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PurposeMethodsResultsConclusionTo provide an overview of pre-selected emerging arboviruses (arthropod-borne viruses) that cause ocular inflammation in humans.A comprehensive review of the literature published between 1997 and 2023 was conducted in PubMed database. We describe current insights into epidemiology, systemic and ocular manifestations, diagnosis, treatment, and prognosis of arboviral diseases including West Nile fever, Dengue fever, Chikungunya, Rift Valley fever, Zika, and Yellow fever.Arboviruses refer to a group of ribonucleic acid viruses transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. They mostly circulate in tropical and subtropical zones and pose important public health challenges worldwide because of rising incidence, expanding geographic range, and occurrence of prominent outbreaks as a result of climate change, travel, and globalization. The clinical signs associated with infection from these arboviruses are often inapparent, mild, or non-specific, but they may include serious, potentially disabling or life-threatening complications. A wide spectrum of ophthalmic manifestations has been described including conjunctival involvement, anterior uveitis, intermediate uveitis, various forms of posterior uveitis, maculopathy, optic neuropathy, and other neuro-ophthalmic manifestations. Diagnosis of arboviral diseases is confirmed with either real time polymerase chain reaction or serology. Management involves supportive care as there are currently no specific antiviral drug options. Corticosteroids are often used for the treatment of associated ocular inflammation. Most patients have a good visual prognosis, but there may be permanent visual impairment due to ocular structural complications in some. Community-based integrated mosquito management programs and personal protection measures against mosquito bites are the best ways to prevent human infection and disease.Emerging arboviral diseases should be considered in the differential diagnosis of ocular inflammatory conditions in patients living in or returning from endemic regions. Early clinical consideration followed by confirmatory testing can limit or prevent unnecessary treatments for non-arboviral causes of ocular inflammation. Prevention of these infections is crucial. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor commenting on a study that evaluated the impact of initial management on the disease evolution of Vogt-Koyanagi-Harada (VKH) syndrome. The study classified patients into three groups based on the 2001 revised diagnostic criteria for VKH disease. However, the letter raises concerns about the limitations of the study, including its retrospective design, small sample size, and the mixing of early-stage and late-stage VKH patients in the same cohort. The authors argue that new diagnostic/classification criteria should be used to properly differentiate between early-stage and late-stage VKH disease for improved management and prognosis. [Extracted from the article]

To clarify whether a true neuroretinitis is part of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Critical literature review. Neuroretinitis has been considered as a prominent feature of IRVAN syndrome. It has been described as late diffuse optic disc staining on fluorescein angiography. However, patients with IRVAN syndrome usually do not present with visual function alterations consistent with optic neuropathy or neuroretinitis. The typical stellate exudative maculopathy seen in IRVAN syndrome is primarily caused by leakage from retinal arteriolar aneurysms at or near the optic disc, and it could be misinterpreted as a feature of neuroretinitis. There is no clinical evidence of true neuroretinitis at any of the disease stages in patients with IRVAN syndrome. The acronym « IRVARE » (Idiopathic Retinal Vasculitis, Aneurysms, and Retinal Exudates) is proposed to better characterize this syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis Methods: Review of literature.Results: Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis.Conclusions: Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum. [ABSTRACT FROM AUTHOR]

We provide an updated review of pre-selected RNA viruses causing ocular inflammation in humans. RNA viruses such as coronaviruses and arboviruses are reviewed elsewhere. A Google Scholar search was conducted to identify recent publications on ocular inflammation caused by the RNA viruses specified here. Human RNA viruses target a wide range of ocular tissues from the anterior to the posterior. Influenza, measles and mumps cause anterior segment manifestations including conjunctivitis and keratitis, while retinitis and optic neuritis may be seen posteriorly. Newcastle disease and RSV cause conjunctivitis, whereas HIV causes characteristic anterior uveitis. Cataracts, microphthalmos, and iris abnormalities are common in congenital Rubella, while Rubella virus is associated with Fuchs uveitis syndrome. Newer technologies make it possible to detect more than one pathogen if present simultaneously. RNA viruses may produce significant ocular morbidity, and care should be taken to investigate ocular symptoms during disease outbreaks. [ABSTRACT FROM AUTHOR]

Behçet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient "Silk Road" route in the Far East and Mediterranean basin. The eye is the most commonly involved organ in BD patients. The prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis. [ABSTRACT FROM AUTHOR]

