Total Loss Of Vision Research Articles

Are large diameter cannulas safe in nonsurgical rhinoplasty?

Are large diameter cannulas safe in nonsurgical rhinoplasty?

Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy.

Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy.

Paeoniflorin Protects Retinal Ganglion Cells in Experimental Glaucoma

Glaucoma is a progressive neurodegenerative eye disease characterized by raised intraocular pressure and a loss of retinal ganglion cells, resulting in partial or total vision loss. We have investigated whether paeoniflorin could reduce intraocular pressure and improve retinal ganglion cell survival in glaucoma-induced rats. In rats with raised intraocular pressure induced by injecting hypertonic saline solution into the limbal veins, oral paeoniflorin markedly brought down the elevated intraocular pressure and significantly prevented retinal ganglion cell loss, as determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling assay and Fluoro-Gold labeling. The expression of the transforming growth factor β protein was effectively diminished by paeoniflorin administration. Also, the expression of extracellular matrix components matrix metalloproteinase 9 a tissue inhibitor of metalloproteinase 1—laminin, collagen I, and collagen IV in the optic nerve head and retinal ganglion cell layer were effectively diminished. Paeoniflorin substantially upregulated the activation of Janus kinase-2/signal transducer and activator of transcription proteins-3 signaling, which plays a crucial role in retinal ganglion cell survival. These results illustrate a protective effect of paeoniflorin through reduction of intraocular pressure, retinal ganglion cell loss, and changes in the extracellular matrix by regulating transforming growth factor β2 signaling and Janus kinase-2/signal transducer and activator of transcription protein-3 signaling. The present work demonstrates that paeoniflorin may be a promising therapeutic agent for glaucoma.

A Critical Review of Vataja Timira, Kacha and Linganasha

Netra is considered as Pradhana indriya and is responsible for Rupagrahana vision. The concept of Timira has been described in our ancient texts in detail with its Nidana Samprapti and Chikitsa. Timira Kacha and Linganasha are the progressive stages of this disease. The word Timira indicates blurriness of vision whereas Linganasha indicates total loss of vision. Timira is classified as six types based on predominance of Doshas and when it attains Raga it is termed as Kacha and if left untreated it progresses to an incurable stage called Lingnasha. The clinical features of Vataja timira Kacha and Linganasha can be compared with various diseases based on their features. Thus in this article an effort was made to understand and analyze the Laxanas of Vataja timira Kacha and Linganasha as per Acharya Sushruta and Acharya Vagbhata.

Cataract, a potential danger for blindness

Cataract is an eye disease, at the base of which is the cloudiness of the crystalline. This pathology, if not treated in time, causes blindness and is considered the main cause of blindness, especially in developed countries. The prevalence of cataract increases with the population aging. A series of co-morbidities such as diabetes, high blood pressure, glaucoma increases the risk of cataract installation, worsening the prognosis of the disease. The purpose of this study is the knowledge of the disease, symptoms, complications and the nursing care, also statistical data on cataract in Vlora district for the period march-September 2019. Nursing care is a part of treatment that has a key role in the preoperative phase and during the rehabilitation process. When people hear the word “blindness,” many assume that severe vision loss is permanent and cannot be cured. In the case of blindness caused by cataracts, vision can usually be successfully restored with cataract surgery and implantation of an intraocular lens. The studies identify that great challenge is to increase the population’s awareness of this serious disease, so that it can be detected and treated in time, preventing the total loss of vision.

