Good Visual Recovery Research Articles

Bilateral Granular Macular Dystrophy Associated with Bilateral Cataracts: About a Case

Macular granular dystrophy is an autosomal recessive genetic disease characterized by corneal opacities responsible for a decrease in visual acuity. We report a case of bilateral granular dystrophy associated with cataract in a young adult seen at Zinder National Hospital. This is a 51-year-old patient with no significant personal or family ophthalmological history who consulted the ophthalmology department of the National Hospital of Zinder for progressive and bilateral visual acuity decline that has been evolving for several years. The ophthalmological examination of the day noted a decrease in visual acuity at a distance in bilateral., corneal deposits in stain and a grade II cortico-nuclear cataract was noted. Immediate bisequential cataract surgery was performed using the phacoAlternative technique with simple postoperative follow-up and good visual recovery. Keywords: Groenouw II, cataract, Zinder

A series of atypical cases of exudative retinal detachment with diagnostic dilemma presenting to a rural eye care center in South India

Abstract Introduction: Retinal detachment results due to the accumulation of fluid in the subretinal space. Retinal detachment can be rhegmatogenous, exudative, or tractional detachment. Exudative detachment occurs due to various choroidal or retinal pathologies. We report a case series of exudative retinal detachment (ERD) with atypical presentation, who were diagnosed and treated in our retina clinic. The aim of our study was to stress on the timely etiological diagnosis in patients who present with ERD in achieving a good visual recovery. We also would like to emphasize thorough systemic evaluation in the management of such cases. Materials and Methods: In this case series, patients who presented to our institution with ERD underwent a comprehensive ocular and systemic evaluation in order to determine the underlying etiology. Results: Our study showed that inflammatory causes, whether infectious or noninfectious uveitic conditions and certain systemic conditions unrelated to uveitis can also cause ERD. Conclusion: A thorough examination of both ocular and systemic condition is crucial for identifying the cause of ERD, ultimately aiding in the preservation of vision. In addition, timely recognition and management of any underlying systemic conditions by the appropriate specialist can significantly decrease the morbidity and mortality in these patients. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

Endophthalmitis following vitrectomy for malignant glaucoma: Multidrug-resistant Klebsiella pneumoniae

The purpose of this case report is to present a case of acute-onset postoperative endophthalmitis, caused by multidrug-resistant (MDR) Klebsiella pneumonia, following pars plana vitrectomy for malignant glaucoma. A 52-year-old male patient underwent elective phacoemulsification cataract surgery with intraocular lens implantation in the right eye. Two weeks later, the patient presented with a diminution of vision and clinical features suggestive of malignant glaucoma. With no response to conventional treatment, pars plana vitrectomy was done. Acute-onset postoperative endophthalmitis developed, with severe intraocular inflammation, caused by MDR Klebsiella pneumoniae. The isolates demonstrated sensitivity to polymyxins and tigecycline only. Intravitreal colistin (0.1 mg/0.1 mL) was administered. The response was satisfactory and the vision could be salvaged. At 2 months follow-up a visual acuity of 20/50 was recorded. This is a rare case report of acute-onset postoperative endophthalmitis due to MDR Klebsiella following pars plana vitrectomy. With timely intervention, the patient came out of two difficult situations of malignant glaucoma and MDR endophthalmitis with a reasonably good visual recovery.

Early and Intensive Management of Chemical Eye Injuries: Case Series

Chemical injuries of the eyes are true ophthalmic emergencies causing significant visual morbidities. They require urgent and immediate assessment and intervention. They are more common in young adults either due to accidental causes or due to criminal assaults. They severely damage the ocular structures; surface epithelium, cornea, conjunctiva, limbal stem cells and can cause permanent unilateral or bilateral vision loss. In this article, we are trying to emphasis on the importance of initiating treatment in the early phase of ocular chemical injury and also emphasizing on extent of chemical ocular injuries, their severity and their varied outcomes through two different types of cases; one with good visual recovery with early initiation of treatment and the other developing complications in spite of being initiating treatment in early phase.

Ophthalmic manifestations as the first presenting feature in dengue fever: a 10-year study.

Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.

