Amiodarone is a commonly used antiarrhythmic used to treat atrial fibrillation and ventricular tachycardias. While this agent can present with pulmonary, thyroid, and hepatic side effects, it can also, less commonly cause neurologic toxicity, particularly optic neuropathy. Optic neuropathy can manifest as acute vision loss. The management of amiodarone-associated optic neuropathy (AAON) includes early recognition of symptom manifestation so that the medication can be discontinued promptly. Here, we describe a case of a 64-year-old male who developed acute onset complete left-sided vision loss after initiation of amiodarone.

Subhyaloid hemorrhage, characterized by localized vitreoretinal detachment due to blood accumulation, often results in sudden vision loss, especially in the macular area. This case report highlights a 23-year-old female presenting with exercise-related Valsalva retinopathy leading to premacular subhyaloid hemorrhage. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser hyaloidotomy, a non-invasive procedure, leading to rapid blood drainage and visual recovery. The patient\'s initial visual acuity was severely impaired, with a significant premacular hemorrhage obscuring the macula. A week later, due to the expanding hemorrhage, Nd:YAG laser hyaloidotomy was performed, demonstrating successful blood dispersion and restoration of vision. Follow-up revealed significant improvement with demarcation of the previous hemorrhage and no evidence of new findings. The case emphasizes the importance of prompt intervention and considers alternative treatments for premacular subhyaloid hemorrhage. While associated with ocular pathologies, such as macular holes and retinal detachment, Nd:YAG laser hyaloidotomy remains a safe and effective outpatient procedure for managing premacular subhyaloid hemorrhage, avoiding the risks of more invasive surgical interventions. The presented case highlights the significance of tailored interventions based on patient history, minimizing the need for invasive procedures and their associated risks.

We report a case involving a post-menopausal female who experienced a sudden loss of peripheral vision in her right eye seven months after a confirmed COVID-19 infection. MRI scans of the brain and orbit excluded neuritis and multiple sclerosis, leading to the diagnosis of non-arteritic anterior ischemic optic neuropathy (NAION). It is known that the intense inflammatory condition resulting from acute respiratory distress syndrome triggered by SARS-CoV-2 infections can result in a heightened tendency for blood clot formation. Emerging research underscores the potential link between the likelihood of a thrombotic event in the eye as a consequence of COVID-19 infection and the development of NAION. The connection between NAION and COVID-19, whether it is correlative or coincidental, remains uncertain. However, this case report aims to present evidence for the plausibility of this link and offer insights into potential ophthalmologic complications caused by COVID-19.

BACKGROUND: Ischemic optic neuropathy (ION) is exceedingly rare in children on dialysis, resulting from poor perfusion of the optic nerve, and presents as sudden acute painless vision loss.
METHODS: We report the case of a 3-year-old male with stage 5 chronic kidney disease (CKD 5) due to focal segmental glomerulosclerosis (FSGS) status post-bilateral nephrectomy on chronic hemodialysis who had acute loss of vision several hours after a hemodialysis session. Earlier that day, he had a drop in blood pressure intra-dialysis to 89/67 mmHg, with at home blood pressures ranging 90/60 to 150/100 mmHg. The patient was treated with tight blood pressure control to maintain blood flow and prevent blood pressure lability, received high-dose corticosteroids with a corticosteroid taper, and placed on high-dose erythropoietin for neuroprotective effect. He regained partial vision beginning approximately 1 month after presentation.
CONCLUSIONS: The exact cause of our patient\'s simultaneous bilateral anterior and posterior ION, confirmed via MRI and fundoscopic examination, is unclear; however, is likely secondary to a combination of fluctuating blood pressure, anemia, anephric status, and hemodialysis. This highlights the need for close blood pressure monitoring, management of anemia, and more diligent ophthalmologic screening in pediatric patients on chronic hemodialysis.

A 29-year-old preeclamptic postpartum patient with no symptoms of hypertension in her medical history before pregnancy was referred to the ophthalmology outpatient clinic with the complaint of sudden bilateral vision loss. Slit-lamp fundus examination and B-scan ultrasonography showed serous retinal detachment (SRD) in both eyes. She was diagnosed with bullous SRD due to preeclampsia (PE). The patient\'s fundoscopy findings regressed spontaneously, and visual acuities improved within one month. SRD should be considered in case of vision loss before or after birth in patients with PE, and such patients should undergo retinal examination.