Intravitreal gene therapy preserves retinal function in a canine model of CLN2 neuronal ceroid lipofuscinosis

CLN2 neuronal ceroid lipofuscinosis is a rare hereditary neurodegenerative disorder characterized by deleterious sequence variants in TPP1 that result in reduced or abolished function of the lysosomal enzyme tripeptidyl peptidase 1 (TPP1). Children with this disorder experience progressive neurological decline and vision loss starting around 2–4 years of age. Ocular disease is characterized by progressive retinal degeneration and impaired retinal function culminating in total loss of vision. Similar retinal pathology occurs in a canine model of CLN2 disease with a null variant in TPP1. A study using the dog model was performed to evaluate the efficacy of ocular gene therapy to provide a continuous, long-term source of human TPP1 (hTPP1) to the retina, inhibit retinal degeneration and preserve retinal function. TPP1−/− dogs received an intravitreal injection of 1 x 1012 viral genomes of AAV2.CAG.hTPP1 in one eye and AAV2.CAG.GFP in the contralateral eye at 4 months of age. Ophthalmic exams, in vivo ocular imaging and electroretinography were repeated monthly to assess retinal structure and function. Retinal morphology, hTPP1 and GFP expression in the retina, optic nerve and lateral geniculate nucleus, and hTPP1 concentrations in the vitreous were evaluated after the dogs were euthanized at end stage neurological disease at approximately 10 months of age. Intravitreal administration of AAV2.CAG.hTPP1 resulted in stable, widespread expression of hTPP1 throughout the inner retina, prevented disease-related declines in retinal function and inhibited disease-related cell loss and storage body accumulation in the retina for at least 6 months. Uveitis occurred in eyes treated with the hTPP1 vector, but this did not prevent therapeutic efficacy. The severity of the uveitis was ameliorated with anti-inflammatory treatments. These results indicate that a single intravitreal injection of AAV2.CAG.hTPP1 is an effective treatment to inhibit ocular disease progression in canine CLN2 disease.

SUDDEN LOSS OF VISION: A RARE PRESENTATION OF DIABETIC KETOACIDOSIS IN THE ICU

SUDDEN LOSS OF VISION: A RARE PRESENTATION OF DIABETIC KETOACIDOSIS IN THE ICU

Digital Accessibility for People with Special Needs: Research, Methodology, Analysis of Accessibility

The paper presents a major part of the research work of a team of scientists under project No. KP-06-Н42/4, funded by the National Institute for Scientific Research, concerning the analysis, evaluation, and improvement of digital accessibility for people with disabilities. The research aims to support accessibility for people with severe or total vision loss, as well as understanding the problems they face, and the ways to overcome them. This includes offering a methodology for assessment, analysis and evaluation of accessibility tested on more than 100 sites and documents. Software programmes were also reviewed for accessibility. The paper also includes examples offering more adequate digital presentations of information to people with disabilities. Examples include a site with accessibility and QR codes, a training site and a system with appropriate digital representation and encoding of information.

Correlation Between Diabetic Retinopathy, Depression Level and Quality of Life in Eye Clinic Zainoel Abidin Hospital

Diabetic retinopathy (DR) is one of the eye disorders caused by complications of diabetes mellitus (DM). Indonesia has a high prevalence of DR (43.1%) compared to other Asia-Pacific countries. Damage and blockage of blood vessels in the retina causes impaired vision, which may lead to a total vision loss. DR requires special treatment, coupled with regular treatment, that is expensive and may result in depression and poor quality of life. This study aimed to determine the association between the degree of diabetic retinopathy with the level of depression and quality of life in people with DR in the eye clinic of Zainoel Abidin General Hospital Banda Aceh. This cross-sectional study was conducted from April 2018 to January 2019. Data were obtained through funduscopy reading, Hamilton Depression Rating Scale (HDRS) questionnaire, and Short-Form Health Survey (SF-36). The subjects of this study were all diabetic retinopathy patients who were sampled using the accidental sampling method. Based on the Spearman correlation analysis, there was a correlation between degree of DR and depression level (p value of 0.004) and quality of life (p value of 0,037). In conclusion, there is a moderate correlation between the degree of DR with depression level and quality of life among DM patients.