Any patient with a diagnosis of central serous chorioretinopathy (CSCR) should be questioned to determine any recent corticosteroid use, as the poor visual outcome may be due to unrecognized corticosteroid use. Atypical forms of CSCR may be misdiagnosed as an inflammatory serous retinal detachment, mainly Vogt-Koyanagi-Harada disease. CSCR that develops in association with preexisting uveitis could be a challenging diagnosis as it might be misinterpreted as a worsening of the primary inflammatory condition. Failure to differentiate CSCR from retinal or choroidal inflammatory diseases may result in inappropriate use of corticosteroids, leading to exacerbation of the condition and permanent visual loss. Discontinuation of corticosteroids should be the first step in the treatment of CSCR associated with corticosteroid therapy, and the use of immunosuppressive or immunomodulatory drugs may be required to control systemic or ocular inflammatory disease. The prognosis is usually favorable, but persistent visual loss may occur. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical, optical coherence tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis (RC) associated with serous retinal detachment (SRD). Methods: The study included 60 eyes with acute toxoplasmic RC. Results: Of 60 eyes, 14 (23.3%) were found to have SRD. The SRD was visible on fundus examination in 6 cases and detectable only by optical coherence tomography (OCT) in the 8 remaining cases. It involved the fovea in 9 eyes. There was evidence of associated choroidal ischemia on fluorescein angiography and indocyanine green angiography in 5 eyes. Findings seen at the acute stage gradually resolved over a period of 2-6 weeks in all patients. Conclusions: SRD, accurately detected by OCT, is a common complication of acute toxoplasmic RC that should be considered as a potential cause of visual loss. Choroidal ischemia might contribute to the development of such complication. [ABSTRACT FROM AUTHOR]

Purpose: To identify factors associated with the development and severity of chorioretinitis (CR) in patients with West Nile virus (WNV) infection. Methods: Prospective study of 38 patients with WNV infection. Results: Simple analysis showed that diabetes (p = 0.027) and age older than 45 years (p = 0.03) were significantly associated with CR. When controlling for age, only association between diabetes and CR remains statistically significant. Diabetic patients' eyes were more likely to have macular involvement (p < 0.0001), 20 or more chorioretinal lesions (p < 0.001), and lesion size 500 μ m or more (p < 0.01). Conclusions: Diabetes was a risk factor for the development and severity of WNV-associated CR. [ABSTRACT FROM AUTHOR]

Purpose : To analyze the pattern of childhood uveitis in a referral center in Tunisia, North Africa. Methods :The study included 64 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1994 to July 2005. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases, including best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination with 3-mirror lens. Standard diagnostic criteria were employed for all syndromes or entities of uveitis. Results : The mean age at onset of uveitis was 12.4 years. The male-to-female ratio was 0.68. The process was unilateral in 51.6% of patients. Mean follow-up was 43.2 months. Anterior and intermediate uveitis each represented 31.25% of cases, posterior uveitis 20.3%, and panuveitis 17.2%. Noninfectious uveitis (75%) was the most frequent type of inflammation. Idiopathic uveitis was found in 50% of patients. Infectious uveitis was responsible for 25% of the cases, with toxoplasmosis (14.1%) being the most frequent cause. Twenty percent of the patients had systemic associations; juvenile idiopathic arthritis was found in 6.25%. Ocular complications occurred in 74.7% of affected eyes, of which the most common were posterior synechiae (28.4%), cataract (17.9%), cystoid macular edema (19%), and optic disc edema (32.6%). Fifty-seven affected eyes (60%) had a final visual acuity more than 20/40 and nine (9.5%) had a final visual acuity less than 20/200. Conclusions : In a hospital population in Tunisia, a specific cause of uveitis in children was found in half the patients. Idiopathic intermediate uveitis was the leading cause of uveitis in our study, followed by idiopathic anterior uveitis and toxoplasmosis. Uveitis associated with juvenile idiopathic arthritis was rare. Visual prognosis appeared to be good. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar.We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019.Mean age at presentation was 34.5 ± 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001).In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage. [ABSTRACT FROM AUTHOR]

