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Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions. [ABSTRACT FROM AUTHOR]

A 28-year-old male arrived in our Ophthalmology Out patient department (OPD) with a chief complaint of bilateral sudden loss of vision in both his eyes of three days’ duration and a history of consumption of 90 mL of alcohol five days prior to the onset of symptoms. An ophthalmic examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. His fundus examination showed bilateral, hyperemic, and edematous discs. The veins around the disc were mildly dilated and tortuous. Magnetic resonance imaging (MRI) brain showed symmetrical hyperintensities and hemorrhages in bilateral gangliocapsular regions and signal abnormalities areas in bilateral cerebellar hemispheres, posterior part of cerebellar vermis, bilateral cingulate gyrus showing diffusion restriction which was suggestive of toxic encephalopathy and toxic neuropathy. Fundus fluorescein angiography was also done for the patient, which showed optic disc staining in the late phase suggestive of optic neuropathy. His vision improved to 20/200 in both eyes with treatment after two months.

Diabetic papillopathy (DP) is a rare ocular manifestation of diabetes mellitus. The exact etiology is not well understood, but in some cases, it may be associated with a rapid correction of the blood glucose level. There are limited case reports describing the use of intravitreal anti-vascular endothelial growth factor antibodies which have shown effectiveness in reducing disc swelling. In this case, we present the case of an 80-year-old diabetic woman diagnosed with DP during a diabetic retinopathy (DR) screening. Her visual acuity (VA) was counting fingers on her right eye and 20/160 on her left eye. At the fundoscopy, an exuberant bilateral hemorrhagic disc edema was observed, along with a nonproliferative DR. This edema was also evident in the fluorescein angiography and was documented through the optical coherence tomography. Brain computed tomography normal. She was treated with ranibizumab with significant improvement of the optic disc edema and the VA. [ABSTRACT FROM AUTHOR]

A 28‑year‑old male arrived in our Ophthalmology Out patient department (OPD) with a chief complaint of bilateral sudden loss of vision in both his eyes of three days’ duration and a history of consumption of 90 mL of alcohol five days prior to the onset of symptoms. An ophthalmic examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. His fundus examination showed bilateral, hyperemic, and edematous discs. The veins around the disc were mildly dilated and tortuous. Magnetic resonance imaging (MRI) brain showed symmetrical hyperintensities and hemorrhages in bilateral gangliocapsular regions and signal abnormalities areas in bilateral cerebellar hemispheres, posterior part of cerebellar vermis, bilateral cingulate gyrus showing diffusion restriction which was suggestive of toxic encephalopathy and toxic neuropathy. Fundus fluorescein angiography was also done for the patient, which showed optic disc staining in the late phase suggestive of optic neuropathy. His vision improved to 20/200 in both eyes with treatment after two months. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of carboplatin-induced bilateral optic neuropathy in a patient with metastatic squamous cell carcinoma of the tongue. Case Report: A 65-year-old man with a history of squamous cell carcinoma of the tongue with metastasis to the right axillary lymph node treated with carboplatin and paclitaxel was evaluated for decreased visual acuity in both eyes. Visual acuity was 20/70 in the right eye and no light perception in the left eye. On dilated fundus examination, optic disc edema was present in both eyes with more severity in the left eye, flame shape hemorrhages around the optic nerve head in both eyes and cotton wool spots around the left optic nerve head. Brain and orbital MRI demonstrated enhancement of the bilateral optic nerve sheaths. He was diagnosed with bilateral carboplatin-induced optic neuropathy. Conclusion: Our findings in this case justify monitoring of patients during their course of intravenous carboplatin therapy. [ABSTRACT FROM AUTHOR]

An 18-year-old female presented with sudden onset bilateral vision loss. Extensive retinal hemorrhages were seen in both eyes. Systemic examination lead to a diagnosis of acute promyelocytic leukemia. The patient was treated with all trans retinoic acid (ATRA) and other medications in the induction phase. Bilateral disc edema was noted during the second consolidation cycle with ATRA. Complete resolution of bilateral disc edema was attained in three weeks' time after discontinuing ATRA. [ABSTRACT FROM AUTHOR]

Osteopathia striata combined with cranial sclerosis (OS-CS) is an inherited skeletal dysplasia that manifests with macrocephaly, orofacial abnormalities, thickened craniofacial bones, and vertically oriented radiodensities of the long bones. Here, we present a severe case of OS-CS in a 4-year-old girl causing optic neuropathy as shown by radiographic evidence, ophthalmic findings, and histopathology. Previous genetic testing in this patient revealed a de novo heterozygous mutation in AMER1 (c.1057C>T, p.Arg353Ter). Although the patient had a pre-existing, appropriately functioning, ventriculoperitoneal (VP) shunt, a subsequent MRI of the brain and orbits showed narrowing of the bilateral optic nerve canals secondary to osseous thickening causing bilateral optic nerve atrophy, worse on the left. The patient underwent staged bilateral orbital osteotomies, optic canal decompression, and bilateral frontal craniotomy, and at 11 months postoperatively, her vision remained stable. Conclusions: While up to 50% of the patients with OS-CS may experience hearing loss due to cranial nerve compression, we present a case of severe visual loss secondary to OS-CS-associated optic nerve compression. [ABSTRACT FROM AUTHOR]

