Nitza Goldenberg-Cohen

Role of transesophageal echocardiography in the evaluation of patients with retinal artery occlusion

OBJECTIVEnTo evaluate the role of transesophageal echocardiography (TEE) in detecting cardiac and thoracic aortic sources of retinal emboli.nnnDESIGNnRetrospective observational case series.nnnPARTICIPANTSnThe study population consisted of 18 patients who were initially seen with retinal artery occlusion (7 central, 11 branch) and underwent TEE as part of the systemic evaluation.nnnINTERVENTIONnAll patients underwent TEE, consisting of complete two-dimensional and Doppler color flow examinations. TEE was done immediately after transthoracic echo (TTE) examination. The medical records were reviewed.nnnMAIN OUTCOME MEASUREnDetection of a possible cardiac or thoracic aortic source of retinal embolus.nnnRESULTSnCardiac or thoracic aortic pathologic conditions, which were a possible source of the retinal emboli, were detected by TEE in 13 of the 18 patients (72%). They included aortic arch atheroma (n = 7), mitral annulus calcification (n = 4), left atrial appendage thrombus (n = 2), valvular abnormalities (n = 5), left atrial smoke (n = 3), and patent foramen ovale (n = 3). In 11 patients (61%), at least one cardiac or aortic source of emboli detected by TEE was missed by TTE. Significant carotid artery disease (>or=40% stenosis) was present in 3 of 16 patients (17%).nnnCONCLUSIONSnTEE is a potentially useful modality for detecting possible sources of retinal artery emboli and may be considered as an adjunct to the routine evaluation of affected patients.

Inflammatory reaction in acute retinal artery occlusion: cytokine levels in aqueous humor and serum.

Purpose: To investigate the role of inflammation in acute retinal artery occlusion (RAO). Methods: Levels of interleukin (IL)-6, IL-8, and tumor necrosis factor alpha (TNF-α) were measured in serum (n = 14) and aqueous humor (AqH) (n = 8) samples from patients with RAO. Findings were compared with 24 age- and disease-matched patients, 10 healthy subjects (serum), and 16 patients undergoing cataract surgery (AqH). Results: Patients who arrived early (within 4–6 hours of occlusion) had higher serum IL-8 and IL-6 levels than controls; the IL-6 level in the AqH was lower than that of controls, while the IL-8 level was higher. In seven patients for whom both serum and AqH samples were available, serum IL-6 levels were higher than their corresponding AqH levels in most patients arriving within 10 hours of occlusion, and AqH IL-8 levels were higher than the corresponding serum levels in all but one. TNF-α levels were consistently higher in the serum than in the AqH at all time points. Conclusions: Serum IL-8 and IL-6 and AqH IL-8 are elevated immediately following acute RAO. The early local suppression of IL-6 may be related to ocular immune mechanisms.

Intralesional and sub-Tenon's infusion of corticosteroids for treatment of refractory periorbital and orbital capillary haemangioma

PurposeTo evaluate the effect of combined intralesional and sub-Tenons administration of corticosteroids for the treatment of refractory periocular and orbital capillary haemangioma in a retrospective, non-comparative study.MethodsSeven infants with resistant periorbital and orbital capillary haemangioma who attended our tertiary centre from 2000 to 2005 were treated with an intralesional injection of a mixture of betamethasone 6u2009mg/cc and triamcinolone 10u2009mg/cc, by body weight, together with sub-Tenons infusion of betamethasone 6u2009mg/cc and triamcinolone 40u2009mg/cc of a volume of 1u2009cc, close to the orbital lesion, in the same session. Visual axis, proptosis, pre- and post-treatment changes in four refractive parameters, and parental satisfaction were evaluated.ResultsNone of the babies had proptosis or visual axis obstruction after treatment. Mean spherical power decreased by 22.7% (P=0.06). Mean spherical equivalent decreased in 34%, but the difference was not statistically significant (P=0.09). No early or late ocular side effects were observed. Mean intraocular pressure results were normal before and immediately after treatment, and during the follow-up period. Parental satisfaction score during follow-up was 9/10. Mean time to improvement was 96.43±58.3 days.ConclusionsCombined local corticosteroid administration by posterior sub-Tenon’s infusion and intralesional injection in babies with extensive capillary haemangioma is associated with a satisfactory anatomical and functional outcome and there were no ophthalmic side effects.

C-reactive protein levels do not correlate with retinal artery occlusion but with atherosclerosis

PurposeTo determine C-reactive protein (CRP) levels in acute retinal artery occlusion (RAO) and their association with atherosclerotic risk factors.MethodsCRP levels in 16 patients with RAO were compared with levels in 16 age-matched controls at risk of atherosclerosis and 16 young volunteers. Repeated CRP testing was performed 6 years later.ResultsElevated CRP levels (>3u2009mg/l) and risk factors for atherosclerosis were detected in seven patients in the study group (44%) and nine at-risk controls (56%). On follow-up, CRP levels were reduced in all seven retested patients. Six patients died of vascular events within 5 years, of whom four had high CRP levels during RAO.ConclusionsCRP level correlates with atherosclerosis but it is not significantly elevated in patients with RAO.