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PURPOSE To report the frequency, optical coherence tomography (OCT) findings, and visual and anatomic outcomes of patients with acute Vogt-Koyanagi-Harada disease presenting with the bacillary layer detachment (BLD) (intraretinal split at the photoreceptor inner segment myoid). METHODS This was a retrospective analysis of a consecutive series of patients with Vogt-Koyanagi-Harada disease having a minimum follow-up of 6 months. All patients had swept-source OCT, fluorescein angiography, and indocyanine green angiography performed at baseline. The characteristics of serial swept-source OCT were recorded and analyzed. RESULTS Sixty-two subjects (42 women; age: 34.2 ± 12 years) with Vogt-Koyanagi-Harada disease were included. 118 eyes (95.2%) had serous retinal detachment at presentation. 112 eyes (94.9%) showed the BLD at baseline. In 8 of 112 (7.1%) eyes with the BLD, the external limiting membrane at the anterior aspect of the BLD showed focal discontinuity. The interdigitation zone at the base of the BLD showed discontinuity in 53 of 112 (47.3%) eyes with the BLD. The ellipsoid zone could not be identified as a separate hyperreflective line at the base of the BLD in 102 of 112 eyes (91.1%). Bacillary layer detachments resolved within 3.4 ± 1.3 days after intravenous methylprednisolone therapy with improvement in the best-corrected visual acuity from 0.96 to 0.4 logarithm of the minimum angle of resolution (20/184 Snellen's equivalent) (P < 0.001). Resolution of serous retinal detachment was observed after 5.9 ± 2.6 days. CONCLUSION In eyes with acute Vogt-Koyanagi-Harada disease, the BLD is a common finding and represents a split in the photoreceptor layer at the inner segment myoid and can be differentiated from serous retinal detachment using swept-source OCT. In addition, resolution of the BLD and photoreceptor recovery can be evaluated using serial swept-source OCT.

Purpose To analyze and describe serial follow-up of choriocapillaris alterations in tubercular serpiginouslike choroiditis (SLC) using optical coherence tomography angiography (OCTA) and to compare it with multimodal imaging. Methods In this prospective cohort study, patients with active tubercular SLC underwent OCTA using Optovue RTVue XR Avanti and other imaging techniques including enhanced-depth imaging OCT (EDI-OCT) (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Serial imaging was performed for a total follow-up of 3 months. Choriocapillaris alterations at the site of lesions were analyzed on OCTA imaging, and their mean lesion areas were calculated. Results Twenty-six eyes (26 patients; 20 males; mean age: 32.68 ± 10.56 years) were included. Fourteen eyes had active multifocal lesions (n = 39), whereas 12 eyes had active placoid lesions (n = 12). At baseline, OCTA showed hyporeflective flow deficit lesions corresponding to the hypofluorescent lesions on indocyanine green angiography in all eyes. In the multifocal type of SLC, the mean lesion area decreased in all eyes compared with baseline, and lesions with a lesion area less than 0.1 mm2 on OCTA showed near-complete resolution with minimal choriocapillaris atrophy. In comparison, all eyes with a placoid type of SLC showed no significant reduction in the lesion area and showed extensive choriocapillaris atrophy. Conclusion Optical coherence tomography angiography has the unique ability to demonstrate pathological flow impairment at the level of choriocapillaris in active tubercular SLC. Serial OCTA analysis reveals that large tubercular SLC lesions result in choriocapillaris atrophy as the lesions heal, whereas smaller multifocal lesions show resolution of choriocapillaris hypoperfusion with minimal atrophy.

PURPOSE To report polyethylene as an unusual cause of corneal foreign body. METHODS Two patients presenting with ocular complaints showed a transparent foreign body on the cornea on careful slit-lamp examination. The foreign bodies were removed and subjected to chemical analysis by Fourier transform infrared spectrophotometry. Treatment was given in the form of topical antibiotics and tear substitutes. RESULTS The foreign bodies were identified as polyethylene. There were no sequelae after foreign-body removal. CONCLUSIONS Because of its transparent nature, polyethylene can be easily missed as a corneal foreign body. A meticulous slit-lamp examination is mandatory to identify it early for appropriate management.

A 75-year-old diabetic man presented with cataract and keratoconus in both eyes. Ocular examination revealed visual acuity of 6/12 in both eyes through pinhole. The patient was scheduled for phacoemulsification with posterior chamber intraocular lens (IOL) implantation in his right eye. Biometry (IOL Master) of the right eye showed K1 as 46.68 diopters (D) at 82 degrees and K2 as 51 D at 172 degrees (average K, 48.87 D) with an IOL power of +19.5 D. The IOL power was calculated by accessing the following Web site: http://www.acrysoftoriccalculator.com/. The AcrySof Toric IOL recommended was SN60T8 with a spherical equivalent of 19.5 D and a residual astigmatism of +0.26 D at 173 degrees. Owing to nonavailability of T8 Toric IOL, it was converted by the Toric IOL calculator to T5 Toric IOL as SN60T5 (spherical equivalent of +19.5 D and a residual astigmatism of +1.8 D at 173 degrees). The IOL selected was Alcon SN60T5 with +19.5 D and +3.00 D cylinder. The steep axis was 170 degrees, and the location of the incision recommended was 135 degrees. Phacoemulsification was uneventful. At 4 weeks of follow-up, the uncorrected visual acuity and best corrected visual acuity in the right eye were 6/6 partial and 6/6, respectively. No rotation of the IOL was noticed.