Nuchal Cystic Hygroma in Fetus: A Case Report.

Cystic hygromas detected prenatally usually have a poor prognosis; hence, a correct and early diagnosis is essential. A prenatal ultrasound may detect a cystic hygroma as early as 10 weeks of gestation. Knowledge of the imaging findings and prognostic factors is necessary for effective perinatal counseling. Nuchal cystic hygromas (NCHs) in fetuses present a rare and challenging medical situation for prenatal care providers. This case report aims to describe a particular case of NCH detected through routine prenatal ultrasound, emphasizing the diagnostic demanding situations, management decisions, and final results. The etiology of NCHs remains multifactorial and complicated. Despite the fact that a few instances are sporadic, a great proportion has been associated with genetic aberrations, mainly chromosomal anomalies such as Turner syndrome, trisomy 21, and trisomy 18. Recent advances in molecular genetic testing, together with chromosomal microarray analysis and non-invasive prenatal testing, have facilitated the identification of the underlying genetic factors, contributing to a better knowledge of the pathogenesis of NCHs. In fetuses, they pose a complex scientific state of affairs with diverse implications. Advances in diagnostic techniques and genetic testing have notably progressed our capacity to become aware of related anomalies, offering precious insights into diagnosis and management alternatives. However, further research is warranted to get to the bottom of the underlying mechanisms of NCH development, enhance prenatal counseling, and refine therapeutic procedures to optimize outcomes for affected pregnancies.

Bilateral Atypical Optic Neuritis following ChAdOx1_nCoV-19 Vaccination: A Putative Plausibility.

PURPOSE: In this case report, we describe the clinical features and treatment outcomes of bilateral optic neuritis developing after the administration of the first dose ChAdOx1_nCoV-19 (Covishield) vaccine in a previously healthy young immunocompetent male. STUDY DESIGN: Case report. RESULTS: A 35-year-old healthy male, presented with sudden decrease in vision which was progressive in nature. The symptoms developed two days following the first dose of the Covid ChAdOx1_nCoV-19 vaccine. A possible diagnosis of vaccine associated optic neuritis was based on the temporal association between the administration of vaccine and the development of ocular symptoms and ruling out other immune or infectious etiologies. The patient showed good response to pulse systemic steroids followed by a short course of oral steroids. CONCLUSION: Bilateral optic nerve involvement with disc edema may represent a rare adverse event of covid 19 vaccine which responds well to a short course of steroids.

Coloboma associated retinal detachment: Anatomical and functional results in the era of microincision vitrectomy surgery with an evaluation of risk factors for a recurrence.

Purpose: : To analyze the anatomical and visual outcomes of microincision vitrectomy surgery (MIVS) with silicone oil tamponade in eyes having coloboma-related retinal detachment (RD) and evaluate the risk factors for recurrence of RD. Methods: : This was a retrospective, multicentric analysis of eyes having coloboma RD undergoing MIVS with silicone oil tamponade between March 2010 and July 2018. Results: : We evaluated 148 eyes of 144 patients. The mean age of presentation was 17.4 ± 9.8 years (range: 2-65 years) and the mean follow-up duration was 13.1 ± 13.8 months (range: 3-84 months). The single operation success rate was 88.5% (131 eyes), with an overall successful outcome achieved in 90.5% (134 eyes). Recurrence of RD occurred in 17 eyes (11.5%) over a mean duration of 2.59 ± 3 months. The risk of recurrence was found to be higher in eyes where relaxing retinectomy (RR) was performed (odds ratio [OR]: 3.22; P = 0.05). A statistically significant improvement in vision was noted in the majority of cases from logMAR 1.85 ± 0.34 preoperatively to logMAR 1.33 ± 0.6 post-surgery (P = 0.002). Conclusion: : MIVS with silicone oil tamponade provided an anatomical success rate of 90.5% in eyes with coloboma RD with a significant improvement in visual acuity. Eyes in which RR was performed were susceptible to higher rates of re-detachment.

Safety and efficacy of suprachoroidal triamcinolone acetonide for the management of serous choroidal detachment prior to rhegmatogenous retinal detachment surgery: A Pilot study.

