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1

Kumar, Jitendra, Apurva Jain, and Rashmi Kumari. "FUNDUS FINDINGS IN PATIENTS OF MILD, MODERATE AND SEVERE DEGREE OF ANAEMIA PRESENTING TO THE TERTIARY HEALTH CARE CENTRE." International Journal of Advanced Research 10, no. 07 (2022): 540–45. http://dx.doi.org/10.21474/ijar01/15070.

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Purpose:To study fundus findings in patients of mild,moderate, and severe degree of anaemia presenting to the tertiary health care centre. Methods:This was a prospective observational study that involved25 patients of anemiacomplaining of blurring of vision, conjunctival pallor, pain, subconjunctival hemorrhage and eyelid swelling. Results:There were 20females and 5 males and the age group taken was 20 to 50 years.Out of 25 patients of nutritional anemia, 12 patients belonged to the age group of 20 to 30 years, out of which 10 were females and 2 weremales. 8 patients belonged to age group of 30 to 40 years, out of which 6 were females and 2 were males. 5 patients belonged to the age group of 40 to 50 years, out of which 4 were females and 1 was male.In our study, it was found that 5 patients belonged to the category of severe anemia with hemoglobin [<6 gm/dl], 8 patients belonged to the category of moderate anemia with hemoglobin ranging between 6-10 gm/dl, 12 patients belonged to the category of mild anemia with hemoglobin ranging between 10-12 gm/dl.On looking for various fundus manifestations in different grades of anemia viz.mild, moderate and severe anemia, we found out that the incidence of retinal vascular changes in the form of venous dilation and tortuosity, pale disc, roth spots, macular edema,subhyaloid hemorrhages, dot – blot and flame shaped hemorrhages showed an increasing trend with increase in severity of anemia. Conclusion:There is a high prevalence of anemia in India which affects female gender more than male gender. Anemic retinopathy is not an uncommon condition but it is generally asymptomatic and gets noted incidentally during general workup of the patients. It has variable presentation in different patients with different grades of anemia.
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2

Sanjay, Srinivasan, Isha Acharya, Priya Srinivasan, and Padmamalini Mahendradas. "Multimodal imaging in radiation retinopathy following orbital metastasis." Medical hypothesis, discovery & innovation in optometry 4, no. 3 (2023): 141–47. http://dx.doi.org/10.51329/mehdioptometry184.

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Background: Radiation retinopathy is a major cause of vision loss in patients receiving radiotherapy to the head and orbit. Diabetic retinopathy is included in the differential diagnosis owing to similar clinical features, including microaneurysms, cotton-wool spots, hard exudates, and macular edema. The only significant pathological difference is that radiation retinopathy spares pericytes, unlike diabetic retinopathy. Multimodal imaging helps diagnose and predict the prognosis of radiation retinopathy, which is presented in this case report.
 Case Presentation: A 55-year-old woman diagnosed with stage-4 metastatic breast carcinoma presented with gradual diminution of vision in the left eye (OS) over 5 months. Vision in the right eye was lost because of orbital radiotherapy for orbital metastasis. The patient underwent multiple sessions of chemotherapy and radiotherapy. Examination of the left eye revealed a best-corrected distance visual acuity (BCDVA) of 20/30. Fundus examination of the OS revealed multiple cotton-wool spots and retinal hemorrhages. Fundus fluorescein angiography (FFA) showed diffuse macular leakage with capillary nonperfusion. Multicolor imaging (MCI) with Spectralis™ revealed black dots in the blue and green reflectance images, corresponding to capillary dilatation on FFA. Darker dots were more evident in the infrared images. BCDVA improved to 20/20 in OS after tapering the dose of oral steroids for 2 months, with improvements in hemorrhages and cotton-wool spots. Focal laser photocoagulation was recommended for the treatment of persistent macular edema. The patient declined further treatment, was lost to follow-up, and passed away 6 months later.
 Conclusions: This case highlights the importance of multimodal imaging for the identification and classification of radiation retinopathy. MCI using SpectralisTM has been described for the first time in radiation retinopathy and can be used to complement existing imaging modalities. Future studies involving more patients and a longer follow-up duration may provide better results for the applicability of these imaging modalities in the clinical setting.
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3

Zamytskiy, E. A., A. V. Zolotarev, E. V. Karlova, N. Yu Il’yasova, and A. S. Shirokanev. "Comparative quantitative assessment of the placement and intensity of laser spots for treating diabetic macular edema." Russian Journal of Clinical Ophthalmology 21, no. 2 (2021): 58–62. http://dx.doi.org/10.32364/2311-7729-2021-21-2-58-62.

