Connecting the Dots: Exploring the Relationship between Optical Coherence Tomography and 99mTc-TRODAT-1 SPECT Parameters in Parkinson's Disease.

Background and Objective: While optical coherence tomography (OCT) is explored as a potential biomarker in Parkinson's disease (PD), technetium-99m-labeled tropane derivative (99mTc-TRODAT-1) single-photon emission computed tomography (SPECT) imaging has a proven role in diagnosing PD. Our objective was to compare the OCT parameters in PD patients and healthy controls (HCs) and correlate them with 99mTc-TRODAT-1 parameters in PD patients. Materials and Methods: This cross-sectional study included 30 PD patients and 30 age- and gender-matched HCs. Demographic data, PD details including Movement Disorders Society Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III) and Hoehn-Yahr (HY) staging, and OCT parameters including macular and peripapillary retinal nerve fiber layer (RNFL) thickness in bilateral eyes were recorded. PD patients underwent 99mTc-TRODAT-1 SPECT imaging. The terms "ipsilateral" and "contralateral" were used with reference to more severely affected body side in PD patients and compared with corresponding sides in HCs. Results: PD patients showed significant ipsilateral superior parafoveal quadrant (mean ± standard deviation [SD] = 311.10 ± 15.90 vs. 297.57 ± 26.55, P = 0.02) and contralateral average perifoveal (mean ± SD = 278.75 ± 18.97 vs. 269.08 ± 16.91, P = 0.04) thinning compared to HCs. Peripapillary RNFL parameters were comparable between PD patients and HCs. MDS-UPDRS-III score and HY stage were inversely correlated to both ipsilateral (Spearman rho = -0.52, P = 0.003; Spearman rho = -0.47, P = 0.008) and contralateral (Spearman rho = -0.53, P = 0.002; Spearman rho = -0.58, P < 0.001) macular volumes, respectively. PD duration was inversely correlated with ipsilateral temporal parafoveal thickness (ρ = -0.41, P = 0.02). No correlation was observed between OCT and 99mTc-TRODAT-1 SPECT parameters in PD patients. Conclusion: Compared to HCs, a significant thinning was observed in the ipsilateral superior parafoveal quadrant and the contralateral average perifoveal region in PD patients. Macular volume and ipsilateral temporal parafoveal thickness were inversely correlated with disease severity and duration, respectively. OCT and 99mTc-TRODAT-1 SPECT parameters failed to correlate in PD patients.

Ophthalmic Manifestations of Seborrheic Dermatitis.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease that affects the sebaceous tissues of the body. The meibomian glands of the eyelids are modified sebaceous glands. Involvement of the meibomian glands and their dysfunctioning are significant in SD; however, the ophthalmic features of SD have been poorly described in the literature. The ophthalmic manifestations of SD and the significance of ocular examinations in SD patients are discussed in this review.

Post-COVID-19 endogenous endophthalmitis case series and review of literature.

PURPOSE: To describe a series of post-coronavirus disease 2019 (COVID-19) endogenous endophthalmitis (EE) patients from a multispecialty tertiary hospital in North India. METHODS: A retrospective chart review including all consecutive cases with EE following confirmed COVID-19 disease from July 2020 to June 2021. RESULTS: Seven eyes of four patients (three female and one male) were included. Two patients had confirmed bilateral fungal (Aspergillus sp.) EE and two patients had presumed fungal EE (one bilateral and one unilateral). Three of these four patients received systemic steroids as part of COVID-19 treatment previously. Five eyes were managed with initial intravitreal injection (IVI), followed by pars plana vitrectomy (PPV), and two eyes were managed with only IVI. All patients received systemic antifungal agents. Intraocular inflammation resolved in all eyes with treatment. One patient of EE also developed voriconazole-induced transient visual hallucination, which resolved on discontinuing the medication. CONCLUSION: This case series represents a series of EE cases following COVID-19 disease or its sequelae or as a result of prior treatment for COVID-19. Ophthalmologists and physicians must be vigilant about these complications and initiate prompt management at the earliest.

Comparison of clinico-radiological profile, optical coherence tomography parameters, and outcome in MOGAD and Neuromyelitis optica spectrum disorder subtypes: A prospective observational study.

