Syp op dr prabha
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A 22-year-old male presented with sudden vision loss in the left eye along with photophobia and watering for 12 days. He had a history of penetrating eye injury and surgery in the right eye two months prior. Examination found anterior and posterior uveitis in the left eye with macular edema and retinal detachment. Tests showed mild inflammation. He was diagnosed with sympathetic ophthalmia affecting the left eye secondary to the prior right eye injury and trauma. He was treated aggressively with high-dose steroids and immunosuppressants. On discharge, his vision had improved but he requires long-term follow up to monitor the chronic nature of sympathetic ophthalmia.
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This document provides an overview of central serous chorioretinopathy (CSC), including its pathogenesis, clinical presentation, diagnosis, course and treatment. CSC is characterized by a localized serous retinal detachment in the macula due to leakage of fluid from the choroid. It typically affects men ages 30-50 and can be associated with stress, corticosteroid use, hypertension and type A personality. Diagnosis is usually clinical but can be confirmed with fluorescein angiography showing characteristic leakage patterns or optical coherence tomography identifying subretinal fluid. While most cases resolve spontaneously, laser photocoagulation or photodynamic therapy may be used in persistent or recurrent cases to seal leaking sites and accelerate resolution.
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This document discusses inflammatory multfocal chorioretinopathies, which are a heterogeneous group of diseases that affect the outer retina, retinal pigment epithelium, choroid, or a combination. It summarizes the key characteristics, ocular manifestations, diagnosis, treatment, and outcomes of several specific conditions that fall under this category, including Birdshot chorioretinopathy, Acute posterior multifocal placoid pigment epitheliopathy, Serpiginous choroiditis, Multiple evanescent white dot syndrome, and Acute zonal occult outer retinopathy.
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This document provides an overview of inflammatory optic neuropathy, specifically optic neuritis. It begins with the anatomy of the optic nerve and its divisions. It then discusses the signs, classification, and common types of optic neuropathy, focusing on inflammatory optic neuritis. It covers the pathophysiology, risk factors, locations of involvement on the optic nerve, and etiological classifications of optic neuritis. The remainder of the document discusses demyelinating optic neuritis in more detail, including its association with multiple sclerosis, workup, symptoms, signs, visual field defects, course, treatment, and results from the ONTT and CHAMPS/CHAMPIONS studies.
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Diabetic Retinopathy: A Clinical Survival Guide
- The patient presented with gradual decreased vision and significant glare. Exam found moderate NPDR with CSME in the right eye and microaneurysms and hemorrhages in the left eye. OCT showed intraretinal fluid in the right macula.
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Syp op dr prabha
- 1. CASE PRESENTATION Dr. PRABHA
- 2. 22yr old male presented with sudden loss of vision left eye of 12 days duration associated with photophobia , watering and metamorphopsia Past history of penetrating injury with uveal tissue prolapse RE eye 2 months back for which emergency wound repair done & treated with systemic & topical steroids & antibiotics
- 3. GENERAL EXAMINTION Moderately built & nourished No pallor , cyanosis , jaundice , clubbing , lymphadenopathy No vitiligo , alopecia PR – 82/mt BP – 140 / 60 mmHg
- 4. SYSTEMIC EXAMINATION CNS – no convulsions , no FND CVS – Loud S2 GIT – no organomegaly RESP – NAD MSK – NAD
- 5. OCULAR EXAMINATION Vision - RE CF ½ m LE 6/36
- 6. RIGHT EYE Lid & adnexa no poliosis , vitiligo Conjuctival congestion Sutured full thickness corneoscleral wound from limbus at 9 o’clock to 6o’clock and is extended 2mm to the sclera AC cells 2+ Flare 2+ Pupil dilated pharmacologically Iris deficient at 6 o’clock
- 7. RIGHT EYE Lens phacodonesis+ Rosette cataract AVF– no cells FUNDUS – media hazy due to cataractous lens & coarse vitreous floaters Disc & vessels normal FR dull Organized vitreous hge inferiorly
- 8. LEFT EYE Conjuctival congestion Cornea clear AC cells 1+ Flare 1+ Pupil dilated pharmacologically Lens clear AVF– no cells
- 9. LEFT EYE FUNDUS – media clear Disc & vessels normal CDR – 0.3 , NRR pink & even Macular edema with ILM folds + 3 to 4 small yellowish white subretinal lesion seen just superior to macula Serous detachment of retina of 3DD seen between IT & IN arcade starting from the inferior disc margin
- 11. INVESTIGATIONS Hb – 14.8 gm% TC – 12600 ccmm DC – N81 , L 18 . E2 ESR- 3mm/hr RBS – 110 BUN – 39mg% S creatinine – 0.7% S.biliribin – 1mg5 ALP – 202 IU SGOT – 42 IU SGPT-24IU Platelet – 3L PS- mild neutrophilia
- 12. FFA – hyperfluorescent , pin point leaks in peripapillary area which persists in late phase Hypofluorescent area with late staining seen superior to macula
- 14. B scan RE – vitreous floaters LE – serous RD WITH CHOROIDAL THICKENING
- 17. DIAGNOSIS OLD OPEN GLOBE INJURY TYPE B GRADE D PUPIL B ZONE 2 WITH VITREOUS HEMORRHAGE WITH ANTERIOR UVEITIS RE POSTERIOR UVEITIS WITH SPILL OVER ANTERIOR UVEITIS LE – SYMPATHETIC OPHTHALMIA
- 18. TREATMENT Gatiquin P eye Drops QID BE Homide eye drops BD BE Inj Methyl prtednisolone 500mg IV BD – 7D followed by Inj Dexamethasone 2cc IM OD T. Azoran 50mg BD
- 19. On discharge Vision CF 1m RE ,NIG NIP 6/12 LE ,NIG NIP BE – AC no cells & flare LE – serous detchment & macular edema reduced
- 20. SYMPATHETIC OPHTHALMIA It is a rare bilateral diffuse granulamatous non necrotizing panuveitis that may develop after either surgical or accidental trauma to one eye ( exciting eye ) followed by latent period and the appearance of uveitis in uninjured fellow eye ( sympathizing eye)
- 21. Incidence recently estimated is 0.03 per 1 lakh population Key features are Bilateral anterior or posterior uveitis of variable severity with uniform choroiditis Associated features Dalen-Fuch spots, papillitis , dysacousis , tinnitus , alopecia , poliosis , vitiligo , headache.
- 23. TREATMENT Enucleation of the inciting eye as a treatment modality is still controversy Treatment should address the T cell mediated nature of the disease Large doses of topical & systemic corticosteroids should be given early in he course of the disease Other immunosuppressive therapies may be considered isolated or in association with steroids
- 24. PROGNOSIS visual prognosis is good with 50% of patient achieving a final visual acuity of 20/40 or better in at least one eye The cause of sympathetic ophthalmia is chronic with frequent exacerbations and if left untreated leads to loss of vision & phthisis bulbi Long term follow up is essential