Posterior Segment Involvement Research Articles

Clinical Outcomes in Patients With Traumatic Dehiscence of Penetrating Keratoplasty Grafts.

The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts. Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating keratoplasty grafts. The study cohort consisted of 65 eyes of 65 patients. The mean age at presentation was 72 years (SD 18), with a male predominance (65%). The most common indications for PKP included keratoconus (42%), corneal scar (31%), and Fuchs corneal dystrophy (8%). Dehiscence occurred as a result of blunt trauma in 94% of cases, and the mean wound length was 6.4 clock hours (SD 2.4), with a predominance of inferior dehiscence. The mean presenting visual acuity (VA) was 2.45 logMAR (SD 0.41), and the mean final VA was 2.17 logMAR (SD 0.99). Graft failure occurred in 64% of patients, and 22% underwent repeat PKP. When stratified by indication for corneal transplantation (keratoconus vs. other), there was no significant difference in graft age at the time of rupture, final VA, rate of graft failure, or rate of repeat PKP. Traumatic dehiscence of corneal grafts remains a rare but serious subtype of ocular trauma with generally poor visual prognoses. Presenting VA along with severity of trauma and posterior segment involvement tend to be the worst prognostic factors in final visual outcome.

Did the metal object hit the cornea? A case report of penetrating ocular injury with embedded foreign body

Introduction : Penetrating ocular injury with IOFBs may cause severe ocular damage. We demonstrate the diagnostic and treatment approach in a case of scleral laceration with a large IOFB.
 Case Illustration : A-24-year-old male presented with a rusty segment of fence wire, sized 15x11 mm, embedded near the nasal corneal margin of the right eye. Upon initial examination the vision was 6/9 with normal IOP. The object obstructed the view of the entry site, therefore corneal wound was suspected. CT scan showed penetrating metal object without posterior segment involvement. Anti-tetanus injection, topical and oral levofloxacin were given. He underwent exploration, foreign body removal and repair surgery. During surgery, the wound was revealed as a scleral laceration, 4 mm from nasal limbus. One day post-operative, vision was 6/20. A 0.1 mm hypopyon was found, along with fibrin at nasal vitreous. Oral and topical corticosteroids were given, and hypopyon disappeared the next day. One week after surgery, vision improved to 6/7.5, with clear vitreous and normal retina.
 Discussion : Ocular injuries with large IOFBs can hinder clinical examination. Corneal entry wound should be ruled out, due to potential permanent damage to visual axis. CT scan was helpful in assessing the depth of object penetration. The object was removed successfully, with no damage to the cornea and retina. Anti-tetanus, antibiotics and corticosteroids were able to control infection and inflammation.
 Conclusion : Large IOFBs which do not affect the visual axis, can be managed with successful outcome, by prompt removal and repair of the entry wound, and control of infection and inflammation.

Vogt-Koyanagi-Harada Disease: The Clinical Spectrum and Management of Case Series in a Tertiary Eye Centre in Northern Part Of Malaysia.

We present the clinical spectrum, the initial clinical presentation with management trends in treating 14 Vogt-Koyanagi-Harada (VKH) disease cases in a tertiary center in the Northern part of Malaysia. There were 14 cases of Vogt-Koyanagi-Harada (VKH) disease retrospectively reviewed over five years (from 2015 to 2020). The mean age at presentation was 37.7 years (range 21-64 years), with female predominance (85.7%). All cases presented with acute uveitic stage and bilateral eye involvement. Of them, 11 (78.6%) were probable VKH, and three (21.4%) were incomplete VKH. All patients attended with acute panuveitis at first presentation. The main posterior segment involvement was disc edema in 57.1% (16 out of 28 eyes) and exudative retinal detachment (ERD) in 35.7% (10 out of 28 eyes). Most of them presented with blindness (3/60 and worse) and moderate visual impair- ment (6/18-6/60); 35.71% each, followed by mild visual impairment (6/12-6/18), and severe visual impairment (6/60-3/60); 7.1% each. Ten patients (71.4%) required combination second-line immunomodulatory treatment during subsequent visits, and only four patients (28.6%) responded well to corticosteroid therapy. Most of the cases achieved no visual impairment (64.3%), followed by mild visual impairment (21.4%) and moderate visual impairment (14.3%), and none were severe or blind at the end of follow-up. VKH is a potentially blinding illness if there is inadequate control of the disease in the acute stage. Most of our patients achievedgood visual outcomes with early immunomodulatory treatment and systemic corticosteroids.