Purpose: To study the safety and efficacy of pre-operative suprachoroidal triamcinolone acetonide (SCTA) for achieving reduction/resolution of serous choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD). Methods: This was a prospective, noncomparative, interventional pilot study. All consecutive patients presenting with RD and coexisting CD underwent transconjunctival injection of SCTA before proceeding with vitrectomy/scleral buckle surgery. Sequential ultrasound B scans were performed for assessing the change in height of the CD. Results: The mean age of the cohort was 53.8 ± 10.8 years (range: 39-72 years). The CD was present in a median of 3 quadrants; the cumulative mean CD height was 5.59 mm (range: 2.02-9.42 mm). Following SCTA, a successful response (>50% reduction) was seen in five eyes by day 3 and in two eyes by day 5. Three eyes failed to respond to SCTA and required surgical drainage before proceeding with vitrectomy. No intraprocedural injection-related complications were noted. A transient rise in the intraocular pressure (30 mmHg) was seen in one eye following vitrectomy and was managed successfully with topical antiglaucoma medications. Conclusion: Suprachoroidal administration of triamcinolone appears to be a safe and effective technique to achieve CD resolution in eyes with RRD.

Risk Factors for Development of Endophthalmitis after Open Globe Injury in Children: A Case-Control Study.

AIM: To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children. METHODS: Retrospective, single-center, case-control study of children aged <18 years who sustained OGI. RESULTS: Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p= < 0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p <0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p<0.05). CONCLUSION: Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.

Klebsiella Cluster Endophthalmitis following Intravitreal Bevacizumab: Role of Early Detection, Pars Plana Vitrectomy, and Intracameral Moxifloxacin.

AIM: To report the clinical profile, outcomes of early vitrectomy for cluster endophthalmitis developing after intravitreal Bevacizumab (IVB), and discuss the role of prophylactic intracameral moxifloxacin for eyes undergoing combined cataract surgery with IVB. METHODS: Single center, retrospective analysis of 35 consecutive eyes developing post-IVB inflammation. RESULTS: Of the 35 eyes that were administered IVB (27 eyes 'IVB alone' and 8 eyes 'IVB with cataract surgery'). Endophthalmitis developed in 28 eyes, 6 eyes were managed with Intravitreal antibiotic (IVAB) alone, while 22 eyes required early vitrectomy. Only one eye undergoing a combined phacoemulsification with IVB developed endophthalmitis. Majority(26/28) of the eyes achieved visual acuity equal to/greater than pre-IVB injection vision over a period of 3.15 ± 3.2 months. CONCLUSION: Early detection and prompt PPV were effectual for achieving good functional outcomes in our cluster of post-IVB Klebsiella endophthalmitis. Intracameral moxifloxacin was protective in cases undergoing combined cataract surgery with IVB.

Bacillary Layer Detachment in Hyper-acute Stage of Acute Posterior Multifocal Placoid Pigment Epitheliopathy: A Case Series.

BACKGROUND: The term bacillary layer detachment (BLD) represents a possible separation between the myoid and ellipsoid component of the inner segment, following insult or injury to the outer retina. It has been described previously in cases of toxoplasma retinochoroiditis, central serous chorioretinopathy, Vogt Koyanagi Harada disease and trauma. PURPOSE: To describe the presence of BLD in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE). METHOD: Clinical and OCT-based description of three consecutive cases of APMPPE with BLD. RESULT: All the three cases (a 25-year-old female, a 36-year-old male, and a 32-year-old male) presented with unilateral, diminution of vision of acute onset. They were diagnosed as APMPPE and OCT revealed a splitting of the ellipsoid zone, resembling a BLD. All the three cases showed complete resolution by 1 week. CONCLUSION: BLD appears in the acute stage of APMPPE and resolves rapidly within a week.

Knowledge, attitude, and practice patterns and the purported reasons for delayed presentation of patients with sight-threatening diabetic retinopathy at a tertiary eyecare facility in Central India: A questionnaire-based study.

