Significant Visual Impairment Research Articles

The Role of Natural Products in Diabetic Retinopathy.

Diabetic retinopathy (DR) is one of the most severe complications of diabetes mellitus and potentially leads to significant visual impairment and blindness. The complex mechanisms involved in the pathological changes in DR make it challenging to achieve satisfactory outcomes with existing treatments. Diets conducive to glycemic control have been shown to improve outcomes in diabetic patients, thus positioning dietary interventions as promising avenues for DR treatment. Investigations have demonstrated that natural products (NPs) may effectively manage DR. Many types of natural compounds, including saponins, phenols, terpenoids, flavonoids, saccharides, alkaloids, and vitamins, have been shown to exert anti-inflammatory, antioxidant, anti-neovascular, and antiapoptotic effects in vivo and in vitro. Nevertheless, the clinical application of NPs still faces challenges, such as suboptimal specificity, poor bioavailability, and a risk of toxicity. Prospective clinical studies are imperative to validate the therapeutic potential of NPs in delaying or preventing DR.

Bilateral multiple recurrent branch retinal vein occlusions secondary to hypercoagulopathy associated with multiple mutations: A rare case report

Abstract: Retinal vein occlusions (RVOs) are relatively common vascular disorders, often resulting in significant visual impairment. We present an intriguing case of a 53-year-old male with recurrent bilateral branch RVOs stemming from underlying hypercoagulopathy. This complex scenario encompassed simultaneous bilateral RVO occurrences and subsequent unilateral recurrences. Despite the absence of systemic comorbidities or conventional risk factors, genetic assessment unveiled notable heterozygous mutations involving Factor V Leiden (G1691A) and Factor II (PT G20210A), along with a homozygous methylenetetrahydrofolate reductase A1298C mutation. While routine hematological indicators remained largely unremarkable, the marked efficacy of anti-vascular endothelial growth factor (anti-VEGF) agents, particularly when administered promptly, emerged as a noteworthy therapeutic avenue. This case underscores the imperative of scrutinizing thrombotic mutations in youthful patients with recurrent RVOs, accentuating the favorable retinal response to anti-VEGF interventions and emphasizing the rewards of timely clinical intervention.

VISUAL OUTCOME FOLLOWING PARS PLANA VITRECTOMY IN POST-OPERATIVE ENDOPHTHALMITIS PATIENTS

Postoperative endophthalmitis is a serious complication following ocular surgery that can lead to significant visual impairment. Pars plana vitrectomy (PPV) is one of the treatment options for managing this condition, but its visual outcomes are not well-established. Objective: This study aimed to assess the visual outcome following pars plana vitrectomy in patients with postoperative endophthalmitis. Methods: This interventional study was conducted at the eye ward of Hayatabad Medical Complex, Peshawar, from September 2023 to February 2024. Forty patients with postoperative endophthalmitis underwent pars plana vitrectomy. Visual acuity was evaluated in the 12th week after the procedure. Results: Among the patients evaluated, 15% demonstrated a visual acuity improvement of 6/18 or higher, while 22.5% showed an improvement of 6/60 or better. Additionally, 35% of patients could count fingers, 17.5% had vision of hand movement, and 10% showed no increase in visual acuity. There was no significant relationship between age distribution and post-follow-up improvement in visual acuity. Conclusion: Pars plana vitrectomy in patients with postoperative endophthalmitis can lead to positive outcomes in terms of improved visual acuity.

Case Report: Pendular Nystagmus Presenting in Usher Syndrome Type I.

