Segment Manifestations Research Articles

An Ophthalmic Insight into Novel Coronavirus 2019 Disease: A Comprehensive Review of the Ocular Manifestations and Clinical Hazards.

Purpose:To discuss the ocular manifestations provoked by novel coronavirus 2019 (COVID-19) disease in humans, the natural history of the disease in the eye, and its treatment.Methods:We designed a narrative review of the ocular manifestations of COVID-19 based on the literature published till July 30, 2020. The databases were PubMed, Scopus, Cochrane Library, Google Scholar, and ScienceDirect. The inclusion criteria were (1) all types of clinical studies and (2) the topic was COVID-19 and its association to the eye regarding the current guidelines.Results:From 168 abstracts screened, 61 papers fully filled the inclusion criteria after the full-text screening. The 61 records include 13 case reports, 17 prospective (case series or cross-sectional) studies, 8 retrospective studies, 12 literature reviews (one systematic review), and 11 letters to the editor. The majority of the papers agreed that ophthalmic manifestations due to COVID-19 were few and rarely encountered. The main ocular pathology seemed to be conjunctivitis, where the viral polymerase chain reaction also happened to be most detectable. Posterior segment or neuro-ophthalmic manifestations were scarce. Viral genome detection in the eye as well as viral portal of entry to the globe is still vague.Conclusion:The exact incidence of ocular manifestations in COVID-19 disease is uncertain. Conjunctivitis is the most prevalent ocular manifestation. It is still a debate whether the eye is a portal of entry for infection.

Post Fever Uveoretinal Manifestations in an Immunocompetent Individual

Background: Post fever uveoretinal sequelae (PFURS) are the various uveoretinal manifestations seen after a systemic febrile illness in an immunocompetent individual caused by bacteria, viruses, and protozoa. These may be the result of a direct invasion by the pathogen or by indirect mechanism mediated through immune mechanisms. Method: The authors aim to review the ocular manifestations, utility of relevant diagnostic tests, management, and prognosis of PFURS. A comprehensive literature search was conducted on PubMed and Google Scholar databases with the search words “retinitis”, “choroiditis”, “neuroretinitis”, “macular edema”, “maculopathy”, “multifocal retinitis”, “chikungunya”, “dengue”, “West Nile”, “typhoid”, and “rickettsiosis”. Only articles published or translated into English language were considered. The key data were extracted, evaluated, and combined. Results: The authors search yielded 95 articles for the period between 1986 and May 2020. Painless blurring of vision was the most common symptom. Patients can have varied posterior segment manifestations, including vitritis, focal and multifocal patches of retinitis which could be unilateral or bilateral, optic nerve involvement, serous detachment at the macula, macular oedema, and localised involvement of the retinal vessels in the form of beading of the vessel wall, tortuosity, and perivascular sheathing. Conclusion: PFURS presents with a similar morphological pattern irrespective of the aetiology and follows a preset natural course before resolution. Treatment may or may not be required. Treating physicians need to be aware of this important ophthalmic condition even after complete resolution of fever.

Corneal and Conjunctival Manifestations of Coronavirus Disease 2019 (SARS-CoV-2) in Sohag Governorate, Egypt

Abstract:PURPOSE: To evaluate the corneal and conjuctival manifestations of patients with positive Coronavirus Disease 2019 (COVID-19) in Sohag Province, Egypt.PATIENTS& METHODS: 63 patients who suffered from COVID-19 in the period 10–24 May 2020 at Sohag Tropical Medicine Hospital were enrolled in this study; they were subjected to anterior segment examination by the portable slit lamp or bedside examination.RESULTS: The study included 63 patients 37 male patients (58.7 %) and 28 female patients (44.4 %). The mean age of patients was 36.12± 14.24 with age range [19:71ys]. 13 cases were presented with anterior segment manifestations. 5(7.9%) patients suffered from conjunctival hyperemia, 2 (3.1%) patients suffered from follicular conjunctivitis, 2 (3.1%) patients presented with conjunctival chemosis and 2(3.1%) patients (one of them was on mechanical ventilation) suffered from subconjunctival hemorrhage.Conclusion: Important number of COVID-19 patients are presenting with ocular complaints mainly anterior segment manifestation like conjunctival hyperemia and follicular conjunctivitis. Infection prevention protocols are mandatory to limit potential ocular transmission of COVID-19 during the pandemic.

