Counting Fingers Research Articles

Luxation antérieure d’un cristallin clair post-traumatique

We here report the case of a 52-year-old patient admitted to the ophthalmic emergency department with ocular pain and redness following right ocular trauma. Ophthalmologic examination of the right eye revealed impaired near visual acuity of counting fingers, diffuse conjunctival hyperaemia, dislocation of the clear crystalline lens into the anterior chamber in front of the iris with contact with endothelial cells and ocular hypertonia 40 mmHg. Ocular ultrasound was normal. The patient received emergency medical treatment based on both local and general hypotonizing drug. Then phacoemulsification including direct surgical removal of the entire lens associated with anterior vitrectomy were performed. Postoperative outcome was marked by normalization of intraocular pressure and by the absence of optic nerve and corneal endothelial cell damage.

Pediatric uveitis complicating in cataract formation regained normal visual acuity – a challenging case

Background: Pediatric uveitis and its complications are important causes of child blindness. Strong inflammatory response and unstable treatment compliance result in worse treatment outcome than adults and frequent recurrence. However, effective anti-inflammatory treatment can still lead to good result. Case report: We report a case of pan-uveitis in a 13-year-old patient, complicating in cataract formation who was successfully treated and regained 20/20 final visual acuity. The patient was admitted to us due to blurry vision, pain and redness on her left eye, with best-corrected visual acuity 12/20, intraocular pressure 15 mmHg, ciliary flush, anterior chamber cell and constricted pupil with poor light reflex. Her left eye was diagnosed with anterior uveitis and treated with topical prednisone acetate along with peri-orbital injection of dexamethasone. At 1-week follow-up, her left eye showed significant progress with best-corrected visual acuity being 16/20 and no inflammatory reaction detected. Due to social distancing in Covid-19 pandemic, she was unable to have follow-up examinations; her condition worsened to pan-uveitis which complicated in cataract formation and her visual acuity fell down to counting finger 0.5m. She was then treated with systemic methylprednisolone in 2 weeks and local corticosteroids in 6 months, including 3 consecutive peri-orbital injections of triamcinolone acetate with monthly interval and topical prednisone acetate; after that she underwent cataract surgery with anterior vitreous humor removed and intraocular lens implanted in the ciliary sulcus. At 1-month follow-up, best-correct visual acuity of her left eye was 20/20 and intraocular pressure was 16 mmHg, the inflammatory response of her left eye was completely in control. Conclusion: Effective anti-inflammatory treatment even after surgery (if existed) takes the decisive role in regaining patient’s vision. Cataract removal surgery on pediatric uveitis patients should combine with vitrectomy and the surgeon should be prepared to place the intraocular lens in the ciliary sulcus.

Partial-thickness compression sutures without descemetopexy for management of acute hydrops in keratoconus: A novel surgical technique.

This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.

Bilateral Exudative Retinal Detachment Secondary to Malignant Hypertension – A Case Report

To report a case of bilateral exudative retinal detachment secondary to malignant hypertension. Hypertension has been identified as a major cause of morbidity and mortality across the world. A 29-year-old female presented with sudden onset painless loss of vision in both eyes since a day. Known case of hypertension for 6 months on irregular medication. On examination vision of the right eye was hand movement with no pinhole improvement, and on left eye it was counting finger 2 meter with no pin hole improvement. Intraocular pressure of both eyes was normal. Anterior segment examination of right eye was normal except relative afferent pupillary defect. Anterior segment of left eye was normal. Fundus examination - Bilateral disc swelling with inferior retinal detachment extending 4 to 7 clock hours with flame shaped haemorrhages and cotton wool spots over blood vessels with AV crossings with dull foveal reflex. OCT showed bilateral exudative detachment of sensory retina. BP -150/100 mmhg. Further investigation found to have acute renal failure, requiring urgent dialysis, and patient was started on dialysis. 3weeks after blood control was acheived ,visual acquity improved to 6/18 BE with exudative retinal detachment in both eyes resolved by its own except with few residual haemorrhages. Accelerated HTN may precipitate bilateral exudative retinal detachment in patient with acute renal failure in young adults. Bilateral exudative retinal detachment is a catostropic event which results in devastating vision loss within very short time span. Timely intervention may save the vision loss and renal failure. Keywords: Hypertensive retinopathy, Exudative retinal detachment, OCT

A Modification of the Inverted Internal Limiting Membrane Flap Technique without Heavy Liquids and Prone Posturing.

