Raghav Ravani

Using intravitreal bevacizumab (Avastin®) – Indian Scenario

In recent times, with a better understanding of the pathophysiology of various retinal conditions, such as age‐related macular degeneration, diabetic macular edema, and retinal vein occlusion, it is now known that vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of these conditions. Hence, anti‐VEGF agents are often the first‐line drugs which have shown to improve visual acuity, rather than just prevent vision loss. The paradigm shift in the management of these conditions is evident by the fact that intravitreal injections have become the most common medical procedure in the United States (about twice the cataract surgery).[1]

Comparative Evaluation of Standard ILM Peel With Inverted ILM Flap Technique In Large Macular Holes: A Prospective, Randomized Study

BACKGROUND AND OBJECTIVE To compare the outcomes of inverted internal limiting membrane (ILM) flap technique (IFT) with the standard ILM peel (SIP) for large macular holes (MHs). PATIENTS AND METHODS This is a prospective, randomized study in which 100 patients with idiopathic MHs with minimum linear dimension of 600 μm or greater were recruited. Group 1 underwent SIP and group 2 underwent IFT. Best-corrected visual acuity (BCVA), type of MH closure, and multifocal electroretinogram (mfERG) were evaluated at presentation, 1 week, 1 month, and 3 months postoperatively. RESULTS Mean postoperative BCVA was 0.86 ± 0.19 in group 1 and 0.67 ± 0.3 in group 2 at 3 months postoperatively (P = .001). Type 1 closure was observed in 34.04% of patients in group 1 and in 62.79% of patients in group 2 (P = .02). mfERG showed improvement in both groups. CONCLUSION IFT provides superior outcomes compared to SIP and, hence, could be considered as the surgical modality of choice in large MH. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:236-240.].

Multimodal imaging questions etiology of idiopathic retinal vasculitis, aneurysms and neuroretinitis syndrome (IRVAN syndrome)

Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome is a rare entity of unknown etiology for which many hypotheses have been proposed with inflammation being the most commonly accepted hypothesis. We report cases of a 9 year old girl and a 22 year old male patient with diagnosis of IRVAN syndrome. The conclusions drawn from the clinical examination and multimodal imaging including optical coherence tomography angiography of the patients are discussed. Our conclusions and interpretation point towards IRVAN being a developmental vascular anomaly rather than a consequence of inflammation. It is thus proposed to be renamed as Idiopathic retinal arteriolar aneurysm syndrome (IRAA).

Splenic tuberculosis and multifocal serpiginoid choroiditis

Serpiginoid multifocal choroiditis is a distinct morphological identity with a reported causal association with Mycobacterium tuberculosis. We report a case of serpiginoid multifocal choroiditis in a 17-year-old boy who was suffering from isolated splenic tuberculosis. He was treated with systemic steroids along with anti-tubercular treatment with good visual recovery. This case was unique as no other organs except spleen and choroid showed tubercular involvement. We hereby emphasize association of extrapulmonary sites with multifocal serpiginoid choroiditis and propose a thorough investigation for primary to be included in routine protocol of choroiditis workup.

Crystalline retinopathy association with flupentixol intake

AimTo report the first case report of an association between flupentixol and crystalline retinopathy.Study designObservational, Case report.Case reportWe report a case of crystalline retinopathy in a 36-year-old female who was suffering from depression and being treated with tablet flupentixol in a cumulative dose of 4380 mg over two years. Fundus examination of both eyes showed multiple, discrete, yellowish white refractile intraretinal deposits over the macula and peripapillary region, located in the inner retina as shown by OCT.ConclusionWe propose regular retinal evaluation in patients with chronic flupentixol intake and larger studies to establish causal relationship between flupentixol and crystalline retinopathy.

