Outcome of pediatric cataract surgery including color vision, stereopsis, and cognition in a tertiary eye care center in India.

BACKGROUND: Pediatric cataract is an important cause of avoidable childhood blindness in India. Although there are studies on clinical features and visual acuity outcomes of pediatric cataract surgery, there are no studies that look into aspects of color vision, stereopsis, and cognitive functions in children with cataracts. Studying these parameters pre- and postsurgery will help us assess the overall components of visual function that are critical for the child's development. With this in mind, we aimed to study the clinical features, outcome of treatment, color vision, stereopsis, and cognitive functions in children with cataracts. MATERIALS AND METHODS: Design: Hospital-based prospective descriptive study. Data of 68 children (0 < 18 years) were collected, on the clinical features, visual acuity, color vision, stereopsis, and social and intelligence quotient before and after surgery. Data analysis was performed using Graph Pad Prism software version 9.4.0 (673). RESULTS: Ninety eyes of 68 children (36-bilateral/32-unilateral) were operated. A total of 46 children were available at 6 months' follow-up (28 bilateral cataracts (46 eyes) and 18 unilateral cataracts). Nineteen (67.8%) of the bilateral, had a best corrected visual acuity of 6/6-6/18 in the better eye and nine (50%) of the unilateral had a visual acuity of 6/18-6/6 in the operated eye. Preoperatively, 61.5% of the children had a stereopsis of 100-600 arc-secs. Post-operatively, 84.4% of the children had a stereopsis in the range <50-600 arc-secs. All children had color vision deficiency. Preoperatively, 62% of the children had strong and moderate deficiency, whereas postoperatively, 66.6% had mild deficiency. We found negative correlation (r = -0.503) between social quotient and percentage of visual impairment indicating that when visual impairment increases social quotient decreases. The mean IQ preoperatively was 94.36 ± 2.98 and postoperatively 101.38 ± 2.77, with 95% confidence interval P value was statistically significant (P = 0.0001). This shows better and faster performance postoperatively. CONCLUSION: Majority of the children had improved visual acuity after surgery. This outcome can be extrapolated to the overall improvement in stereopsis, color vision, and higher cognitive functions.

Posterior staphyloma-induced serous maculopathy: Evolution and successful treatment with subthreshold micro pulse Laser.

PURPOSE: To describe the evolution of posterior staphyloma-induced serous maculopathy (PSISM) in a patient with myopic tilted disc syndrome and its treatment with subthreshold micro pulse laser (SMPL) therapy. CASE DESCRIPTION: A 38-year-old male, diagnosed previously with classical features of myopic tilted disc syndrome presented to the retina clinic after 5 years from the initial presentation with blurred vision in the right eye for 6 months, visual acuity of 6/15 and findings of serous macular detachment (SMD) and subretinal precipitates at the upper margin of the posterior staphyloma. Retinal imaging ruled out other causes of SMD such as chronic central serous chorioretinopathy, myopic macular neovascularisation and dome shaped macula. A diagnosis of PSISM was confirmed. The left eye fundus and macula was normal. RESULTS: Confluent SMPL burns were applied across the SMD. The serous maculopathy resolved over a period of 2 months and visual acuity improved to 6/9. No recurrence of SMD was noted even after 14 months post SMPL. CONCLUSION: PSISM develops gradually in eyes with myopic titled disc syndrome. SMPL is a viable therapeutic option in the management of PSISM and should be considered early in the treatment options.

Characteristics of myelinated retinal nerve fibres in associated straatsma syndrome.

PURPOSE: To study cases diagnosed of myelinated retinal nerve fibres (MRNF) continuous with the optic disc and describe the plausible pathogenic mechanism for the ocular features in Straatsma syndrome. METHODS: This retrospective observational study includes clinically diagnosed MRNF cases. MRNF, myopia, and amblyopia defined Straatsma syndrome. MRNF were classified into three types based on location: type 1 in the superior retina, type 2 in the superior and inferior retina, and type 3 in the inferior retina. MRNF size was measured on Optomap® (Optos, Daytona, UK) images and posterior staphyloma location was noted. Demographics and best-corrected refractive error in logMAR units was recorded. Descriptive statistics and Spearman's corelation test were used to analyse MRNF size's relationship to refractive error and logMAR visual acuity. RESULTS: The study included a total of 19 MRNF eyes from 18 patients. Seventeen (89%) eyes had Straatsma syndrome. Median age was 23.50 [range: 4-75] years. One (6%) patient exhibited bilateral presentation. The median logMAR visual acuity was 0.4 log units (interquartile range: 0.18-1.20) and mean refractive error was -7.21 ± 5.32. Type 2 MRNF (n = 14,74%) was the commonest. Average MRNF size was 34.37 ± 40.73 sq.mm. Posterior staphyloma was noted in 17 eyes, all in close MRNF association. Significant positive corelation was noted between logMAR visual acuity and MRNF size (r = 0.5, p = 0.028). CONCLUSION: Large size MRNF corelated with poor visual acuity in the study. The paper explains the possible pathogenetic mechanisms for the ocular findings seen in MRNF.

