First contact investigations and compliance to treatment in patients with uveitis

AIM:To ascertain the pattern of investigations at first contact in uveitic patients and evaluate compliance to treatment.METHODS:An observational study comprised of 201 uveitic patients presenting for the first time to our centre from January 2019 to June 2020.Detailed information regarding systemic investigations undertaken by specialists at the time of first contact and the cost of these investigations were reviewed on the first visit to our centre.Compliance with the treatment was determined and reasons behind non-compliance were evaluated on the first follow-up in patients who had no improvement in clinical signs and symptoms.RESULTS:The mean age of the study group was 35.35±14.1y and gender composition was 59.7%males and 40.3%females.Anterior uveitis was observed in 45.3%of patients,intermediate uveitis in 31.8%of patients,posterior uveitis in 14.9%of patients and panuveitis in 8.0%of patients.Association with a systemic disease was evident in 17.9%of patients.When compared with standard guidelines and uveitis patterns,systemic investigations were identified to be relevant only in 38.3%of patients.Non-compliance to treatment was documented in 22.4%of patients.Common reasons for non-compliance were inadequate counselling by the treating physician about treatment in 26.7%of patients and a busy schedule at work/school in 22.2%of patients.CONCLUSION:Significant number of investigations performed at first contact is found to be contrary to standard guidelines and are not contributory to the care.About a quarter of patients in this study are found to be non-compliant with the treatment.Compliance is more challenging to achieve in school-going children and working adults.The availability of comprehensive,periodically updated,evidence-based guidelines on the role of investigations and the use of trained counsellors may help to channelize proper evaluation and improve compliance to treatment,respectively,in patients with uveitis.

Ultrasonographic assessment of paediatric ocular emergencies： A tertiary eye hospital based observation

BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the fi rst point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids.RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80(65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage(8.19%), retinal detachment(6.55%), choroidal detachment(4.91%), posteriorly dislocated clear lens(0.81%) and retained intraocular foreign body(5.73%). Non-traumatic cases constituted around 42(34.42%) eyes, which included corneal ulcer(7.37%), retinoblastoma(6.55%), endophthalmitis(4.91%), extraocular muscle cysticercosis(4.91%), orbital cellulitis(4.09%), periocular haemorrhage(2.45%), proptosis(1.63%), paediatric cataract(1.63%) and cryptophthalmos(0.81%). No adverse events of performing the ultrasound was noted.CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of signifi cant posterior segment and orbital diseases.

Evaluation of fundus autofluorescence patterns in age-related macular degeneration

AIM： To study the various morphological patterns of fundus autofluorescence （FAF） images in patients with age-related macular degeneration （AMD） in Indian population.METHODS： Totally 179 eyes of 104 patients with clinical diagnosis of AMD were recruited into the study. Autofluorescence images were captured using confocal scanning laser ophthalmoscope and the patterns of FAF were classified.RESULTS： Of 179 eyes, 27 （15.08%） were early AMD, 58 （32.41%） were intermediate AMD, 94 eyes （52.51%） were late AMD. Of 94 eyes with late AMD, 79 （84.04%） were neovascular AMD and 15 （15.96%） were central geographic atrophy. In eyes with early and intermediate AMD, 9 patterns of FAF were noted. Six patterns （normal, minimal change, focal increased, patchy increased, linear, reticular） were similar to that in the published classification. Two patterns （lacelike and speckled） described in the published classification were not found. Three new patterns （focal hypo-fluorescence, patchy hypo-fluorescence, mixed focal hypo-fluorescence and hyper-fluorescence） were detected. In eyes with neovascular AMD, 6 morphological patterns of FAF were noted. Two patterns （mixed hypo-fluorescence and hyper-fluorescence, central hypo-fluorescence with hyper-fluorescent rim） were similar to that in published classification. Two patterns （normal, near normal or normal background fluorescence in the centre of hypo-fluorescent area） described in the published classification were not found. Four new patterns （minimal change, hypo-fluorescent patch, central hypo-fluorescence with surrounding reticular, bull’s eye） were recognized. In eye with central geographic atrophy 5 morphological patterns were noted and these were similar to that in published classification.CONCLUSION： Phenotypic differences in the pattern of FAF exist in the study population compared to existing classification systems.

Bilateral lens subluxation in a case of Behcet's disease related uveitis

Ocular inflammation accompanying the pediatric Behcet's disease(BD)is characterized by a relapsing and complicated course,often resulting in blindness due to severe bilateral affection(1).Ectopia lentis(EL)is an important association of multiple ocular and systemic syndromes,with favorable visual outcomes if managed ideally(2).We discuss a unique case presenting with a combination of these entities。

Using a ＋20D lens for non-contact slit lamp biomicroscopy of ocular fundus

Noncontact slit lamp examination of the ocular fundus has been classically done using high power convex lenses like+90D,+78D,and+60D.A real and inverted image of the fundus is formed in between the high power convex lens and the slit lamp.The+20D lens is commonly used for binocular indirect ophthalmoscopy.The authors use this+20D lens

Scleral resection in chronic central serous chorioretinopathy complicated by exudative retinal detachment

Background:Effective therapeutic options are limited for the management of chronic central serous chorioretinopathy(CSCR)complicated by exudative retinal detachments(RD).The authors describe the resolution of one such case following partial thickness scleral resection with mitomycin C.Case presentation:This 39-year-old male presented with a unilateral inferior exudative RD in the right eye.There was no history of steroid use either locally or systemically.The fundus fluorescein angiogram showed window defects and leaks typical of chronic CSCR.The axial length was 21.06 mm in the right eye and 21 mm in the left eye.Thickening of the ocular coats was evident on ocular ultrasound.Considering an axial length in the borderline-low range inferotemporal and inferonasal partial thickness scleral resection with mitomycin C was performed.The exudative RD resolved at 4 months.Conclusion:Partial thickness scleral resection may be considered as an option for treating chronic CSCR patients with borderline-low axial length complicated by exudative RD.

Ophthalmic examination as a means to diagnose Subacute Sclerosing Panencephalitis:an optical coherence tomography and ultrawide field imaging evaluation

Background:Subacute sclerosing panencephalitis(SSPE)is a potentially fatal complication of measles.The authors report a case of recurrent myoclonic jerks under investigation,whose ophthalmic examination pointed to the diagnosis.Case presentation:A 12-year-old boy with recurrent episodes of myoclonic jerks was found to have optic disc pallor and an irregular macular scar with pigmentation in the left eye.The retinal finding proved to be a strong diagnostic clue for SSPE.There was a history of exanthematous fever in childhood.Antibodies against measles were detected in both the cerebrospinal fluid and serum.Retinitis with intraretinal and subretinal hemorrhage in the right eye was noted 6-weeks after the initial presentation.Conclusion:The authors describe the importance of ophthalmic evaluation in cases of recurrent myoclonic jerks.Optical coherence tomographic features and ultrawide field imaging characteristics of a case of SSPE are described.