Bilateral acute depigmentation of the iris determined in two cases after COVID-19 infection

Bilateral acute depigmentation of the iris (BADI) is a rare disease characterized by iris atrophy. Although it can be self-limiting, it is sometimes progressive and can lead to glaucoma and severe vision loss. Two female patients were admitted to our clinic because of a change in iris color following coronavirus disease 2019 (COVID-19) infection. After the exclusion of other etiologies in the eye examination, BADI was diagnosed in both cases. Thus, it was shown that COVID-19 may also be involved in the etiology of BADI.

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India

Purpose: To report the clinico?demographic profile of rhino?orbito?cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID?19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross?sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID?19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID?19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty?six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID?19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Advances in the treatment and prevention of acute retinal arterial ischemia / 国际眼科杂志(Guoji Yanke Zazhi)

Acute transient or permanent retinal arterial ischemia is ocular and systemic emergency requiring immediate diagnosis and treatment. Transient monocular vision loss is transient retinal arterial ischemia which leaves no permanent deficits. Central retinal arterial occlusion and branch retinal arterial occlusion lead to permanent visual function deficits in the majority of patients. Current treatment include lowering intraocular pressure, dilating blood vessels, hyperbaric oxygen therapy, intravenous or intra-arterial thrombolysis and so on, but there is still no standard treatment procedure. High risk groups should receive primary prevention measures in order to reduce the incidence of the disease. Patients with acute retinal arterial ischemia are at high risk of subsequent stroke and adverse cardiovascular events. Relevant risk factors should be identified in time, the primary disease should be treated actively, and appropriate secondary prevention measures should be taken to improve the prognosis. This review summarizes the recent treatment and prevention procedures of acute retinal arterial ischemia, to provide references for the management of these diseases.

Caracterización clínica-epidemiológica de las uveítis y su relación con la pérdida visual / Clinical-epidemiologic Characterization of Uveitis and its Relation to Visual Loss

Objetivo: Caracterizar clínica y epidemiológicamente las uveítis y su relación con la pérdida visual. Métodos: Se realizó un estudio observacional prospectivo y longitudinal de serie de casos en 137 pacientes, atendidos en la consulta de úvea del Hospital General Provincial "Carlos Manuel de Céspedes", desde febrero de 2015 hasta febrero del 2018. Se estudiaron las variables: sexo, edad, la clasificación anatómica de las uveítis, clasificación de las uveítis según lateralidad de las crisis, etiología, complicaciones oculares y pérdida visual. Se confeccionaron tablas y gráficos que expresaron los resultados en números absolutos y porcientos, además se emplearon la prueba de la ji al cuadrado de asociación y coeficiente phi de correlación. Resultados: Predominó la edad de 41 a 60 años (37,2 por ciento) y el sexo femenino (60,6 por ciento). Resultaron más frecuentes las uveítis anteriores unilaterales de causa infecciosa. La complicación más frecuente fue la catarata (25,8 por ciento). La mayoría de los pacientes presentaron pérdida visual, con predominio de la leve (36,5 por ciento). Existió asociación estadísticamente significativa entre la clasificación anatómica las de uveítis y la gravedad de la pérdida visual. Conclusiones: Los pacientes más afectados fueron las mujeres entre la cuarta y sexta década de vida. Predominaron los pacientes con uveítis anteriores unilaterales. Las infecciones fueron la causa más común, así como la catarata resultó la complicación más frecuente. La gravedad de la pérdida visual guardó relación directa con la clasificación anatómica de la uveítis(AU)

Objective: To clinically and epidemiologically characterize uveitis and its relation to vision loss. Methods: A prospective and longitudinal observational study of case series was performed in 137 patients, seen in the uvea consultation of the Carlos Manuel de Céspedes Hospital, from February 2015 to February 2018. The following variables were studied: gender, age, anatomical classification of uveitis, classification of uveitis according to laterality of the crisis, etiology, ocular complications and vision loss. Tables and graphs were prepared to express the results in absolute numbers and percentages, and the chi-squared test of association and the phi correlation coefficient were used. Results: Predominance was between 41 and 60 years of age (37.2 percent) and female sex (60.6 percent). Unilateral anterior uveitis of infectious cause was more frequent. The most frequent complication was cataract (25.8 percent). Most patients presented vision loss, with predominance of mild vision loss (36.5 percent). There was a statistically significant association between the anatomical classification of uveitis and the severity of vision loss. Conclusions: The most affected patients were females between the fourth and sixth decade of life. Patients with unilateral anterior uveitis predominated. Infections were the most common cause, and cataract was the most frequent complication. The severity of vision loss was directly related to the anatomical classification of uveitis(AU)

