Abstract Objective: The objective was to study the type, severity, and final visual outcome of ocular injuries following surgery in gun pellet cases. Materials and Methods: We retrospectively reviewed the case records of 24 subsequent cases of gun pallet injury presenting to a tertiary care eye center from January 2015 to March 2016 and analyzed the data with regard to age and sex of the patient, circumstances surrounding the injury, presenting ocular signs, subsequent management, and final visual outcome. Results: Twenty-four patients were included in the study. The mean age of our study group was 20.83 years. Notably, 75% of those injured were below the age of 23 years. All patients were male. Ocular injuries were seen in the scleral area in 3 cases, in the corneal area in 8 cases, and the corneoscleral area in 13 cases. Retained intraocular foreign body was seen in 9 eyes (37.5%). The pattern of eye injuries among 17 eyes out of 24 patients was perforating in nature and the rest was penetrating. Eleven patients out of 24 showed retinal detachment, among 3 out of them showed recurrent retinal detachment due to perforation of the retina with the pellet. Seven eyes with pellet injury were treated with vitrectomy only. Others underwent single/multiple surgical procedures. Most cases needed a belt buckling with lensectomy and vitrectomy. Three of the patient’s eyes had only perception of light (PL+) at the time of presentation in the hospital, while eight eyes had finger count close to face. The final corrected visual acuity improved in 79.17% of cases. Conclusion: Gun pellet ocular injuries are becoming popular in military and violence-affected areas. In severely injured eyes, the visual prognosis remained poor if they will not get treatment as early as possible.
Abstract Here, we present a case of congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), an uncommon benign lesion of the retinal pigment epithelium characterized by a nodular, hyperpigmented appearance in the macular region. This case report highlights the diagnostic features of CSHRPE observed through multimodal imaging, discusses differential diagnoses, and reviews relevant literature. The case report underscores the importance of recognizing this rare entity to prevent misdiagnosis and unnecessary intervention, while emphasizing the value of longitudinal monitoring using high-resolution imaging modalities.
Summary Choroidal neovascular membrane (CNVM) is a rare but vision-threatening complication of optic disk drusen (ODD), particularly uncommon in pediatric patients. We report a case of a 13-year-old female who presented with acute visual deterioration in the left eye and was found to have peripapillary CNVM associated with buried ODD and peripapillary ovoid hyperreflective mass-like structures (PHOMS), where multimodal imaging was critical in establishing the diagnosis. Treatment with intravitreal aflibercept resulted in anatomical regression of the neovascular membrane and functional visual improvement. This case highlights the importance of recognizing PHOMS and ODD as potential risk factors for CNVM and underscores the role of optical coherence tomography-A in diagnosis and monitoring.
Abstract We report a case of a 42-year-old male with chronic central serous chorioretinopathy (CSC) complicated by an exudative macular detachment and a micro-retinal pigment epithelium (RPE) rip. Multimodal imaging confirmed the diagnosis, with fluorescein angiography demonstrating a pinpoint leak with a classic “smoke-stack” plume of fluorescein; optical coherence tomography revealed subretinal fluid (SRF) with fibrinous exudates (turbid fluid), underlying pachychoroid features, and a small focal RPE rip. We performed targeted macular laser directly to the micro-RPE rip after titrating to a barely visible burn. At the eight-week follow-up, the SRF had completely resolved with a reduction of RPE elevation and visual acuity improvement. This case illustrates the successful use of a focal laser in a CSC variant with an RPE micro-tear, leading to resolution of exudative macular detachment and visual improvement.