Update on central retinal artery occlusion.

The medical condition referred to as "central retinal artery occlusion" (CRAO) was first documented by Albrecht von Graefe in 1859. Subsequently, CRAO has consistently been identified as a serious medical condition that leads to substantial visual impairment. Furthermore, it is correlated with vascular complications that have the potential to affect crucial organs such as the brain and heart. A considerable amount of research has been extensively published on the various aspects of this topic, which is marked by notable debates and misconceptions, especially regarding its management and outcomes. The primary aim of this review article is to analyze the latest developments in the understanding of CRAO, which includes its causes, techniques for retinal imaging, systemic evaluation, and therapeutic strategies, such as vitrectomy. This review article offers readers a comprehensive learning experience to gain knowledge on the fundamental principles and recent advancements in CRAO.

Progression of macular retinoschisis following intravitreal aflibercept injection for myopic macular neovascularization-a case report and review of literature.

BACKGROUND: Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic. CASE DESCRIPTION: A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye - 20/60 with - 16D, left eye - 20/20 with - 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml). RESULTS: OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit. CONCLUSION: Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.

Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy.

BACKGROUND: Purtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the precapillary retinal arterioles. We describe novel optical coherence tomography (OCT) findings of internal limiting membrane (ILM) separation and posterior hyperreflective dots in a case of Purtscher-like retinopathy in this report. METHODS: A 33-year-old man with acute pancreatitis and alcohol-induced liver disease presented to the retina department complaining of four days of painless vision loss in both eyes. Both eyes' anterior segment examination and intraocular pressure were normal. Dilated fundus examination of both eyes revealed confluent areas of retinal whitening, hemorrhages, and cotton-wool spots over the posterior pole, indicating Purtscher-like retinopathy. OCT scans through the macula revealed dense inner retinal reflectivity, thickening, and loss of retinal layer stratification, as well as outer retinal layer shadowing and islands of ILM separation, posterior vitreous hyperreflective dots, and minimal subfoveal fluid, all of which corresponded to areas of retinal whitening on fundus photographs. The patient was given a brief course of systemic steroids. RESULTS: On the tenth day after the presentation, visual acuity in the right eye had improved to 6/18 and finger counting at 1 m in the left eye. The retinal findings had faded. The retina had reverted to its normal thickness on the OCT scans, with minimal hyperreflectivity remaining. The ILM separation and posterior vitreous hyperreflective dots were no longer present. CONCLUSION: Following Purtscher or Purtscher-like retinopathy, we believe inflammation could play a major role in the development of these two novel OCT findings. This case offers an additional perspective on the underlying mechanisms responsible for the retinal manifestations observed in Purtscher or Purtscher-like retinopathy.

Successful resolution of serous macular detachment following glaucoma-filtering surgery alone for acquired optic disc pit maculopathy.

PURPOSE: To describe a case of acquired glaucomatous optic disc pit-related maculopathy successfully treated with glaucoma filtering surgery alone. CASE DESCRIPTION: A 67-year-old male was diagnosed with advanced primary open angle glaucoma in both eyes, with a cup: disc ratio of 0.85 in the right eye and 0.95 in the left eye. Visual acuity at presentation was 20/60, and intraocular pressure was 14 mm Hg in the left eye. The fundus of the left eye revealed a serous macular retinal detachment due to an acquired optic disc pit. RESULTS: The left eye of the patient underwent combined cataract and glaucoma filtering surgery. The serous macular detachment resolved completely 15 months after surgery, with a documented visual acuity of 20/40 and intraocular pressure of 10 mm Hg without the use of additional antiglaucoma medications. There was no recurrence of serous macular detachment even after the two-year follow-up visit. CONCLUSION: This case demonstrates that controlling intraocular pressure alone resulted in complete resolution of serous macular detachment in acquired optic disc pit maculopathy without the need for pars plana vitrectomy.