An Effective Framework for the Classification of Retinopathy Grade and Risk of Macular Edema for Diabetic Retinopathy Images

It is well know that for a diabetic patient, Diabetic Retinopathy (DR) is a speedy spreading infection which results in total loss of vision. Hence for diabetic patient, prior DR identification is important issue to protect eyes furthermore supportive for opportune treatment. The DR identification should be possible physically and could likewise distinguished consequently. In previous framework, assessment of fundus pictures of retina for checking the phonological variety in Micro Aneurysms (MA), exudates, hemorrhages, macula and veins is a drawn-out and lavish errand. However in the robotized framework, picture handling strategies can be utilized for before DR identification. Here, a framework for DR discovery is proposed. To start with, the information picture is pre-prepared utilizing crossover CLAHE and circular average filter round normal channel and veins are extricated by Coye Filter. A short time later, picture is exposed to irregularities division, where division of MA, hemorrhages, exudates, and neovascularization are conveyed. Almost 36 distinct highlights are removed from sectioned pictures. A half breed salp swarm-feline multitude advancement (CSO) calculation is used for choosing the appropriate highlights. At last, an arrangement is conveyed by changed RNN-LSTM. Three orders are conveyed, (I) Classification of kind of retinopathy, (ii) Classification of evaluation of retinopathy, (iii) Risk of Macular Edema (ME). The order correctness’s got are: 99.73% for kind of DR, 95.6% for NPDR grade and 99.4% for NPDR Macular Edema Risk, 92.3% for PDR Macular Edema Risk. Our simulation results reveals that with Decision Tree (DT) and Random Forest (RF) Algorithm, this framework provides better results in terms of accuracy of affectability and explicitness and Precision.

Role of Ayurveda in the Prevention and Management of Timir-A Conceptual Study.

Visual disturbances are described in Ayurveda under the terms Timira, Kacha, and Linganasha. Timirais an eye ailment that begins with Avyaktya Darshanaand progresses to total vision loss. Timirahas no independent etiological variables at the eye. Timirais characterized by Sushruta as Ghora Roga, which causes visual disturbances due to the accumulation of Doshasin various Patalasof the eye. Timiraisa disorder of the Drusti Mandalathat begins with impaired vision and progresses to full blindness if left untreated. The entire globe is looking at alternate medical systems to avoid surgical problems, as well as preventative ophthalmology to improve andretain eyesight. In this situation, having a thorough understanding of the Timirais critical for appropriate management of the illness. While considering the sign and symptoms it can be correlated with Cataract, Myopia, Keratoconus etc. regarding similarity with modern; different author has different opinions. A review of Timirafrom several sources has been compiled here, with a focus on cataract and myopia.

Exercise-induced Valsalva retinopathy: A case report and literature review

Introduction. Valsalva retinopathy is an uncommon disorder that usually presents with acute onset of unilateral, or less frequently, bilateral visual impairment varying from subtle scotoma to total vision loss. It occurs as a result of Valsalva?s maneuver. In the vast majority of cases, hemorrhage is preretinal although subretinal, intraretinal and vitreous hemorrhage can be found. Valsalva retinopathy often develops due to numerous triggering activities such as vomiting, coughing, heavy weight lifting, intense aerobic exercise, labor, and general anesthesia. Management options are either clinical observation or invasive techniques. We report a case of premacular hemorrhage due to Valsalva retinopathy induced by gym training. Case outline. A 34-year-old woman was referred to the Eye Clinic, University Clinical Center of Serbia, complaining of sudden and painless unilateral decrease in vision occurred during intense physical activity. Best corrected visual acuity was measured as counting fingers at five meters distance. Dilated fundoscopy demonstrated a large, well demarcated premacular subhyaloid hemorrhage with visible rupture of the retinal vein branch. The patient was treated conservatively. Three months after the onset of symptoms, hemorrhage absorbed and best corrected visual acuity was 20/20. Conclusion. Valsalva retinopathy, although a rare condition, should not be omitted as a differential diagnosis of retinal and vitreous hemorrhages. Standard, observational treatment is generally sufficient for complete vision recovery; however, literature suggests that an individualized approach to each patient is required.

