Choroidal neovascular membrane in a treated choroidal hemangioma.

Association of choroidal neovascular (CNV) membrane with circumscribed choroidal hemangioma is rare, and the CNV development after photodynamic therapy (PDT) is also rare. Etiopathogenesis of these associations is poorly understood. We noted the development of CNV over choroidal hemangioma after PDT therapy in a young female patient in our hospital. Temporal association of CNV development after PDT treatment points toward the possible side effects of PDT. Repeat injections of antivascular endothelial growth factor (ranibizumab) regressed the CNV resulting in a favorable visual outcome.

Sympathetic ophthalmitis following vitreoretinal surgery: Does antecedent trauma make a difference.

Background: Sympathetic ophthalmitis (SO) has been reported following vitrectomy; however, there is a lack of data on the role of antecedent penetrating ocular trauma impacting the disease manifestation in eyes developing SO following vitrectomy. Aim: To report differences in the presentation and outcomes of SO in eyes with or without a history of antecedent penetrating trauma; SO being diagnosed after vitreoretinal (VR) surgery. Design: Comparative case series. Methods: Seventeen consecutive patients presenting with SO following VR surgery, diagnosed between 1995 and 2011 were included. Eyes with and without prior penetrating injury were included in Group I (n = 7) and Group II (n = 10), respectively. All Group I patients had received systemic steroids prior to presentation. Demographic and clinical parameters were evaluated. Results: Differences were observed between Group I and Group II mainly with regards to time interval between VR surgery and diagnosis of SO (1.5 months vs. 8 months, P = 0.10), presence of neurosensory detachments (100% vs. 30%, P = 0.01), and the inciting eye vision at presentation (nil light perception in 28.5% vs. 80%, P = 0.049). Other differences observed though not statistically significant were optic disc and retinal vessel involvement (42% vs. 70%, P = 0.28), Dalen‑Fuchs nodules (localized vs. diffuse) and leaks on fundus fluorescein angiography (pin‑head vs. pin‑point leak). Conclusion: SO in patients with antecedent penetrating ocular trauma present early with the central serous chorioretinopathy‑like picture. Prior use of systemic steroids might have a bearing on the differences in presentation and the visual acuities between the two groups.

Comparison of lea gratings with cardiff acuity cards for vision testing of preverbal children.

Aims: To create a normative data for lea grating (LG) in the Indian population and to compare LG with Cardiff Acuity Card (CAC). Settings and Design: Normative Data was acquired from normal children between 6 months-3 years coming to the ‘Immunisation Clinic’ and ‘Well-Baby Clinic’ at a Civil Hospital. To compare LG with CAC, normal and amblyopic children between 6 months-3 years were evaluated, Materials and Methods: Monocular and binocular visual acuity (VA) was measured using LG and then CAC. VA and time taken to perform the test were compared. Statistical Analysis Used: Pearson's Correlation Coefficient to compare VA and Student paired t-test (significance P<0.005) to compare time. Results: Two standard deviations of VA of 100 normal children overlapped with that published by Lea. Of the 30 amblyopic children aged 18.32 ± 10.5 months (2-36), 18 were females. VA was 0.95 ± 0.3 logMAR (0.7–1.2) and 1.0 ± 0.6 logMAR (0.5–2.1) binocularly and 1.32 ± 0.08 logMAR (0.2-0.6) and 1.15 ± 0.15 logMAR (0.88-1.48) monocularly on CAC and LG respectively. Pearson's correlation coefficient was 0.98 and 0.63 for binocular and monocular assessment respectively. Time taken to perform LG monocularly and binocularly was significantly less (P<0.001) than CAC. Conclusion: Normative data acquired in Indian pre-verbal children is similar to that published by Lea. Though VA by CAC is better than LG, the two tests are comparable.

Principal components’ analysis of multifocal electroretinogram in retinitis pigmentosa.

Aims: To determine waveforms of multifocal electroretinogram (mfERG) in patients with retinitis pigmentosa (RP) contributing significantly to the overall retinal response by using principal components’ analysis. Settings and Design: Prospective, non-randomized, single-visit, observational, case-control study from a single tertiary ophthalmic center. Materials and Methods: Patients with various forms of RP underwent mfERG testing for a period of one year. The first-order kernel responses of RP cases were compared with concurrently recruited healthy controls. Statistical Analysis Used: Parametric data was analyzed using the unpaired t test for differences between the implicit time and amplitudes of cases and controls. Principal components’ analysis was done for each implicit time and amplitude in cases with RP using the Varimax rotation method. Results: From March 2006 to March 2007, 24 cases with typical RP (56%, 47 eyes) were included in the final analysis. Their mean age was 33.7 years (19-69 ± 15.5 years). Comparison of latencies and amplitudes among RP cases with log MAR acuity ≤ 0.18 and those > 0.18, revealed significant difference in the implicit time (P1) in Ring 2 only (P=0.028). Two components (predominently from Ring 1 and 2) each contributing 66.8% and 88.8% of the total variance in the data for latencies and amplitudes respectively, were seen. Conclusions: The first two rings of the mfERG contributed to the variance of waveforms in RP, irrespective of the visual acuity and poor visual field results.

Intravitreal anti-vascular endothelial growth factor agents as an adjunct in the management of coats' disease in children.

We describe the role of intravitreal anti-vascular endothelial growth factor (VEGF) agents in Coats' disease in children. In a prospective, interventional, non-randomized case series, three patients (three eyes) aged 16, seven and two years were diagnosed to have Coats' disease. In Case 1 (16 yr/ male) with macular edema, previous laser photocoagulation being unsuccessful, intravitreal pegaptanib sodium (Macugen™) was tried. Case 2 (seven yr/ male) and Case 3 (two yr/ female) were diagnosed to have Stage 4 Coats' and underwent external needle drainage, laser photocoagulation, SF6 gas injection and intravitreal injection of bevacizumab (Avastin™). Reduction of exudation and attached posterior pole (Cases 2 and 3) was seen at a follow-up of six months and two months respectively. Intravitreal anti-VEGF agents may be successfully used as adjunct treatment in select cases of Coats' disease in childhood.