scholarly journals A case report of bilateral uveitis with meningococcal septicaemia resulting to blindness and adjustment disorder

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Zaharaddeen Garba Habib ◽  
Saudat Garba Habib ◽  
Safiya Gambo ◽  
Sadiq Hassan ◽  
Jamila Sani
Keyword(s):  
Visual Outcome ◽  
Adjustment Disorder ◽  
Ocular Involvement ◽  
Eye Drops ◽  
Ophthalmological Examination ◽  
Neck Stiffness ◽  
Neisseria Meningitides ◽  
Meningococcal Septicaemia ◽  
Counting Finger ◽  
Paediatric Unit

To report the rare case of a patient with bilateral uveitis with meningococcal septicaemia from Neisseria meningitides, resulting to blindness and adjustment disorder. A 9-years-old boy presented to the Emergency paediatric unit of a hospital with complaints of fever, and neck stiffness of one week duration. There was associated sudden decreased vision, pain and photophobia of both eyes. Neck was stiff and retracted with positive Kernig’s and Brudzinski’s signs. Neisseria meningitidis was isolated from both the turbid CSF and the blood. Visual Acuity (VA) was Perception of Light (PL) and Counting Finger (CF) in right and left eyes (RE and LE) respectively, with 360 degrees posterior synechiae and pupillary membrane. Diagnosis of meningococcal septicaemia with bilateral uveitis was made. Patient was treated with IV ceftriaxone, sub-conjunctival dexamethasone, dexamethasone, atropine and moxifloxacin eye drops and other supporting medications. Although he showed improvement of VA to RE-6/36, LE- 6/24, he absconded from follow- up and later relapsed with subsequent blindness (VA of Perception of Light in Both eyes) and symptoms of adjustment disorder. Although ocular involvement is rare in meningococcal septicaemia, patients should always have detailed ophthalmological examination as prompt diagnosis and management could improve the visual outcome.

scholarly journals THU0597 CORNEAL MELT - DON’T ALWAYS BLAME RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 540.3-540
Author(s):  
A. Munir ◽  
C. Sheehy
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Biopsy ◽  
Systemic Vasculitis ◽  
Lower Lobe ◽  
Visual Outcome ◽  
Eye Drops ◽  
Poor Visual Outcome ◽  
Methyl Prednisolone ◽  
History Of ◽  
And Function

Background:Corneal melt is a rare inflammatory disease of the peripheral cornea; it may lead to perforation of the globe and visual failure. Corneal melt can be a manifestation of systemic vasculitis in patients with RA and other conditions, such as cancer. Without early and aggressive treatment it may be associated with a poor visual outcome and a high mortality. It has been reported in patients with stable RA.Objectives:A case report in a patient with long standing but well controlled Rheumatoid Arthritis (RA) and metastatic disease.Methods:A 75 year old male with a background of sero positive Rheumatoid Arthritis for more than 10 years presented to the Eye Casualty with a two week history of a painful left red eye. His other medical history was significant for Stage IIB poorly differentiated cancer of the left lower lobe. Left lower lobectomy with a patch of diaphragm resected. Intratumoural lymphovascular invasion noted. He completed Adjuvant Carboplatin/Vinorelbine chemotherapy September, 2017. He had DVT proximal left leg 22ndof September, 2017. Follow up CT in 2018 demonstrated a right renal upper pole lesion for which he was awaiting biopsy with?metastatic lung disease vs primary renal carcinoma. His RA was well controlled on Methotrexate 10mg weekly. He had been treated by the ophthalmology team for left marginal Keratitis for the prior 2 months with steroid eye drops without significant improvement. On presentation to ED, he described sharp eye pain, waking him from the sleep, associated with watery discharge and photophobia. Examination showed corneal melt in left eye involving 25% of inferior portion of the cornea and spastic entropion with injecting eye lashes. He had no active joints and there were no other signs of vasculitis. CRP was 4.1. He had a negative ANA and ANCA; viral swabs were negative. He was admitted under the medical team. Intravenous Methyl Prednisolone was started. The patient felt better after 5 days of Methyl Prednisolone. Left temporary tarsorrhaphy was done by Ophthalmology. Cyclophosphamide was initiated after discussion with Oncologist pending the result of the renal biopsy. Patient was discharged after 5 days of admission in the hospitalResults:The renal biopsy was positive for metastatic Squamous cell carcinoma of lung. Cyclophosphamide was withdrawn and he was started on Carboplatin/Gemcitabine. The corneal melt improved with complete resolution of his visual symptoms.Conclusion:In this case, although the history of RA was felt by the ophthalmology team to be the most likely association with the corneal melt, we would argue the oncological diagnoses were likely the driving force behind the presentation.References:[1]Sule A, Balakrishnan C, Gaitonde S, Mittal G, Pathan E, Gokhale NS, et al. Rheumatoid corneal melt. Rheumatology (Oxford)2002;41:705–6.[2]S. Yano, K. Kondo, M. Yamaguchi et al., “Distribution and function of EGFR in human tissue and the effect of EGFR tyrosine kinase inhibition,” Anticancer Research, vol. 23, no. 5, pp. 3639–3650, 2003.Disclosure of Interests:None declared

