Linear Nevus Sebaceous Syndrome: Clinical Presentation and Management Considerations.

A relatively rare neurocutaneous condition known as linear nevus sebaceous syndrome (LNSS) is marked by a variety of symptoms as well as the unusual characteristics of developing mosaic RASopathies of phacomatoses. Mental retardation, seizures, and midline facial linear nevus sebaceous were the usual diagnostic triad. A hallmark of LNSS is the papillomatous growth of the epidermis, also known as nevus sebaceous. In this case report, we presented a case of a 13-year-old male with LNSS with a vascular conjunctival lesion and a coloboma of the optic disc.

Understanding the Clinical Relationship Between Diabetic Retinopathy, Nephropathy, and Neuropathy: A Comprehensive Review.

Diabetic retinopathy, nephropathy, and neuropathy are significant microvascular complications of diabetes mellitus, contributing to substantial morbidity and mortality worldwide. This comprehensive review examines the clinical relationship between these complications, focusing on shared pathophysiological mechanisms, bidirectional relationships, and implications for patient management. The review highlights the importance of understanding the interconnected nature of diabetic complications and adopting a holistic approach to diabetes care. Insights gleaned from this review underscore the necessity for early detection, timely intervention, and integrated care models involving collaboration among healthcare professionals. Furthermore, the review emphasizes the need for continued research to elucidate underlying mechanisms, identify novel therapeutic targets, and assess the efficacy of integrated care strategies in improving patient outcomes. By fostering interdisciplinary collaboration and knowledge exchange, future research endeavors hold the potential to advance our understanding and management of diabetic complications, ultimately enhancing patient care and quality of life.

Fulminant Eye Infection in a Patient With Nephrotic Syndrome: A Case Report.

This case report presents the clinical course of a 53-year-old male farmer with nephrotic syndrome, specifically focal segmental glomerulosclerosis, who developed a fulminant eye infection. While receiving maintenance hemodialysis and immunosuppressive therapy, the patient presented with sudden onset redness, discharge, and decreased vision in his right eye. Initial management with topical antibiotics and steroids failed to halt the progression of the infection, leading to corneal perforation and iris prolapse within a few days. Despite the discontinuation of immunosuppressive medications and initiation of broad-spectrum antimicrobial therapy, the patient's compromised renal function and anaemia precluded surgical intervention. This case underscores the challenges in managing severe ocular infections in immunocompromised patients. It highlights the importance of early recognition, aggressive antimicrobial therapy, and close ophthalmologic monitoring in preventing sight-threatening complications. Despite intensive management, the prognosis for visual recovery in such cases may be poor, emphasizing the need for preventive strategies and careful surveillance in high-risk patient populations.

Regeneration of the Retina Using Pluripotent Stem Cells: A Comprehensive Review.

Retinitis pigmentosa and age-related macular degeneration are the most frequent causes of irreversible visual impairment in the world. Existing therapeutic methods could be more effective, underscoring the necessity of new treatments. Reconstructing the retinal photoreceptors through the transplantation of human pluripotent stem cells, representing an attractive approach for restoring vision, has gained momentum. This paper gives an exhaustive account of what has been known in this field, the discoveries made, and the recent progress. This review paper outlines the retina's organisation, cell types, the pathophysiology of retinal injury/degeneration, and the reasoning behind using pluripotent stem cells in retinal regeneration. This article investigates differentiation strategies, molecular components that dictate cell type specification, and the recreation of retinal development in vitro, genetically engineering and manipulating epigenetic marks using various techniques for driving specific cell fates and improving therapy efficacy. Subretinal injection methods, cell encapsulation techniques, scaffold-based approaches, cell sheet transplantation, and their impact on integrating implanted cells into a functional retina are thoroughly reviewed. Using bioengineering approaches, biomaterials and growth factors form a favourable micro-ambience for grafted cells. Issues around safety and efficacy (tumorigenicity, immunological rejection, and long-term integration/functionality) are explored. Moreover, the paper emphasises the significance of rigorous characterisation, immunomodulatory strategies, and clinical and pre-clinical studies to ensure the safety and effectiveness of retinal regeneration therapy. Future perspectives and challenges are presented, looking at fine-tuning differentiation strategies, improving functional integration and regulatory aspects, and using co-therapy and supportive treatments.