A spectrum of ocular manifestations in HIV/AIDS Patients: A retrospective analysis at a tertiary care centre in South India

To evaluate the prevalence of Ocular manifestations in HIV/AIDS patients and its correlation with CD4 countsThe ophthalmology OPD records of 100 HIV positive patients who attended Ophthalmology OPD(referred from ART centre in the Institute) for screening to rule out ocular manifestations in the period of Jan 2009 to Dec 2009 were evaluated retrospectively.Out of 100 patients evaluated, ocular manifestations were seen in 54%. The percentage of patients with Anterior segment manifestations, Posterior segment manifestations and Adnexal manifestations were 12.96 %, 31.48 % and 79.62% respectively. Conjunctivalmicrovasculopathy was the most common Ocular manifestations seen in 36% of the patients. HIV microangiopathy was seen in 10 % of the patients and was the most common Posterior segment manifestations. Sight threatening complications like CMV retinitis was seen in 4 % of the patients. 60.8% of patients with ocular manifestations had CD4 count less than 100 cells/cu.mm. With the decrease in the CD4 count, the prevalence of Ocular manifestations increased. Most common systemic association was Tuberculosis.Though the prevalence of ocular manifestations is low when compared with the previous studies, Sight threatening ocular manifestations are seen frequently in HIV patients due to increased longevity of the patients with HAART therapy and also due to increased duration for the immune system to mature to act against the opportunistic infections. So frequent Ophthalmic examination should be made mandatory for all HIV patients with CD 4 count < 400 cells / cu.mm even if the patients are on HAART therapy.

Tubulointerstitial Nephritis and Uveitis Syndrome: Characterization of Clinical Features

ABSTRACT Purpose: To describe clinical manifestations of patients with tubulointerstitial nephritis and uveitis syndrome (TINU) with a focus on posterior segment findings. Methods: Retrospective chart review. Results: 17 patients were diagnosed with TINU. Ten (59%) were female. Average age at presentation was 19 years (range 7–49). Urine β2-microglobulin was elevated in all tested patients. Six patients (35%) had isolated anterior uveitis. Eleven (65%) had posterior segment findings. Three (18%) had multifocal choroidal lesions, seven (41%) had disc edema, four (24%) had macular edema, three (18%) had choroidal neovascular membranes, two (12%) had retinal vasculitis, one (6%) had disc neovascularization and vitreous hemorrhage, one (6%) had bilateral posterior scleritis. Eleven (65%) required systemic steroid therapy, seven (41%) required immunomodulatory therapy. Conclusions: TINU occurs in all age groups. Posterior segment manifestations are common. Most patients required systemic steroid therapy, with a significant number requiring long-term systemic immunomodulation. Careful fundus examination is required on all patients with TINU.

Traumatic Cyclodialysis Cleft Surgical Management Using Encirclage and Cryotherapy : A Novel Approach

This is a retrospective case series of 4 patients with traumatic cyclodialysis cleft (CC) with features of hypotony and posterior segment manifestations of blunt trauma who were treated using encirclage and trans scleral cryoptherapy along with vitrectomy. Encirclage was placed anteriorly in order to support the cleft. There was closure of cleft and improvement in Intra ocular pressure (IOP) in all cases. Thus the identification and treatment of CC with encirclage in cases with varied posterior manifestation of trauma can lead to good anatomical and visual restoration.

Posterior keratoconus in a patient with familial exudative vitreoretinopathy.