We describe a 42-year-old patient with reported "shaking" vision referred due to concerns of possible vestibular system dysfunction. The patient has known history of Usher syndrome type I, bilateral cochlear implants, and severe vision impairment. This case describes an unusual nystagmus previously only reported in individuals with central demyelinating disorders, significant light deprivation, or in congenital / early-onset visual pathway impairment. Case study. Retrospective chart review of vestibular function. Vestibular function was likely absent in this case. There was no evidence of vestibular (jerk) nystagmus for sinusoidal harmonic acceleration stimuli or repeatable responses for cervical vestibular evoked myogenic potentials. Significant pendular low amplitude high frequency oscillations of approximately 6 Hz were present for horizontal and vertical tracings throughout testing. Nystagmus may not always be associated with vestibular system impairment. In this case, the patient's reported "shaking" vision was attributed to pendular low amplitude high frequency nystagmus and hypothesized to relate to long-standing significant vision impairment. This presentation is unusual in adults and has historically been associated with individuals with significant central pathology or in those with long duration light deprivation.

Insight into Retinal Dystrophy: Understanding Features and Treatment Strategies

Retinal dystrophies such as; Retinitis pigmentosa, Congenital Stationary Night Blindness, stargartds disease, lebers congenital amaurosis, and others; present with significant visual impairments due to various genetic mutations affecting retinal function and photoreceptor maintenance. This review explores the diverse landscape of retinal dystrophies, categorizing subtypes based on affected cell types. It sheds light on the clinical characteristics, diagnostic techniques, and complex genetic underpinnings of many illnesses. The study emphasizes the significance of the genetic landscape and enhanced diagnostic tools for prognosis. It also looks at newer forms of treatment, such as gene treatments and pharmaceutical approaches, providing a succinct summary of the developing field. This review, aimed at researchers and clinicians, is a useful tool for comprehending and treating retinal dystrophies.

Demographic and Clinical Profile of Pediatric Uveitis in Delta Region, Egypt

ABSTRACT Purpose Pediatric uveitis poses unique challenges, characterized by difficulties in performing comprehensive examinations, potential delays in diagnosis, and a heightened risk of ocular complications. This study evaluate the etiologic and clinical characteristics of uveitis in children presenting to the Mansoura Ophthalmic Center, Mansoura, Egypt. Methods A cross-sectional observational study was undertaken involving children diagnosed with uveitis attending the uveitis outpatient clinic at Mansoura University Ophthalmic Center. Comprehensive clinical evaluations were carried out, including detailed history taking and exhaustive ophthalmological examinations. Whenever deemed necessary, Spectral Domain Optical Coherence Tomography (OCT) and Fluorescein Fundus Angiography (FFA) were utilized to secure retinal images. An extensive systemic evaluation was also conducted to discern the diverse causes of uveitis among the participants. Results The cohort comprised 63 children, impacting 97 eyes. Bilateral involvement was seen in 54% of cases, with a male predominance of 58.7%. The predominant etiologies of uveitis were presumed trematode-induced (36.7%), Juvenile Idiopathic Arthritis (JIA) accounting for 28.6%, and in 12.7% of cases, the cause remained undetermined. Anterior uveitis emerged as the primary presentation in 79.4% of cases. Regarding visual loss, cataract was the leading cause at 56.4%, followed by vitritis at 38.4%, and macular edema at 20.5%. Conclusion Anterior uveitis was the most frequent presentation in our pediatric cohort. Despite the challenges, the majority of children with uveitis exhibited no significant visual impairment, with most causes of visual loss being reversible.

Assessment of quality of life of patients which visual impairment and a diagnosis of cataract