Restoring vision after cat bite: a case report on successful diagnostic and therapeutic regimen for Capnocytophaga endophthalmitis

BackgroundCapnocytophaga is a bacterium frequently found in the oral flora of dogs and cats (e.g. Capnocytophaga canimorsus) and humans (e.g. Capnocytophaga gingivalis). Among Capnocytophaga related ocular infections, fulminant endophthalmitis is a rare but sight-threatening clinical manifestation.Case presentationA 35-year-old previously healthy patient presented after a cat bite into the left upper and lower eyelid and nasal part of the conjunctiva of the left eye. At initial consultation, the corrected visual acuity was 0.8 in decimal scale and a detailed clinical examination revealed no evidence of ocular penetration. However, daily follow-up examinations under local therapy revealed a progressive intraocular inflammation, therefore the decision was made to perform a diagnostic vitrectomy with intravitreal and systemic antibiotic treatment. Capnocytophaga felis was detected as the cause of endophthalmitis and the initiated treatment resulted in quick morphological and functional recovery of the left eye. After surgery of secondary cataract, visual acuity improved from hand motion preoperatively to 1.0 postoperatively.ConclusionsEarly recognition as well as prompt and effective treatment of animal bite associated endophthalmitis is essential for good visual recovery and functional outcome. Furthermore, this case highlights the importance of daily follow-up examinations, even in the absence of signs of ocular penetration and intraocular inflammation, to enable prompt and effective treatment initiation. Given the negative results in bacterial culture, we additionally emphasize the value of sequencing-based microbiological diagnostics in unclear cases.

Delayed Spontaneous Closure of a Full Thickness Myopic Macular Hole with Good Visual Recovery

Purpose: To present the longitudinal progression of a myopic macular hole with eventual closure and excellent visual recovery over a decade after initial full-thickness hole formation. Methods: The patient was monitored using time-domain and spectral-domain optical coherence tomography images over 16 years. Results: A 68-year-old man with high myopia was referred for surgical evaluation of a full-thickness macular hole and retinal detachment of his left eye, which were repaired. At initial presentation, the fellow eye demonstrated a lamellar hole, which eventually also progressed to become a full-thickness macular hole. The patient subsequently declined surgery and was observed semiannually over the course of 16 years. At 10 years following initial injury, the full-thickness macular hole closed spontaneously. The visual recovery was excellent with an acuity of 20/25. Conclusion: Although surgical intervention remains the mainstay of treatment for macular holes, patients who are not surgical candidates may still have good visual and anatomic outcomes even long after initial hole formation. Lamellar hole epiretinal proliferation material is frequently seen in myopic full-thickness macular holes and may be associated with eventual delayed hole closure due to their slow progression.

Retinal detachment following lightning injury mimicking acute retinal necrosis: A case report

A 16-year-old male presented with a diminution of vision after 1 month of lightning injury. Fundus examination showed inferior retinal detachment with multiple sieve-like breaks. After pars plana vitrectomy, he developed mutton fat keratic precipitates and anterior segment inflammation. Sieve-like breaks and mutton-fat keratic precipitates (MF-KPs) led to the diagnostic dilemma of viral etiology. The patient responded well to treatment with steroids and antivirals, showing good visual recovery after silicone oil removal. Lightning strike injury–related retinal detachment can rarely mimic an acute retinal necrosis (ARN)-related retinal detachment (RD).

Risk Factors and Outcome of Hyphema in Blunt Injury to Eye

Objectives: To study the causes, associated ocular findings and visual acuity on presentation, complications and visual outcomefollowing treatment in patients of hyphema due to blunt injury.Methods: A retrospective observational study was performed in 80 patients with hyphema due to blunt injury presenting tothe outpatient and emergency department of the tertiary care centre of Gorakhpur, Uttar Pradesh for a period of 6 months. Thegender, age, race, cause of blunt injury resulting in hyphema, eye involved, vision at admission, other associated ophthalmologicalfindings, complications and visual outcomes were noted from the case records of patients. The data was analyzed using SPSSprogramme using the chi-square test.Results: Males were more predominantly affected (88.75%). Half of the patients were aged below 30 years. Sports-related injury(51.25%) was the most common cause for hyphema. Hyphema disappeared within 5 days in 68.5% of patients. Iris injuries werevery commonly associated in the form of mydriasis, iridodialysis. The best corrected vision of 6/18 or better was noted in 46.25%of patients at the last follow-up. The follow-up of these subjects was very poor and thus the incidence of secondary glaucomacould not be established. A significant association was seen between Best corrected visual acuity (BCVA) at presentation andat 6 weeks follow-up (p<0.05).Conclusion: Sports-related injury is the most common cause of hyphema. Good visual recovery, without serious complications,is possible with appropriate and in-time treatment in hyphema patients due to blunt injury.

