Sympathetic ophthalmia presenting with signs of frosted branch angiitis: Report of a case

Sympathetic ophthalmia is an ocular inflammatory disease commonly associated with penetrating trauma. We report a case of sympathetic ophthalmia who had Dalen-Fuchs nodules on presentation and developed a frosted branch angiitis (FBA)-like picture which is not a known feature of this disease. A 25-year-old male patient was seen 8 months following penetrating trauma to the left eye. He was treated with oral steroids and immunosuppressives. Fundus fluorescein angiography confirmed the presence of perivascular retinitis; optical coherence tomography showed retinal thickening and ultrasonography showed peripapillary choroidal thickening. Atypical features such as FBA in cases of sympathetic ophthalmia can be present and can indicate an ongoing active inflammation. Early aggressive management is required to prevent visual morbidity

Update on clinical characteristics and management of uveitic macular edema

Cystoid macular edema is a complication of uveitis which can lead to severe visual impairment if left untreated. Uveitic macular edema occurs when the balance between the water entering the eye and pumped out of the eye is altered thus losing equilibrium in the physiologic function of the retina. Edema has a negative impact on visual recovery in patients with uveitis and may continue to exist despite control of uveitis. This delayed resolution of edema observed clinically and by imaging is most frequent following intermediate uveitis, birdshot retinochoroidopathy, sarcoid uveitis, panuveitis, and iridocyclitis associated with human leukocyte antigen B27. Literature about management of uveitic macular edema is limited, and no consensus has been reached with regard to management protocol. Several treatment options exist including corticosteroids, nonsteroidal anti-inflammatory drugs, immunomodulatory agents, implants, and surgery. These therapies can be administered through various routes such as oral, topical, periocular, or intravitreal injections. A response to treatment is seen as decrease in macular thickness and improvement in visual acuity

The relationship between blood sugar levels (glycosylated haemoglobin) and the risk of development of diabetic retinopathy

Introduction: Diabetic retinopathy is a major cause of visual impairment and blindness in India and with its early detection and timely treatment, the risk of visual loss can be reduced significantly. Onset and progression of retinopathy is determined by fasting and postprandial blood sugar levels and other risk factors such as duration of diabetes, hypertension, nephropathy, hypercholesterolemia and obesity. This study was done to evaluate the role of glycosylated hemoglobin and its association with the severity of retinopathy. Materials and Methods: A total of 100 patients were included. This was a prospective study conducted over 1 year in Sri Ramachandra University, Chennai, India. Fundus examination was done using slit lamp biomicroscopy and indirect ophthalmoscopy on all patients. Ancillary investigations such as fundus fluorescein angiography and optical coherence tomography were performed. HbA1c was measured along with fasting, postprandial, lipid profile and urine sugars. Results: High and uncontrolled levels of HbA1c were associated with maculopathy. A statistically significant difference (p < 0.01) was found in them. The retinopathy however was not related to HbA1C alone. The most frequent type of maculopathy noted was cystoid macular oedema and the level above which it occurred was 7% of HbA1C. Besides HbA1C, the other important factor that was associated with maculopathy was duration of diabetes mellitus. Conclusion: HbA1c value >7.0% was significantly related with maculopathy. The severity of retinopathy is dependent on the level of blood sugar and duration of diabetes. Control of sugar levels is crucial to prevent diabetic retinopathy and its complications which can lead to irreversible complications in the eye

Biopsy Pathology in Uveitis

Uveitis is fraught with speculations and suppositions with regard to its etiology, progress and prognosis. In several clinical scenarios what may be perceived as due to a systemic infection may actually not be so and the underlying etiology may be an autoimmune process. Investigations in uveitis are sometimes the key in identification and management. Invasive techniques could be of immense value in narrowing down the etiology and help in identifying the cause. This article updates one on the invasive techniques used in biopsy such as anterior chamber paracentesis, vitreous tap and diagnostic vitrectomy, iris and ciliary body biopsy, choroidal and retinochoroidal biopsy and fine needle aspiration biopsy (FNAB). In populations where certain infections are endemic, the clinical scenario does not always respect a known presentation and the use of biopsy is resorted to as a sure way of confirming the etiology. Biopsies have a role in diagnosis of several inflammatory and infectious conditions in the eye and are pivotal in diagnosis in several dilemmas such as intraocular tumors and in inflammations. Appropriate and timely use of biopsy in uveitis could enhance the diagnosis and provide insight into the etiology, thus enabling precise management

An analysis of ocular features and vision loss at presentation and after treatment in systemic lupus erythematosus in 60 patients

Introduction: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, multisystem autoimmune disease and ocular involvement occurs in several forms. It may be the first indicator of underlying SLE. Early identification and precise treatment of the disease can reduce blindness. The objective of this study was to analyze the causes of visual loss before and during treatment. Methods: This is a retrospective cohort study on 60 patients over 2 years in multispecialty, tertiary eye care hospital. Ophthalmic examination and routine and ancillary investigations were performed. Patients were followed up for at least one year to assess the progress of ocular features, their response to treatment and development of complications. Case records from a referral practice in patients with systemic lupus erythematosus, with diagnosis of dry eye, peripheral ulcerative keratitis, episcleritis, scleritis, uveitis, retinitis or optic neuropathy were analyzed. Results: In our study, the incidence of episcleritis was most frequent followed by dry eye, retinopathy and keratitis. Age group affected was 34 to 52 years and more in women. Scleritis was associated with decreased vision and maximum complications. Following treatment, cataract was the commonest cause of blindness. Conclusion: Our study showed the presence of simultaneous, multiple ocular complications which make treatment and follow up very crucial to avoid blindness. Ocular signs that occurs in SLE can be vision threatening and requires immediate assessment and management by an ophthalmologist. Drugs used to treat SLE may also cause blindness and coordinated treatment between rheumatologist, physician and ophthalmologist needs to be adopted

