Seasonal Hyperacute Panuveitis (SHAPU) Outbreak Amidst COVID-19 Pandemic.

PURPOSE: To document the demographic profile of the SHAPU outbreak amidst the COVID-19 pandemic. METHODS: A multicentric cross-sectional study of the 2021 SHAPU outbreak during the second phase of the COVID-19 outbreak. RESULTS: A total of 135 patients were diagnosed with SHAPU from August to December 2021, 77 (57%) were children <16 years, males 54.8% and 34.8% had direct physical contact with white moths and 41.5% had severe type of SHAPU. Dramatic increment in the moth abundance was noted in these outbreak sites. Few cases presented with atypical ocular findings, unlike past outbreaks. Due to the ongoing COVID-19 pandemic with restrictions on travel and transportation, timely management was difficult and good visual outcome was achieved only in mild-moderate cases with an early presentation. CONCLUSION: The surge in the number of SHAPU patients, its occurrence in areas previously unreported, and some atypical presentation added raised suspicion of a possible link between COVID-19 and SHAPU.

Increase in SHAPU patients, incidence in unreported areas of Nepal, atypical ocular presentations and shift in disease affection from children towards adults population have raised doubt between connections between SHAPU, white moths and COVID pandemic.

Unilateral blindness presumed as sudden acquired retinal degeneration syndrome (SARDS) in one Dachshund and four Maltese dogs.

OBJECTIVE: To describe blindness, initially presenting as a unilateral condition and diagnosed as sudden acquired retinal degeneration syndrome (SARDS). ANIMALS STUDIED: One Dachshund and four Maltese dogs presented with unilateral blindness, for which the results of general ophthalmic examinations were insufficient to explain the blindness. All dogs were spayed females. RESULTS: Intraocular pressures were normal, and the optical media of the eyes were clear. Fundus appearances of the initially blind eyes were within normal variations, with slightly attenuated retinal blood vessels in some cases when compared with the sighted contralateral eyes. Electroretinography (ERG) amplitudes of the affected eyes were flat and reduced in the contralateral-sighted eyes in four dogs. One dog underwent ERG after the blindness progressed bilaterally 8 days after initial presentation (despite topical steroid medication). Two dogs had no recheck visits, but phone call follow-ups reported bilateral blindness 3 months later in one dog. One dog received no medication and retained vision in the contralateral eye until the last follow-up (94 days later). One dog received systemic cyclosporine and steroid medications and maintained vision in the contralateral eye; however, regular ERG rechecks showed a trend of declining amplitude (448 days). In this dog, optical coherence tomography (OCT) showed different stages of disorganized retinal layers as well as different retinal thickness between the eyes. CONCLUSIONS: Despite normal-looking fundi, ERG and OCT revealed different degrees of retinal changes between both eyes in this study. Eyes with vision might develop progressive blindness after a substantial amount of time in these presumed SARDS cases.

Classification of Seasonal Hyperacute Panuveitis (SHAPU).

INTRODUCTION: Classification are essential part of scientific methodology and has important role in medical reporting system. Even after having 46 years long history, Seasonal Hyperacute Panuveitis (SHAPU), the blinding diseases reported mainly from Nepal lacks a standard classification system. Thus, we aim to contribute in the ophthalmic nosology by purposing a classification system for SHAPU. METHODOLOGY: The classification is suggested on the background of prolonged experience of this entity by the group of investigators who have dedicated years of research on this topic. CONCLUSION: We are optimistic that the proposed classification system will help in effective planning and evaluation of this ocular emergency condition and deliver the appropriate and reliable information for timely management and prevention of complications.

Acute unilateral vision loss from central retinal artery occlusion associated with an atrial septal aneurysm and a patent foramen ovale: a case report.

BACKGROUND: Acute unilateral vision loss is an ophthalmological emergency. It can have multiple aetiologies, and physicians must be able to quickly determine the cause of the condition, as immediate intervention may prevent permanent vision loss. Acute unilateral vision loss has not previously been associated with a patent foramen ovale (PFO). OBJECTIVE: We describe a patient who presented with painless sudden loss of vision in his left eye. He was diagnosed to have central retinal artery occlusion, likely from a paradoxical embolus associated with an atrial septal aneurysm containing a PFO. The patient underwent successful percutaneous closure of the PFO without complication. This report details the evaluation and differential diagnosis of acute unilateral vision loss. Additionally, the controversy of whether a PFO should be closed prophylactically for stroke prevention is discussed. CONCLUSION: Acute unilateral vision loss from central retinal artery occlusion may be caused by a paradoxical embolus originating from an atrial septal aneurysm with a PFO. This case should be considered in the controversy of whether prophylactic closure of a PFO could be beneficial for primary prevention of stroke.