Primary closure of large macular holes remains challenging, and variations of inverted inner limiting membrane (ILM) flap surgery have been described. In the present retrospective, interventional, single-centre case series, we propose a superior flap design with minimal posturing. Eight eyes of eight patients (four women and four men) in the period between July 2020 and March 2022 underwent 23 G three-port vitrectomy with a superior inverted ILM flap and 20% SF6 endotamponade for a full thickness macular hole (MH) by the same experienced surgeon (F. M. H.). Seven MHs were classified as large (> 400 µm) and one as medium (250 - 400 µm). The mean MLD was 638.0 ± 166.4 µm (range: 353 - 851 µm). MH closure was achieved in all (8/8, 100%) patients with a single surgery. The median best-corrected visual acuity (BCVA) improved from 6/120 (Snellen) (range: finger counting [FC] to 6/19) preoperatively to 6/19 (range: FC to 6/9.5) after surgery, without any intra- or postoperative complications. The superior inverted ILM flap technique seems to be a safe and successful approach for the primary closure of large MHs. Further studies should investigate our proposed surgical technique on a larger population, potentially without air or gas endotamponade.

Leukemic retinopathy presenting as concurrent bilateral subhyaloid hemorrhage and subarachnoid hemorrhage in a patient with acute monocytic leukemia: a case report

BackgroundOphthalmic manifestations are common in patients with leukemia, developing in nearly 50% of cases. Intracranial hemorrhage is another potentially fatal complication of leukemia. In this case report, we aim to present a challenging case that involves both ophthalmic and intracranial manifestations in an individual with acute monocytic leukemia.Case presentationA 36-year-old Persian male presented to the emergency room with complaints of fever, headache, and bilateral blurred vision. The patient had been diagnosed with acute monocytic leukemia 3 months prior and had undergone four sessions of induction chemotherapy, the last of which was 10 days prior to admission. The patient was admitted to the internal medicine service, and initial lab studies confirmed pancytopenia, including severe neutropenia, anemia, and thrombocytopenia. Subarachnoid hemorrhage in the left frontal lobe was detected through spiral brain computed tomography scan. Ophthalmic examination revealed visual acuity of light perception in the right eye and 3-m finger count in the left eye. Fundus examination revealed bilateral peripapillary subhyaloid and intraretinal hemorrhages, confirming leukemic retinopathy. The patient showed significant improvement in visual acuity and hemorrhage resolution through conservative treatment and regular follow-ups after 3 months.ConclusionSimultaneous subarachnoid hemorrhage and bilateral subhyaloid hemorrhages seemed to have occurred as a result of pancytopenia. Management approach of ophthalmic manifestations of leukemia involves interdisciplinary cooperation and should be individualized on the basis of the patients’ underlying medical condition.

Anatomical success of tectonic keratoplasty in children at a tertiary care eye hospital.

