Search

Purpose: The current study compares the ability of multicolor imaging (MCI) to detect the lesions of central serous chorioretinopathy against conventional color fundus photographs (CFP). Methods: It was a retrospective, observational case series of 93 eyes of 58 patients of central serous chorioretinopathy who underwent MCI and CFP. MCI and spectral-domain optical coherence tomography (SD-OCT) were performed using Spectralis SD-OCT system (HRA + OCT). CFP was obtained using FF 450 Plus fundus camera (Carl Zeiss Meditec, Jena, Germany). SD-OCT was considered gold standard for subretinal fluid (SRF) and retinal pigment epithelium detachment (PED). CFP was considered confirmatory investigation for fibrin and blue autofluorescence image (BAF) was considered gold standard to detect retinal pigment epithelium (RPE) atrophy. Results: CFP could detect SRF in 41 (44.1%) eyes. MCI detected SRF in 43 (46.2%) eyes. The sensitivity and specificity of MCI to detect SRF were 70.7% and 94.3%, respectively. PED was detected by CFP in 21 (22.6%) eyes and MCI in 27 (29%) eyes. The sensitivity and specificity of MCI to detect PED were 70% and 97.7% respectively. CFP could pick RPE atrophy in 52 (55.9%) eyes whereas MCI was picked it in 78 (83.9%) of eyes. Conclusion: Both MCI and CFP were inferior to a gold standard in identifying the SRF, PED, and RPE atrophy. However, MCI was better than CFP in comparison with gold standard for these clinical findings in CSC. Thus, MCI seems to be a more valuable imaging tool compared to CFP.

Focal choroidal excavation (FCE) is a localized excavation of the choroid, which can be diagnosed by enhanced depth optical coherence tomography (OCT). Choroidal caverns are focal cavitation areas in the choroid which appear hyporeflective on OCT. These are angular or round, empty spaces with posterior tail of hypertransmission. A 47-year-old female presented to us for a routine eye check-up. The best-corrected visual acuity was 20/20 in both the eyes. On fundus examination, a localized pigmented lesion was seen in the right eye inferior to the optic disc, while the fundus of the left eye was normal. Spectral-domain OCT scan through the lesion showed an FCE and a giant cavern with a posterior tail of hypertransmission. The diameter of the cavern was 977 μ ×264 μ, with a subfoveal choroidal thickness (SFCT) of 360 μ. The SFCT of the other eye was 300 μ. Coexistence of FCE and cavern in an eye with thickened choroid is not yet reported in the literature, and their coexistence provides possible insight into the formation of FCE and caverns in the setting of thickened choroid.

Purpose: To describe treatment outcomes of eyes with pachychoroid neovasculopathy (PNV) with PDT and anti-(vascular endothelial growth factor) VEGF therapy. Methods: Retrospective interventional case series. Records of six consecutive cases of PNV were reviewed. Four cases were treated with PDT+ inj ranibizumab. Two cases underwent only PDT. Final visual outcomes and functional outcome including macular status and choroidal thickness were assessed. Results: We analysed six eyes of six patients with PNV. There were four males and two females. Mean age of the patients was 56.5 years. Mean duration of follow up was 8.2 months. All patients received reduced fluence PDT. Four patients received ranibizumab along with PDT; mean BCVA at presentation was 0.41 log MAR units and mean BCVA at final follow up was 0.44 log MAR units. There was significant improvement at final follow up (P = 0.03). Mean subfoveal choroidal thickness (SFCT) at presentation was 445 microns and mean SFCT at final follow up was 293 microns. There was a significant reduction at final follow up (P = 0.02). Conclusion: PDT with or without ranibizumab appears to be an effective treatment modality for PNV.

Acute leukaemia usually presents with ocular features of anaemia and thrombocytopenia (in the form of intraretinal and preretinal haemorrhages, white‐centred retinal haemorrhages, hard exudates and...

Interpretation of optic disc cupping and neuroretinal rim is challenging in myopic eyes because of large, shallow, and tilted disc, myopic crescent, and macular degeneration. Color and red-free optic disc photographs do not reveal the cup/disc ratio often in myopic eyes. We report characteristics of multicolor optic disc photography in three myopic eyes. All eyes underwent multicolor imaging Spectralis SDOCT system (Heidelberg Engineering, Germany). Owing to use of three laser lights in a confocal design, multicolor optic disc photography was able to delineate the neuroretinal rim and optic cup more clearly than color and red-free optic disc photographs.

Acute macular neuroretinopathy (AMN) is a deep retinal ischemic manifestation. It has been reported after the use of sympathomimetics, childbirth, bee sting, oral contraceptives, flu-like illness, intravenous contrast agents and bodily trauma not directly involving the eyes. We report a case of AMN following blunt ocular trauma. An 18-year-old male presented with an acute history of blurring of vision following blunt trauma to the right eye. Spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the outer nuclear layer with ellipsoid layer disruption. This report highlights AMN as a manifestation of blunt trauma, presence of which may be an indicator of poor visual prognosis.

