Post-chemotherapy changes in retinal pigment epithelium in retinoblastoma eyes.

OBJECTIVE: Histopathological analysis of the retinal pigment epithelial (RPE) changes in retinoblastoma (RB) cases who received pre-surgical chemotherapy. DESIGN: Laboratory-based observational study. METHODS: Five-year analysis was performed to identify Retinoblastoma cases who underwent enucleation after receiving systemic chemotherapy. Grossly, RPE cells were observed in flat preparation in small calottes by staining with fluorescein stain in the raw specimens. They were documented under the objective of compound microscope and compared with hematoxylin and eosin-stained slides in the permanent tissue sections. RESULTS: Out of 51 cases of RB, post-chemotherapy enucleation was performed in 17 cases. Mean age of enucleation was 3.2 years. Endophytic RB (11 cases, 64.71%) was more common than the exophytic variety. Choroidal involvement was noted in 8 cases (47.06%), and optic nerve involvement was seen in 5 cases (29.4%). Focal and diffuse RPE changes were seen in one case each (5.88%). Central RPE cell changes near the cell nucleus were seen in all 17 cases (100%), which were documented by both fluorescein and Hematoxylin and eosin stain (100%). Drusens were observed in 8 cases (47.06%), and RPE proliferations were seen in 3 cases (17.65%). CONCLUSION: The study highlights the characteristic histopathological RPE changes after systemic chemotherapy in RB cases. These changes may be attributable to cell nucleus damage after chemotherapy.

Retinopathy of prematurity screening and retinal hemorrhages - Our experience among Indian babies.

Purpose: To evaluate the clinical characteristics of intraocular hemorrhages among babies screened for retinopathy of prematurity (ROP) and thereby their additional risk to the progression of ROP. Methods: A descriptive study was conducted at a tertiary referral hospital, which included 108 eyes of 60 neonates who were discovered to have retinal hemorrhages on retinal screening of 540 babies at risk for ROP. Maternal, obstetric, and neonatal risk factors were assessed in neonates with retinal hemorrhages. Retinal hemorrhages were assessed in terms of type, area, and relation to different retinal zones. Results: Among 540 neonates who were screened, retinal hemorrhages were found in 11.2% (n = 60 babies). Elderly primigravida mothers and spontaneous vaginal deliveries with prolonged second stage of labor were a common maternal risk factors for retinal hemorrhages. Low birth weight and preterm were fetal risk factors with neonatal retinal hemorrhages. These hemorrhages were more often bilateral (no. of babies = 48, 80%). Flame-shaped hemorrhages were more common than dot and blot ones. The majority of cases (no. of eyes = 74, 65%) resolved within 4 weeks, whereas four babies (8 eyes, 7.4%) progressed to ROP were treated with laser. Conclusion: Retinal hemorrhages in neonates are commonly associated with prolonged duration of second stage of labor, advanced maternal age, and anemia. Although not all progress to ROP, recognizing preterm and low birth weight babies with junctional hemorrhages is crucial not to delay the treatment. Regular follow-up until the clearance of hemorrhages and monitoring systemic conditions in these babies of amblyogenic age-group are required.

Pre-Operative SARS CoV-2 Rapid Antigen Test and Reverse Transcription Polymerase Chain Reaction: A conundrum in surgical decision making.

PURPOSE: Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario. METHODS: This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed. RESULTS: 204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample. CONCLUSION: Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

Fundus evaluation in COVID-19 positives with non-severe disease.

PURPOSE: The aim of this work was to study and document retinal changes in coronavirus disease-2019 (COVID-19) positive patients with nonsevere disease using a nonmydriatic handheld fundus camera. METHODS: A cross-sectional observational study was conducted on patients affected by COVID-19 who were admitted at our center. Our study included patients with no, mild, and moderate symptoms (nonsevere cases). Intensive care unit (ICU)-admitted patients were excluded considering the difficulty in procuring the fundus image by the handheld camera due to patients positioning. Patients with systemic conditions (diabetes, hypertension, and severe anemia) known to cause retinopathy were also excluded. Bedside anterior segment examination, fundus examination using indirect ophthalmoscopy and fundus imaging of each patient using a nonmydriatic handheld fundus camera was done by a trained ophthalmologist posted for COVID duty. RESULTS: In a cohort of 138 patients, 94 (68.1%) were men and 44 (31.9%) were women. A total of 276 eyes were evaluated. The mean age of the patients was 38.51 ± 14.4 years. Anterior segment evaluation showed no abnormality in any of the eyes. On fundus screening using nonmydriatic handheld camera, a single streak of superficial retinal hemorrhage was noted at the posterior pole of the fundus in the left eye of one patient (0.72%), which was away from fovea. Laboratory tests revealed low hemoglobin (between 10 and 10.9 g/dL falling under mild Anemia) in 12 patients, elevated total leucocyte count in 6 patients, raised LDH in majority of patients (323 ± 101 Units/L) and elevated CRP (14.6 ± 30.99 mg/L). Rest of the lab parameters were within the normal range. CONCLUSION: In our study, COVID patients with mild-to-moderate symptoms did not show any inflammatory/infective or vaso-occlusive lesions in the retina attributable to COVID-19 infection, except one patient who had a single streak hemorrhage in the macula away from fovea, probably incidental.

Ophthalmic manifestations in the COVID-19 clinical spectrum.

PURPOSE: The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. METHODS: This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed. RESULTS: A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis. CONCLUSION: Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.