To evaluate the anatomical outcome of tectonic grafts performed in children with perforated or melted corneas. The prospective study was conducted at the Department of Paediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from January to December 2017, and comprised children of either gender aged <16 years who received tectonic grafts owing to desmetocoele or corneal perforation of >3mm. The causes of corneal perforation, size of perforation, post-operative graft outcome and globe integrity were noted. Periodic follow-ups were done till December 2019. Data was analysed using SPSS 22. Of the 27 patients, 9(33.3%) were girls and 18(66.7%) were boys. The overall mean age was 47.7±43.5 months. The most common indication was corneal perforation 19(70.4%), followed by descemetocoele 8(29.6%). The most frequent cause was infectious keratitis 13(48.2%), followed by trauma 8(29.6%) and vitamin A deficiency 5(18.5%). The mean size of perforation/descemetocoele was 5.5±1.5mm. Post-operatively, graft failure occurred in 5(18.5%) eyes and required repeat grafts. Globe integrity was restored in all 27(100%) cases, and 24(88.8%) eyes maintained their size and intraocular pressure, while 3(11.1%) became phthisical. Post-operative visual acuity was better than 6/36 in 3(11.1%) eyes, between 6/36 and 6/60 in 10(37%) and counting finger in 14(51.8%). Tectonic graft was found to be a valuable therapeutic option in emergency globe-threatening corneal thinning and perforation and in maintaining the anatomical integrity of eyes.

Bilateral Extensive Syphilitic Punctate Inner Retinitis Triggering Macular Ischemia after Intravitreal Triamcinolone Injections

Purpose: To report a case of extensive syphilitic punctate inner retinitis (SPIR) triggering bilateral macular ischemia after intravitreal triamcinolone injections, and the multimodal retinal imaging findings.Case summary: A 69-year-old male patient with nonproliferative diabetic retinopathy was transferred to our hospital because of bilateral visual deterioration (to counting fingers) after the first intravitreal triamcinolone injection. Fundus examination revealed numerous yellow punctate precipitates in the superficial retinae, retinal arteriolitis, and vitritis. The punctate lesions and surrounding retinal regions showed decreased vascular density on optical coherence tomography angiography, and focal hypofluorescence on fluorescein angiography. The patient was positive for all of the Venereal Disease Research Laboratory test, the fluorescent treponemal antibody-absorption test, and &lt;i&gt;Treponema pallidum&lt;/i&gt; hemagglutination; we diagnosed bilateral SPIR. After treatment with aqueous crystalline penicillin solutions (24 million units per day for 14 days), the punctate lesions reduced but arteriolitis progressed to obliterative vasculitis. After 6 months, the bilateral SPIR and vitritis resolved, and the bilateral visual acuity improved to 20/100. However, inner retinal and macular ischemia persisted because of capillary nonperfusion attributable to obliterative vasculitis.Conclusions: Extensive SPIR can develop after an initial intravitreal steroid injection; the inner retinal ischemia and visual loss may persist after treatment because obliterative vasculitis develops. Therefore, patients scheduled for intravitreal steroid injections should be screened for syphilis infection.

Extensive Foveoschisis in an Emmetropic Patient Associated with Vitreomacular Traction: A Case Report

Aims: To report a rare case of foveoschisis caused by vitreomacular traction in a young emmetropic female patient.&#x0D; Presentation of the Case: A 37-year-old woman, without any systemic or ocular disorders, presented with progressively reduced visual acuity in her right eye over the last 3 months. Best-corrected visual acuity (BCVA) was counting fingers in the right eye. Optical coherence tomography revealed foveoschisis with foveal detachment in her right eye, which was successfully treated with pars plana vitrectomy without internal limiting membrane peeling and gas tamponade. Three months post-operatively the BCVA improved to 6/12.&#x0D; Discussion and Conclusion: Although high myopia is the main cause of foveoschsis, vitreomacular traction can rarely be associated with foveoschisis, specially in young patients without myopia or any other ocular history. In these cases pars plana vitrectomy with extensive posterior vitreous detachment induction may have favorable visual outcomes.

HELLP Syndrome-Associated Purtscher-like Retinopathy

A 36-year-old healthy woman underwent emergent Cesarean section due to preeclampsia. She was intubated and transferred to the intensive care unit for airway management and seizure prevention. She developed hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and tested positive for SARS-CoV-2. On extubation 4 days later, she reported bilateral blindness. Neuroimaging was consistent with posterior reversible encephalopathy syndrome. After hospital discharge (2 weeks after loss of vision), her vision was counting fingers in both eyes.

