Post-fever Retinitis With a Positive Weil-Felix Test: A Study From a Tertiary Center in South India.

Background Post-fever retinitis (PFR) is reported two to six weeks after fever and affects one or both eyes. Rickettsial fever is one of the most common causes of PFR. This study aimed to report the clinical features and treatment outcomes of PFR cases with a positive Weil-Felix test. Methodology In this study, we collected demographic data, fever details, eye symptoms, ocular examination findings, optical coherence tomography (OCT) and fundus fluorescein angiography findings, laboratory findings, and length of follow-up of consecutive PFR cases with a positive Weil-Felix test. All cases were treated with oral doxycycline and prednisolone. Final best-corrected visual acuity (BCVA) and ocular examination findings were recorded. Visual field examination and follow-up OCT results were noted if available. Results A total of nine patients (eight males) with a mean age of 39.1 years with fever before ocular symptoms and positive Weil-Felix test were included. Six patients had bilateral disease. The mean initial and final BCVA in the affected eyes was 1.16 and 0.35 logMAR units, respectively (p < 0001). All 15 eyes had typical white retinitis patches and retinal hemorrhages which resolved after treatment. OCT showed hyperreflectivity and inner retinal disorganization over retinitis patches. White subretinal lines were noted in three patients and retinal nerve fiber bundle defect with corresponding visual field defect was seen in one eye. Conclusions In this study, PFR due to rickettsia infections has been reported from our region for the first time. Hence, eye specialists in the region should be aware of this entity.

Bedside assessment of ophthalmic manifestations in neurocritical care: A study in Southern India.

PURPOSE: This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs), including Dry Eye Disease, Chemosis, and Exposure Keratitis, among patients admitted to the Neurocritical Care Unit (NCC). Additionally, we sought to assess the correlation between these OSDs, the length of hospitalization at NCC, and the Glasgow Coma Score (GCS). The heightened risk of OSD development in the NCC environment, coupled with pre-existing neurological impairments, can lead to conditions like dry eye disease, chemosis, corneal abrasions, and infectious keratitis, ultimately resulting in corneal opacities and perforations that significantly impact visual acuity and overall quality of life. METHODS: In this observational cross-sectional study, we examined the ocular health of all patients admitted to an NCC unit from February to May 2022. We assessed the presence of Conjunctivitis, chemosis, Keratitis, and Dry Eyes in relation to the duration of stay at NCC, GCS, lagophthalmos, adherence to the prescribed eye care protocol in NCC, and the use of mechanical ventilation. Our study comprised one hundred subjects over a four-month period, with a mean age of 51.92 ± 18.73 years (ranging from 17 to 89), including 70% males and 30% females (gender ratio of 2.33). RESULTS: Our findings revealed that 26 eyes (13%) exhibited Conjunctival Hyperemia, 23 eyes (11.5%) displayed Chemosis, and severe dry eye was prevalent in 41 (20.5%) eyes. A statistically significant association was observed between GCS (p-value <0.001) and Keratitis (p-value 0.0035) with dry eyes (Chi-Square Test). Notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003). CONCLUSIONS: Patients admitted to Neurocritical Care Units necessitate meticulous eye care and structured protocols to mitigate the risk of long-term ocular complications such as exposure keratitis. Given their heightened susceptibility to these conditions, proactive measures are imperative to ensure optimal ocular health among NCC patients.

Ocular Manifestations in Pregnancy-Induced Hypertension at a Tertiary Level Hospital in Karnataka, India.

