Left Eye Research Articles

Monocular Tuberculosis-Related Serpiginous-Like Choroiditis with Acute Posterior Multifocal Placoid Pigment Epitheliopathy-Like Presentation in a Danish Patient.

To report a case of tuberculosis-related serpiginous-like choroiditis (TB-SLC) in Denmark in a patient with few risk factors. Single case report. A 54-year-old Caucasian male with no relevant travel history presented with unilateral light placoid confluent elements in the macula of the right eye with a best-corrected visual acuity of 0.2 Snellen. The left eye was normal. Wide-field Fluorescein and Indocyanine green-angiography were performed, and findings were consistent with acute posterior multifocal placoid pigment epitheliopathy. Since the condition was considered sight-threatening, and the patient had no recognizable risk factors for tuberculosis (TB), he was prescribed 50 mg of oral prednisolone. Blood tests and an X-ray were ordered to exclude infectious causes. The first interferon-ỿ release assay (IGRA) test was inconclusive and a new test was ordered. Over the following weeks new white dots appeared in the retina. After the patient had been treated for seven weeks with prednisolone, the second IGRA came back positive, and he was diagnosed with TB-SLC. Upon repeated questioning two months after baseline, the patient remembered that ten years ago he had been in a workplace with 50 different nationalities, and seven years ago he had been in contact with a friend who was treated for latent TB, thus supporting relevant exposure. TB-SLC may occur even in a patient with few recognizable risk factors and in a setting that is not TB endemic. It is imperative to continuously reassess differential diagnoses and initiate or repeat paraclinical testing in cases with atypical features.

Bilateral Hemorrhagic Occlusive Retinal Vasculitis Induced by Osimertinib in a Patient with Non-Small Cell Lung Cancer.

To report a case of bilateral retinal vasculitis in a patient with non-small cell lung cancer undergoing treatment with osimertinib. A 58-year-old woman with lung adenocarcinoma (T4N3M1a stage IV) presented with blurry vision in both eyes (OU). Eighteen months before symptom onset, the treatment was changed from afatinib (20 mg/day) to osimertinib (80 mg/day) because of tumor progression. The visual acuity was 20/30 and 20/25 in the right and left eyes, respectively. Clinical examination revealed few anterior chamber cells, 2+ vitreous cells, haze, and multiple retinal hemorrhages in the peripheral retinas (OU). Fluorescein angiography revealed retinal vasculitis with a severely non-perfused area in the periphery. These findings indicated hemorrhagic occlusive retinal vasculitis (HORV). Osimertinib was reduced to 40 mg/day, and oral prednisolone was started at 30 mg/day. This improved retinal vasculitis; however, the ischemic area did not improve. Pan-retinal photocoagulation was performed while tapering the oral prednisolone to 10 mg/day. Although macular edema (ME) occasionally occurred (OU), systemic and local treatment with steroid-stabilized HORV and ME helped increase the dose of osimertinib to 80 mg/day without cancer progression for 18 months. Her visual acuity remained 10/20 (OU). Osimertinib, a third-generation tyrosine kinase inhibitor, can be used to treat advanced non-small cell lung cancer with epidermal growth factor receptor mutation-induced bilateral HORV. This adverse effect can be managed with systemic and local steroid treatment and continued osimertinib administration.

Comparison of the Effect of Different Treatment Doses of Intrastromal Vancomycin in a Rabbit Model of Methicillin-Resistant Staphylococcus Aureus (MRSA) Keratitis.

To compare the effect of different doses of vancomycin on a rabbit model of MRSA keratitis. Twenty-four eyes of 24 New-Zealand White rabbits were included in the study. MRSA keratitis was applied to 24 left eyes of 24 New Zealand rabbits. Twenty-four hours after MRSA inoculation; 0.5 mg/0.1 mL, 1 mg/0.1 mL, and 2 mg/0.1 mL and balanced salt solution were administered to 6 rabbits in 4 groups, respectively. The effect of different doses of vancomycin on reducing bacterial load was found to be statistically significant when each was compared to the control group (p = 0.006). When comparing the dosages with each other, no superiority was shown (p = 0.297, p = 0.749, p = 0.262 respectively). There was a significant increase in the posttreatment total clinical score in the control and 2 mg/0.1 mL groups compared to the pretreatment score (p = 0.001, p = 0.001 respectively). It is emphasized that necessary treatment can be achieved by administering less antibiotic (0.5 mg/0.1 mL) to the corneal intrastromal area.