Sudden loss of vision in one eye is an emergency, and rapid evaluation and treatment are essential. We report a case of acute vision loss in one eye that was associated with a communication between the right and left receiving chambers of the heart, with blood clot at the communication. It was assumed that clot passing from the venous to arterial side of the heart, was carried in the blood stream, and subsequently blocked the main artery to the affected eye. The communication was closed with a device, without the need for surgery. This potential cause of vision loss has not previously been reported. It is important that physicians search for this type of communication in the heart when there is abrupt vision loss in one eye. The merits of closing such a communication is discussed.

Orbital compartment syndrome resulting in unilateral blindness in two dogs.

Orbital compartment syndrome (OCS) is described in humans as an acute rise in intraorbital pressure following a severe and rapidly evolving orbital affection. It includes orbital oedema, haemorrhage or infection causing a marked reduction in local blood perfusion, and severely affecting the orbital neurovascular structures. If not promptly recognised and treated, it results in irreversible blindness. It is one of the rare ophthalmic surgical emergencies, requiring lateral canthotomy and cantholysis. This case report describes two canine cases of complex orbital, periorbital and facial abscesses resulting in OCS and permanent unilateral blindness diagnosed by ultrasonography, computed tomography and electroretinography.

Prevalence and causes of blindness at a tertiary hospital in Douala, Cameroon.

PURPOSE: The aim of this study was to determine the prevalence and causes of bilateral and unilateral blindness in the town of Douala and its environs based on data from the ophthalmic unit of a tertiary hospital in Douala. METHODS: We conducted a retrospective epidemiological survey of consultations at the eye unit of the Douala General Hospital over the last 20 years (from January 1, 1990 to December 31, 2009). RESULTS: Out of the 1927 cases of blindness, 1000 were unilateral, corresponding to a hospital prevalence of 1.84% and 927 cases were bilateral, corresponding to a hospital prevalence of 1.71%. No statistically significant difference was noted between the two (P = 0.14). The leading causes of bilateral blindness were cataract (50.1%), glaucoma (19.7%), and diabetic retinopathy (7.8%) while the leading causes of unilateral blindness were cataract (40.4%), glaucoma (14.1%), and retinal detachment (9.1%). Cataract (51.2%), cortical blindness (16.3%), and congenital glaucoma (10%) were the leading causes of bilateral blindness in children aged less than 10 years. CONCLUSION: Blindness remains a public health problem in the Douala region with a hospital prevalence which is relatively higher than the national estimate given by the National Blindness Control Program.

Sudden Unilateral Blindness and Ophthalmoplegia after Ruptured Anterior Communicating Artery Aneurysm Surgery: Report of 2 Cases / 대한뇌혈관외과학회지

The incidence of unilateral blindness and ophthalmoplegia after aneurysm surgery is very rare, especially in an anterior communicating artery (ACoA) aneurysm, but if it occurs, it is mainly caused by intra-operative nerve injury or retinal ischemia. We experienced 2 cases of unilateral blindness immediately after surgery. Both patients were classified into Hunt-Hess grade 1 and Fisher grade 3. Angiographic findings of these patients revealed that the aneurysms were located at the left ACoA. The aneurysms were clipped easily with minimal brain retraction via standard pterional craniotomy. In both cases, injury of the optic nerve during surgery was unlikely. Both patients complained of visual loss with ophthalmoplegia ipsilateral to the site of surgery on the 1st postoperative day and showed evidence of retinal ischemia with central retinal artery occlusion on fundoscopic examination. In our patients, we hypothesize that the complications were most likely related to the intra-orbital ischemia initiated by the collapse of the arterial and venous channels in the orbit and/or to the direct or indirect contusion on the intra-orbital structures. These situations could be produced by inadvertent pressure placed on the eyeball with a bulky retracted frontal skin flap. Visual acuity in both patients ranged from no light perception to finger-counting. Their external ophthalmoplegia had completely disappeared 2 weeks after surgery and visual acuity in one patient began to improve. But in the other patient, the condition was irreversible. The degree of visual recovery seems to be dependent on the duration and severity of retinal ischemia by orbital compression. Unfortunately, there is no satisfactory treatment. We recommend careful surgical manipulation, including the use of an eye shield just before aneurysm surgery to protect the ipsilateral eyeball.