Pérdida no orgánica de la visión de colores / Nonorganic loss of color vision

La pérdida no orgánica de la visión o pérdida funcional, es un trastorno en el cual se presenta cierta sintomatología visual, sin que haya causa alguna que pueda justificarlo. Se presenta un caso de una paciente adolescente femenina de 16 años de edad, color de piel blanca, con antecedentes oculares de ptosis palpebral derecha congénita y malos hábitos alimentarios. Su motivo de consulta fue pérdida de la visión de colores no constatada inicialmente; luego, debido a su insistencia, comenzamos a notar una disminución progresiva e incongruente de la visión cromática, con parámetros funcionales visuales normales, defectos en campos visuales computarizados no reproducibles y exámenes de electrofisiología visual normales, con recuperación total de este defecto sin tomarse ninguna conducta terapéutica específica. La pérdida no orgánica de la visión se refiere a cualquier defecto visual en la que no se demuestra alteración de las estructuras que se encuentran entre la córnea y la corteza cerebral occipital. Los trastornos de la vía aferente constituyen la manifestación más frecuente. Puede existir disminución, unilateral o bilateral, de la visión, afectación del campo visual o ambos. La visión de colores es usualmente anormal, pero rara vez, es el motivo de consulta. El origen psicógeno es corriente en niños y es más frecuente en mujeres que en hombres. El déficit adquirido de la visión de colores ocurre a consecuencia de una patología ocular, lesión intracraneal o uso excesivo de algún medicamento y, por lo general, se acompaña de pérdida variable de la agudeza visual(AU)

Non-organic loss of vision or functional loss is a disorder in which certain visual symptomatology is present, without any cause that could justify it. We present a case of a 16-year-old female adolescent patient, white skin color, with ocular history of congenital right palpebral ptosis and bad eating habits. Her reason for consultation was loss of color vision not initially detected; then, due to her insistence, we began to notice a progressive and incongruent decrease in color vision, with normal visual functional parameters, defects in non-reproducible computerized visual fields and normal visual electrophysiology tests, with total recovery of this defect without any specific therapeutic behavior. Non-organic vision loss refers to any visual defect in which no alteration of the structures between the cornea and the occipital cerebral cortex is demonstrated. Disorders of the afferent pathway constitute the most frequent manifestation. There may be unilateral or bilateral decreased vision, visual field impairment, or both. Color vision is usually abnormal, but rarely, it is the reason for consultation. Psychogenic origin is common in children and is more frequent in women than in men. Acquired color vision deficits occur as a consequence of an ocular pathology, intracranial injury or excessive use of medication and are usually accompanied by variable loss of visual acuity(AU)

Decoding 揼uitar pick sign� in COVID-19朼ssociated mucormycosis: A case series

揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.

Spontaneous Subperiosteal Orbital Haemorrhage (SSOH): An Unusual Complication of Acute Coronary Syndrome Treatment

@#Acute coronary syndrome is a medical emergency with a high mortality and morbidity. Reperfusion therapy is widely used in its management. Ocular complications following reperfusion therapy is rare. A 51-year-old man treated with streptokinase, antithrombotic and dual antiplatelet therapy, developed mild proptosis following treatment. After four days, there was sudden worsening of the proptosis associated with orbital compartmental syndrome (OCS). The CT scan of the orbit showed a large spontaneous subperiosteal orbital hemorrhage (SSOH) occupying half of the left orbit. Despite performing an urgent lateral canthotomy and inferior cantholysis, the patient developed irreversible vision loss due to compressive optic neuropathy. While a few cases of mild SSOH have been reported in the medical literature, this is the first documented case of secondary bleed in SSOH. Early recognition and intervention by the treating physician, is crucial in preventing blindness.