The standardization of Uveitis Nomenclature (SUN) Working Group recently affirmed the importance of an anatomic classification of uveitis, endorsing the anatomic clasiffication scheme proposed by the International Uveitis Study Group (IUSG). The group however pointed out and addressed ambiguities in the IUSG system, and proposed new standards for grading the anatomic location and degree of activity of inflammation. Besides clarifying some of the existing nomenclature problems the terminology proposed by the SUN working group still remains confusing in a few points. Ambiguities in the SUN Working group anatomic classification of uveitis were addressed, especially regarding the terms “pars planitis“, “neuroretinitis“ and “anterior and intermediate uveitis“. [ABSTRACT FROM AUTHOR]

Infectious uveitis is a major global cause of vision impairment. Despite the eye’s immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection’s etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A). Methods: We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity. Results: Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes. Conclusion: This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease. [ABSTRACT FROM AUTHOR]

To provide an overview of pediatric pars planitis. Narrative literature review. Pars planitis refers to the idiopathic subset of intermediate uveitis in which there is vitritis along with snowball or snowbank formation occurring in the absence of an associated infection or systemic disease. It is thought to be a T-cell mediated disease with a genetic predisposition. Pars planitis accounts for 5–26.7% of pediatric uveitis cases. Presentation is commonly bilateral but asymmetric, often with insidious onset of floaters and blurred vision. Although pars planitis is known to be a benign form of uveitis in most cases, severe complications secondary to chronic inflammation may arise, with cystoid macular edema being the most common cause of visual morbidity. Mild vitritis in the absence of symptoms, vision loss, or macular edema may be observed. Patients with severe vitritis and/or associated vision-threatening complications require prompt aggressive treatment. A stepladder approach including corticosteroids, immunosuppressive agents, anti‑tumor necrosis factor‑alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Timely diagnosis and adequate treatment of pediatric pars planitis and associated complications are crucial in order to improve visual outcomes. [ABSTRACT FROM AUTHOR]

To report and illustrate the main clinical presentations of posterior herpetic uveitis. Narrative review. The ocular manifestations of posterior herpetic uveitis include different clinical presentations. Herpes simplex and varicella zoster can cause acute retinal necrosis, progressive outer retinal necrosis, and non-necrotizing herpetic retinopathies. Cytomegalovirus has been associated with fulminant retinitis with confluent areas of retinal necrosis and retinal hemorrhages, indolent/granular retinitis, and frosted branch angiitis. These diverse clinical presentations are often associated with specific risk factors and different immunological profiles of the host. Herpetic viruses can cause posterior uveitis, presenting various clinical findings. Specific ocular manifestations and the immunological status of the host can help to differentiate the various herpetic entities before laboratory tests confirm the diagnosis. [ABSTRACT FROM AUTHOR]

To describe optical coherence tomography angiography (OCTA) findings in eyes with active and scarred toxoplasmic retinochoroiditis. OCTA scans in active (25 eyes) and scarred (17 eyes) retinochoroiditis were retrospectively reviewed. In active lesions, OCTA findings included a non-detectable flow signal area in retinal vascular plexuses and choriocapillaris in all 25 eyes (100%), an abnormal intraretinal vascular process in 2 eyes (8%), and an associated area of retinal flow deficit secondary to branch retinal artery occlusion in one eye (4%). In scarred lesions, OCTA findings included a flow deficit area in retinal vascular plexuses and choriocapillaris in all 17 eyes (100%), a visibility of larger deeper choroidal vessels at the level of choriocapillaris in 9 eyes (53%), and a well-defined intraretinal vascular network in one eye (5.9%). Peripapillary scars were associated on OCTA with wedge-shaped loss of radial peripapillary capillaries with corresponding localized retinal nerve fiber layer defect and visual field loss. OCTA allows to non-invasively detect retinal and choroidal vascular changes in active and scarred toxoplasmic retinochoroiditis. [ABSTRACT FROM AUTHOR]

The fundus photographs provided show deep yellowish lesions, multifocal exudative retinal detachments, and optic disc hyperemia in both eyes. Spectral domain optical coherence tomography scans shown demonstrate bilateral exudative retinal detachments involving the macula in the right eye. The exudative retinal detachment is characterized by the presence of subretinal fibrin and septa. The B-scan ultrasonography provided shows low- to medium-reflective choroidal thickening predominating around optic nerve head, in association with exudative retinal detachment in the right eye. All these findings are highly suggestive of acute Vogt-Koyanagi-Harada (VKH) disease rather than multifocal choroiditis. [ABSTRACT FROM AUTHOR]

The author reflects on Behcet Uveitis (BU). Topics discussed include Behcet disease (BD) as a systemic disorder; and ocular complications of BU that are edema, non-perfusion, neovascularization, and atrophy of the retina and optic disc. Also being discussed are tumor necrosis factor (TNF) inhibitor or interferon, conventional immunosuppressive therapy, and indocyanine green angiography (ICGA) and fundus autofluroescence (FAF).

