Sickle Cell Trait Presenting as Unilateral Proliferative Retinopathy and Macular Thinning in a Pregnant Woman

Background. To report a case of a pregnant woman with sickle cell trait (SCT) who presented with unilateral proliferative sickle cell retinopathy. Case Presentation. A 26-year-old otherwise healthy pregnant woman presented with the complaint of visual loss in her left eye. The funduscopic examination showed vitreous hemorrhage, sea fan neovascularization, and pale optic disc. Optical coherence tomography revealed macular inner retinal layer thinning and foveal splaying (saucerization of the foveal pit). The investigations, including hemoglobin electrophoresis, verified the diagnosis of sickle cell trait. Blood pressure, fasting blood glucose tests, and tuberculin skin tests were normal. We treated the patient by peripheral retinal photocoagulation over the area of nonperfusion. Conclusion. Even though the sickle cell trait is generally considered as a milder form of sickle cell disease without severe retinal manifestations, pregnancy should be considered as a trigger that can induce proliferative changes and foveal splaying in this group of patients.

Retinoblastoma Extending up to the Optic Chiasma and Presenting as a Suprasellar Mass

Retinoblastoma is the most common ocular malignancy of childhood. It is present in childhood with leukocoria and strabismus. Most patients are diagnosed under 3 years of age. Funduscopic examination can reveal an intraocular mass, but imaging is essential for complete evaluation of the lesion. Although ultrasound is a non-invasive and relatively inexpensive screening tool, cross-sectional imaging is required to assess the involvement of optic nerve and intracranial spread. We report a case of retinoblastoma in a 5 year old male child who presented with headache diminution of vision in both eyes. Contrast enhanced magnetic resonance imaging (MRI) revealed an enhancing soft tissue mass in the right eye with involvement of optic nerve and optic chiasma and contiguous with a large suprasellar mass causing hydrocephalus. Non-contrast computed tomography (CT) showed extensive calcifications in the mass lesion.

A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

Flexible e-learning video approach to improve fundus examination skills for medical students: a mixed-methods study

Background Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians’ confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach’s value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. Methods We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach’s effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students’ thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. Results The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom’s taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom’s taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen’s kappa = 0.81). Conclusions Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom’s taxonomy. Trial registration This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434).

Bilateral Ampiginous Choroiditis following Presumed SARS-CoV-2 Infection

Purpose. To report a case of bilateral ampiginous choroiditis following presumed SARS-CoV-2 infection. Case Description. A 25-year-old woman presented with metamorphopsia and a paracentral scotoma in her left eye. She endorsed night sweats, headache, and new-onset anosmia beginning 1 week before her visual symptoms. She also had multiple confirmed ill COVID-19 contacts at her workplace before the onset of her symptoms. Funduscopic examination and multimodal imaging revealed placoid lesions in the macula and midperiphery of both eyes consistent with ampiginous choroiditis. COVID-19 antibody testing returned positive for IgG, and an extensive systemic evaluation was otherwise unremarkable. She was treated with oral prednisone and azathioprine with stabilization of the retinal lesions and no progression of her symptoms. Conclusions. Ampiginous choroiditis is an inflammatory chorioretinopathy with an unknown pathogenic mechanism that often necessitates early immunomodulatory therapy. This report suggests that SARS-CoV-2 infection may trigger chorioretinal inflammation in susceptible hosts.

A case of retinal vascular involvement in a 6-year-old patient with Covid-19

Purpose: This study evaluated fundus changes in a 6-year-old child who contracted Sars-CoV-2 without developing symptoms of the disease. Materials and methods: The patient underwent a complete ophthalmic evaluation, which included assessment of visual acuity with and without correction, extensive ophthalmological examination, cicloplegic refraction by retinoscopy and funduscopic examination, OCT, and angio-OCT examination. Results: Fundoscopic examination in a young patient with previous Sars-CoV-2 infection showed marked vascular tortuosity, evident both at the posterior pole and retinal periphery, especially on the arterial vasculature, and cotton wool spots along the retinal vessels, highlightable also at OCT and angio-OCT examination. These alterations persist at a 6-month follow-up. Conclusions: In COVID-19 infection, even in asymptomatic pediatric patients, vasculitis develops also affecting the retinal vessels, appreciable on fundus examination. A thorough eye examination in all COVID-19 patients with close follow-up is therefore important. This is the first case report on retinal changes in a pediatric patient.