Acquired acoria and iris pearls in leprosy: Case report

2021 ◽  
pp. 112067212110240
Author(s):  
Luciana Negrão Almeida Morais ◽  
Joacy Pedro Franco David ◽  
João Victor Peres Lima ◽  
Samia Demachki ◽  
Daniel Guerreiro Diniz ◽  
...  
Keyword(s):  
Case Report ◽  
Cataract Extraction ◽  
Ocular Involvement ◽  
Histopathological Diagnosis ◽  
Extracapsular Cataract Extraction ◽  
Ophthalmological Examination ◽  
Case Description ◽  
Leprosy Case ◽  
Proper Diagnosis

Purpose: To describe a case of a patient presenting with acquired acoria and iris pearls, a rare eye manifestation and pathognomonic finding for leprosy; to reinforce clinical, histopathological, and therapeutic aspects of ocular involvement in leprosy. Methods: Case report. Case description: A 62-year-old male presenting with acquired acoria and iris pearls in both eyes due to leprosy also had anterior uveitis and cataract. Histopathological diagnosis of iris pearls was confirmed by the presence of Hansen’s bacilli. Ophthalmological examination revealed improvement of the visual acuity after iridectomy and extracapsular cataract extraction. Conclusions: To our knowledge, this is the first reported case of acquired acoria in a leprosy patient. It led to impaired vision and reversible blindness. Proper diagnosis and ophthalmological treatment of patients with these conditions are essential for the maintenance of a good quality of life.

scholarly journals Submacular Cysticercosis Successfully Treated through Conservative Management: Case Report

2020 ◽  
Vol 11 (2) ◽  
pp. 315-321
Author(s):  
Renata García Franco ◽  
Alejandro Arias Gómez ◽  
Juvenal Guzman Cerda ◽  
Marlon García Roa ◽  
Paulina Ramirez Neria
Keyword(s):  
Visual Acuity ◽  
Medical Management ◽  
Central Nervous System Involvement ◽  
Vitreoretinal Surgery ◽  
Visual Outcome ◽  
Clinical Findings ◽  
Ophthalmological Examination ◽  
Blurred Vision ◽  
Elevated Lesion ◽  
The Right

Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.

Visual field loss and structure–function relationships in optic neuritis associated with myelin oligodendrocyte glycoprotein antibody

2020 ◽  
pp. 135245852093728
Author(s):  
Romain Deschamps ◽  
Manon Philibert ◽  
Cedric Lamirel ◽  
Jerome Lambert ◽  
Vivien Vasseur ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Neuritis ◽  
Structural Damage ◽  
Structural Changes ◽  
Visual Field Loss ◽  
Visual Outcome ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Mean Deviation ◽  
Ophthalmological Examination ◽  
Fiber Layer

Background: A paradoxical discrepancy between severe peripapillary retinal nerve fiber layer (pRNFL) atrophy and good visual outcome had been reported in patients with myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG)-associated optic neuritis (ON). However, only visual acuity (VA) was assessed. Objectives: To study visual field (VF) outcomes of patients with MOG-IgG-associated ON and evaluate the correlation between functional eye outcome and retinal structural changes assessed by optical coherence tomography. Methods: The records of 32 patients with MOG-IgG-associated ON who underwent ophthalmological examination at least 12 months after ON onset were reviewed. Degree of VF disability was determined by mean deviation (MD). Results: At final assessment (median, 35 months), 4.2% of 48 affected eyes (AE) had VA ⩽ 0.1, 40% had abnormal MD, and among AE with final VA ⩾ 1.0, 31% had mild to moderate damage. Thinning of the inner retinal layers was significantly correlated with MD impairment. Analysis demonstrated a threshold of pRNFL thickness (50 µm), below which MD was significantly worse (mean, −2.27 dB vs −17.72 dB; p = 0.0003). ON relapse was significantly associated with poor visual outcome assessed by MD. Conclusion: Functional impairment measured with VF is not rare, and MD assessment better reflects actual structural damage.

