Bilateral simultaneous Central Retinal Artery Occlusion (CRAO) in a patient with Systemic Lupus Erythematosus (SLE).

PURPOSE: The objective of the study is to report a rare case of severe vaso-occlusive retinopathy with bilateral simultaneous Central Retinal Artery Occlusion (CRAO) in a patient with Systemic Lupus Erythematosus (SLE). OBSERVATIONS: A female patient aged 22 years, presented with a sudden onset of painless diminution of vision in both eyes for three weeks. She had systemic features of SLE for six months at the time of the study. A diagnosis of bilateral CRAO was made after an examination of the fundus and by ruling out other causes of severe vaso-occlusion based on clinical and angiogram findings. Her antiphospholipid antibody (APLA) levels were normal. The visual prognosis was poor even after treatment with intravenous steroids and panretinal photocoagulation. CONCLUSION AND IMPORTANCE: This case highlights the importance of bilateral CRAO as an initial presentation of severe systemic disease. This case demonstrates that despite apparent normal APLA levels, a state of hypercoagulability can exist in SLE patients. In addition, it demonstrates that severe vaso-occlusive complications such as CRAO, which results in blindness, can also develop in a patient with apparently well-controlled SLE. Therefore, it is important to take cognizance of this sight-threatening complication in SLE patients at initial presentation. A holistic approach to management, both systemic and ocular, is required to prevent sight-threatening complications from vaso-occlusion. Early and aggressive intervention can be beneficial in the prevention of severe visual loss.

Diabetic retinopathy in patients with diabetic foot syndrome in South India.

Purpose: The purpose was to study the retinopathy status in diabetic patients with a risk of diabetic foot (DF) syndrome visiting a tertiary care hospital in South India. Methods: In this cross sectional study all patients with diabetes mellitus (DM) with a risk of DF syndrome, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and eighty-two patients diagnosed to have a risk profile for DF syndrome were included in the study. Their mean age was 59.28 years and 75.27% were males. The mean duration of Type 1 and Type 2 variants of DM was 14.9 years and 10.9 years, respectively. Of the 182 patients, 67.58% had retinopathy changes. Proliferative diabetic retinopathy (DR) constituted 17.88% of the total patients with retinopathy. An increased presence of retinopathy in patients with an increased risk grade of DF was found significant by the Chi-square test (P < 0.001). Conclusion: Our study found an increased presence of DR in a South Indian cohort with DF syndrome. The severity of retinopathy was greater in patients with higher grades of risk for DF. The establishment of an association between DR and DF syndrome will help in developing an integrated management strategy for these two debilitating consequences of diabetes.

Leukaemic infiltration of the optic nerve head: a rare site of initial relapse.

A 24-year-old male patient with acute lymphoblastic leukaemia (ALL), in complete remission, presented with the symptoms of gradual onset painless diminution of vision in the right eye (OD) of 2-month duration. On examination, best-corrected visual acuity in OD was finger-counting at 1 m and near vision was less than N36 Anterior segment examination was normal, except for the presence of relative afferent pupillary defect in OD. Fundus examination showed optic disc oedema, peripapillary and vitreous haemorrhage, dilated and tortuous veins over the disc and presence of subretinal infiltrates and subretinal fluid around the optic disc. Clinical picture was suggestive of leukaemic infiltration of the optic nerve head. Cytological analysis of the cerebrospinal fluid did not show any abnormal cells or blasts .Vitreous biopsy from OD was suggestive of leukaemic infiltration. After radiotherapy, the leukaemic infiltrates regressed and visual acuity improved to 6/6, N6 in OD.

Central retinal artery occlusion as a presenting manifestation of polycythaemia vera.

A 60-year-old woman with no premorbidities presented with symptoms of sudden painless vision loss in the left eye (LE). Best-corrected visual acuity in the LE was counting fingers close to face. A relative afferent pupillary defect was observed in the LE. Ocular fundus examination of LE was suggestive of central retinal artery occlusion. Systemic evaluation revealed splenomegaly and normal cardiac and carotid arteries. Haematological investigations revealed increased haemoglobin, haematocrit, platelet count and leucocytosis with low erythrocyte sedimentation rate (ESR). Features of myeloproliferative neoplasm were noted on bone marrow aspiration. An assay for JAK2 mutation was positive. Since erythropoietin levels were normal, a diagnosis of primary polycythaemia vera was made and treated with aspirin and phlebotomy twice weekly until the target haematocrit of under 45% was achieved.

Endogenous Endophthalmitis in Patients with MRSA Septicemia: A Case Series and Review of Literature.

PURPOSE: To report the presentation, predisposing factors, clinical features and outcome in 6 eyes of 3 patients with endogenous endophthalmitis secondary to methicillin resistant staphylococcus aureus (MRSA) septicaemia. METHODS: Retrospective review of case records of 3 patients who were treated for endogenous endophthalmitis secondary to MRSA septicaemia in a tertiary referral institution. RESULTS: All three patients had systemic predisposition to endogenous endophthalmitis (diabetes, urosepsis). Two patients presented within 1 week of onset of visual symptoms and the third after 3 months. Blood culture was positive for MRSA in all patients. Visual and anatomical improvement was noted in two patients who presented early. The third patient's visual outcome despite early treatment with intravitreal antibiotics and vitrectomy was not satisfactory. CONCLUSION: Endogenous endophthalmitis by MRSA is a rare but serious condition. Early and specific therapy based on reliable detection of the underlying microorganism is needed for good anatomical and functional outcome.