Giant Cell Arteritis With Bilateral Central Retinal Artery Occlusion and Tongue Necrosis.

This case report describes a complicated case of giant cell arteritis (GCA) with tongue necrosis and bilateral central retinal artery occlusion (CRAO). An 81-year-old male patient with a history of recent retinal artery occlusion, ischemic stroke, and hypertensive emergency was evaluated. Clinical examination, including a visual acuity assessment, fundus evaluation, and oral examination, was performed. Laboratory investigations, such as erythrocyte sedimentation rate (ESR), were conducted. A temporal artery biopsy was performed to confirm the diagnosis of GCA. The patient presented with sudden vision loss in the left eye following a prior episode of retinal artery occlusion in the right eye. Ophthalmoscopic examination revealed CRAO in the left eye. Additionally, tongue necrosis, a rare manifestation of GCA, was observed. The ESR was significantly elevated. A temporal artery biopsy supported the diagnosis of GCA. The patient was promptly referred for immunologist consultation and initiated on intravenous methylprednisolone therapy. This case highlights the diverse and potentially devastating nature of GCA, involving ocular and systemic manifestations. Bilateral CRAO and tongue necrosis are rare but significant complications of GCA. Prompt diagnosis and early initiation of corticosteroid therapy are crucial to prevent irreversible visual loss and further complications. A multidisciplinary approach involving ophthalmologists and other specialists is essential for the comprehensive management of GCA.

Central retinal artery occlusion following pediatric blunt ocular trauma.

BACKGROUND: To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. METHODOLOGY: The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. RESULTS: A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. CONCLUSION: CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.

Clinical and Multimodal Imaging Features of Subretinal Drusenoid Deposits.

PURPOSE: To describe the multimodal imaging (MMI) features of subretinal drusenoid deposits (SDD) in Indian population. METHODS: Patients diagnosed to have SDD from January 2016 to December 2018 at our tertiary care center were recruited. The diagnosis of SDD was made on the basis of MMI consisting of a combination of color fundus photography (CFP), optical coherence tomography (OCT), red-free (RF) imaging, blue autofluorescence (BAF), and near-infra red reflectance (NIR) imaging. The morphological type and distribution of SDD and the associated retinal lesions were reviewed. RESULTS: Twenty-three patients with SDD were included. The mean age of the patients was 68.1 ± 12.2 years. SDD were noted in 77.8% of eyes clinically (n = 35/45) and could be detected in 100% of these eyes with OCT. The morphology of SDD was nodular in 65.7% of eyes (n = 23/35), reticular in 5.7% (n = 2/35), and mixed pattern in the remaining cases. BAF and NIR showed hyporeflective nodular lesions often with a target configuration. The location was commonly in the perifoveal area, mostly involving the superotemporal quadrant (74.3%, n = 26/35). Associated retinal lesions were type-3 neovascularization or retinal angiomatous proliferation in 17.1% (n = 6/35), disciform scar in 11.4% (n = 4/35), type-1 neovascularization in 8.5% (n = 3/35), and geographic atrophy in 5.7% (n = 2/35) of eyes. The mean subfoveal choroidal thickness was 186.2 ± 57.8 µm. CONCLUSION: SDD commonly have a nodular morphology and their identification often requires confirmations with OCT. Advanced age-related macular degeneration features are frequently present in eyes with SDD and the fellow eyes.

Retinopathy of prematurity care in peripheral districts in Odisha, India: Pilot for a sustainable model.

The outcome of a retinopathy of prematurity (ROP) program initiated in five districts of Odisha over 3 years with partnerships between the government and non-government organizations was prospectively analyzed. The mentoring partners trained the district ophthalmologists and neonatal care providers; the program was handed over when the trainees were considered competent enough to diagnose and treat babies with ROP. During the project period (July 2016-June 2019), 3058 babies were examined; ROP was detected in 33.81% (n = 1034) and 5.06% (n = 159) babies required treatment. At the end of the project, ROP screening was possible in all five districts, and treatment was possible in three districts. ROP care nodal centers were built in one government medical college. To strengthen the initial gain, we recommend creating an Odisha Retinopathy of Prematurity (OD-ROP) steering committee with private-public partnerships to support the program and monitor its progress in other districts of Odisha.

Macular hole following phakic intraocular lens implantation and its management.

A 28-year-old male presented to retina clinic with complains of blurring and distortion in right eye for past 1 week. There was history of implantation of phakic intraocular lens (pIOL) bilaterally 4 months back. Ophthalmic examination revealed a full-thickness macular hole in the right eye. Pars plana vitrectomy with inverted internal limiting membrane flap was planned. Post-operatively, patient had a good gain in vision (20/40) with closure of the hole. Macular hole is an unusual complication of pIOL. A detailed pre-operative fundus screening is indispensable. Early presentation and timely intervention can optimize the visual outcome.