Difficulty in articulation following left progressive blurred vision

Purpose: To report a case of Paracentral acute middle maculopathy (PAMM) caused by severe internal carotid artery (ICA) stenosis and discuss the correlation between PAMM and ICA stenosis. Case description: A 67-year-old male patient presented with left acute blurred vision for 1 week. The best-corrected visual acuity of the left eye was 0.01. Funduscopic examination showed multiple grayish patches around the left macula. Optical coherence tomography (OCT) demonstrated train-track hyperreflective lesions over the inner nuclear layer of the left eye. Afterwards, he experienced sudden slurred speech with fair comprehension. Magnetic resonance imaging and angiography of the brain demonstrated left lacunar infarction with severe left ICA stenosis. After anticoagulant therapy, his dysarthria and left visual acuity were improved significantly. Conclusions: To our knowledge, PAMM in coincidence with lacunar infarction induced by ICA stenosis is firstly described in the literature. PAMM could be a critical warning of ICA stenosis, and this case can alert ophthalmologists to survey ICA stenosis in patients with PAMM.

The history of research of the ophthalmic aspects of hypertension

The awareness of the widespread influence of hypertension on various organ systems is ever increasing. Changes associated with this disease can be observed in the heart, brain, kidneys, but also the organ of vision. These usual microvascular changes are defined as hypertensive retinopathy. During a funduscopic examination, abnormalities such as narrowing of arterioles, symptoms of arteriole and vein intersection, cotton wool spots, intra-retinal exudates, retinal haemorrhages, and in severe cases even swelling of the optic disc and macula. This review presents an overview of the changes at the fundus of the eye that may occur in patients with hypertension, as well as problems with the classification of hypertensive retinopathy over the years, and the development of diagnostic methods in ophthalmology and fundoscopic imaging. Running title: The history of hypertensive retinopathy research

Spontaneous Vitreous Hemorrhage in a Naval Aviator

BACKGROUND: Spontaneous vitreous hemorrhage is uncommon in the general population. Of cases, 1020% are idiopathic or due to occult causes and a majority of the remainder are associated with diabetic disease. The evaluation and disposition of an aviator has not been reported previously. This case will document the work-up and safe return to flight of a patient.CASE REPORT: A 33-yr-old male MH-60R pilot presented with acute blurred vision in the left eye and eye pain which began at his desk. His review of systems was otherwise negative. His medical history was noncontributory. On initial examination his vital signs and external ocular exam were normal. He was immediately referred to the optometry clinic, where a dilated funduscopic examination (DFE) with scleral depression demonstrated a large floater OS composed of streaks of blood and tobacco dust. His DFE was otherwise normal with no retinal tears or vitreous detachments. On repeated DFEs, his intraoccular pressures remained normal and his hemorrhage resorbed without decreased visual acuity or field deficits. A hematologic work-up was negative. After 4 mo of observation, the patient was returned to flight status without further recurrence.DISCUSSION: No known associations exist between aeronautical duties and spontaneous vitreous hemorrhages. The stressors aviators are subjected to, such as high vibrations and increased g forces, may make them more likely to suffer intraocular microvascular damage that could lead to retinal detachment, vitreous detachment, and bleeding. Further reports are needed to determine the risks of recurrence in aviators and their differences from typical spontaneous vitreous hemorrhage patients.Wallace SA. Spontaneous vitreous hemorrhage in a naval aviator. Aerosp Med Hum Perform. 2020; 91(11):904907.

Clinical Features and Surgical Outcomes of Subretinal Proliferation in Proliferative Diabetic Retinopathy

Background: To investigate the clinical characteristics, treatments and prognosis of subretinal proliferation (SRP) in patients with proliferative diabetic retinopathy (PDR).Methods: 154 patients (182 eyes) who received vitrectomy for PDR were retrospectively reviewed. Patients with SRP were enrolled as the study group, and those without SRP served as the control group. The following data were collected from their medical records: demographics, systemic and ophthalmologic findings, and treatment given specifically for SRP. The main outcome measures included the visual acuity, funduscopic examination and final anatomic success. The association between SRP and other systemic involvement of PDR was also analyzed. Results: There were 9 eyes (9 patients) in the study group and 145 eyes (145 patients) in the control group. The average fasting blood glucose was 11.48 ± 3.52 mmol/L and 8.72 ± 3.05 mmol/L, respectively (P = .048). The study group had a significantly higher proportion of tractional retinal detachment (TRD) (P < .0001) and a significantly lower proportion of vitreous hemorrhage (VH) (P = .0006). The rate of silicone oil usage was higher in the study group (P < .0001). No retinal break was found preoperatively or intraoperatively. Only one eye (11.1%) had undergone subretinal band removal procedure intraoperatively, and the final anatomical success rate was 100%. Conclusion: SRP in PDR was associated with higher blood sugar levels and TRD. The retina could reattach successfully after vitrectomy without removal or transection of the subretinal bands in most eyes.