Clinical profile of patients with posterior scleritis: A report from Eastern India.

Purpose: This study aimed to report the clinical profile of patients with posterior scleritis at a tertiary eye center in Eastern India. Methods: This was a single-center retrospective case series of patients who were diagnosed as posterior scleritis between January 2010 and December 2014, with a follow-up period of at least 6 months. Results: The study included 18 patients of posterior scleritis with a mean age of 41.2 ± 10.6 years (range: 26-63 years). With female preponderance (55.6%), majority of the posterior scleritis cases were unilateral (88.9%). Sixteen patients reported with diminution of vision, eleven patients (61.1%) had ocular pain on presentation, and five patients complained of headache. Concurrent anterior scleritis was found in three eyes (15%) with posterior scleritis. Choroidal folds and subretinal fluid at the posterior pole were the most common fundus findings and were seen in seven eyes (35%) each. No systemic association was detected in any patient even after extensive laboratory workup and multidisciplinary consultation. All patients received oral steroid, and 11 (61.1%) of them required intravenous pulse steroid therapy. Immunosuppressive was used in 6 (33.3%) patients, and oral azathioprine was the most common immunosuppressive used in the study. Recurrence was noted in eight eyes (40%). The mean best-corrected visual acuity improved to logarithm of the minimal angle of resolution (logMAR) 0.06 ± 0.051 at the final follow-up from 0.47 ± 0.45 logMAR at presentation (P = 0.00608). Conclusion: Posterior scleritis is relatively rare but can occur without systemic involvement. Aggressive immunomodulatory therapy is required to treat vision-threatening condition.

Clinical Profile of Patients with Tubercular Subretinal Abscess in a Tertiary Eye Care Center in Southern India.

PURPOSE: To retrospectively analyze clinical features, laboratory investigations, treatment and visual outcomes in patients with tubercular subretinal abscess. METHODS: A total of 12 eyes of 12 patients receiving a diagnosis of subretinal abscess, between 2004 and 2014, were included for this retrospective study. RESULTS: The mean age of the presentation was 29.75 ± 16.72 years (range: 14-62 years) and seven (58.3%) were male. The most common anterior segment presentation was anterior uveitis (75%). The mean BCVA at presentation was 1.62 (in logMAR). A tuberculin skin test was positive in seven patients (58.3%) and five patients had a history of pulmonary tuberculosis. Polymerase chain reaction for the Mycobacterium tuberculosis genome was positive in 6 of 11 eyes from aqueous aspirate (54%) and 4 of 7 eyes from vitreous aspirates (57.14%). All patients were started on systemic steroids and an anti-tubercular regimen. The mean duration of follow-up was 134.28 days. The mean BCVA at final presentation was 1.19 (in logMAR). Chorioretinal scar was the most common finding after resolution. CONCLUSIONS: Subretinal abscess is a rare manifestation of ocular tuberculosis. A high degree of suspicion and timely management of the condition can prevent loss of vision.

Clinical Profile of Patients with Necrotizing Scleritis in a Tertiary Eye Care Center in Southern India.

PURPOSE: To report the clinical profile of a series of necrotizing scleritis in an Indian population. METHODS: A retrospective medical record review of 27 consecutive patients with necrotizing scleritis. Patient demographics, ocular and systemic findings, treatment modalities, and visual outcome were recorded. RESULTS: There were 19 males and 8 females (31 eyes) with mean age at presentation of 49.5 years (range: 30-84 years). Underlying immunologically induced disorders was present in 37%. In 70% of the cases with immunologically induced disorders, necrotizing scleritis was the initial presentation. Complicated cataract (25.8%) and exudative retinal detachment (9.6%) were the most common anterior and posterior segment complications, respectively. Cyclophosphamide was the most commonly used immunosuppressive (55.56%) and proved to be the most effective. But even with the best available treatment, globe perforation was encountered in two eyes. CONCLUSIONS: Necrotizing scleritis can be the initial presentation of immunologically induced disorders. This disease entity is plagued with a high rate of ocular complications, especially those which can be devastating, such as globe perforation. Early and intensive therapy can be helpful in salvaging the eye.