Posterior keratoconus is a rare nonprogressive noninflammatory condition unlike anterior keratoconus. It can be congenital or acquired, sporadic or familial, unilateral or bilateral. Bilateral sporadic posterior keratoconus is an extremely rare entity (as bilateral cases are predominantly familial). It is associated with many systemic and ocular features. Various posterior segment manifestations are described in association with posterior keratoconus. We describe a case of FEVR in the setting of bilateral sporadic posterior keratoconus. An occurrence was not reported previously. A 17-year-old male presented with gradual painless diminution of vision OU for 2 years and nystagmus since birth. There was no history of trauma or ocular surgery. Family history was noncontributory. Best-corrected visual acuity (BCVA) was 20/600 in OD and 20/1200 in OS. Deep-set eyeballs with horizontal pendular nystagmus of low frequency and low amplitude were noted. Slit-lamp examination revealed OU localized depression of posterior corneal curvature measuring 4 mm in diameter suggestive of posterior keratoconus [Fig. 1a and d], which was confirmed on anterior segment OCT [Fig. 1b and e]. Typical oil droplet reflex was noted on retro-illumination [Fig. 1c and f]. Rest of the anterior segment was normal in OU.Figure 1: (a-c) slit-lamp photograph of OD showing posterior keratoconus, anterior segment OCT of OD showing posterior keratoconus, clinical photograph in retroillumination. (d-f) slit-lamp photograph of OS showing posterior keratoconus, anterior segment OCT of OS showing posterior keratoconus, clinical photograph in retroilluminationDilated fundus examination of OU revealed small, tilted optic disc with gliotic changes on its surface. Old rhegmatogenous retinal detachment was seen along with multiple subretinal bands [Fig. 2a and b] in bilateral eyes. Tortuous retinal vessels with supernumerary branches ending short of equator were noted, leaving peripheral retina avascular. These findings were confirmed on UWFA [Fig. 2c and d]. In addition, peripheral lattice degeneration in temporal retina with multiple holes was observed OU. Based on clinical and diagnostic evidences, patient was diagnosed to be a case of both eye posterior keratoconus with associated FEVR and RD.Figure 2: (a and b) wide-field clinical photograph of fundus OD showing attached retina with temporal buckle indent with lattice with hole with temporal avascular retina, FFA showing temporal avascular retina. (c and d) wide-field clinical photograph of fundus of OS showing retinal detachment with subretinal band with temporal avascular retina, FFA showing temporal avascular retinaAfter informed consent, the patient underwent scleral buckling surgery in OU sequentially. One month postoperatively, BCVA improved to 20/120 in OD and 20/200 in OS with retina attached. The patient was advised regular follow-up. Discussion Posterior keratoconus is developmental in most cases and is due to anterior chamber cleavage anomaly.[1] Acquired causes, on the other hand, are rare and mostly post trauma.[2] There is constellation of posterior segment features quoted in the literature that can occur along with posterior keratoconus with undetermined genetic linkage.[345678] Our patient had a unique association of bilateral sporadic posterior keratoconus with FEVR, which to our knowledge never reported earlier. Atypical presentation of FEVR with associated retinal detachment and subtle posterior keratoconus makes our case a diagnostic challenge. To conclude, FEVR can occur in the setting of posterior keratoconus. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Anterior and Posterior Segment Manifestations of Pathological Myopia: A Clinical Study from Turkish Aegean Region

