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PURPOSE: To evaluate the outcomes of pars plana vitrectomy (PPV) with microscope-integrated intraoperative optical coherence tomography (I-OCT)-guided traction removal and center-sparing internal limiting membrane (cs-ILM) peeling. METHODS: Nine eyes with myopic traction maculopathy as diagnosed on SD-OCT underwent PPV with I-OCT-guided cs-ILM peeling and were evaluated prospectively for resolution of central macular thickness (CMT) and improvement in best-corrected visual acuity (BCVA), and complications, if any, were noted. All patients were followed up for more than 9 months. RESULTS: Resolution of the macular retinoschisis was seen in all nine eyes on SD-OCT. At 36 weeks, there was a significant improvement in mean BCVA from the preoperative BCVA (P = 0.0089) along with a reduction in the CMT from 569.77 ± 263.19 to 166.0 ± 43.91 um (P = 0.0039). None of the eyes showed worsening of BCVA or development of full-thickness macular hole in the intraoperative or follow-up period. CONCLUSION: PPV with I-OCT-guided cs-ILM peeling helps in complete removal of traction, resolution of retinoschisis and good functional recovery with low intraoperative and postoperative complications.
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Técnicas de Diagnóstico Oftalmológico/instrumentação , Membrana Epirretiniana/cirurgia , Monitorização Intraoperatória/métodos , Miopia Degenerativa/cirurgia , Tomografia de Coerência Óptica/métodos , Vitrectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retinosquise/cirurgia , Acuidade VisualRESUMO
AIM: To report silicone oil tamponade induced vasculitis in the early post operative period - a rare manifestation of 'Toxic Posterior Segment Syndrome' after pars plana vitrectomy for rhegmatogenous retinal detachment. CASE DESCRIPTION: A 50-year-old gentleman presented with vasculitis after a pars plana vitrectomy with silicone oil tamponade on the first post-operative day. He was started on oral steroids (1â mg/ kg) tapered sequentially every week. All signs of vasculitis resolved over a period of one month after which the silicone oil was removed. The patient maintained a visual acuity of 20/90 even after 3 months. There was no recurrence of vasculitis observed thereafter. CONCLUSION: Silicone oil induced vasculitis is a rarely described entity, especially as a manifestation of toxic posterior segment syndrome. This differential must be kept in mind even on the first post-operative day in cases where silicone oil has been used for tamponade.
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Descolamento Retiniano , Vasculite , Masculino , Humanos , Pessoa de Meia-Idade , Óleos de Silicone/efeitos adversos , Descolamento Retiniano/induzido quimicamente , Descolamento Retiniano/diagnóstico , Vitrectomia , Acuidade Visual , Vasculite/cirurgia , Estudos RetrospectivosRESUMO
INTRODUCTION: Tuberculosis can involve any organ in the body including ocular tissue of which the uveal tissue is most commonly infected. Choroidal involvement ranges from choroidal tubercles to granulomas. This is one of the few cases of a solitary choroidal granuloma with no other systemic symptoms in an immunocompetent child. METHOD: A case report. RESULTS: A 12-year-old female, presented with diminution of vision in the left eye for a month. The anterior segment of her left eye was normal. A fundus examination revealed an isolated orangish-yellow choroidal mass, 4 DD in size, involving the posterior pole with overlying subretinal exudation. CT scan of the thorax showed large pulmonary, cervical and pancreatic lymph nodes, along with lytic lesions of the thoracic vertebrae. Excision biopsy of the cervical lymph nodes showed caseating granulomas with no e/o malignancies on histopathology. The patient was started on anti-tubercular therapy. Six months after the treatment, the lesion had reduced in size and her vision had improved. CONCLUSION: Isolated choroidal tuberculomas can be present in eyes with little associated ocular inflammation and no other symptoms of systemic tuberculosis. High suspicion, early diagnosis and rapid initiation of medication are important for the treatment of ocular and systemic tuberculosis.
