Choroidal involvement in acute retinal necrosis: case series and review of the literature.

PURPOSE: To show the role of multimodal imaging in identifying choroidal involvement in acute retinal necrosis (ARN). METHODS: Retrospective case series of ARN patients. Clinical data, including medical history, clinical features and multimodal imaging findings, were collected. RESULTS: Three patients were included. Imaging modalities, such as indocyanine green angiography and optical coherence tomography, were critical in showing choroidal involvement in ARN. CONCLUSION: Choroidal involvement may occur in ARN along with the well-known retinal features.

Analysing the effectiveness of Just-A-Minute Optometry Clinical Pearls: a micro-learning tool in continuing optometry education.

CLINICAL RELEVANCE: Just-A-Minute Clinical Pearls as a microlearning concept may be beneficial in enhancing optometry and ophthalmology practice globally. BACKGROUND: Medical education often witnesses a gap in effectively translating the learnings into clinical practice, pointing to the complex and traditional teaching methods as hindrances. The present work studied the usefulness and acceptability of Just-A-Minute Optometry Clinical Pearls, a micro-learning tool, among optometrists and ophthalmologists. METHODS: Just-A-Minute Optometry clinical pearls were developed by the optometry team of LV Prasad Eye Institute and shared (via email) among optometrists and ophthalmologists on a daily basis between June 2021 to May 2022. In the middle of the project, the recipients were invited to participate in an online survey. The variables studied included frequency of checking clinical pearls, simplicity of their content, grasping speed, most used subspeciality pearls, knowledge gain and retention, practice applicability, overall learning experience, and the likelihood of recommending it to a friend. RESULTS: Among 150 respondents, 103 (68.7%) were ophthalmologists, and 46 (30.7%) were optometrists. The majority were from private (n = 64, 42.7%) and institutional (n = 48, 32%) practices, with 102 (68.4%) having more than five years and 21 (14%) having 2-5 years of experience. About 115 (77%) respondents checked clinical pearls every day, 147 (99%) found the format easy, and 131 (88%) could grasp the content within one minute. They felt that JAM-OCP 'always' enhanced clinical knowledge (n = 108, 72%) and clinical applicability (n = 82, 55%) and helped in knowledge retention (n = 123, 84%). The responses to the clinical application significantly varied (Chi-square tests) among subgroups of education qualification (p < 0.001) and practice types (p < 0.03). CONCLUSIONS: The Just-A-Minute Optometry Clinical Pearls were beneficial to optometrists and ophthalmologists in their practices. This, as a tele-education tool, supports continuing optometry education across the globe.

Experience of focused workshop intervention in presentation skills - Importance of foundational skills for ophthalmologists in training.

Background: The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows in training. Methods: A 10-hour workshop on presentation skills was conducted for ophthalmology fellows in the 2022 cohort at a single institution. An email was sent to the 2022 cohort to recruit participants. A total of 29 fellows (19 females, 10 males) volunteered to participate in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at four different time points of the workshop. The self-rating questionnaire utilized a ten-point rating scale (1-10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results: Both properties & content (PC) and soft skills (SS) showed significant difference (p < 0.001) post workshop compared to earlier stages. The higher self-rating (PC4 and SS4) highlights increased awareness towards the scope of improving the presentation after the workshop intervention. Conclusions: Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.

Asymptomatic Ophthalmomyiasis Interna Posterior with Central Pigment Accumulation in the Inner Retina.

PURPOSE: To report a case of ophthalmomyiasis interna posterior which was asymptomatic and had pigment clumps in the inner retina at the macula. METHODS: Single-centre, observational, retrospective case report. RESULTS: A routine refractive error check-up for an asymptomatic 52-year-old Asian Indian woman, who had relied on glasses for 8 years, unfolded a captivating narrative within her retina. This coloured fundus photo unveils mid-peripheral retinal disease with multiple outer retinal atrophic tracts, circumlinear patterns, and intricately intertwined RPE atrophic tracts. These were hyper-autofluorescent on blue autofluorescence. The inferonasal periphery had two-disc diameters of pigmented retinal-choroidal atrophic scar. The macula revealed a collection of black intraretinal pigments in parafoveal areas. The distinct clinical presentation, marked by multiple tracts and unilateral manifestation without disc pallor, hinted at the intriguing possibility of self-resolved "Ophthalmomyiasis interna posterior." CONCLUSION: The course of disease in ophthalmomyiasis interna posterior can be self-limiting and asymptomatic. The presence of inner retinal pigments at foveal and parafoveal areas, possibly due to pigment migration from the peripheral outer retinal tracts, is a rare presentation.

