Complete resorption of retinal hemorrhages in idiopathic thrombocytopenic purpura.
OBJECTIVE
Idiopathic thrombocytopenic purpura (ITP) is characterized by refractory thrombocytopenia, production of autoantibodies, and persistent predisposition to bleeding affecting virtually all mucocutaneous tissues and various organs.


METHODS
A 50-year-old man with chronic ITP and diabetic maculopathy developed massive preretinal, intraretinal, and numerous subretinal hemorrhages accompanied by impaired vision to 20/400. His platelet count was 1100/microL, hemoglobin concentration was 4.6 mg/dL, however his blood clotting and activated partial thromboplastin time (APTT) maintained a normal 26 sec.


RESULTS
After a splenectomy the patient was placed on high-dose oral corticosteroids (40 mg/day), immunoglobulin, and CellCept. The platelet count was restored to 25,000/microL within months. Four months later the unaffected retina received a panretinal photocoagulation and intravitreal triamcinolone injection (25 mg). Two years after the thrombolytic event the hemorrhages resolved completely and the patient's vision recovered to 20/100.


CONCLUSIONS
Repetitive treatments with immunoglobulins and high-dose corticosteroids may increase the platelet count, inducing a complete resorption of the retinal hemorrhages and visual recovery during a long-term follow-up.
Meyer
C H
CH
Department of Ophthalmology, University of Bonn, Bonn, Germany. meyer_eye@yahoo.com
Callizo
J
J
Mennel
S
S
Schmidt
J C
JC
D002908:Chronic Disease; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005938:Glucocorticoids / Q000008:administration & dosage; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013156:Splenectomy; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
D005938:Glucocorticoids; D006454:Hemoglobins; D014222:Triamcinolone Acetonide