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The purpose of this manuscript is to report a rare case of pediatric central retinal artery occlusion (CRAO) in the setting of atypical hypercoagulable tests. An 11-year-old female presented to the emergency department with painless, visual changes in the left eye. Ophthalmological examination was remarkable for a central area of retinal ischemia and edema with sparing along the distribution of the cilioretinal artery along with a cherry red spot, all of which were consistent with a CRAO. Neuroimaging and infectious disease work-up were unremarkable. Hematological labs demonstrated elevated lipoprotein (a) and factor VIII activity levels. CRAOs generally occur in the adult population in the setting of cardiovascular risk factors and are uncommon in the pediatric age group. In such a demographic, additional investigation including hypercoagulable work-up is warranted. Elevated lipoprotein (a) is thought to be an independent risk factor for atherosclerosis while factor VIII levels can correlate with thromboemboli in the venous vasculature. Becoming aware of such risk factors can help guide the clinician with the diagnostic approach and management when presented with a similar pediatric case., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yi et al.)

Purpose: To determine the prevalence of cytomegalovirus retinitis after cardiac transplantation., Methods: Records of patients who had cardiac transplantation at Jackson Memorial Hospital between November 1986 and November 1994 were reviewed. Patients who had not previously had ophthalmic evaluation after transplantation were invited for retinal examination., Results: Eighty-two patients had cardiac transplantation during the study period. One to 68 months (mean, 24.5 months) after transplantation, ophthalmoscopic examination was performed in 41 patients. Six (14.6%) of 41 patients had healed scars consistent with cytomegalovirus retinitis or active cytomegalovirus retinitis., Conclusions: Cytomegalovirus retinitis lesions were found in six (14.6%) of 41 patients. If remaining patients were unaffected and no patient developed cytomegalovirus retinitis after ophthalmoscopic examination, the prevalence would be 7.3% (6/82). We recommend ophthalmic screening of all patients 3 to 4 months after cardiac transplantation with repeat examinations yearly or as ocular symptoms occur.

Objective: To develop a protocol for the treatment of intraocular lymphoma by the intravitreal injection of methotrexate., Methods: Patients whose results were negative for human immunodeficiency virus and who had pathologically confirmed intraocular lymphoma were eligible for participation in the study. A dose of 400 micrograms of methotrexate was given intravitreally twice weekly until the vitreous was clinically cleared of cells. Weekly injections were then given for 1 month, followed by monthly injections for 1 year., Results: Seven eyes of 4 patients were treated. Three patients have completed the protocol. To date, only 1 eye has suffered a significant loss of vision. No serious ocular toxic reaction has been identified., Conclusions: Survival rates and time to relapse for patients with primary central nervous system lymphoma have improved. The role of ocular radiation therapy must be weighed against the potential drawbacks. Injecting chemotherapeutic agents into the vitreous is worthy of consideration. Four patients treated to date at our institution have had promising results. Intravitreal chemotherapy may result in improved treatment of intraocular lymphoma with reduced morbidity.

Purpose: To document that lacunar, atrophic lesions of the retinal pigment epithelium, previously reported as a complication of treatment, can result from the natural course of retinopathy of prematurity., Methods: We reviewed photographs of patients diagnosed with retinopathy of prematurity at the Casey Eye Institute between 1979 and 1996. Lacunar atrophic lesions of the retinal pigment epithelium were correlated with the clinical records of the affected patients., Result: Three untreated eyes of three patients with retinopathy of prematurity had lacunar atrophic lesions of the retinal pigment epithelium., Conclusions: The spectrum of findings associated with untreated retinopathy of prematurity includes lacunar, atrophic lesions of the retinal pigment epithelium. These lesions are distinct from scars secondary to treatment and are possibly linked to macular dragging and exudative or serous retinal detachment.

Objective: The purpose of this study was to investigate the effects of labetalol on uterine blood flow and cardiovascular parameters in acutely instrumented, hypertensive gravid baboons., Study Design: During the latter half of pregnancy six gravid baboons were acutely instrumented, with ultrasonic flow probes placed on ipsilateral, external iliac, and uterine arteries and a flow-directed pulmonary artery catheter in the pulmonary artery. After a stable arterial pressure baseline was obtained, norepinephrine was infused to increase mean arterial pressure by at least 20%. A 20-minute hypertensive steady state was obtained. Labetalol at 0.5 and 1.0 mg/kg was randomly infused, followed by a 2.0 mg/kg dose, each over 1 minute. A 20-minute recovery period followed every labetalol infusion, allowing the hypertensive steady state to reestablish. External iliac and uterine blood flow measurements were continuously recorded during the baseline and experimental trials. Mean arterial blood pressure, heart rate, pulmonary artery and capillary wedge pressure, central venous pressure, and cardiac output were obtained at 5, 10, and 15 minutes during each steady state and after each labetalol infusion., Results: Labetalol at all dosages significantly reduced the mean arterial pressure and the systemic vascular resistance at 1.0 and 2.0 mg/kg. External iliac blood flow was not consistently significantly reduced; however, uterine blood flow was significantly reduced after the 1.0 and 2.0 mg/kg labetalol dosages (p < 0.05). Although uterine vascular resistance tended to increase after the 1.0 and 2.0 mg/kg doses, statistical significance was not achieved., Conclusion: Low-dose labetalol (0.5 mg/kg) significantly reduces the pharmacologic hypertensive gravid baboon's mean arterial blood pressure without adversely affecting uterine blood flow.