: Cataract is the leading cause of blindness, reducing economic productivity further leading to reduced quality of life (QOL). Various studies done around the globe have demonstrated that cataract and its diagnosis have been associated with poor quality of life and increased mortality. A thorough literature search showed limited study to assess the quality of life in patients with cataract in India. Hence, we designed this study to assess the quality of life of patients which visual impairment and a diagnosis of cataract.This cross-sectional study was conducted in patients diagnosed with cataract with visual impairment visiting the tertiary care center. The study was approved by the Institutional Ethics Committee and patients were recruited after they gave written informed consent. The participants were divided into two groups, Group 1 consisted of male patient whereas Group 2 consisted of female patients. The participant was assessed for visual functioning (VF) and Quality of Life.: The results of our study have demonstrated that out of total 84 participants recruited in the study, majority of them were female (n=50) and both groups were comparable at the time of presentation. All patients had a significant visual impairment at the time of presentation with 22 male participants and 33 female participants had grade III or more visual impairment. All patients had compromised quality of life as evident by the responses obtained from the participants on the visual functional score and quality of life scores. There was also a statistically (p<0.05) higher number of female participants as compared to male participants who had quite a lot of problems of noticing of objects off to side, had to make adjustment to darkness after being in bright light, problem in locating things when it was surrounded by lot of other things.All patients had compromised quality of life as evident by the responses obtained from the participants on the visual functional score and quality of life scores. Though participants in both groups with grade III onwards had higher visual functional scores and quality of life scores.

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

Real-world experience of full-thickness traumatic macular hole among young patients

ObjectiveTo describe the demographics, clinical, and imaging characteristics, and visual outcomes in young patients with full-thickness traumatic macular hole (TMH).MethodsThis retrospective hospital-based study included patients with full-thickness TMH who presented between August 2010 and June 2021. Demographic data, clinical findings, and imaging characteristics were extracted from an electronic medical record system. Regression analyses were performed to determine significant associations among variables and to identify predictors of visual outcomes.Results144 (0.005%) patients among 2,834,616 were diagnosed with Full thickness TMH. The majority of them were male (89.58%; odds ratio [OR] = 6.71) and the holes were unilateral. The mean age at presentation was 23.37 ± 8.19 years. Ball were the most common cause of injuries (22.22%), followed by stick (14.58%) and firecracker (12.50%). The mean LogMAR visual acuity (VA) at presentation was 1.18 ± 0.72, with 25.69% of eyes having VA < 20/400. The mean minimum hole diameter was 619.34 ± 336.16 μm. Sub-retinal fluid was present in 44.44%, followed by intraretinal fluid in 34.03% of eyes. Macular holes closed after vitrectomy in 66.67% of eyes, with mean final VA of 1.07 ± 0.85. Baseline VA was a strong predictor of final VA (R2 = 0.677; p = 0.000168).ConclusionTraumatic macular hole is a unilateral condition with significant visual impairment that is mainly seen in males during the third decade of life. Surgery is successful in most cases but improvements in VA are modest.

Deficiency of Acetyltransferase nat10 in Zebrafish Causes Developmental Defects in the Visual Function.

N4-acetylcytidine (ac4C) is a post-transcriptional RNA modification catalyzed by N-acetyltransferase 10 (NAT10), a critical factor known to influence mRNA stability. However, the role of ac4C in visual development remains unexplored. Analysis of public datasets and immunohistochemical staining were conducted to assess the expression pattern of nat10 in zebrafish. We used CRISPR/Cas9 and RNAi technologies to knockout (KO) and knockdown (KD) nat10, the zebrafish ortholog of human NAT10, and evaluated its effects on early development. To assess the impact of nat10 knockdown on visual function, we performed comprehensive histological evaluations and behavioral analyses. Transcriptome profiling and real-time (RT)-PCR were utilized to detect alterations in gene expression resulting from the nat10 knockdown. Dot-blot and RNA immunoprecipitation (RIP)-PCR analyses were conducted to verify changes in ac4C levels in both total RNA and opsin mRNA specifically. Additionally, we used the actinomycin D assay to examine the stability of opsin mRNA following the nat10 KD. Our study found that the zebrafish NAT10 protein shares similar structural properties with its human counterpart. We observed that the nat10 gene was prominently expressed in the visual system during early zebrafish development. A deficiency of nat10 in zebrafish embryos resulted in increased mortality and developmental abnormalities. Behavioral and histological assessments indicated significant vision impairment in nat10 KD zebrafish. Transcriptomic analysis and RT-PCR identified substantial downregulation of retinal transcripts related to phototransduction, light response, photoreceptors, and visual perception in the nat10 KD group. Dot-blot and RIP-PCR analyses confirmed a pronounced reduction in ac4C levels in both total RNA and specifically in opsin messenger RNA (mRNA). Additionally, by evaluating mRNA decay in zebrafish treated with actinomycin D, we observed a significant decrease in the stability of opsin mRNA in the nat10 KD group. The ac4C-mediated mRNA modification plays an essential role in maintaining visual development and retinal function. The loss of NAT10-mediated ac4C modification results in significant disruptions to these processes, underlining the importance of this RNA modification in ocular development.

