Pradeep Sagar

Intraocular metallic foreign body causing branch retinal vein occlusion.

We report a case of a 40-year-old man with post-traumatic cataract and an intraocular metallic foreign body (IOFB) lying on the retinal surface causing a superotemporal branch retinal vein occlusion. The case was managed using lens aspiration with pars plana vitrectomy and IOFB removal. We only found two previous reports of such a foreign body causing a vascular occlusion. The possibility of a vascular occlusion occurring due to a foreign body within or close to the optic disc is highlighted.

Phthisis Bulbi—a Clinicopathological Perspective

ABSTRACT Phthisis bulbi denotes end-stage eye disease characterized by shrinkage and disorganization of the eye with the resultant functional loss. The major factors associated with the pathogenesis of phthisis are hypotony, deranged blood-ocular barriers, and inflammation. Common causes include trauma, surgery, infection, inflammation, malignancy, retinal detachment, and vascular lesions. A phthisical globe shows a small squared off shape, opaque and thickened cornea, thickened sclera, neovascularization of iris, cataract, cyclitic membrane, ciliochoroidal detachment, and retinal detachment. Microscopic features include internal disorganization, inflammatory reaction, a reactive proliferation of various cells, calcification, and ossification. Early treatment of the causative etiology is the best strategy available to avoid an eye from going into phthisis. A phthisical eye has no visual potential and cosmetic rehabilitation or symptomatic relief of pain remains the mainstay in the management. The authors present a comprehensive review of the etiopathogenesis, pathology, clinical features, and management of the end-stage ocular disease.

Optical coherence tomography angiography features of choroidal hemangioma

This is an observational case series of four cases of choroidal hemangioma. All cases underwent OCT angiography with swept source OCTA (Topcon DRI OCT Triton plus) 6 mm * 6 mm protocol. OCTA at the level of large choroidal vessels demonstrated peculiar vascular pattern in all four eyes. Patterns observed were bag of worms, spaghetti like and vessels with terminal bulbs. In eye with diffuse choroidal hemangioma comparison of choroidal vascular pattern with the contralateral eyes showed significant difference in the vascular architecture. OCTA is an excellent non invasive tool in assessing the choroidal vascular pattern in eyes with choroidal hemangioma.

Comparison of optical coherence tomography angiography and fundus fluorescein angiography features of retinal capillary hemangioblastoma

The aim of this study is to compare the optical coherence tomography angiography (OCTA) and fundus fluorescein angiography (FFA) features of retinal capillary hemangioblastoma (RCH). This is an observational case series of three patients with von Hippel–Lindau (VHL) disease and one patient with juxtapapillary RCH. All patients underwent FFA with a mydriatic fundus camera and OCTA with swept-source angio OCT. The FFA and OCTA characteristics of tumors were compared. In our series, FFA could identify tumors as small as the width of a third-order retinal artery, which was missed on clinical examination. OCTA identified these tiny tumors, but only those closer to the posterior pole. Both FFA and OCTA could identify the intrinsic vasculature and feeder vessel in juxtapapillary RCH. On OCTA, the tumors were better defined than in FFA. The depth of the lesion can be identified on OCTA. Feeder and the draining vessels could be identified precisely in OCTA than FFA, particularly in small tumors. OCTA can identify tumors in VHL missed on clinical examination. It can identify the feeder vessel and intrinsic vasculature of sessile juxtapapillary RCH and aids in its diagnosis. Tumors are better defined in OCTA than FFA due to the absence of leakage. However, FFA can identify nearly all the early tumors, but OCTA fails to image the peripheral tumors due to its smaller field and prolonged acquisition time. Technological advances and the development of wide-field OCTA in the future can be helpful in identifying all the unsuspected tumors in VHL disease.

Silicone Oil in Optic Chiasm: Case Report and Review of the Literature

Purpose: To report a case of silicone oil migration into optic chiasm with resultant visual field defect in the fellow eye. We also summarize the risk factors and pathogenic mechanisms responsible for the silicone oil migration and the subsequent neurological effects associated with it. Methods: A 36-year-old gentleman presented with a history of vitrectomy with silicone oil tamponade in the left eye with sudden-onset temporal field defect in the right eye. Silicone oil was identified in left optic nerve and left half of optic chiasm. Intrachiasmatic and intraneural silicone oil was removed by left pterional craniotomy. Result: Prompt visual field recovery in the right eye after the neurosurgical intervention was noted. Conclusion: Intracranial migration of silicone oil is rare, with only a handful of cases reported in the literature. Intrachiasmal and intraneural silicone oil is associated with loss of nerve fibers and resultant vision and visual field loss. Prompt neurosurgical intervention results in the improvement of visual field defects. So early identification and neurosurgical intervention is warranted. Vitreoretinal surgeons should be aware of transneural migration of silicone oil, and a high degree of suspicion is warranted when patient develops visual symptoms in the fellow eye, particularly in cases with glaucomatous optic neuropathy and secondary elevated intraocular pressure or in any disc malformation.