Recommendations for diabetic macular edema management by retina specialists and large language model-based artificial intelligence platforms.

PURPOSE: To study the role of artificial intelligence (AI) in developing diabetic macular edema (DME) management recommendations by creating and comparing responses to clinicians in hypothetical AI-generated case scenarios. The study also examined whether its joint recommendations followed national DME management guidelines. METHODS: The AI hypothetically generated 50 ocular case scenarios from 25 patients using keywords like age, gender, type, duration and control of diabetes, visual acuity, lens status, retinopathy stage, coexisting ocular and systemic co-morbidities, and DME-related retinal imaging findings. For DME and ocular co-morbidity management, we calculated inter-rater agreements (kappa analysis) separately for clinician responses, AI-platforms, and the "majority clinician response" (the maximum number of identical clinician responses) and "majority AI-platform" (the maximum number of identical AI responses). Treatment recommendations for various situations were compared to the Indian national guidelines. RESULTS: For DME management, clinicians (ĸ=0.6), AI platforms (ĸ=0.58), and the 'majority clinician response' and 'majority AI response' (ĸ=0.69) had moderate to substantial inter-rate agreement. The study showed fair to substantial agreement for ocular co-morbidity management between clinicians (ĸ=0.8), AI platforms (ĸ=0.36), and the 'majority clinician response' and 'majority AI response' (ĸ=0.49). Many of the current study's recommendations and national clinical guidelines agreed and disagreed. When treating center-involving DME with very good visual acuity, lattice degeneration, renal disease, anaemia, and a recent history of cardiovascular disease, there were clear disagreements. CONCLUSION: For the first time, this study recommends DME management using large language model-based generative AI. The study's findings could guide in revising the global DME management guidelines.

Comparison of pigment epithelium detachment composition indices between neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To compare changes in the fibrous component of pigment epithelium detachment composition indices (PEDCI-F) in neovascular age-related macular degeneration (n-AMD) and polypoidal choroidal vasculopathy (PCV) over 12 months. METHODS: This was a retrospective chart review of treatment-naïve n-AMD and PCV eyes treated with anti-vascular endothelial growth factor (anti-VEGF) agents. Optical coherence tomography (OCT) images were recorded at baseline and at 3, 6, and 12 months. OCT images were processed by filtering followed by pigment epithelium detachment (PED) segmentation and analysis of PED lesion heterogeneity based on the composition (PEDCI-F). RESULTS: A total of 74 eyes with n-AMD (36) and PCV (38) were included. Overall, PEDCI-F increased minimally in both n-AMD and PCV groups (both p > 0.05). The majority, i.e., 58.3% and 60.5%, of n-AMD and PCV eyes, respectively, showed an increase in PEDCI-F at 12 months. An increase in PEDCI-F was associated with improved BCVA logMAR (n-AMD, r = -0.79; p < 0.001 and PCV, r = - 0.06; p = 0.74) and the need for fewer anti-VEGF injections (n-AMD, r = - 0.53; p < 0.001 and PCV, r = - 0.09; p = 0.58). CONCLUSION: PEDCI-F increases in the majority of eyes with n-AMD and PCV through 12 months following treatment with anti-VEGF injections. This group had better visual acuity compared to the other subset with reduction in PEDCI-F requiring more anti-VEGF injections and worse visual acuity, possibly due to fibrovascular PED (FVPED) collapse and atrophy or a relative increase in other PEDCI constituents at 12 months.

Progressive retinoschisis and retinal detachment after uncomplicated macular hole repair surgery.

PURPOSE: To report a rare case of progressive retinoschisis and retinal detachment after uncomplicated macular hole (MH) surgery. CASE DESCRIPTION: A 67-year-old man with recent onset vision complaints in the right eye (visual acuity - 20/30), was diagnosed with a small idiopathic full-thickness MH. He underwent a 3-port 25G pars plana vitrectomy surgery with internal limiting membrane peeling and air endotamponade. RESULTS: MH closed with a normal foveal contour and intact retinal layers by the 1st post operative week and vision improved to 20/20. At the 7th week follow-up period, the patient complained of visual disturbances in his right eye for 2 days. Optical coherence tomography scans revealed development of peripheral retinoschisis which progressed towards the macula over the next 4 weeks. At the 13th week following the retinal surgery, patient developed sudden profound vision loss to hand motions and a total retinal detachment was noted. He underwent a second retinal surgery with retinectomy to the stiff retina and silicone oil endotamponade. At the last follow-up visit 8 weeks after the second surgery, the visual acuity had improved to 20/120 and the retina was well-attached with silicone oil in place. CONCLUSION: We present a rare case of progressive retinoschisis and retinal detachment caused by residual ILM contraction after MH repair surgery. To the best of our knowledge, no such complication after MH repair surgery has been reported in the literature.