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Aim: to compare the uniformity and adequacy of the placement of laser spots after mono-impulse and pattern photocoagulation for diabetic macular edema (DME). Patients and Methods: fundus photographs of 83 patients (121 eyes) taken right after retinal photocoagulation for DME were analyzed. Group 1 included images of 63 eyes after pattern photocoagulation and group 2 included images of 58 eyes after mono-impulse photocoagulation. Laser burns of varying intensity based on LʹEsperance scale (including grade 0 burns that were not seen on fundus photos) were calculated. Grade 2 burns were considered optimal. The number of non-optimal laser burns placed on retinal hemorrhages, blood vessels, hard exudates or healthy retina was calculated. The uniformity of the position of laser spots was assessed by calculating the standard deviation from the average distance between laser spots. Results: the percentage of laser spots of optimal intensity was 31.85% in group 1 and 25.15% in group 2. The percentage of non-optimally placed laser spots was 24.34% in group 1 and 7.99% in group 2. The uniformity of the placement was good in both groups (8.16 pixels and 8.44 pixels, respectively), no significant difference was reported (p=0.0591). Conclusion: pattern photocoagulation is preferable for DME compared to mono-impulse photocoagulation to provide adequate intensity of laser burns. Meanwhile, mono-impulse regimen provides more precise placement of laser spots. However, both conventional techniques are not effective enough due many intrinsic drawback, i.e., many laser spots are non-optimal in terms of intensity or placement. In routine practice, these drawbacks are outweighed by the skills and experience of laser surgeon. Planned precise placement of laser spots and the introduction of techniques of more precise preventive adjustment of energy level for each laser spot will contribute to the maximum effect of photocoagulation for DME. Further studies on personalized precise laser photocoagulation will improve the quality and efficacy of the treatment of macular edema. Keywords: diabetic retinopathy, diabetic macular edema, mono-impulse photocoagulation, pattern photocoagulation, navigated photocoagulation. For citation: Zamytskiy E.A., Zolotarev A.V., Karlova E.V. et al. Comparative quantitative assessment of the placement and intensity of laser spots for treating diabetic macular edema. Russian Journal of Clinical Ophthalmology. 2021;21(2):58–62. DOI: 10.32364/2311-7729- 2021-21-2-58-62.
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4

Kasuya, Yuka, and Shinji Makino. "Hypertensive Chorioretinopathy." Scholars Journal of Medical Case Reports 9, no. 12 (2021): 1137–38. http://dx.doi.org/10.36347/sjmcr.2021.v09i12.005.

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A 54-year-old man was referred to the ophthalmology unit for blurring of vision in both eyes. On ophthalmic examination, his best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.7 in the left eye. Fundoscopy revealed disc swelling, cotton-wool spots, superficial retinal hemorrhages, and macular edema with hard exudates in both eyes. Optical coherence tomography (OCT) showed marked serous retinal detachment, involving the fovea, and cystic change of the inner retinal layer in both eyes. We diagnosed the condition as hypertensive retinopathy with marked serous retinal detachment caused by hypertensive choroidopathy. His blood pressure was 189/116 mmHg. There was no secondary cause of hypertension. Two months after resuming his regular medications, his BCVA improved to 0.6 in the right eye and 1.0 in the left eye, with regression of fundus changes, including serous retinal detachment. In malignant hypertension, both retinopathy and choroidopathy can occur, which can be detected on OCT.
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5

Dammacco, Rosanna, Silvana Guerriero, Giovanni Alessio, and Franco Dammacco. "Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review." International Ophthalmology 42, no. 2 (2021): 689–711. http://dx.doi.org/10.1007/s10792-021-02058-8.