Komplikasi Okular pada Demam Dengue

Ocular complications rarely occur in dengue fever, but were reported increasing. Several studies showed that cross-reactive antibody is responsible for ocular involvement in dengue. Blurred vision, followed by posterior segment involvement was seen in most cases. A simple examination in primary medical care such as the Amsler grid may detect scotoma and metamorphopsia. Early recognition of ocular involvement in dengue cases may prevent morbidity.

A clinical study of childhood penetrating ocular trauma in a tertiary care center in Southern India

Aims: Ocular trauma is one of the major causes of monocular blindness in the pediatric age group, causing significant visual morbidity. The purpose of this study is to identify the causes, types, location of injuries, and clinical features due to ocular trauma in a tertiary care center. Settings and Design: It is a retrospective hospital-based observational study. Materials and Methods: Demographic details of 69 consecutive patients up to 14 years of age who were hospitalized for primary repair of penetrating ocular injuries during March 2017 to March 2019 were documented and evaluated. Results: Fifty-six (81.16%) children were male. The mean age was 8.31 ± 3.96 years. Thirty-one (44.93%) were in the 6–10-yearage group. The most common cause of injury was with wooden stick in 23 cases (33.33%). Full-thickness corneal tear was seen in 52 cases (75.36%). Associated anterior segment involvement included iris prolapse in 34 cases (49.28%), hyphemia in 11 (15.94%), and traumatic cataract in 15 (21.74%), interlamellar corneal foreign body in two cases, and associated full-thickness lid tear involving lid margin in two cases. The posterior segment involvement in the form of vitreous hemorrhage in 19 (27.53%) cases, retinal detachment involving macula in seven cases (10.14%), choroidal detachment in six cases (8.69%), endophthalmitis in five cases (7.25%), and retained intraocular foreign body in three (4.35%). Conclusions: Prevention is always considered superior to the best treatment. Parents should be educated about the devastating complications of ocular trauma, need for supervision, and need for timely referral to the eye care center.

A case of syphilitic chorioretinitis masquerading as acute posterior multifocal placoid pigment epitheliopathy

Ocular involvement can be the first and only manifestation of syphilis, and it may mimic any sign of posterior segment involvement. We report a 22-year-old man with syphilitic multifocal chorioretinitis who had clinical and imaging findings with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) features in both eyes without any systemic and neurological symptoms. Systemic antibiotic and corticosteroid treatment led to regression in multifocal chorioretinitis lesions and improvement in visual acuity. Syphilis may present as APMPPE. Syphilis tests should be kept in mind and carefully evaluated in the differential diagnosis of patients presenting with intraocular inflammation of unknown origin.

Sarcoidosis‐related uveitis: A case series study

Purpose: The aim of this study was to characterize the epidemiological and clinical characteristics of ocular involvement in patients with systemic sarcoidosis.Methods: Retrospective case series study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between the 1st January 2022 and the 1st January 2023. Fifteen patients (30 eyes) were included. Based on the International Workshop on Ocular Sarcoidosis criteria, three patients had biopsy‐proven sarcoidosis; eight had presumed sarcoidosis and four had probable sarcoidosis. All patients had a complete ocular examination and systemic work‐up.Results: The median age at presentation was 45 years (range: 29–66). The sex ratio was 1:13. Ocular involvement was the presenting symptom in 11 patients. Bilateral granulomatous uveitis was the presenting form in all patients. Panuveitis was the most common anatomic pattern (9), followed by anterior (3), anterior and intermediate (2) and intermediate (1) uveitis. Posterior segment involvement included multifocal choroiditis (3) retinal vasculitis (5) macular oedema (4) and optic nerve head granuloma (1). Systemic manifestations included bilateral hilar lymphadenopathy (8) eyelid granuloma (2) neurosarcoidosis (3) Peripheral facial nerve palsy (2).Conclusions: Uveitis was the initial presentation of sarcoidosis in the majority of our subjects. Panuveitis was the most commonly encountered anatomic form. Our findings support the prominent role of the ocular examination in the early detection of sarcoidosis.

