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Ramzi Alameddine, Ahmad Mansour, Jong Wook Lee, Seung Ah Yahng, Kyu Seop Kim, Maha Shahin, Nelson Hamerschlak, Rubens Belfort Neto, Shree Kurup, ; Ocular Findings In Aplastic Anemia: Multicenter Study and Literature review. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1571.
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Aplastic anemia (AA) is rare disease with few reports on ophthalmic manifestations. Ocular findings are described in a large series along with a literature review
Retrospective case review of cases in one center, The Catholic University of Korea. A literature review is also presented from 1958 to 2010 of cases with aplastic anemia not receiving any surgical therapy with addition of cases from 4 medical centers
Of 719 AA patients collected, 269 patients had eye examination among them 156 patients had funduscopy and 37 patients had retinal findings (retinal hemorrhage) (23.7%). These 37 patients were studied in detail: 7 had unilateral retinal hemorrhage and 30 had bilateral retinal hemorrhage; mean age was 37.5 years (16-69 range) with 25 men and 12 women; mean hemoglobin was 6.6 g/dl(range2.7-12.6 g/dl) and platelet count 18.8 x109/l (range4-157 x109/l); central retinal vein occlusion-like picture occurred in 9 patients and these had similar rheology to rest of subjects; optic disc edema, cotton wool spots, macular edema and dry eyes occurred in 2, 3, 5 and 3 patients respectively. The ocular findings in 200 patients in the literature with aplastic anemia included retinal hemorrhages in 56%, subhyaloid or vitreous hemorrhage in 9%, peripheral retinal vasculopathy in 5.5%, cotton-wool spots, Sjögren’s syndrome, or optic disc edema in 4% each. Prevalence of retinopathy among series of aplastic anemic patients varied from 20% to 28.3%. Retinopathy was observed in 69% of patients with concomitant severe anemia (hemoglobin level below 8 g/100ml) and severe thrombocytopenia (platelet count below 50,000/mm3)
Retinal hemorrhage is the commonest ocular finding as it occurs in 23.7% of AA patients in the current series. Central retinal vein occlusion-like picture is the second most frequent finding occurring in 4.5% of AA patients and its occurrence is not related to a more severe rheology. The presence of ocular findings relates to the severity of anemia and the concomitance with thrombocytopenia
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