A Narrative Review of Retinopathy in Diabetic Patients.

Patients with diabetes may be at risk of ocular diseases, like retinopathy due to diabetes and oedema of the eye. Patients with retinopathy due to diabetes experience constant injury to the retina and the posterior end of the eye, which is light-sensitive. It is a prominent complication faced by diabetics that threatens a patient's vision. Diabetes can inhibit the body's potential to ingest and maintain blood glycemic levels, resulting in several health problems. Excessive glucose in the blood can affect the eyes and other organs of the body. Diabetes has an effect on the blood supply system of the retina over a prolonged period of time. Diabetes-related retinopathy can lead to blindness as fluid can flow into the macula, which is essential for maintaining a clear visual field. The macula, despite its small size, is the region that enables us to comprehend colours and fine peculiarities well. The fluid swells the macula, leading to an impaired visual field. The weak, irregular blood vessels formed during neovascularization can potentially haemorrhage into the posterior end of the eye, obstructing the visual field. Blood vessels of the eye leak blood and other fluids, causing retinal tissue enlargement and eyesight clouding. Typically, the illness affects both eyes. Diabetes retinopathy is more likely to develop as a person's diabetes progresses. If untreated, retinopathy due to diabetes can result in blindness.

Advancement in Understanding Diabetic Retinopathy: A Comprehensive Review.

Diabetic retinopathy (DR) is a significant global health concern, with its prevalence and severity increasing alongside the rising incidence of diabetes. DR is a leading cause of vision impairment among working-age adults, resulting in substantial economic and healthcare burdens. This article explores the epidemiology and pathophysiology of DR, highlighting the global variation in its prevalence and the associated systemic risk factors. It delves into the complex relationship between glycemic control, duration of diabetes, and medication use in the context of DR development and progression. The review also discusses current screening methods and their implications, emphasizing the need for efficient and scalable approaches. Furthermore, it investigates the various treatment strategies available for DR, including laser photocoagulation, vitreous body excision, and anti-vascular endothelial growth factor (VEGF) therapy, while underlining their limitations and potential side effects. In conclusion, this article underscores the urgency of developing novel preventive and therapeutic approaches for DR. It highlights the potential role of cytokines and growth factors as treatment targets and emphasizes the importance of glycemic control and management of systemic risk factors in mitigating the impact of this vision-threatening complication of diabetes. The article serves as a comprehensive resource for understanding the challenges posed by DR and the need for innovative strategies to address this growing public health concern.

Ocular Dominance and Its Association With Central Corneal Thickness: An Observational Study in Central India.

Background The aim of this study is to determine ocular dominance and its association with central corneal thickness (CCT). These two parameters are of great significance in clinical practice; identifying the dominant eye helps in planning cataract surgeries, treatment of presbyopia, monovision correction, etc., and assessing the CCT helps in early diagnosis and management of keratoconus, glaucoma, contact lens-related complications, and dry eye. Methods A cross-sectional study that involves patients and volunteers who have come for a checkup to the ophthalmology department of the college hospital. Ninety patients were examined for this study within two months. The hole-in-card test is performed to determine the ocular dominance in people with normal and healthy eyes without any pathologies except refractive errors. Specular microscopy through a non-contact modality will be done to assess the thickness of the central cornea in both eyes. Statistical analysis was done using the paired t-test to compare the patient's eyes and the chi-square test, which helps us associate ocular dominance and CCT.  Results Right eye dominance was seen in the majority of the participants (72.91%), whereas left eye dominance was seen in comparatively fewer participants (27.08%). The CCT of the dominant eye is found to be 520.40 ± 29.83 µm and that of the non-dominant eye is 524.40 ± 29.37 µm. A lower CCT in the dominant eye was seen in 83.33% of the subjects; 14.58% of them had a higher CCT in the dominant eye and 2.08% had the same CCT in both eyes. Conclusion From the observational study that has been made, the majority of the population shows right eye dominance. The CCT is relatively thinner in the dominant eye. About 80-85% of the examined people showed a thinner cornea in the dominant eye. But we cannot generalize that the eye with a lesser corneal thickness will be the dominant eye in all the cases, as a few cases have shown dominance in the eye with a thicker cornea.