Abstract Purpose: To use optical coherence tomography (OCT) changes in retinal venous occlusive disease (RVO) as biomarkers to predict the visual outcome. Patients and Methods: Patients with recent RVO complicated by macular edema were included in the study. Patients with ocular comorbidities other than RVO and patients with media opacities precluding a clear fundus view were excluded. Initial full clinical assessment including the measurement of best-corrected visual acuity (BCVA) was done. Fundus photography, fundus fluorescein angiography, and OCT were done. The central subfield thickness (CST) was measured. Disruption of the ellipsoid zone (EZ) in the fovea was documented. The ratio between the vertical size of the largest cyst (VSLC) and the maximum macular thickness (MMT) was calculated. Furthermore, the length of photoreceptor outer segment (PROS) was measured. Assessment was repeated at 1, 3, and 6 months. Correlation between those biomarkers and visual acuity (VA) by multiple linear regression analysis was performed at presentation and at the conclusion of follow-up period after treatment completion. Results: Twenty-four eyes of 24 patients (mean age 54.1, 11 males and 13 females) with RVO were included. Mean logarithm of the minimum angle of resolution BCVA was 1.3 ± 0.5. Mean CST was 618 ± 326 μm. At presentation, the strongest correlation with BCVA was with CST ( R = 0.56) followed by interruption of EZ ( R = 0.32), DRIL ( R = 0.31) and the ratio of VSLC/MMT ratio (0.28). There was a weak negative correlation between PROS length and BCVA ( R = 0.1). At the end of follow-up period, the strongest correlation with final BCVA was with ratio between VSLC/MMT reflecting the pattern of cystoid macular edema and Muller cell integrity followed by EZ interruption and DRIL reflecting ischemic insults. Conclusions: Different retinal micro-structural biomarkers can be observed in patients with RVO by spectral-domain OCT. Among those biomarkers, the strongest predictor of VA at presentation is CMT, followed by interruption of the EZ, followed by disorganization of retinal inner layers (DRIL), followed by decreased PROS length. At 6 months’ follow-up, the correlation between ischemic changes, for example, DRIL and interruption of EZ with BCVA becomes more apparent that at presentation.
Abstract Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and poses significant diagnostic and therapeutic challenges. Its management depends on tumor size, location, patient age, systemic health, and personal preferences. Traditional globe-preserving therapies include plaque brachytherapy and charged particle therapy, both of which achieve local control rates exceeding 90% for small- to medium-sized tumors. The Collaborative Ocular Melanoma Study (COMS) provided pivotal data, demonstrating equivalent mortality outcomes between brachytherapy and enucleation for medium tumors, while supporting enucleation for large tumors. Additional therapies such as transpupillary thermotherapy, photodynamic therapy, and local resection (endoresection or exoresection) can be used in specific scenarios or in combination to maximize tumor control while preserving vision. When tumors are large, display orbital extension, or are associated with severe complications such as intractable glaucoma, enucleation or exenteration may be required to safeguard patient comfort and survival. As adjuvant and neoadjuvant approaches evolve, multimodal regimens combining surgery, radiotherapy, and laser treatments are increasingly tailored to each patient’s unique clinical presentation. Close post-treatment surveillance and imaging are critical for early detection of recurrences and management of complications like radiation retinopathy, optic neuropathy, and cataract formation. This review highlights the recent advances, clinical considerations, and outcomes in UM treatment, emphasizing that individualized, multidisciplinary care remains central to optimizing both survival and vision preservation.
Abstract Retinal vasculitis is an inflammatory condition affecting retinal vasculature (arterial, venous involvement, or both) with diverse idiopathic, infectious, autoimmune, and neoplastic etiologies. Fundus fluorescein angiography (FFA) is the golden standard investigation to highlight the presence of retinal vasculitis, to define the pattern of vascular involvement, and to document the activity. In this case, optical coherence tomography (OCT) has highlighted a characteristic “Erupted volcano” sign in active retinal vasculitis related to sarcoidosis, which could be utilized as an OCT sign of activity rather than usual FFA findings.
Abstract This article discusses the properties and ways to diagnose or identify clinically uveal melanomas and to be able to differentiate between them and other similar diagnoses. The purpose of this article is to aid readers in identifying the melanoma and to be able to thus deal with it timely and accurately as will be seen in the second part. Not only so but the authors have gone on to discuss the investigations needed and the properties to be seen in each for this diagnosis and the similar diagnoses.
Abstract Vogt–Koyanagi–Harada (VKH) disease is a multi-systemic auto-immune inflammatory disorder affecting the eye, ear, central nervous system, and integumentary system. It is characterized by bilateral granulomatous panuveitis with primary involvement of the choroidal stroma by granulomatous inflammation and Dalen-Fuch nodules. In some cases, VKH may be complicated by atrophic maculopathy or macular choroidal neovascular membrane. This case report describes a 27-year-old female initially diagnosed with idiopathic intracranial hypertension who was later found to have inflammatory choroidal neovascularization (CNV) secondary to presumed VKH disease. The case highlights the importance of multimodal imaging in diagnosing and managing VKH and the potential for CNV regression with immunosuppressive therapy, even without anti-VEGF treatment.