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Abstract Purpose To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the administration of antirheumatic drugs. Methods A systematic literature search was performed using the PubMed, MEDLINE, and EMBASE databases. In addition, a cohort of 489 RA patients who attended the Authors’ departments were examined. Results Keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and anterior uveitis were diagnosed in 29%, 6%, 5%, 2%, and 10%, respectively, of the mentioned cohort. Ocular ADRs to non-steroidal anti-inflammatory drugs are rarely reported and include subconjunctival hemorrhages and hemorrhagic retinopathy. In patients taking indomethacin, whorl-like corneal deposits and pigmentary retinopathy have been observed. Glucocorticoids are frequently responsible for posterior subcapsular cataracts and open-angle glaucoma. Methotrexate, the prototype of disease-modifying antirheumatic drugs (DMARDs), has been associated with the onset of ischemic optic neuropathy, retinal cotton-wool spots, and orbital non-Hodgkin’s lymphoma. Mild cystoid macular edema and punctate keratitis in patients treated with leflunomide have been occasionally reported. The most frequently occurring ADR of hydroxychloroquine is vortex keratopathy, which may progress to “bull’s eye” maculopathy. Patients taking tofacitinib, a synthetic DMARD, more frequently suffer herpes zoster virus (HZV) reactivation, including ophthalmic HZ. Tumor necrosis factor inhibitors have been associated with the paradoxical onset or recurrence of uveitis or sarcoidosis, as well as optic neuritis, demyelinating optic neuropathy, chiasmopathy, and oculomotor palsy. Recurrent episodes of PUK, multiple cotton-wool spots, and retinal hemorrhages have occasionally been reported in patients given tocilizumab, that may also be associated with HZV reactivation, possibly involving the eye. Finally, rituximab, an anti-CD20 monoclonal antibody, has rarely been associated with necrotizing scleritis, macular edema, and visual impairment. Conclusion The level of evidence for most of the drug reactions described herein is restricted to the “likely” or “possible” rather than to the “certain” category. However, the lack of biomarkers indicative of the potential risk of ocular ADRs hinders their prevention and emphasizes the need for an accurate risk vs. benefit assessment of these therapies for each patient.
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6

Noor-ul-huda, Muhammad, Samabia Tehsin, Sairam Ahmed, Fuad A. K. Niazi, and Zeerish Murtaza. "Retinal images benchmark for the detection of diabetic retinopathy and clinically significant macular edema (CSME)." Biomedical Engineering / Biomedizinische Technik 64, no. 3 (2019): 297–307. http://dx.doi.org/10.1515/bmt-2018-0098.

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Abstract Diabetes mellitus is an enduring disease related with significant morbidity and mortality. The main pathogenesis behind this disease is its numerous micro- and macrovascular complications. In developing countries, diabetic retinopathy (DR) is one of the major sources of vision impairment in working age population. DR has been classified into two categories: proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). NPDR is further classified into mild, moderate and severe, while PDR is further classified into early PDR, high risk PDR and advanced diabetic eye disease. DR is a disease caused due to high blood glucose levels which result in vision loss or permanent blindness. High-level advancements in the field of bio-medical image processing have speeded up the automated process of disease diagnoses and analysis. Much research has been conducted and computerized systems have been designed to detect and analyze retinal diseases through image processing. Similarly, a number of algorithms have been designed to detect and grade DR by analyzing different symptoms including microaneurysms, soft exudates, hard exudates, cotton wool spots, fibrotic bands, neovascularization on disc (NVD), neovascularization elsewhere (NVE), hemorrhages and tractional bands. The visual examination of the retina is a vital test to diagnose DR-related complications. However, all the DR computer-aided diagnostic systems require a standard dataset for the estimation of their efficiency, performance and accuracy. This research presents a benchmark for the evaluation of computer-based DR diagnostic systems. The existing DR benchmarks are small in size and do not cover all the DR stages and categories. The dataset contains 1445 high-quality fundus photographs of retinal images, acquired over 2 years from the records of the patients who presented to the Department of Ophthalmology, Holy Family Hospital, Rawalpindi. This benchmark provides an evaluation platform for medical image analysis researchers. Furthermore, it provides evaluation data for all the stages of DR.
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7

Jitendra, Kumar, and Jain and Rashmi Kumari Apurva. "FUNDUS FINDINGS IN PATIENTS OF MILD, MODERATE AND SEVERE DEGREE OF ANAEMIA PRESENTING TO THE TERTIARY HEALTH CARE CENTRE." July 5, 2022. https://doi.org/10.5281/zenodo.6997859.