In Vivo Confocal Microscopy Findings of a Rare Cryptococcus neoformans Keratitis.

To report a rare case of fungal keratitis caused by Cryptococcus neoformans, highlighting its unique morphological features using in vivo confocal microscopy (IVCM). This was a retrospective case report. A 66-year-old man presented with foreign body sensation and blurred vision in his left eye for over 10 months. His best-corrected visual acuity was 20/20. Slit-lamp examination revealed a gray-white lesion approximately 4-5 mm in the superficial layer of the central cornea without epithelial defects. The IVCM images revealed numerous round or round-like pathogens, each with a central highly reflective body surrounded by a dark ring, ranging in size from 5 to 30 µm, and to a maximum of 85 µm, observed in the corneal epithelium and superficial stroma. No obvious inflammatory cell infiltration was observed in the lesions or endothelium. C. neoformans infection was confirmed. The round pathogens completely disappeared after 8 weeks of treatment with topical amphotericin B and voriconazole eye drops. Fungal keratitis caused by C. neoformans is rare and easily overlooked due to atypical clinical signs and symptoms. This case reports the unique morphological features of C. neoformans in the cornea using IVCM for the first time, facilitating rapid, noninvasive auxiliary diagnosis of C. neoformans keratitis and treatment follow-up.

Distribution of angle alpha and angle kappa offsets among adult candidates for cataract surgery.

The current study aimed to describe the distribution of angle alpha and angle kappa offsets as well as their associated ocular biometric parameters in a large population of candidates for cataract surgery. This cross-sectional retrospective study included 8,119 eyes of 4,781 candidates for cataract surgery (mean age 70.7 ± 12.9 years). There were 49.9% right eyes, and 53.0% patients were females. The angles offset and ocular biometric parameters were measured by the IOLMaster 700 (Carl Zeiss Meditec, AG, Germany). Patient's age and gender, and most of their ocular biometric measurements were similar for the right and left eyes except for pupil diameter (4.01 ± 1.18 vs. 3.92 ± 1.14 mm, respectively, P< 0.001). The angle alpha offset magnitude was similar for the right and left eyes (0.50 ± 0.20 and 0.51 ± 0.21 mm, P= 0.08), whereas the angle kappa offset magnitude was greater in the right eyes (0.37 ± 0.21 vs. 0.33 ± 0.20 mm, P< 0.001). The angle kappa offset magnitudes were greater in the right eyes compared to the left eyes for both males (0.36 ± 0.21 vs. 0.33 ± 0.21 mm, respectively, P< 0.001) and females (0.37 ± 0.20 vs. 0.34 ± 0.20 mm, respectively, P< 0.001). The offset magnitudes of both angles varied significantly according to gender, eye laterality, angle location, and biometric parameters (e.g., axial length). The offset magnitudes of both angles were positively correlated in both right and left eyes. The offset magnitudes of both the angle alpha and angle kappa present significant variations according to gender, eye laterality, angle location, and biometric parameters, such as AL. These values are also population-specific.

Monkeypox-related ophthalmic disease (MPXROD): Monitoring the antiviral effect of tecovirimat with monkeypox virus detection in tear samples.

