Open Access Case Report

Terson’s Syndrome: Case Report

Adil Elkhoyaali, Imane Jeddou, Ilias Benchafai, Jawad Laaguili, Yassin Mouzarii, . Karimreda, . Abdelbaroubaaz

Asian Journal of Research and Reports in Ophthalmology, Page 1-5

Introduction: Terson's Syndrome, defined since 1900 as the association of vitreous or retinal hemorrhage with subarachnoid hemorrhage, has been extended to include all intraocular hemorrhages secondary to other causes acute intracranial hypertension.

Observation: We report the observation of a 50-year-old woman who presented with bilateral Terson’s syndrome following a rupture of a cerebral aneurysm.

The patient was admitted for disturbance of consciousness and neurologic deficit. Ophthalmoscope examination of the fundus of the eye found pre, intra, and subretinal hemorrhages in the left eye masking the papilla and macula and a small hemorrhagic spot in the pre-retina right eye. This aspect motivated the performance of an angio-MRI which revealed a subarachnoid hemorrhage secondary to the rupture of an aneurysm. The treatment consisted of embolization by coils by arteriography. The evolution was marked by the resorption of the subarachnoid hemorrhage and ocular hemorrhages with good visual recovery: 1 in the right eye and 0,8 in the left eye.

Discussion: The pathophysiology of Terson's syndrome is very controversial. It is associated with SAH in 2 to 27% of cases. Most of these hemorrhages are due to ruptures of aneurysms located in the lower part of the polygon of Willis. TS retinal hemorrhages can sit under, intra or pre-retinal, or diffuse in the vitreous and are easily detected by an examination of the fundus. Vitrectomy allows rapid visual recovery when spontaneous resorption is not obtained after a period of observation.

Conclusion: The early diagnosis of TS in all cases of SAH and IH will improve diagnostic and therapeutic management, and therefore the visual and vital prognosis of these patients. Hence the value of an examination of the fundus in any patient with disturbance of consciousness without obvious etiological context.

Open Access Case Study

Posterior Segment Involvement as Initial Presentations of Patients Withchronic Myeloid Leukemia

L. Elayyadi, H. Boutahar, S. Bourakba, M. Achargui, S. Chariba, A. Maadane, R. Sekhsoukh

Asian Journal of Research and Reports in Ophthalmology, Page 6-10

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm. Ophthalmologic manifestations are among the therapeutic challenges. Here we present two cases of CML (chronic phase) with posterior segment involvement as initial presentation, trying to shed light on this important type of presentation and view of the current literature.

Open Access Case Study

Bilateral Orbital Chloroma Revealing Acute Myeloid Leukemia: A Case Report

Ayoub Redouan, Z. Hammoumi, Loubna El- Maaloum, Bouchra Allali, Asmae El- kettani, Mohamed. EL- Belhadji

Asian Journal of Research and Reports in Ophthalmology, Page 11-15

Chloroma is a rare extra-myeloid tumor composed of leukemia cells derived from granulomatous myeloid precursors. It occurs in only 2 to 8% of acute myeloid leukemia and rarely occurs in the orbital area. We report the case of an adolescent with no specific history, who consults for rapidly progressive bilateral exophthalmos. A blood count showed leukocytosis, bicytopenia and absence of cells blastics. Cranio-orbital computed tomography showed a bilateral multilobed orbital tumor process invading the oculomotor muscles and the optic nerve. Orbital biopsy confirmed the diagnosis of acute myeloid leukemia.

The positive diagnosis is guided by the blood count and confirmed by the biopsy of the orbital tumor and the myelogram. The radiological assessment is of interest in the evaluation of the tumor extent and post-treatment monitoring.

The treatment is based on chemotherapy and corticosteroid therapy combined or not with radiotherapy.

Open Access Case Study

Digital Eye Strain among Children in South India: Prevalence and Risk Factors during the COVID-19 Pandemic- Case Study

Mridula V. Amarnath, Francesc March De Ribot

Asian Journal of Research and Reports in Ophthalmology, Page 24-34

Aim: To study the prevalence, risk factors, and symptoms of digital eye strain among children who attended online classes during the COVID -19 pandemic in Karnataka (South India).

Methods: A Cross-sectional study of the students between 7 to 16 years of age was done. The children, along with the help of their parents, were asked to fill the online survey form. The questionnaire was based on the Computer Vision Syndrome questionnaire, evaluating the total duration of the digital device used before and during the Covid era, the symptoms of DES, its severity, and frequency.

Results: 300 participants responded to the questionnaire, of which 42.9% were males with a mean age of 13±1.75 years. The mean duration of digital devices used during the pandemic era was a 4.1±1.3 hour which was nearly three times more than the pre-Covid era (1.5 ±1.7 hours). 42% (n= 126) were using digital devices for more than 5 hours compared to 2.7% (n=81) before the Covid era and the most common digital device used being the smart phones (n=186(62%).

The prevalence of DES in our cohort was 51%( 153/300); of these, 26% were mild, 13% were moderate, and 11% were severe. The most common symptoms were itching and headache (54% and 53%), respectively. Multivariate analysis revealed age >14 years (p=0.04), male gender (p= 0.004), smartphone use (p=0.04), use of device > 5 hours (p=0.006) and mobile games for more than 1 hour per day (p= 0.05) as independent risk factor for DES in children.

Conclusion: The prevalence of DES among children in the COVID era has increased. This study emphasizes the side effects of prolonged use of devices, type of device, and distance from the digital device that can harm the ocular surface. Hence, both parents and the children need to be aware of this, try to reduce screen time, and follow a good healthy lifestyle.

Open Access Original Research Article

Endoscopic Revision of Unsuccessful Dacryocystorhinostomy under Local Anesthesia

Ben Limbu, Suresh BK. Rasaily, Rohit Saiju

Asian Journal of Research and Reports in Ophthalmology, Page 16-23

Aims: To evaluate etiological factors for unsuccessful Dacryocystorhinostomy (DCR) surgeries and surgical outcome after revisional endoscopic endonasal dacryocystorhinostomy (Re-EEDCR) surgery.

Study Design: Retrospective study.

Place and Duration of Study: Department of Oculoplastic surgery, Tilganga Institute of Ophthalmology, between December 2017 to November 2019.

Methods: All the consecutive cases of previously failed DCRs who underwent revisional endoscopic endonasal DCR under local anesthesia were included. Patients’ medical records were reviewed for demographic profile, pre and intra-operative endoscopic findings during revisional surgery, post, the outcome of surgery. The potential causative factors for unsuccessful DCR were assessed and the surgical outcome of Re-EEDCR was evaluated.

Results: A total of 15 patients, 13 (86.7%) female and 2 (13.3%) male with failed DCR, who had undergone revisional En-DCR were evaluated. The mean age at revisional surgery was 40.53 ±15.88 (range, 18-74 years). The mean duration from primary to Re-EEDCR was 19.93±31.73 months (range, 1-120). The most common causes attributed to a failure of unsuccessful DCR was intranasal adhesion 9(60%) followed by the inappropriate site of ostium 8(53.3%), inadequate marsupialization of sac 6(40%), granuloma formation 2(13.3%), and inadequate ostium site (6.6%). The overall success rate was 93.3% (14/15) without any important intra or postoperative complications.

Conclusion: The most common cause for failed DCR was intranasal adhesions. A revision surgery with endoscopic endonasal approach under local anesthesia can significantly reduce overall surgery time and avoids the risk of further skin scarring. It is a safe and an effective option in the management of unsuccessful DCR surgery.