Ocular occlusions in two cases of COVID-19

In late 2019, we saw the emergence of a new coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS?CoV?2), which rapidly evolved into a global pandemic. We report two cases of ocular vascular occlusion related to coronavirus disease 2019 (COVID?19) disease. The first case is of choroidal artery occlusion, while the second case is of combined central retinal artery and vein occlusion (CRAO and CRVO). We performed a thorough literature search and to the best of our knowledge, neither any of the above said has been reported in COVID?19–positive patients.

Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow?up. The post?T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre?existing glaucoma and lost to follow?up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post?injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post?T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post?IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field

Central retinal vein occlusion post-COVID-19 vaccination

Coronavirus disease 2019 (COVID?19) is known to cause thromboembolic episodes apart from acute respiratory distress syndrome (ARDS). With large vaccine drives all across the world, there are a few case reports on post?vaccine thrombotic events seen with the AZD1222, ChAdO × 1 vaccine. Here, we present two cases of central retinal vein occlusion presenting immediately after receiving the second dose of the Covishield vaccine. Although the causal relationship cannot be drawn, the ophthalmologist should be aware of this adverse reaction

Baseline Characteristics and Risk Factors for Retinal Vein Occlusions

Introduction: Venous obstructive disease of the retina iscausing significant visual morbidity affecting quality of lifeof patient. Incidence of CRVO is 0.8 per 1000 persons and 4.4per 1000 persons for BRVO. RVO most commonly affects thevenous blood supply of entire retina [CRVO] or a quadrantdrained by one of the branches [BRVO] less commonlysuperior or inferior half of retina alone is affected [HRVO].Study Aimed to study demographic characteristics and riskfactors of Retinal Vein Occlusions (Both CRVO and BRVO)Material and methods: This is a cross sectional observationstudy. It included 208 patients [64 CRVO patients and 144BRVO patients]at Retina department, Sarojini Devi EyeHospital, Hyderabad. Study was conducted for 1 year and 7months.Results: Hypertension stands alone as the most significantrisk factor (P Value is 0.005). Other factors studied likeUrban Background, Lack of physical Activity, Diabetes,Hyperlipidemias, CVA, CAD etc. though were present in goodnumbers in the cases studied but they were not statisticallysignificant.Conclusion: Hypertension, Diabetes and Raised SerumLipids are significant risk factors for Retinal Vein Occlusionsin South Indian population

Role of anti vascular endothelial growth factor (VEGF) in ophthalmology.

Vascular endothelial growth factor (VEGF), is a naturally occurring signal protein which is proinflammatory, stimulates angiogenesis and potent inducer of vascular permeability. Its role in normal physiology includes in embryonic development, wound healing and bone repair, neovascularization following MI and demonstrated in brain, kidney and GI mucosa. VEGF is responsible for many retinal diseases by causing new vessel growth and by increasing leakage and causing retinal swelling. Their use in ophthalmology includes in both anterior and posterior segment pathologies. This article explains the role of VEGFs, their mechanism of action, anti VEGFs, classification, their use, various studies and other aspects.

Devastating ocular injury by a rice black bug: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 59-year-old female farmer presented with left painful swollen eye for 1 week after being stung by a rice black bug ( Scotinophara sp. ). It was associated with acute progressive blurring of vision. On examination of the left eye, there was a marked periorbital swelling with proptosis and complete ptosis. The extraocular movements were restricted in all the directions. The cornea was hazy with large epithelial defect. Fundoscopy showed combined features of both central retinal vein and artery occlusions with swollen optic disc and ischaemia of the macular area. CT scan and MRI of orbit and brain showed evidence of orbital soft tissue inflammation. Patient was diagnosed with left orbital cellulitis, keratouveitis and central retinal vein and artery occlusions. The periorbital swelling and proptosis were improved after treatment with systemic and topical antibiotics. However, the vision remained no perception of light(NPL)and limitation of ocular movements persisted. The potential ophthalmic insults by Scotinophara sp. Can be severe and permanent. Awareness of the debilitating insults by Scotinophara sp. To human eye should be instilled timely especially in its prone areas.