Postoperative fungal endophthalmitis due to Basidiobolus ranarum: Report of a rare case

Postoperative fungal endophthalmitis is a significant cause of visual loss due to the rapid progress and severe inflammation. Management is dictated by the precise identification of fungus subspecies, choice of antifungal agent, and associated systemic features. We report a rare case caused by Basidiobolusranarum, never known to have caused endophthalmitis or any form of ocular infection or inflammation. A 59-year-old, Asian, immunocompetent, agriculturist presented with endophthalmitis on the 3 rd postoperative day. Smear and culture from the aqueous and vitreous samples detected a species of fungus called Basidiobolusranarum. Fungal endophthalmitis should be suspected even in patients who present in the early postoperative period and rare species considered even in immunocompetent individuals. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections

Clinical features, visual outcome and association with systemic disease in patients with episleritis and scleritis. A study of 50 eyes

Introduction: Episcleritis and scleritis are inflammatory disorders which can have an acute presentation and are frequently encountered by primary care practitioners.Episcleritis is a benign, self-limited disease that resolves within 2 to 3 weeks. Scleritis is painful, causing visual loss due to uveitis, glaucoma, cataract, and retinal detachment. Both are associated with underlying systemic diseases.We aim to report clinical features, visual outcome and association with systemic disease in patients with visual symptoms. Methods: This is a prospective cohort study conducted on 50 patients over 1 year in a tertiary eye care hospital Complete ophthalmic evaluation was performed. Patients were followed up for one year to look for response to treatment and development of complications. Results: In our study, the incidence of episcleritis was more frequent than scleritis. The age group affected was 34 to 52 years and more in women. Most of our patients with episcleritis showed resolution within 3 weeks. Scleritis was associated with decreased vision and more complications. In both forms of inflammation rheumatoid arthritis, systemic lupus erythematosus and psoriasis were the most common etiology. Conclusion: In rheumatoid arthritis, systemic lupus erythematosus and psoriasis patients, episcleritis and scleritis can be the initial clinical presentation. Clinical features are more severe in scleritis and can be diagnosedwith B scan ultrasound. Visual loss in both can be prevented by early treatment. We found the association with rheumatoid arthritis and SLEto be high in our population. Infections were not as common as autoimmune diseases in the population studied

Uveitis in sporadic Blau syndrome: Long-term follow-up of a refractory case treated successfully with adalimumab

The classic entity of autosomal dominant Blau syndrome (BS) consists of arthritis, dermatitis, and uveitis, occurring as a result of mutations in the NOD2 gene pattern recognition receptor. Sporadic cases are those in which no known gene mutation is identifiable. Uveitis in BS can be refractory to conventional therapy. We report a case of sporadic Blau uveitis managed with adalimumab monotherapy after failing to respond to topical steroids, systemic steroids, methotrexate, and infliximab therapy sequentially. Uveitis resolved completely with adalimumab and the patient has had a disease-free period over a 2-year follow-up with bi-monthly injections for arthritis control

Visual morbidity and spectrum of ophthalmic changes in pregnancy induced hypertension

Aim: To determine the prevalence of ocular changes in pregnancy-induced hypertension (PIH) and co-relate the ophthalmic changes and severity of the disease with visual outcome. Methods and Material: This is a retrospective study conducted from a hospital-based cohort of pregnant women, who delivered from June 2018 to December 2020. A total of 153 patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward were included in this study. History with regard to age, parity, gravida, gestational age, medical history, and ocular findings were noted from the patient's case records. Anterior segment examination, dilated fundus evaluation, blood pressure (BP) recordings, urine proteinuria were done. All data were analyzed using the satistical package for social science (SPSS) program. Results: Out of 153 patients, 78 (50.98%) were primigravida, 55 (35.95%) were gravida 2, and 20 (13.07%) were multigravida. Gestational age ranged from 23–40 weeks. Ocular changes were seen in 57% of the PIH patients. Hypertensive retinopathy was seen in 23.53% of PIH patients with a mean age of 29.06 ± 4.36 years. Grade 1 hypertensive retinopathy was the most common manifestation in PIH patients (51.16%). The visual loss occurred in 72% of eclampsia and12% of pre-eclampsia which was statistically significant (P = 0.03). Papilledema was seen in 6% and refractive error in 41% of the patients. Conclusions: Ocular examination of PIH patients reveals important objective information concerning the disorder. The presence of retinal change is a marker of the severity of PIH and is the most common ocular feature. Detection of progression of these changes reflects ischemic changes of the placenta. Fundus examination in PIH patients is important to predict adverse fetal outcomes, and risks to mother's life