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.

Alteration in pattern reversal visual evoked potential in pediatric population with amblyopia and spherical refractive errors.

Purpose: To study the effect of refractive errors on pattern visual evoked potential (VEP) recordings in the pediatric population. Methods: This cross-sectional observational study assessed 240 eyes of 120 participants attending the outpatient department of a tertiary care center in North India. Participants were between 8 and 18 years of age; 30 participants each were recruited into four groups, namely emmetropia, myopia, hypermetropia, and amblyopia. They were then subjected to pattern reversal VEP, with P-100 amplitude and latency recorded for each participant. Results: The emmetropic group in this study provided normal values of P-100 parameters, namely P-100 latency and P-100 amplitude with readings of 115.78 ± 10.19 ms and 11.11 ± 4.08 µV, respectively. P-100 amplitude was significant compared to P-100 latency in detecting the presence or absence of a specific type of refractive error. It was found that there was a significant association between severity of myopia and P-100 latency (both unaided and aided) with P < 0.05. The severity of hypermetropia showed a significant association with P-100 amplitude (unaided) (P < 0.05). Receiver operating characteristics analysis revealed P-100 amplitude to be a good predictor of refractive error and the cut-offs were calculated. Conclusion: The P-100 parameters of the pediatric Indian population were comparatively higher than conventional values. P-100 latency seemed to better correlate with myopia, while hypermetropia correlated with P-100 amplitude. P-100 amplitude appears to be the most significant predictor of the presence of refractive error in an individual.