{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T01:46:42Z","timestamp":1770515202843,"version":"3.49.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"39","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Rationale:<\/jats:title>\n            <jats:p>To report a rare case of severe atypical hemolytic-uremic syndrome (HUS) in a patient who presented with vitreous hemorrhage and tractional retinal detachment (TRD) in both eyes. To our knowledge, this is the first reported case of atypical HUS complicated with bilateral TRD in the literature.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient concerns:<\/jats:title>\n            <jats:p>A 20-year-old man with atypical HUS demonstrated bilateral visual acuity of hand motion at 30\u200acm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Diagnoses:<\/jats:title>\n            <jats:p>Dilated fundus examination revealed diffuse intraretinal hemorrhage with vascular engorgement, neovascularization of the disc, and neovascularization elsewhere bilaterally. Fluorescein angiography revealed bilateral proliferative retinopathy, retinal hemorrhage, and a large nonperfusion area with extensive neovascularization. Intravitreal antivascular endothelial growth factor (ranibizumab) injection was administered in both eyes, but his ophthalmic condition did not improve, and TRD developed bilaterally. Therefore atypical HUS complicated with bilateral TRD was diagnosed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Interventions:<\/jats:title>\n            <jats:p>Pars plana vitrectomy was performed with panretinal photocoagulation and silicone oil tamponade in the right eye.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes:<\/jats:title>\n            <jats:p>After the pars plana vitrectomy of right eye, the retina was well-attached after surgery, but visual acuity remained poor. Visual evoked potential examination showed poor waveforms bilaterally, which suggested ischemic optic neuropathy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Lessons:<\/jats:title>\n            <jats:p>Atypical HUS can cause systemic thrombotic microangiopathy, resulting in ischemic retinal changes. These ischemic retinal changes can then cause hypoxia, which triggers production of angiogenic factors and subsequently causes retinal vascular hyperpermeability, retinal and vitreous neovascularization, fibrovascular proliferation, vitreous hemorrhage, and TRD, in a manner similar to that of other ischemia-induced proliferative retinopathies. Despite successful surgery in the right eye, our patient's visual acuity did not improve, possibly because of severe and generalized ischemia of intraocular tissue, which resulted in ischemic optic neuropathy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/md.0000000000017232","type":"journal-article","created":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T08:41:37Z","timestamp":1569487297000},"page":"e17232","source":"Crossref","is-referenced-by-count":11,"title":["Bilateral proliferative retinopathy and ischemic optic neuropathy in a patient with atypical hemolytic-uremic syndrome"],"prefix":"10.1097","volume":"98","author":[{"given":"I-Hung","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Ophthalmology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping-Ying","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Wei","family":"Hsiao","sequence":"additional","affiliation":[{"name":"School of Medicine of The National Defense Medical Center, Taipei City, Taiwan, ROC."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu-Heng","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Hsiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2019,9]]},"reference":[{"key":"R1-20230915","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1053\/j.ajkd.2004.02.010","article-title":"Non-enteropathic hemolytic uremic syndrome: causes and short-term course","volume":"43","author":"Constantinescu","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"R2-20230915","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/j.1755-3768.2009.01552.x","article-title":"Ocular involvement in paediatric haemolytic uraemic syndrome","volume":"88","author":"Sturm","year":"2009","journal-title":"Acta Ophthalmol"},{"key":"R3-20230915","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1182\/asheducation-2016.1.217","article-title":"Atypical hemolytic uremic syndrome","volume":"2016","author":"Afshar-Kharghan","year":"2016","journal-title":"Hematology Am Soc Hematol Educ 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syndrome","volume":"19","author":"Sandhu","year":"2015","journal-title":"J AAPOS"},{"key":"R11-20230915","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1038\/eye.2013.111","article-title":"Resolution of ocular involvement with systemic eculizumab therapy in atypical hemolytic-uremic syndrome","volume":"27","author":"David","year":"2013","journal-title":"Eye"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000017232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T22:33:53Z","timestamp":1694817233000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000017232"}},"subtitle":["A case report"],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":11,"journal-issue":{"issue":"39","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000017232","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}