Hypersensitivity reactions are our own immune responses to various triggering factors. These immune responses result in different clinical presentations of various ocular diseases. Various cytokines, interleukins are responsible for a myriad of symptoms and thus our therapy should be targeted on specific immunological pathways. In this article we have summarized various ocular diseases with the causative immune pathways thus simplifying the underlying cause. This article will help in understanding why similar looking diseases may have requirement for different modalities of treatment or why similar medications may work in different ocular diseases. Abstract The mast cells play a major role in pathogenesis of immune reactions. The ocular mast cells are present mainly in substantia propria of the conjunctiva, although they are also found in in lesser numbers in the choroid stroma and meninges of the optic nerve (perivascular location). 16 Mediators released by mast cells can be classified into two groups:
{"title":"Immunological Basis of Symptomatology in Ocular Diseases","authors":"Upma Awasthi, Shalini V. Mohan","doi":"10.7869/djo.325","DOIUrl":"https://doi.org/10.7869/djo.325","url":null,"abstract":"Hypersensitivity reactions are our own immune responses to various triggering factors. These immune responses result in different clinical presentations of various ocular diseases. Various cytokines, interleukins are responsible for a myriad of symptoms and thus our therapy should be targeted on specific immunological pathways. In this article we have summarized various ocular diseases with the causative immune pathways thus simplifying the underlying cause. This article will help in understanding why similar looking diseases may have requirement for different modalities of treatment or why similar medications may work in different ocular diseases. Abstract The mast cells play a major role in pathogenesis of immune reactions. The ocular mast cells are present mainly in substantia propria of the conjunctiva, although they are also found in in lesser numbers in the choroid stroma and meninges of the optic nerve (perivascular location). 16 Mediators released by mast cells can be classified into two groups:","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79792674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial Intelligence versus Doctors: Who Wins?","authors":"B. Chawla","doi":"10.7869/djo.323","DOIUrl":"https://doi.org/10.7869/djo.323","url":null,"abstract":"","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79029723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-02-26DOI: 10.1007/978-4-431-56511-6_1
G. Prakash, T. Iwata, S. Natarajan
{"title":"Asian Eye Genetics Consortium (AEGC)","authors":"G. Prakash, T. Iwata, S. Natarajan","doi":"10.1007/978-4-431-56511-6_1","DOIUrl":"https://doi.org/10.1007/978-4-431-56511-6_1","url":null,"abstract":"","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79033093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Chandrakar, P. Bajaj, Rahul Sharma, Vivek Kumar
Case Report A 46 year old male patient presented with chief complaint of blurring of vision in the left eye since one week which was sudden in onset and painless, progressive in nature. He had mild fever and malaise one week back which responded to anti-pyretics. He had a history of cardiac stenting and was on tablet aspirin. The patient had no personal or family history of eye disease. The best corrected visual acuity was 6/6, N6 in right eye and 6/60, N24 in left eye. Color vision was normal in the right eye, but abnormal in the left eye. On examination, the anterior segment was normal and had no evidence of anterior uveitis in both eyes. Fundus examination showed multiple, sub-retinal, yellowishwhite placoid lesions, predominantly at the posterior pole in both the eyes and there was left eye macular oedema on stereoscopic examination by 90D lens (Figure 1, 2). Optical Coherence Tomography (OCT) of the left eye macula demonstrated serous detachment of the neuroretina, with free fluid between the neuroretina and the retinal pigment epithelium (RPE). Central macular thickness (CMT) was 527 μm (Figure 3), whereas, the right eye was normal and Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) affects young to middle-aged adults of both genders equally and ocular manifestations are often preceded by flu-like illness. Symptoms of the disease include acute vision loss, associated with central and paracentral scotoma. Impairment of vision is usually bilateral, but may be asymmetric. We report a case of a 46 year old male patient who presented to us with blurring of vision in the left eye since one week. Fundus examination of both eyes showed sub-retinal yellowish-white placoid lesions, predominantly at the posterior pole. Optical Coherence Tomography of the left eye macula revealed macular oedema. Fundus fluorescein angiography (FFA) of both eyes showed early hypofluorescence and late hyperfluorescence.