A Study of Visual Improvement and Variation in IOP Following Nd-YAG Laser Capsulotomy

AIM: To study the visual improvement and to correlate the effect of energy used and number of shots with post procedural IOP spike following Nd-YAG laser capsulotomy cases. MATERIALS AND METHODS: A total of 36 patients presented with pseudophakia with PCO attending ophthalmology outpaient department at Rajah Muthiah medical college hospital during the period of October 2020 - December 2022 were included in the study. Patients with glaucoma, Uveitis, high myopia, posterior segment disorders will be excluded from the study. The patient will be subjected to visual acuity testing, detailed slit lamp examination, IOP measurement using Non-contact tonometer pre and post laser procedure and detailed fundus examination done and results were interpreted. OBSERVATION: Among the total 36 participants, 31.4% belong to age group 56 to 65 years followed by 28.6% in the age group 66 to 75 years. 51.4% were males and 48.6% were females. Of the total participants 28.6% had visual acuity of 6/24 in the affected eye and 22.9% had visual acuity of 6/36 in the affected eye.one subject presented with visual acuity of hand movements (HM) only in the involved eye.The mean pre-operative intraocular pressure among the participants was 1.85±0.73. 45.7% had preoperative IOP of 13 to 16 mmHg and 34.3% had preoperative IOP of 8 to 12. The mean number of YAG shots among the participants was 1.96±0.81. 36.3% were provided with 5 to 8 YAG shots and 33.3% with 2 to 4.The mean IOP among the participants in the preop was 14.03±2.92. The mean IOP immediately after the intervention was 15.29±2.83.The mean IOP 20 mins after the intervention was 17.43±2.96.Our study shows that the change in mean IOP after ND YAG LASER administration was significant with P value of less than 0.05 and also our study shows improvement in post laser BCVA with significant P values CONCLUSION: The study concluded that all patients had good visual recovery. The post laser IOP raise is minimal and transient. It varies with amount of laser energy used. Hence recommended to use minimum possible laser energy and must be followed up for raised intraocular pressure changes. Keywords: Intraocular pressure, Neodymium: Yttrium Aluminium GARNET Capsulotomy.

A 48-year-old Caucasian man with unilateral "smudge" in inferior visual field.

To report an increasingly prevalent fundoscopic manifestation of syphilitic uveitis. Case report of a patient with acute retinal necrosis secondary to syphilis. A 48-year-old man presented with decreased vision, anterior segment inflammation, and a wedge-shaped retinal lesion in the superior periphery, with a diaphanous leading edge extending down towards the superior arcade. The patient was HIV+ and poorly compliant with therapy. The top three differential diagnoses were herpetic necrotizing retinitis, syphilis, and lymphoma. An extensive lab workup was positive for syphilis. The patient was treated with IV penicillin G and demonstrated improvement in visual acuity and exam. There have been an increasing number of reports of syphilis patients, especially in the population of men who have sex with men, who present with fundus findings similar to acute retinal necrosis. These findings include a characteristic ground glass, translucent appearance of unifocal or multifocal lesions, primarily affecting the inner retina and sometimes associated with co-localizing occlusive vasculitis. Treatment with IV penicillin G is warranted and has demonstrated good visual recovery.

Bilateral Serous Retinal Detachment as a Complication of HELLP Syndrome.

HELLP syndrome is a pregnancy complication, putting at risk the life of mother and child, characterized by high blood pressure, elevated liver enzymes and low platelets. Serous retinal detachment is a rare complication of pregnancy and may be associated with HELLP syndrome. One of the most common symptoms is a decrease in visual acuity. A rare case of bilateral exudative retinal detachment associated with HELLP syndrome is described in a 38-year-old woman a few hours after delivery. Optical coherence tomography (OCT) showed an amount of subretinal fluid and macular edema. Use of systemic corticosteroids and careful management of blood pressure led to early resolution of subretinal fluid and a good recovery of vision. Her final best corrected visual acuity was 1 (decimal notation) in both eyes at 2 weeks after delivery. These types of cases are rarely reported and highlight the importance of increasing awareness of this pathology among ophthalmologists.

Traumatic anterior phacocele

A 72-year-old lady complained sudden-onset loss of vison in the left eye after falling from bed. She was only able to perceive light from the left eye. Anterior segment examination showed a solid subconjunctival mass in the superonasal quadrant adjacent to limbus, suggestive of anterior phacocele. Ultrasound B-scan confirmed the diagnosis, and patient was taken for surgery which led to good visual recovery. Appropriate and timely diagnosis and management of such cases can improve prognosis of such cases.