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<strong>Purpose:</strong>To study fundus findings in patients of mild,moderate, and severe degree of anaemia presenting to the tertiary health care centre. <strong>Methods:</strong>This was a prospective observational study that involved25 patients of anemiacomplaining of blurring of vision, conjunctival pallor, pain, subconjunctival hemorrhage and eyelid swelling. <strong>Results:</strong>There were 20females and 5 males and the age group taken was 20 to 50 years.Out of 25 patients of nutritional anemia, 12 patients belonged to the age group of 20 to 30 years, out of which 10 were females and 2 weremales. 8 patients belonged to age group of 30 to 40 years, out of which 6 were females and 2 were males. 5 patients belonged to the age group of 40 to 50 years, out of which 4 were females and 1 was male.In our study, it was found that 5 patients belonged to the category of severe anemia with hemoglobin [&lt;6 gm/dl], 8 patients belonged to the category of moderate anemia with hemoglobin ranging between 6-10 gm/dl, 12 patients belonged to the category of mild anemia with hemoglobin ranging between 10-12 gm/dl.On looking for various fundus manifestations in different grades of anemia viz.mild, moderate and severe anemia, we found out that the incidence of retinal vascular changes in the form of venous dilation and tortuosity, pale disc, roth spots, macular edema,subhyaloid hemorrhages, dot &Atilde;&cent;&Acirc;&euro;&Acirc;&ldquo; blot and flame shaped hemorrhages showed an increasing trend with increase in severity of anemia. <strong>Conclusion:</strong>There is a high prevalence of anemia in India which affects female gender more than male gender. Anemic retinopathy is not an uncommon condition but it is generally asymptomatic and gets noted incidentally during general workup of the patients. It has variable presentation in different patients with different grades of anemia.
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8

Dutt, Iku, Rakesh Kumar Karak, and Pooja Devi. "Anemic retinopathy in a patient with abdominal tuberculosis: A case report." Journal of Ophthalmic Research and Practice, May 15, 2024, 1–5. http://dx.doi.org/10.25259/jorp_42_2023.

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Retinal hypoxia caused by anemia can be a cause of retinal nerve fiber infarction and increased transmural pressure. This results in superficial and deep hemorrhages, cotton wool spots, retinal edema, Roth spots, and vessel dilatations. Tuberculosis (TB) may cause anemia due to malabsorption, reduced intake, or due to chronic diseased state. Here, we report a patient of abdominal TB with anemic retinopathy, which was improved after taking proper treatment for anemia.
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9

"Radiation Retinopathy: Pathogenesis, Diagnosis, and Treatment." Güncel Retina Dergisi (Current Retina Journal), December 31, 2022, 213–18. http://dx.doi.org/10.37783/crj-0364.

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Radiation retinopathy is chronic retinopathy that usually after radiotherapy with delayed onset (6 months-3 years) and slow progression. The primary vascular event is endothelial cell loss. Clinically affected individuals may be asymptomatic or may describe decreased visual acuity. Combining anamnesis, complete ophthalmologic examination, and multimodal imaging is essential for diagnosis. The ophthalmological examination may reveal signs of retinal vascular disease such as microaneurysms (the first structural change detected ophthalmoscopically), cotton wool spots, retinal hemorrhages, perivascular sheathing, capillary telangiectasia, macular edema, and optic nerve head edema. Optical coherence tomography can detect macular edema, intraretinal hyperreflective spots that may develop secondary to ischemia, disorganization in the inner retinal layers, and deterioration in the outer retina. Fundus fluorescein angiography helps detect capillary perfusion anomalies and other signs of vascular disease. Diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome, hypertensive retinopathy, Coats' disease, and parafoveal telangiectasia should be considered in the differential diagnosis, and sometimes these diseases may accompany radiation retinopathy. Currently, there is still no standard treatment for radiation retinopathy. Anti-vascular endothelial growth factors (anti-VEGF) and steroid therapy are among the effective treatment options. Retinal laser photocoagulation can be applied for neovascular complications. For macular edema, focal laser photocoagulation was less effective than anti-VEGF and steroid therapy in terms of functional gain.
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10

Bulut, Okyanus, Gulcihan Ozek, Filiz Afrashi, and Cumali Degirmenci. "Thrombotic Microangiopathy Following Hematopoietic Stem Cell Transplantation: A Case of Purtscher-like Retinopathy." Ophthalmic Surgery, Lasers and Imaging Retina, August 2024, 1–4. http://dx.doi.org/10.3928/23258160-20240528-05.