{"title":"Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): A Case Report","authors":"N. Chandrakar, P. Bajaj, Rahul Sharma, Vivek Kumar","doi":"10.7869/djo.320","DOIUrl":"https://doi.org/10.7869/djo.320","url":null,"abstract":"Case Report A 46 year old male patient presented with chief complaint of blurring of vision in the left eye since one week which was sudden in onset and painless, progressive in nature. He had mild fever and malaise one week back which responded to anti-pyretics. He had a history of cardiac stenting and was on tablet aspirin. The patient had no personal or family history of eye disease. The best corrected visual acuity was 6/6, N6 in right eye and 6/60, N24 in left eye. Color vision was normal in the right eye, but abnormal in the left eye. On examination, the anterior segment was normal and had no evidence of anterior uveitis in both eyes. Fundus examination showed multiple, sub-retinal, yellowishwhite placoid lesions, predominantly at the posterior pole in both the eyes and there was left eye macular oedema on stereoscopic examination by 90D lens (Figure 1, 2). Optical Coherence Tomography (OCT) of the left eye macula demonstrated serous detachment of the neuroretina, with free fluid between the neuroretina and the retinal pigment epithelium (RPE). Central macular thickness (CMT) was 527 μm (Figure 3), whereas, the right eye was normal and Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) affects young to middle-aged adults of both genders equally and ocular manifestations are often preceded by flu-like illness. Symptoms of the disease include acute vision loss, associated with central and paracentral scotoma. Impairment of vision is usually bilateral, but may be asymmetric. We report a case of a 46 year old male patient who presented to us with blurring of vision in the left eye since one week. Fundus examination of both eyes showed sub-retinal yellowish-white placoid lesions, predominantly at the posterior pole. Optical Coherence Tomography of the left eye macula revealed macular oedema. Fundus fluorescein angiography (FFA) of both eyes showed early hypofluorescence and late hyperfluorescence.","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79479374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 5 year old boy presented with complaints of pain and photophobia and gross diminution in vision in both eyes. Slit lamp examination revealed cobble stone papillae in the tarsal conjunctivae, diffuse punctate epitheliopathy of cornea and two almost similar round epithelial defects in both corneas. He was diagnosed to be suffering from bilateral vernal keratoconjunctivitis, with grade 2 Shield ulcer in both eyes. Shield ulcer of grade 2 and above is refractory to the combined regime of topical corticosteroids, dual acting antihistamine and lubricating eye drops. After removal of plaque and scrapping of base, the ulcer re-epithelialized completely in two weeks, leaving behind a nebular opacity eccentric to pupil which stained negatively with fluorescein dye. The patient was followed up for two months and no recurrence of ulcer was noted. The unique finding in this case is the presence of bilateral, almost similar lesions in both eyes that were refractory to medical treatment
{"title":"Bilateral Shield Corneal Ulcer","authors":"A. Singh, Vikas Sharma, Anuradha Kunapuli","doi":"10.7869/djo.318","DOIUrl":"https://doi.org/10.7869/djo.318","url":null,"abstract":"A 5 year old boy presented with complaints of pain and photophobia and gross diminution in vision in both eyes. Slit lamp examination revealed cobble stone papillae in the tarsal conjunctivae, diffuse punctate epitheliopathy of cornea and two almost similar round epithelial defects in both corneas. He was diagnosed to be suffering from bilateral vernal keratoconjunctivitis, with grade 2 Shield ulcer in both eyes. Shield ulcer of grade 2 and above is refractory to the combined regime of topical corticosteroids, dual acting antihistamine and lubricating eye drops. After removal of plaque and scrapping of base, the ulcer re-epithelialized completely in two weeks, leaving behind a nebular opacity eccentric to pupil which stained negatively with fluorescein dye. The patient was followed up for two months and no recurrence of ulcer was noted. The unique finding in this case is the presence of bilateral, almost similar lesions in both eyes that were refractory to medical treatment","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86045560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Herpes Zoster ophthalmicus is associated with ocular complications in 50% to 89% of cases. The complications may involve the skin, anterior segment, optic nerve, retina, and central nervous system. Ocular involvement may manifest as a self-limited conjunctivitis, scleritis, stromal keratitis and uveitis. Among neurological complications, post-herpetic neuralgia is the most common, followed by cranial nerve palsies, partial or complete ophthalmoplegia, meningitis, myelitis, encephalitis and delayed contralateral hemiparesis, which more commonly occur in immunocompromised patients. A 52 year old immunocompetent male with herpes zoster involving the facial nerve, along with the mandibular and ophthalmic division of trigeminal nerve leading to lagophthalmus, is presented here.
