Acuity In Right Eye Research Articles

An Optic Nerve Avulsion Due to A Gun Shot Injury: A Case Report

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

Vision improvement after trans-sphenoidal resection of pituitary macroadenoma

Introduction: Pituitary adenomas are tumours that occur in the Pituitary gland. Depending on the size it can be divided into Microadenoma (10mm). It can present with endocrine manifestations secondary to hypo or hyper function of pituitary gland and ophthalmological manifestations due to mass effect. Case Report: A 36-year-old female was admitted to our institution with complaints of loss of vision of right eye, headache and amenorrhea for 3 months, which were progressive in nature. Her MRI Scan revealed a well-defined sellar mass, measuring 27 x 23.18 mm, with suprasellar extension, causing expansion of pituitary fossa and superiorly extending into Hypothalamus with mild compression over optic chiasma. Prolactin level was 72.16 ng/ml. Surgery was done under general anesthesias, by Endoscopic assisted transsphenoidal approach. The adenoma was completely removed. Sella opening was closed by synthetic graft. On awakening from anesthesias visual acuity in right eye was immediately and completely restored. Conclusion: Pituitary adenoma is a complex set of benign tumours that present with hypersecretory syndrome and mass effect. An appropriate imaging of pituitary region using MRI and endocrinological consultation is the standard for detection of pituitary adenoma. Although, medical management and radiotherapy offer effective treatment for these tumours in specific situations, Endoscopic Trans-sphenoidal approach continues to provide optimal outcomes with low incidence of morbidity. Keywords: Pituitary macroadenoma, Vision loss, TransSphenoidal resection.

A Tale of Hypertensive Retinopathy with Choroidopathy and Neuropathy in A Young Patient: A Sign of End Stage Renal Disease

A 35 year old male patient presented with defective vision in the left eye associated with severe headache for past one week. On evaluation, the best corrected visual acuity of right eye (OD) was 20/20 and left eye (OS) was 20/40. Fundus evaluation revealed features suggestive of hypertensive retinopathy, choroidopathy and neuropathy. His blood pressure was 210/140 mm of Hg. Furthermore, on referral to Nephrologist, the patient was diagnosed with renal hypertension and was started on dialysis. Ophthalmic evaluation helped in diagnosing this life-threatening systemic condition; and the possibility of choroidal lesions, though less recognised have important implications in end organ damage.

CENTRAL MYELIN AND DEMYELINATION

INTRODUCTION:CNS demyelinating disorders are common neurological illness that affects the brain. This causes signicant disability and mortality if not properly identied and treated. CNS demyelinating diseases includes multiple sclerosis, acute disseminated encephalomyelitis, NMO spectrum disorders and transverse myelits. Here we are reporting a case of central demyelination. CASE SUMMARY: 44yrs female admitted with subacute onset of weakness of all four limbs, more on left side and sensory disturbance in the form of numbness and tingling in all four limbs, more on left side, associated with urinary urgency and constipation. Patient had right optic neuritis 3 years back. General examination was normal. Vital signs were stable. On nervous system examination, patient had decresed visual acuity in right eye, with relative afferent pupillary defect and impaired red green colour vision, fundus was normal. Motor system examination, Patient had normal bulk, increased tone, brisk deep tendon reexes, power of 4 on right and 4- on left side with extensor planter on both sides. Patient had decresed sensation below C5 spinal cord level, predominantly joint position and vibration sense with positive lhermitte's sign. Other systems were normal. Routine lab investigation ,ECG,CXR were normal. CSF analysis revealed elevated protein of 72mg. MRI BRAIN WITH WHOLE SPINE SCREENING(contrast) revealed Multiple smallT2/FLAIR hyperintense lesion in bilateral juxta cortical, subcortical(involving the temporal lobes and callososeptal interface), subtle patchy enhancement in the left peritrigonal lesion and in body of corpus callosum. Mild atrophy of cervical cord from C3 to C5 with T2 hyperintense involving both hemicord from C2 to C5 level, focal Hyperintensity subtle contrast enhancement in Dorsal cord at the level of D11, Features suggestive of demyelination likely Multiple Sclerosis.

A rare presentation of anterior dislocation of calcified capsular bag in a spontaneously absorbed cataractous eye.

Spontaneous lens absorption and dislocation of empty capsular bag in anterior chamber is an extremely rare phenomenon. The common predisposing factors can be weak zonular structure as in pseudoexfoliative syndrome, historical trauma or spontaneous absorption of hypermature morgagnian cataract. Here we describe a unique and rare presentation of a 53 years old gentleman who presented with defective vision in right eye (RE) for past 7 months. Visual acuity in RE was finger counting close to face and 6/60 in the left eye (LE). Anterior segment examination revealed a translucent membrane with rolled up margins in the right anterior chamber, anterior lens capsule calcification and posterior capsular breach, iridodonesis, pseudoexfoliation, sluggish pupil, and aphakia along with few vitreous strands. B scan revealed cortical matter in the anterior vitreous face in RE. The patient was planned for membrane removal, pars plana vitrectomy along with scleral fixation of intraocular lens. This case highlights the extremely rare presentation of capsular bag in anterior chamber in a spontaneously absorbed cataractous eye.

