Euglycemic pregnant women and those with GDM on insulin had masked hypoglycemia. Masked hypoglycemia was not associated with adverse maternal or fetal outcomes. Therefore, low glucose levels in the hypoglycemic range may represent a physiologic adaptation in pregnancy. This response is exaggerated in women with GDM on insulin.
Background
POEMS (polyneuropathy, organomegaly, endocrinopathy, myeloma protein, skin changes) syndrome is a rare blood disorder with multi-system involvement. The cause is unknown. It is marked by elevated plasma cells, platelets, & VEGF (vascular endothelial growth factor) levels. 52% of patients develop optic disc edema which may be vision threatening but the exact etiology of optic disc edema is uncertain. We report a rare finding of peripheral retinal leakage in POEMS syndrome.
Case presentation
A 60 year-old female with POEMS syndrome presented with bilateral blurred vision. Fundi showed grade 3 disc edema OU. Lumbar puncture showed normal opening pressure. CSF analysis showed elevated proteins with no cells. MRI brain and MR Venogram head were unremarkable. Wide field fluorescein angiography demonstrated multifocal tiny vascular leakage and significant anterior temporal leakage.
Conclusion
The authors hypothesize the disc edema in POEMS syndrome may be caused by increased vascular permeability at the optic disc secondary to increased VEGF (vascular endothelial growth factor) levels. Though disc leakage is a well-documented finding in fundus fluorescein imaging, peripheral retinal leakage in POEMS syndrome is not reported.
Periventricular leukomalacia (PVL) is coagulation necrosis of white matter seen in preterm, low birth weight (LBW) infants and associated with a range of ocular manifestations. We report a case of 2½ months old (47 weeks gestational age) female infant with PVL associated with bilateral high myopia (−16 DS). On examination, child had difficulty in tracking objects and inferior field defect with preference for superior gaze. She was prescribed spectacles and visual stimulation exercises to preserve existing vision and prevent amblyopia. Periventricular leukomalacia can affect full-term infants although it is more common in preterm and LBW infants. All preterm, LBW infants, and those with positive neuroradiological findings must be assessed by an ophthalmologist as early as possible to detect the associated ocular manifestations.
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