Objectives: The objectives of the study were to compare the clinico-radiological profile, optical coherence tomography (OCT) parameters and outcome in Myelin Oligodendrocyte Glycoprotein-IgG-associated disorders (MOGAD) and Neuromyelitis Optica Spectrum disorder subtypes. Materials and Methods: This prospective study involved collection of data regarding neurological assessment, neuroimaging, cerebrospinal fluid analysis, OCT parameters, treatment and outcome. Disease severity and disability were assessed using Expanded Disability Status Scale and modified Rankin scale. Patients were categorized into aquaporin-4 (AQP4+), MOGAD, and double negative (DN; both AQP4 and MOG negative). Results: Among 31 patients included, 42% were AQP4+, 32.2% were MOGAD, and 25.7% were DN. The median age at onset was comparable (AQP4+ vs. MOGAD vs. DN = 28 years vs. 24.4 years vs. 31.5years; P = 0.31). Females predominated in AQP4+ compared to MOGAD group (76.9% vs. 30%; P = 0.02). Majority of patients (73.5%) had a relapsing course with a median of two (range = 1-9) relapses. Ninety-nine demyelinating events occurred: Transverse myelitis (TM) in 60/99 (60.6%), optic neuritis (ON) in 43/99 (43.4%), area postrema (AP) syndrome in 20/99 (20.1%), and optico-spinal syndrome in 10/99 (10.1%). ON was common in MOGAD than AQP4+ patients (58.6% vs. 32.1%; P = 0.03). Spinal cord and brain lesions on magnetic resonance imaging (MRI) were seen in 90.3% and 54.8% patients, respectively. A significantly higher proportion of AQP4+ patients showed longitudinally extensive transverse myelitis as compared to MOGAD group (69.2 % vs. 20 %; P = 0.04), specifically involving dorsal cord (92.3% vs. 50%; P = 0.02). MRI brain lesions, especially involving AP, was frequent in DN than MOGAD (47.1% vs. 6.9%; P = 0.003) and AQP4+ (47.1% vs. 18.9%; P = 0.03) patients. AQP4+ group showed significant nasal RNFL thinning on OCT (P = 0.04). Although 6-month good functional outcome was better in MOGAD than DN and AQP4+ (80% vs. 71.4% vs. 41.7%) groups, they were comparable (P = 0.13). Conclusion: Nearly three-fourth of our patients showed a relapsing course, with TM being the most common clinical presentation. AQP4+ group showed female preponderance, frequent dorsal cord longitudinally extensive transverse myelitis, less frequent ON, and greater nasal RNFL thinning compared to MOGAD group. MRI brain lesions were more common in DN patients. All three groups exhibited good response to pulse corticosteroids and showed a comparable functional outcome at 6-month follow-up.

Retinal Nerve Fiber Layer Thickness in Patients With Obstructive Sleep Apnea.

PRCIS: Average and superior quadrant retinal nerve fiber layer thickness (RNFLT) was lower in the more severe obstructive sleep apnea (OSA) group and inversely associated with apnea-hypopnea index (AHI). OSA may have an impact on RNFLT. PURPOSE: The purpose of this study was to study the RNFLT using optical coherence tomography (OCT) in patients with different severities of OSA. PATIENTS AND METHODS: In this hospital-based prospective cross-sectional study, 90 (90 eyes) newly diagnosed OSA patients aged 18 years or above were enrolled. Based on the AHI, there were 38.8%, 30%, and 31.1% cases of mild (AHI≥5 to <15), moderate (AHI≥15 to <30), and severe (AHI≥30) OSA, respectively. All the participants underwent a comprehensive ocular examination. OCT was done using CIRRUS HD-OCT 500 to measure the RNFLT. RESULTS: The average RNFLT among the 3 OSA groups was significantly different ( P =0.002) and inversely associated with AHI ( P =0.02, rs =-0.16). Severe OSA had thinner average RNFLT than those with mild and moderate OSA ( P =0.01 and 0.003, respectively). Among the 4 quadrants observed, only the superior quadrant RNFLT among the 3 OSA groups was significantly different ( P <0.00001) and inversely associated with AHI ( P =0.01, rs =-0.17). Severe OSA had thinner superior quadrant RNFLT than those with moderate OSA ( P <0.01). The differences in the intraocular pressure among the 3 OSA groups were statistically significant ( P <0.0008). Patients with moderate and severe OSA had higher intraocular pressure than patients with mild OSA ( P =0.002 and 0.001, respectively). CONCLUSIONS: Attention should be paid to the patients with OSA as it may have an impact on RNFLT. OSA patients should be screened for glaucoma as early detection of glaucoma can reduce vision loss in these patients.

