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This review summarizes the impact of systemic and ocular inflammatory disorders on diabetes mellitus (DM) and diabetic retinopathy (DR). Local inflammation is a key pathology in diabetic retinopathy (DR) and is also an evolving target for clinical therapy. The legacy effects of local inflammation at the intracellular level make DR a persistent self-driven vicious process. Ocular inflammation is accompanied as well as incited by systemic inflammation due to diabetes mellitus (DM) itself. Over the years, a multitude of studies have evaluated the impact of systemic inflammatory disorders (SIDs, like rheumatoid arthritis, lupus, psoriasis, etc.) and anti-inflammatory drugs prescribed for managing them on manifestations of DM. Recent studies have indicated increased insulin resistance to be a result of chronic inflammation, and the anti-inflammatory drugs to have a protective effect towards DM. Very few studies have evaluated the impact of SIDs on DR. Furthermore, the evidence from these studies is conflicting, and while local anti-inflammatory therapy has shown a lot of clinical potential for use in DR, the results of systemic anti-inflammatory therapies have been inconsistent. The impact of local ocular inflammation due to uveitis on DR is a crucial aspect that has not been evaluated well at present. Initial pre-clinical studies and small-sized clinical reports have shown a strong and positive relationship between the presence of uveitis and the severity of DR as well as its progression, while larger cross-sectional patient surveys have refuted the same. The long term impact of ocular inflammation due to uveitis on DR needs to be studied while adjusting for confounders. [ABSTRACT FROM AUTHOR]

Purpose: To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) disease in elderly patients. Methods: Retrospective analysis of patients older than 50 years with VKH disease at two referral centers in India. Demographics, extraocular and ocular involvement, treatment, complications, and visual acuity outcomes were noted. Results: In total, 69 patients (mean age at presentation: 56.4 ± 4.7 years) were analyzed; 6/69 patients had diabetes mellitus at presentation, and 10/69 had hypertension. Clinical signs included anterior chamber cells >2+ (29%), granulomatous keratic precipitates (23%), disc hyperemia (26%), neurosensory retinal detachment (34.7%), and "sunset-glow" fundus (52.1%). Patients were classified as probable (n = 50, 72.4%), incomplete (n = 18, 26%), and complete VKH (n = 1, 1.4%). The mean follow-up period was 20.2 ± 19.4 months. Improvement in mean BCVA of (0.63 LogMAR, 6 Snellen lines) was noted on the last follow-up. Patients receiving systemic steroids with immunosuppressants (P < 0.0001) had better visual outcomes at final follow-up compared to steroids alone (P = 0.103). Eight patients (11.6%) had complications due to systemic immunosuppressants, and 17 patients (24.6%) developed diabetes mellitus or had worsening of diabetes while on systemic corticosteroids. Conclusion: Few patients presented with systemic manifestations in our cohort. Those treated with steroids and concurrent immunosuppressants had better outcomes. However, therapy with immunosuppressants was encountered with major dose-limiting complications in a significant number of elderly patients with VKH syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To study the role of Toxoplasma IgG avidity in evaluating the stage of systemic infection during manifestation as toxoplasma retinochoroiditis and its clinical implications in eastern India. Methods: Retrospective chart review of Toxoplasma retinochoroiditis cases with Toxoplasma serology for IgG, IgM, and IgG avidity. Results: Included in this study were 17 eyes of 17 patients who had active retinitis located in the macula (14), mid-periphery (2), or periphery (1). They were either primary lesions (12) or reactivations (5). All the cases had Toxoplasma IgG positive; one case had IgM positivity, while all the cases had high IgG avidity values. IgG avidity had a positive correlation with the duration of symptoms. Conclusion: We observed high IgG avidity values in active retinochoroiditis in both primary ocular Toxoplasmosis and reactivation subgroups. These results indicate a late ocular manifestation after initial systemic infection with a possible incubation period ranging from 5 weeks to 5 months. [ABSTRACT FROM AUTHOR]

To report an atypical case of bilateral syphilitic chorioretinitis. A case report. A young male presented with bilateral pigmentary retinal changes along with multifocal chorioretinal lesions along the blood vessels giving a "beaded pearl" appearance. He was a hitherto undiagnosed case of human immunodeficiency virus infection and was diagnosed to have syphilis. He had a favourable visual and anatomical outcome following treatment. Multifocal chorioretinal lesions along blood vessels forming a "beaded pearls" appearance can be a rare and unique presentation of syphilis. [ABSTRACT FROM AUTHOR]

