Ocular associations in hyperlipidaemia: A rural hospital based study

The incidence of hypercholesterolemia is ever increasing as the co morbid conditions such as diabetes mellitus, hypertension, stressful life is on a rise. Ocular conditions associated with hypercholesterolemia are issues which are minimally discussed. : This prospective cross-sectional study was conducted from January 2019 to June 2019. Complete eye examination was performed including visual acuity examination, refraction, tear film evaluation, slit lamp examination, measurement of intraocular pressure using rebound tonometer, gonioscopy, direct and indirect ophthalmoscopy Total of 81 patients were examined, out of which males were 55, females were 26. Most common ocular finding was Xanthoma and Xanthelasma in 61(70%) patients. Arcus juvenalis was noted in 12 (14.63%), Lipid keratopathy in 23(29.26%). Other comorbidities associated were Hypertensive Retinopathy, diabetic retinopathy, Pre senile cataract, Primary open angle Glaucoma, Branch retinal vein occlusion which has indirect causal relationship. Along with systemic workup, Hypercholesterolemia also warrants a routine detailed ocular examination even if the patient is asymptomatic. This aids in early diagnosis and management of the co-existing ocular morbidities.

Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region

Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.

Ocular Manifestations in Neurocutaneous Syndromes with Emphasis on Neurofibromatosis – A Descriptive Observational Study

BACKGROUND Neurocutaneous syndromes (NCS) are a group of genetic disorders that produce a variety of developmental abnormalities of the eye. Ophthalmic manifestations usually appear early in life and progress with time. The study was conducted to know the prevalence of ocular manifestations in neurocutaneous syndromes with emphasis on neurofibromatosis. METHODS This study was conducted in ophthalmology department at a tertiary care hospital during a period of 2 years among 30 patients. All phakomatoses referred from other specialty departments for ophthalmological evaluation and cases diagnosed in ophthalmology department during routine evaluation were included in the study. RESULTS Neurofibromatosis type 1 (NF-1) accounted for most of (66.67 %) the cases followed by Sturge Weber syndrome (SWS) (20 %). Majority (55 %) of NF-1 and 83.33 % of SWS and all patients of other phakomatoses were in the age group < 30 yrs. 55 % of NF-1 patients were males. 65 % of NF-1 patients gave positive family history. Lisch nodules, the most common ocular finding in NF-1 were present in 85 % of patients and of these 82 % were bilateral. Medullated nerve fibre was seen in 10 % of patients. Glaucoma was seen in 66.67 % of Sturge Weber syndrome patients. Conjunctional telangiectasia was seen in 16.67 % of Sturge Weber syndrome patients. Seizures and radiological features were seen in most patients with Sturge Weber syndrome. Megalocornea with normal intraocular pressure (IOP) was seen in both of our patients with posterior fossa malformations, haemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities (PHACES syndrome). Eyelid coloboma, ectropion uvea, hyperchromia iridis & myopia was seen in one patient with PHACES syndrome. A case of tuberous sclerosis had many systemic features like calcified subependymal nodules, renal angiomyolipomas, skin features and the only ocular finding was hypopigmented iris spots. CONCLUSIONS Ophthalmologist has a role in early recognition of the neurocutaneous syndrome from specific ocular features (like Lisch nodule in NF-1), reducing ocular morbidity by timely treatment (of conditions like glaucoma) and prompt referral to concerned speciality for management of systemic involvement. KEYWORDS Neurofibromatosis, Sturge Weber Syndrome, Tuberous Sclerosis

Feline Ocular Mycobacteriosis: Clinical Presentation, Histopathological Features, and Outcome

This study describes clinical and histopathological features, treatment, and outcome of cats diagnosed with ocular mycobacteriosis. Cases diagnosed from 2012 to 2017 were reviewed for (a) histopathological evidence of ocular (pyo)granulomatous inflammation containing acid-fast bacilli with mycobacterial morphology, (b) positive mycobacterial culture and/or mycobacterial DNA identified by polymerase chain reaction of ocular tissue, or (c) presumed mycobacteriosis based on ophthalmic examination and positive interferon-gamma release assay. Twenty-five cats (31 eyes) were included; 14 cats (17/31 eyes, 55%) were blind at presentation (unilateral: n = 12 cats; bilateral: n = 2 cats); one unilaterally affected cat later became bilaterally blind. Another 5 cats (7/31 eyes, 23%) became blind after initially being bilaterally visual (unilateral: n = 3 cats; bilateral: n = 2 cats). The commonest ocular finding was uveitis (87%). The main histopathological features were granulomatous to pyogranulomatous chorioretinitis with retinal detachment, anterior uveitis, optic neuritis, episcleritis, scleritis, and/or retrobulbar cellulitis. Nineteen cats (76%) had systemic signs, with disseminated disease being diagnosed in 9, defined by interstitial pulmonary disease, generalized lymphadenopathy, and/or nonocular infection. Nine cats were diagnosed with Mycobacterium bovis, 2 with Mycobacterium microti, 1 with Mycobacterium tuberculosis complex, and 1 with Mycobacterium avium-intracellulare complex. The infecting species was unknown in the remaining cats. Combined surgery (enucleation: n = 5 cats; biopsy: n = 3 cats) and systemic treatment with 2 or 3 appropriate antibiotics for 2 to 7 months resulted in remission in 8 of the 10 cats treated; however, the cat treated with dual therapy relapsed after 8 months. A total of 16 cats (64%) were euthanized; 2 were lost to follow-up.