Choriocapillary vascular density changes in choroidal neovascularization associated with choroidal nevus after anti-VEGF injections.

To evaluate choriocapillary vascular density changes in choroidal neovascularization (CNV) type 2 associated with choroidal nevus using optical coherence tomography angiography (OCT-A) before and after anti-VEGF treatment. Observational case report. A 25-year-old woman, was referred to Eye Clinic and presented a decreased visual acuity in right eye. Fundus examination showed a pigmented lesion located in macular region associated with subretinal hemorrhages adjacent to the mass in right eye. The diagnosis of choroidal nevus-associated with CNV was made and confirmed by spectral domain (SD)-OCT, OCT-A, and ultrasound examination. Two monthly ranibizumab intravitreal injections (IVT) were performed and a regression of the activity of neovascular lesion was noted. OCT-A showed a reduction of choriocapillaris vessel density (VD) before the treatment and an increase of VD after IVT injections. OCT-A could be a non-invasive and diagnostic tool to evaluate choriocapillaris vascular changes after IVT injections in CNV associated with choroidal nevus.

Choroidal metastases as initial manifestation of a papillary thyroid carcinoma: A case report

Abstract The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.

Sclerokeratoplasty for the early management of acquired anterior staphyloma

Objective: To report a case of acquired anterior staphyloma after trauma and its first surgical management. Methods: This is a case report of a 17-year-old man who had a history of trauma by insect on the right eye, without a previous history of eye conditions, and evolved with local pain and low visual acuity. The ophthalmological exam showed light perception visual acuity in right eye and 1,0 in left eye, anterior staphyloma and impossibility to blink. The first surgical procedure proposed was sclerokeratoplasty and the second one an optical transplantation but, after step one, the patient did not return to the service and missed the follow-up. Results: Sclerokeratoplasty was proposed once the posterior segment and the crystalline were preserved in topical position. The anterior tumor was excised in free-cut and corneal-scleral graft sutured in single points with 10-0 mononylon. Gatifloxacin 0.3% with Prednisolone Acetate 1%, Epitezan® and Atropine 1% were prescribed immediately postoperative. After 60 postoperative days, he maintained the use of Dexamethasone 0.1% and Atropine 1% and the patient had visual acuity of perception of hand movement in the affected eye. Conclusion: Few treatment options are alternatives to evisceration. In this case report, the sclerokeratoplasty was the chosen technique for the initial management. The second step was not possible due to loss of follow-up. Despite the uncomplicated procedure, we need greater compliance by the patient to conclude the treatment.

Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.

Laser-induced CNV following hair removal procedure

Objective: To describe the chronological features of choroidal neovascular membrane (CNV) development subsequent to accidental firing of diode laser into the eye of a young female during hair epilation. Methods: Descriptive case report. Results: The patient presented one week after the laser injury to a local ophthalmologist complaining of RE (right eye) blurred central vision. Snellen's visual acuity (VA) was 6/ 7.5. Optical coherence tomography (OCT) showed focal disruption of the ellipsoid and the interdigitation zones. Four weeks later, she presented with worsening symptoms and RE VA 6/ 15. Funduscopy revealed a perifoveal grayish lesion with adjacent retinal hemorrhage, which, on fluorescein angiography, was leaking, compatible with CNV. OCT showed a dome-shaped sub-retinal pigment epithelium lesion with extension into the subretinal space and little subretinal fluid. The patient was treated with one intravitreal bevacizumab injection. There was rapid regression of the CNV and improvement of VA to 6/ 7.5 at one-month visit and to 6/ 6 at 6-month visit. Conclusion: All the laser procedures should be conducted with intensive care for both the patient and the laser surgeon since inadvertent effects are constantly being reported due to lack of adherence to safety measures.

LASER toy-induced macular burn: An illustrative case

Introduction: Light amplification by stimulated emission of radiation (LASER) toys are widely available in the market with no clear information about their wavelength and hazardous effects. To be safe to the eyes, LASER should be classified <3b (according to international safety classification). Case History: We here report an illustrative case of macular injury post LASER toy direct exposure. A 12-year-old boy, previously known hypermetrope with left-eye (LE) amblyopia, presented complaining of drop of vision in the right eye (RE) after his colleague pointed a LASER toy directly over his RE. His corrected visual acuity (VA) was 5/60 (amblyopic) in the LE and 6/18 in the RE. The anterior segment was normal in both eyes. Fundus examination showed the LE to be normal, and the RE had a macular yellowish, oval-shaped lesion. Optical coherence tomography and fundus picture revealed central macular burn. Local and systemic corticosteroids were prescribed tapering over 9 days. After 1-week, the patient noticed some improvement in VA in RE to 6/9. Conclusion: LASER toys available in several markets are reported to be vision threatening and cause macular burn which responds partially to corticosteroids. More education and strict regulation of distribution and use of LASER toys and instruments is urgently needed.