Although monkeypox-related ophthalmic disease (MPXROD) is rare, visual impairing complications have been reported. At present, tecovirimat is the standard-of-care antiviral treatment. In this MPXROD case, the effect of tecovirimat was assessed with PCR analysis of tear samples and concurrent monitoring of inflammation with laser flare photometry (LFP). The patient presented with a palpebral lesion and a corneal ulcer in his right eye, with complete absence of the corneal epithelium, high intraocular pressure and anterior uveitis. MPXV-DNA was detected in tear samples with real-time PCR (RT-PCR). A total volume of 0.5 ml tear-wash was aspirated from the inferior fornix, following instillation of saline onto the ocular surface. In addition, LFP was used to quantify inflammation in both eyes. Viral load in tear samples was detected prior to treatment initiation. In the left eye, tear samples tested negative for MPXV-DNA one week post-treatment while MPXV-DNA was still detected in the right eye, before reaching undetectable levels four weeks post-treatment. Objective quantification of anterior chamber inflammation through LFP demonstrated gradual decrease that was more pronounced in the affected right eye and coincided with the clinical improvement of the corneal ulcer. This case of Mpox related corneal ulcer with associated uveitis manifests the feasibility of monitoring the antiviral effect of tecovirimat with virus detection in tear samples and LFP. Our observations indicate that tecovirimat resulted in viral load reduction in both eyes. RT-PCR MPXV detection in tear samples and LFP represent noninvasive tools that could assist with treatment response monitoring.

Posterior staphyloma-induced serous maculopathy: Evolution and successful treatment with subthreshold micro pulse Laser.

To describe the evolution of posterior staphyloma-induced serous maculopathy (PSISM) in a patient with myopic tilted disc syndrome and its treatment with subthreshold micro pulse laser (SMPL) therapy. A 38-year-old male, diagnosed previously with classical features of myopic tilted disc syndrome presented to the retina clinic after 5 years from the initial presentation with blurred vision in the right eye for 6 months, visual acuity of 6/15 and findings of serous macular detachment (SMD) and subretinal precipitates at the upper margin of the posterior staphyloma. Retinal imaging ruled out other causes of SMD such as chronic central serous chorioretinopathy, myopic macular neovascularisation and dome shaped macula. A diagnosis of PSISM was confirmed. The left eye fundus and macula was normal. Confluent SMPL burns were applied across the SMD. The serous maculopathy resolved over a period of 2 months and visual acuity improved to 6/9. No recurrence of SMD was noted even after 14 months post SMPL. PSISM develops gradually in eyes with myopic titled disc syndrome. SMPL is a viable therapeutic option in the management of PSISM and should be considered early in the treatment options.

Changes in optic nerve sheath diameter and its correlation with degree of consciousness, pupil diameter, and light reflex in children with central nervous system infection after osmotherapy

BackgroundHigh intracranial pressure (ICP) is one of the most common complications of central nervous system (CNS) infection. Failure to control high intracranial pressure results in brain herniation and death. One of the treatments for high ICP involves the administration of osmotherapy in the form of 3% NaCl or 20% mannitol with observation during administration. Observation of ICP during administration of osmotherapy is possible through measurement of optic nerve sheath diameter (ONSD), which could be correlated with degree of consciousness, pupil diameter, and light reflex. Previous studies have not correlated ONSD with degree of consciousness, pupil diameter, and light reflex during the administration of osmotherapy.PurposeTo provide insights of incorporating ONSD measurement as a form of non-invasive bedside method for ICP monitoring by correlating it with degree of consciousness, pupil diameter, and light reflex at several time points.MethodsThis study is a prospective cohort study, performed at Dr. Hasan Sadikin General Central Hospital Bandung, Cibabat General Regional Hospital, and General Regional Hospital Bandung Kiwari on children aged 2–18 years with decreased consciousness and CNS infection, from June 2023. Inter-rater reliability was performed with a correlation coefficient of 0.90. Measurement of ONSD, degree of consciousness, pupil diameter, and light reflex simultaneously up to 48 h after initiation of osmotherapy to 30 patients. Correlational analyses were performed using Spearman's rank.ResultsObservation for 48 h after administration of osmotherapy showed changes in ONSD. A significant positive correlation was found between ONSD and degree of consciousness (r = 0.621 for the right eye and r = 0.602 for the left eye, p &amp;lt; 0.001). A significant positive correlation was found between ONSD and light reflex (r = 0.801 for the right eye and r = 0.812 for the left eye, p &amp;lt; 0.001). No significant correlation was found with changes of pupil diameter (r = −0.136 for the right eye and r = −0.141 for the left eye, p &amp;gt; 0.05).ConclusionA significant correlation was found between ONSD and degree of consciousness and light reflex in children aged 2–18 years with CNS infection during administration of osmotherapy.

