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To describe the experience of managing chronic childhood uveitis from a tertiary care center in India. All children diagnosed as chronic uveitis between January 2005 and December 2012 and on follow-up in Pediatric Rheumatology Clinic and Uveitis Clinic, were eligible for enrollment. Information regarding demographics, type of uveitis, treatment, complications, and surgical procedures was obtained from clinic records. All the enrolled patients were assessed for outcome prospectively and underwent a detailed ophthalmological examination to document visual acuity, refraction, intraocular pressure (IOP), slit lamp examination, fundus examination, and vitreous haze findings. Sixty-seven children with chronic uveitis were enrolled in the study. Anterior uveitis was the commonest type seen in 45 children. Juvenile idiopathic arthritis (JIA) was the commonest known etiology and diagnosis of uveitis was made during routine screening in a majority of the JIA patients. No cause could be identified in 43% patients. After a mean follow-up period of 3.95 ± 1.99 y, only 16% eyes were in remission and off therapy. Prolonged oral glucocorticoids were required, besides other immunosuppressants, to control inflammation in 50% patients. Ocular complications were seen in 87% cases with posterior synechiae, band-shaped keratopathy and cataracts being the commonest complications. Among patients with chronic uveitis, 43% had no identifiable cause. JIA was the commonest known cause. Significant ocular complications were common. Even after a mean follow-up of 3.95 ± 1.99 y, a vast majority continued to need immunosuppression for control of disease activity.

Tubercular association with serpiginous choroiditis, also called ‘serpiginous-like choroiditis’ or ‘multifocal serpiginoid choroiditis’ (MSC) is reported from world over, especially from endemic countries. Though the exact mechanism is not yet clear, a direct or indirect infectious trigger by Mycobacterium tuberculosis (MTB) is believed to cause choroiditis.The link of immune mechanisms with ocular inflammation caused by MTB is emerging, and has been supported by both experimental and human data. The molecular and histopathological findings of tubercular serpiginous-like choroiditis have been demonstrated in clinicopathological reports, as well as in animal models. Young to middle-aged healthy males are more frequently affected. The choroiditis lesions of tubercular serpiginous-like choroiditis evolve as multifocal lesions, affecting the retinal periphery as well as posterior pole. They begin as discrete lesions, and spread in a serpiginoid pattern to become confluent. Fundus imaging including autofluorescence is extremely helpful in monitoring patients for response to therapy. Its diagnosis is essentially clinical. Corroborative evidence is obtained by a positive tuberculin skin test, or a positive QuantiFERON-TB Gold (Cellestis, Carnegie, Victoria, Australia) test, and/or radiological (chest X-ray or chest CT scan) evidence of TB elsewhere in the body. Systemic corticosteroids are the mainstay of therapy to control active inflammation, while ATT helps to reduce recurrence of inflammatory attacks. Immunosuppressive agents are indicated in cases with relentless progression, paradoxical worsening, or recurrent choroiditis.

To analyze the longitudinal changes in the outer plexiform layer (OPL) in patients with tubercular serpiginous-like choroiditis (TB SLC) and compare it to the healthy control population. Clinical and imaging data of subjects with TB SLC (minimum 6-month follow-up) and healthy control subjects were reviewed. Optical coherence tomography (OCT) imaging obtained using swept-source device (DRI Triton, Topcon, Japan) from three visits (baseline, 3 months, and 6 months) were analyzed. Three OCT scans were chosen—one passing through the center of the fovea, one line above, and one line below. After random indexing to anonymize the images, they were pre-processed and fed into an automated pipeline to identify, crop, and measure the area of the OPL in the line scan. Longitudinal comparisons of OPL within the patient group were performed. The study included 32 eyes (16 patients; 11 males; mean age: 32.9 ± 7.8 years) with TB SLC. Twenty-eight eyes (14 subjects; 10 males: mean age: 31.1 ± 6.2 years) of healthy control subjects (age- and gender-matched) were also selected. The area of OPL was significantly different between the baseline and month 6 visit (6288 ± 1803 versus 5487 ± 1461; p = 0.0002) at the central scan passing through the fovea. For the scans above and below the fovea, the reduction in OPL area was significant at each visit (p p = 0.04) and the 6-month visit (5487 ± 1461 versus 7136 ± 2539; p