Retinal Occlusive Vasculitis after Intravitreal Injection of Brolucizumab

Purpose: To report two instances of retinal arterial occlusive vasculitis following intravitreal injection of brolucizumab.Case summary: Two patients noted decreased visual acuity approximately one month after receiving intravitreal brolucizumab injections to treat wet age-related macular degeneration. In case 1, an 85-year-old male reported a reduction in visual acuity in his left eye, declining from a Snellen measurement of 0.2 to hand motion. In case 2, a 70-year-old female experienced a decline in visual acuity in her right eye from 0.4 to finger count at 50 cm. Both patients presented with anterior chamber reactions, and fluorescein angiography demonstrated delayed retinal artery filling time, leading to the diagnosis of retinal occlusive vasculitis. They were treated with both topical and systemic corticosteroids. For case 1, a subsequent vitrectomy was performed to remove the inflammatory membrane located behind the intraocular lens. However, despite aggressive interventions, neither patient showed visual improvement.Conclusions: Retinal occlusive vasculitis, which can result from intraocular inflammation, may occur after intravitreal brolucizumab injection. This condition can lead to significant visual impairment even with aggressive treatment.

Vitreous Opacity Following Intravitreal Brolucizumab Injection: A Case Series Review.

To investigate cases of vitreous opacity (VO) similar to asteroid hyalosis (AH) after intravitreal brolucizumab injection. A retrospective chart review was conducted to identify cases showing VO similar to AH among patients who received intravitreal brolucizumab injections at our retinal clinic from January 2022 to January 2023. A total of 220 brolucizumab injections were administered at our hospital. VO, showing yellow-white brilliant reflective particles, was found in six patients (2.7%). When VO occurred, all patients complained of floaters, although none of them complained of other symptoms including decreased visual acuity, pain, or conjunctival redness. The mean number of brolucizumab injections was 2.57 ± 2.38. No significant visual impairment was observed while VO was present. VO improved in all cases, and four cases improved without any treatment. The mean interval from onset to disappearance of VO was 8.0 ± 3.1 weeks. VO, similar to AH, can occur with a relatively high probability after intravitreal brolucizumab injections. Patients complained of severe floaters, but VO was not accompanied by other symptoms including vision impairment, injection, and pain. The VO disappeared after approximately 4 to 14 weeks. In case that other inflammatory findings are not severe, close follow-up without treatment may be sufficient. If a patient complains of floaters after an intravitreal brolucizumab injection, close fundus observation is necessary to evaluate the VO.

Topical Immunosuppressant Agent Cyclosporine (CsA) as Therapy for Ocular Alkali Chemical Injury: Is It Really Beneficial?