White to black: Keratopigmentation

Here we report a case of 34 year old female who presented to our department with chief complaints of photophobia, glare and whitish colouration of cornea in the left eye since 5 months. She had a history of penetrating ocular injury at the age of 6. She underwent penetrating keratoplasty, followed by cataract extraction and Intraocular lens implantation in 2015. On examination, Visual Acuity of right eye was 6/6 and left eye hand movements with projection of light in all quadrants. Slit lamp examination of left eye showed graft failure with leucomatous corneal opacity. Keratopigmentation was done using tattooing gun and jet black dye. Patient became symptomatically better and cosmetically satisfied. We found there was no fading of colour after three months.

Application of horizontal rectus muscle suture clamp for the treatment of congenital nystagmus without intermediate band

Objective To evaluate the efficacy of application of horizontal rectus muscle suture clamp for the treatment of congenital nystagmus (CN) without intermediate band. Methods The data of 11 patients with no intermediate band CN from Jan.2016 to Jun.2017 were retrospectively analyzed. All cases received the self designed surgery of horizontal rectus muscle suture clamp. The visual acuity(LogMAR), the amplitude and frequency of nystagmus before and after operation were summarized. Results The best corrected visual acuity of right eye before and 1, 3 months after operation were 0.65±0.25, 0.42±0.26 and 0.38±0.23, respectively. Those of left eye were 0.62±0.26, 0.38±0.17 and 0.35±0.14, respectively. The postoperative best corrected visual acuity at 1 and 3 months of binocular were improved (P<0.05). The amplitude and frequency of nystagmus at 3 months after operation were decreased. The difference was statistically significant between before and after operation (P<0.05). Conclusion Horizontal rectus muscle suture clamp for the treatment of CN without intermediate band can effectively decrease amplitude and frequency of nystagmus, and significantly improve visual function. Key words: Nystagmus, congenital, without intermediate band; Suture, clamp

Inferior bullous keratopathy caused by iris fibers, resolved with diode laser 532

Purpose: To describe a case of inferior bullous keratopathy caused by iris fibers resolved with laser diode 532.Case report: A 74-year-old woman consulted for deterioration of visual acuity in right eye, accompanied by foreign body sensation. A phacoemulsification surgery with IOL implant had been performed in both eyes three months before. Best corrected visual acuity reached 20/40 in right eye. Slit lamp examination revealed bullous keratopathy located in the central inferior quarter of the cornea of her right eye. Gonosioscopy was performed to rule out having nucleus fragments in the inferior angle. With higher magnification, a pair of fine undulating fibers were observed coming from the anterior layers of the iris and making contact with the posterior face of the cornea. Photocoagulation of the iris fibers was performed with laser diode 532 and photodisruption with Nd-YAG laser, applied at the base of the fibers. After nine days, resolution of corneal edema, and disappearance of bullae was observed. Best corrected visual acuity improved to of 20/25.Conclusions: photocoagulation of iris fibers with laser diode 532 complemented with photodisruption with Nd-YAG laser, in patients with iridoschisis, is an alternative to avoid endothelial decompensation and corneal edema, which may require a corneal transplantation.

Ophthalmological data on 4.5- to 7-year-old Danish children.

To report normative data on visual acuity (VA) for near and distance, refraction, ocular alignment, ocular motility and stereo acuity in a cohort of children aged 4.5-7years. A total of 950 children with normal development from the municipality of Roskilde, Denmark, were invited to participate in an ophthalmic cross-sectional population-based survey, of which 445 children in the age of 54-87months participated with a complete ocular examination including cycloplegia. Visual acuity (VA) was tested using Kay Picturecharts and notified in logMAR units. Mean distance VA was 0.010 logMAR [standard deviation (SD): 0.048] in right eye, and near VA in right eye was 0.012 logMAR (SD: 0.054), with a nonsignificant difference between right and left eye in both parameters (paired t-test, p=0.15 and p=0.08, respectively). Amblyopia was found in 12 children (2.7%), mainly related to refractive errors. The mean refractive error of right eye was +1.75D, and significant hyperopia (greater than +3.0D) was found in 7.9%. No myopia (greater than or equal to -0.5D) was found, astigmatism (>1D) was seen in 4.3%. Manifest strabismus was present in 1.6%, and heterophoria in 4.0%. Reduced or absent stereo acuity was present in 35 children (7.9%) and was related to a reduced VA, refractive error and strabismus. Ophthalmic data of 445 normally developed children are presented, supplementing previous reported normative data in children. We found a relatively high prevalence of amblyopia and of hyperopia, while myopia was not found, confirming previous studies that myopia is not developing at early age in Danish children.

