Clinical profile and demographic distribution of band shaped keratopathy in India: A study of 8801 patients.

Purpose: To describe the clinical profile and demographic distribution of band-shaped keratopathy (BSK) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 2,664,906 new patients presenting between January 2011 and January 2021 (10-year period). Patients with a clinical diagnosis of BSK in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 8801 (0.33%) patients were diagnosed with BSK. The prevalence rates were 0.47% in children (age: <16 years) and 0.31% in adults. The majority of patients were males (62.87%) with unilateral affliction (85.21%). The mean age of the patients was 40.43 ± 23.14 years. The majority (16.93%) of the patients were in the age bracket of 11-20 years. A larger proportion of the patients were from higher socioeconomic status (60.46%) and the urban region (45.9%). Of the 10,103 eyes affected with BSK, the common ocular comorbidities were status post-vitreoretinal surgery (20.55%) and uveitis (12.7%) in children and corneal scar (41.23%) and spheroidal degeneration (13.7%) in adults. Most of the eyes had mild or no visual impairment (24.74%). Among the eyes that needed surgical intervention, chelation with ethylenediaminetetraacetic acid (EDTA) was the most performed surgical procedure (1.68%) along with phototherapeutic keratectomy (0.32%). Conclusion: BSK commonly affects adult males and is unilateral in nature. The majority of the patients in this cohort belonged to higher socioeconomic strata and urban geography. At initial presentation, visual impairment was mild to moderate in a vast majority of the patients, and the most common surgical intervention performed was chelation with EDTA during the study period.

Reversal of Visual Impairment Associated with Vasospasm After Resection of Sphenoclinoidocavernous Meningioma with Intra-Arterial Verapamil.

BACKGROUND: Visual loss can be encountered in the immediate, early, or even delayed postoperative period after resection of skull base meningiomas involving the optic apparatus. Various mechanisms for visual loss can include mechanical injury, vascular insult, optic nerve and chiasm edema, and vasospasm of the blood supply to the visual apparatus. CASE DESCRIPTION: In this article, we describe a patient who developed unilateral visual worsening in the early postoperative period after skull base resection of a sphenoclinoidocavernous meningioma that was compressing the ipsilateral optic nerve. After implementing hyperdynamic therapy and high-dose corticosteroids, catheter angiography showed severe vasospasm of the ipsilateral ophthalmic artery with delayed filling of the choroidal blush. Intra-arterial chemical angioplasty with verapamil was administered that resulted in angiographic improvement and clinical restoration of vision back to preoperative baseline. Vision remained stable in the postoperative course and continued to improve after discharge from the hospital. CONCLUSIONS: To our knowledge, this is the first report of successful reversal of postoperative unilateral visual loss related to vasospasm after resection of a skull base sphenoclinoidocavernous meningioma. This may be a useful strategy to diagnose and treat possible vasospasm-induced visual loss after resection of skull base meningiomas involving the optic apparatus.

Aflibercept (Eylea) and diabetic macular oedema. A first-choice VEGF inhibitor in case of marked visual loss.

Overall, VEGF inhibitors administered by intravitreal injection have a similar harm-benefit balance. However, a publicly funded trial has shown that aflibercept is more effective than ranibizumab and bevacizumab in patients with marked loss of visual acuity.

ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Outcomes in Eyes With Poor Initial Vision.

PURPOSE: To assess the effect of anti-vascular endothelial growth factor treatment on visual acuity outcome in patients with neovascular age-related macular degeneration presenting with very low vision. METHODS: Retrospective analysis of electronic patient care record of 420 eyes treated with ranibizumab between March 2010 and June 2013. The authors classified the extracted sample into 3 categories based on the initial best-corrected visual acuity (BCVA) as measured on the Early Treatment Diabetic Retinopathy Study charts: 0 to 35 letters, 36 to 69 letters, and ≥ 70 letters. Best BCVA achieved in Year 1, and average BCVA over 36 months was computed. The neovascular lesion type, area of lesion, the presence or absence of hemorrhage, retinal pigment epithelium tear, and atrophy were systematically graded as was extent of fibrosis on a categorical scale of 0 to 4. Regression analysis was performed with the best BCVA achieved in Year 1 as the outcome variable and initial BCVA, person, and lesion characteristics as explanatory variables. RESULTS: The mean change in BCVA from the initial visit to the best-attained BCVA during Year 1 was highly statistically significant with an improvement of 9.95 letters. The improvement from initial BCVA to average BCVA over 36 months was 4.01 letters. Regression analysis identified atrophy and fibrosis as predictors of best BCVA, with the model having an r of 0.71. CONCLUSION: Our study supports the use of anti-vascular endothelial growth factor agents even in eyes with low visual acuity particularly when fibrosis and atrophy are absent and suggests algorithms to predict outcome for combinations of visual acuity and lesion characteristics across the full visual acuity range.

Rapid improvement in visual loss with cabergoline treatment in a giant prolactinoma case: 5 years survey.

Giant prolactinoma is a rare subset of macroadenomas. Limited studies demonstrated which therapy could be successfully used in the first-line therapy of giant prolactinoma. We presented a case with a 54 × 40 × 40 mm pituitary adenoma and optic chiasmatic compression with left sphenoid sinus invasion. The tumor caused a loss of visual field of the right side. Cabergoline treatment was started with dose of 1.5 mg/week. Fifteen days later, the clinical visual acuity examination showed a significant improvement in the patient with visual field defect. After the five years follow-up magnetic resonance imagining showed reduction of the adenoma size (17 × 12 mm) was significant. Our findings suggest that, cabergoline can be used as a first-line therapy in giant prolactinomas because tumoral shrinkage without a surgical procedure and rapid improvement in visual field defect is achieved with this medical treatment.