Introduction : Alkali chemicals can cause more severe ocular injury than acidic chemicals, because the alkali can rapidly penetrate the cornea into the anterior chamber of the eye and damage the iris, ciliary body, lens and trabecular meshwork, which can cause significant visual impairment. A topical immunosuppressant Cyclosporine (which also known as Cyclosporin A or CsA) was used in the treatments.&#x0D; Case Illustration : A 3-year-old male patient presented painful eyes 3 days after an accidental ocular injury with Calcium Hydroxide. The ophthalmic examination revealed based on Roper-Hall grading, the injuries indicated grade III-IV ODS. The patient's BCVA OD 2/60, and OS 20/200. The patient was hospitalized and underwent intensive conservative pharmacological therapy, including topical CsA. Corneal healing was examined by serial corneal Optical coherence tomography (OCT) and showed improvement of the corneal haze throughout the follow-ups. From the last follow-up, the BCVA OD 20/70, OS 20/40.&#x0D; Discussion : Topical CsA reduces the number of CD3-positive cells (T lymphocytes) and the production of pro- inflammatory cytokines, which was associated with the decreased expression of matrix metalloproteinase-9, inducible nitric oxide synthase, VEGF and active caspase-3. Corneal neovascularization is a clinical condition caused by alkali burn that, when left untreated, leads to significant visual impairment. VEGF-A is one of the most important mediators of angiogenesis, leading to neovascularization. Hence, topical CsA 0.1% eye drops may play a role in the treatment of alkali corneal injury.&#x0D; Conclusion : This case report showed that topical CsA gave a significant corneal wound healing, combined with the mainstay of alkali chemical injury.

Detecting Keratoconus in Primary Healthcare: What general practitioners could do?

Introduction : Keratoconus (KC) is a rare eye disorder that causes corneal thinning and visual disturbances. KC prevalence in the pediatric population is 0.16%. Children with keratoconus experience faster disease progression and significant visual impairment at diagnosis, impacting their quality of life. This case report aims to raise awareness and provide knowledge regarding KC for general practitioners.&#x0D; Case Illustration : A 14-year-old male visited a primary healthcare facility complaining of difficulty seeing words on the classroom board for the past year. His best-corrected visual acuity was 6/15 (S-10.25 C-5.25x30) OD and 6/60 (S-25.00 C-2.75x150) OS. Upon examination, it was observed that the left cornea was more protruding than the right, with a positive Rizzuti and Munson sign. Based on the findings, the patient was suspected of having keratoconus with amblyopia and was referred to an ophthalmologist for further examination and management.&#x0D; Discussion : Keratoconus is severe and burdensome to society, impacting children's education and quality of life. Early detection and intervention are crucial to prevent worsening. KC can be detected in primary healthcare by observing external signs such as Rizzuti and Munson. KC can lead to severe vision problems and even amblyopia if left untreated. Treating pediatric KC involves improving vision using contact lenses. In cases where contact lenses cannot be used, keratoplasty may be necessary.&#x0D; Conclusion : Primary healthcare providers can identify and assess keratoconus in patients and make referrals to ophthalmologists for treatment to minimize the impact on vision and stop its progression.

Big data for imaging assessment in glaucoma.

Glaucoma is the leading cause of irreversible blindness worldwide, with many individuals unaware of their condition until advanced stages, resulting in significant visual field impairment. Despite effective treatments, over 110 million people are projected to have glaucoma by 2040. Early detection and reliable monitoring are crucial to prevent vision loss. With the rapid development of computational technologies, artificial intelligence (AI) and deep learning (DL) algorithms are emerging as potential tools for screening, diagnosing, and monitoring glaucoma progression. Leveraging vast data sources, these technologies promise to enhance clinical practice and public health outcomes by enabling earlier disease detection, progression forecasting, and deeper understanding of underlying mechanisms. This review evaluates the use of Big Data and AI in glaucoma research, providing an overview of most relevant topics and discussing various models for screening, diagnosis, monitoring disease progression, correlating structural and functional changes, assessing image quality, and exploring innovative technologies such as generative AI.

