Foveal reorganization after treatment of acute foveal toxoplasmic retinochoroiditis

Purpose To report a patient with impaired vision due to foveal involvement of toxoplasmic retinochoroiditis, who was successfully treated with intravitreal clindamycin and dexamethasone and oral therapy with azithromycin, trimethoprim-sulfamethoxazole, and prednisolone and led to successful visual and anatomic recovery. Case presentation A 32-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic retinochoroiditis. He was treated with intravitreal clindamycin and dexamethasone injection followed by six-week regimen of azithromycin, trimethoprim-sulfamethoxazole, and prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea reorganized gradually, and visual acuity concurrently improved from counting finger 3 m to 20/25. Conclusion In foveal toxoplasmic retinochoroiditis lesions, timely treatment is associated with retinal reorganization and visual improvement.

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

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.

Large diameter scleral lens benefits for Asians with intractable ocular surface diseases: a prospective, single-arm clinical trial

To report the efficacy and safety of large diameter scleral lenses and determine their suitability in Asian subjects with intractable ocular surface diseases. This prospective study enrolled intractable ocular surface diseases subjects with uncorrected visual acuity > counting finger but ≥ 0.3 logMAR and best-corrected visual acuity (BCVA) ≥ 0.3 logMAR, to fit large diameter scleral lenses for 12 weeks. 21 eyes (13 subjects) consisting ten eyes (47.6%) with persistent epithelial defects, 6 (28.6%) with graft-versus-host disease, 4 (19.0%) with Stevens–Johnson syndrome and one (4.8%) with severe dry eye were ultimately enrolled. Primary outcome measures were the visual acuity, corneal and conjunctival fluorescein staining, Ocular Surface Disease Index (OSDI), and National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). At week 12 with large diameter scleral lenses, BCVA improved from 0.77 logMAR to 0.27 logMAR (P < 0.001). High-grade corneal and conjunctival fluorescein staining proportion decreased from 61.90 to 14.29% and 52.38 to 9.52%, respectively (P = 0.0036 and 0.0063, respectively). OSDI and NEI-VFQ-25 improved from 67.89 to 34.69 and 51.40 to 64.48, respectively (P < 0.001). No adverse effects were observed. In Asians with intractable ocular surface diseases, large diameter scleral lens improves visual acuity and alleviates signs and symptoms of ocular surface diseases without any significant complications.Trial registration Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Project No. HI12C0015 (A120018)). Clinical Trials.gov, NCT04535388. Registered 18 August 2020—Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04535388.

Foveal Regeneration after Treatment of Acute Foveal Toxoplasmic Chorioretinitis

Purpose: To report a patient with impaired vision due to foveal involvement of toxoplasmic chorioretinitis, who was successfully treated with intravitreal and oral therapy and led to successful visual and anatomic recovery.Case presentation: A thirty two-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic chorioretinitis. He was treated with intravitreal Clindamycin and Dexamethason injection followed by six-week regimen of Azithromycine, Trimethoprim-Sulfamethoxazole, and Prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea was regenerated gradually, and visual acuity was concurrently improved from counting finger 3m to 20/25. Conclusion: In foveal toxoplasmic chorioretinitis lesions, timely treatment is associated with retinal regeneration and visual improvement.

Coats retinopathy with pachychoroid and central serous chorioretinopathy in the fellow eye

A 37-year-old man presented with blurring of vision and scotoma in the left eye since last 2 weeks and has a history of poor vision in his right eye since childhood. On examination, his best corrected visual acuity in the right eye was counting finger 1 m and 20/20, N/12 in the left eye. Fundus examination revealed features of Coats disease in the right eye and central serous chorioretinopathy (CSCR) in the left eye. He was given intravitreal triamcinolone acetonide injection in the right eye for reducing subretinal exudation. Simultaneously, focal laser photocoagulation was done to the CSCR leaks in the left eye to prevent the possible worsening of CSCR due to steroid injection in the fellow eye. He underwent cryotherapy to the retinal telangiectatic vessels 3 weeks after steroid injection in the right eye. Optical coherence tomography (OCT) of both eyes showed pachy vessels with a compression of overlying choriocapillaries. After 1 month, the condition of the right eye was unchanged and the CSCR in the left eye was completely resolved with the recovery of near visual acuity.

To Study the Pattern of Ocular Trauma and Predict-ing the Final Visual Outcome in Paediatric Ocular Trauma Cases in a Tertiary Eye Care Centre of Eastern India

Aim: The study was done to identify causes, demographic and clinical profile and to evaluate factors influencing visual outcome in paediatric ocular trauma patients (up to 15 years). Study Design: It was a prospective interventional study Place and Duration of the Study: The study was done in a tertiary eye care centre of eastern India between January 2019 to February 2020. Materials and Methods: The study was done from January 2019 to February 2020 on children between 1 year to 15 years of either sex with ocular trauma. Demographic details, cause of injury, presenting visual acuity were noted. Follow up was done till 2 months after carrying out appropriate intervention. Results: A total 106 eyes of 106 patients were evaluated and it was observed that children who were of 7 yrs and above were more affected (67%) than below (33%). Male children (59%) were more affected than female (41%). Injuries to Adnexa were found in 52% eyes, 40% injury cases were due to closed injury while open globe injuries comprised 8% of total cases. Common causes of injury were found to be mainly blunt objects and projectile objects. Maximum correction in visual acuity (VA) of more than 6/18 was achieved in 66% eyes, 6/18-6/60 in 11% eyes, <6/60-counting finger at 1 meter in 10% eyes. Conclusion: Late reporting, poor initial visual acuity, involvement of posterior segment, and no immediate primary intervention at time of injury adversely affect visual outcome. Early intervention and globe salvaging repair should be done in all eyes of trauma.