Neuro-ophthalmological manifestations of Behçet’s disease

2018 ◽  
Vol 103 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Ammr Alghamdi ◽  
Bahram Bodaghi ◽  
Chloé Comarmond ◽  
Anne Claire Desbois ◽  
Fanny Domont ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Behçet’S Disease ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Visual Outcome ◽  
Ophthalmological Examination ◽  
Behcet's Disease

BackgroundThe neuro-ophthalmological manifestations of Behcet’s disease (BD) are rare, and data regarding their characteristics and outcome are lacking.ObjectiveTo report prevalence, main characteristics and outcome of neuro-ophthalmological manifestations in BD.Patients and methodsThis is a retrospective monocentric study of 217 patients diagnosed with neuro-Behçet’s disease (NBD), of whom 29 (13.3%) patients presented with neuro-ophthalmological manifestations (55% of men and mean±SD age of 26±8 years). All patients underwent a detailed ophthalmological examination and were followed up in the internal medicine and the ophthalmology departments.ResultsNeuro-ophthalmological manifestations were the first presentation of BD in 45% of patients and developed later in the course of the disease in 55% of patients. They are divided into parenchymal (PM) and non-parenchymal (NPM)-related manifestations in, respectively, 13 patients (45%) and 16 patients (55%). PM included papillitis in seven patients (53.8%), retrobulbar optic neuritis in four patients (30.8%) and third cranial nerve palsy in two patients (15.4%). NPM included papilloedema related to cerebral venous thrombosis in all 16 patients, of whom 6 patients (37.5%) had sixth cranial nerve palsy. At initial examination, 93.1% of patients had visual alterations, including mainly decreased visual acuity visual field defects and/or diplopia. All patients were treated with corticosteroids and 79% of patients received immunosuppressive agents. After treatment, the visual outcome improved or stabilised in 66.7% of patients while it worsened in 33.3. The mean±SD logarithm of the minimum angle of resolution visual acuity improved from 0.4±0.3 at diagnosis to 0.2±0.3 after therapy. 10.3% and 3.4% of patients were legally blind at diagnosis and after therapy, respectively.ConclusionNeuro-ophthalmological manifestations of BD represented 13% of NBD. They could be potentially severe and disabling. Prompt treatment is the key factor in improving visual outcome.

scholarly journals Changing trends in idiopathic retinal vasculitis in a tertiary eye care centre of Nepal over a ten-year period

2012 ◽  
Vol 4 (2) ◽  
pp. 256-262 ◽  
Author(s):  
R Sitaula Kharel ◽  
S Aryal ◽  
S N Joshi ◽  
J K Shrestha
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Retinal Vasculitis ◽  
Visual Outcome ◽  
Common Finding ◽  
Ocular Involvement ◽  
Care Centre ◽  
Eye Care ◽  
Tertiary Care Centre ◽  
Female Ratio

Objectives: To study the demographic profile, clinical presentations, management and visual outcome of retinal vasculitis in a tertiary eye care center of Nepal Materials and methods: A retrospective, record based study of retinal vasculitis cases in the retina clinic of a tertiary care centre in Nepal from January 2009 to January 2011 was carried out. Results of the study were compared to those from the study conducted in a similar set- up between 1998 and 2000. Results: Sixty-nine eyes of 51affected patients were evaluated in the study. The male/female ratio was 2.64:1 vs 19:1 a decade ago (p=0.0027). The mean age of the patients was 33.53 ± 12.29 years in the present study. Bilateral ocular involvement was present in 18 cases (35.3%) vs 56.14% in the past decade (p=0044).The common symptoms were dimness of vision (29.4%), floaters (25.5 %) and flashes of light (3.92%). Seventy-one eyes (69.6%) had the best corrected visual acuity of 6/18 or better. Four eyes (3.92 %) had no light perception. Vascular sheathing was the most common finding (32.35%), followed by vitritis (30.39%). Corticosteroids were primarily used to manage retinal vasculitis (39.21%). No association of retinal vasculitis with tuberculosis was found.Conclusion: The demographic pattern and clinical presentation of idiopathic retinal vasculitis has changed over a decade period in Nepal.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6541 Nepal J Ophthalmol 2012; 4 (2): 256-262  

scholarly journals An Eleven-Year Retrospective Study of Endogenous Bacterial Endophthalmitis

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Takashi Nishida ◽  
Kyoko Ishida ◽  
Yoshiaki Niwa ◽  
Hideaki Kawakami ◽  
Kiyofumi Mochizuki ◽  
...  
Keyword(s):  
Visual Outcome ◽  
Causative Organism ◽  
Ocular Involvement ◽  
Bacterial Endophthalmitis ◽  
Poor Visual Outcome ◽  
Ocular Symptoms ◽  
Good Visual Outcome ◽  
The Mean ◽  
Systemic Antibiotics ◽  
Endogenous Bacterial Endophthalmitis

Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE).Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen.Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%.Staphylococcus aureuswas the most common causative organism (52.3%) of which 72.7% wasmethicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 (P= 0.003) and focal involvements (P= 0.011) had significantly better final VA. Initial VA (P= 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection (P= 0.097) were associated with final VA in eyes receiving intravitreal antibiotics.Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome.

scholarly journals Ocular Involvement in Sarcoidosis

2017 ◽  
Vol 38 (04) ◽  
pp. 514-522 ◽  
Author(s):  
Aniki Rothova ◽  
Fahriye Groen
Keyword(s):  
Optic Nerve ◽  
Systemic Therapy ◽  
Visual Outcome ◽  
Term Treatment ◽  
Ocular Involvement ◽  
Visual Prognosis ◽  
Long Term Treatment ◽  
Chronic Course ◽  
Optic Nerve Involvement

AbstractOcular involvement in sarcoidosis occurs in ∼40% and the eye is the presenting organ in roughly 20%. The course of ocular disease does not necessarily parallel that of systemic disease. Uveitis is the most common presentation and shows mainly a chronic course; anterior uveitis is associated with better visual prognosis than posterior localization. Painful bilateral anterior granulomatous uveitis most commonly occurs in black patients at younger age, while painless posterior bilateral involvement with peripheral multifocal choroiditis is commonly seen in elderly white females. Patients with posterior uveitis develop often ocular complications and central nervous system involvement. Vitritis, segmental periphlebitis, choroidal granulomas, and peripheral multifocal chorioretinitis are often seen clinical features. Optic nerve involvement is uncommon, but if present, results often in poor visual outcome. Lacrimal gland and conjunctival involvement are also common and present clinically as dry eyes or remain asymptomatic with good visual prognosis. Sarcoidosis-associated uveitis is mostly managed by local treatment with steroid drops or periocular and intraocular steroid injections or with novel intraocular corticosteroid implants. Patients with sight-threatening disease or optic nerve involvement need systemic therapy. Systemic therapy is based on a step-up regimen where corticosteroids are used in the initial phase of the disease and if long-term treatment is required, steroid-sparing immunomodulatory drugs are implemented such as methotrexate or biological agents. Despite the mainly chronic course, need for long-term treatment, and frequent ocular surgeries in the majority of patients, the visual outcome of sarcoidosis-associated uveitis is fairly good if therapy has started on time.

scholarly journals PHACOEMULSIFICATION

2016 ◽  
Vol 23 (11) ◽  
pp. 1422-1428
Author(s):  
Faheem Ahmad ◽  
Syeda Iqra Iqbal
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Visual Outcome ◽  
University Hospital ◽  
Complication Rates ◽  
Basic Training ◽  
Ophthalmic Surgery ◽  
Counting Finger ◽  
Good Visual Outcome ◽  
One Year

Introduction: Any opacity in crystalline clear lens that may or maynot impaired vision is called cataract. According to maturity of cataract it may beimmature, mature or hypermature. When a patient develop cataract than there isno significant medical treatment for cataract. Surgery is the treatment of choice forcataract. Phacoemulsification (phaco), a modification of ECCE, has found worldwidepopularity in last two decades. Objectives: To find out visual acuity and complicationsof phacoemulsification in patients operated by senior surgeon during learning curve.Study Design: Descriptive case series. Settings: Department of OphthalmologyIndependent University Hospital, Faisalabad. Period: One year from 01-04-2014to 31-03-2015. Data Collection Methods: Patients coming through the OPD ofthe eye department who fulfilled the inclusion criteria were enrolled and informedconsent was taken from all patients. Results: In this study 100 eyes had undergonePhacoemulsification with IOL under Local anesthesia during study period. The meanage of patients was 57.50 years (range 30-85 years). Regarding the visual acuity inoperated eyes, 80 eyes ( 80 %) had a BCVA of 6/6-6/12, 12 eyes (12 %) had a BCVA of6/18 to 6/36 and 6 eyes (6 %) had a BCVA of 6/60 to CF. While only 2 percent Patienthad visual acuity less than Counting finger(CF). Discussion: During phaco training,the author was taught in stepwise about various stages of phaco and then authorpractice single part every stage of phaco multiple times to be master in every step ofphaco under supervision of an experienced ophthalmologist. Due to learning of phacostep-by-step leads to good surgical outcomes and least complication rates. Afterlearning the phaco basic training, the author started to perform phacoemulsification inIndependent University Hospital Faisal Abad under the supervision of an experiencedophthalmologist followed by independently performing phacoemulsification.Conclusion: Surgeon experienced in ophthalmic surgery along with adequatephacoemulsification training leads to a good visual outcome with minimum peroperativeand post-operative complications.

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