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Purtscher-like retinopathy (PLR) is a rare entity related with retinal ischemia due to endothelial dysfunction and embolization. We present a case of a 17-year-old patient who presented with PLR associated with transplant-associated thrombotic microangiopathy. Visual acuity was finger counting at 1 meter in both eyes. Fundoscopy demonstrated peripapillary cotton-wool spots and hypopigmentation in the middle peripheral retina. Both eyes showed signs of macular edema with intraretinal hemorrhages. Optical coherence tomography and fundus fluorescence angiography was performed to support the diagnosis. After systemic treatments and panretinal photocoagulation, the patient's vision improved and the macular edema resolved. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX–XX.]
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11

SINGH, RAJINDER, SURINDER KAUR, JATIN THUKRAL, and HARBIR KAUR. "PREVALENCE AND SPECTRUM OF OPHTHALMIC MANIFESTATIONS OF DENGUE: OUR EXPERIENCE IN A NORTH INDIAN TERTIARY CARE INSTITUTE." Asian Journal of Pharmaceutical and Clinical Research, May 7, 2022, 86–89. http://dx.doi.org/10.22159/ajpcr.2022.v15i5.44592.

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Objective: This article puts forward various ocular findings and its prevalence in hospitalized patients with confirmed Dengue serology. The aim is to spread awareness about these findings and call for complete eye examination in patients of dengue fever so that the ocular findings are not missed. Methods: This is a cross-sectional study, conducted on confirmed cases of 112 dengue patients in Dengue isolation ward in a tertiary care hospital, Government Medical College, Patiala, India, during and after the monsoon season. Results: Various fundus findings in dengue fever seen in our study are Dot blot hemorrhages, cotton wool spots, macular hemorrhages, macular edema, Roth spots, vascular sheathing, hard exudates, and sub-conjunctival hemorrhage. Cumulative prevalence of these findings was 9.82% in hospitalized patients of dengue fever. Blurring of vision was also a common symptom. Conclusion: Ocular findings do occur in dengue fever, along with other systemic manifestations such as fever, headache, myalgia, arthralgia, retro-orbital pain, hemorrhagic fever, and shock syndrome. Ocular examination should be undertaken in all patients with dengue fever so that these findings are not missed. Further studies are needed to ascertain its pathophysiology.
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Yuan, Langxuan, Yuchen Li, Hanze Zhang, Yucen Hou, Qianyan Kang, and Jianqin Lei. "Bilateral purtscher-like retinopathy associated with DRESS syndrome: a case report." Journal of Ophthalmic Inflammation and Infection 14, no. 1 (2024). http://dx.doi.org/10.1186/s12348-024-00433-x.

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Abstract Background To report a case of Bilateral Purtscher-like retinopathy associated with DRESS syndrome managed with ocular and systemic treatments. Case presentation A 29-year-old healthy female developed multi-organ (cutaneous, hematologic, renal and hepatic) disfunction and profound vision loss 1 month after Human papillomavirus vaccine injection. At the first presentation, her visual acuity was counting fingers in both eyes. Fundus exam showed remarkable cotton-wool spots, retinal hemorrhages and macular edema. She was diagnosed DRESS syndrome and Purtscher-like retinopathy and treated with intravitreal injection of ranibizumab, systemic steroids anticoagulants, and plasma exchange. The patient finally recovered from this life-threatening condition but left with permanent visual damage. Conclusion Purtscher-like retinopathy could be complicated by DRESS syndrome which is usually considered a type IV hypersensitivity reaction.
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"Traumatic Maculopathies Associated with Closed-Globe Injury." Güncel Retina Dergisi (Current Retina Journal), October 1, 2022, 235–41. http://dx.doi.org/10.37783/crj-0324.