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Doenças da Coroide , Tuberculoma , Tuberculose Ocular , Humanos , Feminino , Criança , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico , Tuberculoma/diagnóstico por imagem , Tuberculoma/tratamento farmacológico , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Granuloma/etiologia , Corioide , Doenças da Coroide/diagnóstico , Doenças da Coroide/tratamento farmacológico , Doenças da Coroide/etiologiaRESUMO
Background This study aimed to compare the clinical outcomes of a heparin surface-modified (HSM) hydrophobic acrylic foldable intraocular lens (IOL) (CT LUCIA 601PY) and non-heparin-modified hydrophobic acrylic foldable IOL (AcrySof IQ SN60WF) in diabetic patients undergoing phacoemulsification. Methodology This randomized, single-surgeon, double-masked controlled trial was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. In this randomized controlled trial, 100 eyes of 100 diabetic patients with or without mild-to-moderate diabetic retinopathy were enrolled (HSM IOL, n = 50; non-HSM IOL, n = 50). Outcome measures were aqueous flare, visual acuity, and anterior chamber depth (ACD). These were measured preoperatively as well as one day, one week, one month, three months, six months, and one year postoperatively. Results The HSM IOL group had significantly lower anterior chamber aqueous flare values (photon count/ms) than the non-HSM IOL group on postoperative day one (9.97 ± 5.2 vs. 17.56 ± 11.3, p < 0.001), postoperative week one (11.47 ± 7.78 vs. 17.06 ± 9.4, p = 0.02), and postoperative month three (7.7 ± 4.1 vs. 12.5 ± 5.6, p = 0.004) of phacoemulsification. The corrected distance visual acuity (CDVA) was significantly better in the HSM IOL group on postoperative day one (uncorrected distance visual acuity: p = 0.022; CDVA; p = 0.005), but there was no significant difference at any other follow-ups. ACD was significantly longer in the HSM IOL group at all follow-ups. Conclusions The implantation of HSM IOL resulted in significantly lower inflammatory reactions in the early postoperative period in diabetics.
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Intraocular tumors constitute a small subset of cases in ophthalmologic practice. Proper diagnosis of intraocular tumors is crucial because some pose threat to vision and life, while others may indicate underlying systemic disorders. Intraocular tumors comprise benign and malignant lesions affecting the retina, choroid, optic disc, iris, and ciliary body. Retinal tumors can be classified as vascular, neural, glial, and retinal pigment epithelial tumors. Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality employed in diagnosis and management of retinal and choroidal vascular diseases, and has enhanced our knowledge in better understanding of the vascular physiology and pathology. Multiple case reports and small series evaluating the role of OCTA in retinal tumors are published in literature. OCTA helps in better understanding of the vascularity of intraocular tumors. In addition to this, OCTA has its role in clinical practice. It helps in identification of small retinal capillary hemangioblastoma (RCH), assessment of treatment response, and identification of tumor recurrence in RCH. It aids in identification of retinal astrocytic hamartoma missed on clinical examination and differentiating retinal astrocytic hamartoma and presumed solitary circumscribed retinal astrocytic proliferation. It helps in assessment of risk of tumor recurrence in retinoblastoma. It helps in differentiating tumors of retinal pigment epithelium (RPE) origin from pigmented tumors of the choroid. It also helps in detection of choroidal neovascular membrane in combined hamartoma of the retina and RPE.
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Angiofluoresceinografia , Fundo de Olho , Neoplasias da Retina , Tomografia de Coerência Óptica , Humanos , Neoplasias da Retina/diagnóstico , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Retina/diagnóstico por imagem , Retina/patologiaRESUMO
A lady who underwent lensectomy for microspherophakia and pars plana vitrectomy for retinal detachment in her left eye developed recurrent filtering blebs at the site of sclerotomies. Filtering blebs were managed by suturing the sclerotomies. Targeted gene sequencing identified a variant of ASPH gene (p.Arg688Gln) which is not known to be associated with Traboulsi syndrome. But considering the paucity of cases with genetic analysis, it would be possible that p.Arg688Gln is a pathogenic variant. This is the first case report of Traboulsi syndrome due to an ASPH variant not reported earlier that can lead to recurrent filtering blebs.
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Ectopia do Cristalino , Glaucoma , Descolamento Retiniano , Feminino , Humanos , Glaucoma/diagnóstico , Glaucoma/etiologia , Glaucoma/cirurgia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , VitrectomiaRESUMO
Congenital hypertrophy of retinal pigment epithelium (CHRPE) is a benign, pigmented, flat lesion arising from the retinal pigment epithelium (RPE). In this study, we describe optical coherence tomography angiography (OCTA) features of two eyes with solitary CHRPE. We found that the retinal vasculature over CHRPE was normal in both cases. We observed that in solitary CHRPE, segmentation artifacts can interfere in the interpretation of retinal vasculature due to thinning of the outer retina. Visualization of the underlying choroidal vasculature was obscured to some extent by masking effect of the hyperpigmented RPE. The choroidal vasculature was better appreciated on en face OCTA. On OCTA, the retinal and choroidal vasculature associated with CHRPE was found to be normal in our study.
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Angiofluoresceinografia/métodos , Doenças Retinianas/congênito , Epitélio Pigmentado da Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Fundo de Olho , Humanos , Hipertrofia/congênito , Hipertrofia/patologia , Masculino , Doenças Retinianas/patologia , Epitélio Pigmentado da Retina/anormalidadesRESUMO
In this series, we discuss the role of optical coherence tomography angiography (OCTA) in assessing response to treatment in intraocular vascular tumors. This is a series of two cases: Multiple retinal capillary hemangioblastoma (RCH) treated with laser photocoagulation and diffuse choroidal hemangioma (DCH) with radiotherapy. In large RCH and DCH, optical coherence tomography (OCT) showed significant reduction of subretinal and intraretinal fluid. But post-treatment mean tumor vascular density (MTVD) was slightly reduced. In one small RCH, vascular loop was seen suggesting minimal residual disease. So, OCTA helps in identifying treatment inadequacy and understanding alternate mechanism involved in treatment response in vascular tumors.
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Neoplasias da Coroide/diagnóstico , Corioide/patologia , Angiofluoresceinografia/métodos , Hemangioma/diagnóstico , Fotocoagulação a Laser/métodos , Retina/patologia , Neoplasias da Retina/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Neoplasias da Coroide/complicações , Neoplasias da Coroide/cirurgia , Fundo de Olho , Hemangioblastoma/complicações , Hemangioblastoma/diagnóstico , Hemangioblastoma/cirurgia , Hemangioma/complicações , Humanos , Masculino , Neoplasias da Retina/complicações , Neoplasias da Retina/cirurgiaRESUMO
We present a rare case of retinal racemose angioma complicated with fleeting macroaneurysm (MA). A 50-year-old female presented with diminution of vision in her right eye for 6 years. Fundus examination showed a racemose angioma with hemorrhagic MA temporal to the fovea in the right eye. On subsequent follow-ups, spontaneous thrombosis of MA was noted with the development of new MA inferior to the fovea, with intraretinal hemorrhage extending into the fovea. Focal laser to MA resulted in resolution of MA with improvement in vision. We report optical coherence tomography angiographic features of the fleeting MA in a case of racemose angioma.
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Aneurisma/diagnóstico , Angiofluoresceinografia/métodos , Hemangioma/diagnóstico , Artéria Retiniana/diagnóstico por imagem , Hemorragia Retiniana/diagnóstico , Neoplasias da Retina/diagnóstico , Tomografia de Coerência Óptica/métodos , Aneurisma/complicações , Aneurisma/cirurgia , Feminino , Fundo de Olho , Hemangioma/complicações , Hemangioma/cirurgia , Humanos , Fotocoagulação a Laser , Pessoa de Meia-Idade , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/cirurgia , Neoplasias da Retina/complicações , Neoplasias da Retina/cirurgiaRESUMO
PURPOSE: To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe. METHODS: In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released. RESULTS: Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully. CONCLUSIONS: This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.