{"title":"Herpes Zoster Involving Trigeminal and Facial Nerve In an Immunocompetent Patient","authors":"P. Nair, Chaitali R Patel","doi":"10.7869/DJO.319","DOIUrl":"https://doi.org/10.7869/DJO.319","url":null,"abstract":"Herpes Zoster ophthalmicus is associated with ocular complications in 50% to 89% of cases. The complications may involve the skin, anterior segment, optic nerve, retina, and central nervous system. Ocular involvement may manifest as a self-limited conjunctivitis, scleritis, stromal keratitis and uveitis. Among neurological complications, post-herpetic neuralgia is the most common, followed by cranial nerve palsies, partial or complete ophthalmoplegia, meningitis, myelitis, encephalitis and delayed contralateral hemiparesis, which more commonly occur in immunocompromised patients. A 52 year old immunocompetent male with herpes zoster involving the facial nerve, along with the mandibular and ophthalmic division of trigeminal nerve leading to lagophthalmus, is presented here.","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86844573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
was performed to remove hyphaema and anterior vitrectomy was done. The wound was closed Ocular injuries are widely reported with spectacle related eye trauma, particularly due to sports. The trauma is usually sufficient to break the lenses in the spectacles and the resultant globe laceration is cause of morbidity. 31 year-old male patient presented with history of trauma while playing with football over left eye. Detailed examination showed corneal laceration with spectacle screw impacted and the arm of the spectacle frame hanging outside. Anterior segment examination showed flat anterior chamber with hyphema and vitreous prolapse. Plain radiographs of orbit showed metal intra ocular foreign body. Patient underwent corneal tear repair with removal of the spectacle arm along with screws. Football is the one of the common cause of ocular injury, but the wearing of protective headgear is still not prevalent. Ophthalmologists have a role in creating awareness as the population at risk is young, by actively encouraging the usage of protective eyewear.
{"title":"An Unusual Case Of Spectacle Related Ocular Injury: Importance Of Protective Sports Eyewear","authors":"A. Gupta, Pradip Poriya, D. Kanani","doi":"10.7869/DJO.321","DOIUrl":"https://doi.org/10.7869/DJO.321","url":null,"abstract":"was performed to remove hyphaema and anterior vitrectomy was done. The wound was closed Ocular injuries are widely reported with spectacle related eye trauma, particularly due to sports. The trauma is usually sufficient to break the lenses in the spectacles and the resultant globe laceration is cause of morbidity. 31 year-old male patient presented with history of trauma while playing with football over left eye. Detailed examination showed corneal laceration with spectacle screw impacted and the arm of the spectacle frame hanging outside. Anterior segment examination showed flat anterior chamber with hyphema and vitreous prolapse. Plain radiographs of orbit showed metal intra ocular foreign body. Patient underwent corneal tear repair with removal of the spectacle arm along with screws. Football is the one of the common cause of ocular injury, but the wearing of protective headgear is still not prevalent. Ophthalmologists have a role in creating awareness as the population at risk is young, by actively encouraging the usage of protective eyewear.","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86885370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Climatic droplet keratopathy (CDK), alternatively known as oil droplet keratopathy, is an acquired corneal degenerative disorder that usually initiates at the limbus and extends towards the visual axis in the interpalpebral area causing irritation, irregularity and thinning of the corneal surface associated with visual deterioration. Clumps of variably sized golden-yellow globules accumulate in the superficial corneal stroma and are derived from photochemical Delhi J Ophthalmol 2017;28;; Doi; http://dx.doi.org/10.7869/djo.315
{"title":"Climatic Droplet Keratopathy","authors":"S. Madan, S. Beri","doi":"10.7869/DJO.315","DOIUrl":"https://doi.org/10.7869/DJO.315","url":null,"abstract":"Climatic droplet keratopathy (CDK), alternatively known as oil droplet keratopathy, is an acquired corneal degenerative disorder that usually initiates at the limbus and extends towards the visual axis in the interpalpebral area causing irritation, irregularity and thinning of the corneal surface associated with visual deterioration. Clumps of variably sized golden-yellow globules accumulate in the superficial corneal stroma and are derived from photochemical Delhi J Ophthalmol 2017;28;; Doi; http://dx.doi.org/10.7869/djo.315","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84923559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neuroretinitis