A Case of Tolosa-Hunt Syndrome Presented with Headache, Ptosis and Vision Loss

Cavernous sinus syndrome (CSS) is defined as the involvement of two or more of the third, fourth, fifth (V1, V2) or sixth cranial nerves or involvement of only one of them in combination with a neuroimaging-confirmed lesion in the cavernous sinus. Some cases of CSS are attributed to Tolosa-Hunt syndrome (THS), an idiopathic inflammatory disease of the cavernous sinus. THS is characterized by painful ophthalmoplegia due to granulomatous inflammation in the cavernous sinus. THS is a diagnosis of exclusion that requires a vigorous series of differential diagnoses, and corticosteroid therapy is known to dramatically resolve clinical findings of THS. We report a case of a patient with painful ophthalmoplegia associated with vision loss, which was suspected to be THS. This patient followed a relatively typical clinical course of THS on steroid pulse therapy. We emphasize the differential diagnosis of THS, its presentation, and treatment.

The use of handheld spectral domain optical coherence tomography in pediatric ophthalmology practice: Our experience of 975 infants and children.

Purpose: Optical coherence tomography (OCT) is an important imaging tool assessing retinal architecture. In this article, we report a single centers experience of using handheld spectral domain (SD)‑OCT in a pediatric population using the Envisu 2300 (Bioptigen Inc., Research Triangle Park, NC, USA). Methods: We studied SD‑OCT images from 975 patients imaged from January 2011 to December 2014. The variety of cases that underwent an SD‑OCT was analyzed. Cases examples from different case scenarios were selected to showcase unique examples of many diseases. Results: Three hundred and sixty‑eight infants (37.7%) were imaged for retinopathy of prematurity, 362 children (37.1%) underwent the test for evaluation of suboptimal vision or an unexplained vision loss, 126 children (12.9%) for evaluation of nystagmus or night blindness, 54 children (5.5%) for an intraocular tumor or a mass lesion such as retinoblastoma, and 65 children (6.7%) for other diseases of the pediatric retina. The unique findings in the retinal morphology seen with some of these diseases are discussed. Conclusion: The handheld SD‑OCT is useful in the evaluation of the pediatric retinal diseases. The test is useful in the assessment of vision development in premature children, evaluation of unexplained vision loss and amblyopia, nystagmus and night blindness, and intraocular tumors (including retinoblastoma).

Association between visual impairment and depression in the elderly: a systematic review / Associação entre deficiência visual e depressão em idosos: uma revisão sistemática

ABSTRACT A systematic review was conducted to investigate the relationship between visual impairment and depression in the elderly. We searched electronic databases (LILACS, SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials) from inception to August 2014 and researched the described references. The search strategy used the following terms: (visual impairment or blindness) and (elderly) and (depression). Of the 641 electronics, 42 works were selected in full and another 20 were identified as being possibly relevant. Ten studies were included. The studies ranged in sample size from 31 to 21,995 participants. Depression was associated with visual impairment in all studies; however, without standardization of diagnostic tests, we could not conduct a meta-analysis or establish a relationship between visual impairment and depression in the elderly.

RESUMO A revisão sistemática foi realizada para investigar a correlaçõa entre deficiência visual e depressão em idosos. Foram pesquisados nas bases eletrônicas (LILACS, SCIELO, MEDLINE e Cochrane Central Register of Controlled Trials) do início até agosto de 2014 e pesquisas de referências descritas. A estratégia de busca utilizou os termos: (deficiência visual ou cegueira) e (idosos) e (depressão). Dos 641 eletrônicos, 42 trabalhos na íntegra foram selecionados e mais 20 trabalhos foram identificados como possivelmente relevantes da lista destes. Do total de estudos, 10 foram incluidos. Os estudos variaram entre 31 e 21.995 participantes. A depressão foi relacionada com deficiência visual em todos os estudos, mas sem padronização de testes diagnósticos não foi possível realizar a metanálise, nem estabelecer relação entre deficiência visual e depressão em idosos.

Ocular ischemic syndrome: A classical presentation of an uncommon condition.

We report a 47-year-old male who presented with acute monoocular vision loss, and had classical signs of global ocular ischemia in the right eye. Fundus fl uorescein angiography demonstrated delayed choroidal fi lling and no perfusion of retinal vasculature. Carotid Doppler and computed tomogram (CT) angiography studies revealed extensive bilateral atherosclerotic disease involving the carotid circulation. Ophthalmologists must be aware of the possibility of this potentially fatal condition, which is extremely rare. An astute clinical diagnosis, targeted workup for systemic associations and a prompt referral may turn out to be life-saving.