An accidental ocular alkali injury-a case report on effective management and successful outcome

Ocular surface burns require timely interventions to prevent any blinding sequelae. We report a case of an accidental alkali injury successfully managed in terms of eye integrity and visual rehabilitation. A 28years-old male factory worker presented to the emergency eye care department with accidental spill of caustic soda in left eye before two hours. On presentation, patient was managed with an immediate eye irrigation. Ocular examination revealed LE Dua’s grade IV injury and visual acuity of counting fingers at 3 meters. Patient was managed with medical treatment and amniotic membrane transplant with tenonplasty for delayed epithelization due to limbal ischemia. Complete ocular surface epithelization was achieved with visual acuity improvement to 6/6 with glasses in LE. Ocular surface burns with alkali agents can cause severe damage to an eye. Immediate eye wash and appropriate medical therapy with timely surgical interventions can prevent blinding sequelae and reduce ocular surface co-morbidities. Keywords: Ocular surface burns, alkali injury, amniotic membrane transplant, tenonplasty

Visual outcomes of macula-involving rhegmatogenous retinal detachment in patients with and without age-related macular degeneration

BackgroundThe prognosis for patients with macula-off rhegmatogenous retinal detachment (RRD) and concomitant age-related macular degeneration (AMD) is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD.MethodsThis was a retrospective chart review of 1149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls), and 29 AMD eyes. The main outcome measure was postoperative visual acuity following pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB in control eyes versus AMD eyes. This was compared using Fisher’s exact test.ResultsThere was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a worse visual outcome overall (p = 0.0048). A similar percentage of AMD versus non-AMD eyes achieved vision better than 20/40. More patients in the non-AMD group achieved a final visual acuity between 20/40 and 20/200. Of patients with AMD, more had vision worse than 20/200 though 58% maintained functional vision (better than 20/200). Those without AMD had a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023).ConclusionsThough postoperative visual acuity was worse overall in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is likely a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD.

Outcomes of Toric Intraocular Lens Implantation After Radial Keratotomy

Purpose: To report high toric intraocular lens (IOL) implantation in a patient with previous radial keratotomy and significantly flat corneal powers. Methods: Case report. Results: A 64-year-old woman with previous bilateral 8-incision radial keratotomy was referred for cataract surgery. Corrected distance visual acuity was 20/70 in the right eye and counting fingers in the left eye (could not be refracted). The power of the flat meridian was below 30.00 diopters (D) bilaterally, so no IOL power predictions were reported by standard biometric devices. Calculations were run with the American Society of Cataract and Refractive Surgery (ASCRS) IOL Calculator for Eyes with Prior Radial Keratotomy using data from biometry, tomography, and topography. Toric cylinder and meridian were calculated with the ASCRS Barrett Toric Calculator. Given reasonable agreement in corneal cylinder and meridian between imaging modalities, toric IOLs (3.75 D IOL cylinder) were implanted. Postoperatively, spherical equivalent was −0.50 D in the right eye and plano in the left eye. Cylinder was reduced from 3.24 to 1.00 D in the right eye and from 4.13 to 1.00 D in the left eye. Conclusions: Toric IOLs offer an opportunity to reduce postoperative astigmatism in radial keratotomy cases with high cylinder, significantly flat corneal powers, and no classic bowtie pattern on topography. Pre-cataract refractions are useful in these cases after radial keratotomy, because corneal imaging modalities may underestimate astigmatism after radial keratotomy. [ Journal of Refractive Surgery Case Reports. 2022;2(4):e68–e71.]

