Hemi-central retinal vein occlusion as a rare manifestation of the hypercoagulable state in COVID-19

To date, COVID-19 has no definite effective targeted therapy, and management is primarily supportive. Central retinal vein occlusion (CRVO) is frequently caused by systemic risk factors posing hypercoagulable states. In April 2020, a female patient with a history of hypertension, diabetes mellitus and chronic kidney disease presented with 2 days of loose, watery stools, nasal congestion and severe lethargy. The patient denied dyspnoea or fever. A week after the initial symptoms, the patient reported decreased vision from the left eye. Dilated funduscopy and fluorescein angiography suggested hemi-CRVO. The patient refused intravitreal antivascular endothelial growth factor agents because of non-severe visual loss. Testing was positive for COVID-19 IgG antibodies; reverse transcription PCR was not available. Vision improved within 3 weeks of presentation. We recommend that clinicians keep a high suspicion for acute onset of thrombotic events in patients with COVID-19 and thrombotic predisposing risk factors.

Severe Visual Loss Caused by Inhalational Methanol Poisoning in Fireworks Production: A Report on 3 Cases

BACKGROUND Explosion injury is a common occupational injury with fireworks production. There are few reports about the relationship of severe visual loss and acute methanol poisoning in fireworks laborers. CASE SUMMARY Here we report 3 patients of visual loss caused by inhalation exposure to high concentration of methanol, who were engaged in the granulation process of fireworks manufacturing industry. They presented with severe metabolic acidosis and visual impairments, accompanied with headache, chest tightness, shortness of breath, dizziness and vomiting. One patient developed bilateral blindness and two patients improved after timely hemodialysis treatment.CONCLUSION This case report emphasizes the risk of methanol poisoning in the fireworks industry or other factories using commercial alcohol. Early hemodialysis intervention and metabolic acidosis correction are crucial for rescuing visual impairment caused by methanol exposure. The awareness and supervision of commercial alcohol are indispensable for similar industrial manufactures.

Rhegmatogenous retinal detachment presentation and surgery in uveitic eyes

Background/aimsTo explore the occurrence, uveitis activity, features, rate of proliferative vitreoretinopathy (PVR) and outcomes following rhegmatogenous retinal detachment (RRD) in a large tertiary referral uveitis service.MethodsRetrospective analysis of subjects attending between 2008 and 2019. Multivariate analysis of risk factors for RRD was calculated. Nelson-Aalen plots were used to demonstrate cumulative risk of RRD. Outcomes of RRD surgery and prognostic indicators were analysed.ResultsTwo thousand four hundred and forty-seven (2447) subjects (3516 eyes) with uveitis included. The mean follow-up was 5.7 years (19 767 eye-years); 56 eyes developed a RRD (1.6%). Thirty-two eyes had surgery in our unit. Risk factors for RRD were posterior uveitis or panuveitis (HR 3.386, p<0.001), male gender (HR 2.045, p=0.029) and infectious aetiology (HR 1.942, p=0.044). PVR was present in six (18.8%) eyes at presentation, and a further four (12.5%) developed it after the primary surgery. Final follow-up data showed 16 (50%) moderate or severe visual loss, although 29 (90.6%) had anatomical reattachment without oil in situ.ConclusionsThere is a high rate of RRD in uveitis eyes. This is accompanied by high rates of PVR and redetachment. Anatomical success was high, but visual outcomes remain unpredictable.

Trans-septal endoscopic management of transalar transsphenoidal meningoencephalocele in a neglected adult patient with severe visual loss and pituitary dysfunction

The article's abstract is not available.

Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis—A Global Emerging Disease

The review aims to document the new emerging hypervirulent Klebsiella pneumoniae (Kp) endogenous endophthalmitis (EKE) in terms of incidence, microbiological characterization of the pathogenic agent, associated risk factors, management, and outcomes. Hypervirulent (hv) strains of KP (hvKp) induce invasive liver abscesses (LA) with specific clinical features. Up to 80–90% of cases have hepatic liver abscess as a primary focus of infection, followed by renal or lung hvKp infections. However, the incidence of EKE in patients with KPLA varied between 3.4% (19) and 12.6% (13), with a total of 95 cases of endophthalmitis in 1455 cases of KPLA (6.5%). Severe visual loss was encountered in 75% of cases, with 25% bilateral involvement. Intravitreal antibiotics are the mainstay therapeutic approach. Pars plana vitrectomy is a subject of controversy. HvKp strains present mostly natural “wild-type” antibiotic resistance profile suggestive for community-acquired infections, being highly susceptive to the third and fourth generation of cephalosporins and carbapenems. Antimicrobial resistance in hypervirulent strains was recently documented via plasmid transfer and may result in extremely difficult to treat cases. Global dissemination of these strains is a major epidemiologic shift that should be considered in the diagnostic and therapeutic management of patients with endogenous endophthalmitis. Ophthalmologic screening in patients with KPLA and other hvKp infections and a multidisciplinary therapeutic approach is extremely important for early diagnosis and preservation of the visual function.

