Severe ocular involvement in disseminated intravascular coagulation complicating meningococcaemia.
BACKGROUND
Disseminated intravascular coagulation (DIC) is characterized by inappropriate widespread activation of coagulation leading to extensive microvascular thrombosis and haemorrhage. Ocular involvement typically manifests as fibrin-platelet clots in the choroidal vessels of the posterior pole with overlying serous retinal detachment and sparing of the retinal vessels.


METHODS
Case report.


RESULTS
An 18-year-old female with meningococcal septicaemia and DIC developed bilateral dense vitreous haemorrhage. At vitrectomy multiple areas of sub-internal limiting membrane haemorrhage were evacuated and silicone oil injected. The patient developed bilateral large macular holes with inferior tractional retinal detachment. Two years later, final visual acuity was 6/36 OD and count fingers OS.


CONCLUSIONS
Ocular involvement in DIC can be more extensive than choroidal vascular occlusion alone. Previous reports suggest that DIC associated with sepsis (especially meningococcaemia) may present with more severe manifestations. This may be due to sub-clinical endophthalmitis or haemorrhagic ischemia. Visual prognosis can be poor.
Lewis
Karinya
K
Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK.
Herbert
Edward N
EN
Williamson
Tom H
TH
D000293:Adolescent; D016470:Bacteremia / Q000150:complications*; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008589:Meningococcal Infections / Q000150:complications*; D011379:Prognosis; D012163:Retinal Detachment / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014792:Visual Acuity; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000150:complications* / Q000473:pathology / Q000601:surgery