Secondary Multiple Evanescent White Dot Syndrome Following Blunt Trauma.

To report a case of secondary unilateral MEWDS following blunt trauma to the eye. Observational case report of one patient. A 25-year-old male initially presented after being hit in the left eye with a football, with visual acuity of 20/50, traumatic iritis, commotio retinae, vitreous hemorrhage, and a large pigment epithelial detachment in the superior macula. He was lost to follow-up for two years before presenting with a sudden decrease in vision. On exam, best corrected VA (BCVA) was counting fingers and clinical exam demonstrated fibrosis in the superior macula, small white lesions around the optic disc and throughout the posterior pole, and ellipsoid zone disruption on OCT. Given the clinical appearance, a diagnosis of Multiple Evanescent White Dot Syndrome was made and the decision was made to observe. Two months later, without treatment, BCVA improved to 20/20, and there was resolution of the white lesions in the posterior pole as well as improved continuity of the ellipsoid zone on OCT. We describe a case of Multiple Evanescent White Dot Syndrome two years after blunt trauma to the eye; a far longer latency than previously reported cases of MEWDS secondary to blunt trauma.

Treatment of Nocardia Chorioretinitis Related Choroidal Neovascularization with Aflibercept: A Case of Unveiled Immunocompromise with anti-GM-CSF Antibodies.

The purpose of this study was to describe a case of Nocardia chorioretinitis-related choroidal neovascularization (CNV) in a patient with anti-GM-CSF antibodies with resolution of choroidal neovascularization and visual recovery following a series of intravitreal anti-vascular endothelial growth factor. This study is a case report. In our case, a 50-year-old female, thought to be immunocompetent, presented with metamorphopsia and decreased visual acuity in the left eye in the setting of disseminated Nocardiosis. She had evidence of a subfoveal Nocardia lesion with subretinal fluid and CNV. Following a series of off-label injections with aflibercept, the patient had improvement in lesion size, exudation, and visual acuity. Extensive workup yielded underlying immunocompromise due to presence of anti-GM-CSF antibodies, likely predisposing her to disseminated Nocardiosis. The use of aflibercept in Nocardia chorioretinitis led to resolution of neovascular activity with visual recovery in a patient with disseminated Nocardiosis.

Predicting intraocular lens tilt using a machine learning concept.

To use a combination of partial least squares regression and a machine learning approach to predict intraocular lens (IOL) tilt using preoperative biometry data. Kepler University Clinic Linz, Linz, Austria. Prospective single-center study. Optical coherence tomography, autorefraction, and subjective refraction were performed at baseline and 8 weeks after cataract surgery. In analysis I, only 1 eye per patient was included and a tilt prediction model was generated. In analysis II, a pairwise comparison between right and left eyes was performed. In analysis I, 50 eyes of 50 patients were analyzed. Difference in amount, orientation, and vector from preoperative to postoperative lens tilt was -0.13 degrees, 2.14 degrees, and 1.20 degrees, respectively. A high predictive power (variable importance for projection [VIP]) for postoperative tilt prediction was found for preoperative tilt (VIP = 2.2), pupil decentration (VIP = 1.5), lens thickness (VIP = 1.1), axial eye length (VIP = 0.9), and preoperative lens decentration (VIP = 0.8). These variables were applied to a machine learning algorithm resulting in an out of bag score of 0.92 degrees. In analysis II, 76 eyes of 38 patients were included. The difference of preoperative to postoperative IOL tilt of right and left eyes of the same individual was statistically relevant. Postoperative IOL tilt showed excellent predictability using preoperative biometry data and a combination of partial least squares regression and a machine learning algorithm. Preoperative lens tilt, pupil decentration, lens thickness, axial eye length, and preoperative lens decentration were found to be the most relevant parameters for this prediction model.