Abstract Purpose: The purpose of this study is to assess the clinical relevance of incorporating a spectral-domain optical coherence tomography (OCT) examination into the routine preoperative evaluation of patients scheduled for a standard cataract surgical procedure and to document the subtle macular pathologies that are missed in preoperative clinical examination. Setting and Design: A prospective observational study at the Department of Ophthalmology, Vision Eye Centre, New Delhi, Delhi, India. All patients were examined by one retina specialist and operated by an experienced cataract surgeon. Patients and Methods: A total of 300 patients were recruited and divided into two groups of 150 participants each. Patients in Group 1 underwent preoperative OCT macula, whereas patients in Group 2 underwent a thorough clinical fundus evaluation but not OCT. Postoperatively, OCT was done in patients with suboptimal visual acuity to assess the reason. Suboptimal visual acuity is defined as best corrected visual acuity of 20/30 or worse in an eye with previously undiagnosed macular pathology. Any changes in the management plan or additional vitreoretinal intervention planned after the detection of macular pathology on OCT were noted. Results and Conclusions: Among 150 patients in Group 1, 12 had drusen, 4 had epiretinal membrane, and 1 had paratoveal pigment epithelial detachment. All (100%) patients had 6/6 visual acuity on postoperative day 14. In Group 2, 149 patients (99.33%) had 6/6 visual acuity by postoperative day 14, and 1 (0.67%) had 6/9 visual acuity. Postoperatively, no patient had suboptimal visual acuity and all patients with normal fundus on examination achieved good visual outcomes. Preoperative OCT did not significantly alter the surgical plan or influence postoperative visual prognosis, although we were able to detect subtle pathologies such as drusen and epiretinal membrane, which were not clinically apparent in a few patients.
Abstract Intraocular retinal vascular tumors represent main four distinct entities, which include retinal capillary hemangioma, retinal cavernous hemangioma, retinal vasoproliferative tumor, and as well as retinal arteriovenous communications (Wyburn-Mason syndrome). Choroidal hemangiomas whether circumscribed or diffuse are among retinal vascular tumors presentation. In this review article, these entities will be discussed in detail with emphasis on recent updates in the diagnosis and management. To select the best treatment option, it is very important to identify the clinical signs including the exact site, the size of the tumor, and as well as any vision-threatening complications. Different treatment modalities include cryotherapy, argon laser photocoagulation, transpupillary thermotherapy, brachytherapy, or external beam irradiation.
Abstract Phacomatoses are a diverse group of illnesses with varying patterns of inheritance. Although the central nervous system is the primary target of these disorders, they can also affect the skin, viscera, eye, and other connective tissues, with varying clinical presentations. Nowadays, there are currently over 30 entities in this group. In our review, we will demonstrate the hereditary pattern, systemic and ocular features, and as well as diagnostic criteria of the most common phacomatosis syndromes.
Abstract Historically, uveal metastasis was thought to be a rare entity; however, recently with improved patient survival, advances in the medical care of cancer patients, and spreading awareness, an increasing number of patients with uveal metastasis are being diagnosed. Uveal metastasis is now considered the most common intraocular malignancy with ocular involvement in 8%–10% of patients with metastatic disease. Early detection and treatment may help avoid significant visual loss and improve quality of life. Moreover, a multidisciplinary approach is crucial in formulating the treatment plan, the recent years have witnessed marked advancement in the management of such patients with marked improvement in outcomes and patient survival. In this review article, we are going to outline the clinical features of uveal metastasis, the diagnostic approach, and different management options.
Abstract Retinoblastoma is the most common malignant intraocular tumor in childhood and accounts for 3% of all childhood cancers, with an incidence of approximately 1 in 17,000 live births, and approximately 8000 new cases are diagnosed each year worldwide. Despite the great advances in retinoblastoma management modalities, with survival rates reaching up to 95%–98% in developed countries, early diagnosis still represents a challenge in developing countries, resulting in a longer lag time in diagnosis and lower survival rates. This review article aims to highlight the various retinoblastoma presentations and shed light on possible retinoblastoma mimickers. Accurate differentiation between retinoblastoma and conditions that mimic retinoblastoma is crucial for proper management, and a high index of suspicion is therefore necessary for a proper and prompt diagnosis of retinoblastoma cases, which is the key to decreasing morbidity and mortality.