To describe the pathogenesis and the general immune mechanisms of the most frequent causes of bacterial uveitis. Narrative review Both extra- and intracellular bacteria can induce uveitis, whereas intracellular bacteria are generally transported into the inner eye via cells of the innate immune system, mainly macrophages. Systemic adaptive immunity is usually induced before the bacteria are localized to the inner eye, and once T and B cells have detected the pathogens behind the blood-eye barriers they elicit an acute and/or chronic inflammatory response deteriorating visual acuity that can severely affect the non-regenerating, intraocular tissues. An understanding of pathogenic mechanisms, and its correlation with clinical and imaging features, can facilitate early recognition of microbial factors and institution of appropriate therapy. [ABSTRACT FROM AUTHOR]

A 23-year-old man, under treatment for relapsing remitting multiple sclerosis, presented with sudden drop in vision in the left eye for the past 1 week. We noted optic atrophy with sclerosed vessels in multiple quadrants in both eyes, moderate vitreous haze, and active retinal vasculitis in left eye. The patient received therapeutic pars plana vitrectomy in the left eye, and the vitreous sample was analyzed for immunophenotypes by flow cytometry (T-cells) and immunohistochemistry (B-cells). 65.1% of total vitreous cells were CD3+ T-cells. These included 42.4% CD4+, and 20.6% CD8+ T-cells. Immunohistochemistry detected CD20+ B-cells (not quantifiable). Our analysis demonstrated a mixed B- and T-lymphocyte vitreous infiltrate in multiple sclerosis-associated uveitis. [ABSTRACT FROM AUTHOR]

To report the pattern of noninfectious scleritis across a tertiary eye-care network. A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system. 1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32–685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%). This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations. [ABSTRACT FROM AUTHOR]

We report the use of DNA chip technology in the identification of Toxoplasma gondii as the etiological agent in two patients with recurrent intermediate uveitis (IU). Both patients had recurrent episodes of vitritis (with no focal retinochoroidal lesion) over varying time intervals and were diagnosed to have IU. The tuberculin test was negative in both. Blood counts, erythrocyte sedimentation rate, and serum angiotensin convertase enzyme levels were normal. In both cases, the vitreous fluid tested positive for the T. gondii DNA sequence by using a uveitis DNA chip (XCyton Pvt. Ltd., Bangalore, India). It contained complimentary sequences to "signature genes" of T. gondii, Mycobacterium tuberculosis, M. chelonae, and M. fortuitum. The enzyme-linked immunosorbent assay (ELISA) detected elevated serum antitoxoplasma IgG levels in both. They responded to the antitoxoplasma therapy with oral co-trimoxazole (and additional intravitreal clindamycin in patient 1), with no recurrence during follow-ups of 6 and 8 months, respectively.

Purpose: To describe clinical and imaging characteristics of the outer retinal folds (ORF) in cases of retinitis, retinochoroiditis, and chorioretinitis.Methods: Retrospective review of retinitis cases with presence of ORFs either at presentation or during follow up.Results: ORFs were seen adjacent to retinitis lesions in 16 eyes of 14 cases (retinitis post-febrile illness n = 10, toxoplasma retinochoroiditis n = 2, fungal chorioretinitis n = 2) either at presentation (n = 2) or during follow up (n = 14). Optical coherence tomography (OCT) appearance was outer retinal vertical stout lesions involving ellipsoid, external limiting membrane, and outer nuclear layer. All the cases had a presence of past or concurrent subretinal fluid and/or subretinal hyperreflective material when ORF was seen. ORF resolved with variable outer retinal atrophy over a mean period of 2.86 months.Conclusion: ORF is observed in cases of retinitis with subretinal fluid either at presentation or during resolution. It is not specific to any etiological disease. Differentiation of this sign from vertical outer retinal stripes in viral retinitis on OCT is important to avoid misinterpretation. [ABSTRACT FROM AUTHOR]