Multicolour® imaging findings in residual emulsified silicone oil bubbles.

PURPOSE: To describe the findings of Multicolour® imaging (MCI) in the presence of residual emulsified silicone oil (SiO) droplets. CASE REPORT: A 62-year-old man had previously undergone surgery for a traumatic retinal detachment in the left eye, followed by SiO removal a few years ago. His presenting visual acuity was 6/60 in the left eye and intraocular pressure was 12 mm Hg. Clinical examination revealed the presence of emulsified residual SiO droplets in the vitreous cavity, 'inverse hyperoleon' at the posterior pole and pathological myopia. Retinal findings were documented using optical coherence tomography (OCT), fundus autofluorescence (FAF), and MCI on the Spectralis (Heidelberg, Germany) machine. RESULTS: On OCT, the emulsified SiO droplets in the preretinal and intraretinal layers appeared as multiple hyperreflective dots with no underlying shadowing trapped beneath the residual posterior hyaloid or preretinal membrane in the region of the posterior staphyloma. Residual emulsified silicon oil on the retinal surface appeared to have greenish hue on the composite multicolour image and was hyperreflective on individual blue and green reflectance images and dark and hyporeflective on the infrared reflectance image. The SiO droplets appeared dark and were difficult to identify on the short wavelength FAF image. CONCLUSION: To the best of our knowledge, this case report describes the MCI findings in emulsified SiO droplets for the first time.

Abnormal retinal vessel filling in central retinal artery occlusion.

CLINICAL RELEVANCE: Central retinal artery occlusion (CRAO) is an ophthalmic emergency with a poor prognosis. Several initial CRAO presentation factors can influence the final visual outcome. Fluorescein angiography filling of retinal vessels in CRAO has not been studied in great detail. BACKGROUND: The aim of this paper is to study the aberrant filling of the retinal vessels on fluorescein angiography in patients with CRAO and understand its clinical relevance. METHODS: Cases of CRAO diagnosed between June 2017 and May 2022 and who had undergone a fundus fluorescein angiography were included. Comparisons were made between the cases with and without aberrant filling of the retinal vessel. RESULTS: Twenty-two eyes of 22 patients (14 males and 8 females) with CRAO underwent fluorescein angiography. Ages of the patients ranged from 18 to 73 years, while time interval between development of acute onset vision problems and presentation to the retinal clinic ranged from a minimum of 1 day to a maximum of 30 days. Snellen visual acuity at presentation ranged from perception of light (PL +) to 6/6. On fluorescein angiography, aberrant flow of the fluorescein dye into the retinal vein was observed in four of the 22 (18%) eyes with CRAO. All these cases showed a patient's temporal cilioretinal artery. The cases with aberrant filling of the retinal vessels showed a better presenting visual acuity (6/6-6/60), lesser severity of inner retinal damage and a better final visual acuity (6/6-6/60) compared to CRAO cases without aberrant filling. CONCLUSION: Aberrant filling of the retinal vein can be seen on fluorescein angiography in eyes with CRAO and a patent temporal cilioretinal artery. Such eyes with aberrant retinal vessel filling have a better visual prognosis.

Recommendations for initial diabetic retinopathy screening of diabetic patients using large language model-based artificial intelligence in real-life case scenarios.