Identifying predictive factors for long-term visual recovery after corneal endothelial keratoplasty in Fuchs' dystrophy: Potential interaction between the corneal dysfunction and retinal status.

Descemet membrane endothelial keratoplasty (DMEK) is the main treatment for Fuchs' dystrophy (FECD). The outcomes are excellent, but the final visual recovery may vary from patient to patient with sometimes no obvious reason of such a spread. We conducted a clinical prospective multicentric study to identify the predictive factors for the visual result 1 year after surgery. Eighty three patients (83 eyes) were included. Postoperative BCVA after 1 year was 0.20 ± 0.18 logMAR. Logistic regression revealed that good visual recovery correlated negatively with preoperative central macular thickness (p < 0.001) and the need for rebubbling (p = 0.05), and positively with preoperative visual acuity (p = 0.009). Multivariate formula to predict the 1-year BCVA has been suggested. Preoperative retinal status seems to be the main predictive factor for long-term visual result after DMEK. Our predictive multivariate model could assist in better informing the patient about the prognosis of the surgery, and in adjusting the therapeutic strategy also, further highlighting the essential collaboration between both cornea and retina subspecialists.

Brain structural and functional MRI alterations and their predictive value for the visual outcome at 3 years in clinically isolated optic neuritis

To investigate the structural and functional magnetic resonance imaging (MRI) alterations and their clinical significance for predicting visual outcomes at 3 years in clinically isolated optic neuritis (CION). Forty-three CION patients and 44 matched healthy controls (HC) underwent a three dimensional (3D) T1-weighted and resting-state functional MRI using a 3 T MRI system. Grey-matter volume (GMV) and functional MRI measures were compared among HC and CION patients with good and poor outcomes. The correlations between MRI measures and visual outcomes were investigated, and a binary logistic regression model was performed to predict the visual outcome. CION patients with good and poor outcomes showed similar patterns of decreased GMV and increased functional MRI activities compared to HC. Compared to patients with good visual recovery, CION patients with poor visual recovery showed significantly reduced GMV in the insula and superior temporal gyrus (STG), decreased amplitude of low-frequency fluctuation (ALFF) in the inferior frontal gyrus (IFG), and increased functional activities in the middle frontal gyrus (MFG) and middle temporal gyrus (MTG). Binary logistic regression analysis predicted poor visual recovery, including decreased GMV in the bilateral insula (right insula: odds ratio [OR]=17.46, p<0.001; left insula: OR=10.538, p=0.001; respectively) and STG (OR=16.551, p<0.001) and increased ALFF (OR=17.148, p<0.001) and regional homogeneity (OR=10.068, p=0.002) in the left MTG. CION patients showed decreased GMV and increased functional activities predominantly located in visual- and cognition-related areas. Decreased GMV and increased ALFF or regional homogeneity in the high-order visual regions (insula, STG, and MTG) are promising imaging markers predicting poor visual outcomes at the 3-year follow-up.

A 10-Year Single-Center Study of the Clinical Characteristics of Optic Neuritis-Related NMOSD, MS, and Double Seronegative Optic Neuritis, Together with Factors Predicting Visual Outcomes.

The clinical characteristics of three types of optic neuritis (double seronegative optic neuritis; DN-ON, Neuromyelitis optica spectrum disorder-related optic neuritis; NMOSD-ON, and multiple sclerosis-related optic neuritis; MS-ON) were examined in order to identify factors that may affect good visual recovery in Thai patients. The study included patients diagnosed with three types of optic neuritis at Rajavithi Hospital between 2011 and 2020. Visual acuity at the end of 12 months was used as the treatment outcome. Multiple logistic regression analysis was used to evaluate potential predictors of good visual recovery. Of the 76 patients, 61 had optic neuritis, with DN-ON as the most common subtype (52.6%). MS-ON patients were significantly younger (28.3 ± 6.6 years, p = 0.002) and there was a female predominance in all subgroups (p = 0.076). NMOSD-ON patients had a significantly higher proportion of poor baseline VA (p < 0.001). None of the NMOSD-ON patients achieved 0.3 logMAR visual recovery in the 12-month period (p = 0.022). A delay in treatment with intravenous methylprednisolone (IVMP) for more than 7 days increased the risk of failure to gain 0.3 logMAR visual recovery by five times (OR 5.29, 95% CI 1.359-20.616, p = 0.016), with NMOSD-ON as the strongest predictor (OR 10.47, 95% CI; 1.095-99.993, p = 0.041). Early treatment with intravenous methylprednisolone may be important for achieving at least 0.3 logMAR visual recovery in Thai patients with optic neuritis.