Bilateral multiple blisters of retinal pigment epithelium in a healthy young female.

BACKGROUND/ PURPOSE: Multiple serous pigment epithelium detachments (PEDs) have been infrequently reported. We report a case of a young female with bilateral innumerable serosanguinous PEDs, giving an appearance of multiple blisters. METHODS: A 26-year-old female presented with sudden onset diminution of vision in left eye. She had bilateral innumerable translucent blister-like elevations of retinal pigment epithelium (RPE) and a few hemorrhagic blister-like elevations at macula and submacular blood in left eye. Multi-modal fundus imaging was performed. Pneumatic displacement and intravitreal injection of ranibizumab was performed in left eye. RESULTS: optical coherence tomography (OCT) confirmed multiple serous PEDs with pachychoroid morphology in both eyes and few hemorrhagic PEDs at the macula in left eye. The lesions were hypoautofluorescent with a halo of hyperautofluorescence. Fluorescein angiography revealed pooling into the serous PEDs in both eyes and few late leakage points in the area of blocked fluorescence at the macula in left eye. One-month following the intervention, subretinal blood had partially displaced with modest visual acuity gain. However, the patient refused further intravitreal injections. CONCLUSION: Bilateral extensive serous PEDs, to the extent noted in this case, have not been previously reported. A widespread RPE-Bruch's membrane defect is suspected.

Paracentral acute middle maculopathy with occlusive retinal vasculitis in presumed intraocular tuberculosis and hyperhomocysteinemia.

A male patient presented with a sudden visual decline in the right eye (OD). Fundus revealed bilateral vasculitis; OD also showed an occluded inferior retinal vein and a wedge-shaped retinal opacification of the inferior macula and nasal retina. Fluorescein angiography revealed occlusive retinal vasculitis, while optical coherence tomography showed paracentral acute middle maculopathy (PAMM) in the OD. A thorough systemic evaluation revealed hyperhomocysteinemia and a positive Mantoux test. A diagnosis of PAMM with occlusive retinal vasculitis in presumed intraocular tuberculosis and hyperhomocysteinemia was made. Retinal vasculitis improved with oral corticosteroid, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. However, the patient declined antitubercular therapy despite recommendations. This unique report indicates that PAMM may complicate tubercular retinal vasculitis, especially in the presence of systemic hypercoagulable states.

Orbital Venolymphatic Malformation Treated With Sodium Tetradecyl Sulfate: A Case Report.

Orbital and periorbital venolymphatic malformations (VLMs) are benign congenital vascular lesions and constitute 1%-3% of all orbital masses. Widespread facial venous malformations have a high incidence of associated intracranial developmental venous anomalies (DVAs). In such cases, there can be a sudden increase in proptosis following upper respiratory infection or minor trauma. Numerous percutaneous intralesional sclerosing agents like sodium tetradecyl sulfate (STS), bleomycin, doxycycline, ethanol, and OK-432 (Picibanil) have been used for treating VLMs. We hereby report a rare case of retro-orbital VLM treated successfully with STS injection and an isolated dural arterio-venous (AV) fistula in the same patient.

Simultaneous bilateral inflammatory choroidal neovascularization in a case of healed serpiginous-like choroiditis.

Objective: Inflammatory choroidal neovascularization (i-CNV) is an infrequent but sight-threatening complication of posterior uveitis. Although it can occur in a wide range of infectious and non-infectious uveitides, presence of simultaneous bilateral i-CNV is rare. In this report, we present a unique case of bilateral simultaneous i-CNV in a young patient of healed tubercular serpiginous-like choroiditis. Method: A 20-year-old male presented with recent worsening of vision in the right eye for one month. Fundus examination revealed bilateral multifocal healed choroiditis lesions with right eye tiny subfoveal hemorrhage raising the suspicion of an underlying choroidal neovascularization. Fundus fluorescein angiography and optical coherence tomography confirmed presence of choroidal neovascular membrane in both eyes. Result: Resolution of activity was noted in both eyes after bilateral sequential intravitreal bevacizumab injections. Conclusion: Inflammatory choroidal neovascularization may be seen in patients with healed tubercular serpiginous-like choroiditis, after a long period of quiescence. Simultaneous bilateral presentation is rare but possible, requiring mandatory multimodal imaging of both eyes under high index of suspicion. Early institution of anti-vascular endothelial growth factor may salvage optimum vision in such a scenario.

Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment.

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post-traumatic posterior GRT and full-thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21-year-old-male presented with sudden diminution of vision in the right eye (RE) following blunt-trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior-GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post-operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior-GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video. Video Link: https://youtu.be/p04-_t0Wuuc.

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India.

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

Factors Determining Improvement in Stereopsis and Binocularity After Good Postoperative Alignment in Patients With Childhood-Onset Strabismus.

INTRODUCTION: The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity. METHODS: Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative alignment within 10 PD. Pre- and postoperative stereopsis and binocularity testing were performed using the Titmus fly test, random dot test, Bagolini striated glass test, and Worth four dot test at one, four, and 12 weeks postoperatively. RESULTS: A total of 73 patients (55% males and 45% females) who underwent surgery at our center were studied. The mean age at the time of surgery was 16 ± 7.7 years (range: 5-35 years). We found that factors such as age of strabismus onset, type of deviation, and amblyopia had a statistically significant influence on the postoperative surgical outcome. A statistically insignificant relationship was noted with gender, refractive error, and duration of strabismus. Patients who had strabismus after six months of age noticed a significant improvement in stereopsis (p-value = 0.000) than those who had strabismus before six months of age (p-value = 0.660). Further, there was a statistically significant improvement in patients having exotropia (p-value = 0.018) or combined horizontal and vertical deviations (p-value = 0.000), but there was no significant improvement in patients with esotropia (p-value = 0.180). Moreover, non-amblyopes had a significantly better postoperative stereopsis than amblyopes (p-value = 0.006). Although there was no association between preoperative deviation and improvement in stereopsis (p-value = 0.081), patients having preoperative deviation in the range of 31-45 PD had a statistically significant improvement in stereopsis (p-value = 0.000). There was no significant difference between postoperative residual deviation and final stereopsis (p-value > 0.05). All the results were the same for both the Titmus test and the random dot test. Binocular fusion was observed in 34 subjects, and uniocular suppression was noted in 38 subjects preoperatively. It was observed that only one patient gained binocular single vision postoperatively. CONCLUSION: The presence of amblyopia, esotropia, early onset of strabismus (within six months of age), and a larger preoperative deviation (>45 PD) were associated with poorer stereopsis. In patients with horizontal strabismus, the coexistence of vertical deviation had a positive impact on the postoperative stereopsis. Gender, refractive error, and duration of strabismus did not influence the final stereopsis in our study.

Clinical profile and retinal nerve fibre layer thickness of optic disc oedema patients at a tertiary care institute in North India.

BACKGROUND: Optic disc oedema (ODE) is an important manifestation in various ocular as well as systemic disorders. Measurement of retinal nerve fibre layer (RNFL) thickness in ODE patients may help in monitoring the progress of the disease and treatment response. OBJECTIVE: To assess the clinical characteristics, aetiology and retinal nerve fibre layer (RNFL) imaging features of optic disc oedema (ODE) patients. DESIGN: A retrospective observational study. METHODS: This hospital-based study included performed for patients presenting with unilateral or bilateral ODE at the ophthalmology outpatient department of a tertiary institute between January 2019 and December 2019. Clinical features of all ODE patients were noted. RNFL thickness was measured by spectral-domain optical coherence tomography (Cirrus 500, Carl Zeiss Meditec, Dublin, CA, USA). RESULTS: Sixty-four patients with ODE were seen with female preponderance (56.2%). The mean age of presentation was 36.8 ± 13.8 years. Bilateral ODE was seen in 57.8% patients. The most common cause of bilateral ODE was idiopathic intracranial hypertension (IIH) and vascular papillopathy. Retinal vein occlusion (RVO)-associated ODE was the most common unilateral presentation. Presenting visual acuity was best with IIH and worst with anterior ischaemic optic neuropathy (AION). The mean duration of symptoms was maximum with intracranial space-occupying lesion associated papilloedema and minimum with AION. The mean RNFL thickness was highest in uveitis-associated ODE, followed by compressive ON, and IIH. A positive correlation was noted between clinical ODE severity and RNFL thickness. All aetiological categories (except uveitic and compressive) had maximum RNFL thickening in the inferior quadrant and minimum in the temporal quadrant. CONCLUSION: The current study provides a clinical profile and RNFL measurements of ODE patients at this locality. The clinical severity of ODE correlated positively with RNFL thickness and most of the categories of ODE followed the normative pattern of RNFL thickness (inferior > superior > nasal > temporal) despite thickening.