PURPOSE: To study the role of artificial intelligence (AI) to identify key risk factors for diabetic retinopathy (DR) screening and develop recommendations based on clinician and large language model (LLM) based AI platform opinions for newly detected diabetes mellitus (DM) cases. METHODS: Five clinicians and three AI applications were given 20 AI-generated hypothetical case scenarios to assess DR screening timing. We calculated inter-rater agreements between clinicians, AI-platforms, and the "majority clinician response" (defined as the maximum number of identical responses provided by the clinicians) and "majority AI-platform" (defined as the maximum number of identical responses among the 3 distinct AI). Scoring was used to identify risk factors of different severity. Three, two, and one points were given to risk factors requiring screening immediately, within a year, and within five years, respectively. After calculating a cumulative screening score, categories were assigned. RESULTS: Clinicians, AI platforms, and the "majority clinician response" and "majority AI response" had fair inter-rater reliability (k value: 0.21-0.40). Uncontrolled DM and systemic co-morbidities required immediate screening, while family history of DM and a co-existing pregnancy required screening within a year. The absence of these risk factors required screening within 5 years of DM diagnosis. Screening scores in this study were between 0 and 10. Cases with screening scores of 0-2 needed screening within 5 years, 3-5 within 1 year, and 6-12 immediately. CONCLUSION: Based on the findings of this study, AI could play a critical role in DR screening of newly diagnosed DM patients by developing a novel DR screening score. Future studies would be required to validate the DR screening score before it could be used as a reference in real-life clinical situations. CLINICAL TRIAL REGISTRATION: Not applicable.

A rare case of hyperpigmented torpedo maculopathy.

PURPOSE: To describe a rare presentation of torpedo maculopathy (TM). CASE DESCRIPTION: A 25-year-old male was examined in the retina clinic for a macular scar in the left eye. His visual acuity was 20/20, N6 in both eyes and no past history of ocular trauma or any medical or ocular history. The anterior segment was quiet and intraocular pressure was normal. RESULTS: The patient's left eye on 78D slit lamp biomicroscopy revealed a flat, diffusely hyperpigmented fusiform torpedo-like lesion with sharp margins and surrounding hypopigmentation located predominantly temporal to the fovea, with its tip pointing towards it and just crossing the vertical foveal midline. Dilated fundus examination with binocular indirect ophthalmoscopy revealed no peripheral chorioretinal lesions or vitritis in both eyes. OCT scan through the lesion revealed gross damage to the outer retinal layers, as well as thickening of the retinal pigment epithelium and underlying shadowing, as well as a hyporeflective subretinal cleft involving the lesion. OCT also revealed outer retinal layer damage with an intact retinal pigment epithelium through the lesion's hypopigmented margins. Fundus autofluorescence image revealed a globally hypoautofluorescent lesion in the left eye, with surrounding patchy hyperautofluoroscent areas. Based on the patient history, clinical and imaging findings, other differential diagnoses such as atypical congenital hypertrophy of retinal pigment epithelium (RPE), choroidal nevus, RPE hamartoma, trauma and inflammatory conditions were ruled out. The diagnosis of TM was confirmed based on the typical lesion shape and location. CONCLUSION: A torpedo lesion with diffuse hyperpigmentation is an unusually rare presentation.

Right-angled vessel characteristics in different stages of type 2 macular telangiectasia (MacTel).

PURPOSE: To study right-angled vessels (RAV) in disease progression and macular neovascularization in type 2 macular telangiectasia (MacTel) eyes. METHODS: This retrospective image analysis study examined type 2 MacTel patients' multicolour® and OCT imaging records from January 2015 to March 2023. Age, gender, laterality, visual acuity, systemic disease, and follow-up duration were recorded. RAV characteristics were assessed using OCT and multicolour® images. This study examined RAV characteristics and type 2 MacTel disease stage. RESULTS: In total, 270 eyes of 146 patients (97 females, 66%) with a mean age of 60.77 ± 9.34 years were studied. 153 (57%) eyes showed RAV. The non-proliferative stage of type 2 MacTel had either no RAV or a normal-calibre right-angled vein, while the proliferative stage had a right-angled artery and a dilated or normal-calibre RAV [p < 0.001]. RAV characteristics differed at the final follow-up (p < 0.001). 11 eyes transitioned from non-proliferative to proliferative after a median period of 26 months (range: 5-96 months). RAV characteristics changed from a normal calibre right-angled vein at presentation to a normal calibre vein and artery in 6 (55%) eyes and to a dilated vein and artery in 5 (45%) eyes respectively. CONCLUSION: RAV characteristics may indicate type 2 MacTel stages. A right-angled artery in type 2 MacTel may indicate proliferative disease.

Epiretinal membrane formation and optic disc vascularisation in type 2A macular telangiectasia (MacTel).

