[Ocular pathology of child abuse]

Akutes Winkelblockglaukom nach massiver intraokularer Blutung bei exsudativer altersbedingter Makuladegeneration unter gerinnungshemmender Therapie

BACKGROUND

Acute secondary angle closure glaucoma after massive vitreous and subretinal hemorrhage from exudative age related macular degeneration is a seldom, but devastating complication of an anticoagulative therapy.

PATIENTS

Four patients (age range 70-76 years) developed unilateral acute angle closure glaucoma after massive intraocular bleeding due to exudative age-related macular degeneration and anticoagulative therapy. Three patients received Phenprocomoun and one patient thrombolytic therapy with heparin. One eye had led to blindness at initial investigation. Pars plana vitrectomy was performed in the remaining three eyes. Within a few months, 2 of these 3 eyes were blind, one eye had light perception and all three eyes developed hypotonia.

CONCLUSION

Acute angle closure glaucoma after intraocular bleeding may be the initial clinical manifestation of overtreatment with anticoagulants. Early pars plana vitrectomy probably will increase the surveillance rate of the eye but not the visual prognosis.

X-linked retinoschisis: A clinical and molecular genetic review

X-linked retinoschisis is a leading cause of macular degeneration in male children. It is characterized by a high degree of clinical variability. Clinical features include a stellate foveal retinoschisis, with or without peripheral retinoschisis. The schisis occurs within the inner retina, primarily at the level of the nerve fiber layer. The disease-causing gene, X-linked retinoschisis 1, has recently been identified, and is expressed in photoreceptor and bipolar cells. This gene codes for retinoschisin, a secreted protein containing a discoidin domain which may be involved in cellular adhesion or cell-cell interactions. The identification of this gene allows for improved diagnosis and contributes to the understanding of this condition. Visual prognosis is variable, as X-linked retinoschisis exhibits a high degree of phenotypic variability. Although there is no treatment to halt the progressive maculopathy, clinical management is directed toward treatment of amblyopia and surgical correction of certain complications. X-linked retinoschisis is an important condition to study, both to improve the clinical management of this disorder, and to better understand retinal function and development. Herein, we review the clinical, histopathologic, and molecular genetic and treatment options of X-linked retinoschisis.

Bilateral periopticointrascleral hemorrhages associated with traumatic child abuse

PURPOSE

To report a case of bilateral periopticoscleral hemorrhages associated with traumatic child abuse.

METHODS

Postmortem gross examination and histopathologic studies of both eyes and the optic nerves of a 6-month-old infant who died from subdural hematoma.

RESULTS

Gross examination and histopathologic step sections disclosed bilateral intrascleral hemorrhages around both optic nerves. In addition, bilateral diffuse multilayered retinal, vitreous, and sublaminar (beneath the internal limiting membrane) hemorrhages were present.

CONCLUSION

Periopticointrascleral hemorrhages are characteristic of blunt head trauma and may constitute important forensic evidence in cases of suspected child abuse.