Nripen Gaur

Blood flow pattern in a choroidal hemangioma imaged on swept-source-optical coherence tomography angiography

This report demonstrates the blood flow pattern in a case of choroidal hemangioma (CH) using swept-source-optical coherence tomography angiography (SS-OCTA). Fluorescein angiography, SS-OCT, and SS-OCTA images of a patient with CH were obtained using a standard protocol. The internal vascular pattern of the tumor was identified on both OCT and OCTA. Dark areas were identified in the CH. These were interspersed between areas of visible blood flow, as imaged on SS-OCTA. Peripheral vascular arcades were also identified within the tumor. SS-OCTA should be evaluated as an imaging tool to study the blood flow within choroidal tumors.

What's new for us in strabismus?

Strabismus is one of the most challenging subspecialties encountered in the field of ophthalmology. The concept of etiology of strabismus is being advanced with the development of newer imaging modalities and increased understanding of the genetics of strabismus. Imaging is also being used to aid in the planning of strabismus surgery. Newer horizons are being explored in the amblyopia management. The good old eye-pad is being replaced with the iPad. Early detection of loss of stereopsis is being used to decide the timing for strabismus surgery. Improvement of binocular summation has been discovered as a benefit of corrective strabismus surgery. Newer surgical techniques such as new transposition procedures are being developed to correct complex strabismus. Strabismus surgeries aided by adjustable sutures have increased the precision of a strabismologist. A new light has been thrown on the psychosocial impact of strabismus. A present-day strabismologist has advanced from the goal of ocular alignment to a bigger perspective “to regain the paradise lost: stereopsis.”

Proparacaine-Induced Mydriasis During Strabismus Surgery

ABSTRACT Aim: To evaluate the mydriatic effect of proparacaine hydrochloride (PH) in children undergoing strabismus surgery under general anesthesia (GA). Methods: This was a pilot, prospective, non-randomized, self-controlled interventional study. Nine children with esotropia or exotropia undergoing horizontal muscle squint surgery under GA at a tertiary eye care center were included. The six Group 1 patients underwent both eye surgeries, while the three Group 2 patients underwent single eye surgery. PH was instilled in one eye of Group 1 patients and both eyes of Group 2 patients. Change in pupil diameter (PD) was analyzed as the main outcome measure. Results: Mean age of the patients was 4.67 ± 2.64 years. In the study eyes, mean average baseline PD was 1.59 ± 0.40 mm (range: 1.06–2.37), while postoperative average PD was 3.99 ± 1.34 mm (range: 1.79–6.02). The mean baseline PC had increased from 5.51 ± 1.09 mm to 12.6 ± 3.58 mm at the end of the surgery. PD and PC increased in all of the study eyes while no change in PD or PC was seen in the control eyes of either of the groups. The dilated pupil was skewed horizontally towards the muscle being operated upon in all of the study eyes. Conclusions: PH has a mydriatic effect of its own. It penetrates through the bare sclera and leads on to skewed dilation of the pupil. Surgeons should consider this effect while judging pupil alignment at the end of the surgery.

Eyes that cannot be seen: a rare case of ankyloblepharon filiforme adnatum (AFA) in a neonate

An infant aged 17 days was presented to our clinic with inability to open both eyes along with facial deformity. The vitals were found to be normal and no other systemic abnormality was recorded. On ocular examination, the child was found to have bilateral ankyloblepharon along with cleft lip and cleft palate. An urgent examination was done under general anaesthesia which revealed ankyloblepharon involving bilateral eye (figure 1A) barring a small area on the medial aspect of both eyelids. A probe was passed from the small …

