Undiagnosed Behçet's Disease Complicated by Multiple Pseudoaneurysms and COVID-19 Infection.

Behcet's disease (BD) is a rare multiorgan systemic disorder characterized by recurrent episodes of acute inflammation. Involvement of the vascular system, gastrointestinal tract, and central nervous system portends a poor prognosis. We report the case of a 54-year-old man who presented with a 2-week history of symptoms attributable to infrarenal aortic and left tibioperoneal trunk pseudoaneurysms, defined by CT angiography which also revealed right lower lobe pulmonary artery (PA) and right anterior tibial arterial aneurysms. A prior history of recurrent oral ulceration, periodic fever, cerebral venous sinus thrombosis, and aseptic endocarditis with pulmonary emboli invoked a diagnosis of BD. Immunosuppression was commenced immediately, following synchronous endovascular and open arterial intervention, except the PA aneurysm. He developed a fever and cough 8 days postoperatively as a consequence of COVID-19 infection from which he recovered without complications. The management of the patient's four aneurysms in different vascular territories and postoperative COVID-19 infection in the presence of mandatory immunosuppression are discussed.

Multifocal electroretinography-assisted anatomical and functional evaluation of subthreshold green laser in acute central serous chorioretinopathy.

PURPOSE: To compare observation versus subthreshold green laser (STL) in acute central serous chorioretinopathy (CSC) in terms of anatomical and functional outcomes. METHODS: Prospective randomized interventional study. 30 eyes with the first episode of acute CSC underwent complete ophthalmologic examination, measurement of best-corrected Snellen visual acuity (BCVA), contrast sensitivity (CS), fundus fluorescein angiography (FFA), spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG) at baseline. Patients were randomized equally to group A (observation) or group B (STL using 532 nm wavelength applied to the leakage point). Outcome measures included BCVA, CS, central foveal thickness (CFT), and mean macular thickness (MMT) on SD-OCT and P1 amplitude and implicit time (IT) on mfERG. Patients were followed up for 6 months. RESULTS: Mean BCVA was comparable between the two groups on follow up; however, mean CS was significantly higher in group B at 6 months (P = 0.032). CFT was significantly lower in group B at 1 month (P = 0.001) and 3 months (P = 0.049); however, this difference was not maintained at 6 months (P = 0.265). P1 amplitude and IT in all 5 rings were comparable between the two groups at baseline. On follow up, P1 amplitude of ring 1 became significantly higher in group B at 3 months (P = 0.036) and 6 months (P = 0.022). CONCLUSION: Immediate treatment of acute CSC with STL, as compared to conservative management, leads to more rapid resolution on SD-OCT and superior functional outcomes as evidenced by CS and mfERG.

Multifocal electroretinography in patients with macular telangiectasia type 2.

PURPOSE: To evaluate the multifocal electroretinographic (mfERG) response in patients with macular telangiectasia (MacTel) type 2. METHODS: Prospective, observational case series. Thirty-four eyes of 18 patients diagnosed with nonproliferative MacTel type 2 underwent recording of best-corrected visual acuity (BCVA), fundus fluorescein angiography, spectral domain optical coherence tomography (SD-OCT) and mfERG using 61 hexagonal elements, in accordance with ISCEV guidelines. The P1 average response densities and implicit times of the first-order kernel responses were grouped into five concentric rings centred on the fovea. Data from the left eyes of cases (18 eyes) were compared with 34 eyes of age- and sex-matched controls. Correlation analyses were performed between BCVA, mfERG parameters and SD-OCT measurements. RESULTS: Mean BCVA of the cases was 0.3 ± 0.26 ranging from 0 to 1. On SD-OCT, mean central foveal thickness was 205.78 ± 40.92 µm and average mean macular thickness was 248.22 ± 23.08 µm. Mean P1 amplitudes were significantly decreased in eyes with MacTel type 2 as compared to controls in ring 1 (p = 0.039). Mean P1 implicit time in all the rings was comparable between the two groups. BCVA was significantly and negatively correlated with P1 amplitude in ring 1 (r = - 0.518, p = 0.028) in eyes with MacTel type 2. CONCLUSION: mfERG reflects localised inner retinal dysfunction in MacTel type 2. Correlation with BCVA reinforces that mfERG should be used to objectively assess the macular function in these patients.

Long-term visual outcome and its predictors in macular oedema secondary to retinal vein occlusion treated with dexamethasone implant.

BACKGROUND: To evaluate the functional long-term outcome in patients with macular oedema (MO) secondary to central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) treated with dexamethasone implant (DEX implant) and to identify its clinical predictors. METHODS: A 24-month, retrospective, multinational, real-world study. Chart review of patients with either naïve or recurrent MO secondary to CRVO/BRVO treated with DEX implant, including best-corrected visual acuity (BCVA), central subfield thickness (CST), demographic baseline characteristics and details of any additional treatment during follow-up. RESULTS: A total of 155 eyes (65 CRVO, 90 BRVO) from 155 patients were included. At 24 months, mean BCVA did not change significantly in CRVO (-2.1±24.5 letters, p=0.96) and BRVO patients (1.3±27.0 letters, p=0.07). A worse baseline BCVA (p<0.001), visual acuity (VA) gain ≥5 letters at 2 months (p=0.006) and no need for adjunctive intravitreal therapy after first DEX implant (p=0.001) were associated with a better final BCVA gain. Treatment-naïve patients (p=0.006, OR: 0.25, 95% CI 0.11 to 0.57) and those with a baseline CST≤400 µm (p=0.02, OR: 0.25, 95% CI 0.10 to 0.63) were identified as being less likely to need additional intravitreal therapy. CONCLUSION: Clinical baseline characteristics and the early treatment response were identified as possible predictors for long-term outcome and the need of adjunctive intravitreal therapy in MO secondary to BRVO/CRVO treated by DEX implant.

Anterior segment optical coherence tomography of intraocular lens opacification.

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.