Ocular complications in pre-eclampsia

Exudative retinal detachment (ERD) is a rare complication of pre-eclampsia in pregnancy. The pathophysiology is uncertain but it is thought to be due to microvasculopathy involving the choroidal circulation. We report a case of a 36-year-old woman with underlying essential hypertension complicated with impending eclampsia in her third trimester of pregnancy. She developed bilateral bullous ERD at 34 weeks of gestation. Following emergency caesarean section, her blood pressure normalised after 10 days and the ERD partially resolved spontaneously after 30 days. Her best-corrected visual acuity improved from hand movement (HM) in the right eye and counting finger (CF) in the left eye to 6/24 bilaterally after 30 days postpartum. Pre-eclampsia-induced ERD is usually managed conservatively and the prognosis is usually good.

CHARACTERISTICS OF RETINAL DETACHMENT PATIENTS WITH PROLIFERATIVE VITREORETINOPATHY AT Dr. SOETOMO GENERAL ACADEMIC HOSPITAL

Introduction: The aim of this study is to evaluate the incidence and characteristics of retinal detachment patients with proliferative vitreoretinopathy. Methods: Retrospective review of medical record from primary retinal detachment (RD) patients with proliferative vitreoretinopathy (PVR) between 2013 and 2017 at Outpatient Department of Ophthalmology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Result: : The number of RD patients with PVR at Dr. Soetomo General Academic Hospital in 2013-2017 was 80 patients (21%), consisting of 59 men and 21 women with mean of age was 47.5 ± 14.3 years. The characteristics of the subjects were phakic 72.5%, aphakic 1.25%, high myopia 23.75%, history of trauma 18.75% and affected to right eye 60%. Retinal characteristics were break conditions in the retina (located at superotemporal (34%), horseshoe tear (56%), and single break (60%)), macula off (90%), area of detachments were 4 quadrants (43,75%), PVR conditions were grade B PVR (45%), mean duration of RD was 156 days, mean length of surgery waiting list was 61.1 days. The majority of treatment types were vitrectomy (70,4%), majority of tamponade using silicone oil (59.3%), majority of pre-operative and post-operative visual acuity were less than 3 meters counting finger, pre-operative (91.25%) , post-operative 1 month (76%) and 6 months (52.5%), and the majority of post-operative retinal reattachment were 77.3%. Conclusion: The results of this study indicate the number of RD patients with PVR was lower than previous studies. Various results of patient characteristics can be used as guidelines for ophthalmologists in determining actions and explaining the prognosis of the disease. Further research with a larger sample size and prospective methods will be better able to provide better results. Keywords: retinal detachment, proliferative vitreoretinopathy, characteristic pvr

Cap-puncturing mechanism for ophthalmic postoperative antibiotic eye drops: friend or foe?

A retrospective case series highlights two cases of postoperative endophthalmitis, in which similar improper technique of puncturing the antibiotic bottle with a nonsterile needle was noted. Patient A, a 65-year-old man with three weeks’ history of uneventful combined cataract and pars plana vitrectomy (PPV) presented with acute painful right eye and vision blurring from 6/12 to 1/60 for two days. Examination showed severe anterior chamber activity and hazy fundal view. B-scan showed dense vitritis. Vitreous sampling revealed gram positive cocci, but no culture growth. Patient B, a 69-year-old man presented with three days’ history of right painful red eye and vision dropped to light perception following an uneventful cataract surgery. Examination showed severe anterior chamber activity with hypopyon, raised intraocular pressure, and no fundal view. B-scan detected dense vitritis with loculation. Vitreous sampling cultured Pseudomonas aeruginosa in Patient B. In both cases, the patients reported piercing the generic topical ciprofloxacin 0.3% bottle tip with a nonsterile needle instead of the prescribed method of using the sterile, inner aspect of the bottle cap. However, the cultures of the bottle contents were negative in both cases. Both patients received intravitreal, topical, and systemic antibiotics and subsequently underwent PPV. Patient A recovered vision to baseline, while Patient B recovered to counting finger vision. The cap-puncturing mechanism for eye drop bottles is designed to maintain the sterility of the contents. However, this may backfire when patients do not understand the prescribed technique. We postulate that this improper technique predisposed the two cases to endophthalmitis.

Playing Reading, Using Hands: Which Activities are Linked to Number-Space Processing in Preschool Children?

Literate subjects from Western cultures form spatial-numerical associations (SNA) in left-to-right direction, which follows their reading habits. In preliterate children, sources of SNA directionality are more disputable. One possibility is that SNA follows children's early knowledge about text orientation. It could also reflect ipsilateral/contralateral tendencies in manual task execution. Furthermore, SNA's characteristics could differ depending on the evaluation method used. In this study, we test SNA in preliterate preschoolers using object counting, finger counting, and numerosity arrangement tasks. We examined the relations of SNA to children's directional reading knowledge and their manual response tendencies. Left-to-right SNA was pronounced for object counting, disappeared for the numerosity task, and was reversed for finger counting. In all tasks, left-to-right SNA dominated in children who responded contralaterally with their hand. Reading knowledge was partially related to numerosity-based SNA, but not to other SNAs. Based on these findings, we discuss developmental characteristics of different forms of number-space associations.