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Unusual retinal manifestations of PORN combined complications of central retinal artery and vein occlusions / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To describe an unusual combination of retinal manifestations in an AIDS patient with progressive outer retinal necrosis (PORN),complicated by combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).·METHODS:A case report.·RESULTS:The patient presented with PORN with primary optic nerve involvement complicated by combined central retinal artery occlusion(CRAO) and central retinal vein occlusion(CRVO) as a primary manifestation of Varicella Zoster Virus (VZV).Aggressive treatment with intravitreal and specific systemic anti-VZV therapy,in addition to systemic highly active antiretroviral therapy (HAART) achieved retinal quiescence with sparing of the fellow eye.Visual outcome of the affected eye was poor.·CONCLUSION:We present the first report of PORN associated with the unusual combined complications of CRAO and CRVO. Aggressive local treatment was combined with systemic therapy,which achieved local control and empirical prophylaxis for the fellow eye.

Characteristics of Acute Hemorrhagic Central Retinal Vein Occlusion

PURPOSE: To investigate the characteristics of patients with acute hemorrhagic central retinal vein occlusion. METHODS: We reviewed the medical records of 124 eyes of 122 patients who were diagnosed to have central retinal vein occlusion within one month after onset and followed for six months or longer. Eyes were divided into three groups - ischemic, hemorrhagic and nonischemic - and the visual prognosis and complications were compared among the three groups. RESULTS: The hemorrhagic group had a tendency to be a male and younger than the other groups. The mean initial and final visual acuity of the hemorrhagic group was logMAR 1.23 and 1.54, respectively, and showed significant decrease rate of visual acuity compared to that of ischemic group (p=0.022), logMAR 1.31 and 1.35, respectively. Iris neovascularization (INV) / angle neovascularization (ANV) occurred in 6 eyes (7.4%) of the ischemic group and in 3 eyes (12.5%) of the hemorrhagic group. The mean period form the initial examination to INV/ANV occurrence was 4.67 and 2.33 months, respectively. All eyes of the hemorrhagic group and 4 eyes (66.7%) of the ischemic group with INV/ANV progressed to neovascular glaucoma. CONCLUSIONS: The hemorrhagic group had a worse final visual acuity, a greater decreasing rate of visual acuity, and earlier occurrence of INV/ANV than ischemic group. Close follow-up and proper management are warranted in patients with acute hemorrhagic central retinal vein occlusion.

A Case of Central Retinal Vein Occulsion Successfully Treated with Unsei-in and Gorei-san / 日本東洋医学雑誌

The prognosis of central retinal vein occlusion (CRVO) is generally poor. I report a case of a 67-year-old man with CRVO who underwent Kampo therapy. He ultimately continued to use Unsei-in for one year and 10 months, and he also continued to use Gorei-san for 9 months with no severe side effects. His visual acuity, which was LV: 0.02 (n. c.) before this therapy, has improved to LV: 0.2(0.3×S+0.75D_??_C-1.0DA×110°). Ocular neovascularization did not occur. These results suggest Kampo therapy is effective on CRVO.

Conversion of Nonischemic Central Retinal Vein Occlusion to Ischemic Occlusion

Most nonischemic CRVOs present relatively good prognosis in visual acuity and spontaneous resolution is relatively common after a certain period of time, but a small portion convert to ischemic CRVOs. The point of conversion from nonischemia to ischemia ranges from few weeks to several years. But because more than half of these conversions occur within the first four months, it requires careful follow-up during this period. The authors retrospectively reviewed 44 patients(47 eyes)who initially showed definite signs of nonischemic CRVO on fundus examination and nonperfusion area less than 10 disc areas proven by fluorescein angiogra-phy. The conversion rate, point of conversion, incidence of anterior segment neovascularization and neovascular glaucoma, predictive factors related to conversion were identified. The average age of the patients was 46. 1 years and 26 patients(59. 0%) were male. 25 patients(56. 8%)had underlying systemic and ocular disorders such as hypertension, chronic renal failure, diabetes mellitus, primary open-angle glaucoma. Final visual acuity was 0.5 or above in 24 eyes(51. 0%)and 0.1 or below in 14 eyes(29. 8%). 7 eyes(14. 9%)converted to ischemic occlusion. The average age of this group of patients was 40.8 years and 4 eyes had underlying systemic disorders. Initial visual acuity showed wide range from 0.15 to 0.7 but final visual acuity was 0.1 or below in all of the cases. The point of the conversion was less than 4 months(average: 9.3 weeks)in all eyes and 5 eyes(71.4%)developed anterior segment neovascularization. All of the eyes that showed definite evidence of anterior segment neovascularization were treated with panretinal photocoagulation but in 2 eyes(28. 6%), regression of neovascularization did not occur and further developed neovascular glaucoma.