Systemic lupus erythematosus Purtscher like retinopathy optical coherence tomography angiography assessment implications

AbstractPurpose: to underline the importance of optical coherence tomography angiography (OCT‐A) in the diagnosis, assessment of final visual outcome and better understanding of the Purtscher like retinopathy, as well as to emphasize on performing an ophthalmologic evaluation in all patients with systemic lupus erythematosus, as eye involvement is closely related with disease activity.Methods: case report. Ophthalmologic multimodal imaging assessment of a patient short after experiencing a systemic lupus erythematosus severe outset.Results: fundus examination revealed multiple cotton‐wool exudates and sharp defined intraretinal white flecken lesions, concentrated in the posterior pole, which along macular edema and the context of lupus disease led to the diagnosis of Purtscher like retinopathy, raising concern about underlying disease activity. OCT‐A evidenced ischemic affront in the superficial and deep vascular plexuses but also at choroidal level, preconizing a poor visual outcome. Precapillary retinal vascular stops and choroid lobular ischemic images were of note. Six months after initial consultation, previously displayed ischemic images gave rise to retinal and choroidal atrophy translated in counting fingers best corrected visual acuity with the posterior ensue of retina neovascularization.Conclusions: This case proves ophthalmologic evaluation mandatory for all patients suffering from lupus and reveals OCT‐A as an imaging tool of great value in the assessment of Purtscher retinopathy. To our knowledge, this is would be the first report of a SLE Purtscher‐like retinopathy characterized by OCT‐A, matching graphically and unprecedently vascular micro‐embolism stops and ischemic areas, seen as void signals, with the pathognomonic Purtscher flecken and Paracentral Acute Middle Maculopathy (PAMM) lesions.

Microspherophakia and megalocornea with or without secondary glaucoma: A case series

AbstractPurpose: To report a case series of 6 eyes of 3 children diagnosed with microspherophakia and megalocornea with or without secondary glaucoma (MSPKA) and to discuss its clinical features and management.Methods: We reviewed 3 cases of a boy (case 1) and 2 sisters (cases 2,3) diagnosed with MSPKA from two consanguineous families. Ultrasound biomicroscopy was performed in 2 eyes and anterior‐segment swept‐source optical coherence tomography in 6 eyes.Results: Mean corneal diameter was 13 mm. Lens equatorial diameters were, in case 1, 6.2 mm in the right eye (RE) and 6.1 mm in the left eye (LE); in case 2, 7.4 mm (RE) and 7.7 mm (LE). Systemic work‐up was unremarkable.Case 1: A 6‐year‐old boy presented with bilateral lens subluxation and advanced secondary angle‐closure glaucoma (SACG). Best‐corrected visual acuity (BCVA) was 20/200 (RE) and was limited to counting fingers (LE). We performed phacoemulsification, anterior vitrectomy and retro‐pupillary iris‐claw intraocular lens implantation (RPIC‐IOL) in both eyes. At 5 months follow‐up, BCVA was 20/50 (RE) and 20/100 (LE). Intraocular pressure (IOP) decreased to 14 mmHg in both eyes.Case 2: Ophthalmologic examination in a 5‐year‐old girl showed in both eyes: a BCVA of 20/50, megalocornea, normal IOP and iridophacodonesis. Surgery with scleral fixation of the capsular bag will be considered.Case 3: An 8‐year‐old girl was referred after a bilateral lensectomy following spontaneous luxation of the lens into the anterior chamber in her RE. Examination showed bilateral megalocornea, aphakia and normal IOP. Secondary RPIC‐IOL implantation and amblyopia management were planned.Genetic testing for the Latent Transforming Growth Factor Beta Binding Protein 2 (LTBP2) gene mutation was performed in both sisters.Conclusions: MSPKA is a rare condition that can be associated with extraocular manifestations. Patients are at a high risk of lens dislocation and SACG. Surgical management remains challenging and should not be delayed.