P-49 Unexpected spontaneous evolution of a symptomatic Rathke's cleft cyst

Abstract Introduction Rathke's cleft cysts (RCCs) are relatively rare sellar and suprasellar lesions that arise from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. These cysts are often found incidentally during neuroimaging studies for unrelated issues. Despite their non-neoplastic nature, RCCs can lead to a spectrum of clinical manifestations due to their potential to compress surrounding structures, including the pituitary gland, optic chiasm, and adjacent neurovascular structures. However, the majority of Rathke's cysts will remain asymptomatic and typically do not necessitate any medical intervention. Instances of spontaneous regression of these cysts are infrequent, and cases of regression occurring after a recurrence are exceptionally rare. Clinical Case The patient is a 57-year-old individual with a medical history of well-controlled type 2 diabetes and high blood pressure. Additionally, the patient had a history of right ocular trauma in 1989 resulting in a decrease of visual acuity. The patient presented with persistent chronic headaches, leading to the detection of a Rathke's cleft cyst as revealed by a pituitary MRI showing a cystic structure measuring 15×11 mm in the sellar region. The cyst displayed a predominant left-sided lateralization and was characterized by T1 hypointensity as well as T2 hyperintensity. No enhancement was observed on post-gadolinium contrast injection. The cyst exerted a mass effect on the optic chiasm. Hypophyseal axis assessment revealed intact function. Notably, the patient exhibited significant visual field impairment in the right eye, marked by loss of the superior, nasal, and inferior fields, while the right visual field remained unaffected. The patient was managed conservatively based on the rationale that the visual disturbances were attributed to the ocular trauma and not linked to the RCC. Follow-up hypothalamo-hypophysial MRI conducted in April 2023 demonstrated complete spontaneous regression of the Rathke's cleft cyst, with an improvement of his chronic headache. Conclusion The natural history of RCCs is multifaceted leading to heterogenous outcomes ranging from volume progression with hormonal deficiencies and/or visual disturbances to stability over time to even spontaneous involution. The precise mechanism underlying the latter remains unclear. One possible explanation could involve disruptions in the equilibrium between the secretion and absorption of the cystic fluid, or even the potential occurrence of cyst rupture. The potential for involution or stability of the cyst is influenced by the cyst size. The likelihood of spontaneous involution advocates for a conservative strategy in cases of symptomatic RCCs where headaches are the sole presenting symptom.

Long-Term Visual Outcome of Patients with Blau Syndrome

ABSTRACT Purpose To document the long-term visual outcomes in patients with Blau syndrome. Methods A retrospective institutional cohort study was conducted, and 13 patients with genetically confirmed Blau syndrome were included. Demographic and clinical data were collected from standardised medical charts. Baseline was defined as the first detected uveitis and data were recorded onwards at intervals of 1, 3, 5, 10, 15 and 20 years. Results Anterior uveitis was the most common classification at baseline (57.1%). Among patients with documented uveitis lasting 10 years or more, all of them developed panuveitis. Median logMAR visual acuity at baseline was 0 (range −0.5; 0.7), 0.19 (range 0; 1.5) at year 5, and 0.7 (range 0.1 – no perception of light) at year 20, as recorded in 13, 16, and 10 eyes, respectively. All patients received treatment with topical and oral steroids, and multiple systemic immunosuppressants including biologics. Disease control, defined as having cells <1+ in both eyes and using topical steroid eye drops less than twice daily, was achieved in 14.3% to 37.5% of patients at the different time points. Cataract surgery was performed in 12 eyes of 8 patients, 3 eyes of 3 patients necessitated glaucoma surgery, and 4 eyes of 4 patients required surgery for retinal detachment. Conclusion Uveitis associated with Blau syndrome commonly leads to severe, chronic panuveitis, requiring long-term systemic immunosuppression. Early diagnosis and timely initiation of biologics may prevent significant visual impairment.

