Carotid-cavernous fistula masquerading as thyroid associated orbitopathy: a diagnostic challenge.

Purpose: To report a case of indirect carotid-cavernous fistula (CCF) in a patient who presented as a case of thyroid-associated orbitopathy (TAO). Case presentation: A 60-year-old female, known case of hypothyroidism, presented with left-sided headache associated with pain, protrusion and redness of left eye, the examination revealing vision of 20/ 80, proptosis, chemosis and severe ophthalmoplegia. All routine investigations were normal, including thyroid hormone levels. MRI brain & orbits showed increase in bulk of all extraocular muscles with tendon sparing. In view of suspicion of TAO, she was initially misdiagnosed and treated with parenteral and oral steroids, which resulted in further worsening of vision. Optical coherence tomography macula of the left eye revealed acute central serous chorioretinopathy that compelled the stoppage of steroids. While reviewing the patient again, dilated cork-screw tortuous episcleral vessels were found in the left eye. Thus, advised Digital subtraction angiography, confirmed as a case of low-flow left Indirect CCF, managed with endovascular embolization therapy improved her ocular symptoms completely in three days. Conclusion: CCF may mimic TAO due to overlapping features. In-view of different treatment protocols for both, it is critically important to look for atypical features in thyroid eye disease and keep CCF as one of the differential diagnoses for accurate management. Abbreviations: CCF = carotid-cavernous fistula, ICA = internal carotid artery, ECA = external carotid artery, TAO = thyroid-associated ophthalmopathy, BCVA = best corrected visual acuity, MRI = magnetic resonance imaging, IVMP = intravenous methylprednisolone, OCT = Optical coherence tomography, CSCR = central serous chorioretinopathy, DSA = digital subtraction angiography, IOP = intraocular pressure, CT = computed tomography.

Eight years' experience in mobile teleophthalmology for diabetic retinopathy screening.

Background: Screening for diabetic retinopathy in the community without compromising the routine work of ophthalmologists at hospitals is the essence of teleophthalmology. This study was aimed at investigating the efficacy of teleophthalmology practice for screening diabetic retinopathy from 2012 to 2020. It was also aimed at comparing the 2-year prevalence of camps organized by a district hospital in South India, as well as the footfall, reporting, follow-up, patient response, and diagnostic efficacy at these camps. Methods: All patients with diabetes and unexplained vision deterioration attending the mobile camp units underwent non-dilated fundus photography. Patients underwent teleconsultation with the ophthalmologist at the district hospital, and those requiring intervention were called to the district hospital. Trends were studied for the number of patients reporting to the hospital. Patient satisfaction was recorded based on a questionnaire. Results: A total of 682 camps were held over 8 years, and 30 230 patients were examined. Teleconsultation was done for 12 157 (40.21%) patients. Patients requiring further investigations, intervention for diabetic retinopathy, or further management of other ocular pathologies were urgently referred to the district hospital (n= 3293 [10.89%] of 30 230 examined patients). The severity and presence of clinically significant macular edema increased significantly with an increased duration of diabetes mellitus (P < 0.001). The percentage of teleconsultations showed an increasing trend over the years (P = 0.001). Similarly, considering trends of patients reporting to the hospital, the attrition rate decreased over the years (P < 0.05). A total of 10 974 of 12 157 (90.27%) patients who underwent teleophthalmic consultation were satisfied with the service. Conclusions: Teleconsultations over the years showed an increasing trend, and the attrition rate decreased over the years. Teleophthalmology is achieving success in providing high-quality service, easy access to care, and in increasing patient satisfaction. Future studies on the role of teleophthalmology for other leading preventable causes of blindness seem possible and necessary.

Periventricular leukomalacia: an ophthalmic perspective.

Periventricular leukomalacia (PVL) is a common magnetic resonance imaging (MRI) finding in cases of hypoxic ischemic encephalopathy. PVL, in MRI, is identified by the increased signal intensity of periventricular white matter on T2-weighted sequences which is more conspicuous in the posterior cortex. It occurs because of perinatal damage to the cerebral cortex. This insult is in the form of hypoxia, metabolic insults, prematurity, seizures, or infection. Periventricular area is most prone to damage owing to its immaturity and vascular supply. PVL is proven to affect vision in children. Depending on the area and cause of affection, PVL is associated with variable ophthalmic manifestations. It is known that visual function is closely linked to the overall neurodevelopment of a child. A multidisciplinary approach is required to promote the growth and development of these children, and in the midst of multiple disabilities, visual function should not be overlooked. A comprehensive knowledge of the ophthalmological presentation in the developing world can aid us in an early and accurate diagnosis and in intervention for better therapeutic recovery and rehabilitation of these children.

Study of onchocerciasis-related visual impairment in North Kivu province of the Democratic Republic of Congo in Africa.

Purpose: The Objective of this study is to determine baseline data regarding onchocercal eye lesions and associated visual loss in the Nord Kivu province, an onchocerciasis hyperendemic tropical rain forest area in the Democratic Republic of Congo (DRC). Methods: A cross-sectional study was conducted in the Nord Kivu province of the DRC during which 2150 subjects were examined ophthalmologically. The eye examination included visual acuity (VA), slit-lamp examination, ophthalmoscopy, intraocular pressure, and visual field assessment by the confrontation test. Patients with suspicion of glaucoma were further evaluated by Humphreys automated perimeter. Results: 39 (1.81%) out of 2150 subjects had onchocerciasis-related eye lesions and 4 (0.19%) were blind (VA <3/60). Chorioretinitis (0.88%) was the most frequent onchocerciasis lesion followed by keratitis (0.46%), microfilaria in the anterior chamber (0.28%), iridocyclitis (0.28%), secondary glaucoma (0.19%), complicated cataract (0.19%), and optic atrophy (0.19%). Visual impairment was discovered in 114 (5.3%) out of 2150 subjects, of whom 39 (0.19%) had blindness and 75 (3.4%) had low vision. Visual impairment was mostly caused by nononchocerciasis-related diseases like cataract (27.2%), retinal diseases (19.3%), glaucoma (15.8%), and iridocyclitis (15.8%) rather than because of onchocerciasis (9.6%) among all causes of visual impairment. Conclusion: Features of ocular onchocerciasis usually described in forest and savanna areas were relatively less common than expected in and around Goma, the capital of the Nord Kivu province of the DRC.