PURPOSE: To identify the reasons for delayed presentation among patients with sight-threatening diabetic retinopathy (STDR) and to assess their knowledge, attitude, and practice (KAP) patterns in context to diabetes mellitus (DM) and diabetic retinopathy (DR). METHODS: Single-center, cross-sectional, questionnaire-based KAP survey. All consecutive cases of STDR who presented to our tertiary eye care facility from June 2020 to November 2020 were recruited. The KAP scoring survey tool was incorporated into the questionnaire to help evaluate and represent the patient's disease. RESULTS: 170 patients with STDR were enrolled in the study. The mean age of patients was 54 ± 9.34 years (Range: 21-70 years); 110 patients (64.7%) were between 41 and 60 years; 131 patients (76%) had DM for more than 5 years. The STDR changes were more prevalent in patients with an educational qualification of high school or less (n = 142; 83.5%). Fifty-two patients (30.6%) had been informed regarding the detrimental effect of diabetes on the eyes and were recommended to consult an ophthalmologist by the treating physician. Of these, 24 (46.15%) patients were educated about retinal changes due to diabetes. Eighty-five (50%) patients in our study had good knowledge about DM; 13 (7.6%) patients had good knowledge about DR. For patients not compliant for follow-ups with the treating physician, the use of "home glucometers for self-monitoring (n = 60, 35.3%) was the most prevalent reason. The main reason for poor compliance for undergoing a dilated fundus examination by the ophthalmologist was "Had good vision, so didn't feel the need" in 143 (90.5%) patients. CONCLUSION: The absence of visual complaints, lack of knowledge, and failure to undergo a dilated fundus examination in the past were the prevalent risk factors in patients presenting with STDR. Knowledge/practice about DR was poor among the patients with STDR. The treating physicians and ophthalmologists were the most common sources for patient education.

Comparison of post-cataract surgery endophthalmitis rates using syringing or regurgitation on pressure over the lacrimal sac as a preoperative screening tool for nasolacrimal duct obstruction: An impact assessment of protocol alteration due to the COVID-19 pandemic.

Purpose: To compare the post-cataract endophthalmitis (PCE) rates among eyes undergoing syringing or regurgitation on pressure over the lacrimal sac (ROPLAS) test prior to cataract surgery. Methods: We performed a single-center, retrospective, comparative analysis of eyes developing PCE who underwent syringing prior to cataract surgery (group A) in the pre-COVID-19 era between November 1 2019 and January 31, 2020 and the eyes that underwent ROPLAS test prior to cataract surgery (group B) in the COVID-19 era between November 1, 2020 and January 31, 2021. Results: A total of 87,144 eyes underwent cataract surgery during the two time periods of the study. Syringing was performed in 48,071 eyes, whereas ROPLAS was performed in 39,073 eyes. In group A, 19 eyes (0.039%) developed PCE, whereas 20 eyes (0.051%) developed PCE in group B (P = 0.517). Between the two groups, the grade of anterior chamber cellular reaction (P = 0.675), hypopyon (P = 0.738), and vitreous haze (P = 0.664) were comparable. Gram-positive organisms were detected in 4 eyes in group A and 6 eyes in group B; 2 eyes in group A had gram-negative bacilli. The presenting visual acuity (Group A: LogMAR 1.42 and Group B: LogMAR 1.30) and final visual acuity (Group A: LogMAR 0.52 and Group B: LogMAR 0.5) were comparable between the two groups. (P = 0.544 and 0.384, respectively). Conclusion: The rates of PCE were comparable among the eyes undergoing either syringing test or ROPLAS prior to cataract surgery.

Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium.

