Retinopathy of prematurity screening and retinal hemorrhages - Our experience among Indian babies.

Purpose: To evaluate the clinical characteristics of intraocular hemorrhages among babies screened for retinopathy of prematurity (ROP) and thereby their additional risk to the progression of ROP. Methods: A descriptive study was conducted at a tertiary referral hospital, which included 108 eyes of 60 neonates who were discovered to have retinal hemorrhages on retinal screening of 540 babies at risk for ROP. Maternal, obstetric, and neonatal risk factors were assessed in neonates with retinal hemorrhages. Retinal hemorrhages were assessed in terms of type, area, and relation to different retinal zones. Results: Among 540 neonates who were screened, retinal hemorrhages were found in 11.2% (n = 60 babies). Elderly primigravida mothers and spontaneous vaginal deliveries with prolonged second stage of labor were a common maternal risk factors for retinal hemorrhages. Low birth weight and preterm were fetal risk factors with neonatal retinal hemorrhages. These hemorrhages were more often bilateral (no. of babies = 48, 80%). Flame-shaped hemorrhages were more common than dot and blot ones. The majority of cases (no. of eyes = 74, 65%) resolved within 4 weeks, whereas four babies (8 eyes, 7.4%) progressed to ROP were treated with laser. Conclusion: Retinal hemorrhages in neonates are commonly associated with prolonged duration of second stage of labor, advanced maternal age, and anemia. Although not all progress to ROP, recognizing preterm and low birth weight babies with junctional hemorrhages is crucial not to delay the treatment. Regular follow-up until the clearance of hemorrhages and monitoring systemic conditions in these babies of amblyogenic age-group are required.

Scleral Buckling and Corneal Topography in a Rare Case of Keratoconus with Rhegmatogenous Retinal Detachment in an Indian Patient.

BACKGROUND: Management of Rhegmatogenous Retinal Detachment (RRD) in keratoconus could be challenging in various aspects. Visualisation of fundus due to altered reflex along with axial myopia could pose difficulty while performing pars plana vitrectomy. Our patient underwent Scleral Buckling with good anatomical results. We came across an isolated case of Keratoconus with Retinal detachment without any pre existing comorbidities unlike earlier reports where patients with history of atopic dermatitis had Keratoconus associated with RRD. The main purpose was to know the outcome of scleral buckling and its effect on corneal topography in a case of keratoconus with RRD. CASE: A 35 year old female presented with diminution of vision in both eyes since childhood, but more so in the right eye (RE) since last 6 months. She was aphakic with VA of 1/60 and 2/60 in the right and left eye respectively. She was diagnosed as both eyes keratoconus with RE near total rhegmatogenous retinal detachment (RRD) with sub retinal gliosis. She gave no history of vigorous eye rubbing or atopic dermatitis. For RE she underwent uneventful scleral buckling surgery. OBSERVATION: In post operative follow up, the retina was attached. Placido based corneal topography was done pre operatively with keratometry reading of RE - K1 62.79@96º, K2 - 55.92@6˚ and repeated at the end of three months follow up with readings of RE - K1-61.45@98˚, K2- 54.50@ 8˚. There were minimal changes in the keratometry values post operatively with flattening of vertical meridian and horizontal meridian. CONCLUSION: In keratoconus, RD can occur without any predisposed or preceding condition. Although majority of cases are associated with atopic dermatitis and eye rubbing. Scleral buckling (SB) was successful with good functional and anatomical outcome., however it has minimal effect on corneal topography.

Neurocysticercosis - A Window to Intraocular Involvement.

OBJECTIVE: To analyse the clinical characteristics of intraocular cysticercosis and the association of neurocysticercosis with intraocular involvement in these patients Materials and methods: Retrospective case series of records of patients managed at a Tertiary Care Hospital in South India. Case records of patients managed at a Tertiary Care Hospital in South India over two years (October 2012 - October 2014) were reviewed and cases reported with intraocular cysticercosis were included in the study and results analyzed. RESULTS: Five (5) patients of intraocular cysticercosis were diagnosed in a two year period at our centre, 60% being bilateral. Eight (8) eyes of five (5) patients had intraocular cysts documented by clinical examination and B mode ultrasonography (75% eyes with active cysts, 25% eyes inactive) .Visual acuity at presentation of eyes with active cysts ranged from perception of light to counting finger 4m. The 75% eyes had tractional retinal detachment at presentation. Neurocysticercosis was documented in 80% of the cases oncomputed tomography / magnetic resonance imaging . Six (6) eyes with active cysts underwent parsplanavitrectomy with cyst removal using vitreous cutter with concurrent management of tractional retinal detachment in five (5) eyes. Postoperative visual recovery was poor in eyes with associated tractional retinal detachment while good anatomical outcome was achieved in all six (6) cases. CONCLUSION: Intraocular cysticercosis can be associated with cysts in other areas. High number of patients with neurocysticercosis (80%) in those with intraocular cysticercosis in our study may indicate positive association between the two which needs further investigation.