Retinal arterial macroaneurysms represent an acquired vascular irregularity that is primarily observed in the elderly population. The high variability surrounding the clinical presentation of this condition makes the initial diagnosis challenging. Employing several diagnostic techniques including fundus fluorescence angiography, optical coherence tomography, and optical coherence tomography angiography ensures that any hemorrhages secondary to macroaneurysms rupture are identified promptly. This is crucial for appropriately managing the case and ensuring a good prognosis. Here, we present a case of a multilayered hemorrhage secondary to a ruptured retinal arterial macroaneurysm managed with a pars plana vitrectomy with gas tamponade and we aim to highlight the recent advancements in diagnosis and management of this condition.

Scedosporium apiospermum is a ubiquitous, highly resistant opportunistic fungus found in sewage and polluted waters and may infect the paranasal sinuses. Orbital Apex Syndrome may occur following trauma, surgery, or infection. An 80-year-old male with diabetes mellitus and mild dementia underwent uncomplicated, bilateral functional endoscopic sinus surgery for chronic sinusitis with polyposis. Initial pathology was reported as non-invasive bacterial and fungal species. On postoperative day 4, he had sudden right vision loss and abducens nerve palsy. Imaging noted violation of the lamina papyracea and inflammation of the optic nerve without compression. Medical therapy was begun and the patient developed sudden vision loss of the left eye. The patient then underwent emergent surgical decompression of both optic nerves. A final culture from the original surgery of S. apiospermum was made on postoperative day 10. Aggressive medical therapy was continued and the patient ultimately expired from complications of medical therapy and other underlying conditions. Trauma to the delicate bony walls of the orbit during sinus surgery in an immunocompromised patient who is unknowingly colonized with S. apiospermum can lead to the rapid spread of this highly neurotoxic organism.

Central retinal artery occlusion (CRAO) is characterized by the sudden, painless loss of vision. Typical sonographic and optic coherence tomography (OCT) findings are a retrobulbar spot sign and prominent middle limiting membrane (p-MLM) sign. It remains uncertain whether the retrobulbar spot sign alone or coinciding with the appearance of p-MLM sign is a prognostic marker for visual acuity and the development of secondary retinal ischemia after CRAO. In our prospective cohort study, we included patients with a non-arteritic central artery occlusion < 4 weeks. We examined the following parameters at prespecified time points: ultrasound examination of orbital cavity, Spectral Domain-OCT examination, visual acuity test, and fundoscopy and ultra-widefield angiography to diagnose retinal vascularization. The presence of p-MLM sign in SD-OCT after CRAO was accompanied by significantly better vision during the first four weeks (2.3 (IQR 0.75) vs. 2.6 (IQR 0.33); p = 0.006). Moreover, the spot sign seems to be a prognostic factor for developing secondary retinal ischemia (8 (100%) vs. 0 (0%); p = 0.036). A retrobulbar spot sign seems to be a negative prognostic factor and is associated with secondary retinal ischemia, whereas a p-MLM sign is a somewhat positive prognostic factor for visual acuity.

Cancer-associated retinopathy (CAR) is a rare cause of vision loss that was first reported in 1976. It is reported that the retinopathy associated with cancer occurs due to antibodies against the tumor antigens that cross-react with retinal cell layers. We present the case of a young male who came to the emergency department with sudden onset of bilateral vision loss. He had a large-sized testicular seminoma with metastatic retroperitoneal lymphadenopathy. Several primary ophthalmological and systemic conditions were considered. He had multiple, positive anti-retinal antibodies. The cancer was felt to be the cause of the vision loss based on the clinical presentation and the presence of anti-retinal antibodies. He was treated with intravenous steroids, plasmapheresis, and curative chemotherapy, but there was no improvement in vision. Unfortunately, he died due to multiorgan failure. Our case is the second on seminoma-associated retinopathy in the literature.

Hyperphosphatemia in the absence of renal failure is an unusual occurrence, particularly in children, but is a common primary feature of familial hyperphosphatemic tumor calcinosis. We report a child with hyperphosphatemia who presented with multiple episodes of neurologic dysfunction involving lower motor neuron facial nerve palsy along with sequential visual loss. He also had an episode of stroke. There was an extensive metastatic calcification of soft tissue and vasculature. Hyperphosphatemia with normal serum alkaline phosphatase, calcium, parathyroid hormone, and renal function was noted. He was managed with hemodialysis and sevelamer (3 months) without much success in reducing serum phosphate level, requiring continuous ambulatory peritoneal dialysis (3 years). Intact fibroblast growth factor 23 (FGF23) was undetectable, with C-terminal FGF23 fragments significantly elevated (2575 RU/ml, normal <180 RU/ml). Sequencing demonstrated homozygous c.486C >A (p.N162K) mutation in FGF23 exon 3, confirming the diagnoses of primary FGF23 deficiency, the first case to be reported from India.