Macular hole-associated retinal detachment in Best vitelliform dystrophy: Series of two cases and literature review

Two eyes of 2 patients with macular hole-associated retinal detachment in clinically diagnosed vitelliruptive stage of Best vitelliform dystrophy were surgically managed by 25-gauge sutureless pars plana vitrectomy, internal limiting membrane (ILM) peeling with inverted ILM flap, and short-acting (SF6) gas tamponade. The patients were assessed with respect to best-corrected visual acuity, color fundus photographs, shortwave fundus autofluorescence, and swept source optical coherence tomography. Surgical intervention led to Type 1 closure of macular hole, resolution of retinal detachment, and improvement in vision in both patients.

Macular telangiectasia type II with pachychoroid spectrum of macular disorders

Purpose: To report the cases with features of macular telangiectasia type II and pachychoroid spectrum of macular disorders simultaneously. Methods: It is a retrospective case series from a tertiary eye care center. Multimodal imaging features of these eyes including color fundus photographs, red free imaging, short-wave autofluorescence, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography were studied. Results: Six eyes of three patients having combination of macular telangiectasia type II and pachychoroid group of disorders were found. Three eyes showed features of central serous chorioretinopathy, one eye had polypoidal choroidal vasculopathy, one eye had pachychoroid pigment epitheliopathy and one had thickened choroid. Conclusion: This is the first report of macular telangiectasia type II in association with the pachychoroid spectrum of macular disorders and provides insight into possible common etiopathogenetic mechanisms.

Platelet Transfusion Related Panophthalmitis and Endophthalmitis in Patients with Dengue Hemorrhagic Fever

Dengue is a vector-borne viral illness of major public health importance. It is endemic in many parts of India and also causes frequent epidemics. Platelet transfusions are given in severe cases of dengue fever to treat and prevent hemorrhagic complications. Here, we report three patients in North India with development of panophthalmitis and endophthalmitis shortly after receiving platelet transfusion.

“Dye front reciprocation” in combined central retinal vein occlusion with cilioretinal artery infarction

Manuscript received: 21.07.17; Revision accepted: 11.09.17 A 26‐year‐old otherwise healthy female with no known systemic illness presented with sudden painless dimness of vision in the left eye for 1 day. Systemic examination was within normal limits with blood pressure of 126/72 mmHg. Her best‐corrected visual acuity was 20/20 in the right eye and 20/200 in the left eye. Anterior segments were normal. Left eye fundus revealed a white patch along the territory of cilioretinal arteries along with disc edema, dilated tortuous vessels, and intraretinal hemorrhages [Fig. 1a]. Swept source optical coherence tomography showed hyperreflective inner retinal layers along the distribution of cilioretinal artery. There were no cystoid changes or foveal thickening/edema [Fig. 1b]. A diagnosis of central retinal vein occlusion (CRVO) with cilioretinal artery infarction (CRI) was made. Arm to retina time was normal on fluorescein angiography. However, the filling of cilioretinal arteries (two in number) was delayed as it was seen along with the arterial phase. The arteriovenous transit time was prolonged with delayed filling of dilated tortuous retinal veins. Fundus fluorescein angiography demonstrated systolic advancement of the dye front within the cilioretinal arteries [Fig. 2a, c, d and f at 13 s, 16 s, 18 s, and 20 s, respectively] with its diastolic retraction from the arteries [Fig. 2b and e at 15 s and 19 s, respectively].[1,2] This phenomenon is known as “Dye front reciprocation”.

Successful closure of full-thickness macular hole associated with circumscribed choroidal haemangioma.

Circumscribed choroidal haemangiomas are orange-red elevated masses located posterior to the equator. Two-thirds of these are present in the macular area. These tumours can lead to various macular changes including serous macular detachment, cystoid macular oedema, epiretinal membrane, macular exudates and hemorrhages. Choroidal and retinal neovascularisation have also, rarely, been reported. We report a case of macular hole in a patient with circumscribed choroidal haemangioma which was successfully managed with pars plana vitrectomy and internal limiting membrane peeling. It is the first such report to the best of our knowledge.