To analyse the demographics and presenting features of patients presenting with optic neuritis and papillitis. Clinical profiles of 40 patients presenting with optic neuritis and papillitis at a tertiary care center were collected retrospectively and prospectively. Detailed medical and ophthalmic history was taken especially about mode, duration and course of the disease, drug intake, alcoholism, smoking, pregnancy, lactation, convulsions, pyrexia, history suggestive of TB, syphilis, neurological deficit. A comprehensive ophthalmological and neurological evaluation was done for each patient along with radiological work up. Patients were prospectively followed up for an average of three months. Females in the reproductive age group constituted largest number of the patients (61.8%) in the present series. Maximum patients (70%) were between 20-50 years of age. Vision was found to be affected in all the patients at presentation and most of them presented with vision CF or HM (35.4% and 29.25% respectively) while 4 patients had complete loss of vision. Two third (66.7%) of patients reported eye pain at presentation. Abnormal pupillary reaction was found in most patients with the most common being RAPD on swinging flash light which was seen in 85.4%. Equal percentage (39.5%) of patients presented with Blurred Hyperemic (BH) disc and ophthalmoscopically normal appearing disc. Onset and progression of disease was found to be rapid in most cases ranging from few hours to days. Visual recovery post treatment was found to be good with most eyes achieving vision 6/24 or better. Optic neuritis has varied clinical presentations. Most of our patients were young to middle aged females. The most common presenting features were decrease in vision ranging from slight to profound, eye pain and abnormal pupillary reaction. Morphological abnormalities in appearance of optic disc were also found in two third of cases.Rapid progression was noted in almost all cases. Most of the cases achieved a good outcome at the end of follow up period.
To evaluate the visual and neurological outcomes of Optic Neuritis Treatment Trial (ONTT). 40 Patients presenting with optic neuritis were enrolled in this study to analyze the Visual and Neurological outcomes after treatment according to ONTT Protocol, with emphasis on signs of anaemia, protein calorie malnutrition, vitamin deficiency, generalized lymphadenopathy, sinusitis, septic foci. Patients were followed up for three subsequent visits to assess the rate of visual recovery.Maximum patient 35(87.5) treated according to ONTT protocol while 5 (12.5%) treated with oral steroids alone. Maximum 33 eyes (70.2%) attain BCVA > 6/36 after 1st follow-up (with in 1 month) while 10(21.3%) eyes attain BCVA of 6/6 after 1st follow-up. 11 eyes (25.6%) attain BCVA 6/6 after II follow-up. General prognosis for recovery of vision was good and was slightly worse in more severely affected cases in the present series. Pallor of the optic disc and defect of vision did not always correspond–3 eyes which showed temporal of the disc at the end of follow up had a final vision of 6/9 or better in each eye.
Purpose: To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019-associated mucormycosis (CAM). Methods: This was a prospective interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re-assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra-orbital anti-fungal therapy, site-centered peri-bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Results: Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Conclusion: Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site-centered peri-bulbar injections can be considered as an approach for delivering intra-orbital anti-fungal therapy in selected patients.
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