Confounder for Optic Disc Evaluation in Glaucoma.

Congenital disc anomalies like optic disc coloboma or optic disc pit are rare occurrences. Coloboma involving disc or optic disc coloboma occurs due to defective closure of choroidal fissure, which can be unilateral or bilateral. These anomalies are discovered on routine examination or referred to as an open-angle glaucoma suspect. These anomalies can be asymptomatic or may present with visual field defects. Here we report a case of both eyes angle closure glaucoma with incidental finding of unilateral coloboma involving disc in the left eye. Optical coherence tomography of the optic nerve head showed peripapillary nerve fiber loss. Thus assessing such patients for diagnosis and the progression of visual field defects in managing glaucoma is quite challenging.

A Review of Pathogenesis and Risk Factors of Diabetic Retinopathy With Emphasis on Screening Techniques.

Diabetes mellitus (DM) is an important topic for public health in India and globally. The rise in the number of cases of diabetes in India is alarming as it will eventually increase the number of cases of diabetic retinopathy (DR). DM is related to many microangiopathic abnormalities, among which DR has recently emerged as a common cause of vision impairment in middle and low-income countries. If diagnosed on time, we can prevent vision impairment and complete blindness in patients with the help of proper treatment. Life-long retinal check-ups among people who have diabetes are an essential strategy for the early diagnosis of DR. In this article, we have focused mainly on the significance of DR in loss of vision, the risk factors associated with the disease, the proper pathogenesis of the disease, including the involvement of vascular endothelial growth factor (VEGF), the further consequences of the disease, screening techniques that are already available and those that need to be incorporated, and finally the treatment options available for the patients. The knowledge about this disease and various components related to it, be it either risk factors, pathogenesis, or screening techniques and treatment, would surely help clinicians better understand the condition to formulate strategies for its early diagnosis and cost-effective and sustainable treatment, which would ultimately result in providing better care to the patients.

Ocular Adverse Effects of Gefitinib: A Case Report.

Gefitinib is a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. It is used for treating locally advanced or metastatic non-small cell lung carcinoma and is well tolerated systemically. However, sight-threatening ocular adverse effects, like corneal ulcer and perforation, can occur due to the expression of EGFR on limbal and conjunctival epithelia. In this report, we describe a case of a 36-year-old female who presented with loss of eyebrow hair and eyelashes of both eyes and blurring of vision in the right eye. On ocular examination, the patient had anterior blepharitis, madarosis, punctuate epithelial erosions and reduced corneal sensation in both eyes, and corneal thinning in the right eye. On specular microscopy, there was decreased central corneal thickness in both eyes. Treatment with topical antibiotics and lubricating drops led to the resolution of blepharitis and punctate epithelial erosions. This case report aims to create awareness among ophthalmologists and oncologists about the early detection of gefitinib-related ocular adverse effects and timely intervention in patients.

Comprehensive Review of Pulmonary Hypertension and Treatment Options in the Paediatric Population.