Statistical approaches in published ophthalmic clinical science papers: a comparison to statistical practice two decades ago

The aim of this study is to evaluate the current practice of statistical analysis of eye data in clinical science papers published in British Journal of Ophthalmology (BJO) and to determine whether the practice of statistical analysis has improved in the past two decades. All clinical science papers (n=125) published in BJO in January–June 2017 were reviewed for their statistical analysis approaches for analysing primary ocular measure. We compared our findings to the results from a previous paper that reviewed BJO papers in 1995. Of 112 papers eligible for analysis, half of the studies analysed the data at an individual level because of the nature of observation, 16 (14%) studies analysed data from one eye only, 36 (32%) studies analysed data from both eyes at ocular level, one study (1%) analysed the overall summary of ocular finding per individual and three (3%) studies used the paired comparison. Among studies with data available from both eyes, 50 (89%) of 56 papers in 2017 did not analyse data from both eyes or ignored the intereye correlation, as compared with in 60 (90%) of 67 papers in 1995 (P=0.96). Among studies that analysed data from both eyes at an ocular level, 33 (92%) of 36 studies completely ignored the intereye correlation in 2017, as compared with in 16 (89%) of 18 studies in 1995 (P=0.40). A majority of studies did not analyse the data properly when data from both eyes were available. The practice of statistical analysis did not improve in the past two decades. Collaborative efforts should be made in the vision research community to improve the practice of statistical analysis for ocular data.

Case Report: Hyperprolactinemia and growth hormone deficiency associated with Morning Glory Syndrome; with a review of the literature

Morning Glory Syndrome (MGS) is a rare congenital malformation of the optic nerve that is caused by a failure of the closure of the choroidal embryonic fissure in utero. The syndrome is usually seen in association with midline cranial defects, such as transsphenoidal and basal encephaloceles. Although MGS usually presents as an isolated ocular finding, it can be associated with endocrinological abnormalities. We report a case of a 32 year old female with MGS with hyperprolactinemia and growth hormone (GH) deficiency. She was diagnosed with MGS at the age of three and her past medical history was significant for left eye blindness, hyperprolactinemia and GH deficiency. She has received GH replacement and oral contraceptive pills in the past. Our investigations revealed elevated prolactin levels (63mg/l) and borderline low GH levels. Magnetic resonance imaging revealed an abnormality involving the optic chiasm, left optic nerve and compression of the pituitary gland by a basal encephalocele. Genetic studies were positive for a mutation in Paired box 6 gene (PAX6). She is being currently treated with cabergoline for her hyperprolactinemia. Our aims of this report are to highlight the hormonal manifestations of MGS and to review the etiopathogenesis of this rare disorder.

Bilateral Birdshot Retinochoroiditis and Retinal Astrocytoma

Background. This case highlights the importance of recognising multiple pathologies within the eye which may not necessarily be linked. Both birdshot retinochoroiditis and astrocytoma are rare conditions. The case underlines the need for early identification and treatment of birdshot retinochoroiditis with steroids and disease modifying drugs. Astrocytoma in the absence of tuberous sclerosis is also uncommon. Case Presentation. A 36-year-old male presented with 3-month history of bilateral progressive flashing lights and floaters. He was systemically well with no significant past medical history. Fundal examination revealed retinal vasculitis and active creamy lesions in the choroid radiating from the optic nerve. In the supranasal periphery of the right eye there was a raised white, jagged lesion protruding into the vitreous. Fluorescein angiogram and indocyanine green showed marked venous vasculitis, hypofluorescence, and disc leakage in keeping with birdshot retinochoroiditis. The supranasal lesion features were in keeping with astrocytoma and this was thought to be a coincidental finding. Conclusions. Retinal astrocytoma may be present as an isolated ocular finding; however, patients must still be investigated for tuberous sclerosis which is the most common association. Birdshot retinochoroiditis typically responds well to steroid therapy, and disease modifying drugs should be considered as soon as possible.