Background and Objective:Myopia is one of the most prevalent vision conditions caused by a mismatch between the refractive power and axial length of the eyeball. High myopia may have a degenerative disorder, including cornea, sclera, choroid, optic disc, vitreous, macula, and peripheral retina. Although there are few studies regarding clinical features of pathological myopia, especially in the far-eastern countries where myopia is common, but are no comprehensive data in our region. This study was aimed to demonstrate both anterior and posterior ocular segment manifestations of pathological myopia.Methods:One hundred forty eyes of 82 patients who met the pathological myopia criteria were enrolled in this prospective study. Measurements of Central Corneal Thickness (CCT), endothelial cell parameters, Anterior Chamber Depth (ACD), Axial Length (AL) and Subfoveal Choroidal Thickness (SFCT) were performed in all patients. Presence of posterior segment pathologies such as peripapillary atrophy, tilted disc, Lacquer's crack, foveoschisis, myopic maculopathy, Choroidal Neovascularization (CNV), and peripheral retinal degeneration was recorded.Results:The mean age was 54.1 ± 14.2 years. 43 (52.4%) of the patients were female. One hundred patients (71.4%) were phakic and 40 (28.6%) were pseudophakic. The mean CCT, corneal endothelial cell density, ACD, AL, and SFCT were 548.91 ± 43.44 µm, 2335.89 ± 374.38 cells/mm2, 3.93 ± 0.79 mm, 28.75 ± 2.20 mm, and 94.56 ± 73.11 µm, respectively. Tilted disc, peripapillary atrophy and posterior staphyloma were detected in 89 (63.6%), 119 (85%) and 78 (55.7%) eyes, respectively. Normal fundus, tessellated fundus, diffuse chorioretinal atrophy, focal chorioretinal atrophy and macular atrophy were seen in 13 (9.3%), 59 (42%), 26 (18.6%), 14 (10%), and 28 (20%) eyes, respectively. Lacquer crack, CNV, and Fuchs spot were observed in 11 (7.9%), 39 (27.9%), and 47 (33.6%) eyes, respectively.Conclusion:This study reported clinical characteristics of eyes with pathological myopia in a retina specialty clinic at a tertiary referral center from the Turkish Aegean Region. Pathological myopia may affect both anterior and posterior ocular segments. However, posterior segment manifestations may be associated with lesions that threaten vision. Therefore, periodic follow-up in patients with pathological myopia is critical.

Ultra-widefield Fluorescein Angiography and OCT Findings in Tubulointerstitial Nephritis and Uveitis Syndrome

To report the spectrum of posterior segment findings in tubulointerstitial nephritis and uveitis syndrome (TINU) and discuss the abnormalities that can be seen on imaging. Retrospective, consecutive case series. Patients with TINU and posterior segment manifestations on examination or imaging. Patients with elevated urine beta-2 microglobulin (Uβ2M) and a diagnosis of TINU were included if they were evaluated at the Cole Eye Institute and did not have alternative etiologies for uveitis. Electronic medical records were reviewed for abnormal findings on ultra-widefield fluorescein angiography (UWFFA) and OCT. Presence of peripheral vascular leakage, optic disc leakage, chorioretinal lesions, or leakage within the macula on UWFFA. For OCT findings, patients were categorized as having intraretinal fluid, epiretinal membrane, or optic nerve edema. Twenty eyes from 10 patients (6 female, 4 male) with a bimodal age distribution (10-46 years and 77-83 years) were included. Eighteen of 20 eyes (90%) underwent UWFFA; 13 eyes demonstrated the presence of peripheral vascular leakage, 5 eyes showed optic disc leakage, and 6 eyes had leakage within the macula. All eyes underwent OCT imaging; 7 eyes demonstrated intraretinal fluid, 4 eyes were found to have an epiretinal membrane, and 1 eye had optic nerve edema. Six eyes lacked anterior uveitis on initial or follow-up examination but had abnormal findings on UWFFA or OCT. Tubulointerstitial nephritis and uveitis syndrome is under-recognized in the clinical setting. It can manifest in patients of all ages, and posterior segment involvement is not uncommon. Abnormalities may be seen on posterior segment examination or imaging in the absence of anterior segment inflammation. Tubulointerstitial nephritis and uveitis syndrome should be considered in the differential diagnosis for patients presenting with bilateral uveitis without evidence of infection or other clear etiology for intraocular inflammation.

