Anterior Chamber Fluorescein Leakage in a Child with Intraocular Pressure Elevation and Vitreous Hemorrhage

Overview

Journal Am J Ophthalmol Case Rep

Specialty Ophthalmology

Date 2023 Oct 9

PMID 37808082

Authors

Natan Hekmatjah

Azam Qureshi

Armin Afshar

Julius T Oatts

Affiliations

Soon will be listed here.

Abstract

Purpose: To report a case of a child with neovascular and ghost cell glaucoma in the setting of previously treated vitreous hemorrhage with unique fluorescein leakage from abnormal iris vessels ultimately preventing successful fluorescein angiography.

Observations: A 3-year-9-month-old female with a medical history of very high-risk B-cell acute lymphoblastic leukemia presented with eye pain and was noted to have a complete vitreous hemorrhage and intraocular pressure elevation in the right eye which was refractory to maximum medical therapy and vitrectomy. Following vitreous hemorrhage resolution, an examination under anesthesia with fluorescein angiography was found to have diffuse leakage of fluorescein into the anterior chamber, presumably due to the active iris neovascularization. This anterior chamber fluorescein signal prevented visualization of the retinal vasculature. The patient was diagnosed with mixed mechanism glaucoma (neovascular and ghost cell) due to a resolved vitreous hemorrhage in the setting of a presumed prior ischemic event.

Conclusions And Importance: We report a case of an unsuccessful fluorescein angiogram in the setting of anterior chamber fluorescein leakage due to active iris neovascularization, and review considerations for the differential diagnosis and useful diagnostic tests in this clinical scenario.

References

Lindgren G, Lindblom B . Causes of vitreous hemorrhage. Curr Opin Ophthalmol. 1996; 7(3):13-9. DOI: 10.1097/00055735-199606000-00003. View

Shazly T, Latina M . Neovascular glaucoma: etiology, diagnosis and prognosis. Semin Ophthalmol. 2009; 24(2):113-21. DOI: 10.1080/08820530902800801. View

Spirn M, Lynn M, Hubbard 3rd G . Vitreous hemorrhage in children. Ophthalmology. 2006; 113(5):848-52. DOI: 10.1016/j.ophtha.2005.12.027. View

Razeghinejad R, Lin M, Lee D, Katz L, Myers J . Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol. 2020; 65(5):530-547. DOI: 10.1016/j.survophthal.2020.02.003. View

Balubaid M, Alqahtani A . A Case of Acute Promyelocytic Leukemia With Retinal Hemorrhages Beneath Internal Limiting Membrane During Clinical Remission. Cureus. 2021; 13(2):e13387. PMC: 7975131. DOI: 10.7759/cureus.13387. View

Rishi P, Rishi E, Gupta A, Swaminathan M, Chhablani J . Vitreous hemorrhage in children and adolescents in India. J AAPOS. 2013; 17(1):64-9. DOI: 10.1016/j.jaapos.2012.10.013. View

Satoh K, Takaku Y, Ohtsuki K, Mizuno K . Effects of aging on fluorescein leakage in the iris and angle in normal subjects. Jpn J Ophthalmol. 1999; 43(3):166-70. DOI: 10.1016/s0021-5155(99)00012-x. View

Rodrigues G, Abe R, Zangalli C, Sodre S, Donini F, Costa D . Neovascular glaucoma: a review. Int J Retina Vitreous. 2016; 2:26. PMC: 5116372. DOI: 10.1186/s40942-016-0051-x. View

Kudo T, Suzuki Y, Metoki T, Nakazawa M . A case of childhood vitrectomy performed for dense vitreous hemorrhage secondary to leukemia therapy and tumor lysis syndrome. Case Rep Ophthalmol. 2015; 6(1):34-8. PMC: 4327334. DOI: 10.1159/000374088. View

10.

Hayreh S . Neovascular glaucoma. Prog Retin Eye Res. 2007; 26(5):470-85. PMC: 2871536. DOI: 10.1016/j.preteyeres.2007.06.001. View

11.

Hamad A, Moinuddin O, Blair M, Schechet S, Shapiro M, Quiram P . Late-Onset Retinal Findings and Complications in Untreated Retinopathy of Prematurity. Ophthalmol Retina. 2020; 4(6):602-612. PMC: 7282927. DOI: 10.1016/j.oret.2019.12.015. View

12.

Dumbraveanu L, Cusnir V, Bobescu D . A review of neovascular glaucoma. Etiopathogenesis and treatment. Rom J Ophthalmol. 2022; 65(4):315-329. PMC: 8764420. DOI: 10.22336/rjo.2021.66. View

13.

Naik A, Rishi E, Rishi P . Pediatric vitreous hemorrhage: A narrative review. Indian J Ophthalmol. 2019; 67(6):732-739. PMC: 6552577. DOI: 10.4103/ijo.IJO_688_18. View

14.

Dattilo M, Newman N, Biousse V . Acute retinal arterial ischemia. Ann Eye Sci. 2018; 3. PMC: 6124502. DOI: 10.21037/aes.2018.05.04. View

15.

Nieves-Moreno M, Peralta J, Noval S . Neovascular Glaucoma in Children: A case series and a review of the literature. Eur J Ophthalmol. 2022; 32(6):3289-3294. DOI: 10.1177/11206721221078678. View

16.

Kwok A, So A, Lam S, Ng J, Fok T, Lam D . Can vitreous haemorrhage indicate non-accidental injury if mild retinopathy of prematurity is present?. Eye (Lond). 2000; 14 Pt 5:812-3. DOI: 10.1038/eye.2000.224. View

17.

Peddada K, Weiss S, Kumar S, Malik D . Retinal and Preretinal Hemorrhages in a Patient Receiving Hyper-CVAD Chemotherapy for T-Cell Acute Lymphoblastic Leukemia. Case Rep Ophthalmol Med. 2019; 2018:9457549. PMC: 6304476. DOI: 10.1155/2018/9457549. View

18.

Calvo C, Hartnett M . The utility of ultra-widefield fluorescein angiography in pediatric retinal diseases. Int J Retina Vitreous. 2018; 4:21. PMC: 5987662. DOI: 10.1186/s40942-018-0122-2. View

19.

Simon J, Sood S, Yoon M, Kaw P, Zobal-Ratner J, Archer S . Vitrectomy for dense vitreous hemorrhage in infancy. J Pediatr Ophthalmol Strabismus. 2005; 42(1):18-22. DOI: 10.3928/01913913-20050101-02. View

20.

Awuah A, Asiedu K, Adanusa M, Ntodie M, Acquah E, Kyei S . A case of leukemic retinopathy mimicking common ischemic retinopathies. Clin Case Rep. 2016; 4(2):133-7. PMC: 4736509. DOI: 10.1002/ccr3.457. View