Surgical approach to endophthalmitis: an overview.

Endophthalmitis is one of the most severe ocular emergencies faced by ophthalmologists worldwide. Without prompt treatment significant visual loss is inevitable. With increased understanding of the science of endophthalmitis, recent studies have shown a clear role of early and more definitive surgery to achieve better visual and anatomic outcomes. Surgery in endophthalmitis encompasses a whole gamut of interventions. There are diagnostic procedures like anterior chamber tap and vitreous biopsy or therapeutic procedures like complete pars plana vitrectomy and retinal detachment repair. Current literature is deficient on a detailed description of the spectrum of surgical interventions in endophthalmitis. In the current communication, we summarize the studies based on various surgical interventions in endophthalmitis. We also elaborate in detail on each surgical maneuver, taking the reader through the nuances of each surgery via an exhaustive description and appropriate photos and surgical video clips.

Macular Punctate Lesions Presenting as a Primary Manifestation of Ocular Toxoplasmosis.

PURPOSE: To study clinical features and outcomes of primary ocular Toxoplasmosis (OT) cases presenting as macular punctate lesions. METHODS: Retrospective review of three cases of OT with positive Toxoplasma serology. RESULTS: We describe three cases presenting as primary OT with no evidence of old retinochoroidal scar in either eye. All the cases had multiple foveal or extrafoveal, punctate, inner/outer, or combined lesions at macula with minimal vitreous reaction. During the first/primary episode, all the lesions resolved with 1. retinal atrophy, thinning (n = 1) or 2. Progressed to limited full-thickness retinitis lesions (n = 2). Recurrence as typical retinochoroiditis was seen in one eye. More than four-fold IgG positivity was seen in all cases while IgM positivity was seen in two cases. CONCLUSIONS: Macular punctate lesions (inner/outer/combination) can be the primary manifestation of ocular toxoplasmosis in the absence of old retinochoroiditis scars in either eye.

Anterior Non-Necrotizing Scleritis with Active Uveitis in Cases of Ocular Syphilis.

PURPOSE: To study clinical characteristics and management outcomes of cases of ocular syphilis co-presenting with scleritis and active uveitis. METHODS: A retrospective analysis of cases diagnosed with ocular syphilis between January 2020 and December 2023 was conducted at a tertiary eye care centre. Clinical records, investigations, and outcomes were reviewed to identify cases with scleritis with active uveitis. Demographic data, clinical features, treatment modalities, and resolution patterns were analyzed. RESULTS: Among the 135 eyes of 95 cases of ocular syphilis studied, scleritis with uveitis was observed in 3.70% of eyes (five eyes). All cases with scleritis and uveitis were unilateral and male, with ages ranging from 32 to 61 years. Concurrent features included placoid chorioretinitis, retinal vasculitis, and anterior uveitis. Misdiagnosis with subsequent oral steroid therapy precipitated scleritis as an exacerbation in two cases. Three cases, which were previously undiagnosed, were found to be HIV-positive. Scleritis manifested as anterior, non-necrotizing inflammation, often accompanied by chemosis, and responded rapidly to antibiotic and non-steroidal anti-inflammatory therapy. Scleritis resolution preceded that of chorioretinitis and retinal vasculitis. CONCLUSIONS: Non-necrotizing anterior scleritis with chemosis can be a rare presentation of active syphilitic uveitis. Large placoid chorioretinitis lesions, preceding inadvertent oral steroid and/or undiagnosed HIV status were the possible risk factors for the development of concurrent scleritis.