Covid-19 induced optic neuritis – A case report

COVID-19 illness is an evolving disorder, and many extrapulmonary manifestations have been reported. With this report, we are highlighting one of the neuro-ophthalmologic complications of Covid-19. We report a case of 16 years old boy who presented with complaints of rapid loss of vision and retroorbital pain in the Right eye during recovery from Covid -19 infection. Clinically, radiologically, CSF, Blood, and all other investigations suggest Probable Covid -19 Right Eye Optic Neuritis. The patient showed remarkable recovery following steroid therapy. This report aims to add a case to the limited literature available on Optic Neuritis following Covid-19 infection.

Keratoplasty for keratoconus: advantages and disadvantages

Keratoconus is a progressive bilateral corneal ectasia, accompanied by loss of vision due to high irregular astigmatism, which is the leading indication for corneal transplantation. The review presents a variety of surgical corneal transplantation techniques for keratoconus available today and discussed their advantages and disadvantages.

Corneal Trauma

Trauma is often the main cause of unilateral loss of vision in developing countries. Although corneal trauma can range from tiny corneal abrasions to sight-threatening and penetrating ocular injuries, even minor corneal trauma that breaches the epithelium has the potential to result in microbial keratitis and its associated complications, up until complete loss of vision. Even though ocular trauma is a global problem, blindness from eye injuries occurs mostly in developing countries, especially those where wars and civil conflicts bring around eye traumas from various weapons such as land mines, chemical substances, etc. Chemical injuries from both acids and alkalies are common causes of corneal injury due to their easy availability and soft regulations regarding their use. This chapter includes photos of trauma cases of the anterior segment, corneal and conjunctival foreign bodies, sequelae of blunt and penetrating trauma, chemical injuries, as well as a case of posttraumatic iris cyst.

Ocular Trauma in Pediatric Population

Pediatric ocular trauma is the main challenge for ophthalmologists. It is the most crucial cause of monocular blindness. Thus, it is the main problem in public health management. This study is aimed to determine the clinical characteristics and visual consequences of ocular trauma. The ocular trauma with further complications can result in blindness. An immediate evaluation of the potential damage may be impossible because of vitreous hemorrhage or may be ill-advised because of hyphema or damage to other ocular or orbital structures. Books like Comprehensive Ophthalmology by Dr. A K Khurana and various articles, WHO (World Health Organization) website, etcetera were referred for this review article. Trauma in pediatric age groups is more prevalent than that in adult age groups. The so, the male gender is more prone to such injuri females. This study concludes that trauma to eyes the is the leather dying cause of ocular morbidity, which can be avoided by simple measures. First aid and early treatment can cause a significant decrease in loss of vision due to ocular trauma. Thus, a little awareness in parents and guardians can help decrease loss and blindness in the pediatric population. Eye injury, if occurred in a closed eye, causes contusion or lamellar laceration, and if that happens in an open eye, then it can lead to rupture, perforation, or penetrating injury to the eyeball. Troma to the eyes is the leading cause of ocular morbidity, which simple measures can avoid. First aid and early treatment can cause significant decrease in loss of vision due to ocular trauma. Thus, a little awareness in parents and guardians can help decrease loss and blindness in the pediatric population.

Generalized Pruritus and Gradual Loss of Vision as the Presenting Complaints of Acute HIV Infection: Management Challenges during COVID-19 Pandemic

