The Wyburn-Mason or Bonnet-Dechaume-Blanc syndrome is a sporadic illness which is a type of phakomatosis, usually present as unilateral arteriovenous malformations(AVM), for the first defined by Magnus in 1874 as retinal AVM later in 1932 another description gave by Yates and Payne; as an AVMs of the retina and cerebral vasculature, while in 1937 Bonnet, Dechaume and Blanc defined as AVM involving facial, retinal and brain blood vessels, then in 1943 all literature revised by Wyburn-Mason to put together to his case reports, therefore, the name of Bonnet-Dechaume-Blanc syndrome given in France, but in English articles entitled as Wyburn-Mason syndrome. At that time, due to a deficiency in diagnostic imaging techniques, all the diagnosis were performed by clinical findings, operation, or autopsy. Usually, it is a unilateral disorder comprising of three distinct components: orbit, brain (ipsilateral to the retina) and face, in the face; the sensory region of the trigeminal nerve distribution involved, that takes the shape of naevi which might be wholly formed and illness, is complete, or the naevi might be faint or absent, the latter regarded as an incomplete disease but rarely a bilateral involvement encountered with an asymmetrical grade of malformation. The pathology starts in the early embryonic period, and if vascular dysgenesis encountered can lead to a wide range of neurocutaneous vascular defects in the cerebrum or ocular or both. When the disorder reaches the last stage, the AVM can compress the optic nerve causing impaired perfusion, ischemia eventually optic atrophy. Another explanation for visual loss is glaucoma as a result of elevated vascular pressure, neovascularization resulting from ischemia, which might lead to vitreous hemorrhage(5). Archer et al. staged the disease into three groups: Group 1 (AVM cannot be detected clinically). Group 2 (Clinically seen as edema and hemorrhage due to direct AVM, i.e., no capillary network between them). Group 3 (Clinically, it is impossible to distinguish arteries from veins due to severely dilated blood vessels all over retina). We present a 41-year-old male presented with a gradual decrease in his visual acuity in both eyes.
A 58-year-old Caucasian female presented to the clinic with progressive cloudy vision in her left eye. She had an ocular prosthesis in her right eye, and her visual acuity was 20/100 and intra-ocular pressure was 32 mm-Hg in her left eye. Exam revealed a polymethyl methacrylate (PMMA) lens with the optic and inferior haptic anterior to the iris. She had trace pigmented cells and a ring-shaped scar posterior to the iris consistent with a Soemmering's ring.. This was confirmed on ultrasound biomicroscopy and determined to be the causative etiology of her intraocular lens (IOL) dislocation.
The treatment of normal tension glaucoma can be difficult. Some normal tension glaucoma patients show progression of glaucomatous optic neuropathy despite an intraocular pressure in the normal range, and sometimes even with an intraocular pressure in the low teens. The question therefore arises as to whether there are other therapeutic options besides lowering the intraocular pressure. One treatment modality discussed in the literature is calcium channel blockers. We suspect that calcium channel blockers are particularly useful in glaucoma patients having a primary vascular dysregulation.
Objective: To outline the clinical presentation, management and outcome of lens induced glaucoma in Chittagong Eye Infirmary and Training Complex. Methods: A case series review was done among the patients who visited Chittagong Eye Infirmary and Training Complex from January 2015 to December 2018. Demographic data, clinical presentations, management and outcome were recorded and analysed. Results: 30 phacomorphic cases and 20 phacolytic glaucoma patients were included in our study. The mean age at presentation was 60 years. Female to male ratio was 2:1. The reason for late presentation was distance which was 60% in phacomorphic glaucoma and 50% in phacolytic glaucoma. The main symptoms were reduced vision followed by ocular pain and redness of eye. Visual acuity was either HM or just PL in all eyes before surgery. All patients underwent SICS with posterior chamber lens implantation. IOP reduced tremendously upon discharge and vision kept improving up to a month after surgery. Conclusion: Reduced vision, ocular pain and redness are the main clinical presentations of lens induced glaucoma. Cataract surgery proves to be effective in lowering IOP and visual recovery in patients with lens induced glaucoma.
