An Unusual Ocular Manifestation of Disseminated Tuberculosis: Combined Retinal Vascular Occlusion Inducing Acute Loss of Vision.

Disseminated tuberculosis (TB) is a life-threatening disease caused by the hematogenous spread of Mycobacterium tuberculosis. Acute loss of vision as a symptom of disseminated TB is uncommon, as per the literature. Uveitis is the most common ocular manifestation of TB, and tubercular retinal arterial or venous occlusion, with or without ocular signs, has been rarely described before. We discuss the case of a 34-year-old truck driver who presented with fever, cough, and sudden painless loss of vision in the right eye. Examination revealed optic neuropathy, as well as central retinal artery and venous occlusion. Investigations showed bilateral miliary shadows on chest X-ray and multiple ring-enhancing brain lesions on MRI brain, consistent with disseminated TB. Anti-tubercular therapy led to clinical improvement. We report this case to highlight the rarity of this condition.

The effects of renal transplantation on diabetic retinopathy: clinical course and visual outcomes.

PURPOSE: To elucidate the clinical course of diabetic retinopathy (DR) after renal transplantation (RT) in a hospital based cohort. DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 56 eyes of 28 patients, who had DR and end stage renal disease (ESRD) due to diabetes and had undergone RT, were included in this study. Diagnosis and management of DR was carried out according to early treatment of diabetic retinopathy study (ETDRS) guidelines. DR outcome was defined as worsening if there was >2 step increase in the grade of DR or need for intervention such as laser (macular or pan retinal) or vitreoretinal surgery, improvement for <2 step change while stabilization was defined if DR remained within these two limits. RESULTS: The mean age of the patients were 48.9 years. The mean duration of diabetes in the study group was 12.7 years. The patients were followed-up for a mean period of 52.2 ± 43.6 months. The pre-transplant mean Best corrected visual acuity (BCVA) was 0.4876 log MAR units and post-transplant mean BCVA was 0.4858 (P = 0.05). However, there was a significant visual improvement in first 20 months of renal transplant (P = 0.03). Worsening of DR was noted in 16 (32%) eyes whereas improvement was seen in 4 (8%). However, majority of eyes 30 (60%) had stable retinopathy at the final follow-up. CONCLUSIONS: RT stabilized the retinopathy status in the majority of patients although in a minor subset the disease course was unpredictable.

Role of famciclovir in the management of acute retinal necrosis in developing countries.

PURPOSE: To evaluate clinical presentations, management strategies, and results in patients with acute retinal necrosis (ARN) who received famciclovir. METHODS: In a retrospective, noncomparative, interventional case series, we reviewed case records of patients with ARN from the computerized database between January 2007 and December 2009. Data collected included demographic details of the patient, relevant history, examination findings, drugs administered, clinical response, and final visual acuity. The main outcome measures were visual acuity and clinical response. RESULTS: Famciclovir was administered in three cases of ARN. In these three immunocompetent patients, there was complete resolution of ARN with improvement in visual acuity and absence of other eye involvement or recurrence in the primary eye. CONCLUSION: One may consider treating ARN with oral famciclovir in immunocompetent patients in developing countries when intravenous acyclovir treatment is not affordable to the patient or when there is clinical resistance to acyclovir.

Enterobacter endophthalmitis: clinicomicrobiologic profile and outcomes.

PURPOSE: To report the clinical presentations, antibiotic sensitivities, management, and outcomes of Enterobacter endophthalmitis. METHODS: This is a retrospective, consecutive, noncomparative, interventional case series. The medical records of culture-proven Enterobacter endophthalmitis cases from the endophthalmitis registry between January 1995 and March 2006 were reviewed. RESULTS: Enterobacter was the causative agent in 36 culture-proven cases. The causative event was cataract surgery in 11 and trauma in 25 patients. The presenting visual acuity was light perception in 26 eyes (72.2%). Polymicrobial infection was detected in 7 patients (19.4%). Enterobacter organisms were most sensitive to ciprofloxacin (n = 34; 94%), followed by amikacin (n = 31; 86%) and ceftazidime (n = 28; 78%). In postoperative endophthalmitis, final visual outcome of ≥20/200 was achieved in 3 patients (27%) and of ≥5/200 in 5 patients (45%). The eyes became phthisical in 3 patients (27%) and evisceration was carried out in 1 patient. In posttraumatic endophthalmitis, final visual outcome of ≥20/200 was achieved in 5 patients (20%) and of ≥5/200 in 7 patients (28%). The eyes of 11 patients (44%) became phthisical and evisceration was carried out in 1 patient. CONCLUSION: Enterobacter organisms are mostly susceptible to ciprofloxacin, amikacin, and ceftazidime. Despite this coverage, the visual outcome is often poor.