Pneumatic Retinopexy Involving the Use of Intravitreal Air Injection and Laser Photocoagulation for Rhegmatogenous Retinal Detachment in Phakic Eyes

The clinical efficacy of pneumatic retinopexy (PR) using intravitreal pure air injection and laser photocoagulation for rhegmatogenous retinal detachment (RRD) remains unknown. Thirty-nine consecutive patients with RRD (39 eyes) were included in this prospective case series. All patients underwent two-step PR surgery containing pure air intravitreal injection and laser photocoagulation retinopexy during hospitalization. The main outcomes were best-corrected visual acuity (BCVA) and primary anatomic success rates after PR treatment. The mean follow-up was 18.3 ± 9.7 months, ranging from 6 to 37 months. The primary anatomic success rate was 89.7% (35/39) after PR treatment. Final reattachment of the retina was achieved in 100% of cases. Macular epiretinal membrane was developed in two patients (5.7%) among successful PR cases during the follow-up. The mean logMAR BCVA value was significantly improved from 0.94 ± 0.69 before surgery to 0.39 ± 0.41 after surgery. The average central retinal thickness was significantly thinner in the RRD eyes of macula-off patients (206.8 ± 56.13 μm) when compared with the fellow eyes (234.6 ± 48.4 μm) at the last follow-up (p = 0.005). This study concluded that an inpatient PR procedure with pure air injection and laser photocoagulation is a safe and effective approach to treating patients with RRD, who may achieve a high single-operation success rate and good visual acuity recovery.

Factors Affecting Visual Recovery in Patients with Ethambutol-Induced Optic Neuropathy.

To study visual recovery and identify the factors that may affect it in patients with ethambutol-induced optic neuropathy (EON). Medical charts of patients who developed optic neuropathy after ethambutol (EMB) treatment for tuberculosis infection were retrospectively reviewed. Demographic details and clinical data were examined to assess visual recovery after discontinuation of ethambutol treatment. The univariate and multivariate relationships between various factors and visual recovery were evaluated using regression analysis. Of 5394 patients diagnosed with tuberculosis infection and treated with EMB, 23 patients (0.43%) were diagnosed with EON. Logistic regression analysis found that female sex was the categorical factor significantly associated with good visual recovery with an odds ratio of 12.0 (95% confidence interval 1.56, 92.29; p = 0.02), while linear regression analysis identified good initial visual acuity as the numerical factor significantly related with it (p < 0.001). After adjustment with multivariate analysis, initial visual acuity was found to be the only significant factor associated with visual recovery. All patients with initial visual acuity of better than 20/200 at first visit achieved good visual recovery. The incidence of EON in patients treated with EMB was 0.43% in this hospital-based study. Good visual recovery was noted in 39.13% of these patients, and initial visual acuity was the factor that affected visual recovery. It is recommended that patients on EMB have regular screening by an ophthalmologist for early detection of the disease, and if it is discovered, that the use of the drug be immediately discontinued in order to prevent potentially devastating visual loss.

Posterior lens capsular neovascularization in the absence of any risk factors

Neovascularization of the posterior capsule after uncomplicated cataract surgery is a rare occurrence. This case entails a similar presentation, however, in the absence of any known predisposition. An 80-year-old male presented with painless progressive diminution of vision in his right eye after having undergone uncomplicated cataract surgery with good visual recovery 3 years back. He had a visual acuity of counting fingers close to face with accurate projection of rays with no further improvement. He was found to have posterior capsular opacification with capsular neovascularization. He was managed with intravitreal ranibizumab followed 2 weeks later by neodymium: yttrium-aluminum-garnet capsulotomy clearing the visual axis. His visual acuity improved; however, the best-corrected visual acuity was 6/60 due to an epiretinal membrane.

Retinal pigment epithelium tear in an idiopathic acute onset bullous central serous chorioretinopathy

Although retinal pigment epithelium (RPE) tears are common in patients with chronic conditions such as exudative age-related macular degeneration or may occur in response to anti-vascular endothelial growth factor or laser treatment, a spontaneous RPE tear can occur in patients with acute and new-onset bullous central serous chorioretinopathy (CSCR). We present a rare case of a healthy young Asian man with unilateral massive subretinal fluid (SRF). An idiopathic acute-onset bullous CSCR with an RPE tear was diagnosed through ancillary examinations. This patient exhibited good visual recovery as indicated by foveal sparing, spontaneous resolution of SRF, and the lack of a need for unnecessary surgery.