Systemic lupus erythematosus (SLE) associated uveitis in India - A case series.

PURPOSE: To report the uveitic manifestations of patients with systemic lupus erythematosus (SLE). METHODS: This was a retrospective analysis of all SLE cases with ocular manifestations seen by a single ophthalmologist between 2015 and December 2021. RESULTS: In total, seven patients with a median age of 40 (range 18-50) years were included in the study. Female (85.7%) predominance was noted. Ocular findings were bilateral in 71% (five patients) of cases. Majority (10 eyes, 83%) of the patients had retinal vasculitis as the common finding. Antinuclear antibodies were positive in all the patients. The vision improved in two (16.6%) eyes, was stable in eight (66%) eyes, and worsened in one (8%) eye. All the patients were treated with oral steroids along with immunosuppressive agents. CONCLUSION: Though SLE is rare cause of uveitis, it can be associated with significant ocular morbidity. Hence, early diagnosis and treatment can salvage vision in many cases.

Retinal venous occlusion in a child following Corbevax COVID-19 vaccination.

A 13-year-old boy developed painless diminution of vision in left eye 15 days after taking first dose of coronavirus disease 2019 (COVID-19) vaccine (Corbevax). Fundus and fluorescein angiography revealed central retinal vein occlusion in the left eye. Blood investigations were noncontributory. He was administered three doses of pulse corticosteroids followed by a tapering dose of oral corticosteroids. Retinal vascular occlusion can occur following COVID-19 vaccination in children, and early and aggressive systemic anti-inflammatory therapy can be helpful.

An unusual presentation of macular telangiectasia type 2 with a large pigment deposit.

Macular telangiectasia type 2 (MacTel) is a bilateral retinal disease that seems to be limited to the juxtafoveal region of the macula. We herein report an unusual presentation of MacTel with a large pigment deposit at the macula. Fundus of the right eye showed a large pigment deposit at the macula and right-angled venule. The left eye fundus showed a grayish discoloration due to subretinal fibrosis, dark pigment clumps and right-angled venule in the macula. Lesions were highlighted on multicolor imaging and blue reflectance imaging. Spectral domain optical coherence tomography (SD-OCT) of both eyes showed hyperreflectivity on the inner aspect of the retina corresponding to the area of pigment clumping.

Efficacy of anti-VEGF in the treatment of choroidal neovascular membrane secondary to pattern dystrophy simulating fundus flavimaculatus.

Pattern dystrophies are a group of inherited disorders of the retinal pigment epithelium. A 44-year-old female came with loss of vision in her right eye. The fundus of both eyes showed flecks in the posterior pole with a CNVM in the right eye. FFA and SD OCT confirmed the presence of CNVM. The patient underwent treatment with anti-VEGF injection. Post treatment, the vision improved with a reduction in subretinal fluid along with a scarring CNVM. To conclude, we report an extremely rare case of PDSFF associated CNVM and its favourable response to anti-VEGF injection.

Acute macular neuroretinopathy after blunt ocular trauma: A rare association.

Acute macular neuroretinopathy (AMN) is a deep retinal ischemic manifestation. It has been reported after the use of sympathomimetics, childbirth, bee sting, oral contraceptives, flu-like illness, intravenous contrast agents and bodily trauma not directly involving the eyes. We report a case of AMN following blunt ocular trauma. An 18-year-old male presented with an acute history of blurring of vision following blunt trauma to the right eye. Spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the outer nuclear layer with ellipsoid layer disruption. This report highlights AMN as a manifestation of blunt trauma, presence of which may be an indicator of poor visual prognosis.

Measurement of size of pigmented choroidal nevus: Superiority of multicolor imaging compared to conventional color fundus photography.

Choroidal nevi are benign fundus lesions that require regular follow with documentation. Conventional color fundus photography (CFP) has traditionally been used to images these lesions. Multicolor imaging (MCI) available on Spectralis spectral domain optical coherence tomography system is increasingly been tested vis-à-vis conventional CFP in various retinal diseases. We present data of the right eye of a 59-year-old gentleman with choroidal nevus who underwent conventional CFP as well as MCI. Nevus appeared orange red on MCI and its size appeared larger than the same measured on conventional CFP. We also report infrared reflectance and near infrared autofluorescence features of choroidal nevus.

Trans-lamina cribrosa pressure difference and open-angle glaucoma. The central India eye and medical study.

PURPOSE: To assess associations of the trans-lamina cribrosa pressure difference (TLCPD) with glaucomatous optic neuropathy. METHODS: The population-based Central India Eye and Medical Study included 4711 subjects. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44 Body Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]-0.18×Age[Years] -1.91. TLCPD was IOP-CSFP. RESULTS: Mean TLCPD was 3.64±4.25 mm Hg in the non-glaucomatous population and 9.65±8.17 mmHg in the glaucomatous group. In multivariate analysis, TLCPD was associated with older age (P<0.001; standardized coefficient beta:0.53; regression coefficient B:0.18; 95% confidence interval (CI):0.17, 0.18), lower body mass index (P<0.001; beta: -0.28; B: -0.36; 95%CI: -0.38, -0.31), lower diastolic blood pressure (P<0.001; beta: -0.31; B: -0.12; 95%CI: -0.13, -0.11), higher pulse (P<0.001; beta:0.05; B:0.02; 95%CI:0.01,0.2), lower body height (P = 0.02; beta: -0.02; B: -0.01; 95%CI: -0.02,0.00), higher educational level (P<0.001; beta:0.04; B:0.15; 95%CI:0.09,0.22), higher cholesterol blood concentrations (P<0.001; beta:0.04; B:0.01; 95%CI:0.01,0.01), longer axial length (P = 0.006; beta:0.03; B:0.14; 95%CI:0.04,0.24), thicker central cornea (P<0.001; beta:0.15; B:0.02; 95%CI:0.02,0.02), higher corneal refractive power (P<0.001; beta:0.07; B:0.18; 95%CI:0.13,0.23) and presence of glaucomatous optic neuropathy (P<0.001; beta:0.11; B:3.43; 95%CI:2.96,3.99). Differences between glaucomatous subjects and non-glaucomatous subjects in CSFP were more pronounced for open-angle glaucoma (OAG) than for angle-closure glaucoma (ACG) (3.0 mmHg versus 1.8 mmHg), while differences between glaucomatous subjects and non-glaucomatous subjects in IOP were higher for ACG than for OAG (8.5 mmHg versus 3.0 mmHg). Presence of OAG was significantly associated with TLCPD (P<0.001; OR:1.24; 95%CI:1.19,1.29) but not with IOP (P = 0.08; OR:0.96; 95%CI:0.91,1.00). Prevalence of ACG was significantly associated with IOP (P = 0.04; OR:1.19; 95%CI:1.01,1.40) but not with TLCPD (P = 0.92). CONCLUSIONS: In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of open-angle glaucoma.

Prevalence and associated factors of glaucoma in rural central India. The Central India Eye and Medical Study.

PURPOSE: To assess the prevalence of glaucoma in rural Central India. METHODS: The population-based Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study included 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. Glaucoma was defined by glaucomatous optic disc morphology, and in a second step, by the criteria of the International Society of Geographical and Epidemiological Ophthalmology (ISGEO). RESULTS: Optic disc photographs were available for 4570 (97.0%) subjects. Glaucoma was detected in 122 subjects (51 unilateral) (2.67% (95%CI: 2.20, 3.14). Glaucoma prevalence for the age groups of 30-39yrs, 40-49yrs, 50-59yrs, 60-69yrs, 70-79yrs, and 80+ years was 0.54% (95%CI: 0.11, 0.98), 1.03% (95%CI: 0.49, 1.57), 1.40% (95%CI: 0.58, 2.23), 6.62% (95%CI: 4.92, 8.31), 8.71% (95%CI: 5.55, 11.75), and 14.3% (95%CI: 4.13, 24.4), respectively. In multivariable analysis, glaucoma was associated with higher age (P<0.001), lower body mass index (P = 0.025), lower blood hemoglobin concentration (P = 0.03), higher intraocular pressure (P<0.001), disc hemorrhages (P<0.001), higher prevalence of myopic retinopathy (P<0.001), lower level of education (P = 0.03), longer axial length (P<0.001), thinner retinal nerve fiber layer (P<0.001), higher vertical cup/disc diameter ratio (P<0.001), and narrow anterior chamber angle (P = 0.02). Ratio of open-angle glaucoma to angle-closure glaucoma was 7.7:1 (1.93% (95%CI: 1.64, 2.22) to 0.24% (95%CI: 0.14, 0.34)). Using the ISGEO criteria, glaucoma prevalence was 2.8% (95%CI: 2.3, 3.3) with a less clear association with older age. CONCLUSIONS: Glaucoma prevalence in remote rural Central India is comparable to other regions. Associated factors were older age, lower body mass index, lower blood concentration of hemoglobin, lower level of education, higher intraocular pressure, disc hemorrhage, myopic retinopathy, and longer axial length. The ratio of open-angle glaucoma to angle-closure glaucoma was about 8:1.