Generalized lymphadenopathy and 18-fluorine fluorodeoxyglucose positron emission tomography/computed tomography: targeting diagnostic intervention, characterizing disease extent, and assessing treatment efficacy in syphilis.

18-Fluorine fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has been shown to have use in the diagnosis of inflammatory and infectious diseases in addition to its primary use in cancer. We describe a case of early neurosyphilis that initially presented as symmetric, generalized lymphadenopathy on PET/CT. We conclude that PET/CT may play a role in evaluating targeted diagnostic interventions, disease extent, and treatment efficacy for disseminated syphilis.

Autoimmune hypophysitis presenting with intracranial multi-organ involvement: three case reports and review of the literature.

BACKGROUND: Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus. CASE PRESENTATION: Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level. CONCLUSION: The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration.

Is intravitreal bevacizumab an effective treatment option for nonarteritic anterior ischemic optic neuropathy?

Nonarteritic anterior ischemic optic neuropathy (NAION) causes sudden profound loss of vision with no known cause or cure. Various treatment modalities, both surgical and pharmacologic, have been tried without success. The purpose of our retrospective study was to evaluate the effect of intravitreal bevacizumab (Avastin) as a treatment option for NAION. We evaluated demographics of 5 patients and compared visual acuity and automated visual fields prior to and following intravitreal bevacizumab injection. Visual acuity at presentation was 20/20 in 4 of 5 patients and 20/150 in 1. Visual acuity improved to 20/40 in the patient who presented with decreased acuity and decreased slowly in 3 patients and rapidly in 1. All patients presented with variable visual field defects: 1 improved slightly, 3 progressed, and 1 remained stable. One patient subsequently developed NAION in the fellow eye. These results are consistent with the natural course of the disease, and bevacizumab did not appear to have a dramatic effect on the clinical outcome in this small series of patients with NAION.

Nerve growth factor eye drop administration improves visual function in a patient with optic glioma.

BACKGROUND: Spontaneous visual improvement in people with an optic glioma (OG) of the anterior or retrochiasmatic optic pathways is rare. OBJECTIVE: To evaluate the effects on visual function of nerve growth factor (NGF) eye drop administration in a patient with severe visual impairment due to a low-grade OG. METHODS: A 45-year-old woman with OG and long-standing optic nerve atrophy was assessed before and after 2 NGF treatment courses. The drug used was 2.5S murine NGF. One milligram of NGF, diluted in saline solution, was administered onto the conjunctiva of both eyes for 10 consecutive days 3 times a day for each treatment. The follow-up was performed by clinical, neuroradiologic, and electrophysiological tests (electroretinogram and visual evoked potentials [VEPs]) at the end of each treatment and 30 and 60 days later. RESULTS: A repeated subjective and objective improvement of visual function (>3 lines visual acuity; >40° visual field; >50% VEP amplitude increase, Wilcoxon test P < .01) was recorded after NGF treatment. These measures tended to deteriorate toward baseline values 60 days from the end of each NGF treatment. No ocular or systemic side effects were observed throughout treatment. CONCLUSIONS: Conjunctival NGF may be a beneficial adjunct therapy for visual loss in patients with OG, possibly exerting its effects on residual viable optic pathways.

Patterns of referral of retinal patients for low vision intervention in the anti-VEGF era.

PURPOSE: The goal of this study was to see how the availability of ranibizumab affected the referral patterns for low vision (LV) evaluation. METHODS: This study used a retrospective review and a comparison of all patients newly referred from retinal Practice 1 (J.T.T., R.N.S.) for LV consultation, from July 2005 to June 2006 (Year 1, preranibizumab) and from July 2006 to June 2007 (Year 2, ranibizumab available), and a retrospective review of patients referred by retinal Practice 2 (M.J.E.) since February 2007. RESULTS: Practice 1: In Year 1, 24 patients with choroidal neovascularization were referred for LV, and in Year 2, only 12 were referred. There was a trend for those patients referred in Year 2 to have worse visual acuity and Pelli-Robson contrast sensitivity than those in Year 1. In Years 1 and 2, 18 and 11 patients with other conditions were referred for LV consultation, respectively. For these patients without choroidal neovascularization, there was no significant difference between groups for visual acuity or contrast sensitivity. Practice 2: The mean best-corrected visual acuity of patients with bilateral choroidal neovascularization referred was 20/145, and no patient had visual acuity > or =20/100. CONCLUSION: Although the use of antivascular endothelial growth factor agents puts visual acuity in a zone more favorable for successful LV intervention, patients with better acuities may not be referred for LV evaluation despite their residual visual impairments and their scotomas, and despite the fact that without LV intervention, they are having difficulty with reading and other activities of daily living. The frequent visits required for monthly injection, the tendency to wait until a course of therapy is complete before referring patients, and a lesser appreciation for the need for LV intervention in patients with only moderate visual loss may be factors in explaining this.

Neuromyelitis optica with CSF examination mimicking bacterial meningomyelitis.

Neuromyelitis optica (NMO) is a rare inflammatory demyelinating disease of the central nervous system that causes severe attacks of optic neuritis and myelitis. Abnormal CSF findings are one of the characteristics of NMO that help to distinguish it from classical multiple sclerosis. Here we describe two cases of Devic's syndrome with CSF findings suggestive of bacterial meningomyelitis.