A Case of Bilateral Optic Edema in a 71 Year Old Diabetic

A 71 year old Hispanic male with a past medical history of hypertension, type II diabetes mellitus, and bilateral anatomically narrow angles status post bilateral peripheral iridotomies presented with the complaint of “looking through a film.” The patient could still drive, work as a cashier, see his computer and television, and read with his glasses. It was worse in the morning and resolved when he washed his face. The patient denied headaches, jaw claudication, weight loss, and anorexia. Pt had no neurologic deficits including diplopia. The patients hemoglobin A1c 4 months prior to being seen was 7. The patient endorsed checking his blood sugars at home and most are less than 200. The patient routinely checks his blood pressure at home and it is usually 130s/70s. The patient’s best corrected visual acuity was 20/20 in each eye at distance, intermediate, and near. His Ishihara color test was 11/11 in each eye as well. His intraocular pressure was 13 in each eye with corneal thickness of 642 OD and 626 OS. There was no relative afferent pupillary defect in each eye, extraocular muscle movements were full, and his confrontation fields were full as well. His anterior segment exam was unremarkable except for nuclear sclerosis of each lens. The fundus examination was remarkable for bilateral optic disc swelling with heme off both optic discs. Fluorescein angiography demonstrated bilateral optic disc leakage. OCT showed a flat sensory retina in each macula. The patient had an emergent MRI that demonstrated diffuse loss of normal high T2 signal, but no intracranial mass was present. CRP and ESR were both within normal limits when accounted for the patient’s age. The patient’s papilledema improved on one month follow-up exam without intervention. Due to the patient’s history of diabetes, normal corrected visual acuity, reportedly well controlled blood pressure, and essentially unremarkable work-up, the patient was diagnosed with diabetic papillopathy.

Eales Disease Debut in Childhood

Introduction: Eales disease is considered a peripheral retinal vascular disease characterized by inflammation (vasculitis), ischemia, vascular occlusion, and neovascularization. Its etiology is not yet defined, it generally affects young men in the second decade of life. Case: Male patient, 10 years old of age with a red eye with blurred right eye vision of 1 month of evolution that worsened 4 days before coming to the service, accompanied by photophobia and eye pain. Discussion: Eales disease affect to more often young males, whose main characteristic peripheral phlebitis which can cause retinal ischemia and neovascularization. Although its etiopathogenesis is unknown. Some cases in the literature that relate it to a type IV hypersensitivity reaction to M. tuberculosis’s antigens The treatment of choice was systemic and topical corticosteroids, with a very good clinical response and periodic follow-up of the patient, with warning signs.

Identification of Ocular Trauma Pattern with Risk and Prognostic Factors in the North Bund Area of Shanghai

Background: Ocular trauma is a leading cause of blindness. Identification of ocular trauma pattern is necessary for better ocular trauma prevention and treatment. Objective: The aim of this study is to identify ocular trauma pattern in the North Bund area of Shanghai. Methods: A retrospective cross-sectional study was conducted with 206 ocular trauma patients at Shanghai General Hospital. Results: A gender related ocular trauma pattern was identified that consists of several risk and prognostic factors. Of 206 ocular trauma patients, 182 patients were males (88.35%) and only 24 patients were females (11.65%). Males had significantly higher percentage of penetrating/intraocular foreign body injuries compared to females, which is associated with age and occupation. A significantly higher average monthly percentage of ocular trauma is observed in summer, suggesting that season change alters the risk of eye injury. Although proper treatments of complications are beneficial for patients, the visual outcome is determined by the location and size of injuries. Conclusion: We identified a gender related ocular trauma pattern with several risk and prognostic factors in the North Bund area of Shanghai.

Vitrectomy Versus Combined Vitrectomy-Scleral Buckling for the Treatment of Pseudophakic and Aphakic Retinal Detachment

There is a disagreement on the ideal intervention for pseudophakic and aphakic retinal detachment. The goal of this thesis is to outline the difference between the two surgical approaches in getting higher reattachment rates and better visual outcomes. The study is a prospective randomised study to evaluate the efficacy of vitrectomy alone versus a combination of both vitrectomy and scleral buckling in the treatment of pseudophakic and aphakic retinal detachment. Aim: The aim of this study is to compare the anatomical and functional results of primary vitrectomy alone versus vitrectomy-scleral buckling for pseudophakic and aphakic retinal detachment. Patients and Methods: A total of 30 eyes with pseudophakic or aphakic retinal detachment will be divided into two groups. Fifteen consecutive pseudophakic or aphakic eyes with retinal detachment will be operated by vitrectomy-scleral buckling (Group-A) and Fifteen additional patients will be operated by vitrectomy alone (Group-B). Results: The two groups of the patients with a postoperative follow-up of at least 6 months continue to maintain an attached retina after one operation. Visual acuity has improved by at least 2 lines on the Snellen chart in 25 patients, remained the same in 2 patients, and decreased in 1 patient. Conclusion: This randomised study shows the same anatomic results when performing a PPV, fluid-air exchange, internal drainage, and endolaser together and SF6 gas injection with or without a scleral buckling for pseudophakic retinal detachment.