Visual impairment in high flow and low flow carotid cavernous fistula

Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of “3 point sign” is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. “3 point sign” must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.

Prevalence and Associations of Posterior Segment Manifestations in a Cohort of Egyptian Patients with Pathological Myopia

ABSTRACT Purpose To determine the prevalence of posterior segment manifestations among consecutive patients with pathological myopia attending our University Hospital general ophthalmology clinic and their association with age, refractive error, axial length and each other. Methods Patients diagnosed with pathological myopia underwent full ophthalmological examination, optical coherence tomography, fluorescein angiography, and ocular ultrasonography. Manifestations detected were recorded for each eye and their prevalence and association with age, refractive error, axial length and each other was determined. Results A total of 127 eyes of 77 patients with pathological myopia were examined. The most prevalent manifestation was peripheral retinal lesions, found in 63.8% of examined eyes, followed by tigroid fundus, found in 59.1%. Peripheral lesions were significantly associated with more myopia (P = .02) and longer axial length (P = .046). The commonest peripheral lesion was white without pressure, found in 37.8% of eyes. Lattice degeneration was found in 11.8% and snail track degeneration in 4.7% and was not associated with degree of myopia or axial length. Diffuse chorioretinal atrophy was present in 40.9% of eyes, while patchy atrophy was present in 18.9%. Macular holes were present in 4.7% of eyes and were significantly associated with foveoschisis (P = .035) and retinal detachment (P = .003), while foveoschisis was present in 5.5% and was significantly associated with older age (P = .012), longer axial length (P = .010) and patchy chorioretinal atrophy (P = .024). Retinal detachment was found in 6.3% of eyes and retinal breaks in 4.7%. Posterior staphyloma was detected in 33.1% and lacquer cracks and choroidal neovascular membranes in 6.3% of eyes. Conclusions The prevalence of pathological myopia manifestations may differ between different populations. This may be due to the multiple genetic and environmental factors involved which may result in a variable natural history of the condition among different populations.

Ocular surface disorder among HIV and AIDS patients using antiretroviral drugs

Background: Ocular disorders occur in 50% – 80% of HIV and AIDS patients, and dry eye has been reported as one of the most common anterior segment manifestations in these patients. Aim: The aim of this study was to investigate ocular surface disorders (OSDs) or dry eye in people living with HIV and AIDS on antiretroviral (ARVs) in a controlled setting. Setting: Mankweng Hospital, ARV Clinic. Methods: This study included 130 HIV and AIDS participants attending an ART Clinic at Mankweng Hospital and 48 controls. Each participant had an anterior and posterior segment eye examination with a slit lamp and fundus camera, respectively. The dry eye or OSD was investigated with Schirmer’s test and invasive fluorescein tear breakup time (TBUT). Results: The means of the Schirmer’s test and TBUT were 6.7 mm ± 4.0 mm and 6.9 ± 4 seconds in HIV and AIDS participants, while the means in the control group were 13.5 mm ± 3 mm and 14.2 ± 3 s, respectively. The correlations between the severity of dry eye and the level of CD4 cell count were positive and significant. Conclusion: There was decreased tear production as measured by the Schirmer’s test and TBUT in our study participants. Statistically significant correlations were found between the severity of dry eye and the level of CD4 cell count. Although the entire pathogenesis of dry eye in HIV and AIDS patients remains unclear, it may be associated with lymphocytic infiltration and destruction of the lacrimal gland.

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common anterior segment disorders in the HAART era. The statistical analysis showed no association between age, sex, CD4 count, duration of infection or receiving HAART and anterior segment disorders. Anterior segment abnormalities reduce the quality of life of patients, so ophthalmologists have to be aware and complete ocular examination should be performed in all HIV infected patients.

