Atlas of Ophthalmology

Bilateral Roth Spots in Subacute Bacterial Endocarditis (Colour Photography, OD & OS)

Retina -> Diseases of Hematopoesis (see under Systemic Diseases)
Patient: 48 years of age, male, BCVA 0.4 at OD, 0.9 at OS; IOP 13/11 mmHg Ocular Medical History: deterioration of visual acuity in last 5 days at both eyes. General Medical History: since 2 weeks fever, 5 years ago surgery at heart valves; CRP 62,3 mg/l, leucocytes 12000/μl, Hb 14,8 g/dl, thrombocytes 276000/μl, blood culture ++ coagulase negativ staphylococcus. Main Complaints: dark spots in central visual field Methods: Colour Photography. Findings: Colour Photography: multiple white-centred retinal haemorrhages scattered in the posterior poles of both eyes Discussion: Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. More recent histological evidence suggests, that they are not foci of bacterial abscess. They are nonspecific and may be found in many other diseases. A variety of insults can result in retinal capillary rupture. It was suggested by (1) and others, that in subacute bacterial endocarditis a low grade disseminated intravascular coagulopathy predisposes to capillary bleeding in the retinal vasculature. White-centred haemorrhage results from the rupture of retinal capillaries and the extrusion of whole blood. Subsequent platelet adhesion to damaged endothelium and the platelet release reaction initiates the coagulation cascade, that results in the formation of a platelet-fibrin thrombus. Morphologically, this fibrin thrombus appears as a pale white lesion in the centre of the haemorrhage. White-centred haemorrhages are observed, can be subclassified according to common underlying mechanisms resulting in capillary rupture. Literature: Ling R, James B : White-centred retinal haemorrhages (Roth spots). Postgrad Med J. 1998 Oct;74(876):581-2.

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