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Diabetic Retinopathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Prior to proliferative retinopathy, macular edema or ischemia begins to cause visual problems. Sometimes, there is no vision loss even if retinopathy becomes advanced. Initial signs of nonproliferative retinopathy include capillary microaneurysms, soft exudates known as cotton-wool spots, dot-and-blot hemorrhages of the retina, and hard exudates. Hard exudates suggest that chronic edema is present. Cotton-wool spots are microinfarctions of the retinal nerve fiber layer that result in opacification of the retina. They have fuzzy edges, a white color, and they obscure the blood vessels lying below them. In later states, signs include macular edema, intraretinal microvascular abnormalities, and venous dilation. Macular edema can be seen during slit-lamp biomicroscopy. It appears as elevations and blurring of the retinal layers.
Wavy Lines, Distorted Vision and Blur
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Macular oedema: Causes retinal thickening and loss of foveal reflex. You may also see cystoid appearance in the macula if there is significant cystic macular oedema (see Figure 13.2). If the patient is diabetic, changes are more likely to be bilateral and may be associated with microaneurysms and exudations. In vein occlusions, there is accompanying dilatation and tortuosity of the venous circulation with a mixture of flame-shaped dot/blot haemorrhages. Cotton wool spots may also be present, or the patient may have undergone recent cataract surgery.
How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
Systemic lupus erythematosus is a systemic collagen vascular disease. The underlying pathogenesis is caused by autoimmune necrotising vasculitis. The majority of patients are female and of child-bearing age. Diagnosis is made clinically by the presence of specific signs. Superficial punctate keratitis is the most common sign in the cornea. Cotton wool spots are characteristic of SLE retinopathy. Proliferative retinopathy can occur but is uncommon. The main cause of death is renal failure.
Retinopathy and Systemic Disease Morbidity in Severe COVID-19
Published in Ocular Immunology and Inflammation, 2021
Jessica G. Shantha, Sara C Auld, Casey Anthony, Laura Ward, Max W. Adelman, Cheryl L. Maier, Kenneth W. Price, Jesse T Jacob, Tolulope Fashina, Casey Randleman, Lucy T. Xu, Joshua Barnett, Ofer Sadan, Prem A. Kandiah, Jay B. Varkey, Colleen S. Kraft, Nadine Rouphael, Susanne Linderman, Rafi Ahmed, Carolyn Drews-Botsch, Jesse J. Waggoner, Max Weinmann, David J. Murphy, Steven Yeh
While there is limited insight into the mechanisms underlying retinopathy in COVID-19, one recent study of recovered COVID-19 patients showed a reduction in the retinal capillary density of the foveal region of the retina compared to healthy normal controls, suggesting a prior ischemic or inflammatory insult.26 In the context of recent COVID-19, these findings could represent sequelae from transient, undetected retinopathy during the acute phase of COVID-19. Similarly, cotton wool spots may arise from a variety of factors including ischemia due to hypoperfusion or thrombotic occlusion.27 Complement-mediated mechanisms may also contribute to cotton wool spot formation.28 While complement levels were not routinely measured in this hospitalized cohort, prominent complement activation has been implicated in severe COVID-19,29 as has cross-talk between complement, inflammation, and coagulation pathways.29 Thus, the high rate of retinopathy in our patients may be related to their markedly elevated CRP and D-dimer levels, with resultant endothelial damage and microthrombi.
An evidence‐based approach to the routine use of optical coherence tomography
Published in Clinical and Experimental Optometry, 2019
Angelica Ly, Jack Phu, Paula Katalinic, Michael Kalloniatis
Structural OCT has limited value in evaluating signs of severe non‐proliferative DR such as venous calibre abnormalities and intra‐retinal microvascular abnormalities; however, OCT may assist in the differential diagnosis of cotton wool spots, seen as a hyper‐reflective thickening of the retinal nerve fibre layer, as well as in confirming the presence of neovascularisation and determining the location of vitreous and pre‐retinal haemorrhage.2015 Using OCT, neovascularisation may appear as pre‐retinal hyper‐reflective material on the retinal surface or proliferating along the posterior vitreous interface. Vitreous haemorrhage can be seen as hyper‐reflective dots within the vitreous cavity and pre‐retinal (or sub‐hyaloid) haemorrhage may present as an area of hyper‐reflectivity trapped between the internal limiting membrane of the retina and the posterior vitreous interface.2017
Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers
Published in Ocular Immunology and Inflammation, 2018
Rosanna Dammacco, Pasquale Procaccio, Vito Racanelli, Angelo Vacca, Franco Dammacco
As stated above, ocular findings may sometimes represent the initial manifestations of SLE that need to be promptly recognized to prevent sight-threatening complications. Their severity usually reflects overall disease activity. In one patient, Purtscher-like retinopathy was diagnosed, and it seems appropriate to emphasize how it is different from SLE retinopathy. In patients with Purtscher-like retinopathy, intravenous FFA shows arteriolar occlusion and areas of capillary leakage in the macula. The key ophthalmological findings are multiple areas of retinal whitening between retinal arterioles and venules (Purtscher flecken) and cotton wool spots. Less frequent findings include optic disc swelling, retinal hemorrhages, pseudo-cherry-red spots, and macular edema. Its pathogenesis is commonly ascribed to microembolization, resulting in arteriolar precapillary occlusion and microvascular infarcts. SLE retinopathy, however, shows on ophthalmological examination and FFA sheathed or tortuous retinal vessels; retinal vascular attenuation; cotton wool spots; hemorrhages; edema of the papilla; and less frequently retinal detachment, optic atrophy, and hard exudates. The pathogenesis of SLE retinopathy has been ascribed to vasculitis of the retinal capillaries and arterioles.13