Case 9

A 45 years old male is presenting to do refractive surgery to get rid of his glasses. Ocular examination is normal. His glasses are Rt. sphere -5.25 cylinder -2.50X155, Lt. only cylinder -3.50X145. His BCVA is 0.5 bilateral. Corneal pachymetry and topography were done and his central corneal thickness in the right 495 microns and left 504 microns.

Corneal topography (normalized scale) shows asymmetrical vertical bowtie astigmatism with some inferior steepening. Keratoconus possibility index (KISA) is within normal (<60%> no Keratoconus), it is 4 for the right and 5 for the left.

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Does this patient have Keratoconus? Would LASIK procedure be an option for him? Does he need any other management?

Case 8

A 57 years old female presented with severe diminution of vision in the left eye which is constantly decreasing. She has a history of NIDDM of 5 years with poor control. BCVA was 3/60. She has already seeked ophthalmological advice and has received bilateral LASER treatments for her retina.

FFA was done and shows disc oedema with splinter hemorrhages, lower macular retinal oedema associated with other focal exudative changes, scattered microaneurysms and no evidence of retinal ischemia or vascular proliferation.

What is the likely diagnosis, further investigations and management?

Case 7

A 25 years old female complained of some diminution of vision in the left eye.
Examination of the posterior segement revealed an upper temporal macular lesion with overlying vitreous haemorrhage.
1st FFA and Ultrasound were done followed by OCT.

FFA report shows an eleveated lesion with SRF with no clear evidence of vessel involvement with overlying hemorrhage and no evidence of retinal mass.

Ultrasound report did not exclude a mass and showed the elevated lesion which was said to be either subretinal serous or hemorrhagic acculumation.

Finally OCT was done and to my surprise it did not show any serous detachment of the retina but a detachment of the ILM and part of NFL, there was total PVD and there was posterior shadowing in some parts by the overlying organized vitreous hemorrhage.

What is the likely diagnosis of this case?
Is there any more confirmatory investigations?
And finally how would it be managed?

Case 6

This case is presented by Rabab Khattab Msc.

Female patient 80 years old, diabetic since 20 years , bilateral pseudophakia, history of right old branch vein occlusion. PRP and intravitreal injection 4 months ago.
current presentation is diminution of vision. BCVA Rt. 5/60 Lt. 6/60.






What has interrested me is the picture of the background macula in the early phase of FFA seen as homogenous hyperfluorescent dots (enlarge the image to see it) showing late diffuse leakage and causing diffuse macular oedema which is confirmed by OCT.
Is this an ischemic macula or just diffuse excudative maculopathy? and how should it best be managed?

Case 5

A 45 years old male presents with sudden diminution of vision in the right eye 2 days ago, his BCVA is PLGP. He is hypertensive with no history of other systemic diseases.

The colour photo shows retinal pallor, cherry red spot at the fovea, and attenuated retinal arteries.

OCT line scan passing through the fovea shows an increase in overall retinal thickness and hyper-reflectivity of the inner retina with posterior shadowing.

What do you think is the diagnosis, any other investigations needed and what about the management?

Case 4

28 years old male with a past history of lumbar puncture and who presents with recent attacks of headache and blurring of vision. His BCVA is 6/12 bilateral. These are the colour photos of his fundus and the respective OCT line scans (vertical) passing through the optic nerve of the left then the right eye.

The images show pre-papillary white patches with minimal blurring of mainly the nasal disc edge, the OCTs show cup filling with elevation of the disc edges. What do you think?

July Scientific Meeting

You are welcomed to join us to attend our Scientific Meeting held on 6-7-2007 at Tiba Center.
(56 Abbaseya Street)

Schedule:

10.00am-10.30am: Sweep VEP in Evaluation of VA in Children

(Assistant Prof. Dr. Mona Nada)

10.30am-11.15am: Applications of IOL Master

(Prof. Dr. Yahia Khairat)

11.15am-12.00pm: Applications of UBM

(Prof. Dr. Zeinab El Sanabary and Consultant Dr. Mervat Hanafy)

12.00pm-12.30pm: Specular Microscopy

(Prof. Dr. Laila Hammouda)

12.30pm-1.00pm: Glaucoma Progression Analysis in Automated Perimetry

(Assistant Prof. Dr. Omayma Eyada)

1.00pm-2.00pm: Gomaa Prayer & Coffe Break

2.00pm-2.30pm: Poster Session

(Lecturer Dr. Hanan Abdelalim, Nayera Tawfik, M.Sc.,

Tarek Hussein, M.Sc., Mohamed Mahmoud, M.Sc.)

2.30pm-3.00pm: Introduction to Bostan Blog Website

(Nahla Sobhy, M.Sc.)

3.00pm-4.30pm: Debates on OCT Diagnosis

(Prof. Dr. Tarek El Emari, Prof. Dr. Karim Raafat,

Consultant Dr. Naela Siam and Lecturer Dr. Ahmed Sobhy)

Do you have an interesting case?

If you have any interesting case you want to share with everyone and want their comment or opinion, please send us all the information about the case (history, images or any investigations done) and let everyone share his view....contact mail: bostancenter@gmail.com

Case 3

Color photography shows a red rounded lesion surrounded by hard exudates and hemorrhage located along one of the branches of the inferior temporal retinal artery.
FFA shows an early hyperfluorescent spot corresponding to the lesion seen in the color photo, which increases in intensity and slightly in size along the angiogram. Areas of blocked fluorescence correspond to the hemorrhage seen in the color photo.
OCT line scan passing through the hyperfluorescent spot seen in FFA shows markedly increased retinal thickness with intraretinal fluid accumulation (hemorrhage) causing underlying shadowing. There is also evidence of partial PVD.