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Traumatic maculopathies due to closed-globe injury are commotio retinae (Berlin’s edema), choroidal rupture, traumatic macular hole, retinitis sclopetaria, shaken baby syndrome, Valsalva retinopathy, and Purtscher retinopathy. The main pathology in commotio retinae is in the outer retinal layers and usually resolves spontaneously. Blunt eye traumas coming from the anterior aspect can cause choroidal ruptures. These are mainly due to the rupture of inelastic Bruch membrane and adjacent structures. If they involve fovea, visual loss can occur. Late choroidal neovascularisation may develop in 1/10 of the cases. Traumatic macular holes develop in less than 2% of the blunt ocular traumas. Early macular holes result from tangential traction whereas late holes from anteroposterior vitreoretinal traction. They can be closed spontaneously within 4 months, especially in young patients. Retinitis sclopetaria is rare. It results from high-velocity pellets that hit but do not penetrate the globe. Shock waves can cause the rupture of the choroid and overlie the neurosensory retina. The shaken baby syndrome is a result of the violence in the family. It must be reported to the police. Retinal hemorrhages, cotton wool spots, and hemorrhagic retinoschisis areas are the prominent features. The sudden increase in intrathoracic or abdominal pressure may lead to the rupture of the retinal capillaries and usually a sub-internal limiting membrane hemorrhage in Valsalva retinopathy. If it is larger than 3-disc diameters and persists for more than 3 weeks; it may be drained into vitreous with an Nd-YAG laser. Purtscher retinopathy is an occlusive microvasculopathy resulting from severe head trauma or compression injuries of the thorax. Intraretinal hemorrhages, geometric white areas (Purtscher flecken), and cotton wool spots are typical features. Usually fades within 1-2 months. Medicolegal aspects as well as ocular and systemic associations are also important in closed globe injuries and should not be neglected.
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Oh, Angela J., Michael Javaheri, Hamid Hosseini, and Pradeep S. Prasad. "Purtscher-like retinopathy in a 19-year-old with maturity-onset diabetes of the young: a case report." Journal of Medical Case Reports 17, no. 1 (2023). http://dx.doi.org/10.1186/s13256-023-03985-z.

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Abstract Background We report the first case of Purtscher-like retinopathy in a patient with 17q12 deletion-associated maturity-onset diabetes of the young. Case presentation A 19-year-old diabetic Hispanic male with history of cataracts and toe amputations presented with sudden onset of painless bilateral vision loss for 1 week with no associated trauma. Visual acuity was counting fingers at six feet in both eyes. Dilated retinal examination revealed bilateral peripapillary cotton wool spots and intraretinal hemorrhages, and significant subretinal and intraretinal fluid on optical coherence tomography. Fluorescein angiography revealed arteriolar staining and leakage around the disc with areas of capillary nonperfusion, supporting the diagnosis of Purtscher-like retinopathy. Systemic workup revealed multiple diabetic complications including chronic osteomyelitis of multiple toes, nonhealing diabetic foot ulcers, neurogenic bladder and bowel, and bilateral lower-extremity muscular neuropathies. Genetic evaluation revealed a 17q12 deletion, which is associated with maturity-onset diabetes of the young 5. On follow-up examination, he received a single intravitreal antivascular endothelial growth factor injection in the left eye (off label) for persistent macular edema. Although his retinal edema improved, his visual acuity remained poor. Conclusions The presentation of our patient’s multiple diabetic complications along visual symptoms suggests Purtscher-like retinopathy can be a sequela of uncontrolled diabetes. Purtscher-like retinopathy is a rare but possible consideration in diabetic patients who present with acute-onset vision loss.
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Billia, Filippo, Nadia Palmieri, Andrea Maccari, Feliciana Menna, and Andrea Consigli. "Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case." Case Reports in Ophthalmology, August 11, 2023, 348–52. http://dx.doi.org/10.1159/000531663.

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A 13-year-old was admitted to our clinic complaining about a vision loss of over 2 weeks. Bilateral optic disc edema, peripapillary flame-shaped hemorrhages, macular star pattern exudates, and cotton wool spots were found in fundoscopic examination. The OCT exam showed bilaterally serous retinal detachments in sub-foveal region with intraretinal exudates. A pediatric examination found a high systemic hypertension of 230/140 mm Hg, and laboratory tests revealed increased levels of plasmatic and urinary catecholamines. An abdominal MRI showed a left suprarenal pheochromocytoma and the child underwent an adrenalectomy urgently. Informed patient consent was obtained from legal guardians to publish clinical images. Malignant hypertension (MHT) as a result of a pheochromocytoma is an extremely rare condition in childhood. MHT crisis represents a potential life-threatening event and an immediate treatment can prevent a multi-organ failure, including the eyes. An early diagnosis of MHT by fundus examination can lead to a completely favorable ophthalmological evolution and entirely functional recovery.
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