Macular Hole in Posterior Microphthalmos

Posterior microphthalmos is a rare ocular disorder characterized by disproportionately short vitreous length and numerous posterior segment findings. We report a rare coexistence of bilateral macular hole with posterior microphthalmos in a 15-year-old girl. Detailed ophthalmic examination and investigations including B scan ultrasonography and optical coherence tomography were performed. Ophthalmic examination showed bilateral high hyperopia. Best corrected visual acuity was 6/18 in each eye with correction of +12 D in right eye and +10 D in left eye. Ocular biometry measurements showed short total axial length (16.3 mm both eyes) with remarkable shortening of posterior segment (9.3 mm right eye; 9.28 mm left eye) but normal anterior segment parameters. Anterior chamber depth and horizontal corneal diameter were within normal range. Fundus evaluation revealed bilateral macular hole. Optical coherence tomography finding was compatible with bilateral lamellar macular hole in both eyes. B scan ultrasonography showed sclerochoroidal thickening with foreshortening of vitreous cavity. A variety of posterior segment manifestations associated with posterior microphthalmos have been reported but macular hole is an extremely rare association. This finding is noteworthy and probably among very few in literature.

Ophthalmic manifestations of bartonella infection.

The eye is commonly affected in disseminated cat scratch disease (CSD) caused by Bartonella species. This article reviews recently published data on epidemiology of CSD, clinical features of ocular involvement, diagnosis and treatment. The annual incidence of CSD has been estimated as 4.7 per 100 000 in the United States. It occurs predominantly in the southern states, with a peak in January, and disproportionately affects children. Retinal infiltrates, neuroretinitis and branch retinal artery occlusions have been reported as common manifestations of ocular bartonellosis in recent series. The use of different antigens for serodiagnosis and new real-time PCR assays for molecular diagnosis have been described. Despite lack of a standard treatment, good visual outcomes were generally reported in patients with ocular bartonellosis. Bartonella infections continue to be a burden worldwide and epidemiologic features may guide preventive measures in high-risk regions and populations. An increased awareness of diverse posterior segment manifestations will lead to an early diagnosis of ocular bartonellosis. Laboratory diagnostic methods continue to evolve and may be applied to the investigation of ocular fluids for a definitive diagnosis of ocular bartonellosis. Well designed clinical trials are required to establish the optimum treatment of especially sight-threatening manifestations.

Enhanced Vitreous Imaging in Uveitis

ABSTRACTPurpose: To study the structural visibility of the posterior vitreous cavity and vitreoretinal interface using Spectral Domain–Optical Coherence Tomography in patients with uveitis using conventional, Enhanced Depth Imaging (EDI), Combined Depth Imaging (CDI), and Enhanced Vitreous Imaging (EVI) techniques.Methods: It was an observational cross-sectional study of 59 eyes of 33 patients between age group 12–72 years (Median 43) diagnosed as uveitis with posterior segment manifestations underwent OCT using conventional, EDI, CDI, and EVI techniques. The visibility of posterior vitreous was graded in all the techniques.Results: A statistically significant difference was seen in posterior vitreous visibility on comparing all four techniques. EVI showed better visibility of posterior vitreous cavity compared to all other techniques (P < 0.001).Conclusions: EVI technique provides better structural visibility of posterior vitreous compared to conventional, EDI, and CDI techniques.

Outcomes of cataract surgery with/without vitrectomy in patients with pars planitis and immunosuppressive therapy.

