Chorioretinal biopsy in an immunocompromised patient with subretinal mass.

A 59-year-old woman with autoimmune diseases presented with rapidly decreased vision in the left eye. Clinical examination and investigations were inconclusive. Pars plana vitrectomy and chorioretinal biopsy were performed. The histopathologic examination revealed acute branching, septate hyphae morphologically consistent with Aspergillus spp. The infection responded to systemic and intravitreous voriconazole. The subretinal mass gradually subsided but eventually the eye became blind. Chorioretinal biopsy is a valuable diagnostic procedure which, in some cases, may be the only way to provide a definite diagnosis and specific treatment of patients with progressive chorioretinal lesions of unknown etiology. In the presented case, although the vision cannot be recovered, we can avoid unnecessary enucleation and prevent the spread of infection that may threaten patient’s life.

Nonmydriatic digital retinal images for determining diabetic retinopathy.

OBJECTIVE: To evaluate the efficacy of nonmydriatic digital retinal images for determining diabetic retinopathy. MATERIAL AND METHOD: Single field 45-degree digital retinal images of 225 eyes from 142 diabetic patients were obtained with a nonmydriatic camera. The images were diagnosed and graded by a general ophthalmologist. These results were compared with clinical diagnosis obtained by retinal specialists, after examination by using biomicroscope with plus lens and indirect ophthalmoscope of the patients. International clinical diabetic retinopathy disease severity scale was used for grading diabetic retinopathy in all cases. RESULTS: Presence of diabetic retinopathy was detected in 70 eyes (31.1%). The sensitivity and specificity for determining diabetic retinopathy was 68.57% (95%CI 57.00-78.20) and 92.25% (95%CI 87.00-95.50), respectively. The positive predictive value and negative predictive value was 80.00% (95%CI 68.20-88.20) and 86.67% (95%CI 80.60-91.00). Overall accuracy was 84.89%. CONCLUSION: Single field 45-degree nonmydriatic digital retinal images were limited by fair sensitivity for determining diabetic retinopathy although overall accuracy from the present study was relatively high. Upcountry, this tool might facilitate increased access of diabetic patients for eye evaluation but cannot replace standard eye examination.

Sheathotomy without separation of venule overlying arteriole at occlusion site in uncommon branch retinal vein occlusion.

Two cases of uncommon branch retinal vein occlusion (BRVO) with vein overlying artery at occlusion site that can be found in less than 1% who underwent retinal venule sheathotomy without separation of retinal vessel for decompression of BRVO were reported. Both patients had macular hemorrhage, edema, and area of macular capillary nonperfusion. Visual acuity (VA) worsened to 6/60 in both cases. The retinal venules were dissected around the crossing site without separation of retinal vessels. Intraoperative dilation, pulsation and restoration of downstream blood flow of the involved venules were observed. In the first patient, at 1 day, 2 weeks, and 6 weeks postoperatively, VA improved to 6/36, 6/9, and 6/6, respectively, and remained unchanged at 12 months postoperatively. In the second patient, VA improved to 6/24 on the first day postoperatively and improved to 6/18 at 1 week follow up and continuously improved to nearly normal at 2 months postoperatively then patient lost contact. Postoperative fundus fluorescein angiogram showed dilated and improved perfusion with decreased macular edema in both cases. Optical coherent tomography confirmed remarkable reduction of retinal thickness (from 874 microns preoperatively to 420 microns at 1 week postoperatively) in the second patient. Retinal venule sheathotomy without separation of retinal vessel for decompression of BRVO with venule overlying arteriole at occlusion site could be effective for improving VA and decreased macular edema.

Corneal lattice dystrophy, a concealed ophthalmic problem in Thailand.

One single family of corneal lattice dystrophy was examined and interviewed to elucidate the variety of clinical manifestations, factors associated with visual impairment, and the impact on the patient's quality of life. Forty-three out of 88 family members (48.9%) were affected. The inheritance pattern was autosomal dominant. Corneal haze grading from 1 to 4 was 5.3 per cent, 26.3 per cent, 43.4 per cent, and 25 per cent respectively. Surface irregularity grading from 1 to 4 was 18.4 per cent, 39.5 per cent, 32.9 per cent, and 9.2 per cent respectively. Forty-five per cent of the patients had VA < or = 20/200. Corneal haziness, irregularity, corneal erosion and disease duration were significantly related to visual impairment (p < 0.05). This disturbed the patient's activities such as reading (79.1%), working (62.8%) and daily life (69.8%). Corneal lattice dystrophy within the same family may present with different manifestations depending on the severity and duration of the disease and might be misdiagnosed. Inadequate knowledge among patients was susceptible to the high prevalence of the disease leading to impaired quality of life.