An unusual presentation of uveo-meningeoencephalitic syndrome.

INTRODUCTION: Unilateral uveo-meningeoenchephalitic syndrome is a relatively rare entity. Our case highlights the importance of keeping this entity in mind when a unilateral picture suggestive of Vogt Koyanagi Harada syndrome crops up. CASE: A 34-year-old male came with chief complaints of blurring of vision in the right eye since two days with a prodrome of intense headache and redness in the right eye. On examination, the vision in the right eye was counting fingers close to face and 20/20 in the left eye. Clinical examination suggested unilateral uveo-meningeoenchephalitic syndrome which was confirmed on multimodal imaging. OBSERVATIONS: This case highlights the fact that though uveo-meningeoenchephalitic syndrome is bilateral, by definition; the initial presentation may still be unilateral and a prompt diagnosis and treatment can prevent the involvement of the other eye. CONCLUSION: Any case presenting with signs of symptoms suggestive of Vogt Koyanagi Harada should be treated as Vogt Koyanagi Harada even though the initial presentation may be unilateral. A prompt diagnosis and early treatment will ensure that the other eye does not get involved. Early Vogt Koyanagi Harada may just present with choroidal hyperpermeability and multiple septate pockets of SRF without any vitreous cells or anterior segment inflammation.

ROP examination of premature babies at an eye hospital referred from urban and semi-urban NICUs.

INTRODUCTION: Retinopathy of prematurity (ROP) is seen in low gestational age (GA) and birth weight (BW) babies leading to retinal vascular damage. Screening of preterm would help in early identification of this, sight-threatening disease. Multiple factors play an important role in planning screening strategies for these preterm. The objective of this study was done to find the differences and the reasons affecting the proportion of ROP distribution between urban and semi-urban regions in North India. MATERIALS AND METHODS: In this retrospective, comparative study, all babies referred for ROP examination by paediatricians or other general ophthalmologists between 2013 to 2016 were included in the study. Demographic, clinical and treatment related findings were recorded. RESULTS: Five hundred and fifty eight babies (467: urban and 91: semi urban) were examined for ROP. The mean BW in urban and semi-urban settings was 1348.6 ± 395.21 gm and 1703.77 ± 401.76 gm respectively. The mean GA was 30.99 ± 2.93 weeks and 30.73 ± 2.08 weeks in the urban and semi-urban cohorts respectively. The average time for first ophthalmic examination following birth was 23.82 ± 13.69 (range: 3-77) days in urban and 101.16 ± 238.26 (range: 13- 330) days in semi-urban settings. 94% of the babies completed all screening examination visits. Any ROP was identified in 12% and 33.0% of urban and semi-urban cohorts respectively; Type 1 was detected in 7.5% of urban babies and 24% of semi-urban babies. CONCLUSION: Proportion of ROP in the urban region was 3 times lesser than the semiurban region. Differences in proportion of babies developing any ROP and Type 1 ROP between semi-urban and urban groups is likely due to selection bias, as a high proportion of semi-urban babies did not attend for examination or failed to complete all the examinations necessary. This was particularly true for females. More needs to be done to increase access to regular, systematic screening of preterm babies within neonatal units.

Retinal meteor.

We describe a case of a 65-year old man diagnosed with retinal vasoproliferative tumour secondary to posterior uveitis. The fluorescein angiography shows an interesting meteor-like leak emanating from the tumour and rising towards the superior retina in the later frames of the angiogram. Pictorially, we call it the "Retinal Meteor" and also describe the possible mechanism for this pattern of leakage.

Ocular infection with Gliocladium species-report of a case.

PURPOSE: The purpose of this study is to report a case of ocular infection with Gliocladium species due to an exposed scleral buckle. DESIGN: Interventional case report was used as the study design. METHODS: A 60-year-old diabetic male patient presented with persistent pain, redness, and discharge in his left eye since 2 months. He had been treated previously with both topical and systemic steroids for a diagnosis of autoimmune scleritis. He had undergone scleral buckling surgery with cryotherapy for an inferior rhegmatogenous retinal detachment in the past. His best-corrected visual acuity was 6/6, N6 and 6/6, N6 in the right and left eyes, respectively. Retraction of the left lower lid revealed an exposed scleral buckle with an overlying necrotic conjunctiva. Scleral buckle removal was done. Microbiological examination showed Gliocladium species growing on blood agar and Sabouraud dextrose agar. Treatment was started with topical antifungal medication and oral antibiotics. RESULTS: Following treatment, signs of infection showed resolution. Patient underwent retinal reattachment surgery with favorable anatomic and visual outcome. CONCLUSION: Ocular infection with Gliocladium species has not been previously reported. Poor response to steroids and uncontrolled diabetes should make the clinician aware of a possible fungal infection. Removal of the scleral buckle, identification of the causative organism, and use of appropriate antibiotics are important for the accurate management of the case.

Nocardia choroidal abscess-a Case report with Review of literature.

INTRODUCTION: Nocardia is a common cause of corneal infections but is a rare cause of choroidal abscess. We report a rare case of choroidal abscess, secondary to Nocardia and its management. CASE: We report a case of choroidal abscess secondary to Nocardia asteroides species in an immunocompetent young male diagnosed by culture positivity of vitreous biopsy. He was managed by oral trimethoprimsulfamethoxazole and intravitreal Amikacin injections. CONCLUSION: All the previous reported cases were found to be immunocompromised patients. However, our patient was immunocompetent and the confirmation of diagnosis was done by culture of vitreous biopsy in comparison to a retinochoroidal biopsy, in all other previous cases.