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Dr. Shraddha Raj Shrivastava
Title: Juvenile XLRS: Beyond the Fovea
Description: A 9 year old boy, presented with both eyes diminution of vision, since childhood. Visual acuity OU was 6/24, with a normal anterior segment.
On pseudocolor SLO fundus images of both eyes, we can see tiny cyst-like cavities at the fovea, which correspond to the intra-retinal foveoschisis on OCT. On widefield imaging, there is generalised peripheral schisis, with the inferior retina showing large areas of schitic cysts and vitreous veils.The inferior peripheral schisis is seen more strikingly in the infrared images.
Thus, the patient was clinically diagnosed as having X-linked Retinoschisis. His elder brother (13 years old), had similar fundus findings. Both were prescribed topical carbonic anhydrase inhibitors (dorzolamide) for foveoschisis and asked to follow-up in 3 months. The need for genetic counselling was discussed with the parents and reports are awaited.
Dr. Gulshan Barwar
Title: The Steroid Trap: Fibrinous CSCR Masquerading as VKH
Description: 40 years old gentleman presented with bilateral visual loss and exudative retinal detachment and was diagnosed elsewhere as VKH. Oral corticosteroids were prescribed and continued for a prolonged period, but the condition progressively worsened.
Multimodal imaging revealed bilateral serous retinal detachment with inferior gravitational pooling of subretinal fluid and fibrinous exudation. OCT demonstrated extensive neurosensory detachment with dense hyperreflective subretinal fibrin and retinal pigment epithelium alterations, favoring a diagnosis of fibrinous CSCR rather than VKH.
The absence of significant inflammatory signs and deterioration despite steroid therapy further supported the diagnosis. Corticosteroids were discontinued, following which the patient showed gradual anatomical and visual improvement. This case highlights fibrinous CSCR as an important masquerader of VKH and emphasizes the crucial role of multimodal imaging in avoiding potentially harmful steroid therapy.
Dr. Abhishek Karra
Title: Splitting the light – Bacillary layer detachment in Vogt-Koyanagi-Harada (VKH) disease
Description: A 32 year old, female presented with blurring of vision in her right eye since 3 days. On examination, both the eyes showed multiple, ill-defined creamy yellow-gray placoid lesions at the posterior pole along with subretinal fluid which was more pronounced in the right eye.
The OCT of the right eye shows large serous retinal detachment with multilobulated fluid. On careful examination, we can see the splitting of the photoreceptor layer producing the characteristic image of bacillary layer detachment (BALAD). She was diagnosed as VKH disease and was started on high dose corticosteroids.