A Clinical Study of Ocular Trauma in Paediatric patients attending Tertiary Care Centre

Aims: To study demographic parameters, modes of injury, its impact and relation to visual outcomes in paediatric ocular trauma. Methods: A prospective observational study was done at a tertiary centrefor 120 eyes of 117 patients over a period of 2 years. Results: Mean age of patients in this study was, 7.97 ± 3.919 years with males being predominance. No severe injuries were noted in children whose parents had college-level education. Mean distancebetween the place of injury and our centrehad no significant correlation with final BCVA but it significantly correlated with delay in presentation. Wooden Stickand household itemswere the most common agents of injury, followedby iron wire/rod/nailand Chemical/Thermal agents. Most common pathology was Corneal tear followed by corneoscleral tear and Chemical / Thermal injuries. Posterior segment involvement was seen in 27.5 %of cases. Traumatic cataract was noted in 13 eyes. Open globe injuriesexceededclosed globe ones. Prognostically closed globe injuries had better visual outcome and achieved higher BCVA than closed globe ones irrespective of mode of management being surgical/ nonsurgical. Conclusion: This study showed a demographic snapshot for the patients of ocular trauma, withthe male child between the age group of 6-8 years most commonly affected. BCVA was relatednot to socioeconomic status, but educational status of the patients. Mode and type of injury strongly correlated withvisual acuity. Final BCVA correlated to BCVA at presentation, and not to the treatment factors, thusmaking primary prevention of trauma of paramount importance. Keywords: Ocular Trauma, Corneoscleral Tear, Paediatric Open Globe Injury

Ocular manifestations and clinical outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU).

To describe the various ocular clinical features and visual outcomes in Tubulointerstitial Nephritis and Uveitis Syndrome (TINU). The medical records of 13 patients (26 eyes) diagnosed with TINU were reviewed. Twenty-six (26) eyes of 13 patients with TINU were reviewed in this study. The median age at onset of uveitis was 14 (range, 9-45). Eight (61.5%) subjects were female. The median follow-up of patients was 30 months (range, 6-89 months). Posterior segment findings were seen in 18 eyes of 9 patients (69.2%). The most common posterior findings were optic nerve head inflammation (16 eyes, 88.8%) and retinal vasculitis (13 eyes, 72.2%). Other posterior findings included vitritis (8 eyes, 44.4%), macular edema (6 eyes, 33.3%), snowball (4 eyes, 22.2%), and chorioretinal lesions (2 eye, 11.1%). Eight patients had fluorescein angiography (FA) data available and most eyes had retinal capillary leakage (13 eyes, 81.2%) followed by optic disc staining/leakage (12 eyes, 75%). Twelve (12) patients (92.3%) were treated with immunomodulatory treatment (IMT) and/or biologics. Five patients (%38.4) required biologics to control intraocular inflammation. Posterior segment involvement may be common in patients with TINU syndrome. FA provides significant information for detecting posterior segment involvement and disease activity in TINU. The majority of patients required systemic treatment in order to control intraocular inflammation and prevent relapses.

Posterior Segment Ocular Findings in HLA-B27 Positive Patients with Uveitis: A Retrospective Analysis.

To describe the prevalence and characteristics of posterior segment manifestations in patients with HLA-B27-associated uveitis using wide field imaging. Medical records of patients diagnosed with HLA-B27-associated uveitis from a tertiary uveitis clinic were reviewed. Posterior segment involvements including but not limited to peripheral vasculitis, optic disc inflammation, and macula edema documented based on medical records and various imaging modalities including wide field fluorescein angiography and optical coherence tomography, were noted. Demographic characteristics, accompanied with systemic diseases as well as duration and chronicity of uveitis, were also evaluated. Patients with significant systemic and ocular comorbidities were excluded. Statistical analyses including chi-squared tests and paired t-tests were employed. Of the 44 patients with HLA-B27 associated uveitis, 22 patients (50%) were noted to demonstrate posterior segment involvement. Disc leakage and peripheral vasculitis were the most common findings of posterior involvement. Those with anterior chamber inflammation were found to have a significantly increased risk of posterior involvement. Those with posterior involvement were also noted to have a statistically significant decreased visual acuity. No significant association was found between documented duration of disease and posterior segment involvement. The prevalence of posterior segment involvement in HLA-B27 associated uveitis is higher compared to previous reports when evaluated with wide angle imaging modalities. Careful examination of the posterior segment is required in patients with HLA-B27 associated uveitis.

