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Retinal hemorrhage in dogs

Retinal hemorrhage in dogs



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Retinal hemorrhage in dogs (RH) is a common cause of death in dogs presenting to veterinary emergency clinics, with many deaths associated with trauma.[@bib0130] The most common etiology is rupture of the arterial and/or venous vessels of the optic disc resulting in exudative and/or hemorrhagic retinopathy.[@bib0130], [@bib0135], [@bib0140] Trauma has been reported to be responsible for 45% to 73% of RH cases,[@bib0135] although the most frequent cause of RH is spontaneous rupture of small prelaminar retinal vessels.[@bib0135]

Retinal hemorrhage may progress to secondary retinal detachment and visual loss.[@bib0135], [@bib0140] In the first few days, RH may be asymptomatic or associated with mild to moderate exudative changes and intraocular bleeding. After 7 days, the presence of intraocular bleeding can be an indicator of poor prognosis.[@bib0135] It is therefore of paramount importance that any dog that is found to have a retinal hemorrhage undergoes a thorough ophthalmic examination. This includes fundoscopy with a portable slit lamp, indirect ophthalmoscopy, intraocular pressure measurement, and a determination of the anterior chamber depth (ACD), using a scleral indentation method.[@bib0135], [@bib0145]

The development of high-resolution ultrasonography (HRU) has provided veterinarians with an easy and fast way to evaluate the vitreous cavity and retina in small animals.[@bib0150], [@bib0155], [@bib0160] However, the ability of HRU to detect retinal hemorrhage has not been evaluated in dogs. The m of this study was to compare the diagnostic performance of HRU and indirect ophthalmoscopy in the evaluation of RH in dogs.

Methods {#s0010}

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A prospective study was performed to evaluate the diagnostic performance of HRU and indirect ophthalmoscopy in the detection of RH in dogs. The study was approved by the Ethics Committee of the School of Veterinary Medicine and Animal Science of the University of São Paulo (protocol number 24/2014).

Forty-one dogs that presented with unilateral or bilateral RH to a private veterinary hospital from April 2014 to March 2015 were evaluated.

Animals were recruited in the following groups: 1) healthy control dogs, i.e., dogs without clinical signs of ophthalmic disease, examined by indirect ophthalmoscopy, 2) dogs with suspected unilateral or bilateral RH, examined by indirect ophthalmoscopy, and 3) dogs with unilateral or bilateral RH confirmed by direct ophthalmoscopy or ultrasound examination. Cases were classified as "unilateral RH" if the funduscopic examination of the affected eye revealed RH in one or more areas and "bilateral RH" if RH was present in both eyes. The dogs were recruited based on convenience sampling. Dogs were excluded if they presented with other ocular diseases or trauma, such as ocular neoplasia, proliferative retinopathy, uveitis, iridocyclitis, or traumatic retinal detachment. The dogs were assigned to the control group if they had normal eyes, based on indirect ophthalmoscopy. All healthy dogs were client-owned dogs that had undergone routine physical examination by a general practitioner and no abnormalities had been detected.

Each dog underwent indirect ophthalmoscopy, a fundoscopic examination with a portable slit lamp, and HRU using the Sonos 5500 portable ultrasound unit (Siemens, Munich, Germany). The same technician performed all ophthalmic procedures.

To assess retinal health in the eyes of healthy dogs, the following examinations were performed: fundoscopic examination with a portable slit lamp (Oculus C8, Hubei, China), intraocular pressure measurements (Tonopen XL, Reichert, NY), and HRU, which was performed by a single examiner in order to reduce examiner variability. To assess the quality of the HRU images, a second examiner who had been trned in the same manner as the first examiner and was blinded to the results of the ophthalmic examinations evaluated HRU images. The examiner made an overall assessment of the images and assigned an overall score of "good," "fr," or "poor." The quality of the ultrasound images was classified as "good," "fr," or "poor" and the presence or absence of hemorrhages were also recorded. The ultrasonographer was not informed about the results of the ophthalmic examination. All ophthalmic procedures were performed in the right eye unless stated otherwise.

The ophthalmic examination was performed in the following manner: indirect ophthalmoscopy was performed using a slit lamp with a portable fundus camera (Retcam III fundus camera, Clarity Medical Systems, Rochester, MN). Intraocular pressure was measured with a tonometer (Tono-Pen XL Tonometer, Reichert Inc, Depew, NY). HRU was performed using the Sonos 5500 portable ultrasound unit with a 5- to 12-MHz linear array probe. The images were stored and evaluated by a second, trned ultrasonographer who was blinded to the results of the ophthalmic examination and who had received trning and performed examinations on the same unit used in the study.

The images were evaluated by two observers who were blinded to the clinical condition of the dogs. One observer classified the retinal hemorrhages as either localized or diffused, using a previously established classification system ([Figure 1](#f0010){ref-type="fig"}).[@bib0135] A diffuse hemorrhage was defined as a large amount of subretinal or intraretinal hemorrhage that involved the entire fundus, with no or little involvement of the peripheral retina. A localized hemorrhage was defined as small intraretinal or subretinal hemorrhages that were typically observed near the optic disc. A small amount of intraretinal hemorrhage that is present in areas of a more mature vasculature in dogs, in


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