Pattern of Eye Diseases in Dhaka City District Level and Village Areas in Bangladesh

Background: Ocular morbid conditions are responsible for partial or total blindness. Ocular morbidities by its sheer magnitude form an enormous problem, not only in human suffering, but also in terms of economical loss and social burden. Objective: The aim of this study is to determine the pattern of eye Diseases. Methods: This was a cross sectional study. This study was done in Dhaka city, different districts of Dhaka Division and different Upazilla of Dhaka district. From these three sites 3124 patients were randomly selected. All the members of a family were cross-examined and then diseased individuals were isolated for detail history taking and clinical assessment. Results: The results revealed that 3124 study subjects were had ocular morbidity. Common ocular morbidity was 1153 had Refractive error (36.9%), 105 had Cataract, 15(0.5) had Glaucoma, 63(2.0) had Chronic Dacryocystitis, 14(0.4) had Pterygium, 6(0.2) had Diabetic Retinopathy, 56(0.2) had Retinitis pigmentosa and 1763 (56.4) others. Males were more affected as compared to females. It was observed that as the age increases the prevalence of ocular morbidity increases. Conclusion: The leading cause of eye diseases in this study was Refractive error, Cataract, Glaucoma, Chronic Dacryocystitis, Pterygium, Diabetic Retinopathy, Retinitis pigmentosa and others etc.

Effects of Preoperative Versus Intraoperative Application of Mitomycin C on the Outcome of Pterygium Surgery: A Meta-Analysis

Background: The use of mitomycin C (MMC) has been recommended to reduce postoperative recurrence in patients undergoing pterygium surgery. However, the outcomes with preoperative (PO) and intraoperative (IO) application of mitomycin C have not been adequately compared. Objective: This study aimed to evaluate PO MMC versus IO MMC in terms of recurrence and complications for pterygium treatment. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched with the keywords “pterygium,” “mitomycin,” and “preoperative” and “intraoperative.” Randomized controlled trials (RCTs) comparing PO MMC with IO MMC in pterygium surgery were included. A risk of bias tool was used to perform qualitative assessments. Outcome measurements were recurrence and complications of the ocular surface. Review Manager 5.3 was used for statistical analysis. Results: Five RCTs with 390 participants (390 eyes) showing primary or recurrent pterygium were included. Recurrence of pterygium with PO MMC was similar to that with IO MMC (RR = 1.04, 95% CI, 0.61 to 1.76, P = 0.89). There was no significant difference between the two treatments (PO MMC vs. IO MMC) with respect to complications of the ocular surface, including conjunctival complications (RR = 1.04; 95% CI, 0.61 to 1.76; P = 0.89), scleral complications (RR = 0.72; 95% CI, 0.14 to 3.73; P = 0.70), and corneal complications (RR = 1.33; 95% CI, 0.32 to 5.48; P = 0.70). Conclusion: PO MMC was as efficient as IO MMC in controlling the recurrence and complications in pterygium surgery.

An Orbital Mass Partially Responsive to Steroid

A 68 year old woman presented with a progressively enlarging orbital mass. MRI of her brain and orbits was consistent with an orbital pseudotumor. Although there was some improvement in the patient’s pain and the size of the mass, it did not fully resolve.The patient had a biopsy demonstrate non-caseating granulomatous inflammation. A chest X-ray and CT chest demonstrated bilateral hilar lymphadenopathy. Further examination and interviewing of the patient revealed several months of joint paints and lower extremity nodules. The patient was diagnosed with orbital sarcoidosis and was started on methotrexate by a rheumatologist

Predicting the Success Rate of Levator Resection Surgery Using Whitnall Ligament Position

Ptosis is defined as lower positioning of the upper eyelid margin which normally is placed 1.5 mm below the superior corneal limbus [1]. Ptosis can be accounted as the 3rd most common eyelid disorders following chalazion and entropion [2]. It may result in amblyopia, visual field defect, cosmetic and psychological problems. Generally, ptosis is subdivided to congenital and acquired cases [3]. Abnormal development of levator muscle or innervation abnormalities is responsible for congenital cases of ptosis. On the other side, trauma, several neurologic disease, and defective levator aponeurosis can lead to acquired ptosis [4]. Levator function, clinical feature, and concomitant eyelid or face abnormalities are the determining factors for choosing appropriate surgical plan [5]. Common surgical approaches include frontalis suspension technique and levator muscle procedures (levator advancement and levator resection) in which frontalis suspension is performed in cases with poor levator function and the latter one is suitable for patients with preserved levator function [4]. Levator resection outcomes are not absolutely predictable. Multiple factors such as ptosis severity, levator function, and age of patient have been discussed as predictive factors for surgical success rate.

Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.

Optic Disc Drusenoid Deposits with Hemifield Defects in a Patient with IgA Nephropathy - New Findings

To describe emerging new OCT and Humphrey visual field findings is the objective of the study. A previously treated 20-year old female patient for skin rashes, hematuria, and pain abdomen 8 months ago reported with visual disruption in the right eye for the last one week. Features of leukocytoclastic vasculitis on skin biopsy and glomerular mesangial cell hyperplasia on renal biopsy inferred a clinical diagnosis of IgA nephropathy. Consequently, proteinuria manifested one month after administration of prednisolone 50 mg/day tapered for 8 months, Visual acuity of 6/9 in the right eye and 6/6 in the left eye with normal color vision recorded in addition to early signs of papilledema. Classically, on OCT, hyperreflective intense echoes discovered in the optic disc, and accordingly inferior hemifield defects established predominantly in the right eye on HFA. Total leucocyte count at11720 cells/cu mm and ESR 60 mm/hr by the Wintrobe method with the presence of albumin, RBCs, and pus cells on urine analysis in addition to positive occult stool blood detection. C3, C4, and ANCA panel revealed negative results and the USG abdomen disclosed fatty liver with mesenteric nodes. In conclusion, Optic disc drusenoid deposits corresponding with hemifield visual field defects detected in the current case study is possibly the associated early fundus manifestation of IgA nephropathy.