The clinical manifestations of Axenfeld-Rieger Syndrome can be profound and diverse, primarily affecting the eye but also involving various systemic structures. Ocular features include iris stromal hypoplasia, corectopia, polycoria, and posterior embryotoxon. These ocular abnormalities often lead to glaucoma, which can be severe and sight-threatening if left untreated.
Reports of syphilis in England have increased over the last 10 years. This bacterial infection is transmitted through direct contact with active primary and secondary lesions. Ocular syphilis can result from dissemination of the organism to different organs. Symptoms vary and include vision loss, photopsia, scotoma and eye pain. Syphilis results in ocular inflammation and typically presents with uveitis affecting both posterior and/or anterior segments. Serological testing is the mainstay of diagnosis but all patient should also be tested for HIV co-infection. Early administration of antibiotics improves prognosis.
The Royal College of Ophthalmologists annually organizes the Duke-Elder Undergraduate Prize examination, which is open for entry to all undergraduate medical students. It serves as an initial step for medical students to gain a better understanding of the field of ophthalmology. Furthermore, it contributes to enhancing one's portfolio, increasing the likelihood of securing a competitive ophthalmology training number, which, in recent years, has seen a fierce competition ratio of 10:1.
Adult-onset Foveomacular Vitelliform Dystrophy (AFVD) is a rare retinal disorder characterized by the formation of vitelliform lesions in the macular region of the retina. AVMD is associated with genetic mutations in several genes, including BEST1, PRPH2, IMPG1, and IMPG2, and it is categorized within a group of conditions known as "pattern dystrophies." While some familial cases have been reported, AFVD is predominantly sporadic in occurrence, with symptoms typically emerging in individuals between the ages of 30 and 50.
As a teaching fellow in ophthalmology, I have delivered various aspects of the curriculum, including examination skills. Direct Ophthalmoscopy (DO) is currently taught within the ophthalmology placement, and it is a skill that the GMC require medical students to develop competency in. However, perhaps due to the minimal time and exposure within ophthalmology, in what is usually a two-week placement, the students’ confidence in their ability to perform this or indeed identify abnormalities is variable. There is also evidence to show that postgraduate doctors are not confident in this skill. The Royal College of Ophthalmologists (RCO) encourage undergraduates and junior doctors to conduct slit lamp examination (SLE). SLE is not currently taught within the ophthalmology undergraduate curriculum across most schools. This article will discuss the possibility of developing the way we teach medical students to carry out ophthalmology examinations, and if students see value & are interested in this advancement.
We present a case with a sustained 2-year effect post one FA implant. A 72-year-old male patient presented with a left hemi-retinal vein occlusion with macular oedema in January 2013. Initial treatment was intravitreal dexamethasone implants. Although he showed an excellent response, it became short lived with further retreatment, with the effect lasting for 8-10 weeks on average before oedema returned. This necessitated additional treatment with numerous anti-VEGF injections in addition to treating angiographically ischemic areas with retinal laser. At 17 months follow up, after off label use of FA, we demonstrated an improvement in both visual acuity and central subfield thickness for the patient Retinal vein occlusion is a common pathology that can be treated by various means. The off label fluocinolone acetonide (FA) implant demonstrated a sustained response over 2 years in this case. Further prospective studies of its use are needed to confirm its role in clinical practice.
Posner-Schlossman syndrome, also known as glaucomatocyclitic crisis, is a rare condition characterised by recurrent transient elevations in intraocular pressure (IOP) concomitant with anterior chamber inflammation. It principally affects young to middle-aged adults, chiefly males, within the age range of 20 to 50 years. While the exact aetiology remains equivocal, several factors have been implicated, including possible viral triggers, autoimmune processes and genetic predilection.
The Ophthalmology Specialty Training pathway continues to be one of the most competitive in the UK, with approximately 9 applicants for each available position. The application process undergoes annual modifications, and the 2023/2024 cycle has introduced some significant changes compared to previous years.
Ocular sarcoidosis typically presents either to the uveitis or neuro-ophthalmic service, depending on the compartment affected. Here we present a case of a 70-year-old woman who developed profound right eye visual loss to hand movements over two weeks with unilateral disc swelling and optic neuropathy. OCT demonstrated the dynamics of vertically migrating intraretinal hyperreflective foci, subretinal fluid, choroidal thickening and vitreous haze. Intracranial and orbital imaging, blood tests, lumbar puncture and whole-body PET MRI excluded neoplastic, infiltrative, inflammatory, infectious and known auto-immune causes. Treatment with corticosteroids led to rapid improvement of symptoms and the final visual outcome was good: pinhole acuity 0.3 with 10/17 Ishihara plates correctly identified, though a central scotoma remained. A literature review suggests that intraretinal sarcoidosis may be a novel, OCT-supported manifestation of this systemic disease. OCT permits dynamic monitoring of the inflammatory response on a cellular level between three adjacent compartments. These findings highlight the importance of multidisciplinary management of sarcoidosis, with OCT as a central part of the standard work-up.
In my experience, ophthalmological issues are often underestimated, in many situations considered comparably less important than other ongoing medical issues. Despite this, newly qualified foundation doctors must be able to recognise some of the most serious, most urgent and most common ophthalmological problems, at a minimum.