Vr Saravanan

Screening for retinopathy of prematurity-a comparison between binocular indirect ophthalmoscopy and RetCam 120

AIM To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard. SETTING AND DESIGN Prospective, comparative study. MATERIALS AND METHODS A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method. RESULTS ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively. CONCLUSION Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.

Fulminate retinopathy of prematurity - clinical characteristics and laser outcome.

PURPOSE To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP. METHODS Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiros classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP. RESULTS Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease. CONCLUSION Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.

Worm in the eye: the rationale for treatment of DUSN in south India.

Aim: To discuss the rationale for different techniques of treatment for DUSN (diffuse unilateral subacute neuroretinitis) and their effectiveness in two patients from south India. Methods: Two rare cases of live worms in DUSN from India are reported, where filarial Brugia malayi is endemic. Both cases presented with progressive unilateral loss of vision with no history of animal contact. They were 40 year old, apparently healthy men. In case 1, the worm (1500–2000 μm) was easy to identify with wriggling movements among crisscrossing diffuse subretinal tracks. The worm was destroyed by a single shot of laser to its advancing end, which was followed by oral steroid to control the inflammation caused by the dead worm. In case 2, the worm was small and difficult to identify. Initially diffuse neuroretinitis was diagnosed and treated with intravenous methylprednisolone and oral corticosteroid. A week later, a small live worm (400–600 µm) was found and subsequently destroyed by laser photocoagulation followed by a combination of anthelminthics. Results: The patients’ vision had improved to 6/60–6/36 from counting fingers after a few weeks. Conclusion: The role of a combination of laser treatment, systemic steroid, and anthelminthics is discussed.

In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems

Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.

Intracameral injection of bevacizumab (Avastin) to treat anterior chamber neovascular membrane in a painful blind eye

Intracameral injection of bevacizumab (Avastin) helped in the successful regression of an anterior chamber neovascular membrane in a painful blind eye. The effect was persistent even after six months of follow-up. This is the first report on intracameral administration of bevacizumab with six months of follow-up.

Purtscher-like retinopathy: A rare complication of peribulbar anesthesia

Purtscher and Purtscher-like retinopathy is a distinctive retinal syndrome characterized by ischemic retinal whitening in a peripapillary pattern. We report a case of Purtscher-like retinopathy in a healthy 64-year-old man after a routine peribulbar anesthetic injection for cataract surgery. Although peribulbar anesthesia is considered to be a safer alternative to retrobulbar anesthesia, it has been associated with unusual but grave complications including central retinal artery occlusion.

Low Fluence Photodynamic Therapy Versus Graded Subthreshold Transpupillary Thermotherapy for Chronic Central Serous Chorioretinopathy: Results From a Prospective Study

BACKGROUND AND OBJECTIVE The authors compare low fluence photodynamic therapy (PDT) against graded subthreshold transpupillary thermotherapy (TTT) for chronic central serous chorioretinopathy (CSC). PATIENTS AND METHODS Forty-two eyes of 42 patients with chronic CSC were included in this prospective, nonrandomized, interventional trial. All patients were offered PDT as an initial intervention. If they declined PDT, TTT was offered. RESULTS Twenty patients underwent PDT and 22 underwent TTT. The difference in best-corrected visual acuity between the TTT and PDT groups at baseline and at 6 months after treatment was not significant (P = .728). The mean foveal thickness decreased significantly in both groups (P = .001). However, patients in the TTT group required more treatments (P = .013) and longer time for resolution of the CSC (P = .013). CONCLUSIONS Both PDT and TTT may be equally effective in the treatment of chronic CSC. Graded subthreshold TTT may be a cost-effective and safe alternative for PDT. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:334-338.].

Progressive keratoconus, retinal detachment, and intracorneal silicone oil with obsessive-compulsive eye rubbing

An 18-year-old boy with an obsessive-compulsive disorder of eye rubbing presented with forme fruste keratoconus (KC) and posterior subcapsular cataracts. After evaluation, he underwent phacoemulsification in his left eye with intraocular lens implantation. The aggressive eye rubbing, however, aggravated the rapid progression to established KC, and further acute corneal hydrops within 3 months. Within the next 3 months, the eye rubbing precipitated rhegmatogenous retinal detachments (RDs) in both eyes. Furthermore, after undergoing a combined cataract and RD surgery with belt buckling and silicone oil endotamponade in his right eye, the repeated eye rubbing caused extrusion of the implanted silicone oil into the subconjunctival space and within the corneal stroma. This is the first report to our knowledge describing this unique complication associated with eye rubbing. It also highlights the need for increased vigilance and care that needs to be directed toward patients predisposed to such complications.

Exophiala dermatitidis Endophthalmitis: Case Report and Literature Review

We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species. Beside the case description, we also aim to provide a literature review of previously reported eye infections caused by Exophiala species in order to help the future diagnosis and management of the disease.

Iatrogenic subretinal injection of Ozurdex® implant and its effect on macular edema

PURPOSE: The purpose of this study was to report a rare case of subretinal lodgement of Ozurdex® implant (Allergan Inc., Irvine, CA, USA) and its effect on macular edema in a case of central retinal vein occlusion (RVO). METHODS: A rare complication of subretinal lodgement of Ozurdex® implant without retinal perforation was encountered in a case of RVO with intractable macular edema. As associated retinal perforation was not noted, no intervention was done. The patient was regularly followed up at 1 month, and the effect on macular edema and intraocular pressure was analyzed. RESULTS: The corticosteroid pellets got disintegrated and totally absorbed with a subtle chorioretinal scar by the 3rd follow-up month without any intervention. Even though subretinal, it was capable of reducing macular edema by 181 microns at 1 month postinjection, and its effect started wearing off by 2 months. DISCUSSION: Subretinal lodgement of Ozurdex® implant is rare and preventable, yet a potential complication of intravitreal implants which is now in vogue. We speculate a too acute angle of injection or incomplete insertion of the drug delivery system applicator (DDS) away from the limbus or perhaps less refined previous DDS applicator to be a cause for subretinal delivery of the implant. The early disintegration of implant occurred due to breach in structural integrity that caused loss of controlled drug release and rapid absorption. It reduced macular edema up to 2 months without elevating intraocular pressure. CONCLUSION: A more widespread application of any technology always portends a more significant risk for complications, and an ophthalmologist should be aware of this potential risk. Though subretinal, corticosteroid implant was capable of reducing macular edema by 181 microns by 1 month and its effect wore off by 2 months.