Seeing through thick and through thin: Retinal manifestations of thrombophilic and hyperviscosity syndromes

Rajagopal, Rithwick; Apte, Rajendra S.

doi:10.1016/j.survophthal.2015.10.006

Cited by 34 publications

(19 citation statements)

References 74 publications

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“…An interesting feature of this case is the development of HVS, which typically manifests with mucosal bleeding, blurred vision, and headache. 10 HVS can be diagnosed on retinal examination with findings of venous tortuosity, dilatation, and intraretinal hemorrhage, as occurred in this case, 11 and is confirmed with serum viscosity measurement. The first evidence of HVS in this case might have been the spontaneous echo contrast, or "smoke," detected on echocardiogram.…”

Section: Discussionsupporting

confidence: 74%

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Fleming

Sena

Manesh

et al. 2017

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. This icon represents the patient's case. Each paragraph that follows represents the discussant's thoughts.

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Section: Discussionsupporting

confidence: 74%

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Fleming

Sena

Manesh

et al. 2017

Journal of Hospital Medicine

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“…The appearance of the fundus in especially untreated or newly diagnosed MPN patients is venous dilation and tortuosity, haemorrhages, cotton wool spots and occasionally Roth spots. These changes often disappear after treatment [14,16,18,19,28,31,[33][34][35][36][37][38][39][40][41][42][43], but most of the literature on the subject consists of case stories. A study by Carraro et al investigated retinopathy and associated fundus lesions in haematological disorders with anaemia and thrombocytopenia [18].…”

Section: Retina and Choroidmentioning

confidence: 99%

“…Retinal vascular occlusions in MPNs are the result of acquired defects in the blood components and hyperviscosity, as mentioned earlier, causing microvascular disturbances and disruption of the coagulation cascade. Hyperviscosity occurs from either elevation of the cellular or acellular (protein) elements of the blood [6,36,49,[63][64][65]. The ophthalmologist must be aware of suspicious ocular thrombotic events, where the patient lacks the typical predispositions for vascular occlusions, such as increasing age, hypertension, diabetes mellitus, smoking and glaucoma.…”

Section: Vaso-occlusions Haemorrhages and Microangiopathymentioning

confidence: 99%

Ocular Manifestations in Patients with Philadelphia-Negative Myeloproliferative Neoplasms

Liisborg

Hasselbalch

Sørensen

2020

Cancers

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The major complications of Philadelphia-negative (Ph-Negative) myeloproliferative neoplasms (MPNs) are thrombosis, haemorrhage and leukemic transformation. As systemic and haematological diseases, MPNs have the potential to affect many tissues and organs. Some complications lead to the diagnosis of MPNs, but other signs and symptoms are often misdiagnosed or neglected as a sign of MPN disease. Therefore, we reviewed the current literature to investigate and delineate the clinical manifestations seen in the eyes of Ph-negative MPN patients. We found that ocular manifestations are common among patients with MPNs. The most frequently described manifestations are due to the consequences of haematological abnormalities causing microvascular disturbances and hyperviscosity. More serious and vision-threatening complications as thrombotic events in the eyes have been repeatedly reported as well. These ocular symptoms may precede more serious extraocular complications. Accordingly, combined ophthalmological and haematological management have the potential to discover these diseases earlier and prevent morbidity and mortality in these patients. Furthermore, routine ophthalmological screening of all newly diagnosed MPN patients may be a preventive approach for early diagnosis and timely treatment of the ocular manifestations.

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“…Other ocular alterations are hemorrhagic and exsudative findings and retinal vein oclusions. 2,4,7 After the diagnosis prompt therapy of HVS can prevent lifethreatening complications. Supportive treatment is based in intravenous fluids to prevent volume depletion.…”

Section: Discussionmentioning

confidence: 99%

Hyperviscosity syndrome - a case report

Costa¹,

Almeida²,

Batista³

et al. 2019

IJFCM

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Hyperviscosity syndrome (HVS) is a life-threatening complication. The clinical manifestations include a variety of symptoms like visual symptoms, altered mental status, stroke or congestive heart failure. Prompt treatment is needed to avoid progression to multisystem organ failure. We report a case of a 73-year-old man with a 3-months history of headaches and altered mental status. His neurological exam showed symmetrical decreased pain, thermal and tactile sensitivity in the upper and lower limbs and symmetrical decreased muscle strength in the lower limbs. His eye exam showed retinal hemorrhages and dilated retinal veins. His blood counts showed anemia, increased C-reactive protein, sedimentation rate and serum viscosity. He had an elevated immunoglobulin M and serum immunofixation revealed Ig M-kappa paraprotein. The bone marrow aspiration and biopsy revealed a Waldenström Macroglobulinemia. He was diagnosed with HVS and was treated with plasmapheresis, chemotherapy and fluids.HVS diagnosis requires a high degree of clinical suspicion, andclinicians should be aware of suggestive clinical and laboratory findings.

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Seeing through thick and through thin: Retinal manifestations of thrombophilic and hyperviscosity syndromes

Cited by 34 publications

References 74 publications

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Ocular Manifestations in Patients with Philadelphia-Negative Myeloproliferative Neoplasms

Hyperviscosity syndrome - a case report

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