Clinical features and visual outcomes of pediatric optic neuritis in the Indian population: A prospective study

Purpose: Optic neuritis, defined as inflammation of the optic nerve, is the most common optic neuropathy affecting adults. Various studies in Southeast Asia have shown that the clinical profile of optic neuritis might differ in these regions from that reported in the western literature. Through this study, we evaluate the clinical profile of pediatric optic neuritis (PON) in the Indian population. Methods: This was a hospital?based prospective observational study. Patients with optic neuritis younger than 16 years who attended the neuro?ophthalmology clinic from May 2016 to April 2017 were included in the study. Results: This study included 54 eyes of 38 patients. The mean age of presentation was 10.6 years. Unilateral disease (58%) was found to be more common, and a slight female preponderance (58%) was noted. The most common feature was visual loss (96.3%). Pupillary light reflex abnormality was seen in most patients. Fundus examination revealed disk edema (77.7%) to be the most common feature. Neuroimaging was performed in 34 patients, and multiple sclerosis was diagnosed in four patients. At 3 months follow?up after treatment, 89% of eyes had best correct visual acuity of 6/9 or better (P < 0.001). Conclusion: In our study, we found the clinical profile of PON to be similar to that seen in western studies as well as those done previously in the Indian population, although with a few differences

Erythropoietin as a treatment option for indirect traumatic optic neuropathy: A pilot study

Purpose: Our study aims to evaluate the effectiveness of intravenous erythropoietin (EPO) in patients with indirect traumatic optic neuropathy (TON), assess the side effects, and compare the visual function results among three groups of patients who had received different treatment options – EPO, steroids, and observation. Methods: Patients with indirect TON presenting to the neuro?ophthalmology clinic from August 2019 to March 2020, were assigned to three groups, with six patients in each group. In group 1, patients were recruited prospectively and received recombinant human erythropoietin, whereas, in groups 2 and 3, patients were recruited retrospectively and received intravenous methylprednisolone followed by oral steroids and multivitamins, respectively. Groups 1 and 2 included patients presenting within 2 weeks of trauma, whereas group 3 included those presenting beyond that. Best?corrected visual acuity, pupillary reaction, color vision, and visual fields following treatment were measured. Results: Initial visual acuity in the EPO group ranged from 20/80 to no perception of light (No PL). The mean initial BCVA (1.82 logMAR, standard deviation [SD] = 0.847) improved to 1.32, SD = 0.93 logMAR after treatment recorded at the third month (P = 0.0375), with no significant adverse effects. The initial BCVA of group 2 ranged from 20/120 to No PL. The mean initial BCVA (1.95, SD = 0.77 logMAR) improved to 1.45 logMAR, SD = 0.97 after treatment (P = 0.0435) but three patients had side effects of steroids. Initial visual acuity in Group 3 ranged from 20/40 to no PL. The mean initial BCVA (1.09 logMAR, SD = 1.10) worsened to 1.19 logMAR, SD = 1.06 after treatment after treatment (P = 0.0193). The improvement in BCVA when compared between the three groups was not significant. Conclusion: Both erythropoietin and steroids are effective in the management of traumatic optic neuropathy. However, erythropoietin shows lesser or no side effects when compared to steroids

Neuro-ophthalmological manifestations of diabetes mellitus during COVID-19-related lockdown in India

Purpose: The coronavirus disease 19 (COVID?19) pandemic has resulted in a huge impact on the health care system. Diversion of health care workforce toward management of a high number of COVID?19 cases and lockdown restrictions have affected the follow?up of patients. The objective of this study was to analyze the impact of this situation on the control of diabetes, eventually resulting in related neuro?ophthalmological complications. Methods: This retrospective case series included diabetic patients visiting the neuro?ophthalmology clinic at a tertiary care eye center in India from 25 March 2020 to 25 September 2020 during the lockdown. The incidence of diabetes?related neuro?ophthalmological complications, including third, fourth, sixth nerve palsies and non?arteritic anterior ischemic optic neuropathy (NAION) was evaluated and compared with that of the same period during 2019. Results: Overall disease incidence rate was significantly higher in the year 2020 (60.2%) compared to the previous year of 2019 (29.8%). The proportion of third nerve palsy (4.8% vs 16.3%, P < 0.001) and NAION (0.3% vs 14.3%, P < 0.001) had increased. Even though the percentage of sixth nerve palsy was 25% in 2020, this was not significantly different from 2019. There was a reduction in the percentage of fourth nerve palsy cases from the year 2019 to 2020. Conclusion: There was a significant increase in diabetes?related neuro?ophthalmic complications during the COVID?19 lockdown. This can possibly be attributed to worsening of glycemic control in diabetic patients.

Study of role of amniotic fluid total protein (AFTP) assessment in the diagnosis of tubercular ascites

Background: It is not economically feasible to estimate the serum and ascitic albumin level for calculating Serum Ascites Albumin Gradient (SAAG) in every suspected tubercular ascites patient. Ascites fluid total protein (AFTP) seems a cheaper and viable alternative. Authors attempted to compare the efficacy of Amniotic Fluid Total Protein (AFTP) against Serum Ascites Albumin Gradient (SAAG) in the diagnosis of Tubercular Ascites.Methods: Patients who were admitted to Medicine Wards, with the complaints of distension of abdomen, proved by ultrasound to have ascites, were included in the study. Total 102 Patients of ascites were included. The incidence of Tuberculous ascites was observed and special features regarding their clinical presentation, ascitic fluid values and imaging studies were noted.Results: Tubercular ascites was seen in 18 (17.6%) patients out of the 102 subjects studied. In the group of patients having raised ascitic fluid ADA, authors found that the number of patients having raised AFTP (16 cases, 88.88%) was significantly more than the patients having lower SAAG (13 cases, 71.22%) (p=0.007).Conclusions: In the setting where calculating SAAG may prove to be quite expensive, AFTP is a reasonable predictor of Tubercular infection in ascitic fluid.