiber layer (RNFL) defects corresponding to the location of the cotton-wool spot was noticed. One year later, disc and RNFL defect were unchanged but the previous field defect disappeared. CONCLUSIONS: Isolated cotton-wool spots can occur without serious systemic diseases in healthy patients. A single isolated cotton-wool spot in the present case disappeared spontaneously leaving permanent structural damage on the retina over time.
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Adulto , Femenino , Humanos , Caries Dental , Ojo , Estudios de Seguimiento , Fibras Nerviosas , Valores de Referencia , Retina , Retinaldehído , Factor Reumatoide , Tomografía de Coherencia Óptica , Pruebas del Campo VisualRESUMEN
PURPOSE: To present a case of a single isolated cotton-wool spot in a healthy patient. CASE SUMMARY: A 43-year-old woman with no systemic disease complained of sudden inferior field defect of the right eye. On fundoscopic examination of the right eye, a single soft white spot was observed in the superotemporal vascular arcade. An elevated hyper-reflective area in the inner retina corresponding to a white spot was observed on optical coherence tomography. Automated perimetry revealed an arcuate field defect which was wider than the cotton-wool spot. A complete workup for systemic diseases was within normal range except a positive rheumatoid factor. At the 2-week follow-up, the patient's subjective symptom improved and the white spot decreased. After 6 months, the cotton-wool spot disappeared and slit-like retinal nerve fiber layer (RNFL) defects corresponding to the location of the cotton-wool spot was noticed. One year later, disc and RNFL defect were unchanged but the previous field defect disappeared. CONCLUSIONS: Isolated cotton-wool spots can occur without serious systemic diseases in healthy patients. A single isolated cotton-wool spot in the present case disappeared spontaneously leaving permanent structural damage on the retina over time.
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Adulto , Femenino , Humanos , Caries Dental , Ojo , Estudios de Seguimiento , Fibras Nerviosas , Valores de Referencia , Retina , Retinaldehído , Factor Reumatoide , Tomografía de Coherencia Óptica , Pruebas del Campo VisualRESUMEN
PURPOSE: We report a case of Purtscher-like retinopathy following the removal of a dislocated IOL and scleral fixation of a new IOL. METHODS: A 60-year-old man presented with sudden visual loss of the right eye. An ophthalmologic examination revealed IOL dislocation. He underwent removal of the dislocated IOL and scleral fixation of the new IOL. Visual acuity was 0.02 in the right eye on the second postoperative day. A fundus examination and fluorescein angiography were performed. RESULTS: A peripapillary multiple cotton wool spot, pale macula and cherry red spot were noted in the right eye. Fluorescein angiography showed arteriolar obstruction around the macula and leakage of the mild arteriolar fluorescein dye. At one month follow-up, macular edema, hemorrhage and peripapillary cotton wool spots were increased. CONCLUSIONS: This case of Purtscher-like retinopathy following scleral fixation of the IOL did not have any obvious etiologic cause.
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Humanos , Persona de Mediana Edad , Luxaciones Articulares , Fluoresceína , Angiografía con Fluoresceína , Estudios de Seguimiento , Hemorragia , Edema Macular , Prunus , Agudeza Visual , LanaRESUMEN
PURPOSE: We report one case of Purtscher's retinopathy related to chest compression by safety belts during motor vehicle accident. METHODS: A 31 old year man was referred to our ophthalmologic department because of diminished vision in the left eye at 6 days after motor vehicle accident. Best uncorrected visual acuity (UCVA) was right eye 1.0 and left eye 0.5. RESULTS: Best corrected visual acuity (BCVA) was both 1.0. In the left fundus there was multiple cotton wool spots, retinal hemorrhages and macular edema. At 15 days after accident, multiple cotton wool spots and retinal hemorrhages still be seen. Fluorescein angiography showed capillary nonperfusions and blocked fluorescence by retinal hemorrhages in the arteriovenous phase, leakage of dye in the region of capillary nonperfusion in the late venous phase. At 58 days after accident, multiple cotton wool spots remarkably decreased, however vision remained as 0.2. At 78 days after accident, left eye vision improved to 0.5. CONCLUSIONS: This case suggested to consider a safety belt injury as the cause of Purtscher's retinopathy.