P19 Total visual loss in connective tissue disease – an unusual presentation of optic peri-neuritis

Case report - IntroductionSince the discovery of aquaporin-4 antibody in 2004, the association between visual loss and auto-immune disease has become increasingly apparent. Certainly, neuro-myelitis optica spectrum disorders (NMOSD) can co-exist with connective tissue disease (CTD). The complexity comes in trying to differentiate the two diagnoses. NMOSD feels like the tip of an iceberg with regards to autoimmune eye disease. When no specific antibody can be found, the clinical syndrome can only be described.Case report - Case descriptionA 22-year-old female, with a history of childhood ITP presented with 4 months of myalgia, arthralgia, raised inflammatory markers (ESR 81, CRP 49) and weight loss. She had no clinical features suggestive of CTD. PET-CT demonstrated abnormal uptake associated with large joints. Small joint musculoskeletal ultrasound was normal. Initial ANA was borderline positive. 3 months later she presented with right-sided retro-orbital pain of 3 weeks' duration, followed by abrupt onset total visual loss in the right eye. The visual acuity in the left eye was also reduced. Ophthalmological examination revealed brilliant white optic atrophy of the right disc, with only perception of light. On the left, the disc and acuity were normal. MRI coronal STIR images of the orbits demonstrated inflammatory change in the peri-optic structures and signal change in the optic nerve anteriorly. Post-contrast images confirmed abnormal enhancement affecting the right optic nerve sheath and surrounding fat, some intrinsic enhancement of the optic nerve and some ill-defined enhancement of the left optic nerve sheath. Saggital T2 imaging of the spine confirmed no cord lesions.All disease-specific antibodies were negative (rheumatoid factor, CCP, connective tissue disease screen, dsDNA, ENA panel, anti-phospholipid, centromere, MOG, Aquaporin-4). HLA-B27 was negative. Complements were normal. HIV, syphilis and Lyme serology were all negative. She was initially treated with oral prednisolone and hydroxychloroquine with poor recovery of vision in the right eye.2 years later, she developed a small deep left thalamic infarct, and was switched to azathioprine. Following a further episode of right eye pain associated with a rise in ESR, treatment was changed to injectable methotrexate resulting in resolution of arthralgia and normalisation of inflammatory markers.Surveillance MRI this year has identified a subtle area of high FLAIR signal in the right pons, with further interval scan awaited.Case report - DiscussionInflammatory eye disease is a developing field, with the relatively recent identification of aquaporin-4 and MOG antibodies in the context of neuromyelitis optica spectrum disorders.Case report - Key learning pointsThis patient initially presented with an inflammatory arthritis, and then went on to develop abrupt onset visual loss. The rheumatologist should remain vigilant for development of optic peri-neuritis in CTD, and consider investigation if eye pain or discomfort develops.In NMOSD, aquaporin-4 (AQP4) antibodies are directed against the AQP4 channels on astrocytes. It is possible that optic peri-neuritis in this case may be due to inflammation in the optic nerve sheath caused by an as-yet unidentified antigen/antibody-mediated process.In patients presenting with CTD who develop optic neuritis or peri-neuritis, further evaluation for NMOSD is essential. AQP4 and MOG antibodies are now readily available and easily checked in routine practice.There appears to be an emerging association between NMOSD and CTD, and the rheumatologist should remain vigilant for the presence of dual pathology.

Central retinal vein occlusion and its management through Ayurveda

Central retinal vein occlusion (CRVO) is a condition in which the main vein that drains blood from the retina closes off partially or completely. This condition is associated with sudden, unilateral, and moderate-to-marked or total loss of vision. In the present case report, a 58-year-old male patient suffered from CRVO with chief complaints of sudden painless diminution of distant and near vision of the right eye with a duration of 1 week and was treated with Ayurveda medications and therapeutic procedures. Oral medicines such as decoctions, herbal powder, and tablets were administered along with therapeutic procedures which include Nasya (medication through nasal route) therapy and local therapies such as Bidalaka (application of medicated paste on eye lids) and Shirolepa (application of medicated paste on head). Pre- and post-assessments were done by visual acuity (VA), posterior segment examination, and optical coherence tomography, which showed improvement at the end of 3 months’ treatment. At the end of the treatment, there is improvement noted in distance and near VA in the right eye. Ophthalmoscopic findings revealed a reduction in hemorrhages and edema in the right eye. The effectiveness of Ayurveda interventions observed in the present case indicates that CRVO can be treated with Ayurveda medication and therapeutic procedures such as Nasya, Bidalaka, and Shirolepa.

