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Case 1

A 50 year old female, home maker came with the complaints of painless progressive diminution of vision in right eyes of 3 days duration which was sudden in onset.
No H/O diurnal variation in vision, no coloured halos or pain.
Patient has no H/O evening rise in temperature, weight loss, cough with expectoration.
OCULAR EXAMINATION
UCVA of RE was CF1/2 mt and LE was 6/60.
Anterior segment examination of BE was normal.
IOP by NCT was 13mmHg and 14mmHg in both eyes respectively.
Fundus examination(fig1) :- OD- CDR- 0.3, creamy yellow placoid geographic patches, with ill defined margins spreading centrifugally with finger like projections suggesting active serpiginous like choroidal lesions at the macula with absent foveal reflex, no vitreous cells (fig1.A)
OS- CDR -0.3, greyish geographic projections in inactive/ healing phase, FR+, no vitreous cell (fig1.B)
INVESTIGATION
Blood investigation –WNL
Chest XRAY AND HRCT Thorax -WNL
Mantoux was positive and also Quantiferon TB Gold (IGRA) positive. TREATMENT
Patient was started on ATT ( HRZE regimen),Tab. Pyridoxine and also on oral corticosteroids (Tab.Wysolone 40mg OD) which was then tapered.
She was asked to follow up in the OPD every15 days to monitor LFT and drug induced optic neuropathy.

Case 3

A 13 year old female child presented with gradual diminution of vision in left eye for past 2 years . No h/o use of spectacle in the past.
OCULAR EXAMINATION
Visual acuity-BCVA in RE was 6/6 ,LE CF 1/2mts with no improvement
IOP(GAT) -12 and 13mmhg respectively.
Slit lamp examination revealed no specific findings and no rubeosis.
Distant direct ophthalmoscopy-Red glow and yellow reflex (Fig1)was seen in RE& LE respectively.
Dilated fundoscopy – RE was normal. LE – normal C:D ratio with sub retinal exudates involving macula in supero and inferotemporal quadrants with abnormal retinal vessels(Fig 2).
OCT-LE showed exudates with macular edema(Fig 3).
FFA-LE showed abnormal inferotemporal vessels with aneurysmal dilatation which leaked profusely giving typical(a)“light bulb appearance”.Peripheral to abnormal vasculature was an (b)area of capillary non perfusion(fig4).
Patient was diagnosed as LE Stage 2B coat’s disease (shields classification). Patient was given one dose of intravitreal Bevacizumab
Fig5-Fundus photo of LE 2 months post intavitreal bevacizumab shows reduction in exudation at inferiotemporal quadrant

Case 4

A 21-year-old woman presented to our OPD with gradual decrease of vision in RE over 2 years followed by protrusion of eye associated with pain, watering of eye and unilateral right side temporal headache. No H/O diplopia, No systemic comorbidities, No H/O ocular trauma or surgeries. No significant family history.

OCULAR EXAMINATION
BCVA: RE -HM+ve, LE: 6/6 and N6, Head posture normal, RE Exotropia and Facial symmetry maintained, EOM were Normal, Mild proptosis noted.
Anterior segment examination(Fig1) through slit lamp RE circumciliary congestion with diffuse corneal edema and Iris Naevus present at 3-5 o clock position, pupil 7 mm dilated and fixed, lenticular changes noted.
Intra ocular pressure through Goldmann Applanation tonometer showed RE:43 mm Hg, LE: 13 mm Hg.
Fundus examination RE Media Hazy, pale disc with C:D= 0.9 Nasal shifting NRR Thinning noted(Fig 2). LE with in normal limits(Fig 3).

INVESTIGATION
OCT shows

DIAGNOSIS
Unilateral delayed developmental glaucoma -secondary to cogan-reese syndrome.

TREATMENT
Anti glaucoma medications were given after controlling IOP planned for Trabeculectomy with MSICS.