MULTIMODAL IMAGING DURING THE EVOLUTION OF BLOOD-BRAIN BARRIER DISRUPTION MACULOPATHY.

PURPOSE: To highlight the course of blood-brain barrier disruption maculopathy in a patient with successfully managed relapsed central nervous system lymphoma. METHODS: Case report with fundus autofluorescence and optical coherence tomography imaging, and literature review. RESULTS: A 57-year-old patient diagnosed with central nervous system large B-cell lymphoma had a normal ophthalmic evaluation on his first visit. Subsequently, when his malignancy recurred locally, he was started on blood-brain barrier disruption therapy and intraarterial methotrexate. During the course of the therapy, he developed bilateral retinal pigment epithelial abnormalities located in the foveal and perifoveal zones. The changes were first mildly progressive and then marginally regressive in nature with minimal eventual loss of visual acuity to 20/32 and 20/25 in his right and left eye, respectively. CONCLUSION: Maculopathy is a known complication in patients with central nervous system malignancies undergoing blood-brain barrier disruption. A detailed clinical evaluation using fundus autofluorescence and high-definition optical coherence tomography are informative in managing such patients.

Choroidal melanoma: A short review with an Indian perspective.

Choroidal melanoma (CM), the most common intraocular tumor in adults, is still a rarity in Asia. Having a high propensity for metastasis with a poor survival, recognizing it early is essential. Although it has typical clinical features, there are instances of simulating lesions. Fine-needle aspiration biopsy can be a valuable tool not only to confirm our clinical suspicion but also aid in prognosticating it. From days of histopathological prognostic markers, we are moving on to genetic markers which are reliably providing insights, helping us in providing a better care for our patients. Eye preservation has taken an all new important meaning in CM with many centers opting for different modalities of radiation. Herein, we try to provide a short synopsis of CM looking into its epidemiology, clinical features, diagnosis, and management. We also look briefly into the role of fine-needle biopsy in managing CM. Being a tertiary referral ocular center in India, we do come across CM; we have shared the preliminary reports of our analysis of managing CM over a 9-year period.

Morphological and functional outcomes following modified early treatment diabetic retinopathy study laser in diabetic macular edema.

AIM: The aim was to report morphological and functional outcomes following modified early treatment diabetic retinopathy study (ETDRS) laser in diabetic macular edema (DME). MATERIALS AND METHODS: Structural and functional changes using spectral domain optical coherence tomography (OCT) and microperimetry (MP) were studied before and 4 months after laser in 37 eyes with clinically significant macular edema (ME) requiring modified ETDRS laser treatment. Paired t-test was used to compare pre and postlaser outcomes P < 0.05 was considered statistically significant. RESULTS: Central foveal thickness showed a significant reduction after laser P = 0.004. There was a significant reduction in mean retinal thickness (MRT) and retinal volume in all the quadrants of ETDRS except for the temporal and nasal quadrants in outer 6 mm ring. Maximum reduction in MRT was seen in eyes with DME having neurosensory detachment (382.66 µ to 292.61 µ). Retinal sensitivities reduced in all quadrants following laser, however, fixation patterns showed improvements. The change in VA was positively correlated to change in MRT (r = 0.468, P = 0.032). CONCLUSION: Laser not only causes structural benefits such as reduction of retinal thickness and volume, it also causes improvement of fixation patterns.

Acute retinal necrosis: clinical features, management and outcomes--a 10 year consecutive case series.

PURPOSE: To determine the viral diagnosis and clinical outcome of eyes with acute retinal necrosis (ARN). METHOD: A retrospective analysis was done of 62 eyes of 53 patients presenting to a tertiary care ophthalmic institute between 1997 and 2007 with features of ARN. All patients with active disease were started immediately on intravenous acyclovir followed by oral antivirals along with systemic steroids. A prophylactic laser retinopexy was performed in patients with a clear media to areas posterior to the necrotic retina. RESULTS: The aqueous and the vitreous sample revealed herpes simplex virus in 19 (30.60%) and varicella zoster virus in 28 patients (45.16%). Forty-one (66.12%) eyes had retinal detachment. Prophylactic laser photocoagulation was given in 19 (30.64%) eyes. Surgical intervention was required in 32 (51.61%) eyes. Favorable functional outcome was seen in 28 (45.1%) eyes. CONCLUSION: ARN is a fulminant disorder, which if treated early and aggressively gives good results.

The effects of renal transplantation on diabetic retinopathy: clinical course and visual outcomes.

PURPOSE: To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. RESULTS: The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 ± 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. CONCLUSIONS: RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.

High altitude retinopathy.

High altitude retinopathy is a condition often seen among mountain climbers or among persons who reach high altitudes rapidly. In this report, we describe a case of a 57 year old healthy gentleman who presented with diminution of vision in both the eyes associated with retinal hemorrhages and the spontaneous resolution of the same.