Chronic myeloid leukaemia (CML) is a clonal myeloproliferative disorder of haematopoietic stem cells characterised by increased proliferation of the granulocytic cell line without the loss of their...

Retinochoroidal colobomas are congenital.1997 They can be sporadic or inherited. Multicolour imaging (MCI) is a new non‐invasive retinal imaging modality available on the Spectralis platform. We he...

Myelinated nerve fibers (MNF) are characterized as whitish, relatively sharply demarcated, feather-like structures located in the retinal nerve fiber layer. MNF are located quite frequently in contiguity with the optic nerve head. This may lead to a diagnostic dilemma by preventing clear visualization of the optic disc margins. We herein describe the utility of multicolor imaging (MCI) in identifying optic disc anatomy in a case of MNF contiguous to the disc. MCI and infrared reflectance were superior to color fundus photography in delineating disc margins. Our pilot study describes the efficacy of MCI in delineating optic disc anatomy in a case of MNF.

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.

Purpose: The aim of this study was to examine the hyperreflective dots seen in choroid on spectral domain optical coherence tomography (SDOCT) in eyes with diabetic macular edema (DME) and correlate it with visual acuity. Design: Consecutive, cross-sectional case series of patients with DME between January 2017 and December 2017. Methods: Eyes with DME having central foveal thickness ≥250 μm were included. SDOCT was performed using Spectralis system (Heidelberg Engineering, Germany). Hyperreflective choroidal foci (HCF) were defined as well-circumscribed dots within choroid having reflectivity equal to or higher than adjacent retinal pigment epithelium. HCF were counted manually within 1500 μm of fovea using a horizontal line scan by a blinded observer. Eyes were divided in 3 groups: group A (no HCF), group B (1–10 HCF), and group C (>10 HCF). Results: One hundred nineteen eyes of 60 DME patients were included. Sixty (50.4%) eyes were in group A, whereas 42 (33.6%) and 17 (14.2%) eyes belonged to group B and group C, respectively. The mean logMAR best corrected visual acuity was significantly lower in group B (0.76 ± 0.79) and C (1.2 ± 0.78) as compared with group A (0.22 ± 0.49) (P = 0.001). Mean central foveal thickness in group A (300.4 ± 122.4 μm) was significantly lower than group B (455.52 ± 209.1 μm) and group C (529.4 ± 196.4 μm) with P value of 0.001. Conclusions: The present study describes HCF as novel prognostic SDOCT biomarker in DME whose presence denotes poor visual acuity. Further longitudinal studies are required to substantiate our findings.

Choroidal vascular knuckles have reportedly2016 been misdiagnosed as hot spots on indocyanine green angiography (ICG), therefore leading to erroneous diagnosis of polypoidal choroidal vasculopathy....

Purpose: The aim of this study is to assess the ability of multicolour imaging (MCI) to detect foveal cysts in diabetic macular edema (DME) and compare it with conventional color fundus photography (CFP) and foveal autofluorescence (FAF) pattern. Methods: It was a retrospective review of 112 eyes of 84 DME patients with central foveal thickness ≥250 μ who underwent MCI, CFP and shortwave autofluorescence imaging. MCI was performed with Sepctralis spectral domain optical coherence tomography (SDOCT) (Heidelberg Engineering, Germany). Results: 97 (86.6%) eyes had cystoid increased autofluorescence (cystoid iFAF), 9 (8%) had spot iFAF and 6 (5.35%) had irregular decreased FAF (dFAF). Among eyes with cystoid iFAF, OCT detected DME cysts in 93 (95.6%) eyes, MCI in 75 (77.3%) and CFP in 5 (5.15%) eyes. In all these eyes, the location of cysts on OCT and MCI corresponded with the location of cystoid iFAF, whereas none of the eyes with cyst seen on CFP correlated with the location of cystoid iFAF. Conclusion: MCI was superior to CFP in detecting DME cysts at fovea. It also correlated with hyperautofluorescence pattern in these eyes. MCI may have a potential role in diabetic retinopathy screening by segregating eyes with DME which would require treatment. Our findings need to be further validated in a larger and prospective study design.