Evaluation of fundus autofluorescence patterns in age-related macular degeneration

AIM To study the various morphological patterns of fundus autofluorescence (FAF) images in patients with age-related macular degeneration (AMD) in Indian population. METHODS Totally 179 eyes of 104 patients with clinical diagnosis of AMD were recruited into the study. Autofluorescence images were captured using confocal scanning laser ophthalmoscope and the patterns of FAF were classified. RESULTS Of 179 eyes, 27 (15.08%) were early AMD, 58 (32.41%) were intermediate AMD, 94 eyes (52.51%) were late AMD. Of 94 eyes with late AMD, 79 (84.04%) were neovascular AMD and 15 (15.96%) were central geographic atrophy. In eyes with early and intermediate AMD, 9 patterns of FAF were noted. Six patterns (normal, minimal change, focal increased, patchy increased, linear, reticular) were similar to that in the published classification. Two patterns (lacelike and speckled) described in the published classification were not found. Three new patterns (focal hypo-fluorescence, patchy hypo-fluorescence, mixed focal hypo-fluorescence and hyper-fluorescence) were detected. In eyes with neovascular AMD, 6 morphological patterns of FAF were noted. Two patterns (mixed hypo-fluorescence and hyper-fluorescence, central hypo-fluorescence with hyper-fluorescent rim) were similar to that in published classification. Two patterns (normal, near normal or normal background fluorescence in the centre of hypo-fluorescent area) described in the published classification were not found. Four new patterns (minimal change, hypo-fluorescent patch, central hypo-fluorescence with surrounding reticular, bulls eye) were recognized. In eye with central geographic atrophy 5 morphological patterns were noted and these were similar to that in published classification. CONCLUSION Phenotypic differences in the pattern of FAF exist in the study population compared to existing classification systems.

An unusual case of congenital hypertrophy of retinal pigment epithelium with overlying hemorrhages

A 24-year-old asymptomatic female was referred to the vitreoretina services in view of the presence of a pigmented lesion in the right eye. Fundus examination showed the presence of a solitary, hyperpigmented flat lesion with scalloped margins in the inferotemporal quadrant suggestive of congenital hypertrophy of retinal pigment epithelium (CHRPE). Scattered retinal hemorrhages were evident over the lesion [Fig. 1]. Fundus fluorescein angiography (FFA) showed blocked fluorescence due to pigment epithelial hypertrophy. A small retinal vein within the lesion showed segmented filling suggestive of sluggish flow. Areas of capillary dropout with leakage from smaller venules adjacent to the vein described above were seen [Fig. 2]. Spectral domain optical coherence tomography (SD-OCT) of the lesion showed thickened hyper-reflective retinal pigment epithelium (RPE) with shadowing, attenuation of the overlying retinal layers, abruptly terminating outer layers at the edge of the lesion and irregular focal hyper-reflective areas in the inner retinal layers corresponding to intraretinal hemorrhages [Fig. 3]. The above features suggested CHRPE with small vein occlusion.

Prophylactic laser photocoagulation of fundal coloboma: does it really help?

abrasions, concentrations of 2% or more delayed re-epithelialization, but concentrations of 1% did not (Hamill et al. 1984; Archer et al. 1990). Hypersensitivity reactions to chlorhexidine are varied, including contract dermatitis, urticarial, dyspnoea and anaphylactic shock; however, the rate of allergic reactions to chlorhexidine has not been well established. Patch testing using chlorhexidine in one study revealed a positive rate of 2%, (Abdallah 2015) while in another study 0.47% of patients with contact allergy were sensitive to chlorhexidine (Nagendran et al. 2009). We did not have any episodes of allergic reaction to 0.1% chlorhexidine gluconate in our cohort. We have found chlorhexidine gluconate (0.1%) is safe and efficacious antisepsis prophylaxis for IVI, particularly for those patients with betadine sensitivity in whom the significance of postprocedure pain should not be underestimated. We have also successfully used chlorhexidine gluconate 0.1% for cataract surgery antisepsis.