Retinal shortening: Ultrasonic evaluation of proliferative vitreoretinopathy

Purpose: To evaluate the effect of extraretinal proliferative vitreoretinopathy (PVR) on retinal shortening in eyes with rhegmatogenous retinal detachment (RD) using ultrasound (USG) and objectively prove the presence of intraretinal PVR (iPVR). Methods: This is a double-masked pilot prospective controlled case series. Patients with total RD planned for vitreoretinal surgery were included in the study. USG was used to determine retinal-to-choroidal length ratios (RCRs) in all the quadrants. Group 1 included 10 patients with preoperative PVR more than Grade B while Group 2 had 14 with PVR of Grades A or B. Severe retinal shortening was defined as RCR < 0.8. Primary outcome measures were severe retinal shortening and an early unexplained recurrence of RD within 15 days of surgery. Results: Mean RCRs were significantly low in all the four quadrants of Group 1 upon comparison with Group 2. The mean RCR had a good negative correlation with number of quadrants of PVR (R = −0.66, P ≤ 0.001). Overall, severe quadrantic retinal shortening was detected in nine patients. In these 9 patients, 11 of the 36 retinal quadrants had severe retinal shortening in the absence of extraretinal PVR (ePVR). Six patients developed early unexplained RD, and all of these belonged to Group 1. Severe quadrantic retinal shortening had the highest odds ratio of developing early unexplained RD (odds ratio = 58, P = 0.01). Conclusion: Retinal shortening occurs both due to ePVR and iPVR, and iPVR occurs independently at least in some cases. Severe quadrantic retinal shortening indicates poor primary anatomical prognoses.

Ultrasonographic evaluation of transition from normal to ectatic area: A comparison between myopic staphylomata and coloboma

Choroidal coloboma and posterior staphyloma are two clinically distinct entities, with choroidal excavation being a unifying feature. They are associated with early onset cataract which can make ophthalmoscopy difficult. This report studies the transition between the normal and ectatic area in these cases with ultrasound. We evaluate “posterior hump” as a sign of differentiation between these two conditions.

Optical coherence tomography of the Kayser-Fleischer ring: an ancillary diagnostic tool for Wilson’s disease in children

This report presents anterior segment optical coherence tomography (AS-OCT) images of Kayser-Fleischer ring (KFR) in a child. The AS-OCT images highlight differential reflectivity of the KFR depending on amount of copper deposited in cornea, thus supporting the role of AS-OCT as a follow-up tool. Utility of AS-OCT for diagnosing and documenting the KFR in children otherwise uncooperative for detailed slit lamp examination is discussed.

Bilateral near total blindness due to miliary neurocysticercosis.

A man aged 18 years presented to our neuro-ophthalmology clinic with symptoms of headache, and painless and gradual onset bilateral visual loss since 2 months. While systemic examination was normal, visual acuity was noted to be perception of light in both eyes. Both pupils reacted sluggishly to light. Both eyes were found to be normal on examination apart from minimal temporal optic disc pallor. Urgent MRI of the head and orbits was ordered, which revealed numerous foci of neurocysticercosis (NCC) scattered throughout the brain parenchyma, giving it a ‘starry sky appearance’ (figure 1A). The occipital lobe was also found to be studded with such lesions along with surrounding oedema. A prominent cyst, along with scolex, was found to be …

Bilateral ischaemic optic neuropathy and retinopathy along with cortical infarct in a case of Takayasu disease

A 27-Year-old female presented with complaints of sudden onset visual loss along with right sided deviation of the angle of mouth since past 30 days. Vision loss had worsened in the last week. There was history of severe headache which was not associated with vomiting. There was no history of any other neurological deficit or prior systemic illness. Examination for cranial nerve function revealed a left sided upper motor neuron facial nerve palsy and rest of the neurological examination was within normal limits. On ocular examination, the patient had best-corrected visual acuity of light perception (PL) in right eye (RE) and 6/36 in left eye (LE). A grade four relative afferent pupillary defect was noted in RE, while slit lamp examination and …

Transorbital globe sparing penetrating cranial injury with a metallic screw: large cranio-orbital foreign body

A 14-year-old man presented to the emergency services following trauma to his left eye (LE) sustained during a battery explosion. The patient was conscious, and oriented in time, space and person, and higher mental functions were preserved. The patient had visual acuity of light perception in his left eye. Head of a metallic screw could be seen on ocular examination and the screw appeared to penetrate the left superior orbit through the upper eyelid (figure 1A). Details of the eyeball could not be visualised, though the cornea appeared opacified. Intraocular pressure could not be assessed on digital palpation due to severe lid oedema. The fellow eye was within normal limits. Ultrasound was avoided in view of suspected open globe injury. An urgent CT scan was advised which revealed the extension of the …