Intravitreal dexamethasone as an adjunct for the treatment of dengue virus related maculopathy: a case report

Dengue infection related ocular pathology whether as a direct manifestation of coagulopathy or as a sequale of immunological reaction is being increasingly recognized in endemic regions and has expanded out into a spectrum with pan ocular presentation. Authors present a case of a young female from an endemic region who developed visual field abnormality and loss of vision several days after onset of fever. She was diagnosed with dengue virus infection and subsequently went on to develop thrombocytopenia requiring transfusion. Detailed ophthalmological evaluation revealed maculae edema, and changes consistent with neuroretinitis and posterior segment vasculitis. She was treated with a combination of pulse steroid therapy and intravitreal dexamethasone injection. Patient went on to have excellent visual recovery on follow up with no persisting visual field deficit.

Clinical Features of Anterior Ischemic Optic Neuropathy

PURPOSE: To analyze the clinical features of anterior ischemic optic neuropathy (AION) and to evaluate the visual prognosis METHODS: Medical records of 52 eyes in 47 patients who were diagnosed with AION from January 1991 to December 2000 were retrospectively reviewed. The clinical features, associated systemic disease, visual fields findings, and fundus findings in the patients were analyzed. RESULTS: The mean age of the patients was 55.9 years (20~81 years). Twenty-six were men (55.3%) and 21 were women (44.7%). The initial visual acuity of less than 0.1 was 24 eyes (46.2%), that of 0.1 to 0.5 was 23 eyes (44.2%), and more than 0.5 was 5 eyes (9.6%). In seasonal onset, frequency of AION during the winter was 18 eyes (37.5%). As the associated systemic diseases, 15 had diabetes mellitus (31.9%), and 27 had hypertension (57.4%). In laboratory examination, erythrocyte sedimentation rate (ESR) was elevated in 4 patients (8.5%). In fundus examination, the optic disc swelling was found in 16 eyes (30.8%), and optic disc atrophy was found in 36 eyes (69.2%). In Goldmann perimetry, the altitudinal field defect was found in 23 eyes (44.2%), most commonly. The mean follow-up period was 1.7 years (2 months ~ 9 years), and the visual acuity improved in 13 eyes (25.0%), worsened in 6 eyes (11.5%), and did not change in 33 eyes (63.5%) at the final follow-up. CONCLUSIONS: In conclusion, patients with AION showed various clinical features and overall visual prognosis is poor. Because AION is frequentely associated with systemic diseases, careful evaluation on the systemic disease is mandatory.

A Clinical Study of the Optic Nerve Diseases

The authors clinically analyzed 240 patients of optic nerve diseases who visited the Department of Ophthalmology of Kyung Hee University hospital during four and a half years from July 1985 to February 1990. The most common optic nerve disease was optic nerve atrophy(59.2%), followed by optic neuritis, anterior ischemic optic neuropathy, papilledema, compressive optic neuropathy, retrobulbar optic neuritis, toxic neuropathy, and anomaly of optic nerve. According to sex, there was no significant difference between female and male. In comparison with age groups, the largest group was in the age group of 21-30 years. In cases of optic nerve atrophy, the most common cause was trauma(29.1%), most common age group was 21-30 years. In cases of optic neuritis, the most common cause was idiopathic(61.7%), most common age group was 31-40 years. Visual improvement was seen in 85.3%. In cases of anterior ischemic optic neuropathy, the most common cause was idiopathic(35.0%), most common age group was 41-50 years. Visual improvement was seen in 15%. In cases of papilledema, the most common cause was brain tumor (88.2%), most common age group was 41-50 years.