Ocular dominance and its association with retinal thickness profile - A cross-sectional study.

The retinal thickness profile is essential for detecting ocular diseases like glaucoma and other optic neuropathies. The retinal nerve fiber layer (RNFL) thickness is affected by age, ethnicity, axial length, optic disc area, and inter-eye differences. Ocular dominance has a strong functional correlation with cerebral cortical activity. However, its relationship with RNFL thickness profile is yet to be fully established. A cross-sectional study was conducted in 136 healthy adults to study the association between ocular dominance and RNFL parameters measured by Spectral domain optical coherence tomography (SD-OCT) and to study the association of ocular dominance with other parameters such as handedness, intraocular pressure, average axial length, average keratometry, and refractive error. Sighting ocular dominance was detected using the Miles test, and sensory ocular dominance was detected using the fogging test. Visual acuity and refraction assessment were done, and the patients underwent ocular biometry using the Lenstar 900 machine to measure the axial length and keratometry. The RNFL thickness was measured using the Cirrus HD optical coherence tomographer. One hundred and thirty-two (97.06%) individuals were right-handed, four (2.94%) were left-handed, 108 (79.41%) participants were right eye dominant, and 28 (20.59%) were left eye dominant. There was 100% agreement between sighting and sensory ocular dominance. The average RNFL thickness and other measured ocular parameters were comparable in the dominant and nondominant eyes. Regardless of dominance, the left eyes in the study cohort had a greater statistically significant difference in superior RNFL thickness (P < 0.05), which correlated with increased central macular thickness. Ocular dominance occurred mostly in the right eye. The RNFL thickness profile is not associated with ocular dominance in emmetropic and mild myopic individuals with normal best corrected visual acuity.

Chronic cannabis use alters the spontaneous and oscillatory gamma dynamics serving cognitive control.

Regular cannabis use is associated with cortex-wide changes in spontaneous and oscillatory activity, although the functional significance of such changes remains unclear. We hypothesized that regular cannabis use would suppress spontaneous gamma activity in regions serving cognitive control and scale with task performance. Participants (34 cannabis users, 33 nonusers) underwent an interview regarding their substance use history and completed the Eriksen flanker task during magnetoencephalography (MEG). MEG data were imaged in the time-frequency domain and virtual sensors were extracted from the peak voxels of the grand-averaged oscillatory interference maps to quantify spontaneous gamma activity during the pre-stimulus baseline period. We then assessed group-level differences in spontaneous and oscillatory gamma activity, and their relationship with task performance and cannabis use metrics. Both groups exhibited a significant behavioral flanker interference effect, with slower responses during incongruent relative to congruent trials. Mixed-model ANOVAs indicated significant gamma-frequency neural interference effects in the left frontal eye fields (FEF) and left temporoparietal junction (TPJ). Further, a group-by-condition interaction was detected in the left FEF, with nonusers exhibiting stronger gamma oscillations during incongruent relative to congruent trials and cannabis users showing no difference. In addition, spontaneous gamma activity was sharply suppressed in cannabis users relative to nonusers in the left FEF and TPJ. Finally, spontaneous gamma activity in the left FEF and TPJ was associated with task performance across all participants, and greater cannabis use was associated with weaker spontaneous gamma activity in the left TPJ of the cannabis users. Regular cannabis use was associated with weaker spontaneous gamma in the TPJ and FEF. Further, the degree of use may be proportionally related to the degree of suppression in spontaneous activity in the left TPJ.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Correlation of glycosylated hemoglobin (HbA1c) with retinal nerve fiber layer (RNFL) thickness and central macular thickness (CMT) in the diabetic population in North India.