Central Retinal Vein Occlusion During Embolization for Carotid Cavernous Sinus Fistula

Most trauma induced fistulas are direct communications between the intracavernous carotid artery and the cavernous sinus. Theses abnormal communications are characterized by high pressure, high blood flow and a clinically obvious constellation of symptoms and signs. We here in report a patient with traumatic carotid cavernous sinus fistula(CCSF). who developed central retinal vein occlusion(CRVO) during detachable balloon embolization. The mechanism of CRVO occurring during detachable balloon embolization. The mechanism of CRVO occurring during detachable ballon embolization for CCSF was discussed. We report this case with the review of previous reports.

Comparison of Risk Factors Associated with Central and Branch Retinal Vein Obstruction

Central retinal vein occlusion(CRVO) and branch retinal vein occlusion(BRVO) are the most common retinal vascular diseases. Althouht the pathogenesis of these two dieseases are different, the clinical features are similiar. In this paper, we studied on several factors such as sex, age, laterality, refractive error, intraocular pressure(IOP) and, systemic diseases(56 eyes of CRVO group and 128 eyes of BRVO group). In BRVO hroup, female, above 50 years old, bilaterality and hyperopia(above +3.0D) are more frequent than in CRVO group. In CRVO group, high IOP and below 40 years old are more frequent than in BRVO group. The hing incidence of female in BRVO group(P=0.034) and the high incidence of high IOP in CRVO group(P=0.011) are statistically significant. Diabetes melitus, glucose intolerance, tuberculosis, and syphilis are more frequently associated in CRVO group than in BRVO group, whereas hypertension and heart disease are more frequently associated in BRVO group. An abnormal level in CRP, VDRL and PTT are higher in CRVO group than in BRVO. On the other hand, the incidences of abnormal lipid profile, Hb A2 fraction and RA are higher in BRVO group than in CRVO. In cases of CRVO, the incidence of hypertension is higher in patients of 50 years old or older than in patients do 49 years old or younger, In cases of BRVO, the incidence of heart disease in patients of 50 years old or older is higher than in patients of 49 years old or younger, which both diseases are statistically significant(P<0.05).

Visual Outcome of Central Retinal Vein Occlusion

This study was performed to investigate the visual prognosis in ischemic and nonischemic central retinal vein occlusion(CRVO), to investigate the difference in clinical course of two types, and to identify prognostic factors for poor visual outcome. Fifty seven patients with CRVO were included. Eyes were classified into ischemic or nonischemic type by indirect ophthalmoscopy and fluorescein angiography. Among 58 eyes, 27 eyes(46.6%) were of the nonischemic CRVO and 31 eyes(53.4%) of the ischemic CRVO. Nonischemic CRVO was more common in patients under 45 years and had more benign clinical course than ischemic CRVO. Factors significantly related to visual outcome were initial visual acuity in ischemic CRVO(P<0.01) and the presence of systemic disease in nonischemic CRVO(P<0.01). Hypertension and diabetes were the most commonly associated systemic diseases. The leading causative factors for poor visual outcome were chronic macular edema and neovascular glaucoma in ishemic CRVO, and chronic macular edema in nonischemic CRVO.

ERG b/a ratio and retinal circulation time of CRVO

Fourteen cases of central retinal vein occlusion (CRVO) were studied with electroretinogram (ERG) and fluorescein angiogram. The cases were divided into a venous stasis retinopathy group (VSR,9 cases) and a hemorrhagic retinopathy group(HR, 5 cases). The b/a ratio and retinal circualtion time (RCT) were measured and compared with the control group. The mean b/a ratio of the HR group (0.86) was decreased as compared with the VSR group (1.18) and the control group (1.23). The RCT of the HR group was markedly delayed to 13.68 seconds as compared with the VSR group (11.09 sec) and the control group (6.4 sec). These facts suggest that both the b/a ratio and the RCT are possible parameters for estimating retinal ischemia and that the ERG is a reliable examination method for classification of CRVO.