A Comparative Study on the Effects of Vintage Nonpharmacological Techniques in Reducing Myopia (Bates eye exercise therapy vs. Trataka Yoga Kriya).

Background:Human eye captures light rays as they come and fall on the retina and convert them into an image. However, in myopia, light rays fall in front of retina, causing blurring of image. Correction of this is generally done using correcting devices such as corrective glasses and contact lenses. Existence of some alternative therapies is also noticed in literature.Aim:To compare the effects of Bates eye exercises and Trataka Yoga Kriya on myopia.Materials and Methodology:Ethical clearance was obtained from the institution, and informed consent was taken from participants. In this randomized comparative study, 24 participants (48 eyes) were taken based on inclusion and exclusion criteria and were randomly divided into two groups: Group A and Group B, where Bates eye exercise therapy and Trataka Yoga Kriya were given, respectively, for 8 weeks. Participants were assessed for their refractive errors and visual acuity pre- and post-intervention.Results:Data were analyzed by SPSS version 20. Results obtained revealed that both Bates exercises and Trataka Yoga Kriya were not significantly effective in reducing refractive errors and in improving visual acuity (P value of refractive error in right eye: 0.4250; left eye: 0.4596; P value of visual acuity in right eye: 0.5691; left eye: 0.8952).Conclusion:This study concludes that nonpharmacological approaches such as eye exercises and Trataka Yoga Kriya are not significant on myopia.

Weightlifters - Need to Be Cautious Especially Having Pigment Dispersion Syndrome or Pigmentary Glaucoma

Weightlifter developed sudden diminution of vision after exercise with visual acuity in right eye (RE) HM and in left eye (LE) CF 1foot, Intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) in both eyes were 34 mmHg with antiglaucoma medications. Slit lamp examination of both eyes showed edematous cornea, concave configuration of iris, semi dilated pupil, sluggishly reacting to light and pigment on corneal endothelium &amp; on clear lens in RE, LE lens was clear. Gonioscopy showed open angle with increased pigmentation. Fundus examination showed cup disc ratio 0.8 in RE &amp; 0.85 in LE. Anterior segment optical coherence tomography (ASOCT) confirmed concave configuration of iris. Patient was treated with antiglaucoma medications &amp; peripheral iridotomy done with Nd: YAG in BE which decreased concave configuration of iris. Visual acuity improved to 6/6 in RE &amp; 6/9 in LE. BE IOP with GAT 14 mmHg, Humphery visual field (HVF) 10-2 showed advanced field defects, Central corneal thickness 598µ, OCT showed retinal nerve fibre layer thickness in RE 75µ &amp; 64µ in LE. Planned for trabeculectomy with MMC subsequently in BE. Conclusion: Weightlifters can need to remain cautious especially having Pigment dispersion syndrome or pigmentary glaucoma &amp; should undergo regular ophthalmic checkup

Cilioretinal obstruction during pregnancy

Abstract Purpose To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. Methods A retrospective study of the medical records. Results From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: a 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: a soft exudate in the papillomacular bundle with retinal edema and embolism on a cilioretinal artery branch. The exudate and edema disappeared after 5 weeks, and the scotoma was reduced. Case 2: a 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: an area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. Conclusions The etiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.

1例Leber遗传性视神经病变早期诊断和治疗

LHON发病是因为线粒体DNA位点突变导致能量不足，视神经细胞萎缩甚至死亡。rAAV2-ND4提供正常的ND4，增加能量供应，有潜力治愈LHON。我们观察了一例视神经受损早期的患者，希望能进一步明确早期诊断、治疗对于LHON的影响，此病例中，患者病程短，发病后迅速予以营养神经、能量供给后患者视力曾恢复至OD:0.8 OS:0.6。 LHON is caused by a point mutation in mtDNA, which leads to a reduction in energy production by the mitochondria. Because optic nerve tissue requires much more energy than other tissues, it becomes severely damaged when energy production drops, and pathological changes in optic nerve cells and even atrophy can occur. Given the results of the present study, it seems potential to suppose that rAAV2-ND4 therapy supplied normal ND4 to the mitochondria, and thus increased energy supply to the optic nerve. We observed an early case to explore how to diagnose and treat matters earlier. In this case, the patient was newly attacked. He got medicine for energy and nerve nutrition almost immediately. His visual acuity of right eye was improved to 0.8, which of the left eye was improved to 0.6.

Obstrucción de la arteria ciliorretiniana durante el embarazo

PurposeTo determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. MethodsA retrospective study of the medical records. ResultsFrom the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. ConclusionsThe aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.