Diabetic papillopathy (DP) is a rare ocular manifestation of diabetes mellitus. The exact etiology is not well understood, but in some cases, it may be associated with a rapid correction of the blood glucose level. There are limited case reports describing the use of intravitreal anti-vascular endothelial growth factor antibodies which have shown effectiveness in reducing disc swelling. In this case, we present the case of an 80-year-old diabetic woman diagnosed with DP during a diabetic retinopathy (DR) screening. Her visual acuity (VA) was counting fingers on her right eye and 20/160 on her left eye. At the fundoscopy, an exuberant bilateral hemorrhagic disc edema was observed, along with a nonproliferative DR. This edema was also evident in the fluorescein angiography and was documented through the optical coherence tomography. Brain computed tomography normal. She was treated with ranibizumab with significant improvement of the optic disc edema and the VA.

Wernicke's encephalopathy (WE) due to hyperemesis gravidarum is an under-diagnosed but potentially disastrous condition. We report a case of a young lady with hyperemesis gravidarum who developed Wernicke's encephalopathy.

Renal tuberculosis (TB) is a rare clinical disorder in the pediatric population. A 15-year-old female presented with intermittent blurring of vision in both eyes associated with fever, abdominal pain, and weight loss. Fundus examination showed bilateral disc edema. Her blood pressure was 220/110 mmHg. Renal parameters were deranged with bilaterally enlarged kidneys. Renal biopsy was suggestive of epithelioid cell granuloma with Langhans type giant cells. The patient was diagnosed with as a case of refractory hypertension due to tubercular interstitial nephritis with bilateral Grade IV hypertensive retinopathy. She was started on antitubercular therapy and antihypertensives. There was a complete resolution of disc edema 2 months following initiation of therapy. Optic disc edema can be a presenting sign in renal TB. Early diagnosis and prompt referral can be associated with good visual and systemic outcomes.

A 29-year-old female with treated acute lymphoblastic leukemia in remission presented with blurred vision and pain on movement of the right eye. On examination, visual acuity was 20/25 in the right eye and 20/20 in the left eye. Direct ophthalmoscopy revealed that the optic disc was swollen with peripapillary hemorrhage in the right eye. The rest of the clinical examination was within normal limits. Magnetic resonance imaging demonstrated enhancement of her right optic nerve. Lumbar puncture and bone marrow examination revealed no malignant cells. Only vitreous fluid cytology showed blast cells. Intravitreal injection of methotrexate was given, and repeated vitreous tapping was normal. The vision of her right eye remained 20/20 until 1 year later when optic disc and retinal vascular occlusion was noted. Her vision deteriorated to no light perception within 2 weeks, and optociliary shunt vessels occurred. Isolated disc swelling with positive vitreous cytology can be the first and only presentation of relapsed hematologic disorders. Infiltrative optic neuropathy should be considered in the differential diagnosis of optic disc edema. Vitreous tapping could be considered as the diagnostic procedure even if the results of lumbar puncture were negative. [ABSTRACT FROM AUTHOR]

A 36-year-old female presented with blurring of vision in one eye for 10 days after 1 month of an episode of COVID-19 infection. Her fundus showed disc edema with blurring of margins along with exudation around the fovea. Her C-reactive protein levels were raised. She responded well to oral steroids. A likely association with COVID-19 infection and its associated immune response was suspected.

A cilioretinal artery occlusion (CLRAO) associated with optic disc edema was diagnosed in a patient seven days after the second dose of viral vector SARS-CoV-2 vaccination. The patient developed sudden blurred vision in the inferior hemifield of the right eye. His fundus examination showed retina edema at the superotemporal quadrant within vascular arcades of the right eye. Fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherent tomography angiography (OCTA) were used to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Renal tuberculosis (TB) is a rare clinical disorder in the pediatric population. A 15-year-old female presented with intermittent blurring of vision in both eyes associated with fever, abdominal pain, and weight loss. Fundus examination showed bilateral disc edema. Her blood pressure was 220/110 mmHg. Renal parameters were deranged with bilaterally enlarged kidneys. Renal biopsy was suggestive of epithelioid cell granuloma with Langhans type giant cells. The patient was diagnosed with as a case of refractory hypertension due to tubercular interstitial nephritis with bilateral Grade IV hypertensive retinopathy. She was started on antitubercular therapy and antihypertensives. There was a complete resolution of disc edema 2 months following initiation of therapy. Optic disc edema can be a presenting sign in renal TB. Early diagnosis and prompt referral can be associated with good visual and systemic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To analyse baseline imaging characteristics and factors affecting poor visual acuity in diabetic papillopathy., Methods: This was a retrospective, observational study conducted at a tertiary eye care centre in eyes with a diagnosis of diabetic papillopathy. Demographic data including age, gender, duration of diabetes, type of diabetes, HbA1c values and other systemic co-morbidities were recorded. Baseline best corrected visual acuity (BCVA), and various imaging characteristics were noted., Results: 37 eyes of 22 patients with diagnosis of diabetic papillopathy were included [mean age of 46.6 ± 13.5 years, five (22.7%) females and 17 (77.3%) males]. Bilateral involvement was seen in 15 (68.2%) patients. The mean baseline BCVA was 0.51 ± 0.49 logMAR (Snellen equivalent 20/60). Two eyes (5.4%) had features of concurrent mild NPDR, 9 eyes (24.3%) had moderate NPDR, 10 eyes (27.03%) had severe NPDR while 16 (43.2%) other had PDR. All eyes had optic disc edema while 4 had disc pallor at presentation. Telangiectatic vessels/ neovascularisation of disc was present in 17 eyes (45.9%) detected either clinically or on optical coherence tomography (OCT) angiography. 11 (29.7%) eyes had a peripapillary cuff of subretinal fluid accompanying the disc edema. Sixteen eyes (43.2%) had centre involving macular edema seen on OCT. In eyes with a macular edema, the mean central macular thickness was 407.4 ± 71.42 microns at baseline. On assessing the baseline factors that contribute to the final visual acuity, presenting visual acuity was the only variable found to be statistically significant., Conclusion: Although described to have good visual outcome, eyes presenting with poor visual acuity tend to have worse vision on follow up. This may aid in prognosticating and guiding management plan., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A 36-year-old female presented with blurring of vision in one eye for 10 days after 1 month of an episode of COVID-19 infection. Her fundus showed disc edema with blurring of margins along with exudation around the fovea. Her C-reactive protein levels were raised. She responded well to oral steroids. A likely association with COVID-19 infection and its associated immune response was suspected. [ABSTRACT FROM AUTHOR]