PURPOSE: To describe a rare clinical finding of epiretinal membrane (ERM) and abnormal optic disc vascularisation in type 2A macular telangiectasia (MacTel). CASE DESCRIPTION: A 52-year-old asymptomatic healthy male was examined in the retina clinic. In both eyes, corrected visual acuity was 20/20, N6. Anterior segment examination and intraocular pressure were both normal in both eyes. RESULTS: The right eye's dilated fundus examination revealed loss of retinal transparency and superficial intraretinal crystals. A thick ERM extending from the optic disc to the macula obscured the details of the underlying perifoveal region in the left eye fundus. The diagnosis of bilateral type 2 MacTel was confirmed by confocal blue reflectance imaging, fluorescein angiography (FA), and macular optical coherence tomography (OCT). The left eye macular OCT scan also revealed a thick ERM without causing significant retinal traction. Furthermore, FA of the left eye revealed early hyperfluorescence with intense late leakage at the inferior aspect of the optic disc, giving the impression of abnormal optic disc vascularisation. No other cause for the disc vascularisation could be identified. OCT scan through the area with the optic disc leakage revealed a tuft of irregular hyperreflective tissue lying over the ERM. OCT angiography imaging confirmed the vascularity within the tuft of hyperreflective tissue over the ERM. Over a two-year period, no changes in clinical or imaging features were observed. CONCLUSION: In type 2A MacTel eyes, ERM formation and abnormal disc vascularisation are uncommon findings. More histopathologic research is needed to characterise these membranes.

Vitreomacular interface abnormalities in type 2 macular telangiectasia (MacTel).

PURPOSE: To describe the different types of vitreomacular interface abnormalities (VMIA) seen on optical coherence tomography (OCT) in type 2 macular telangiectasia (MacTel) and explain the possible reasons for its development. METHODS: In this retrospective cross-sectional study, type 2 MacTel eyes with macular volumetric OCT imaging protocol were included to identify different types of VMIA such as abnormal PVD, vitreomacular traction (VMT), ERM, and lamellar and full-thickness macular hole. The VMIA findings were then correlated with different MacTel disease stages and visual acuity. RESULTS: One thousand forty-three OCTs of 332 type 2 MacTel eyes from 169 patients at different visits were examined. VMIA was detected in 709 (68%) of those OCT scans in 216 (65%) eyes. There were 273 (39%), 31 (4%), 89 (13%), 7 (1%), and 381 (54%) OCT scans with vitreomacular adhesion, VMT, ERM, and inner and outer lamellar macular holes discovered respectively. VMIA eyes had a high frequency of abnormal PVD (p = 0.001) and retinal pigment clumps (RPCs) [p = 0.032]. Eyes with abnormal PVD (p = 0.034) and RPC (p = 0.000) had a higher rate of ERM development. RPC was linked to an increased risk of developing ERM (odd ratio 2.472; 95% CI 1.488-4.052). RPC and ERM contributed significantly to poor visual acuity (0.661 ± 0.416, 20/92). CONCLUSION: OCT reveals a high frequency of VMIA in advanced type 2 MacTel eyes. RPC could be responsible for the development of anomalous PVD, as well as subsequent VMIAs and ERM. Additional work is required to examine the long-term changes and surgical outcomes of these eyes.

Ink blot leakage in central retinal artery occlusion.

PURPOSE: To describe a typical case of acute central retinal artery occlusion (CRAO) with an ink-blot pattern of hyperfluorescent leak on fundus fluorescein angiography (FFA). CASE DESCRIPTION: A 21-year-old woman came to the clinic with one day of painless right eye vision loss. Her right eye had finger counting at ½ meter. Her right eye had a relative afferent pupillary defect, but her anterior segment and intraocular pressure of both eyes were normal. RESULTS: The right eye fundus showed signs of acute CRAO with severe grade on optical coherence tomography (OCT). FFA imaging showed a mid-phase hyperfluorescent leak that persisted until the late stage. OCT scan through the hyperfluorescent spot showed absence of neurosensory detachment with normal retinal pigment epithelium, ruling out a central serous chorioretinopathy (CSCR). Ocular massage and anterior chamber paracentesis were performed. At the 10-day follow-up, the patient's visual acuity was counting fingers at ½ meter, and the OCT scan showed findings of CRAO chronicity. The hyperfluorescent spot disappeared on the subsequent FFA. CONCLUSION: We report a case of ink-blot leakage on FFA, similar to that observed in CSCR in an eye with acute CRAO. We propose that the hyperfluorescent spot in our acute CRAO was likely caused by red blood cell aggregation or rouleaux formation.

Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report.

BACKGROUND: Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION: A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS: The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION: This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.