Clinical Profile, Prognostic Factors and Surgical Outcomes in Lens Induced Glaucoma: A Prospective Study from a Tertiary Care Centre in Western Maharashtra, India

Introduction: Cataracts are a major cause of preventable blindness in India. A considerable number of patients continue to present with advanced cataracts, which can result in complications such as Lens Induced Glaucoma (LIG). LIG is a secondary glaucoma that occurs due to mature or hypermature cataracts, potentially causing significant visual impairment. Aim: To determine the clinical presentation, prognostic factors, and surgical outcomes in patients with LIG. Materials and Methods: A prospective study involving 60 patients with LIG was conducted at a tertiary care centre in Western Maharashtra, India from September 2022 to June 2024. All patients underwent Small Incision Cataract Surgery (SICS) and were followed-up postoperatively on day 1, day 7, and week 6. Results: The mean age of the patients was 69.03 years, with 66.7% being females. Symptoms such as pain, redness, headache and diminished vision were present in all patients. The mean duration of symptoms was 4.08 days. All patients presented with poor visual acuity (&lt;6/60), and the majority had shallow Anterior Chamber (AC) depth (83.3%). The highest number of cases exhibited elevated Intraocular Pressure (IOP), with a range of 41-50 mmHg. Postoperative visual outcomes improved significantly by week 6 in 51.7% of patients. Conclusion: Early diagnosis and management of cataracts are crucial in preventing LIG and improving visual outcomes. Community outreach programs for early detection and management are essential in a developing country like India.

Acute Bilateral Painless Vision Loss in a Pediatric Patient With Infective Endocarditis

Infective endocarditis (IE) is a complex cardiac condition with a myriad of systemic complications, affecting approximately 5% of patients with ocular manifestations. This report details a rare and severe presentation of IE, marked by the acute onset of bilateral vision loss attributed to central retinal arterial occlusion (CRAO) and posterior ischemic optic neuropathy (PION), both critical conditions resulting from vascular impairments associated with IE. CRAO, characterized by the sudden obstruction of blood flow to the retina, leads to rapid vision deterioration, showcasing the critical impact of vascular emboli originating from infective endocardial lesions. On the other hand, PION, a less common vascular disorder, affects the posterior segment of the optic nerve, typically sparing the optic disc from edema but resulting in significant visual impairment. This case emphasizes the importance of recognizing ocular symptoms in patients with IE, as early detection and intervention are vital for managing these rare but devastating complications.

Herpetic keratouveitis: A three year follow‐up case

Aims/Purpose: Herpetic keratouveitis1 is a common presentation to Eye Casualty but due to the broad spectrum of manifestations that it can present with, it is an easy diagnosis to miss. The aim of this report is to create awareness among ophthalmologists of how this disease can present, appropriate clues to the diagnosis as well as how it should be managed.Methods: A 76 year old male presented to the eye emergency department with a 1 week history of significant visual deterioration (6/90 pinhole), redness and photophobia in his left eye. He was initially treated 6 weeks prior with a course of tapering steroid drops for presumed acute anterior uveitis which led to an initial improvement in symptoms, followed by a sudden worsening of symptoms. Ocular examination revealed a 9 mm × 8 mm central corneal ulcer with a satellite lesion superonasally, Descemet folds, reduced corneal sensation with mild anterior chamber inflammation and no posterior segment pathology. Corneal scrapes as well as PCR was sent for culture and sensitivity.Results: PCR revealed a positive result for herpes simplex virus and the patient showed significant improvement with oral acyclovir, topical gancyclovir ointment and topical steroid drops. In the 3 years following the initial presentation, the patient has had 3 further episodes of left herpetic keratouveitis and has now been put on lifelong maintenance dose oral acyclovir and FML drops.Conclusions: We report this case to highlight the key clinical features compatible with herpetic keratouveitis. This disease can be chronic and should be considered in any patient presenting with chronic anterior uveitis not improving with steroid drops. PCR remains the gold‐standard for diagnosis however this is not always positive and clinical diagnosis remains key.Reference1. Cunningham E.T. Diagnosing and treating herpetic anterior uveitis. Ophthalmology 2000; 107(12: 2129–30. doi:10.1016/s0161‐6420(00)00287‐6.