Changes in the Visual Field associated with Cranio-caudal Diameter of Pituitary Macro adenoma

Background: Pituitary macro adenomas are benign in origin, mass effects of which, may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The visual disturbance in pituitary macro adenomas range from dimness of vision to bilateral total loss of vision. Visual field defect is one of the common presentations of pituitary macro adenomas. They usually results in bitemporal hemianopia by causing compression on optic chiasm. Our main objective of this study was to evaluate the changes of visual field in relation with cranio-caudal diameter of pituitary macro adenoma. Methods and Materials: This cross-sectional, observational study was carried out at Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from April, 2019 to September, 2020. Thirty six patients with pituitary macro adenomas underwent visual field analysis using Humphrey Field Analyzer30-2 program at Bangabandhu Sheikh Mujib Medical University. Correlation betweenmean deviation of visual field with craniocaudal diameter of pituitary macroadenomas, volume of tumor, duration of sypmtoms were observed. Results: This study was conducted on 67 eyes of 36 patients including 22 male and 14 female subjects with mean age of 39.00 years and histologically proven pituitary adenoma. Mean cranio-caudal diameter was 31.72 mm. Highest number of patients had cranio-caudal diameter of 32-41 mm with mean deviation of -12.95 dB and -12.24dB in right and left eye respectively. Regarding correlation of mean deviation of visual field with cranio-caudal diameter of pituitary macro adenoma, Pearson correlation showed that r value was -0.358(p-value0.044) in right eye and -0.527(p-value 0.012) in left eye. Conclusion: When pituitary macro adenomas grow in vertical direction it results in deterioration of visual field by compressing optic chiasma. The present study ascertains that there is significant correlation between the cranio-caudal diameter of pituitary macro adenoma and deviation visual field.

Role of Major Histocompatibility Complex Genes in the Susceptibility and Protection of Primary Open Angle Glaucoma and Primary Congenital Glaucoma

Introduction: Glaucoma is a prevalent disease seen in the Ophthalmology department that includes a group of neurodegenerative eye pathologies associated with total loss of vision. It is known for its clinical diversity and secondary to this, it is assumed that multiple genes play a role in its pathogenesis. Among these, those that regulate the immune response which includes the HLA genes are of particular interest because they have been associated with a subgroup of glaucoma patients known as Primary Open Glaucoma. Methods: In this study, we studied 3 different groups of patients with glaucoma in whom HLA alleles were determined by sequence-specific primers (SSP) technique. Results: An association of HLA-DRB1*16 was found with the susceptibility to develop Primary Congenital Glaucoma. In addition, HLA-DRB1*14 was associated with glaucoma without angular dysgenesis, and HLA-DRB1*03 to glaucoma with iridocorneal dysgenesis. Conclusion: In conclusion, the data obtained allow us to suggest that glaucoma is a clinical and genetically heterogeneous disease in which one of the subgroups has an autoimmune mechanism in which the Mexican mestizo population shows genetic susceptibility and it differs from POAG with angular dysgenesis and POAG without dysgenesis.