A Review of the Various Roles and Participation Levels of B-Cells in Non-Infectious Uveitis

Non-infectious uveitis is an inflammatory disorder of the eye that accounts for severe visual loss without evident infectious agents. While T cells are supposed to dominate the induction of inflammation in non-infectious uveitis, the role of B cells in the pathogenesis of this disease is obscure. Therefore, this review aimed to discuss diverse B-cell participation in different non-infectious uveitides and their roles in the pathogenesis of this disease as well as the mechanism of action of rituximab. Increasing evidence from experimental models and human non-infectious uveitis has suggested the participation of B cells in non-infectious uveitis. The participation levels vary in different uveitides. Furthermore, B cells play multiple roles in the pathogenic mechanisms. B cells produce autoantibodies, regulate T cell responses via antibody-independent functions, and constitute ectopic lymphoid structures. Regulatory B cells perform pivotal anti-inflammatory functions in non-infectious uveitis. Rituximab may work by depleting pro-inflammatory B cells and restoring the quantity and function of regulatory B cells in this disease. Identifying the levels of B-cell participation and the associated roles is beneficial for optimizing therapy. Diversified experimental model choices and emerging tools and/or methods are conducive for future studies on this topic.

Metronidazole-Induced Irreversible Optic Neuropathy

Metronidazole-induced optic neuropathy is a rare complication. Most patients have excellent visual recovery. In this study, we report a patient who presented with a sudden onset of severe visual loss after a 1-week course of metronidazole. Myelitis developed simultaneously. The vision and the accompanying neurological deficiency of the patient did not improve even after metronidazole was discontinued immediately and various treatments were given.

A Prospective Review of Patients Receiving Intravitreal Anti-VEGF: How are we doing during the SARS-Cov-2 Pandemic?

Objective: During the SARS-CoV-2 pandemic, service provision of Anti- Vascular Endothelial Growth Factor (anti-VEGF) therapy is continued to prevent severe visual loss. As the majority of the patients requiring intravitreal anti- VEGF are elderly and vulnerable, we aim to assess the safety and efficacy of the delivery of anti-VEGF therapy. Method: A prospective data collection of 337 patients who attended the nurse led injection clinics in the UK during the lockdown period from 30 March 2020 to 1 June 2020. A follow up of all of the attended patients was conducted to assess for diagnosis of SARS-CoV-2. Results: 182 (54%) were female and 155 (46%) male. Majority (95%) were Caucasian and 5% were Asian ethnicity. The indication for anti-VEGF injection include wet age related macular degeneration (wet AMD) (70.9%), Diabetic Macular Oedema (DMO) (17.2%), and Retinal Vein Occlusion (RVO) (11.9%). Mean age was 78.84±9.76 for wet AMD, 67.63±3.26 for RVO and 59.28±14.54 for DMO. More wet AMD patients reported subjective deterioration of vision compared to RVO and DMO (40.2% vs. 37.5% vs. 22.4%) [P=0.04]. Chronic Obstructive Pulmonary Disease (COPD) is more common in the wet AMD group as compared to other groups (P=0.03). Five patients from the study group were tested for SARS-CoV-2, none were positive. Conclusion: Delivery of anti-VEGF therapy is safe with the current precautionary measures despite caring for a vulnerable group of patients. Majority of the wet AMD patients are continuing to attend intravitreal injection appointments.

MOG Antibody Positive Optic Perineuritis: an Observational Study in Han Chinese

ObjectiveTo shed light on the clinical characteristics, magnet resonance imaging(MRI) changes, and prognosis of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) positive OPN in Han Chinese.MethodsWe observed 39 MOG-IgG positive patients in our ward from January 1, 2017 , to December 31, 2019. Twenty patients met OPN inclusion criteria included contrast enhancement surrounding the optic nerve, and at least one of the following clinical symptoms: 1) reduction of visual acuity, 2) impairment of visual field, and 3) eye pain. Single course group(n=11) and recurrence group(n=9) were used for comparison. Outcome variables included Wingerchuk visual acuity classification.Results Of the 20 patients with MOG-IgG positive OPN, 12(60%) were women. Ten cases (50%) presented with bilateral and 17 eyes (56.67%) with severe visual loss (SVL,≤ 0.1). Twenty-one(70.00%) eyes showed edema of optic disc. Twenty-five eyes (83.3%) had longitudinally extensive perineural enhancement. At follow-up, 4 (13%) eyes still had SVL, while 26 (87%) eyes had no SVL, and of the 19 ON patients, 3 (9%) eyes still had SVL. Seven patients (35.00%) experienced at least a relapse(median interval 13.5 months ), and of the 19 ON cases, 4 (21%) patients experienced relapse. The relapse occurred more often in younger patients than the older (mean year: 38.00 vs. 45.54 years; P = 0.025). There were no optic chiasm and brainstem lesions.ConclusionsMOG-IgG positive OPN in Han Chinese often causes severe bilateral visual loss and longitudinally extensive perineural lesion. Younger patients are more likely to relapse. Optic chiasm and brainstem lesions were relatively rare.