Von Hipple-Lindau disease complicated with central retinal vein occlusion: a case report

BackgroundCentral Retinal Vein Occlusion (CRVO) is a rare complication of von Hipple-Lindau (VHL) disease. This report presents the first case of VHL disease complicated with CRVO caused by VHL c.208G > A mutation.Case presentationA 20 s man whose left eye visual acuity gradually declined for half a year. The visual acuity of the left eye is counting fingers. Fundus examination revealed that retinal hemangioblastoma was also found in addition to typical CRVO signs such as tortuous expansion of retinal veins and flame-shaped hemorrhage of the retina. Liver tumor, cerebral infarction and erythrocytosis were found during systemic examination, and the diagnosis of polycythemia was confirmed by bone marrow smear. Furthermore, both family history and genetic analysis indicated that the patient had VHL disease caused by VHL c.208G > A. In this patient, a large number of bone marrow erythrocytes proliferated due to VHL disease, which led to the increase of blood viscosity and erythrocyte vascular adhesion, resulting in the obstruction of central retinal vein blood flow, and finally CRVO. For CRVO and its pathogenic factor polycythemia, patient received laser retinal photocoagulation and phlebotomies. After a 1-year follow-up, the vision in the left eye improved to 0.2 logMAR.ConclusionsThis is a rare case of polycythemia complicated by CRVO in patient with VHL disease. It reminds us that the systemic disease factors should be fully considered in the diagnosis of young patients with CRVO, and that treatment requires a coordinated effort of physicians.

ODP506 Posterior Staphyloma misdiagnosed as unilateral Grave's ophthalmopathy

Abstract 21 year old female presented to our clinic for management of "grave's disease" She was given diagnosis of Graves’ disease three years before presentation to our institution She was treated with PTU for 2-3 months then it was stopped On physical exam On physical exam she has a small diffused goiter Left eye was prominent without chemosis or lid lag Right eye was normal Decreased vision in the left eye, counting fingers only Thyroid function was normal Thyroid receptor antibody was negative Because of decline of vision and unilateral protrusion of Left eye she was referred to ophthalmology for further evaluation. MRI of the Orbits was ordered MRI revealed findings consistent with Staphyloma Staphyloma is a chronic eye condition which results from poor vision if left untreated and causes increase in AP diameter of eye which results in protrusion of eye which might be confused with grave's ophthalmopathy This diagnosis should be considered when patients present with unilateral ophthalmopathy, especially if there is significant decline in vision in the effected eye. Since she presented late in adulthood there is no treatment to improve her vision at this point From the thyroid standpoint she had negative thyroid antibodies and normal thyroid function Ultrasound of thyroid showed thyroid to be diffusely enlarged with homogenous texture Complete eye exam by ophthalmology is indicated in evaluation of ophthalmopathy especially in case of red flags like decreased vison or unilateral presentation With unilateral Ophthalmopathy MRI of the orbits should be part of the workup to exclude other etiologies such as retro-orbital tumors which may be confused with grave's ophthalmopathy. As evident in this case MRI revealed different diagnosis. Presentation: No date and time listed

Outcomes of Zone 3 Open Globe Injuries by Wound Extent: Subcategorization of Zone 3 Injuries Segregates Visual and Anatomic Outcomes

Open globe injuries (OGIs) are categorized by zone, with zone 3 (Z3) comprising wounds > 5 mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogeneous. Open globe injuries with far posterior Z3 (pZ3) wounds were hypothesized to have worse visual and anatomic outcomes. Single-center retrospective cohort study. A total of 258 eyes with Z3 OGIs. A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥ 10 mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes. Visual acuity on a logarithm of the minimum angle of resolution (logMAR) scale. Secondary outcomes included anatomic outcomes, development of retinal detachment and proliferative vitreoretinopathy, and the number of secondary surgeries. A total of 258 Z3 OGI eyes with > 30 days follow-up were assessed; 161 (62%) were pZ3. At 3-month follow-up, pZ3 OGIs were more likely to exhibit no light perception (pZ3: 38%; aZ3: 17%; P < 0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; P < 0.002), and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; P < 0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared with aZ3 injuries (P < 0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β= 0.29, 95% confidence interval [CI], 0.09-0.50, P < 0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse, and afferent pupillary defect. Far posterior wounds injuries were more likely to develop retinal detachments (pZ3: 87%; aZ3: 71%; P < 0.01) and proliferative vitreoretinopathy (pZ3 66%; aZ3 47%; P < 0.03). Patients with pZ3 OGIs were significantly more likely to reach poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with patients with aZ3 OGI (pZ3: 56%; aZ3: 40%; P < 0.03). Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improves the prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases. Proprietary or commercial disclosure may be found after the references.