Intraocular tuberculosis presents a diagnostic challenge because of its protean clinical manifestations. Thus, it becomes imperative to distinguish chorioretinal inflammation due to tuberculosis from other infectious as well as non-infectious posterior uveitis since the clinical manifestations of these entities may be quite similar. With advancing technology, a number of novel imaging modalities are available today that enable in vivo near-histologic assessment of the chorioretinal tissue, greatly aiding the clinician in establishing a diagnosis and monitoring the therapeutic response of tubercular lesions. Techniques such as ultra-wide field fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography and most recently, optical coherence tomography angiography, provide valuable information that helps in advancing our knowledge regarding the pathogenesis and natural history of the disease. The index review describes how these techniques supplement each other, and highlights the relevance of multimodal imaging in the management of intraocular tuberculosis. [ABSTRACT FROM AUTHOR]

To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). A retrospective comparative study 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10–3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10−3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p =.006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p =.006 and p ≤ 10–3, respectively), and retinal hemorrhages (p =.048) and optic atrophy (p =.040) in the ORV group. Occlusive and non-occlusive RV have distinctive clinical and etiological profile. [ABSTRACT FROM AUTHOR]

The article discusses the diagnoses, characteristics, treatment and outcomes of uveitis or eye inflammation, following a mosquito-borne viral infection. Topics include ocular infection by Zika virus, cases of Purtscher-like retinopathy after dengue fever and association of chikungunya virus infection with blurred vision.

To report a case of unilateral acute foveolitis following COVID-19 vaccination. A case report. A 24-year-old woman developed a sudden blurring of vision in the left eye (LE) 5 days after receiving the first dose of COVID-19 vaccine. Examination of the LE showed a visual acuity at 20/40, 2+ cells in the vitreous, and a small yellow-orange foveal subretinal lesion. Late-phase fluorescein angiography showed a mild diffuse retinal vascular leakage and a faint foveal hyperfluorescence. ICG angiography showed in the late-phase hypofluorescence of the centrofoveal lesion. OCT B-scan demonstrated a conical hyperreflective subfoveal lesion on the retinal pigment epithelium associated with disruption of the outer retinal layers. En-face OCT revealed granular hyperreflective specks mainly in the inner nuclear layer. Work-up results were unremarkable. The patient received oral prednisolone with subsequent full functional and anatomic recovery. Foveolitis may rarely occur as a complication of COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

To describe a case of outer retinitis with frosted branch angiitis associated with mumps infection treated with hyperbaric oxygen (HBO) therapy. Observational case report A four-year-old boy with bilateral blindness was diagnosed with necrotizing outer retinitis with frosted branch angiitis associated with serologically confirmed mumps virus infection. He was treated with HBO therapy. Visual acuity subsequently improved to 20/40 in the right eye and to 20/320 in the left eye. Sequential follow-up optical coherence tomography examinations showed progressive recovery of the outer retinal layers in the right eye. HBO therapy appears to be a feasible and safe treatment that might improve the anatomical and functional outcome in patients with mumps retinitis. [ABSTRACT FROM AUTHOR]

Purpose: To test interobserver agreement in the fluorescein/indocyanine green angiography (FA/ICGA) scoring system for uveitis. Methods: Four observers scored 32 dual FA/ICGAs. Spearman rank correlation was used to analyze correlation between pairs of observers in scores assigned to angiographic signs. Kappa statistics were used to test agreement between pairs of observers in comparative total FA and ICGA scores. Results: The authors found a significant correlation between pairs of observers in scores assigned to all FA signs and all except one ICGA sign. The only discordant sign was early stromal vessel hyperfluoresence on ICGA. There was a moderate to substantial agreement between pairs of observers in comparative FA/ICGA total scores. Conclusions: The level of agreement between uveitis specialists in scoring of dual FA/ICGA indicates that the scoring system tested in this study will be useful for clinical studies of uveitis. Increased experience with this system may further improve its reproducibility. [ABSTRACT FROM AUTHOR]

Purpose: To develop an algorithm for the diagnosis of Behçet's disease (BD) uveitis based on ocular findings. Methods: Following an initial survey among uveitis experts, we collected multi-center retrospective data on 211 patients with BD uveitis and 207 patients with other uveitides, and identified ocular findings with a high diagnostic odds ratio (DOR). Subsequently, we collected multi-center prospective data on 127 patients with BD uveitis and 322 controls and developed a diagnostic algorithm using Classification and Regression Tree (CART) analysis and expert opinion. Results: We identified 10 items with DOR >5. The items that provided the highest accuracy in CART analysis included superficial retinal infiltrate, signs of occlusive retinal vasculitis, and diffuse retinal capillary leakage as well as the absence of granulomatous anterior uveitis or choroiditis in patients with vitritis. Conclusion: This study provides a diagnostic tree for BD uveitis that needs to be validated in future studies. [ABSTRACT FROM AUTHOR]

Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases. [ABSTRACT FROM AUTHOR]

Purpose: To provide an overview of the role of multimodality approach to the diagnosis and assessment of uveitic macular edema (UME). Methods: Review of literature. Results: Optical coherence tomography (OCT) has become the gold standard in the detection, quantification, monitoring of treatment, and determination of prognosis in UME. Fluorescein angiography provides essential information on blood-retinal barrier disruption as a result of intraocular inflammation and allows detection of associated retinal ischemia and neovascularization. Dye-less OCT angiography can reveal the presence of various qualitative and quantitative retinal microvascular changes mostly involving the deep capillary plexus. Reading acuity and retinal sensitivity assessed by microperimetry represent sensitive measures for visual dysfunction in UME and may supplement distance visual acuity in the follow-up of patients with UME. Conclusion: Conventional and new imaging modalities and ancillary tests complement each other in the diagnosis, assessment, and monitoring of patients with UME. [ABSTRACT FROM AUTHOR]

Purpose: Overview of treatment options for the most common intraocular opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), including ocular syphilis, ocular tuberculosis, toxoplasmic chorioretinitis, and viral retinitis. Method: Narrative Review. Results: Despite the huge advances in the development of combined antiretroviral therapy (cART) for the management of patients with human immunodeficiency virus (HIV) infection, opportunistic infections still represent a significant diagnostic dilemma and cause of ocular morbidity in patients with HIV. Conclusion: Although the treatment of intraocular infections in patients with AIDS may be challenging, prompt assessment of the clinical features and appropriate aggressive management of the underlying etiology are critical to avoid life and vision threatening. [ABSTRACT FROM AUTHOR]

Purpose: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. Methods: Multicentre retrospective analysis. Results A total of 138 TIU and 309 TBP patients were included. A total of 382 subjects received antitubercular therapy (ATT) (n = 382/447; 85.4%) and 382 received corticosteroids (n = 382/447; 85.4%). Treatment failure was observed in 78 individuals (n = 78/447; 17.4%), occurring less frequently in patients receiving ATT (n = 66/382; 17.2%) compared to those who did not (n = 12/65; 18.5%). The study did not show any statistically significant therapeutic effect of ATT in patients with TIU and TBP. Conclusion Taking into account the limitations of the retrospective, non-randomized study design, resultant reliance on reported data records, and unequal size of the samples, the current study cannot provide conclusive evidence on the therapeutic benefit of ATT in TIU and TBP. [ABSTRACT FROM AUTHOR]

Purpose: To examine disease profile of tubercular uveitis (TBU) in Paediatric population. Methods: Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. Results: Mean age of disease presentation was 12.8 (range 4–18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21). Conclusions: Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical findings, anatomical features, and treatment outcomes in subjects with ocular tuberculosis (OTB) at 24 months in the Collaborative Ocular Tuberculosis Study (COTS)-1. Methods: Of the 945 subjects included in COTS-1, those who completed a 24-month follow-up after completion of treatment were included. The main outcome measure was a number of patients with treatment failure (TF). Results: 228 subjects (120 males; mean age of 42.82 ± 14.73 years) were included. Most common phenotype of uveitis was posterior (n = 81; 35.53%), and panuveitis (n = 76; 33.33%). Fifty-two patients (22.81%) had TF. On univariable analysis, odds of high TF was observed with bilaterality (OR: 3.46, p =.003), vitreous haze (OR: 2.14, p =.018), and use of immunosuppressive therapies (OR: 5.45, p =.003). However, only bilaterality was significant in the multiple regression model (OR: 2.84; p =.02). Conclusions: Majority of subjects (>75%) achieved cure in the COTS-1 at 24-month follow-up. The concept of "cure" may be a valuable clinical endpoint in trials for OTB. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a major infection that can affect the eye as first and sole presentation without features of systemic disease. Controversy exists regarding diagnosis and management of tubercular uveitis (TBU), further compounded by regional variations in disease expression. Purpose: Collaborative Ocular Tuberculosis Study (COTS)-1 aims to address knowledge deficits through collaboration amongst uveitis specialists across the globe by sharing the data of patients with TBU presented at participating centers from January 2004 to December 2014. Methods: Data collection was facilitated by a novel method of real-time encrypted web-based data entry allowing regular updates as new data and recommendations become available. Results: Information on clinical features, investigation findings, management, and treatment outcomes were reviewed to get an idea about real world scenario. Conclusion: The current review aims to focus on methodology and briefing of published reports from COTS group in COTS-1 study to highlight key messages from this large data. [ABSTRACT FROM AUTHOR]

Purpose: To contribute a global description of the spectrum of choroidal involvement in tubercular uveitis (TBU).Methods: Retrospective cohort study of TBU patients with choroidal involvement from 25 centers between January 2004 and December 2014. Medical records of patients with a minimum follow-up of 1 year were reviewed.Results: 245 patients were included. The phenotypic variations included serpiginous-like choroiditis (SLC) (46%), tuberculoma (13.5%), multifocal choroiditis (MFC) (9.4%), ampiginous choroiditis (9%), among others. 219 patients were treated with anti-tubercular therapy (ATT) (n = 219/245, 89.38%), 229 patients with steroids (n = 229/245, 93.47%) and 28 patients with immunosuppressive agents (n = 28/245, 11.42%). Treatment failure was noted in 38 patients (n = 38/245, 15.5%). Patients with SLC and ampiginous choroiditis appeared to have superior outcomes on survival analysis (p = 0.06).Conclusion: This study provides a comprehensive description of choroidal involvement in TBU. Patients with SLC and ampiginous choroiditis may have better clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To describe swept-source optical coherence tomography angiography (OCTA) findings in uveitic cystoid macular edema (CME).Methods: Prospective study of 36 eyes.Results: Cystoid black spaces were shown in the deep capillary plexus (DCP) in 36 eyes (100%) and in the superficial capillary plexus (SCP) in 6 eyes (16.7%). Grayish areas of capillary non perfusion/hypoperfusion were seen in 69.4% of eyes in the DCP (vs 25% in the SCP, p < .001). The foveal avascular zone was larger than in the control healthy eyes in the DCP (p < .001). Capillary density was lower than in the control group in the SCP (p = .001) and the DCP (p < .001). Of 11 eyes with resolved CME on OCT, 4 eyes showed complete recovery of both plexuses on OCTA. There was a persistence of areas of capillary rarefaction in 4 eyes, and of hypoperfusion/nonperfusion in 3 eyes.Conclusion: OCTA visualizes perifoveal microvascular changes in uveitic CME. [ABSTRACT FROM AUTHOR]

Purpose: To report optical coherence tomography angiography (OCT-A) findings in eyes with ocular sarcoidosis (OS) and to compare these findings with those of fluorescein angiography (FA). Methods: Observational, cross-sectional, case-control study. Patients presenting with OS involving the posterior segment were evaluated using FA, structural-OCT and OCT-A. OCT-angiograms of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) were qualitatively and quantitatively analyzed. Results: OCT-A seemed more sensitive than FA in detecting perifoveal capillary arcade disruptions, areas of hypoperfusion/non-perfusion and capillary abnormalities (p<0.05). Capillary hypoperfusion was more frequently detected in the DCP than in SCP, conversely capillary abnormalities were more often observed at the level of the SCP. Capillary vessel density values were significantly lower in eyes with OS than in healthy controls both at the level of DCP and CC (p<0.05). Conclusion: The depth-resolved nature of OCT-A allowed new insights on OS-induced microvascular and perfusion impairments. [ABSTRACT FROM AUTHOR]

Purpose: To report the cases of two patients who presented with acute Vogt-Koyanagi-Harada (VKH) disease and associated retinal pigment epithelium detachment (PED). Methods: 2 case reports. Case 1: A 22-year-old male patient complained of acute bilateral decrease in vision. Initial best corrected visual acuity (BCVA) was 20/63, OU. There was 1+ vitreous cells, OU, exudative retinal detachment (ERD) in the right eye (RE), and a macular deep yellow lesion suggestive of PED in the left eye (LE). Case 2: A 40-year-old female patient presented with bilateral vision blurring. BCVA was 20/40 in the RE and 20/32 in the LE. There was 1+ vitreous cells OU, bilateral optic disc swelling and retinal striae. Results: Multimodal imaging showed features of acute VKH disease with associated PED in the two patients. ERD and PED resolved under oral prednisone and cyclosporine in both cases. Conclusion: PED may rarely occur in acute VKH disease at presentation. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis. Methods: In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (18 females; 53 Asian Indians) were included. Results: 59 (6.13%) of COTS-1 underwent PCR analysis. PCR was positive for Mycobacterium TB in 33 patients (23 males; all Asian Indians). 26 patients were PCR negative (18 males). Eight patients with negative PCR had systemic TB. Anti-TB therapy was given in 18 negative and 31 PCR cases. At 1-year follow-up, five patients with positive PCR (15.15%) and three with negative PCR (11.54%) had persistence/worsening of inflammation. Conclusions: Data from COTS-1 suggest that PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in the real world scenario. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of gevokizumab for the treatment of Behçet's disease uveitis in a prospective, open-label, randomized phase 2 trial.Methods: Behçet's disease patients with new acute ocular exacerbation or at risk of exacerbation received 30 or 60 mg gevokizumab every 4 weeks intravenously or subcutaneously, on top of a stable regimen of immunosuppressives and corticosteroids (≤20 mg/day equivalent prednisolone). Patients withdrew in cases of ocular exacerbation.Results: A total of 21 patients were included (17 acute and 4 at-risk; mean duration of uveitis 45.6 ± 37.4 months). There were no serious adverse events related to gevokizumab. Recorded adverse events were mostly associated with exacerbation of uveitis or its complications. Response was evaluated for 14 acute patients and all showed rapid control of acute ocular exacerbation, mostly within 1 week, without any increase in corticosteroid dosage.Conclusions: Gevokizumab was well tolerated and rapidly controlled acute ocular exacerbations of Behçet's disease uveitis without the need for high-dose corticosteroid. [ABSTRACT FROM AUTHOR]

Purpose: To describe the pattern of acute retinal necrosis (ARN) syndrome in a referral center in Tunisia.Methods: Retrospective review of the charts of 12 patients (12 eyes).Results: Necrotizing retinitis involved >50% of the retina in 33.3% of eyes. Polymerase chain reaction on aqueous humor sample identified herpes simplex virus-1 in 4 eyes (33.3%) and varicella zoster virus in 3 eyes (25%), and was negative in 5 eyes (41.7%). All patients received intravenous acyclovir, followed by oral antivirals. Follow-up ranged from 6 to 16 months. Retinal detachment (RD) occurred in 3 eyes (25%), but no patient developed bilateral ARN. Final visual acuity was 20/200 or worse in 7 eyes (58.3%). Delay in diagnosis (p = 0.015), macular involvement (p = 0.045), development of RD (p = 0.018), and 25-50% of retinal involvement (p = 0.045) were associated with a worse visual outcome.Conclusion: ARN carries poor visual prognosis in Tunisia. [ABSTRACT FROM AUTHOR]

Purpose: Ocular tuberculosis is an extrapulmonary tuberculous condition and has variable manifestations. The purpose of this review is to describe the clinical manifestations of ocular tuberculosis affecting the anterior and posterior segments of the eye in both immunocompetent and immunocompromised patients. Methods: Review of literature using Pubmed database. Results: Mycobacterium tuberculosis may lead to formation of conjunctival granuloma, nodular scleritis, and interstitial keratitis. Lacrimal gland and orbital caseating granulomas are rare but may occur. The intraocular structures are also a target of insult by M. tuberculosis and may cause anterior granulomatous uveitis, anterior and posterior synechiae, secondary glaucoma, and cataract. The bacillus may involve the ciliary body, resulting in the formation of a localized caseating granuloma. Posterior segment manifestations include vitritis, retinal vasculitis, optic neuritis, serpiginous-like choroiditis, choroidal tubercules, subretinal neovascularization, and, rarely, endophthalmitis. Conclusions: The recognition of clinical signs of ocular tuberculosis is of utmost importance as it can provide clinical pathway toward tailored investigations and decision making for initiating anti-tuberculosis therapy. [ABSTRACT FROM AUTHOR]

Purpose: To characterize and analyze ocular involvement associated with visual loss in a cohort of patients with rickettsial disease. Methods: Retrospective study of 16 eyes of 14 patients. Results: Mean initial visual acuity (VA) was 20/63 (range, 20/800-20/25). White retinal lesions infiltrating inner retina was the most common finding occurring in 14 eyes (87.5%). It was associated with a serous retinal detachment (SRD), accurately detectable by optical coherence tomography, in 11 eyes (78.6%). Other findings included optic neuropathy in 7 eyes (43.75%), cystoid macular edema in 1 eye (6.25%), branch retinal artery occlusion in 1 eye (6.25%), and choroidal neovascularization in 1 eye (6.25%). Thirteen patients were treated with a 2-week course of oral doxycycline 200 mg/day. Mean final VA was 20/40. Conclusions: Inner retinitis, associated with mild vitritis and SRD, and optic neuropathy are the most common vision-threatening ocular manifestations of rickettsial disease. [ABSTRACT FROM AUTHOR]

Objective: To review the published literature on parasitic infections of external eye. Methods: Published articles and case reports on parasitic infections of external eye were reviewed and relevant information was collected. Results: Parasitic infections of the eye are rare. However, being more commonly seen in developing nations, they require active measures for screening, diagnosis, and therapy. Parasites of importance causing external ocular disease are protozoan parasites, such as Leishmania; metazoans, such as nematodes (roundworms), cestodes (tapeworms), and trematodes (flatworms); or ectoparasites, such as Phthirus pubis and Demodex. [ABSTRACT FROM AUTHOR]

Behçet disease (BD) is a common, complex, and severely debilitating systemic vasculitis. Despite an increasing understanding of BD overall, there remain many critical questions to be addressed in terms of the epidemiology, pathophysiology, and treatment of this condition. The opinions of uveitis experts related to these issues were recently surveyed and are summarized herein. The survey results revealed significant disparities between responders in terms of important concepts regarding the clinical features, diagnosis, and treatment of this important inflammatory eye disease. [ABSTRACT FROM AUTHOR]

The article focuses on acute retinal necrosis, a rare sight-threatening condition that is defined by the combination of clinical features like retinal necrosis usually located in peripheral retina with circumferential extension, occlusive vasculopathy and anterior chamber inflammatory reaction. Topics discussed include the case of a 53-year-old patient who presented with a loss of vision in the right eye and was later diagnosed with acute retinal necrosis.

Purpose: To report 2 cases of branch retinal artery occlusion (BRAO) associated with Behççet disease (BD). Design: Small case series. Methods: Review of two patients'' charts, fluorescein angiography, and optical coherence tomography (OCT). Results: The authors report two young patients, diagnosed with BD, who developed decreased vision secondary to BRAO for the first patient and cilioretinal artery occlusion associated with branch retinal vein occlusion for the second patient. In the two cases, artery occlusion was associated with active intraocular inflammation. Conclusions: BRAO, with subsequent transient or permanent visual impairment, is an additional ocular complication of BD. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of orbital sarcoidosis manifesting with enophthalmos. Methods: A 60-year-old woman presented with right enophthalmos. She had a palpable mass in her anterior orbit inferiorly. She underwent a complete ophthalmic evaluation, magnetic resonance imaging, and histopathologic examination. Results: A magnetic resonance imaging scan disclosed an orbital, extraconal mass, with displacement of the orbital floor. A biopsy specimen of the mass demonstrated a granulomatous inflammation without caseation necrosis. Workup revealed hilar lymphadenopathy, pleural nodule, and splenomegaly. The patient was treated with corticosteroids, with subsequent involution of the mass and disappearance of enophthalmos. Conclusion: Although orbital sarcoidosis usually manifests with proptosis or palpebral swelling, enophthalmos should be considered as ophthalmic manifestation of sarcoidosis. [ABSTRACT FROM AUTHOR]