Introduction Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of previously known hypertension. PIH is a common and serious complication accompanying pregnancy. Pre-eclampsia and eclampsia are multisystem disorders that can involve end organs like kidneys, liver, eyes, haematopoietic system and placenta. Though ocular involvement is not uncommon in PIH, ocular examination is not always done in all cases of PIH. Timely detection of changes in retinal vasculature can be a hint to the underlying changes in the vascular system of the various end organs of the human body including placental circulation. Adequate management of PIH is very important for both fetal and maternal well-being. Aim To evaluate the ocular manifestations in women affected by PIH (mild pre-eclampsia, severe pre-eclampsia and eclampsia) presenting to a tertiary-level hospital. Methodology This was a hospital-based cross-sectional study carried out for a period of one year at a tertiary-level hospital. A total of 120 subjects diagnosed as cases of pre-eclampsia/eclampsia admitted to the eclampsia ward of the obstetric unit formed the study population. After taking history, a detailed ocular examination was done for all patients and the findings were noted. Results The mean age of the study population was 31.91 ± 4.38 years (range 21 to 39 years). The mean gestational age was 30.89 ± 3.98 weeks. Fifty-three (44.17%) were primigravida, 64 (53.33%) were multiparous, and three (2.5%) were grand multiparous. Sixty-two (51.67%) had mild pre-eclampsia, 50 (41.67%) had severe pre-eclampsia and eight (6.67%) had eclampsia. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) recorded in the study were 155.32 ± 11.89 mmHg and 104.3 ± 11.41 mmHg respectively. Ocular symptoms were present in 43 (35.83%) participants. Blurring of vision (19.17%) was the commonest ocular symptom observed in the study population followed by photopsia (13.33%), diplopia (9.17%), intermittent loss of vision (5.83%), ocular pain (6.67%), and scotoma (1.67%). Systemic symptoms included headache (11.67%), epigastric pain (3.33%), and nausea (5%). Anterior segment findings like conjunctival congestion, lid edema, and subconjunctival hemorrhage each accounted for 1.67% of the study population. Fundal changes were present in 33.33% of cases. Arteriolar narrowing was the commonest fundal finding amounting to 15.83%, followed by arteriovenous (AV) crossing changes also in 15.83%, cotton wool spots in 5.83%, retinal haemorrhages in 8.33%, papilledema in 2.5%, and choroidal infarcts in 1.67% participants. Grade 1 hypertensive retinopathy was observed in 15.83% of participants, grade 2 in 8.33% of participants, grade 3 in 6.67% of participants and grade 4 in 2.5% of participants. The mean SBP and mean DBP were high among those with fundal changes (163.35 ± 10.25 mmHg and 111.15 ± 10.29 mmHg) compared to those without fundal changes (151.3 ± 10.58 mmHg and 100.88 ± 10.41 mmHg). This was statistically significant. Proteinuria showed significant correlation with retinal changes. Conclusion The retinal vasculature changes correlate with the severity of hypertension, hence, it is very important to seek ophthalmologic opinion for evaluation, diagnosis and prompt management of PIH.

Visual Outcome Following Manual Small Incision Cataract Surgery at a Tertiary Center in South India.

Introduction Cataract being one of the leading causes of avertible blindness has been found to be quite prevalent in developing countries like India. The National Programme for Control of Blindness (NPCB) aims at reducing blindness due to cataract via cataract control programs. The most commonly performed surgery is the manual small incision cataract surgery (MSICS). Aim The aim of this study was to determine the visual acuity and outcome in patients who underwent MSICS in a tertiary hospital in south India. Methodology A prospective longitudinal interventional study was conducted in a tertiary hospital in Karnataka, India, over a period of nine months. A total of 105 eyes underwent MSICS and were followed up for one month to assess their postoperative visual outcome and complications, if any. During this period, they were started on antibiotic + steroid combination eyedrops, which were tapered over four weeks. Results Results were assessed based on visual grading categorized by the World Health Organization (WHO). A total of 103 (98.1%) patients had good vision, i.e., visual acuity of 6/6 - 6/18, followed by two (1.9%) who had moderate vision i.e., visual acuity of <6/18 - 3/60, and none were blind or with visual acuity of <3/60. Complications seen intraoperatively in two patients (1.9%) were iris prolapse and posterior capsular rent, respectively, and postoperatively one (0.95%) patient showed hyphema with inferior haptic in the anterior chamber. Conclusion This study proves that a good visual outcome with a low complication rate can be achieved after MSICS with posterior chamber intraocular lens implantation.