As possession of a mobile phone becomes ubiquitous in the general population, its hazards, especially for vision, should be better known and understood. Although blast injuries are common in war, gas cooking and with firecrackers, mobile phone blasts, popularly known as BOMBILE (Blast of Mobile Battery in the Living Eye), are becoming more and more frequent. We present three cases phone battery explosion diagnosed with ocular surface burn. Although none had severe injuries and vision was salvageable and no visual or cosmetic impairment resulted, this may not always be so. Public education, producer liability, and better technological solutions are urgently required to lessen the risks.
Background: Dry eye is a multifactorial, heterogeneous disorder of the preocular tear film because of tear deficiency or excessive tear evaporation. Many patients who have undergone cataract surgery have complained of dry eyes postoperatively. The aim of this study was to evaluate the incidence and severity pattern of dry eye after clear corneal phacoemulsification. Design: Cohort Follow up study. Materials and Methods: 140 uncomplicated cataract patients coming to Indira Gandhi Medical College and Hospital, Shimla were selected for study. Dry eye incidence and pattern were analyzed preoperatively and at days 1, 7, 30 and 60 after phacoemulsification using Results: The incidence and severity of dry eye peaked at seven days post-phacoemulsification and was measured by OSDI questionnaire and all four clinical tests. Within 30 days and 2 months post-surgery, both the symptoms and signs showed rapid and gradual improvements respectively. Conclusion: The incidence of dry eye after phacoemulsification was 11%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that’s patients should be evaluated both before and after phacoemulsification to prevent further damage to the ocular surface and manage the patient effectively so that the patients have a good quality of life.
Synesthesia of vision and somatosensory is based on physiology of interconnection of neurons in different nuclei of thalamus or areas of cerebral cortex. Work studied effect on the intensity of Pressure Phosphenes (PP) of various methods of heating eyes and hands, as well as manual influence on cervical spine. Along with subjective assessments of the PP intensity, EEG and ECG were used for chronometry of bioelectrical activity of brain and heart. From analysis of frequency and amplitude spectra of EEG, it was concluded that mechanism of PP generation is dominated by processes of redistribution and recombination of charges in retinal and LGB layers. Stimulation of PP by heating hands was associated with convergence of LGB neurons and neurons of thalamus nuclei, which are responsible for thermoreception and are adjacent to LGB. Enhancement of effect of PP stimulation by heating hands in water and in sauna was explained by resonant mechanism of heat transfer from heated water to water of physiological fluids of epidermis and water associated with proteins of ion channels of thermoreceptor membranes. It was suggested that breakdown of water clusters in physiological fluids of epidermis at temperature above 42°C promotes to transformation of thermoreceptors into pain receptors.
Objective: To assess the knowledge and practice of patients undergoing cataract surgery before and after structured teaching program at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram. Materials and methods: Quantitative research approach and a quasi experimental research design were used to accomplish the stated objectives. The investigator selected a sample of 30 patients undergoing cataract surgery using a convenience sampling technique. The data were collected by interview schedule using a knowledge questionnaire and observation check list. Teaching was given with appropriate A-V aid and instilling eye drops was demonstrated. Result: Inferential and descriptive statistical analysis was performed by using SPSS-IBM 20. Results were calculated by using p value<0.05. The results revealed that, in pre test 90% of the patients had inadequate knowledge where as in post test 50% of the patients had moderately adequate knowledge and 50% of the patients had adequate knowledge on post operative care after cataract surgery. The good practice of instilling the eye drops and home care after surgery was 20%. Pearson correlation showed a positive relationship between knowledge and practice. (P<0.001) Conclusion: The study result shows that after intervention knowledge and practice on post operative care after cataract surgery were improved significantly.
Choroideremia is a rare, X-linked chorioretinal dystrophy caused by mutations in the CHM gene. Diagnosis is suggested by the characteristic phenotype, X-linked family history and level of Rab Escort Protein 1 (REP1) in peripheral blood mononuclear cells. Genetic testing is essential for confirmation. This case describes the use of multimodal imaging for early diagnosis of choroideremia in an asymptomatic young adult. A 27-year-old asymptomatic male was referred to the retina clinic at Louisiana State University Health Care Network in March 2020 for incidental findings. He did not have any visual complaints. His clinical examination was subtle relative to the classic extensive chorioretinal atrophy with scleral exposure typically seen on fundus examination and color fundus photography in choroideremia. Multimodal imaging findings prompted genetic testing leading to an early diagnosis of choroideremia. Multimodal imaging helps understand the natural history and improved evaluation and diagnosis of rare conditions.
