Minimally invasive procedure for optic disc pit maculopathy: vitrectomy with scleral plug and analysis on pattern of resolution.

Optic disc pit maculopathy (ODP-M) is a rare complication of optic disc pit which can cause irreversible visual impairment. The aim of this study is to evaluate the anatomical and functional outcomes and pattern of resolution of ODP-M following vitrectomy with posterior vitreous detachment (PVD) induction and scleral tissue plug for treatment of ODP-M without ILM peeling, laser or use of long term gas/tamponade or head positioning. This retrospective study included 7 patients with ODP-M, meeting the inclusion criteria. Patients were followed up for 6 months. Complete anatomical success was defined as "Total resolution of all the fluid in retinal compartments". All of the patients had complete resolution of the optic pit maculopathy following surgery. The mean duration for complete resolution was 18.3 weeks. Pattern of resolution of ODP-M was found to be resolution of the subretinal fluid (SRF) followed by disappearance of the retinoschitic lesions (RL) and finally disappearance of macular edema (ME). The proposed minimally invasive procedure (MIP) can produce comparably good and equally reliable results for the treatment of ODP-M.

Frosted branched angiitis due to viral meningo-encephalitis and ocular toxoplasmosis; a rare case report from Nepal.

Frosted branched angiitis (FBA) is characteristic florid translucent retinal perivascular sheathing of both arterioles and venules in association with variable uveitis and vasculitis affecting the entire retina. The vascular sheathing is supposed to be an immune-mediated reaction, possibly due to immune complex deposition in vessel walls secondary to various underlying etiologies. The authors aim to report a case of FBA secondary to herpes simplex virus and Toxoplasma gondii infection causing the diagnostic dilemma. This is the first case report on FBA from Nepal. Case report: An 18-year-old young boy hospitalized with the diagnosis of acute viral meningo-encephalitis presented with the complaint of diminution of vision and floaters in both eyes for a week. Herpetic infection was confirmed with the cerebro-spinal fluid analysis and was under antiviral drugs. His presenting visual acuity was 20/80 in both eyes and ocular features were suggestive of FBA. The vitreous sample analysis revealed raised toxoplasma titre so intravitreal clindamycin was administered twice. The ocular features resolved in the subsequent follow ups with intravenous antiviral treatment and intravitreal antitoxoplasma treatment. Conclusions: FBA is a very rare clinical syndrome secondary to many immunological or pathological causes. So, possible etiologies must be ruled out for timely management and good visual prognosis.

Pathologic Risk Factor in Retinoblastoma: An Institutional Experience Based on Analysis of Enucleated Eyes.

BACKGROUND: Mortality resulting from the metastasis of retinoblastoma is uncommon in the developed world, however it still constitutes a major problem in developing countries like Nepal. The cases of retinoblastoma with increased risk of metastasis even after enucleation can be predicted from the histopathological examination of the enucleated specimen. We conducted this study aiming to assess the frequency and spectrum of high-risk histological features in enucleated specimens of retinoblastoma. MATERIALS AND METHODS: Forty-two specimens of primary enucleation done for treatment of retinoblastoma received in the Department of Pathology at UCMS from 1st January 2016 to 31st December 2018 were included in the study. All slides were reviewed for high-risk histological features along with tumor differentiation, tumor extension, necrosis, and staging. Correlation of high-risk histological features with age and tumor size was calculated using unpaired t-test and correlation with tumor differentiation, necrosis and staging was done using Pearson Chi square test. RESULTS: The median age at enucleation was 24 months. All patients had endophytic lesion with a mean tumor size of 1.8cm. One or more high-risk histological features were identified in 30.9% (13/42). The most common high-risk histological feature was retrolaminar optic nerve invasion (10/12, 71.4%). Statistically significant correlation of high risk histological features was noted with tumor size (p=0.011) and AJCC stage of tumor (p=0.0001). CONCLUSION: Complete histopathological evaluation of retinoblastoma requires searching for high-risk histological features, the presence of which will guide the clinician in timely planning for subsequent neoadjuvant therapy.

An Experience with Intravitreal Dexamethasone Implant for Uveitic Macular Oedema.

Intravitreal steroid implants are the latest trend for uveitis macular oedema treatment. Dexamethasone intravitreal implants are new in our contexts but we report 2 cases of uveitic cystoid macular oedema where this implant proved very useful in the treatment of recalcitrant macular oedema where other treatment modality fails. Two cases of non-infectious uveitis and intermediate uveitis with recalcitrant uveitic macular oedema underwent dexamethasone intravitreal implantation. Their central macular thickness and central macular volume reduced significantly with the implant. With the reduction in macular parameters, the best-corrected visual acuity also improved and visual rehabilitation was achieved. Thus, dexamethasone intravitreal implant helps in sustained drug delivery inside the vitreous leading to resolution of uveitic macular oedema in recalcitrant cases.  Keywords: Macular oedema; ozurdex; steroid; uveitis; vision.