TNOA Journal of Ophthalmic Science and Research

: 2022  |  Volume : 60  |  Issue : 4  |  Page : 338--340

Photo quiz: Holistic integrative ophthalmology with multiplex imaging part IV

Prasanna Venkatesh Ramesh1, Shruthy Vaishali Ramesh2, Aji Kunnath Devadas3, Prajnya Ray3, Shishir Verghese4, Shivani Shipra5, Anugraha Balamurugan6, Sathyan Parthasarathi7,  
1 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
4 Department of Retina & Vitreous Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
5 Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
6 Department of Vitreo-Retinal Services, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
7 Department of Glaucoma, Sathyan Eye Care Hospital and Coimbatore Glaucoma Foundation, Coimbatore, Tamil Nadu, India

Correspondence Address:
Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Tennur, Seshapuram, Trichy - 620 017, Tamil Nadu

How to cite this article:
Ramesh PV, Ramesh SV, Devadas AK, Ray P, Verghese S, Shipra S, Balamurugan A, Parthasarathi S. Photo quiz: Holistic integrative ophthalmology with multiplex imaging part IV.TNOA J Ophthalmic Sci Res 2022;60:338-340

How to cite this URL:
Ramesh PV, Ramesh SV, Devadas AK, Ray P, Verghese S, Shipra S, Balamurugan A, Parthasarathi S. Photo quiz: Holistic integrative ophthalmology with multiplex imaging part IV. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2023 Mar 24 ];60:338-340
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Full Text

 Question 1

Identify the finding. A 55-year-old female presented with defective vision in the right eye (OD). On examination, best corrected visual acuity (BCVA) was 20/200 in OD and 20/20 in the left eye (OS). The anterior segment in both eyes were normal. Fluorescein angiography of OD [Figure 1] revealed marked delay in arteriovenous transit time with hypofluorescent areas in the periphery depicting capillary non-perfusion areas greater than 10-disc diameter and hyperfluorescent regions in the macula due to leakage of dye depicting cystoid macular oedema. Anti-VEGF injection and panretinal photocoagulation were advised.


 Question 2

Identify this condition. A 3-month-old infant was brought to outpatient department (OPD) with white reflex in both eyes [Figure 2a and b]. Ocular evaluation revealed multiple white opacities within the crystalline lens [Figure 2c and d] involving the central area. Ultrasound biomicroscopy (UBM) showed multiple hyperechoic spots within the lens. Surgical management was performed to avoid amblyopia.


 Question 3

Identify the condition. A 5-year-old male presented to the outpatient department with blurring of vision in both eyes (OU). His best corrected visual acuity was 20/60 in OU. Anterior segment examination in OU was unremarkable. OD fundus [Figure 3] showed an intriguing feature of a crashing comet/shooting star with anomalous disc and superior vascular drag of the superotemporal arcade. Conservative management was advised along with family screening, as the condition was in stage 1. The disease was also noted in his family members, who were currently asymptomatic with no knowledge of this disease.


 Question 4

Identify the finding. A 47-year-old male patient came for diabetic eye check-up. His best corrected visual acuity was 20/20 in OD and 20/40 in OS. Anterior segment examination was found to be normal. Fundus photography is shown in [Figure 4]a. His fundus fluorescein angiography [Figure 4b, c and d] was performed, which revealed extensive areas of capillary non-perfusion. The patient was advised to have three sitting laser treatment for his left eye.


 Question 5

Identify the finding. A 22-year-old female came for ophthalmological evaluation due to severe frontal headaches and blurring of vision in both eyes [Figure 5]. Fundus examination was conducted for both eyes. Visual field test and optical coherence tomography were performed to rule out the differential diagnosis of this situation. The prevalence of this condition remains unknown, as it is not included in the register of rare diseases. Ophthalmological follow-up of the patient was advised.


 Question 6

Identify these findings. A 55-year-old female [Figure 6a], 67-year-old male [Figure 6b] and 75-year-old female [Figure 6c] came with complaints of diminished vision and glare in both their eyes which was worse in the morning. Slit lamp examination was conducted followed by a specular microscopy examination [Figure 6]. Sodium chloride 5% drops were advised for all, along with regular follow-up.


Central retinal vein occlusion. It is the second most common retinal vascular disease and a common cause of loss of vision, especially in older patients. There are two types, ischaemic and non-ischaemic CRVO; ischaemic CRVO accounts for about 70% of cases. Fluorescein angiography is imperative as it helps in detecting areas of retinal capillary non-perfusion and diagnosing ischaemic CRVO to initiate timely management.Coralliform cataract. Coralliform cataract is a particular type of congenital cataract with round or elongated processes in which many layers of the lens in the central area are affected by branching opacities.Familial exudative vitreoretinopathy (FEVR). FEVR is usually bilateral and asymmetric. It is a group of inherited retinal diseases characterized by premature arrest of vessels, which leads to incomplete retinal vascularization along with retinal ischaemia. Its mode of inheritance is autosomal dominant. Life-long monitoring is required as these patients might progress to fibrovascular proliferation and retinal detachment leading to secondary complications.Non-proliferative diabetic retinopathy (NPDR). Diabetic retinopathy is classified using the Early Treatment Diabetic Retinopathy Study method. The ETDRS states that scatter photocoagulation is necessary for high-risk cases. FFA along with fundus examination plays an important role in identifying such high-risk cases by revealing areas of non-perfusion and leakage.Situs inversus of the optic disc. It is a rare, usually bilateral, congenital embryological abnormality associated with high myopia, optic disc coloboma or tilted optic disc. This occurs due to the redirection of the head of the optic nerve due to the abnormal insertion of the optic stalk into the optic vesicle. It is characterized by nasal emergence of the retinal vessels from the optic disc followed by acute arching of the vessels towards the temporal direction in absence of dragged retina.Various spectrums of Fuchs' endothelial corneal dystrophy. Fuchs' endothelial dystrophy is a condition that causes vision problems which usually clears during the day. Its signs and symptoms usually start in the fourth to fifth decade of a person's life. Fuchs' endothelial dystrophy is a non-inflammatory, autosomal dominant dystrophy involving the endothelial layer of the cornea. The damage to the cornea in Fuchs' endothelial dystrophy can even lead to corneal blindness.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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