PURPOSE: To analyze the serum cytokines profile in patients with tubercular multifocal serpiginoid choroiditis (TB MSC) receiving anti-tubercular therapy (ATT) and oral corticosteroids. METHODS: In this prospective longitudinal study, patients with active TB MSC were included. Serum levels of interferon (IFN)-γ, interleukin (IL)-10, and tumor necrosis factor (TNF)-α were analyzed using bead-based immunoassay. The levels of transforming growth factor (TGF)-β were measured using cytokine bead array. Serial measurement was performed at baseline, 1, 3, and 6 weeks after initiation of therapy. Patients developing paradoxical worsening (PW) of TB MSC were identified and their serum levels of cytokines were compared with those patients who showed healing of lesions. Comparison of cytokine levels with baseline values was also performed. RESULTS: Twelve patients (three females) were included in the study. Four patients showed paradoxical worsening of TB MSC at 3.2 ± 1 weeks after initiation of therapy. Compared to patients who showed healing of lesions, patients with PW showed higher baseline IL-10 (not significant; p = 0.28). Among patients developing PW, levels of IFN-γ peaked at 1 week ((p = 0.01) and levels of TNF-α peaked at 3 weeks (p = 0.02) (coinciding with PW) compared to patients who showed healing. There was no significant difference in TGF-β levels at any time point in either group (p > 0.47). CONCLUSIONS: Baseline and serial levels of inflammatory serum cytokines may help in predicting the response to ATT and corticosteroids in TB MSC. Patients with paradoxical worsening may show rise in pro-inflammatory cytokines after initiation of ATT indicating higher bacillary load.

The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on visual outcome in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Retrospective chart review of patients who underwent PPV for PDR and followed for at least 6 months after surgery. Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to group A. Those who did not receive IVB were assigned to group B. The primary outcome measure was visual outcome at 6-month follow-up. The secondary outcomes were postoperative complications. At 6 months, visual acuity improved by at least 0.3 logMAR units in 70 (74.5 %) of the 94 eyes in group A versus 46 (52.9 %) of the 87 eyes in group B (p = 0.002). Postoperative vitreous hemorrhage occurred significantly less frequently in group A (6 eyes, 6.4 %) than in group B (14 eyes, 16.1 %; p = 0.037). The incidence of other postoperative complications did not differ significantly between the two groups. Preoperative use of bevacizumab improved the 6-month visual outcome in patients undergoing PPV for PDR and significantly reduced the occurrence of postoperative vitreous hemorrhage.

Purpose To report the behavior of intravitreal Ozurdex® implant in eyes with post-lensectomy–vitrectomy (PLV) aphakia. Methods Retrospective chart review of three eyes with PLV aphakia (three patients with uveitis) who received intravitreal injection of Ozurdex® for cystoid macular edema (one eye), persistent inflammation (one eye), and ocular hypotony (one eye). Final outcome was assessed in terms of effectiveness, stability, and tolerance of the implant. Results Following the implant, an initial improvement was seen in all the three eyes. However, the implant migrated into the anterior chamber (AC) at 1 week in two eyes and at 5 weeks in one eye, and wandered between the AC and vitreous cavity with changing postures of the patient. Two eyes developed corneal edema, of which one eye underwent implant removal from the AC. Conclusion Ozurdex® implant should be contraindicated in eyes with PLV aphakia to avoid its deleterious effect on the corneal endothelium.

Objective This study aims to describe changes in high-resolution spectral domain optical coherence tomography (SD-OCT) scans with simultaneous fundus autoflorescence (FAF) signals in tubercular serpiginouslike choroiditis (SLC). Methods Simultaneous SD-OCT and FAF imaging of eyes affected with SLC from acute stage until resolution of lesions was obtained using Spectralis HRA+OCT system (Heidelberg Engineering, Heidelberg, Germany). Patients Four eyes (three patients) with SLC were prospectively followed. Results Acute lesions of SLC (diffusely hyperautofluorescent) corresponded to hyperreflective areas on SD-OCT involving the retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with a minimal distortion of inner retinal layers. There was no backscattering from inner choroid. During healing, lesions became discrete with a hypoautofluorescent border and predominant hyperautofluorescence centrally. The hyperreflective fuzzy areas on SD-OCT scans disappeared, and irregular, knobbly elevations of outer retinal layers appeared. The RPE, POST, IS/OS junction, and ELM could not be distinguished. The ONL appeared normal. The choroid showed an increased reflectance. As the lesions healed further over the next 3–6 months, they became predominantly hypoautofluorescent with loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan. Conclusion The SD-OCT provided an insight into the ultrastructural changes in the outer retina during the course of acute SLC lesions. The changes on OCT correlated with abnormal FAF findings.