STUDY OF OUTCOMES IN PATIENTS OF CHRONIC SIMPLE GLAUCOMA UNDERGOING SMALL INCISION CATARACT SURGERY WITH TRABECULECTOMY

Aim:To study outcomes of procedure ( Small incision cataract surgery with PCIOL implantation with trabeculectomy) in terms of visual acuity , intraocular pressure and complications. Methodology: A hospital based descriptive longitudinal study was done on 22 patients with chronic simple glaucoma operated at Pravara rural hospital ,Loni. The pre-operative and post operative data was collected in terms of Visual Acuity recorded with Snellens chart and Intra Ocular pressure recorded with help of Applanation Tonometer or Non Contact Tonometer in uncooperative patients. The Trabeculectomy and SICS with PCIOL were performed at separates site.The preoperative mean IOP was 28 mmHg with good functional visual acuity ranging from Finger counting 4 meters to 6/24 with coexisting cataract. The IOP and VA were noted post operative 1 Week and 6 weeks. Results: Mean age of the patients in the study was 74 , 5 ( 22.7 %) were less than and equal to 60 years , 8 ( 36.3 % ) were between 61 and 70 years , 7 ( 31.8 % ) were between 71 and 80 years , 2 ( 9.1 %) were above 80 years .Out 0f 22 patients , 16 (72.7%) were male and 6 ( 27.3) were female .Mean intraocular pressure on post operative 1 week and 6 weeks was 17.3 mmHg and 17 mmHg respectively . Significant visual improvement was seen in patients who underwent combine surgery .Postoperative BCVA at 6 weeks below 6 / 60 in 3 patients (13.6 %) , between 6 /60 to 6/24 in 9 ( 40 .9 %) , above 6 /24 in 10 patients (45.5 %). Conclusion: Management of coexisting cataract with chronic simple glaucoma in one setting has advantage of no financial burden as financial burden is main cause of non compliance in the poor rural population.

Effectiveness of laser coagulation in children with Coats’ disease

AIM: This study aimed to investigate the effectiveness of retinal laser coagulation in children with Coats disease.&#x0D; MATERIAL AND METHODS: The study included 118 patients who were examined and treated from January 2017 to December 2021; 102 of them were boys (86.6%) and 16 were girls (13.4%). All children had unilateral disease. All children underwent a comprehensive ophthalmological examination. Laser coagulation was performed in 113 patients using a green laser (532 nm). The number of retinal laser coagulation sessions ranged from 2 to 13 (on average 5.22.36) with intervals from 1.5 to 6 months (on average 2.010.46).&#x0D; RESULTS: Generally, retinal laser coagulation was effective in CD in 85.8% of cases (in 97 of 113 children). Effectiveness was 100% for vascular malformations and exudates outside the macula, 97.3% for vascular and exudative retinal changes involving the macular zone, 92.3% for local retinal detachment, 90.5% for widespread retinal detachment, 60.0% for subtotal retinal detachment, and 30.0% for total. Only those who had peripheral Coats disease symptoms were found to have visual acuity of 0.6 or above, both before and after treatment. Visual acuity did not exceed 0.1 in 92% of patients with vascular and exudative changes in the periphery and in the macula and in 94% with local and widespread retinal detachment. After successful retinal laser coagulation, 11 children (13.4%) had visual acuity of 0.4 or higher, 13 children (15.9%) had visual acuity between 0.1 and 0.3, 45 children (54.9%) had finger count of 0.09, and 13 children (15.9%) lack objective vision.&#x0D; CONCLUSION: Retinal laser coagulation using a laser with a wavelength of 532 nm is an effective method for treating CD at all stages, including cases of the disease with the development of retinal detachment.