Posterior segment involvement in systemic lupus erythematosus – A series from South India

To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE).Retrospective study at a tertiary referral eye center in south India between 2016 and 2022.Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS-related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases.Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

Eye damage in COVID-19. Part 2: posterior segment complications, neuro-ophthalmic manifestations, vaccination and risk factors

Posterior eye segment involvement in COVID-19 has varied manifestations: vascular, inflammatory, and neuronal. All of them are triggered by SARS-CoV-2 virus but they cannot be viewed as exclusively specific to COVID-19. According to the literature, the mean age of the patients varies from 17 to 75 with the median of 50 years. The median duration between the appearance of ophthalmic symptoms and the detection of COVID-19 was 12 days. The disease affects both men and women equally. Direct exposure to the virus, immune-mediated tissue damage, activation of the coagulation system, the prothrombotic state caused by a viral infection, concomitant diseases and medications used in the treatment contribute to the development of eye pathologies. Ophthalmologists should be aware of the possible relations of posterior eye segment pathologies, orbit and neuro-ophthalmic disorders with SARS-CoV-2, as well as the possible exacerbation of chronic forms of inflammatory eye diseases and autoimmune disorders due to anti-COVID-19 vaccination.

Panuveitis of undetermined origin after diagnostic pars plana vitrectomy: clinical characterization and long-term outcome from a tertiary referral center.

To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy. Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported. Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival. PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.

COVID -19 hastalarında arka segment optik koherens tomografi bulguları

Abstract: 
 Purpose: COVID – 19 which is still the leading health problem in the world, is not yet fully understood, therefore the study aims to investigate the posterior segment of the eye in patients with COVID – 19 using optical coherence tomography (OCT).
 Materials and Methods: The present study was designed prospective and cross-sectional. Patients with a positive test result of COVID – 19 and healthy controls who were older than 18 years were included in the study. Excluded from the study were the patients with any systemic comorbidity and ocular disease. The demographic and clinical data, including ocular findings and the OCT data, including hyper-reflective (HR) lesions, retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and macular thicknesses (MT) were recorded as outcomes and analyzed. 
 Results: Twenty patients with SARS-CoV-2 and 20 healthy subjects were included in this study. There was no difference between COVID -19 patients and healthy controls in terms of the RNFL, GCC, and macular thicknesses (P > 0.05). HR lesions were detected in 18(45%) eyes of 9(45%) patients with COVID – 19 and 15(37,5%) eyes of 8(40%) healthy subjects’ retinae with no significant difference between groups (P = 0.165). 
 Conclusions: Hyper-reflective lesions could only be retinal vessels' tangential cuts seen in OCT B-Scans. There was not enough data that could indicate posterior segment involvement of COVID – 19.

