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.

Endophthalmitis caused by Hathewaya histolytica: A diagnostic dilemma.

A 76-year-old male presented with pain, redness, and decreased vision in the left eye for 5 days. The patient had undergone combined cataract extraction and vitrectomy for a macular hole 2 weeks back. The vision had reduced to the perception of light in the left eye. Clinical examination revealed lid edema, conjunctival congestion, hazy cornea, and exudative membrane in the pupillary axis with no view of the fundus. Ultrasound examination of the left eye showed plenty of moderate reflective dot echoes. The patient was diagnosed with postoperative endophthalmitis and underwent vitrectomy with intravitreal injection of antibiotics. Growth of Hathewaya histolytica was obtained from the vitreous sample. The organism was sensitive to imipenem. Three weeks following the presentation, visual acuity had improved to counting fingers at one meter in the left eye. This is the first report of endophthalmitis due to H. histolytica. Ophthalmologists should be aware of such ocular infections due to a rare microorganism.

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.

An optical coherence study on optic disc parameters and peripapillary retinal nerve fiber layer thickness in patients with optic disc edema.

PURPOSE: This study aimed at evaluation of patients diagnosed with optic disc edema (ODE) in terms of demographics, etiology, clinical presentation, and optical coherence tomography parameters. METHODS: An observational cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with ODE underwent comprehensive ophthalmic evaluation. Peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters were assessed using optical coherence tomography. Radiologic investigations were done as deemed necessary. RESULTS: One hundred and forty-eight eyes with ODE (134 eyes from 67 patients with bilateral ODE and 14 eyes from 14 patients with unilateral ODE) and 148 eyes of age- and gender-matched control group were included in the study. The mean age of the study population was 31.51 ± 13.33 years, with 44 (54.3%) males and 37 (45.6%) females. Bilateral ODE was seen in 82.7% of patients. Idiopathic intracranial hypertension was the most common cause of bilateral ODE, and nonarteritic anterior ischemic optic neuropathy was the most common cause of unilateral presentation. Decreased vision and headache were the main symptoms reported by a majority of patients. Peripapillary RNFL thickness was significantly increased in the ODE group compared to controls. CONCLUSION: The current study provides the clinical profile and optic disc and RNFL measurements of ODE patients in an Eastern Indian population. Detailed history and careful evaluation are necessary, as the treatment strategy is highly dependent on the underlying etiologies.

Unilateral branch retinal vein occlusion with vitreous hemorrhage mimicking Terson's syndrome.

We report a case of unilateral traumatic vitreous hemorrhage following injury to the anterior cranium. A 55-year-old female presented with gradual loss of vision in her left eye following trauma to the anterior cranium. Funduscopy revealed fresh vitreous hemorrhage. Conservative management was futile with further visual deterioration over the next 2 weeks. During pars plana vitrectomy, fresh retinal hemorrhages were noted along the superotemporal (ST) vein suggesting bleed due to vein rupture. Postoperative fundus fluorescein angiography indicated ST branch retinal vein occlusion. Since trauma can be an inciting factor for both, this case could be a variant of Terson's syndrome.

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.