Pulmonary hypertension (PH) is a complex condition that can occur as a result of a wide range of disorders, including left heart disease, lung disease, and chronic pulmonary thromboembolism. Multiple improvements have been made in the diagnosis and treatment of pulmonary arterial hypertension (PAH) including a greater understanding of the involvement of extrapulmonary vascular organ systems, validated point of care, clinical assessment tools, and a focus on the initial exposure of numerous pharmacotherapeutics in the appropriate level of care. To achieve a minimal symptom burden, improve the patient's biochemical, hemodynamic, and functional profile, and reduce adverse impact, early diagnosis of PAH is a key objective today. The preferred method of management for thromboembolic PH, which is chronic, is pulmonary endarterectomy since the majority of affected patients are operable. The timing of pulmonary endarterectomy should never be delayed for medical reasons, and risk stratification can enable us to select patients who have a high chance of success. Patients who are not qualified for endarterectomy should be referred for drug trials. Even though there are more effective ways to guarantee a sufficient, long-lasting septostomy, atrial septostomy is promising but undervalued. The procedure's indications remain the same and need to be taken into account more frequently. Class III or IV patients who are not improving need to be consulted at a transplant centre as soon as possible as they may be candidates for potential recipients of bilateral sequential lung or heart-lung transplants, which is a significant choice for some people. PH is rarely linked to other conditions like connective tissue or thromboembolic disease. It is either idiopathic or linked to congenital heart disease. Infants and children with PH are more frequently recognised in conjunction with a congenital diaphragmatic hernia and developmental lung diseases like bronchopulmonary dysplasia. Although the underlying disease has not yet been treated and advanced structural changes have not yet been reversed, the value of natural life and survival have suggestively increased. Children's haemodynamic and functional outcomes have improved as a result of endothelin receptor antagonists, prostacyclin analogues, and phosphodiesterase type 5 inhibitors, which are examples of targeted pulmonary vasodilator therapies. The health maintenance of paediatric PH is still difficult because treatment decisions are largely based on the findings of adult studies that have been supported by evidence and the clinical expertise of paediatric specialists.

Ocular Gene Therapy: A Literature Review With Focus on Current Clinical Trials.

Gene therapy has been one of the most researched topics in the last decade. It has now become a revolutionized therapeutic tool of modern medicine. Gene therapy is the alteration of the defective gene involved in the disease process in the host cells. It delivers therapeutic genetic information via modified viral or non-viral vectors. Ocular gene therapy, in particular, has progressed in treating inherited retinal diseases since the eye is a favourable organ for gene therapy development. The advantage of the eye as a target for gene therapy is attributed to its easy accessibility and blood-ocular barrier. Several ongoing clinical trials are investigating various gene therapies for other ocular diseases, including neovascular age-related macular degeneration, retinitis pigmentosa (RP), Usher syndrome, glaucoma, and several others. However, there are challenges such as ocular inflammation and humoral response, infection by the viral vectors, and insertional mutagenesis. These limitations depend on several factors; whether viral or non-viral vectors are used, which viral vectors were used, the route of administration, whether subretinal, intravitreal, or suprachoroidal, and the dose of vectors and the target tissue. These complications may lead to therapeutic failure and vision loss due to intraocular inflammation. This review aims to summarize existing knowledge about ocular gene therapy and the associated limitations we face, with a special focus on a few ongoing clinical trials.

A Classical Presentation of Optic Disc Pits With Complex Maculopathy.

A rare congenital abnormality of the optic disc, known as the optic disc pit (ODP), can cause progressive vision loss when it is associated with maculopathy. Only 15% of ODP cases are bilateral, with a reported incidence of 1 in 11,000 cases and with no gender differentiation. A 56-year-old woman presented in the outpatient department with a history of gradual painless diminution of vision in the right eye for one year. On ocular examination of the right eye, the patient has a vision of counting finger 1 m not improving with pinhole, and anterior segment evaluation is within normal limits. On fundus examination, we could appreciate a grayish, white small hypopigmented depression present in the inferotemporal part of the optic disc suggestive of ODP and edema present in the inferior half of the macula along with cystoid macular edema. The fundus photo of the right eye was suggestive of inferotemporal ODP in the right eye and normal fundus in the left eye. Optical coherence tomography (OCT) of the right eye showed inferotemporal ODP connecting with the subarachnoid space of the optic nerve. The macula showed diffuse edema extending from disc to macula, neurosensory detachment, macular schisis, and cystoid macular edema. We report a case of unilateral ODP maculopathy (ODP-M), which is a congenital anomaly of the optic nerve head (ONH) located at the inferotemporal part of the optic disc with multilayered separation involving all retinal layers and connecting with the subarachnoid space, as seen on OCT.