Ocular disease as the presenting sign of rheumatoid arthritis - An observational case series.

Rheumatoid arthritis (RA) is an inflammatory auto-immune multi-system disorder affecting the synovial joints. Ocular manifestations occur in a significant proportion of patients with RA. Although there are literature studies available indicating that ocular involvement can be the presenting sign in RA, reports available are sparse. Our case series is a report of seven patients presenting with ocular manifestations of RA. It highlights the fact that familiarity with the characteristic features of RA among ophthalmologists and physicians helps in making a timely diagnosis, assessing the disease activity, and understanding how a diagnosis of systemic disease made on ocular manifestations can alter the course of the disease in terms of reducing morbidity and prolonging life expectancy.

Ocular Features and Visual Outcome in Children with Moyamoya Disease and Moyamoya Syndrome: A Case Series.

Moya Moya Disease (MMD) is characterised by idiopathic vasculopathy affecting the terminal internal carotid arteries resulting in the formation of extensive collaterals at the base of the brain, leptomeninges and parenchymal regions with resultant infarcts and bleeds. Four children presented with clinico-radiological features suggestive of Moyamoya disease/syndrome. This includes global developmental delay, recurrent seizures, transient ischaemic attacks and impaired vision. The first patient had vision of 6/15 in both eyes with bilateral optic disc pallor. Second case also had bilateral optic disc pallor with arteriolar attenuation, but had vision of perception of light only in both eyes. The third child had vision of 6/60 with alternate divergent squint and clinical features suggestive of Neurofibromatosis 1 (NF 1). Fourth patient presented with poor fixation in both eyes with bilateral total cataract. He underwent bilateral cataract surgery with intraocular lens implantation and vision improved to 2/60 with good fixation. We also describe their medical and neurosurgical interventions in this report.