Posterior segment involvement in Infantile Nephropathic Cystinosis – A review

Cystinosis is a rare lysosomal storage disease with a prevalence of 1:100.000-1:200.000 cases. It is caused by biallelic mutations in the CTNS gene, which encodes cystinosin that transports cystine out of lysosomes. Due to its dysfunction cystine crystals accumulate in the lysosomes and ultimately cause apoptosis of the cell. Since cystinosin is ubiquitously present in the body, cystine crystals are deposited in every body structure and lead to the dysfunction of various organ systems in the course of time. Cystine crystals deposited in the cornea are a clinical hallmark of the disease, while there is less awareness of concomitant posterior segment alterations. Frequently, symmetrical pigment epithelial mottling and patches of depigmentation starting in the periphery, which progress towards the posterior pole, can be encountered upon fundus biomicroscopy. Spectral Domain Optical Coherence tomography (SD-OCT) represents an elegant tool for visualizing chorioretinal cystine crystals at the posterior pole. An SD-OCT-based clinical grading of the severity of the chorioretinal manifestation can potentially be applied as a biomarker for systemic disease status and monitoring of oral therapy adherence in the future. Along with previous histological examinations, it may also give information about the location of cystine crystals in the choroid and retina. This review aims to increase the awareness of vision-threatening retinal and choroidal changes in cystinosis and the concomitant findings in SD-OCT. Die Cystinose ist eine seltene, autosomal rezessiv vererbte lysosomale Speicherkrankheit der Aminosäure Cystin mit einer geschätzten Prävalenz von 1:100.000 bis 1:200.000. Ursächlich sind Mutationen im CTNS-Gen, welche für den lysosomalen Aminosäure-Transporter Cystinosin kodieren. Die Fehlfunktion des Cystinosins führt zu einer Akkumulation von Cystin im Lysosom und letztlich zur Apoptose der Zelle Das intrazelluläre Cystinosin ist ubiquitär im Körper vorhanden, sodass sich Cystin-Kristalle in jedem Gewebe ablagern und zu einer Dysfunktion verschiedener Organsysteme führen. Korneale Cystinkristallablagerungen sind pathognomonisch für die Erkrankung, während begleitende Veränderungen am hinteren Pol bislang weniger Beachtung fanden. Fundoskopisch sind häufig symmetrische retinale Pigmentepithelauflockerungen und depigmentierte Areale zu erkennen, die in der Peripherie beginnen und zum hinteren Pol fortschreiten. Die optische Kohärenztomografie (SD-OCT) eignet sich sehr gut zur Visualisierung chorioretinaler Cystinkristallablagerungen. Eine SD-OCT-basierte klinische Einstufung des Schweregrads der chorioretinalen Manifestation kann in Zukunft möglicherweise als Biomarker für den systemischen Krankheitsstatus und für die Überwachung der oralen Therapieadhärenz eingesetzt werden. In Zusammenschau mit früheren histologischen Untersuchungen können OCT-morphologische Aufnahmen Aufschluss über die genaue Lokalisation der Cystinkristalle in der Aderhaut und Netzhaut geben. Diese Übersichtsarbeit soll das Bewusstsein für visusbedrohende Netzhaut -und Aderhautveränderungen in der infantilen nephropathischen Cystinose und die begleitenden Befunde im SD-OCT schärfen.

Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects.

Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care in the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), resulting in a remarkable decrease in disease-related vision loss. However, the need for regular injections places a significant burden on patients, caregivers, and the healthcare system and improvements in vision may not be maintained long term. As a result of its drying potency and duration of action, brolucizumab, an intravitreal anti-VEGF therapy approved for the treatment of nAMD and DME, could decrease injection frequency for patients and provide an efficacious treatment; however, balancing its benefits and risks can be challenging. There have been reports of intraocular inflammation (IOI) in patients treated with brolucizumab, which, if left untreated, may result in severe vision loss. Recent evidence, however, indicates that early recognition of IOI and prompt and aggressive systemic corticosteroid treatment in response to posterior segment involvement can lead to favorable outcomes in these relatively rare but severe cases. A series of consensus meetings were conducted in 2022 between Swiss medical retina experts and diabetologists, discussing the current data for brolucizumab and exploring various challenges to its use, including the associated risk of IOI. The outcome is a collation of practical insights and guidance for ophthalmologists on the use of brolucizumab in patients with nAMD and DME, including patient selection and assessment, treatment regimen and monitoring, and the recognition and management of adverse events.

Clinical Profile and Visual Outcome of Traumatic Glaucoma Patients Following Closed Globe Injury in the Rural Part of Eastern Uttar Pradesh at a Tertiary Eye Care Centre: A Retrospective Cohort Study

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (>21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value <0.001). Surgical management was required in 30 (32.25%) eyes, with 13 (13.97%) eyes undergoing trabeculectomy. Conclusion: Post-traumatic IOP elevation occurred in 93 (35.90%) eyes with CGI, and 13.97% of these eyes required glaucoma filtering surgery for IOP control. Overall, medical management was necessary in 67.74% of eyes, while 32.25% required surgical intervention. Eyes with posterior segment involvement had poor visual acuity. Poor baseline vision and vitreo-retinal involvement increased the risk of a poor visual outcome.