Diseases that Result in Disability in Adults

The common types of disabilities in adults are those of the locomotor system which affects mobility, those affecting activities of daily living (ADL), hearing and sight. These disabilities may be caused by a variety of diseases. Diseases of musculoskeletal, neurological, eye, ear, and psychiatric origin, as well as cancers, may lead to impairments which when severe lead to disability in mobility as well as in performing essential self-care activities. Important impairments to consider with regards to mobility and dependency are lower and upper extremity impairments, visual/ hearing impairment, affective disorders and poor balance. Ambulation is not only affected by impairments to lower limb but also by compromised cardiopulmonary status.

Cortical Blindness Following Spinal Surgery: Very Rare Cause of Perioperative Vision Loss

A 38-year-old man was operated with posterior spinal decompression and pedicle screw instrumentation for his L2 fracture with incomplete neurological deficit. In the recovery, he complained of blindness in both eyes after twelve hours. Computed tomographic scan and magnetic resonance angiography revealed bilateral occipital lobe infarcts. He remained permanently blind even after three years follow-up. Though rare, perioperative vision loss is a potential complication following spine surgery in prone position. We report a rare occurrence of cortical blindness following lumbar spine surgery.

Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss.

Dengue hemorrhagic fever leading to hemorrhage in pituitary adenoma is not reported till date: We herein report the first case of bilateral visual loss secondary to pituitary adenoma hemorrhage associated with dengue hemorrhagic fever. Urgent transnasal trans sphenoidal decompression of the macroadenoma prevented permanent visual loss in this patient. Pituitary apoplexy should be considered as differential diagnosis of visual deterioration apart from retinal hemorrhage, maculopathy, and optic neuropathy in cases of dengue hemorrhagic fever. Early decompression of optic nerves helped in the restoration of vision.

Pérdida transitoria de la visión / Transient vision loss

La pérdida transitoria de la visión monocular (PTVM), es un síntoma alarmante relacionado frecuentemente con alteraciones vasculares retinales y puede tener consecuencias importantes desde el punto de vista ocular y vital. Es por ello, que se requiere de un manejo precoz y adecuado. El presente artículo tiene por objeto revisar las principales causas, su presentación, diagnóstico y manejo, como enfermedades oclusivas vasculares y alteraciones el nervio óptico entre otras

Transient monocular vision loss (TMVL) is an alarming symptom often in relation with retinal vascular anomalies that may have severe consequences for vision and life, so it should be evaluated urgently and a prompt approach is needed. This article will review the main causes, its presentation, diagnosis and management such as vascular occlusive diseases and optic nerve abnormalities among others

Acute bilateral vision loss as the presenting feature of subacute sclerosing panencephalitis.

A 12-yr-old boy with an atypical presentation of subacute sclerosing panencephalitis (SSPE) is described. Bilateral macular chorioretinitis preceded the neurological symptoms by 3 weeks. Both visual and neurological features had an acute onset. Clinicians need to be aware that macular chorioretinitis in a child may be the heralding feature of SSPE.

Clinical Analysis of Sensory Strabismus

PURPOSE: This study was carried out for the clinical analysis of deviation axis of sensory strabismus METHODS: We retrospectively reviewed the medical records of 100 patients who had been diagnosed with sensory strabismus and undergone surgery. Etiology, age at onset of vision loss, duration of vision loss, refraction in sound eye, angle of deviation according to sensory esotropia and exotropia were analyzed. RESULTS: The most common etiology was corneal opacity which occurred in 17 patients (17.0%). Fifteen patients had esotropia and 85 patients exotropia. Esotropia was commonly developed in congenital origin (9 patients, 60%) and under the age of 5 years (12 patients, 80%). Exotropia was commonly developed in acquired origin (68 patients, 80%) and over the age of 6 years (53 patients, 62.4%) (P=0.003). When the refraction in sound eye was hyperopia, esotropia developed in 3 patients (18.8%) and exotropia in 13 patients (81.2%). When the refraction in sound eye was myopia, esotroia developed in 12 patients (14.3%) and exotropia in 72 patients (85.7%). But there was no statistical significance (P=0.445). CONCLUSIONS: Type of horizontal strabismus in sensory strabismus was significantly related to the age at onset of vision loss, but not to the refraction in sound eye.