To describe clinical and multimodal imaging characteristics of punctate inner retinal toxoplasmosis (PIRT) as an atypical presentation of ocular toxoplasmosis (OT). Retrospective review of OT cases with PIRT lesions and review of the literature. We describe five cases (6 eyes). PIRT lesions were seen adjacent to active/healed toxoplasma retinochoroiditis. The appearance of PIRT was creamy yellowish-white, inner retinal, punctate, and sub-centimetric lesions. The depth of these lesions on optical coherence tomography was till the outer plexiform layer. Co-existing punctate outer retinal toxoplasmosis (PORT) was found in three eyes and recurrent retinochoroiditis in three. The fate of PIRT was resolution with minimal retinal thinning or progression to a full-thickness retinochoroiditis. PIRT was noted in association with typical toxoplasma retinochoroiditis and PORT lesions, and had equal chances of resolution or progression to full-thickness lesions. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics and epidemiology of uveitis presenting to a multi-tier ophthalmology hospital network in Southern India.Methods: Cross-sectional hospital-based study of 19,352 patients with uveitis presenting between March 2012 and August 2018.Results: In total, 1,734,272 new patients were seen across the secondary and tertiary centers of our multi-tier ophthalmology hospital network during the study period. Among them, 25,353 eyes of 19,352 patients were diagnosed with uveitis and were included in the study. Uveitis constituted 1.11% of all cases. The majority of patients were male (60.33%) and had unilateral (68.09%) affliction. The most common age group was 21-50 years with 12,204 (63.06%) patients. The most common type of uveitis was anterior uveitis, which was seen in 7380 (38.14%) patients, followed by posterior uveitis in 5397 (23.89%) patients. Among the infectious causes, tuberculosis was the most common etiology (2551 patients, 13%) followed by toxoplasmosis (1147 patients, 6%).Conclusion: Uveitis constituted 1.11% of all cases presenting to our clinics. It was more common in the age group of 21-50 and was predominantly unilateral. Anterior uveitis was the most common subtype seen in 38%. [ABSTRACT FROM AUTHOR]

To look at markers to differentiate ocular sarcoidosis from ocular tuberculosis in a high TB endemic population. Retrospective multicenter study involving seven tertiary eyecare centers in India between July 2016 to December 2016. Demographic, clinical and laboratory data were retrieved from respective hospital databases. Group A included biopsy-proven ocular sarcoidosis while group B included ocular tuberculosis. Data from 2726 consecutive patients with uveitis were retrieved from the databases. Group A had 61 cases while group B included 307 cases. The mean age in group A was 43 ± 16.55 years while in group B was 38 ± 13.13 years. Females were more common in group A. Uveitis with low Schirmer test (OR-30, CI-95%), candlewax retinal vasculitis (OR-8.69, CI-95%), hilar lymphadenopathy (OR-15.23, CI-95%), fissural nodules (OR-39.11, CI-95%) had higher odds of having ocular sarcoidosis. Presence of dry eye, candlewax retinal vasculitis, hilar lymphadenopathy, and fissural nodules if present in a patient with uveitis, could help differentiate ocular sarcoidosis from ocular tuberculosis in a high TB endemic population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate recurrence patterns following anti-tubercular therapy (ATT) in different anatomical presentations of ocular tuberculosis (OTB).Methods: Retrospective analysis of clinically diagnosed OTB patients divided anatomically into groups A (anterior + intermediate uveitis) and B (posterior + panuveitis). Recurrence was defined as reappearance of intraocular inflammation in a quiescent eye following completion of at least 6-months ATT. Anatomical sites of recurrence were compared to that of presentation.Results: No significant difference in post-ATT recurrent inflammation was noted between groups A (14.29%, 4/28) and B (8.59%,11/128) (p = .57). Mean follow up was 13.13 ± 14.67 months. All group A recurrences were in the same anatomical segment, whereas in group B, 41.7% (5/11) recurrences were in group A sites. Overall, the group A:B ratio was significantly higher during recurrent inflammation (8:7) than at presentation (28:128) (p < .0001, z-score).Conclusion: Anterior and intermediate uveitis, though uncommon at presentation, are relatively more common during post-ATT recurrences in OTB. [ABSTRACT FROM AUTHOR]

The pathogenesis of ocular tuberculosis (TB) has remained unclear due to the challenges of performing mechanistic studies on clinical samples. Animal models have the potential to bridge these gaps by providing information about ocular dissemination and localization of mycobacteria, innate and adaptive immune response, and granuloma formation in the eye. Here, we critically review various animal models of ocular TB from the early 20th century to date and derive novel insights into pathogenesis of ocular TB that have direct implications on the diagnosis and treatment of this disease. Future directions on experimental approaches to understanding pathogenesis of ocular TB are also discussed. [ABSTRACT FROM AUTHOR]

Purpose: Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. Methods: We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. Results: The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5–72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7–63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. Conclusion: Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19. [ABSTRACT FROM AUTHOR]