Background. Although the prevalence of HIV is low in Bangladesh, there is a potential for an increased number of cases. This is because of high cross-border mobility (India and Myanmar) of people and increased injection drug abusers amongst youth in the cities and rural areas, HIV can present in many ways, from asymptomatic to advanced disease, including various atypical (generalized itching) and advanced (loss of vision) manifestations. A high degree of suspicion is required to diagnose HIV in a country like Bangladesh. Early diagnosis and prompt treatment are essential to have a better outcome. Methods. Here, we report two thought-provoking cases where patients were suffering from generalized itchy lesions (pruritic papular eruption) throughout the body for a long time and gradual loss of vision in another case. Results. Due to lack of suspicion, initially, HIV screening was not done. Both patients visited several health centres, but no diagnosis was made. Moreover, COVID-19 pandemic worsens the situation. Finally, they were diagnosed with HIV; unfortunately, one of them lost her vision due to CMV retinitis and another patient died of other complications. Conclusion. Ongoing COVID-19 pandemic put many challenges to ensure optimum care, especially for patients with long-sufferings like HIV. Clinicians have to have a very high degree of suspicion while dealing with patients presented with rare manifestations, particularly in a low endemic clinical setting.

A Novel CLN6 Variant Associated With Juvenile Neuronal Ceroid Lipofuscinosis in Patients With Absence of Visual Loss as a Presenting Feature

The neuronal ceroid lipofuscinoses (NCLs), also known as Batten disease, are a group of autosomal recessive lysosomal storage disorders that are characterized by neurodegeneration, progressive cognitive decline, motor impairment, ataxia, loss of vision, seizures, and premature death. To date, pathogenic variants in more than 13 genes have been associated with NCLs. CLN6 encodes an endoplasmic reticulum non-glycosylated transmembrane protein, which is involved in lysosomal acidification. Mutations in CLN6 cause late-infantile juvenile NCL (JNCL) adult-onset NCL, and Kufs disease. Members from two available families with JNCL were clinically evaluated, and samples were collected from consenting individuals. The molecular investigation was performed by whole-exome sequencing, Sanger sequencing, and family segregation analysis. Furthermore, in silico prediction analysis and structural modeling of the identified CLN6 variants were performed. We report clinical and genetic findings of three patients from two Greek-Cypriot families (families 915 and 926) with JNCL. All patients were males, and the first symptoms appeared at the age of 6 years. The proband of family 926 presented with loss of motor abilities, ataxia, spasticity, seizure, and epilepsy. The proband of family 915 had ataxia, spasticity, dysarthria, dystonia, and intellectual disability. Both probands did not show initial signs of vision and/or hearing loss. Molecular analysis of family 926 revealed two CLN6 biallelic variants: the novel, de novo p.Tyr295Cys and the known p.Arg136His variants. In family 915, both patients were homozygous for the p.Arg136His CLN6 variant. Prediction analysis of the two CLN6 variants characterized them as probably damaging and disease-causing. Structural modeling of the variants predicted that they probably cause protein structural differentiation. In conclusion, we describe two unrelated Cypriot families with JNCL. Both families had variants in the CLN6 gene; however, they presented with slightly different symptoms, and notably none of the patients has loss of vision. In silico prediction and structural analyses indicate that both variants are most likely pathogenic.

The Role of Mitochondria in Optic Atrophy With Autosomal Inheritance

Optic atrophy (OA) with autosomal inheritance is a form of optic neuropathy characterized by the progressive and irreversible loss of vision. In some cases, this is accompanied by additional, typically neurological, extra-ocular symptoms. Underlying the loss of vision is the specific degeneration of the retinal ganglion cells (RGCs) which form the optic nerve. Whilst autosomal OA is genetically heterogenous, all currently identified causative genes appear to be associated with mitochondrial organization and function. However, it is unclear why RGCs are particularly vulnerable to mitochondrial aberration. Despite the relatively high prevalence of this disorder, there are currently no approved treatments. Combined with the lack of knowledge concerning the mechanisms through which aberrant mitochondrial function leads to RGC death, there remains a clear need for further research to identify the underlying mechanisms and develop treatments for this condition. This review summarizes the genes known to be causative of autosomal OA and the mitochondrial dysfunction caused by pathogenic mutations. Furthermore, we discuss the suitability of available in vivo models for autosomal OA with regards to both treatment development and furthering the understanding of autosomal OA pathology.