This case series describes three Vogt–Koyanagi–Harada (VKH)-spectrum presentations and highlights the utility of multimodal imaging and prompt corticosteroid therapy. Case 1 was a 42-year-old female with type 2 diabetes mellitus and thyroid disorder who presented with unilateral painless visual loss; high-dose systemic steroids produced complete anatomical recovery with visual acuity improving to 6/6 by 2 months. Case 2 was a 60-year-old female with bilateral painful visual loss; systemic corticosteroids led to the resolution of subretinal/choroidal fluid, and vision improved to 6/12 in both eyes. Case 3 was a 37-year-old male with preceding herpes zoster ophthalmicus and recurrent keratouveitis/scleritis who progressed to bilateral posterior uveitis; intravenous methylprednisolone followed by high-dose oral prednisolone achieved complete detachment resolution and symptomatic improvement. These cases emphasize that VKH may masquerade as a unilateral disease, present with choroidal detachment and vascular occlusion, or follow viral keratouveitis, yet remains highly steroid-responsive when treated early.
Purpose: The purpose of this study was to evaluate whether the three-dimensional (3D) Super Formula can be used to assess accuracy in ocular biometry. Setting: The study setting was the department of ophthalmology, a tertiary care hospital in Central India. Design: The study design was a prospective observational study. Materials and Methods: Seventy-four eyes with senile cataract underwent biometry using the IOLMaster 500. From each series of readings, either the emmetropia power or the lowest negative power closest to emmetropia was chosen. This intraocular lens (IOL) power, along with axial length and averaged keratometry (K), was computed using the Ladas 3D online calculator. Plots were noted as inside or outside the shaded zone of the Ladas 3D graph. Following cataract surgery, absolute refractive error (ARE) was calculated at 6 weeks as the difference between spherical equivalent and predicted refractive error. Results: SRK/T was most used (74.3%), followed by Holladay (17.6%) and Hoffer Q (8.1%). Accuracy did not differ significantly among formulae (P = 0.053). Holladay achieved the highest proportion of eyes with ARE <±0.5 D (92.3%), followed by SRK/T (85.5%) and Hoffer Q (83.3%). Preoperatively, 94.6% of eyes plotted inside the Ladas graph; postoperatively, 81.1% remained inside. Of 70 plots inside, 60 eyes (85.7%) had ARE <±0.5 D, while all outside plots showed ARE >±0.5 D. Conclusion: The Ladas 3D Super Formula graph demonstrated strong concordance with postoperative refractive outcomes. Holladay and SRK/T provided the highest accuracy, supporting its utility in refining biometric precision for IOL power calculation.
Purpose: The purpose of the study was to compare visual acuity and disease resolution in patients with postphacoemulsification cystoid macular edema (CME) managed through a traditional face-to-face model versus a virtual pathway. Methods: We prospectively reviewed 136 eyes with suspected postcataract CME between May 2023 and May 2024 at a single NHS Ophthalmology center. Cases were categorized as hospital-managed or virtually managed. In the virtual pathway, topical treatment was initiated remotely by a Consultant Ophthalmologist, with follow-up and management by qualified community optometrists; hospital cases were managed conventionally by the hospital team. Patients undergoing combined procedures were excluded. The analyses included 48 eyes managed virtually and 51 managed in hospital clinics. Collected variables included age, interval from cataract surgery to referral, number of subsequent hospital visits, anatomical resolution, treatment modality, final best-corrected visual acuity (BCVA), and adverse events. Results: Rates of anatomical resolution with topical therapy alone were similar - 79% in the virtual group and 74% in the hospital group. The BCVA was comparable between the groups (mean logMAR: 0.166 [virtual] vs. 0.195 [hospital]), with no significant difference. Hospital attendance was significantly reduced in the virtual group. Conclusion: An ophthalmology-led virtual review pathway for postcataract CME maintained visual outcomes, while markedly reducing referral delays and routine hospital visits. Wider adoption of virtual CME services could increase ophthalmology clinic capacity, with continued refinement of escalation criteria to optimize outcomes.
