Inadvertent triple globe penetration during peribulbar anesthesia.

Inadvertent globe perforation following peribulbar anesthesia can lead to unpleasant experiences if not identified early and managed appropriately. We present the case of a 75-year-old female who came with decreased vision in the left eye (LE) following cataract surgery under peribulbar block. Her visual acuity in the right eye (RE) was 6/24 and LE was 6/75. Fundus examination of LE showed vitreous hemorrhage with localized subretinal hemorrhage along the inferotemporal arcade suggestive of globe perforation. Optical coherence tomography (OCT, Spectralis. Heidelberg imaging, Germany) scan across the perforation site showed subretinal hemorrhage and full-thickness retinal tear. On follow-up, two more focal points of retinal whitening were noted in the inferotemporal equatorial region. The patient was kept under close monitoring, and 4 weeks later, vision improved to 6/9 and barrage laser was done around the perforation sites. Serial OCT scans and close follow-up in iatrogenic globe perforation can result in good visual outcomes.

Sequential retinal pigment epithelium tears following intravitreal Ranibizumab injections for age-related macular degeneration.

PURPOSE: To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD). METHODS: Retrospective, observational case. CASE DESCRIPTION: A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre,

Bilateral Post Fever Retinitis With Retinal Vascular Occlusions Following Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV2) Infection.

INTRODUCTION: As the world fights the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several reports of retinal manifestations of the disease are emerging. Post fever retinitis is a well reported ocular inflammatory reaction to multiple invasive agents, be it virus, bacteria or other microbial agent. PURPOSE: We report an interesting case of bilateral multifocal retinitis with multiple vascular occlusions in a patient, three weeks after a febrile illness. RESULTS: Investigations to ascertain the cause of fever resulted in identifying ephemeral seropositivity for several different Ribonucleic acid (RNA) viruses. The retinitis was managed with systemic steroids, doxycycline and anticoagulants with improvement in vision. CONCLUSION: High and persistent seropositive response against (SARS-CoV-2) helped us to narrow it as the causative agent but the cross reactivity of SARS-CoV-2 with other viruses can be misleading and needs careful interpretation.

Foveal cyst: Unknown etiology and unexplained response to treatment.

BACKGROUND: Foveal cysts have been associated with vitreous traction due to a taut posterior hyaloid. These eyes may progress to become a full-thickness macular hole, remain stable, or resolve after a posterior vitreous detachment. A foveal cyst in an eye with a complete posterior vitreous detachment and no other obvious pathology is unusual. CASE PRESENTATION: A 21-year-old male presented with blurred vision in the left eye of 1-month duration. On examination his left-eye vision was 20/60, and anterior segment examination was normal. Fundus examination showed internal limiting membrane folds with a suspected lamellar macular hole. A spectral domain optical coherence scan showed a thin dome-like cyst in the sub foveal region involving the outer retinal layer with a detached posterior hyaloid face. A trial of intravitreal dexamethasone implant was given, following which there was improvement in vision and resolution of the foveal cyst. At the third-month follow-up, the patient presented with a stellate pattern of hyporeflectivity in the macular area both on spectral domain optical coherence scan and multicolor imaging with no change in visual acuity. CONCLUSION: The presence of a foveal cyst in a young male without any risk factors is peculiar, and the rapid response to intravitreal dexamethasone implant raises questions about the pathogenesis. The stellate pattern of hyporeflectivity on spectral domain optical coherence scan imaging with an intraretinal "filling defect"-like picture on fluorescein angiography suggests a possible ongoing ischemic pathology.

Looking beyond occlusion: A novel perspective for amblyopia treatment.

PURPOSE: The aim of this study was to evaluate the efficacy of Orthoptek (Magnocellular Stimulator OMS; Carditek Pvt. Ltd., Bangalore) as a treatment modality for amblyopia and strabismus. METHODS: Thirty-five patients with amblyopia of any type, reduced vision in one or both eyes with no binocular vision and or poor stereopsis were included in the study. All patients underwent a minimum of 10 sessions of therapy with each session lasting for a cumulative period of 60 min. At the end of the 10th session, patients were evaluated for improvement in visual acuity, stereopsis, Binocular single vision and amount of strabismus, if any. RESULTS: The mean logMAR corrected distance visual acuity improved from 0.31 ± 0.34 and 0.32 ± 0.44 to 0.08 ± 0.12 and 0.07 ± 0.12 posttreatment in the right eye and left eye, respectively. Following therapy, 34 (97%) patients showed improvement in stereopsis, orthophoria was noticed in 28 (80%), and binocular single vision was noted in 33 (94%). All patients were followed up for 1 year with maintenance therapy and none showed any regression. CONCLUSION: We believe that top-down impulses and the role of the attention area in the parietal cortex have not been studied well enough in the treatment of amblyopia. Our device addresses these issues and corrects the visual deficits in amblyopia. However, the study needs validation of this pilot study from independent centers. The same will be done at some stage.