A 9-year-old male attended our clinic with the blurred vision in his right eye, for one day duration. No past history of systemic or ocular illnesses except for recurrent tonsillitis. On ocular examination; his left eye (OS) visual acuity (VA) was 6/6, and the right eye (OD) VA was 6/9.5 which corrected to 6/9 with +0.75 diopter sphere. Fundus examination revealed normal optic nerve and a serous detachment in the posterior pole, nearly about the disc size. The optical coherence tomography angiography (OCTA) showed neurosensory retinal detachment with subretinal fluid. The family was not able to perform the fundus fluorescein angiography (FFA) due to the financial crisis in the region. Given this background, the diagnosis of idiopathic central chorioretinopathy had given. The clinical course was monitored without any treatments and spontaneous remission achieved within two months and the last OCTA taken after six months.
The purpose of this study is to develop an algorithm for Chronic Corneal Dystrophic Disease treatment using 1% sodium hyaluronate in the complex treatment as well as updating drug information in the treatment of corneal dystrophy. The efficiency of eye surface disease treatment by subconjunctival injection of 1% sodium hyaluronate is studied. The study describes hyaluronic acid functions depending on its molecular weight. It shows the necessity of using sodium hyaluronate of low molecular weight (500-700 kDa) in the treatment of patients with eye surface disease after keratitis. The study includes 40 patients aged 21 to 82 years. Patients had ocular surface disease in the outcome of inflammatory diseases accompanied by dry eye disease of varying severity for 2-10 years. The result shows that injections of exogenous HA during keratopathies treatment may contribute to the regeneration and activation of metabolic processes in the tissues of the cornea.
Purpose: To investigate whether inner retinal thickness can be used as a reliable biomarker in patients with mild cognitive impairment (MCI) for early diagnosis and correlate these changes with cognitive decline. Material and methods: Using spectral domain optical coherence tomography (SD-OCT) in MCI and control subjects we assess peripapillary Retinal Nerve Fiber Layer (RNFL) thickness, macular thickness and volume and macular Ganglion Cell Complex (mGCC was defined as the combination of retinal fiber, ganglion cell and inner plexiform layers) thickness, Ganglion Cell Complex Global Volume Loss (GCC GVL%) and Ganglion Cell Complex Focal Volume Loss (GCC FVL%). We assessed cognitive function using Mini Mental State Examination (MMSE) score. A database was created with the use of the Statistical Program for Social Sciences (SPSS® ver12). Descriptive Statistics were utilized to find means, medians, standard deviations and interquantile ranges. Statistical significance was set to 95%. Independent t-tests were used to compare means between patients and control group when variables reached normal distribution. Mann-Whitney U test was used to compare medians between patients and control group when variables did not reach normal distribution. Results: In MCI patients there was found a statistically significant decrease in overall RNFL thickness (Mann-Whitney test, p: 0.009) and temporal RNFL thickness (T-test, p: 0.013) and increased macular GCC FVL% (Mann-Whitney test, p: 0.001) compared to the controls. There was found no significant correlation between retinal thickness and cognitive decline in MCI patients. Conclusion: Our study showed decreased inner retinal thickness in MCI patients. The potential use of inner retina thickness as a reliable biomarker in early diagnosis needs to be further explored in longitudinal studies with large cohorts.
Laser Vision Correction (LVC) is an elective, self-pay and safe surgical procedure to correct myopia and hyperopia. Since FDA approval 25 years ago, there have been a progression of technological improvements leading to better outcomes and LVC is now one of the safest surgical procedures. A potential pool of 50 million patients, 6000 trained ophthalmic surgeons regularly treat in over 1000 centers. Treatments remain low from an earlier peak of 1.4 million to less than 800,000 over last 10 years. The factors preventing patients undergoing surgery have not changed and include the cost and fear of laser surgery. The latter is overcome by word of mouth referrals and positive social media messaging. Patients can be “in and out” in less than two hours with a rapid recovery, minimal postoperative restrictions and have 20/20 vision within 24 hours. Laser vision correction and especially LASIK, remains the treatment of choice for myopic and hyperopic patients wanting to remove their dependency on glasses and contact lenses.
