All trans retinoic acid-induced bilateral disc edema in a case of acute promyelocytic leukemia.

An 18-year-old female presented with sudden onset bilateral vision loss. Extensive retinal hemorrhages were seen in both eyes. Systemic examination lead to a diagnosis of acute promyelocytic leukemia. The patient was treated with all trans retinoic acid (ATRA) and other medications in the induction phase. Bilateral disc edema was noted during the second consolidation cycle with ATRA. Complete resolution of bilateral disc edema was attained in three weeks' time after discontinuing ATRA.

Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India.

PURPOSE: This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. METHODS: This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. RESULTS: A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. CONCLUSION: Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.

Ocular manifestations in HIV patients attending a tertiary care hospital in Eastern India and correlation of posterior segment lesions with CD4+ counts.

PURPOSE: We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts. METHODS: This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case. RESULTS: A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30-39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001). CONCLUSION: Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections.

Bilateral disc edema: An unusual presentation of renal tuberculosis in a child.

Renal tuberculosis (TB) is a rare clinical disorder in the pediatric population. A 15-year-old female presented with intermittent blurring of vision in both eyes associated with fever, abdominal pain, and weight loss. Fundus examination showed bilateral disc edema. Her blood pressure was 220/110 mmHg. Renal parameters were deranged with bilaterally enlarged kidneys. Renal biopsy was suggestive of epithelioid cell granuloma with Langhans type giant cells. The patient was diagnosed with as a case of refractory hypertension due to tubercular interstitial nephritis with bilateral Grade IV hypertensive retinopathy. She was started on antitubercular therapy and antihypertensives. There was a complete resolution of disc edema 2 months following initiation of therapy. Optic disc edema can be a presenting sign in renal TB. Early diagnosis and prompt referral can be associated with good visual and systemic outcomes.

Pseudo endophthalmitis following intravitreal triamcinolone acetonide for cystoid macular edema in a post-vitrectomised eye.

Post-operative endophthalmitis is a vision threatening complication following intraocular surgery requiring prompt treatment. Clinical picture mimicking infectious endophthalmitis can rarely be produced following intravitreal triamcinolone acetonide injection. A 65-year-old male with previous history of pars plana vitrectomy and lens removal was diagnosed with post-operative cystoid macular edema in his right eye. He received intravitreal triamcinolone acetonide injection in his right eye. Two days following the injection he complained of further reduction in vision and presented with a clinical picture resembling infectious endophthalmitis. Nil active intervention was done. There was significant improvement in vision one week following the injection. Ophthalmologists should be aware of this clinical scenario so that excessive and unwarranted treatment can be avoided.

Off label intravitreal Brolucizumab in treatment of recurrent macular edema due to branch retinal vein occlusion: A case report.

A 59 year old female presented with progressive loss of vision in right eye (RE) of 6 months duration. She had been diagnosed with inferotemporal branch retinal vein occlusion with macular edema in RE and had received 4 doses of intravitreal Ranibizumab previously. Best corrected visual acuity in RE was 20/120, N24. Optical coherence tomography scans of RE showed significant cystoid macular edema with central macular thickness of 546 µm. She was treated with single dose of intravitreal Brolucizumab (6 mg/0.05 ml). Vision improved to 20/32, N6 one month following injection with return to normal foveal architecture. Visual gains and reduction in central macular thickness were maintained with no recurrence of macular edema 2 months following the procedure. No adverse effects were noted during the entire follow up.

A case of recalcitrant neovascular wet age-related macular degeneration treated with Intravitreal Brolucizumab.

A 72-year-old male presented with loss of vision in left eye of 1 year duration. Patient had been diagnosed with wet neovascular age related macular degeneration in left eye and had received multiple injections of anti- vascular endothelial growth factor agents in past. Clinical and imaging studies showed persistent subretinal fluid. The patient was shifted to intravitreal Brolucizumab. There was complete resolution of subretinal fluid with improvement of vision 1 month following injection. Improvement of vison was maintained 3 months following injection with macula remaining dry.

Variation in Visual Outcome to Anti-Vascular Endothelial Growth Factors in Choroidal Neovascular Membrane Developing in Eyes with Previously Untreated Versus Focal Laser-Treated Central Serous Chorioretinopathy.

PURPOSE: To report the visual outcome in choroidal neovascular membrane developing (CNVM) in eyes with central serous chorioretinopathy (CSCR) with our without prior focal laser. METHODS: A retrospective case series of eyes with CNVM secondary to CSCR treated with intravitreal anti-VEGF. RESULTS: Ten eyes of nine patients of CNVM with CSCR who underwent intravitreal anti-VEGF injections were analyzed. Five eyes had CNVM without prior laser photocoagulation, and five eyes developed CNVM after laser photocoagulation for CSCR. Intravitreal injection bevacizumab was given in five eyes and ranibizumab in five eyes. The lasered group had significantly shorter duration of the disease, fewer injections given, and better visual acuity at final follow-up (P <0.05). None had any recurrences of either CSCR or CNVM until the last follow-up. CONCLUSION: CNVM in CSCR with prior history of focal laser had better outcome than that developed de novo, without prior history of laser.

Pro Re Nata Intravitreal Bevacizumab for the Treatment of Idiopathic Choroidal Neovascular Membrane.

PURPOSE: To study the efficacy of intravitreal bevacizumab on a pro re nata basis for treatment of idiopathic choroidal neovascular membrane. MATERIAL AND METHODS: Thirty-seven eyes of 37 patients presenting with idiopathic choroidal neovascular membrane were included in the study. Intravitreal bevacizumab (1.25 mg/0.05 ml) was given on a pro re nata basis from the base line. RESULTS: Twenty-one (58.3%) patients were male and 15 (41.7%) were female aged 13-49 years. Idiopathic choroidal neovascular membrane showed a classic leak on fluorescein angiogram in all the eyes. Subfoveal location (25; 67.6%) was the commonest site of involvement. Mean number of intravitreal bevacizumab injections required to achieve resolution was 2.81 ± 1.4. At final follow-up, 31 (83.8%) eyes had maintained or improved vision (Group A) and six (16.2%) eyes had worsening of vision (Group B). There was no significant difference in mean age, gender, and mean number of injections between groups A and B. CONCLUSION: Intravitreal bevacizumab on a pro re nata basis is effective in the treatment of idiopathic choroidal neovascular membrane. A larger controlled study would be required to formulate an accurate injection protocol.

Spontaneous puerperal extraperitoneal bladder wall rupture in young woman with diagnostic dilemma.

A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.

Endophthalmitis caused by Alcaligenes faecalis: a case series.

PURPOSE: To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Alcaligenes faecalis. METHODS: Retrospective analysis of all the cases of A. faecalis endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2012 was done. RESULTS: A total of five cases were included in the study. Out of the five cases, one was of endogenous origin and the rest were post cataract surgery. All but one case underwent vitreo-retinal surgical intervention followed by intravitreal antibiotics. Alcaligenes faecalis was isolated in all the cases. Sensitivity to ceftazidime, aminoglycosides and ciprofloxacin was 20%, 60% and 80%, respectively. Two patients attained a final visual acuity of 6/24. One eye became phthisical in due course. CONCLUSION: Alcaligenes faecalis is a very rare cause of endophthalmitis. Aminoglycosides and fluroquinolones can be considered as main line of treatment.