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Aggressive posterior retinopathy of prematurity (APROP) is the most severe form of retinopathy of prematurity (ROP), with rapid progression to tractional retinal detachment. Exudative retinal detachment (ERD) has rarely been described as a primary presentation in ROP. We present a case of unlasered zone 1 APROP in a 34-week infant presenting with bilateral ERD, which was treated with intravitreal ranibizumab. After injection, the left eye developed acute endophthalmitis, which was managed by intravitreal antibiotic therapy and early vitrectomy. Subsequent laser photocoagulation of the avascular areas resulted in regression of ROP. This case highlights the role of intravitreal anti-vascular endothelial growth factor in treating ERD in APROP and the need for close observation for endophthalmitis after injection.

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Swept-source optical coherence tomography angiography (SS-OCTA) is a promising new imaging modality for assessing retinal and choroidal vasculature. Faster scanning speed, large number of A-scan acquisition, and enhanced depth penetration has enhanced the detailed analysis of retinal layers. The authors discuss SS-OCTA features of a rare case of retinal arteriovenous malformation. Image analysis revealed the anomalous large-caliber vessels occupying up to the entire retinal thickness with associated echolucent changes in the inner retinal layers surrounding the retinal vessels, along with disruption of the outer retinal layers, including the inner/outer segments of photoreceptors beneath the large tortuous vessels outside the foveola in absence of any capillary nonperfusion areas or lack of significant macular edema. At the fovea, the outer retinal layers were intact due to a smaller caliber and less-deep extension of the anomalous vessels. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:216-219.].

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Severe macular oedema causing marked loss of vision is seen in cases of retinitis developing postviral fever. The use of antivascular endothelial growth factor agents for macular oedema and submacular fluid secondary to viral retinitis has not been studied or well established in the past. We report a case series of two patients of postviral retinitis with severe macular oedema resistant to steroid therapy, treated with intravitreal bevacizumab. The patients showed significant symptomatic improvement in the visual acuity. The retinitis lesions resolved slowly and macular oedema regressed. Bevacizumab appears to be a safe and useful agent to manage macular oedema subsequent to postviral retinitis. An early resolution of macular oedema helps in the preservation of visual acuity which left untreated can cause severe visual loss.

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Cytomegalovirus retinitis (CMVR) is an opportunistic infection seen in immunocompromised patients, especially suffering from acquired immune deficiency syndrome. It is uncommonly seen in hematological malignancies and in patients on immunosuppressants. The authors present a 12-year-old girl with unilateral CMVR who was on maintenance phase therapy for mixed phenotype (B/myeloid) leukemia. Serology for human immunodeficiency virus was negative. The child was successfully treated with oral valganciclovir and repeated intravitreal ganciclovir injections. CMVR in pediatric population with leukemia can be successfully treated with oral valganciclovir and intravitreal ganciclovir injections.

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Bilateral optic disc edema in a diabetic patient may be caused by diabetic papillopathy. We herein report on a patient with bilateral optic disc drusen simulating diabetic papillopathy. A 55-year-old patient with type 2 diabetes presented with decreased vision of 1-month. Diabetic papillopathy was initially considered as there was disc edema in both eyes with focal hemorrhages at the disc margin and mild visual loss. Ultrasound of the optic nerve head revealed optic disc drusen in both eyes and this was also confirmed by the control photograph. Optic nerve head drusen should be considered in the differential diagnosis of a diabetic patient presenting with disc edema.

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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.

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PURPOSE: To compare graft outcomes following pterygium excision and conjunctival autograft fixation using patient's in situ autologous blood or standard fibrin glue-assisted conjunctival autograft adhesion. METHODS: Outcomes of 23 consecutive eyes which underwent pterygium excision and conjunctival autograft with autologous in situ blood coagulum (group I) were compared with historical case controls (20 eyes) that had undergone fibrin glue-assisted conjunctival autograft (group II). Primary outcome measure was graft stability. Secondary outcome measure was severity of graft inflammation at day 1, day 7, 3 months, and 6 months. RESULTS: The two groups were similar regarding age, gender, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive error, tear function tests, and pterygium size. Mean surgical time was similar for the two groups (14.2±2.74 min, group I; 12.25±1.88 min, group II; P=0.1); with the mean difference in operative time being 1.95 min (95% CI, 0.48-3.42 min). Postoperatively, there was a statistically significant reduction in astigmatism and improvement in UCVA, BCVA, and spherical equivalent in all eyes. No difference was found in mean epithelial defect healing time, UCVA, BCVA, astigmatism, tear film break-up time, and Schirmer I and II at 6 months between the two groups. Initial graft stability was better for group II at 1 month (P=0.001) but was similar for both groups at 6 months. Median score of graft inflammation was significantly more for group II during the first week (P<0.05; Wilcoxon rank-sum test). CONCLUSION: Autologous blood may be used as an effective alternative with lesser postoperative inflammation in comparison to glue-assisted autograft fixation.

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A 21-year-old male presented with a chief complaint of night blindness since early childhood. The patient had no history of hemeralopia or photophobia, and no family history of such illness or use of glasses. On examination, his visual acuity was 6/6 in both eyes. Pupils were reacting normally. Dilated fundus examination revealed diffuse golden-yellow sheen throughout the fundus with prominent retinal vasculature, but arteries and veins were less distinguishable. Choroidal vessels were not visible. The patient was then patched and dark adapted for 6 hours. The dark-adapted fundus showed the disappearance of the golden sheen with normal visible choroidal and retinal vasculature. This characteristic phenomenon observed on fundus examination from dark-adapted state to light adaptation is known as Mizuo-Nakamura phenomenon. Although this phenomenon is classical of Oguchi disease, it is also seen in X-linked cone dystrophy and X-linked retinoschisis. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1068.].

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The authors report the use of optical coherence tomography angiography (OCTA) (DRI OCT Triton; Topcon, Tokyo, Japan) to localize, characterize, and confirm the presence of a choroidal neovascular membrane in a patient of focal choroidal excavation (FCE) with recent-onset metamorphopsia and visual blurring. En face OCTA images just above the level of the retinal pigment epithelium-Bruch's membrane complex typically showed the presence of a glomerulus-like neovascular network with an adjacent dark area suggestive of a Type 2 choroidal neovascularization (CNV). OCTA was found to be a very useful, noninvasive, and quick imaging modality to detect secondary CNV formation in a case of FCE. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:969-971.].

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A 25-year-old man developed diminution of vision and redness in both eyes 5 weeks after a conjunctival flap procedure in the right eye. On examination, there was panuveitis and exudative retinal detachment in both eyes. The right eye had an inferotemporal conjunctival flap with iris incarceration. Fundus fluorescein angiography revealed typical pinpoint leaks and optical coherence tomography demonstrated multiple neurosensory detachments in the left eye. The patient received frequent topical steroids and cycloplegics. Intravenous dexamethasone pulse was given followed by high-dose oral prednisone, after which the patient recovered vision. The conjunctival flap in corneal perforation may predispose to sympathetic ophthalmia.

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