Objective The objective is to correlate visual outcomes in malignant hypertensive retinopathy with changes in systemic causative factors and spectral domain optical coherence tomography (SD OCT) morphologic parameters. Materials and methods This is a prospective observational study including patients presenting within two weeks of acute rise of systolic blood pressure (SBP) ≥ 180 mm Hg or diastolic blood pressure (DBP) ≥ 120 mm Hg and with posterior segment involvement in both eyes. Baseline SBP, DBP, mean arterial pressure (MAP), best corrected visual acuity (BCVA), and SD OCT parameters such as central macular thickness (CMT), subfoveal choroidal thickness (SCT), and sub-retinal fluid (SRF) height were measured at presentation and followed monthly up to three months. These variables at baseline and three months were compared and correlated. Results Thirty-three patients (66 eyes) having malignant hypertension were included in the study. Diverse clinical presentations noted among patients were optic disc edema, hard exudates in the macula, peripapillary splinter hemorrhage, cotton wool spots, Elschnig spots, exudative retinal detachment, optic neuropathy, and severe exudative retinopathy. SD OCT shows hyperreflective dots and intraretinal fluid with or without SRF. At three months, the mean SBP, DBP, MAP, CMT, SRF, and SCT all decreased significantly from baseline (p<0.001). Changes in SBP, DBP, MAP, and SCT correlated significantly with changes in BCVA (p<0.001). Conclusion In malignant hypertensive retinopathy, macular edema with SRF is the major cause of mild-to-moderate decrease BCVA at presentation, but macular ischemia, exudative RD, and optic neuropathy can cause a significant decrease in vision. A decrease in SBP, DBP, MAP, and SCT correlate significantly with visual outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Sanjay Gandhi Postgraduate Institute of Medical Sciences issued approval PGI/BE/539/2016. This research project was cleared by the Institutional Ethics Committee, Sanjay Gandhi Postgraduate Institute of Medical Sciences. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mishra et al.)

This case highlights the atypical presentation of Foster-Kennedy syndrome (FKS) associated with Neurocysticercosis (NCC), a prevalent cause of space-occupying lesions in areas endemic to the parasite. We report a newly diagnosed case of NCC in a 13-year-old boy who presented with a one-day history of abnormal movements of the left side of the body and no ocular complaints. Fundus examination of the patient revealed temporal disc pallor and a cup disc ratio (CDR) of 0.6 in the right eye suggesting unilateral optic disc atrophy and a hyperaemic disc with CDR 0.3 and blood vessel tortuosity in the left eye suggesting contralateral impending disc edema, mimicking the classic triad of FKS. He was diagnosed with NCC based on clinical features and radiological findings and was started on Carbamazepine (400 mg), Prednisolone (60 mg), Albendazole (400 mg), Acetazolamide (750 mg), and Vitamin B12 complex. Abbreviations: BCVA = Best Corrected Visual Acuity, CDR = Cup-Disc Ratio, CT = Computed Tomography, FKS = Foster Kennedy Syndrome, IDSA = Infectious Diseases Society of America, ICP = Intracranial Pressure, IOP = Intraocular Pressure, MRI = Magnetic Resonance Imaging, NCC = Neurocysticercosis, OOC = Orbital/Ocular Cysticercosis, OD = Right Eye, OS = Left Eye, OU = Both Eyes, RNFL = Retinal Nerve Fibre Layer, WNL = Within Normal Limits., (#x00A9; The Authors.Romanian Society of Ophthalmology.)

Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient's life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mishra et al.)