Frosted Branch Angiitis (FBA): A case report

The purpose of the study is to describe a rare case report for raising the awareness of existence of this rare ocular disease and also review the characteristics of this disease. A 35-year-old man presented with acute vision loss in both eye after high grade fever. On fundoscopic examination flower petal pattern blood vessel sheathing in temporal quadrant of both eyes was seen. A provisional diagnosis of frosted branch angiitis was considered. The patient responds promptly with Intravenous and oral corticosteroid. A total of 58 cases have been reported in worldwide literature. The disease is likely to represent a common immune pathway in response to multiple infective agents. CBMJ 2020 July: Vol. 09 No. 02 P: 42-44

Choroidal Melanoma: An Overview

Pigmented fundus lesions on fundoscopic examination are not an uncommon finding. Pigmented tumoral lesions can arise from the retinal epithelium or choroidal melanocytes causing a spectrum of disorders, ranging from choroidal naevus and foreign bodies to the rarer choroidal melanoma. As choroidal melanoma is the most common primary malignant intraocular tumour, this educational review aims to provide a structured overview of this topic to students and junior doctors, to help establish an understanding of such a rare but life-threatening condition. This will also provide the reader with an insight on referral guidelines in the United Kingdom, a brief overview of various treatments, and factors that affect patient’s prognosis.

A case of retinal vascular involvement in a 6-year-old patient with Covid-19

Purpose: This study evaluated fundus changes in a 6-year-old child who contracted Sars-CoV-2 without developing symptoms of the disease. Materials and methods: The patient underwent a complete ophthalmic evaluation, which included assessment of visual acuity with and without correction, extensive ophthalmological examination, cicloplegic refraction by retinoscopy and funduscopic examination, OCT, and angio-OCT examination. Results: Fundoscopic examination in a young patient with previous Sars-CoV-2 infection showed marked vascular tortuosity, evident both at the posterior pole and retinal periphery, especially on the arterial vasculature, and cotton wool spots along the retinal vessels, highlightable also at OCT and angio-OCT examination. These alterations persist at a 6-month follow-up. Conclusions: In COVID-19 infection, even in asymptomatic pediatric patients, vasculitis develops also affecting the retinal vessels, appreciable on fundus examination. A thorough eye examination in all COVID-19 patients with close follow-up is therefore important. This is the first case report on retinal changes in a pediatric patient.

Demographic profile & correlation between retinal exudates and hematological parameters in leukemic patients

Background: Leukemia is frequently associated with fundoscopic abnormalities. However, no organized effort has been made for analyzing leukemic retinopathy in our country. This study was done to observe the demographic profile and correlation between fundoscopic findings of retinal exudates and hematological parameters in leukemic patients. Materials and Methods: The study was a hospital-based descriptive cross-sectional study among 50 leukemic patients in Medicine and Oncology departments of Bangladesh Medical College and Hospital (BMCH) from May, 2020 to October, 2020. Fundoscopic examination was done which was reviewed by an ophthalmologist. Collected data was analyzed statistically by using SPSS-17 (Chicago, Illinois). Results: Among 50 leukemic patients’, the fundal lesion was detected in 32 patients (64%), retinal exudates are rare. Only 3 patients (6%) had exudates while others (29 patients, 58%) have retinal hemorrhages. Exudates did not show any statistically significant relationship with types of leukemia (p value = 0.53). There was no statistically significant association between fundal exudates and high white cell count (p = 0.56) or low hemoglobin level (p = 0.11) or low platelet level (p = 0.11). Conclusion: This study has identified retinopathy occurring frequently in leukemic patients. Therefore, an adequate attention should be paid at fundoscopic evaluation while treating leukemic patients.

Congenital myopia complicating pregnancy: A rare case and mini-review of the literature

A highly myopic 35-year-old female patient (P0, G1) with reduced visual acuity R 3/10 l 3/10 due to bilateral choroidal neovascularization (CNV) admitted at our Department. The patient had atomic history of congenital myopia firstly diagnosed at the age of 2-y-old. The initial diagnosis established a refractive error over 8 diopters (high grade myopia) progressively increased. During third trimester of gestation her vision was acutely diminished. The fundoscopic examination depicted elevated intraocular pressure and deterioration of myopia to -30D bilaterally. (Fruoresceinangiography revealed active CNV). Patient underwent selected caesarean section due to increased risk of macular hemorrhage. She discharged from hospital the 4th pod in good clinical condition. Assiduous ocular and obstetrical monitoring appeared mandatory in order to insure optimal therapeutic mapping. Objective of our study remains proper diagnosis and treatment of such a rare case.

Venous hypertension caused by a meningioma involving the sigmoid sinus: case report

Background Intracranial venous hypertension has been associated with a few cases of meningioma secondary to compression of the venous sinus. This is the rare case of small meningioma involving the sigmoid sinus leading to intracranial venous hypertension mimicking venous thrombosis. Case presentation A 39-year-old woman suffered visual dysfunction due to bilateral papilledema. Noncontrast head computed tomography (CT) showed no intracranial space-occupying lesions or hydrocephalus. Cerebrospinal fluid examination revealed high opening pressure. Various image inspections such as three-dimensional CT angiography, magnetic resonance imaging, and cerebral angiography demonstrated a small 2.5-cm lesion causing subtotal occlusion of the dominant right sigmoid sinus. No improvement of clinical manifestations was observed after medical treatment for 6 months, so right presigmoid craniectomy was performed. Operative findings revealed that the tumor was located predominantly involving the sigmoid sinus. The pathological diagnosis was fibrous meningioma. Postoperative fundoscopic examination showed improvement of bilateral papilledema. Conclusions We treated a patient presenting with intracranial hypertension due to a small meningioma involving the sigmoid sinus. This unusual case suggests that early surgical strategies should be undertaken to relieve the sinus obstruction.

Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes

ObjectiveAn ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival.Methods and analysisThis retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88–92%], epoch 2 targets [90–95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage.ResultsA total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively.ConclusionIncidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.

Awareness of diabetic retinopathy among diabetic patients

Objectives: To assess the awareness of diabetic patients about diabetic retinopathy. Method: The cross-sectional study was conducted at the Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan, from April 2018 to April 2019, and comprised diabetic patients of either gender aged 21-80 years. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic, diabetes and diabetic retinopathy characteristics. Fundoscopic examination was done, and the presence and stage of diabetic retinopathy were documented. Data was analysed using SPSS 20. Results: Of the 132 subjects, 9(6.8%) were male and 123(93.2%) were females. The majority 64(48.5%) was aged 61-80 years. Overall, 74(56.1%) patients were aware that diabetes could affect their eyes, 57(43.2%) were never diagnosed with diabetic retinopathy, 76(57.6%) had gained information about diabetic retinopathyfrom ophthalmologists, 61(46.2%) and 29(22%) respondents reported that eyes should be examined ‘only when vision is affected’ and ‘every 6 months’ respectively, 98(74.2%) said the biggest barrier in getting eyes examined earlier was ‘lack of knowledge’, 23(17.4%) believed surgery was done for diabetic retinopathy treatment and 33(25%) believed that surgery, laser and injections all can be used. Significant relationship of diabetic retinopathy was found with duration of diabetes and the general health status (p<0.05). Conclusion: Though more than half the patients were aware that diabetes could affect the eyes, awareness of diabetic retinopathy and its consequences was low. Key Words: Awareness, Diabetes mellitus, Diabetic retinopathy, Continuous...