Background: Recent developments in assisted reproductive technology focus on potential advances to improve its success rate. Atosiban, a combined oxytocin/vasopressin V1a receptor antagonist, is a novel class of drug involved in basic priming of the uterus for successful implantation during embryo transfer (ET). Objectives: The objective of this study is to evaluate the efficacy of atosiban (study group) in ET patients in comparison to placebo (control group) regarding implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate and to assess the safety profile of atosiban. Materials and Methods: A total of 320 women undergoing in vitro fertilization-ET at a tertiary care hospital were enrolled in the study. In the study group, atosiban was given as initial intravenous (IV) bolus injection 0.9 ml (6.75 mg), 30 min before ET followed by continuous IV infusion of atosiban. In the control group, placebo (normal saline) was infused at the same rate and dose. Pregnancy was confirmed 14 days after ET by β-human chronic gonadotropin level. IR and CPR were determined by doing transvaginal sonography 3 weeks and 6 weeks postET, respectively. Results: In women with atosiban treatment, the positive pregnancy rate and CPRs were 41.25% and 36.25%, respectively. The IR per embryo transferred was 17.5%. No major side effects of atosiban were noted among enlisted patients. The miscarriage rate and ectopic pregnancy rate were low (12.12% and 4.54%, respectively). Forty-two women had singleton gestation, while twin and triplet pregnancies were encountered in 13 and 3 women, respectively. No congenital anomalies were observed during an antenatal scan at 18–20 weeks in ongoing pregnancies. The positive pregnancy rate, the CPR, and the IR in the control group was 35%, 30%, and 16.5%, respectively, which was significantly lower than the atosiban group. Conclusion: Atosiban reduces uterine contractions and increases endomyometrial perfusion, both of which have potential benefits regarding improved IRs, CPR, and ongoing pregnancy rates. Atosiban has a good embryonic safety profile.

Background: Recent developments in assisted reproductive technology focus on potential advances to improve its success rate. Atosiban, a combined oxytocin/vasopressin V1a receptor antagonist, is a novel class of drug involved in basic priming of the uterus for successful implantation during embryo transfer (ET). Objectives: The objective of this study is to evaluate the efficacy of atosiban (study group) in ET patients in comparison to placebo (control group) regarding implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate and to assess the safety profile of atosiban. Materials and Methods: A total of 320 women undergoing in vitro fertilization-ET at a tertiary care hospital were enrolled in the study. In the study group, atosiban was given as initial intravenous (IV) bolus injection 0.9 ml (6.75 mg), 30 min before ET followed by continuous IV infusion of atosiban. In the control group, placebo (normal saline) was infused at the same rate and dose. Pregnancy was confirmed 14 days after ET by β-human chronic gonadotropin level. IR and CPR were determined by doing transvaginal sonography 3 weeks and 6 weeks postET, respectively. Results: In women with atosiban treatment, the positive pregnancy rate and CPRs were 41.25% and 36.25%, respectively. The IR per embryo transferred was 17.5%. No major side effects of atosiban were noted among enlisted patients. The miscarriage rate and ectopic pregnancy rate were low (12.12% and 4.54%, respectively). Forty-two women had singleton gestation, while twin and triplet pregnancies were encountered in 13 and 3 women, respectively. No congenital anomalies were observed during an antenatal scan at 18–20 weeks in ongoing pregnancies. The positive pregnancy rate, the CPR, and the IR in the control group was 35%, 30%, and 16.5%, respectively, which was significantly lower than the atosiban group. Conclusion: Atosiban reduces uterine contractions and increases endomyometrial perfusion, both of which have potential benefits regarding improved IRs, CPR, and ongoing pregnancy rates. Atosiban has a good embryonic safety profile.

The influence of pregnancy on the subsequent course of pre-existing nephrotic syndrome is controversial as also the effect of membranous glomerulonephritis on maternal and perinatal outcome. We describe a case of successful pregnancy outcome in Hepatitis B reactive patient with pre-existing nephrotic syndrome (renal biopsy proven case of Membrano-proliferative Glomerulonephritis). She had regular nephrology consultation and her renal disease was well compensated. After sonographic confirmation of live intrauterine pregnancy at 9th gestational week, patient was given methylprednisolone (5mg once daily). Antihypertensive drugs were also given. At 35 weeks of gestation, patient went in labour and cesarean section was performed in view of previous caesarean section. Feto-maternal outcome was good. The intrapartum and postpartum period was uneventful. Renal functions were well preserved. A vigourous healthy 1.93 kg baby was discharged with mother in a stable condition after receiving hepatitis B immunoglobulin.

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that commonly affects women of childbearing age. Lupus nephritis in pregnancy increases risk of maternal and fetal morbidity and mortality. Active disease during pregnancy and disease flares can lead to poor outcome. Higher rates of fetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes, gestational diabetes, osteoporosis, avascular necrosis, hypertension, preeclampsia, ecclampsia, stroke, HELLP syndrome, and maternal death are major issues. There is difficulty in recognizing disease flare because of normal physiological changes during pregnancy. Preeclampsia mimics disease symptoms of lupus nephritis and presents confusion in diagnosis. Management option is limited to few safer drugs. Lupus nephritis with antiphospholipid antibodies presents with refractory fetal loss and complete heart block associated with anti-Ro antibodies. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. Our aim is to report a case of primigravida 37 years old with controlled lupus nephritis.

Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity. We report a case of 26 years old lady with crescentic tear of anterior urethra from pubic symphysis. Management consisted of primary urethral repair.

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient.