Dr. Gunjan Rana, Dr. Zia Chaudhuri, Dr. Anurag Shandil
We report a 12 year male, who presented 4 years back with visual acuity (VA) of 3/60 OD and 6/36 OS, was diagnosed as having uveitis OS and blue-dot cataract OU and was operated upon for cataract OU with recovery of VA of 6/18 OU. The patient subsequently had profound hearing loss and neuro-psychiatric deterioration diagnosed as attention deficit hyperactivity disorder (ADHD) and later as dissociated disorder. VA was maintained at 6/9 with refractive correction for 2 years till the patient presented with seizures, difficulty in standing, walking, loss of appetite and progressive visual loss upto negative perception of light OU. MRI demonstarted acute non-haemorrhagic infarct in the parieto-occipital and posterior temporal lobes OU. MRA was suggestive of mitochondrial encephalopathy, lactic acidosis and stroke-like symptoms (MELAS). This unique case demonstrates associated ocular visual impairment cameoflaging CVI in MELAS. Systemic signs provide early clues, important for management.