Prevalence of Ophthalmic Manifestations in COVID-19 Positive Indoor Patients during Second Wave at Rural Tertiary Care Hospital of Gujarat: A Prospective Observational Study

Introduction: Coronavirus Disease-2019 (COVID-19) can affect multiple system of body including eye. In eye, it can cause mild conjunctivitis, posterior segment involvement, neurosensory involvement and lethal opportunistic infection like mucormycosis. Associated co-morbidities, severity of COVID19 infection and corticosteroids used in its management can affect ophthalmic involvement. Aim: To determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Materials and Methods: This prospective observational study was conducted on indoor patients of Shree Krishna Hospital, a rural, tertiary care hospital affiliated with Pramukh Swami Medical College, Karansad, Gujarat, India, from 1st May 2021 to 1st January 2022. Second wave of COVID-19 was from 13th March 2021 to 19th June 2021. Patients’ demographic data, details of COVID-19 infection severity score, oxygen requirement, use of corticosteroids, history of various co-morbidities and stages of Rhino-Orbital-Cerebral Mucormycosis (ROCM) (if present) were noted. Bedside ophthalmic examination was done with torch light, fluorescent strip, cobalt blue light of direct ophthalmoscope and fundus examination with indirect ophthalmoscopy under institutional COVID-19 guidelines. Descriptive Statistics {Mean, (SD), Frequency, (%)} were used for analysis of the collected data. Results: Out of 649 COVID-19 patients, 368 were male and 281 were female with mean age of 52.58 (±15.38) years. All over prevalence of ophthalmic manifestations was 9.86% (n=64 out of 649 patients). A total of 63 patients (9.71%) did not require any oxygen supplement, 352 patients (54.24%) required nasal prongs, 201 patients (30.97%) required non invasive ventilator support and 33 patients (5.08%) required mechanical ventilation. The 378 patients (58.24%) received cortico-steroids in oral or intravenous form. A total of 325 patients (50.1%) had diabetes,267 patients (41.1%) had hypertension, 29 patients (4.5%) had chronic kidney disease and 15 patients (2.3%) had thyroid disease. A total of 52 patients (8.01%) had conjunctivitis. Mean age of patients with conjunctivitis was 50.04 (±15.28) with male preponderance (n=30, 57.7%). Most common systemic presentation was fever (n=29,55.8%). Patients with conjunctivitis had high D-dimer (>500 ng/mL) (n=42;80.8%) and C-Reactive Protein (CRP) values (>3 mg/L) (n=39;75%). A total of 144 patients (22.2%) were vaccinated with COVID-19 vaccine first dose while ten patients (19.23%) out of 52 patients having conjunctivitis were vaccinated. Out of 649 patients, prevalence of ROCM was 1.85% (n=12) with mean age 58.58 years (±9.71 years) and male preponderance (n=8, 66.66%). Nine out of twelve patients had high blood sugar levels (mean level 340 mg/ dL) at the time of admission. Out of twelve, eight patients had received corticosteroids for management of COVID-19 infection. Six patients of ROCM (50%) did not require any oxygen support while two patient (16.7%) required nasal prongs for mean 7.50 days and four patient (33.3%) required non invasive ventilator support for mean 7.33 days (±2.5 days). One patient had stage 2C disease, one had stage 3B, five patients had stage 3C while five patients had stage 4C disease. Conclusion: Ocular manifestations of COVID-19 range from conjunctivitis to ROCM. Conjunctivitis has mild and self-limited course while ROCM is sight threatening and life-threatening condition, if not treated appropriately.