The role of inflammation in diabetic retinopathy (DR) is well-established and dysregulation of a large number of inflammatory mediators is known. These include cytokines, chemokines, growth factors, mediators of proteogenesis, and pro-apoptotic molecules. This para-inflammation as a response is not directed to a particular pathogen or antigen but is rather directed toward the by-products of the diabetic milieu. The inflammatory mediators take part in cascades that result in cellular level responses like neurodegeneration, pericyte loss, leakage, capillary drop out, neovascularization, etc. There are multiple overlaps between the inflammatory pathways occurring within the diabetic retina due to a large number of mediators, their varied sources, and cross-interactions. This makes understanding the role of inflammation in clinical manifestations of DR difficult. Currently, mediator-based therapy for DR is being evaluated for interventions that target a specific step of the inflammatory cascade. We reviewed the role of inflammation in DR and derived a simplified clinicopathological correlation between the sources and stimuli of inflammation, the inflammatory mediators and pathways, and the clinical manifestations of DR. By doing so, we deliberate mediator-specific therapy for DR. The cross-interactions between inflammatory mediators and the molecular cycles influencing the inflammatory cascades are crucial challenges to such an approach. Future research should be directed to assess the feasibility of the pathology-based therapy for DR. [ABSTRACT FROM AUTHOR]

Purpose: To describe the course of posterior subhyaloid precipitates (PSPs) accompanying active retinitis. Methods: Retrospective study of three retinitis cases associated with PSPs and literature review. Results: Cases 1 and 2 were Toxoplasma retinochoroiditis. Case 3 had bilateral retinitis post-febrile illness. PSPs were yellowish-white spherical lesions seen in the presence of partial posterior hyaloid detachment (PVD) in the retro-hyaloid space lining the inferior PVD margin. In all 3 cases, PSPs resolved during treatment for primary disease. Resolution of PSPs preceded resolution of retinitis. Literature review revealed similar lesions in CMV retinitis and syphilis in addition to Toxoplasma retinochoroiditis. Conclusion: PSPs were seen in the presence of active retinitis and partial PVD when inflammatory aggregates gravitate inferiorly in the subhyaloid space. They were observed during active retinitis and their resolution preceded the resolution of retinitis, thus providing a potential marker for disease resolution. [ABSTRACT FROM AUTHOR]

Purpose: To analyse clinico-microbiological profile, antimicrobial susceptibilities, and visual prognostic factors in post-traumatic endophthalmitis (PTE). Methods: Retrospective clinico-microbiological data analysis for five years (2014–18). Prognostic factors for visual outcomes were analysed by multivariate logistic regression analysis. Results: Four hundred and eighteen patients with clinically diagnosed PTE were analysed. Culture positivity was found in 46.7% samples (44.5% vitreous, 83.3% non-vitreous). Pathogens isolated were Gram positive cocci (GPC, 49.3%, good susceptibility to vancomycin/cefazolin), Gram negative bacilli (GNB, 28.1%, <90% susceptibility to all antibiotics and 25.8% multidrug resistance), Gram positive bacilli (13.1%) and fungi (9.5%). Poor visual prognosis was associated with culture positivity, fungal or polymicrobial PTE, poor view of fundus and presence of membranes on ultrasound scans. Conclusion: GPC and GNB are the predominant pathogens in PTE, with GNB most commonly multidrug resistant. Culture positivity, polymicrobial and fungal PTE, poor view of fundus and vitreous membranes are markers of poor visual outcome. [ABSTRACT FROM AUTHOR]

Purpose: Infection by the SARS-CoV2 virus results in an immune dysregulated state which can predispose to reactivation of Herpes viruses. This report describes the development of Acute Retinal Necrosis (ARN) in two patients who had recovered from SARS-CoV2 infection.Methods: Observational report of two consecutive patients who presented with ARN after having recovered from SARS-CoV-2 infection.Results: Case 1 was a 5-year-old child with extensive peripheral necrotizing retinitis. Case 2 was a 61-year-old gentlemen with bilateral retinal detachment with sieve-like breaks and optic atrophy. Both patients had recovered from SARS- Cov-2 infection 1 month ago. PCR from vitreous sample of both patients was positive for Herpes simplex virus. Case 1 was treated with oral valacyclovir. Case 2 underwent surgery in both eyes for retinal detachmentConclusion: Immune dysregulation after COVID-19 infection can result in reactivation of herpesvirus and may lead to development of ARN. [ABSTRACT FROM AUTHOR]