Purpose: To assess changes in the presentation patterns of posterior segment trauma during the COVID-19 pandemic from six tertiary eye care institutes of North and Central India. Methods: A multicenter, hospital-based, retrospective comparative analysis of patients presenting with posterior segment trauma was done during the COVID-19 (Group A) (March 25, 2020 - September 30, 2020) period and the pre-COVID-19 (Group B) (March 25, 2019 - September 30, 2019) period. Results: A total of 405 patients were diagnosed with posterior segment trauma (Group A: 206, Group B: 199). The time interval between onset of trauma and presentation was higher in Group A (16.59 ± 29.87 days) as compared to Group B (9.41 ± 19.19 days) (P = 0.004). A majority of patients in Group A had a history of prior consultation before presentation (P = 0.049). In Group A, 120 (58.2%) patients sustained ocular trauma at home as compared to 80 (40.2%) patients in Group B (P < 0.0001). Patients presenting with light perception were significantly more in Group A (43.7%) as compared to Group B (30.2%) (P = 0.004). In Group B, 37.6% patients had presenting visual acuity of counting finger or better as compared to 27.6% patients in Group A (P = 0.07). Patients in Group A had a significantly higher proportion of post-traumatic endophthalmitis with delayed presentation (P = 0.011) and retinal detachment (P = 0.041). Patients undergoing surgery for foreign-body removal were significantly fewer in Group A (P = 0.05). Conclusion: Although the number of patients presenting with posterior segment trauma was comparable in Groups A and B, a greater number of patients sustained home injuries during the COVID-19 pandemic. A majority of these patients had delayed presentation with poor presenting visual acuity and a higher tendency of retinal detachment.

Clinical profile and response to steroids in post-fever retinitis: a nine-year experience from a referral institute in the rural hinterland of Central India.

PURPOSE: To describe the demographics, clinical features, and treatment outcomes with systemic steroids in eyes presenting with post-fever retinitis (PFR) from Central India. METHODS: Single-center, retrospective analysis of 147 eyes of 98 PFR cases between 2011 and 2019. RESULTS: Mean age of the study cohort was 33.46 ± 12.76 years, with 72 males and 26 females. The mean interval between the onset of fever and the diminution of vision was 21.10 ± 13.54 days (range 0-60 days). The number of PFR cases increased over the nine years with 89 cases (90.1%) presenting during winters. Unilateral involvement was seen in 49 cases, while 49 had bilateral involvement. Clinical characteristics included: multifocal retinitis (n = 122; 61.2%), hemorrhages (n = 132; 89.8%), disc edema (n = 57; 38.8%), anterior chamber reaction (n = 28; 19%), and vitritis (n = 103; 70.1%). Treatment included intravenous followed by oral steroids in 70 patients and oral steroids exclusively in 23; five patients denied treatment. The visual acuity improved from 1.09 ± 0.52 LogMAR to 0.29 ± 0.42 LogMAR (p < 0.05). CONCLUSION: There has been an increase in the prevalence of PFR cases over the last decade with clustering during the winters. Multifocal retinitis, retinal hemorrhages, and vitritis were the most common clinical findings in our series. The retinitis resolved with improvement in vision following steroid therapy in all eyes.

Impact of prophylactic intracameral moxifloxacin on post-cataract surgery endophthalmitis: data from a tertiary eye care facility in rural India.

PURPOSE: To study the impact of prophylactic intracameral (IC) moxifloxacin on the incidence, clinical profile and outcomes in eyes developing post-cataract surgery endophthalmitis (PCE). METHODS: This was a single-centre, retrospective, comparative, observational study in which all eyes with PCE between June 2013 and May 2014 without IC moxifloxacin prophylaxis (group A) and June 2015-May 2016 with IC moxifloxacin prophylaxis (group B) were analysed. RESULTS: A total of 101,815 cataract surgeries were performed in group A and 112,967 in group B. PCE was diagnosed in 179 eyes (0.18%) in group A and 92 eyes (0.08%) in group B (p < 0.001). Greater reduction in risk of PCE was seen in subsidised patients compared to private. The presenting and final visual acuity was significantly better in group B (p < 0.05). CONCLUSIONS: Prophylactic IC moxifloxacin reduced the incidence of PCE with maximum benefit being observed for the subsidised patients and also helped achieve a significantly better visual acuity following the resolution of endophthalmitis.

Resolution Pattern and Predictors of Outcome for Optic Disc Pit - Maculopathy Following Vitrectomy: An Optical Coherence Tomography Based Morphometric Analysis.