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State.

PURPOSE: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. METHODS: A cross-sectional study was conducted among school-going children of age group 6-16 years of standard I-XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05. RESULTS: In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7-2.9) (P < 0.001). CONCLUSION: Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.

An Unusual Presentation of Retrobulbar Cavernous Hemangioma in a Young Woman.

A 38-year-old woman presented with sudden-onset painful lid swelling, proptosis and external ophthalmoplegia on the right side for 20 days, associated with loss of vision for nine days. On contrast-enhanced computed tomography (CECT), a retrobulbar mass was noted involving intraconal and extraconal spaces, extending up to the orbital foramina with enhancement and thickening of meninges. CT arteriography further revealed multiple feeding vessels from the maxillary artery. Embolization of feeding vessels followed by right orbital exenteration with primary reconstruction using forehead flap was done. This is an unusual case of orbital cavernous hemangioma (OCH) which emphasizes the importance of CT arteriography in specific cases of OCH, where routine neuroimaging may be inconclusive.

Macular dual retinitis with Herpes simplex and Cytomegalovirus following periocular corticosteroid in a patient of Pemphigus Vulgaris.

BACKGROUND: Cytomegalovirus (CMV) retinitis may occur in non-HIV individuals following systemic immunosuppressive treatment or periocular corticosteroid administration. However, simultaneous multiple viral retinitis is rare in HIV-negative individuals. We report a case of dual viral retinitis in a non-HIV female on systemic immunosuppressive for pemphigus vulgaris who was administered a periocular corticosteroid injection. METHOD: A 32-year-old female on double immunosuppressive therapy (prednisolone and cyclophosphamide) for pemphigus vulgaris, presented with gradual painless diminution of vision in the right eye for one month. She was initially diagnosed to have possible autoimmune neuroretinitis by the referring ophthalmologist and received a single injection of posterior subtenon triamcinolone acetonide for the same. Her vision however deteriorated further and she received an intravitreal ganciclovir injection with a revised diagnosis of CMV retinitis. Due to suboptimal response she was referred to us. Aqueous Polymerase chain reaction (PCR) revealed dual positivity for CMV and Herpes simplex virus. She was successfully managed with intravitreal ganciclovir injections, systemic acyclovir and tapering of systemic immunosuppressive drugs. RESULT: The retinitis lesions resolved gradually leaving behind a pale optic disc and foveal atrophy at 12 weeks follow-up. CONCLUSION: Infective etiology must be ruled out in immunosuppressed patients before considering periocular corticosteroids. Dual viral involvement, although rare, may cause fulminant retinitis in predisposed individuals. High index of suspicion and PCR from ocular fluids should be performed at the earliest in patients with atypical or poorly responding retinitis lesions.

Optical coherence tomography angiography-guided diagnosis of a traumatic choroidal rupture-associated choroidal neovasular membrane and its management with intravitreal ranibizumab.

A 25-year-old female presented with sudden onset diminution of vision in the right eye (oculus dextrus [OD]) following blunt trauma after a sports injury. Ocular examination revealed best-corrected visual acuity (BCVA) of 20/30 in OD and fundus revealed commotio retinae, localized preretinal bleed, and a large choroidal rupture (CR). She was managed conservatively at that moment. Three months following trauma, she returned with further deterioration of BCVA (20/80) in OD. Optical coherence tomography angiogram (OCTA) confirmed the presence of choroidal neovascular membrane (CNVM). She was treated with single intravitreal ranibizumab injection. Repeat OCTA after 6 weeks showed the regression of CNVM. Her BCVA improved to 20/30 at 6 months of follow-up. In the index report, we present a unique OCTA guided the diagnosis of posttraumatic CR-associated CNVM and its successful management with single intravitreal ranibizumab.