A case of choroidal neovascular membrane in 6-year-old boy with juvenile idiopathic arthritis.

PURPOSE: The purpose of this study is to report a case of choroidal neovascular membrane (CNVM) in a patient of juvenile idiopathic arthritis (JIA). DESIGN: The design of this study is an interventional case report. METHODS: A 6-year-old boy, a known patient of JIA, presented with a complaint of redness and ocular pain with mild diminution of vision in his left eye. Fundus examination revealed a CNVM with retinal thickening and subretinal fluid which was confirmed on OCT. Treatment with intravitreal injection of anti-VEGF (ranibizumab) and oral immunosuppressive showed resolution of the CNVM. RESULTS: The result of this study is a successful treatment of CNVM with a single anti-VEGF injection and systemic immunosuppression. CONCLUSIONS: Although a rare complication, CNVM can occur in patients with JIA.

Quantitative Reduction in Central Foveal Thickness After First Anti-VEGF Injection as a Predictor of Final Outcome in BRVO Patients.

PURPOSE: To analyze the predictive ability of quantitative reduction in central foveal thickness (CFT) after the first antivascular endothelial growth factor (anti-VEGF) injection to assess final outcome in branch retinal vein occlusion (BRVO) patients. DESIGN: A retrospective interventional consecutive case series. METHODS: We retrospectively reviewed 60 treatment-naive BRVO patients. All the patients were treated with bevacizumab injection pro re nata. We measured the reduction in CFT 1 month after injection and at each visit along with other optical coherence tomography (OCT) features like external limiting membrane (ELM) integrity, ellipsoid zone (EZ) integrity, and foveal bulge (FB). RESULTS: At final follow-up more patients in the >25% CFT reduction group had a better mean best-corrected visual acuity (BCVA) and dry macula as compared with the ≤25% group (0.25 logMAR vs 0.46 logMAR, P = 0.03; 28 eyes vs 9 eyes, P = 0.005). Based on the final visual outcome we divided patients into 2 groups: group 1, BCVA ≥ 20/40; group 2, BCVA <20/40. Analysis at 1 month after injection revealed the ELM was intact in 27 (73%) and 5 (21.7%), EZ was intact in 28 (75.7%) and 11 (47.8%), and FB was intact in 12 (32.4%) and 2 (8.7%) patients, respectively, in groups 1 and 2 (P = 0.001, 0.02, 0.03). CONCLUSIONS: Patients who have more than a 25% reduction 1 month after the first anti-VEGF injection and a restored ELM, EZ, and FB have a significantly higher likelihood of achieving BCVA ≥20/40.

Efficacy of reduced dose of intravitreal triamcinolone acetonide in a case of active serpiginous choroiditis.

Active serpiginous choroiditis (SC) is a vision-threatening condition which requires intensive treatment using corticosteroids and/or immunosuppressives, especially if the lesions are involving or encroaching on the macula. Use of oral and intravenous high-dose steroids are contraindicated in uncontrolled diabetics. Intravitreal steroid delivers a localized dose in such situations. This case report highlights the efficacy of reduced dose of intravitreal triamcinolone acetonide (2 mg) in the treatment of active SC.

Bilateral retinitis pigmentosa with unilateral choroidal nevus: A hitherto unreported association.

Retinitis Pigmentosa (RP) has been reported to be associated with retinal hemangioma, retinal angiomatous proliferation, polypoidal choroidal vasculopathy and vasoproliferative tumours. However there is no previous report of choroidal nevus in an eye with RP. We describe such a case in which the eye with RP had a choroidal nevus at the macula. The coexistence of these two entities in the same eye emphasizes the need of careful examination of patients with RP. The presence of choroidal nevus warrants additional investigations such as B scan ultrasonography and a close follow-up to pick up changes in the nevus size and morphology.