Purpose To study the outcomes of subthreshold micropulse yellow laser (SML) and eplerenone (EP) therapy in central serous chorio-retinopathy (cCSCR)Methods Retrospective study of 28 eyes of 27 patients undergoing SML and 20 eyes of 19 patients undergoing EP therapyResults Median duration of follow-up was 8 months for SML and 4.5 months for EP group. Complete SRF resolution was seen in 12/28 (42.8%) eyes in SML and 4/20 (20%) in EP group. Six eyes in SML group and two eyes in EP group needed additional SML. No EP patients demonstrated hyperkalemia warranting stopping of therapy. Baseline visual acuity (VA) was correlated positively with final VA in both groups. Presence/absence of focal leaks had differing outcomes in both treatment groups in terms of anatomical resolution.Conclusion Both treatment modalities were effective in the management of cCSCR showing comparable favorable anatomical outcomes, but visual outcomes were not significant, probably due to chronicity of the pathology.
Purpose: Assessment of anxiety and depression in patients attending low vision care (LVC) using Hospital Anxiety and Depression Scale (HADS). Methods: In this prospective, observational study, 100 patients with best-corrected visual acuity (BCVA) worse than 6/18 in the better eye or limitation of field of vision to <10° from center of fixation were assessed on the depression and anxiety subscales of HADS questionnaire before and after LVC. HADS is a 14-item scale with seven items each for anxiety and depression subscales. Scoring for each item ranges from zero to three. A subscale score >8 denotes anxiety or depression. Results: Mean age at presentation was 38.2 years. Mean duration of symptoms was 9.6 years. Underlying etiology of visual impairment included retinal dystrophy/degeneration (n = 35), disorders of the optic nerve (n = 17), glaucoma (n = 10), diabetic retinopathy (n = 9), age-related macular degeneration (n = 5), uncorrected refractive errors (n = 5), and miscellaneous diseases (n = 19). Mean presenting BCVA in the better eye was 0.83 (±0.64) which improved significantly to 0.78 (±0.63) after LVC (P < 0.001). The HADS-Depression subscale score was comparable for severity of visual impairment for both distance (P = 0.57) and near vision (P = 0.61). Similarly, HADS-Anxiety scores were also comparable for severity of distance (P = 0.34) and near-visual impairment (NVI; P = 0.50). At baseline, mean HADS-Depression and HADS-Anxiety scores were 8.4 (±3.7) and 9.6 (±4.3) points, which improved significantly to 6.0 (±3.4) and 6.7 (±3.7), respectively, after low-vision correction (P < 0.001). Conclusion: Low vision correction can significantly improve anxiety and depression indicators in visually impaired patients.
Abstract We present a unique case of a 36-year-old female presenting with features suggestive of bilateral combined vascular occlusion, hearing loss, and encephalopathy. Multimodal imaging was done for both eyes fundus evaluation including wide-field color fundus photography, optical coherence tomography, and fundus fluorescein angiography. After extensive ocular and systemic investigations, she was diagnosed to have Susac syndrome (SS). She was referred to a neurologist and otologist for systemic evaluation and underwent laser photocoagulation in both eyes, followed by pars plana vitrectomy in her left eye. Combined bilateral retinal vascular occlusion in association with SS is very rare.
Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP). Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression. Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6–13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4–4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98–3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4–14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09–0.5, P < 0.005). Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.
We thank authors for the interest in our report and expanding the scope of discussion.[12] In our series, Intra-arterial Chemotherapy (IAC) was carried out in all patients by placing the microcatheter close to the origin of the ophthalmic artery where the predominant flow of chemotherapeutic agent was guided into the ophthalmic artery and controlled by intermittent fluoroscopic screening and manual hand injection. The manual injection was pulsatile with the adequate pressure of injection maintained so that the medicine enters the ophthalmic artery without causing any spasm or dissection. These techniques help us prevent arterial dissection/thrombosis/severe vasospasm. Here follows a point-by-point rebuttal. In one of the cases, the ostium of ophthalmic artery was extremely narrow with collateral supply from an external carotid artery, through the middle meningeal artery. The latter was super-selectively catheterized, and IAC carried out. In all other cases, catheterization of the ophthalmic artery was possible. Hence, our rates of ophthalmic artery catheterization are consistent with the reported rates of successful catheterization in >98% of cases in the first attempt.[34] In 2 cases, the internal carotid artery (ICA) showed a looping in its course where the mother catheter was kept proximal to the loop fearing the risk of spasm. In another 2 cases, there was an acute angle of the origin of ophthalmic artery from ICA. Hence, care was taken that the microcatheter was stationed proximal to ostium by either manipulating the microcatheter gently or by placing the mother catheter more inside the ICA. We rarely use a reverse V tipped microcatheter. We have used Echelon 45° angle microcatheter in 1 case. As a general rule, we use straight tip microcatheter in almost all cases of IAC, as they are least traumatic and don't cause spasm, which is very common with angled tip microcatheters for their inherent shape. Angled microcatheters are also mainly used for aneurysm coiling procedures, so the tip is not as soft as the straight tip microcatheter. Although not the primary objective of the study/procedure, the visual acuity was documented in all our cases, using age-appropriate and acceptable methods [Table 1]. We did not encounter any case of foveal/choroidal atrophy in our series, as expected with melphalan (5/7.5 mg) and topotecan (1 mg). Although one case developed STBRVO and arteriolar attenuation, the fovea was spared.Table 1: Visual outcomes for patients undergoing intra-arterial chemotherapy: 2 years follow-upAs has been established, primary IAC is ideal for unilateral sporadic retinoblastoma (RB). Most of the cases in our series had bilateral RB with advanced disease; that is the nature of our referral practice. We used IAC as a secondary salvage therapy in most of these eyes notwithstanding reports of "tandem" treatment for bilateral RB with primary IAC.[34] We believe intravenous chemotherapy (IVC) provides adequate systemic cover for germline tumors (all bilateral cases), reducing the risk of second primary malignancies later in life. Secondary IAC has shown good results in eyes resistant to IVC and facing enucleation as the only option. This becomes especially relevant in bilateral cases with one eye already enucleated. We agree with the authors, due to small sample size, a comparison of primary vs secondary IAC outcomes was not statistically feasible. We continue to follow these cases for a longer duration while also recruiting newer cases for management with IAC and hope to report a more detailed analysis of various parameters in the long-term in future. As reported in our previous report, we believe this technique should be limited to select, experienced centers until the full value and limits of this approach are realized. We continue to use this technique with caution.[5] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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