The current study was aimed to find correlation of glycosylated hemoglobin with retinal nerve fiber layer thickness (RNFLT) and central macular thickness (CMT) in the diabetic population in North India. This was a cross-sectional observational study of 300 diabetic patients divided equally in two groups with and without retinopathy, and 150 people were included as control. The study was conducted from October 2020 to August 2022. All patients underwent slitlamp fundoscopy with a +78 D lens, and spectral-domain (SD) optical coherence tomography was performed to measure the RNFLT and CMT, and the staging of retinopathy was done as per the ETDRS classification. Along with that, blood investigations were ordered, including fasting (FBS) and post-prandial (PPBS) blood sugar and glycosylated hemoglobin (HbA1c). Quantitative variables were compared using one-way analysis of variance, or Kruskal-Wallis test was applied for inter-group comparison, followed by a Student Newman Keuls Test. The mean age of the patients in the diabetic group with retinopathy was 52.62 ± 9.38 years. The overall male: female ratio was 3:2. The mean FBS in the diabetic group with retinopathy was 146.54 ± 45.40mg/dl; the PPBS and HbA1c in the same were 210.39 ± 63.71mg/dl and 7.85 ± 1.33%, respectively. RNFL thinning was found in all four quadrants in diabetics irrespective of the status of retinopathy (P-value = 0.000) with a significant weak negative (r<0.4) correlation of glycosylated hemoglobin values with RNFLT in the inferior (r value = -0.300, P-value = 0.000) and superior (r value = -0.236, P-value = 0.004) quadrants of right eyes and in inferior (r value = -0.176, p- value = 0.031), superior (r value = -0.222, P value = 0.006), and nasal quadrants (r value = -0.166, p- value = 0.043) of left eyes in diabetics with retinopathy. However, in diabetics without retinopathy, no correlation was found. On correlating HbA1c with CMT, a weak positive (r<0.3) association existed in both eyes in the diabetic group without retinopathy (r = 0.020 and 0.048 for OD and OS, respectively) and diabetics with retinopathy (r = 0.152 and 0.127 for OD and OS, respectively). However, the association was not found to be significant in either of the groups (P-value > 0.05). The study concluded that neurodegeneration occurs in diabetic retinopathy as evident with nerve fiber layer thinning, and it is negatively correlated with glycosylated hemoglobin (HbA1c).

Refractive errors and the uniform patient fee scheme at a public hospital in South Africa

Background: Uniform Patient Fee Scheme (UPFS) refers to the healthcare subsidy levels provided by public hospitals in South Africa. Such subsidies indirectly reflect socio-economic factors and thus potentially might impact upon distributions of refractive error.Aim: To investigate refractive errors based on the UPFS-classified records of patients consulted at an Optometry Clinic between January 2018 and December 2019. This will provide frequencies and other measures, possibly providing preliminary estimates of prevalences for the wider population for the region concerned.Setting: The study was conducted at Sekororo Hospital in Limpopo province.Methods: Data for UPFS and refractive errors (via subjective refraction) were collected retrospectively based on the archived clinical records. Statistics and Data Analysis (Stata) software was used to analyse data.Results: For H0 in the right eyes means (± s.d.) for myopia, hyperopia, and astigmatism were −2.04 ± 2.60, 1.38 ± 1.72, and −1.07 ± 0.64, respectively. For H0 (left eyes): Myopia (−2.04 ± 2.09), hyperopia (1.47 ± 1.73), and astigmatism (−1.04 ± 0.64). For H1 (right eyes): Myopia (−1.79 ± 1.50), hyperopia (1.06 ± 0.72), and astigmatism (−1.14 ± 0.81). For H1 (left eyes): myopia (−1.71 ± 1.46), hyperopia (1.24 ± 0.91), and astigmatism (−1.71 ± 0.74). (No records were found for H2, H3, or private patients.)Conclusion: Hyperopia and astigmatism were the most common in H0 records while myopia was the most common in H1.Contribution: Various authorities and others in South Africa might use this data and results for National Health Insurance planning policies and implementation purposes.

Isolated Intracranial Hypertensions as Onset of Myelin Oligodendrocyte Glycoprotein Antibody Disease

Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is characterized by multiple phenotypic conditions such as acute disseminated encephalomyelitis, optic neuritis, and myelitis. MOGAD’s spectrum is expanding, with potential symptoms of increased intracranial pressure that are similar to idiopathic intracranial hypertension (IIH). We report a boy with new-onset continuous headache and a brain MRI at onset suggesting idiopathic intracranial hypertension (IIH). The patient showed resistance to treatment with acetazolamide and, after one month, developed optic neuritis in the left eye. Laboratory tests documented positive MOG antibodies (anti-MOG) in the serum. The final diagnosis was MOGAD, with the initial symptoms resembling IIH.

Prothrombin deficiency with recurrent subretinal hemorrhage.

Ocular hemorrhage has been recorded in congenital factor deficiencies like hemophilia A, but it has never been documented in prothrombin deficiency. Here, we describe an unusual case of sudden vision loss in the right eye caused by subretinal hemorrhage following a coughing episode in a 67-year-old woman. Notably, the patient underwent left eye enucleation 12 years previously under similar circumstances due to subretinal hemorrhage. During the interview, it was discovered that the patient had a history of prothrombin deficiency, which was subsequently confirmed through laboratory testing. Aside from recurrent ocular bleeding and 1 instance of bleeding following dental extraction in childhood, there is no other history of bleeding. Subsequent molecular studies revealed a homozygous missense mutation at G1499A (Arg500Gln), a variant previously identified as R457Q. Although the likelihood of prothrombin deficiency initiating subretinal hemorrhage is low, it is likely to worsen retinal hemorrhage and contribute to difficulty in controlling bleeding. A comprehensive coagulation workup is essential in patients with ocular hemorrhage. Determining factor II activity should be included in individuals exhibiting variably prolonged prothrombin time and activated partial thromboplastin time with correction in mixing studies. Additional investigations, such as genetic sequencing and family studies, are advised for those with isolated low prothrombin levels.

Infantile Idiopathic Intracranial Hypertension: Case Report of an 8-Month-Old Child

AbstractIdiopathic intracranial hypertension (IIH), a clinical disorder also known as pseudotumor cerebri, is characterized by increased intracranial pressure of unknown causes. Although it is most commonly observed in young obese women, IIH can also occur in the pediatric population; however, it is extremely rare in infants. Infants do not typically exhibit characteristic signs and symptoms of IIH, making it challenging to diagnose. Additionally, treatment modalities for this disease remain uncertain. We report an 8-month-old female child admitted to the pediatric emergency department with IIH. Our patient presented initially with fever, vomiting, and diarrhea, and then she developed inability to abduct the left eye. Papilledema was not detected in our patient. Magnetic resonance imaging and lumbar puncture contributed to diagnosis of the patient. Dexamethasone (0.5 mg/kg/d, twice a day) and acetazolamide (5 mg/kg/d) were administered; dexamethasone was stopped at the 48th hour after esotropia had resolved. The patient developed left ptosis in the first month after discharge. Acetazolamide was administered for a duration of 5 months and was discontinued once the patient's eye findings improved. With a sudden onset of neurological findings in a healthy infant with normal neuroimaging, IIH should be considered in the differential diagnosis and cerebrospinal fluid pressure should be measured. The principles of treatment for this disease are based on adult guidelines, but the efficacy of acetazolamide has also been reported in the pediatric population, like in our case.

Exploring autism via the retina: Comparative insights in children with autism spectrum disorder and typical development.

Autism spectrum disorder (ASD) is a widely recognized neurodevelopmental disorder, yet the identification of reliable imaging biomarkers for its early diagnosis remains a challenge. Considering the specific manifestations of ASD in the eyes and the interconnectivity between the brain and the eyes, this study investigates ASD through the lens of retinal analysis. We specifically examined differences in the macular region of the retina using optical coherence tomography (OCT)/optical coherence tomography angiography (OCTA) images between children diagnosed with ASD and those with typical development (TD). Our findings present potential novel characteristics of ASD: the thickness of the ellipsoid zone (EZ) with cone photoreceptors was significantly increased in ASD; the large-caliber arteriovenous of the inner retina was significantly reduced in ASD; these changes in the EZ and arteriovenous were more significant in the left eye than in the right eye. These observations of photoreceptor alterations, vascular function changes, and lateralization phenomena in ASD warrant further investigation, and we hope that this work can advance interdisciplinary understanding of ASD.