Stereotactic cryoablation of large tumors of the sellar region with intraoperative CT scans\u2014technical note

BackgroundCryoablation has been used by neurosurgeons in the past and is currently being used by other disciplines to treat kidney cancer, skin lesions, and cardiac conduction defects. Because the currently available cryogenic probes can safely create large lesions and the lesion generation (in the form of ice-ball) can be monitored on intraoperative CT images, cryoablation was used to treat large tumors in and around the sella. In this paper, the author describes a technique to perform this procedure.Main bodyThree large tumors in 3 patients were treated with this method. Age of the patients was 26–58 years with a male/female ratio of 2/1. Patient 1 had a non-secreting pituitary adenoma (measuring 8 × 8 cm) and presented with long-standing total visual loss in both eyes, severe headache, and seizures. She had previous resection and radiation therapy. Patient 2 had prolactinomas (measuring 5.1 × 4.6 cm) and presented with progressive loss of vision and diplopia. Patient 3 had recurrent craniopharyngioma (measuring 7.2 × 5 cm) with prior treatment with resection radiation and frequent drainage of the cyst. He presented with headache and progressive worsening of his vision.The procedure was done on the CT table with intraoperative scans, using Patil stereotactic frame and argon cryoablation probe (Healthtronics). 3-D images were used to plan targets and trajectories. The probe was placed at the target via a trans-nasal trans-sphenoidal route. One to 3 lesions measuring 2.5–3 cm in diameter were made to ablate the tumor. Ice-ball formation was monitored live on CT images.There is no complication. One patient had near-complete resolution of the tumor, two had partial resolution of their tumors, and all had resolution of their presenting symptoms at follow-up of 3–24 months (median 6 months). In one patient, symptoms reoccurred due to the formation of new tumor masses.Short conclusionCryoablation of intracranial tumors and can be done safely and effectively. Live monitoring of lesion generation using CT imaging is a major advantage of this technique.

The basic science of optic nerve regeneration.

Diverse insults to the optic nerve result in partial to total vision loss as the axons of retinal ganglion cells are destroyed. In glaucoma, axons are injured at the optic nerve head; in other optic neuropathies, axons can be damaged along the entire visual pathway. In all cases, as mammals cannot regenerate injured central nervous system cells, once the axons are lost, vision loss is irreversible. However, much has been learned about how retinal ganglion cells respond to axon injuries, and many of these crucial discoveries offer hope for future regenerative therapies. Here we review the current understanding regarding the temporal progression of axonal degeneration. We summarize known survival and regenerative mechanisms in mammals, including specific signaling pathways, key transcription factors, and reprogramming genes. We cover mechanisms intrinsic to retinal ganglion cells as well as their interactions with myeloid and glial cell populations in the retina and optic nerve that affect survival and regeneration. Finally, we highlight some non-mammalian species that are able to regenerate their retinal ganglion cell axons after injury, as understanding these successful regenerative responses may be essential to the rational design of future clinical interventions to regrow the optic nerve. In the end, a combination of many different molecular and cellular interventions will likely be the only way to achieve functional recovery of vision and restore quality of life to millions of patients around the world.

Impact of COVID-19 Pandemic on Infectious Keratitis Outcomes: A Retrospective Multicenter Study in Tertiary Eye Hospitals of South India.

The purpose of this study was to report the adverse effects of the COVID-19 pandemic on the clinical outcomes of infectious keratitis in South India. Two hundred fifty-eight patients presented with infectious keratitis at 6 tertiary care centers when strict travel restrictions were in place from March 24 to May 31, 2020. Case records were collected retrospectively and analyzed for demographics, type of initial treatment, length of delay in presentation, microbiological diagnosis, clinical course, and final treatment outcome. The mean age of the patients was 49.2 years, with most of them (61.2%) being male. Forty-one patients (15.9%) did not receive any treatment for at least a week after the onset of symptoms. One hundred eight patients (41.9%) presented with severe ulcer (32 had a frank perforation). Resolution of the infection was achieved only in 103 patients (45.6%). A total of 90 patients (39.8%) with ulcers had a perforation, yet only 29 patients (32.2%) could receive keratoplasty because of the unavailability of donor tissues. At the end of 6-month follow-up, 47 patients had anatomical failure (loss of globe) and 12 additional patients had functional failure (total permanent vision loss). Delay in presentation and acute shortage of donor corneal tissues for emergency keratoplasty because of the COVID-19 pandemic had a grave impact, resulting in irreversible blindness in a significant number of patients.

A classic case of ischemic central retinal vein occlusion with macular edema

Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.