Clinical outcome of first hundred consecutive therapeutic penetrating keratoplasties done at a tertiary eye care centre in Eastern India

ABSTRACT Aim: To analyze the clinical outcome of first 100 consecutive cases of therapeutic penetrating keratoplasty (TPK) done at a tertiary eye care centre in Eastern India. Materials and Methods: A retrospective analytical observational study of first 100 consecutive patients of TPK was done at RIO, IGIMS, Patna, Bihar for nonhealing keratitis with or without perforation with a minimum 1 year follow up examination. Patients with vitreous exudates were excluded from the study. Results: Organisms were isolated in 60% of cases of which 65% were fungi (Aspergillus), 20% were bacteria, (Staphylococcus aureus) and 15% had mixed infection. 17 cases required lens removal during surgery. Repeat graft infection was noticed in 23 cases of which 9 had fungi, 2 had bacterial isolate and rest was inconclusive preoperatively. A repeat TPK was performed in 7 patients out of the reinfected cases. Anatomical restoration could be achieved in 96% of cases. Graft clarity allowing clear view of anterior chamber could be seen in 26 cases. 4 cases of graft infection with posterior segment involvement finally required evisceration. 47 out of 100 TPK cases had raised intraocular pressure (IOP) of which 10 underwent glaucoma surgery for uncontrolled IOP despite medications. Conclusion: TPK is a challenging surgery still having definite role in management of nonresponding progressive keratitis. Maintaining graft clarity postoperatively is a difficult task in these cases therefore success should be measured in terms of infection eradication and anatomical restoration.

Study of epidemiology, clinical profile, visual outcome and prognostic factors of blunt ocular trauma in a teaching hospital

To describe the epidemiology, patterns of ocular trauma, clinical presentation, visual outcome and prognostic factors of blunt ocular trauma.A teaching hospital based prospective observational study was conducted over a period of 4 years from March 2012 to Feb 2016. 226 patients of all age group fulfilling the various inclusion and exclusion criteria were included in the study. All patients underwent detailed protocol based workup including a comprehensive ocular examination along with relevant radiological tests. Data regarding demographic profile, etiology, circumstances of the injury, traumatic agents, mode and mechanism of injury, extent and severity of injury, clinical features, management and visual outcome was analyzed and prognostic factors including ocular trauma score were evaluated.Out of 402 total cases of ocular trauma, 226 caused by blunt objects were included in this study. 181 (80.1%) were male rest 45(19.9%) were female. The mean age was 42.6 ± 18.8 years. Blunt trauma was more prevalent in age group 16-25yrs (24.3%) followed by 26-35 years (23.9%). Majority (68.6%) of victims belonged to rural background. Most of the patients sustained trauma at road /street (30.5%) and home (27.9%). The most common cause of blunt trauma was road traffic accident (26.5%) followed by sports related injury (22.6%) and physical assault (21.7%). The most frequent traumatic agent was wooden object (26.0%) followed by stone / brick (25.2%) and metallic object (23.1%). Only 32.3% of patients had isolated ocular injuries, rest had associated polytrauma. 93.3% victims had unilateral ocular injury. Left eye (52.3%) was predominantly involved. Majority of injured eyes had more than 3 ocular structure involvement. Out of 241 injured eye 14.0% eyes had only globe injury while 61.4% eyes had simultaneous globe and adnexal injuries. 55.6% eyes had closed globe injury while 19.9% eyes had globe rupture. 20.7% eyes had purely posterior segment injury, while 23.2% eyes had both anterior and posterior segment injury. Most common clinical finding was corneal abrasion (45.6% eyes) followed by hyphema (44.0% eyes), traumatic mydriasis (35.7%), vitreous hemorrhage (33.2%) retinal detachment (20.3%), lens dislocation (22.8%) and traumatic cataract (17.4%). At the time of initial presentation 33.2% eyes had visual impairment and 35.7% eyes had blindness. 14.5% eyes with closed globe injury and 5.0% eyes with open globe injury had zone III injury. Ocular trauma score was in Category I in 14.9% injured eyes and in category II in 7.1% eyes. After 6 months 14.5% of the right eye and 24.2% of the left eye showed blinding outcome.Blunt trauma is the commonest mode of ocular injury. Young adult males are more vulnerable. Intraocular hemorrhage, zone III injury, posterior segment involvement and low ocular trauma score are poor prognostic factors.