in Lyme disease is a rare entity, which is caused by Borrelia burgdorferi. Diagnosis of the disease is based on clinical history, symptoms and serological testing. Here, we present a case of a young 12 year old female suffering from unilateral neuroretinitis associated with Lyme disease characterized by sudden loss of vision, optic disc swelling and macular star. After the diagnosis, the patient received medical therapy and improved well. Early diagnosis and appropriate management of this disease may improve vision with a good outcome. relative afferent pupillary defect in the left eye. Colour vision was defective in the left eye. Extraocular motility and confrontational visual fields were full in both eyes but on Humphry field analyzer, there was centroceacal scotoma noted in the left eye. Intraocular pressure was 12.2mmHg in both eyes. Slit lamp examination of both eyes was unremarkable with no evidence of anterior chamber and anterior vitreous cells. Fundus examination revealed optic disc oedema with hard exudates arranged in a macular star pattern in the left eye (Figure-1a). Fluorescein angiography confirmed our diagnosis of neuroretinitis (Figure-1b). Routine blood investigations were within normal limits but serological testing showed positive IgM antibodies for Borrelia, suggestive of Lyme disease. After diagnosis of the case as neuroretinitis due to Lyme disease, the patient received intravenous infusion of methylprednisolone750mg in 150ml GDW in 45minutes for three consecutive days with intravenous ceftriaxone 500mg QID daily for 21 days. After pulse therapy of methylprednisolone for 3 days, the patient was switched on oral prednisolone with a dose of 20mg once a day with capsule omeprazole 10mg empty Abstract stomach for another 2 weeks. After 3 days of pulse therapy, the patient’s vision improved to the level of 6/6 in the right eye and 6/12 in the left eye, and at 1 month follow up, the patient’s vision was 6/6 in both eyes. After one month post treatment, there was marked decrease in disc oedema noted clinically and angiographically (Figure-2a & 2b). Repeat serological test after one month treatment showed low titer of IgG antibodies and absence of IgM antibodies for Borrelia.
{"title":"Management Of Neuroretinitis In A Case of Lyme Disease","authors":"S. Nainiwal, S. Kumari, Balbir Singh, R. Yadav","doi":"10.7869/djo.309","DOIUrl":"https://doi.org/10.7869/djo.309","url":null,"abstract":"Neuroretinitis in Lyme disease is a rare entity, which is caused by Borrelia burgdorferi. Diagnosis of the disease is based on clinical history, symptoms and serological testing. Here, we present a case of a young 12 year old female suffering from unilateral neuroretinitis associated with Lyme disease characterized by sudden loss of vision, optic disc swelling and macular star. After the diagnosis, the patient received medical therapy and improved well. Early diagnosis and appropriate management of this disease may improve vision with a good outcome. relative afferent pupillary defect in the left eye. Colour vision was defective in the left eye. Extraocular motility and confrontational visual fields were full in both eyes but on Humphry field analyzer, there was centroceacal scotoma noted in the left eye. Intraocular pressure was 12.2mmHg in both eyes. Slit lamp examination of both eyes was unremarkable with no evidence of anterior chamber and anterior vitreous cells. Fundus examination revealed optic disc oedema with hard exudates arranged in a macular star pattern in the left eye (Figure-1a). Fluorescein angiography confirmed our diagnosis of neuroretinitis (Figure-1b). Routine blood investigations were within normal limits but serological testing showed positive IgM antibodies for Borrelia, suggestive of Lyme disease. After diagnosis of the case as neuroretinitis due to Lyme disease, the patient received intravenous infusion of methylprednisolone750mg in 150ml GDW in 45minutes for three consecutive days with intravenous ceftriaxone 500mg QID daily for 21 days. After pulse therapy of methylprednisolone for 3 days, the patient was switched on oral prednisolone with a dose of 20mg once a day with capsule omeprazole 10mg empty Abstract stomach for another 2 weeks. After 3 days of pulse therapy, the patient’s vision improved to the level of 6/6 in the right eye and 6/12 in the left eye, and at 1 month follow up, the patient’s vision was 6/6 in both eyes. After one month post treatment, there was marked decrease in disc oedema noted clinically and angiographically (Figure-2a & 2b). Repeat serological test after one month treatment showed low titer of IgG antibodies and absence of IgM antibodies for Borrelia.","PeriodicalId":23047,"journal":{"name":"The Official Scientific Journal of Delhi Ophthalmological Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79160937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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