BACKGROUND: To characterize the resolution pattern and macular structure recovery of optic disc pit-maculopathy (ODP-M) following vitrectomy using spectral domain-optical coherence tomography (SD-OCT). METHODS: This is a single-center, retrospective, observational case series. Serial SD-OCT scans of all consecutive eyes of ODP-M undergoing vitrectomy were evaluated to analyze the sequence of maculopathy resolution. RESULTS: Subretinal fluid (SRF) resolved/reduced in 9 of 12 eyes over a mean of 6 months. For eyes showing resolution, we observed that the closure of the communication tract (CT) [1-3 months] preceded the closure of outer layer defect (OLD) [2-6 months], while SRF[1-12 months] and outer retinal fluid(ORF)[1-12 months] were the last to be resolved. Three eyes with residual SRF/macular fluid had a patent CT. CONCLUSION: Maculopathy resolved in a staged manner: closure of CT preceded the closure of OLD and absorption of SRF. Non-closure of CT was associated with the persistence of maculopathy. SYNOPSIS: Optic disc pit maculopathy following vitrectomy shows a staged resolution. The persistence of maculopathy is seen in eyes with non-closure of the communication tract. ABBREVIATION: Key CDVA: Corrected distance visual acuityCMT: Central macular thicknessCR: Complete restorationCT: Communication tractILM: Internal limiting membraneIRF: Inner retinal fluidIR: Incomplete restorationMLF: Multilayered fluidODP-M: Optic disc pit maculopathyOLD: Outer layer defectORF: Outer retinal fluidPPV: Pars plana vitrectomyPVD: Posterior vitreous detachmentSD-OCT: Spectral Domain-Optical Coherence TomographySRF: Subretinal fluid.

Cataract surgery in eyes with associated coloboma: Predictors of outcome and safety of different surgical techniques.

Purpose: The aim of this study was to report the outcome of cataract surgery with different surgical techniques in eyes with coexisting coloboma and to define factors of prognostic importance. Methods: Retrospective case sheet review of patients presenting between January 2016 and December 2018, who underwent cataract surgery in eyes with coexisting coloboma. Results: Of the 3,30,231 cases operated during the study period, 280 eyes of 276 patients had associated colobomatous malformation. The prevalence of coloboma in eyes undergoing cataract surgery was 0.085%. The mean age of the patients was 46.4 years (range 19 -88 years). Phacoemulsification (PE) was performed in 130 eyes (46.4%), manual small incision cataract surgery (M-SICS) was done in 115 eyes (41.1%), and 35 eyes (12.5%) underwent intra capsular cataract extraction. Intra-operative complications were noted in 26 (9%) eyes. Incidence of intra-operative and post-operative complications was comparable between PE and M-SICS groups (p = 0.94). The mean corrected distance visual acuity (CDVA) improved from logMAR 1.71 ± 0.62 to 0.87 ± 0.61 (p = 0.00009). On multivariate analysis, microcornea (p = 0.002), type 1 and 2 coloboma (p < 0.001), and intraoperative complications (p = 0.001) were associated with poor visual outcome. Conclusion: Favorable functional outcomes can be achieved with phacoemulsification in eyes with softer cataract and corneal diameter >8 mm and with M-SICS in eyes with hard cataracts and corneal diameter of 6-8 mm. PE should be considered as the primary choice whenever permissible by the corneal diameter and severity of nuclear sclerosis. Poor functional outcomes were seen in eyes with smaller corneal diameter, extensive chorioretinal coloboma, and intraoperative complications.

Retinal vasculitis and skin ulcer preceding Budd-Chiari syndrome in a patient with Behcet's disease.

Behcet's disease (BD) is a multisystem disorder with a classical triad of recurrent oral ulcers, genital ulcers, and uveitis. It involves both arterial and venous system which can lead to life-threatening complications. Both superficial and deep venous systems can be involved leading to peripheral skin lesions and devastating complications like cerebral venous thrombosis and Budd-Chiari syndrome (BCS). This report describes a case of an HLA B-52 positive BD in a 22-year-old woman who presented with retinal vasculitis and venous ulcer on the foot and later on developed ascites due to obstruction of supra-hepatic inferior vena cava (BCS). This report highlights the fact that BCS can develop in patients of BD and every ophthalmologist should be aware of this life-threatening complication while they are treating these patients, as timely diagnosis and intervention can prevent mortality.