The purpose of this study was to evaluate the characteristics and outcomes of cataract surgery with/without vitrectomy in patients with pars planitis who received immunosuppressive therapy. This was a retrospective case series, single-center study. Twenty-two patients with pars planitis who received immunosuppressive therapy were included, with a median age at presentation of 9.5years, having had cataract surgery. The following data was collected: age at presentation and at cataract surgery, time of follow-up, best-corrected visual acuity (BCVA) before the surgery and at 1week, 1 and 6months after the procedure, immunosuppressive therapy, complications and causes for failed visual improvement. The variables associated with an improvement in visual acuity were evaluated. All patients had phacoemulsification with intraocular lens implantation. The most common immunosuppressive therapy used for the patients was methotrexate in nine patients (40.9%). The BCVA improved from a median of 20/400 to 20/100 after 6months of follow-up (p=0.0005); 14 patients (63.6%) improved two lines of vision or more. No significant risk factors were found for the association with improvement in visual acuity after the surgery. No improvement in visual acuity was attributed to posterior segment manifestations or amblyopia; the most common complication was posterior capsule opacification in 11 eyes (50%). The median follow-up after the surgery was 32months. Phacoemulsification was the procedure for all the patients. Visual acuity improved in patients with pars planitis treated with immunosuppressive drugs who underwent cataract surgery, except for the patients with posterior segment complications or amblyopia.

Prevalence of ocular retinal disorders in patients with diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus is a life style disorder that requires synergistic interaction among the patient, the family and health-care team. Retinopathy is the prime cause of new-onset blindness among young adults in the working age group. Therefore, it is important to screen patients with diabetes regularly for the development of retinal disease. Aim and Objective: Assessment of the prevalence of diabetic retinopathy (DR). To create awareness about avoidable blindness in diabetic patients and to direct the patient toward further evaluation and follow-up. Materials and Methods: The study is a hospital-based, non-interventional, cross-sectional prospective study. The visual disorders are evaluated in 500 patients attending Ophthalmology Outpatient Department of Kanyakumari Government Medical College Hospital. Estimation of visual acuity, color vision, slit lamp examination, intraocular pressure, retinoscopy and fundus examination, visual field analysis is done to detail the defective vision. Results: Data are analyzed using SPSS. The common pathological changes in the posterior segment causing defective vision are DR - 94 patients (18.8%), Combined retinopathy - 10 (2%). The common associated systemic disease is hypertension - 210 patients (42%). Conclusion: DR is the most common posterior segment manifestation of diabetes mellitus. Our goal is to prevent sight-threatening retinopathy from developing. Effective control of hyperglycemia, hypertension, and yearly screening fundus examination is essential for all the patients.

Eye changes among HIV positive patients on antiretroviral therapy in Nepal.

To find out eye findings among HIV positive patients in the era of antiretroviral therapy. Method This Hospital based cross sectional descriptive study was carried at B. P. Koirala Lions Centre for Ophthalmic Studies. Patient profile, WHO clinical stage, CD4+ cell count, duration of HIV, antiretroviral therapy, and systemic diseases were recorded. All the cases underwent ocular examination as per the study protocol and the findings were noted in a proforma developed for the study. The results were analysed with SPSS 14.0. Of 100 HIV positive cases (including 55 antiretroviral therapy patients) 62% patients were male and 38% were female. The mean age of presentation was 27.72 years. Heterosexual transmission (62%) was the commonest mode of transmission of HIV. Thirty seven percent patients were illiterate. Systemic disease was present in 20% cases. Ocular complaint was present in 53% patients. Ocular disease was present in 40% HIV positive patients. Almost 55% of these cases were on antiretroviral therapy. Moderate to lower CD4 count patient had frequent eye disease. Patients in WHO Stage III and IV also had frequent eye problems. Anterior segment and external ocular disorder was present in 25% patients. The commonest manifestation was conjunctivitis in10% of total cases. Posterior segment manifestation was present in 11%, neuro-ophthalmic lesion in 4% and orbital lesion in 1% patient. Anterior segment manifestation is still common ocular manifestations in HIV positive patients in Nepal. Patients in WHO Stage III and IV are more vulnerable for eye changes. Young aged male and migrant workers are at risk of acquiring HIV in developing country like Nepal. Eye findings even in patientson antiretroviral therapy are similar. However, large sample size and long follow up study is required to have final disclosure.

Posterior segment involvement in cat-scratch disease: A case series

Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.