Unilateral childhood blindness: a hospital-based study in Yaoundé, Cameroon.

INTRODUCTION: We performed an analytic and prospective study over a period of 12 months from January 2nd to December 31st, 2008, at the Gynaeco-Obstetric and Paediatric Hospital of Yaoundé, Cameroon. Our aim was to determine the prevalence and causes of unilateral blindness in school children aged 6 to 15 years. RESULTS: Among the 1,266 children aged 6 to 15 years who were recruited, 60 presented with unilateral blindness (4.7%): 42 boys (6.96%) and 18 girls (2.71%). The mean age was 10.15 +/- 3.4 years. In patients with unilateral blindness, 65% was due to ocular trauma. DISCUSSION: The hospital-based prevalence of unilateral blindness in children is relatively high and ocular trauma is the leading etiology. CONCLUSION: Unilateral blindness in school children is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Early management of nontraumatic diseases such as infantile glaucoma and some tumors could improve outcome and avoid blindness.

Permanent unilateral blindness associated with peripartum cardiomyopathy.

Peripartum Cardiomyopathy (PPCM) is a rare and ominous disease manifested in the peripartum period of women with complications concerning different organic systems. We describe a case of peripartum cardiomyopathy which was complicated with acute permanent unilateral blindness, further documented embolic retinal artery occlusion as a consequence of PPCM. This is a quite unusual event with PPCM, since to our knowledge there is no previously reported case with PPCM as the sole associated factor. The purpose of our paper is to emphasize that thromboembolism of the central retinal artery, seems to be compatible with peripartum cardiomyopathy and that, peripartum blindness, may be attributed to the cardiomyopathy diagnosis.

Five Cases of Orbital Infarction Syndrome Caused by Compression of Surgical Scalp Flap / 대한뇌혈관외과학회지

Orbital infarction syndrome is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests proptosis, ophthalmoplegia, and unilateral blindness. We recently experienced 5 cases of proptosis, ophthalmoplegia and unilateral blindness immediately after operation for 2 years. The cause of orbital infarction syndrome in these cases appeared to be the direct compression of orbit by the tightly retracted frontal scalp flap. We report and discuss possible mechanism with literature review.

Sudden Unilateral Blindness after Intracranial Aneurysm Surgery

The incidence of unilateral blindness and ophthalmoplegia after aneurysm surgery is very rare, but if there is, it is mainly caused by intraoperative nerve injury. We experienced 6 cases of unilateral blindness immediately after surgery for 5 recent years. These patients were classified from Hunt-Hess grade I to II except for one patient with III. All patients complained of visual loss with varying degree of lid edema and ophthalmoplegia ipsilateral to the surgery site. Angiographic examination of these patients revealed that the aneurysm site was located at the internal carotid artery bifurcation in one case and the middle cerebral artery bifurcation in five cases. All of them were relatively far from the optic nerve. The aneurysm was clipped easily with minimal brain retraction via standard pterional craniotomy since the brain was slack in all cases. In all cases, injuring the optic nerve during surgery was remote. All patients showed evidence of retinal ischemia of fundoscopy with or without fluorescein an giography. The pathophysiology of this ischemic event is unknown. In our patients, we could exclude possible etiologic factors such as abnormal systemic and ocular conditions, causing ischemia in intraorbital structures, increased intracranial pressure, intraoperative hypotension, carotid atherosclerosis, and vasculitis. Accordingly we believe that the complications ween in our cases were most likely related to intraorbital ischemia initiated by a collapse of the arterial and venous channels in the orbit and/or to direct or indirect contusion on the intraorbital structures. These situations could be produced by inadvertent pressure placed on the eyeball with a bulky retracted frontal skin flap. Visual acuity in these patients ranged from no light perception to the ability to see objects and detect color. Their conditions were irreversible. Unfortunately a satisfactory treatment is lacking. Neurosurgeons should be aware that this complication may follow intracranial aneurysm surgery and should ensure that the retracted flap is not compressive to the eye-ball, especially in patients with risk factors.