Aberrant filling of the retinal vein on fluorescein angiography in branch and hemi-central retinal artery occlusion.

OBJECTIVE: To study aberrant filling of the retinal vessels on fluorescein angiography (FA) images in patients with branch (BRAO) or hemi-central retinal artery occlusions (hemi-CRAO) and correlate with associated changes on optical coherence tomography (OCT). METHODS: Cases of acute BRAO or hemi-CRAO having FA and OCT images at presentation between June 2017 to May 2022 were included. Comparisons were made between the cases with and without aberrant filling of the retinal vessel. RESULTS: Thirty-nine eyes of 39 patients with acute retinal artery occlusions underwent FA and OCT imaging. Seven of the ten cases with either BRAO or hemi-CRAO showed aberrant filling of the retinal vein on FA. No case with CRAO showed aberrant filling on FA. The cases with aberrant filling showed a better presenting visual acuity and lesser severity of retinal ischemia on OCT. Shunts between the retinal artery in the unaffected region and the retinal vein in the affected segment was seen in two eyes. The remaining five eyes showed no arteriovenous anastomosis. Cases with aberrant filling had a better visual function even at the last visit. CONCLUSION: Aberrant retinal vein filling across the horizontal median raphe in the affected region in BRAO or hemi-CRAO eyes had less severity of retinal ischemia and better presenting and final visual acuities. Reduced perfusion in retinal capillaries with altered retinal vascular anatomy or arteriovenous shunts could be probable reasons for the development of this FA finding. Presence of aberrant filling of the retinal vein could indicate better final visual prognosis.

Trends in teleconsultations for uveitis during the COVID-19 lockdown.

Purpose: To study the use of teleophthalmology as a tool to manage patients with uveitis and to describe the experience of teleconsultation for uveitis at a tertiary eye care hospital in India during the two waves of the COVID-19 pandemic. Methods: A prospective observational case series of uveitis patients seeking teleconsultations during the first (March 25-May 2020) and second lockdown (April 27 to June 21, 2021) in a tertiary eye care center were analyzed. Results: There were 79 teleconsultations in the first and 89 teleconsultations in the second lockdown. A majority of the patients presented in the age group of 41-60 years in both the lockdowns. There were both new or primary consultations and follow-up patients (6% vs. 94%) in the first lockdown, and similarly in the second lockdown (8% new vs. 92% follow-up). The majority of patients resided in Bengaluru city (78% in the first and 76% in the second lockdown). After evaluation through video consultation, only 15% required a hospital referral in the first lockdown, whereas in the second lockdown, 21.3% were referred to the hospital. During the second lockdown, 20% presented with COVID-19 infection-related ailments. Conclusion: Based on our preliminary experience using a customized smartphone-based application for teleconsultation, we found it to be an alternative option to provide continuation of ophthalmic care to uveitis patients. Given the current COVID-19 situation, it can help avoid physical visits of uveitis patients to the hospital.

Inter-observer agreement and sensitivity of Optomap images for screening peripheral retinal lesions in patients undergoing refractive surgery.

PURPOSE: The aim of this study was to compute the sensitivity, specificity and inter-reader variability of ultra-widefield retinal imaging (Optomap 200Tx) for screening retinal lesions before myopic refractive surgery. METHODS: Two hundred and eight eyes of 109 consecutive refractive surgery candidates were included in this study. All subjects underwent Optomap 200Tx, mydriatic slit-lamp lens examination and dilated retinal examination with scleral indentation by a retinal specialist. Retinal findings by indirect dilated examination by retinal specialist was considered as the gold-standard. Sensitivity analyses for the readers were calculated between the Optomap images and the gold-standard retinal examination. RESULTS: Seventy-three of the 208 eyes (35.1%) had peripheral retinal lesions diagnosed by the retinal specialist on dilated fundus examination. Peripheral lesions were seen on the Optomap images in 111 (53.4%) eyes. Compared to the dilated retinal examination, the detection rate with the Optomap 200Tx was 78.1% and specificity rate was 60%. The accuracy rate between the 3 readers ranged from 72% to 87%. The highest accuracy was noted with the reader post 1 year of retinal training (86.54%). CONCLUSION: The Optomap 200Tx showed a high sensitivity and moderate specificity for identifying peripheral retinal lesions in eyes undergoing refractive surgery. The Optomap examination is a convenient, fast and feasible method for detecting the pathological fundus changes in myopic eyes. The reliability of the examination improves when the images are interpreted by a reader with prior retinal training.