Role of secukinumab in ankylosing spondylitis with tubercular uveitis.

We present the case of a 32-year-old Indian male one-eyed individual with a history of unilateral panuveitis with HLA B 27 positive spondyloarthropathy on systemic immunosuppressant (Adalimumab). He developed recurrent inflammation in the same eye in a span of 2 years, later complicated with retinal vasculitis. On evaluation, he was diagnosed with tubercular uveitis and started on antitubercular treatment along with systemic steroids. Inview of Increased IOP due to steroid response, Inj. Secukinumab ( IL 17 A inhibitor) was started and significant improvement was noted.

Prognostic Value of Hyperreflective Material on Visual Acuity in Treatment-Naïve BRVO.

BACKGROUND AND OBJECTIVE: To correlate between hyperreflective material (HRM) seen on optical coherence tomography (OCT) and visual outcomes in treatment-naïve acute branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: Demographic and OCT features of patients with acute BRVO were analyzed retrospectively. OCT parameters noted were macular edema type, HRM presence and location, and outer retinal layer integrity. Eyes were separated into two groups: Group 1 (BRVO without HRM) and Group 2 (BRVO with HRM). RESULTS: Forty-seven eyes (67%) were included in Group 1 and 23 eyes (33%) were included in Group 2. Mean presenting logMAR visual acuity in Groups 1 and 2 was 0.521 ± 0.428 (mean Snellen equivalent = 20/66) and 0.627 ± 0.427 (mean Snellen equivalent = 20/85), respectively. Poor vision at final visit was noted in the BRVO with HRM group (P = .027). More intravitreal injections were required for macular edema resolution in the HRM group (4.83 vs. 2.67). CONCLUSIONS: Presence of HRM in BRVO is associated with poorer vision. It can be a useful prognostic biomarker. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:320-327.].

Novel Method of Plugging the Hole: Anatomical and Functional Outcomes of Human Amniotic Membrane-Assisted Macular Hole Surgery.

PURPOSE: To describe the surgical outcomes of macular holes (MHs) by inserting a human amniotic membrane (hAM) plug. METHODS: In this retrospective, interventional, comparative case series, 10 patients who had undergone hAM plugging for a MH were included in the study. Seven patients had idiopathic full-thickness MHs, 1 patient had traumatic MH, and 1 patient each had a MH-induced retinal detachment and combined retinal detachment. The control group included 10 cases with similar configuration and duration of MHs treated with the inverted peeling of the internal limiting membrane technique. All patients underwent a standard 3-port, 25-gauge transconjunctival pars plana vitrectomy and hAM plug transplantation in the subretinal space under the MH. The anatomic and functional outcomes were assessed at 4 weeks postsurgery. RESULTS: At the 4-week follow-up visit, all the MHs in the hAM plug group achieved hole closure, whereas 80% of the eyes in the control group were able to achieve hole closure. Improvement of 0.1 logMAR vision was noted in 8 of the 10 patients. At the 4-week follow-up visit, the external limiting membrane and ellipsoid zone layer continuity over the hAM was defined only in one case. No significant difference was found between the hAM plug group and controls in visual and anatomical responses. No complications following hAM transplantation such as rejection, endophthalmitis, or hypotony were noted following surgery. CONCLUSION: Subretinal hAM graft transplantation can be a useful option in the repair of primary or refractory MHs not only for achieving anatomic closure but also for the accompanying visual improvement.

Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries.

Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC) before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure. This technique, used in 12 eyes, seems to be effective in patients with angle-closure glaucoma, malignant glaucoma, and per-operative sudden increase in vitreous pressure during surgery. Small-incision surgeries are ideally suited for this procedure. This minimally invasive technique is simple to perform and complications are unlikely to be more than what is seen with intravitreal injections.