Adenoma and adenocarcinoma, are two uncommon acquired true neoplasms of the RPE. They highly mimic uveal melanomas which carry high risk of metastasis so it is critical to recognize RPE tumors and distinguish them from melanomas. The majority of RPE neoplasms present as a dome shaped elevated darkly pigmented lesion. The presence of exudative retinal detachment, yellow intraretinal exudation around the mass as well as the presence of a feeding artery and a draining vein are among the distinguishing features from uveal melanomas. Acquired RPE neoplasms are usually peripheral however, peripapillary RPE neoplasms has been reported. Among the management options for the small sized RPE tumors below 4 mm in thickness are cryotherapy or transpupillary thermotherapy. For larger tumors; PDT, partial lamellar sclerouvectomy or external beam irradiation were recommended. Recently, Episcleral Brachytherapy has been addressed to be an effective primary management plan with minimal long term complications in cases of RPE adenoma.
Melanocytoma, also known as magnocellular nevus, most commonly occurs on the optic disk, sometimes involving the adjacent retina or choroid. It may be confused with malignant melanoma both clinically and histopathologically. Histopathologically, melanocytoma is composed of deeply pigmented, round to oval nevus cells without malignant features. Typically, melanocytoma is benign 1 and shows a stationary course, although minor enlargement occurs in 10%–15% of cases. In rare cases, severe visual loss can result from tumor necrosis, compressive optic neuropathy, or malignant transformation, which occurs in 1%–2% of cases. Therefore, it is generally a benign lesion requiring minimal intervention but warrants lifetime follow-up.
Retinoblastoma (RB) is the most common intraocular malignancy in children. Unfortunately, survival in developing countries was found to be significantly worse (40%) compared with developed countries (79%). Early diagnosis and suspicion of RB in early intraocular stages is paramount for successful management and improved outcomes. The management of RB is in constant evolution for the sake of globe salvage. Treatment protocols are extremely diverse; varying from one case to another and are dependent on local resources, therefore, the success rates are variable. The introduction of chemotherapy in the early 1990s, especially intraarterial chemotherapy has led to remarkable success in treating eyes with more advanced diseases. Novel drugs, oncolytic viruses, and immunotherapy are promising approaches in the treatment of intraocular RB. This review navigates the landscape of RB management, delving into staging, diverse recent treatment modalities with their common side effects, and the ongoing challenges that necessitate a comprehensive approach.
Paracentral acute middle maculopathy (PAMM) can be caused by a variety of retinal, ocular, iatrogenic, and systemic factors. Patients with PAMM typically have a sudden onset of paracentral scotomata, difficulty focusing, and/or blurred central vision. Isotretinoin is associated with multiple ocular side effects, including eye dryness and loss of night vision. In this study, we present a case of PAMM after 13 months of isotretinoin treatment with no evidence of other causes or relevant medical history.
Purpose: To study patient's acceptability and safety of offering a prophylactic early single session of pan-retinal photocoagulation (PRP) for moderate nonproliferative diabetic retinopathy (NPDR) in selected patients. Settings and Design: Mixed observational and interventional study. Patients and Methods: The observational study included 82 eyes of 68 patients presenting with proliferative diabetic retinopathy (PDR) or its complications and the interventional study included 48 eyes of 48 patients with moderate NPDR who were offered a single session PRP because they were unlikely to comply with the follow-up protocol and were at higher risk of diabetic retinopathy (DR) progression. Results: The observational study showed that nearly 51% of patients had no idea about the DR screening protocols, 47.5% of included eyes presented with vitreous hemorrhage, 30.5% with tractional retinal detachment, and 22% with retinal neovascularization. The interventional study showed that minor patients' complaints were reported such as night vision problems, flashes, and peripheral field defects. There was no significant change in the mean preoperative logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over time throughout the study (P = 0.951). At the end of follow-up, 89.5% of included eyes showed no loss of any lines of their preoperative logMAR CDVA and 10.5% lost only one line. All eyes remained in the same stage of moderate NPDR with no signs of progression to severe or very severe NPDR or proliferative DR. Conclusion: Prophylactic early PRP is an acceptable, safe, and satisfactory procedure for patients with moderate NPDR in low-resource settings.