Purpose: To describe disease manifestations and outcomes of ocular syphilis in Asian Indian population.Methods: Retrospective analysis of patients diagnosed with ocular syphilis at a tertiary referral center in India. Demographics, history, extraocular and ocular manifestations, ocular and systemic investigations, treatment and visual acuity outcomes were noted. All patients were diagnosed after necessary laboratory investigations including HIV ELISA (Human immunodeficiency virus, enzyme-linked immunosorbent assay), VDRL (venereal disease research laboratory), and TPHA (treponema pallidum hemagglutination).Results: Totally, 20 patients with mean age at presentation 38.25 ± 9.76 were analyzed. 9/20 patients had bilateral involvement. 8/20 had concurrent HIV at presentation with an average CD4 counts of 592.25 ± 411.34 cells/microliter. The mean duration of symptoms at time of presentation was 15.45 ± 35.15 weeks. VDRL test was reactive in 45% (9/20) patients whereas, all patients had a reactive TPHA test. Clinical manifestations included outer retinal placoid chorioretinitis lesions (8/20, 40%), followed by retinitis mimicking acute retinal necrosis as the second most common phenotype (4/20, 20%). Other presenting manifestations noted were panuveitis, miliary retinitis lesions, retinal vasculitis, intermediate uveitis, and anterior uveitis. The clinical phenotypes in immunocompromised included panuveitis, acute retinal necrosis and isolated anterior uveitis. Mean follow up duration was 6.32 ± 6.15 months. An improvement in mean best corrected visual acuity (BCVA) of (0.63 LogMAR, approximately 6 Snellen lines, P < 0.02) was noted at last follow-up.Conclusion: Phenotypic manifestations of ocular syphilis are varied. Non-treponemal tests like VDRL may be unreliable when compared with treponemal tests in diagnosing ocular syphilis. Syphilitic uveitis is considered equivalent to neurosyphilis and is treated similar to neurosyphilis. [ABSTRACT FROM AUTHOR]

A middle-aged man had been diagnosed as retinitis and treated with steroids previously. The patient had developed macular infarction in the course of illness. We diagnosed him to have rickettsial retinitis on the basis of clinical features and positive Weil-Felix test. The patient’s condition improved after treatment with oral antibiotics. The vasculature of the infarcted macula showed partial reperfusion late in the course of follow-up. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes. Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia. [ABSTRACT FROM AUTHOR]

Objectives: To report the microbiological spectrum of conjunctival flora and prevalence of biofilm-forming Methicillin-resistant Staphylococcus aureus (MRSA) in conjunctival flora in chronic dacryocystitis.Design: Prospective, case-control study.Methods: We included patients with unilateral chronic dacryocystitis, and their unaffected eyes as control. Microbiological profile and antibiotic susceptibility of the isolates was determined by standard microbiological procedures. S. aureus isolates were further evaluated for Methicillin resistance by Oxacillin resistance screening agar method and mecA polymerase chain reaction (PCR) and for biofilm synthesis by Congo red agar method, Microtitre plate (MTP) assay, and ica A and ica D PCR.Results: We found 95 patients with unilateral chronic dacryocystitis. Aerobic Gram-positive isolates (74.2%, n = 72) were more than Gram-negative (25.7%, n = 25) or anaerobic isolates (20.5%, n = 25). S. aureus was most common (46.4%, n = 45), followed by Pseudomonas aeruginosa (10.3%, n = 10). Gram-positive isolates showed highest sensitivity to Linezolid (100%) and higher generation fluoroquinolones. Gram-negative isolates showed good sensitivity (>90%) to all tested antibiotics. S. aureus isolates showed MRSA prevalence as 93.5% and 96.9% by Oxacillin resistance screening agar method and mecA PCR, respectively. Biofilm formation was found in 71.8% MRSA isolates by MTP assay and 58.1% MRSA isolates were resistant to ≥3 classes of antibiotics.Conclusions: Gram-positive organisms, specifically S. aureus, are the major etiological agent in chronic dacryocystitis. There is high prevalence of MRSA in these isolates and concurrent biofilm formation. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the safety and efficacy of sustained-release intravitreal dexamethasone implant (Ozurdex) in management of TB-associated multifocal serpiginoid choroiditis (MSC).Methods: Retrospective review of TB-associated MSC patients, treated with anti-TB therapy (ATT) and adjunctive intravitreal Ozurdex.Results: Nine eyes of six patients were included. Four patients required Ozurdex implant for progressive or new lesions following ATT and two for additional systemic contraindications to corticosteroids - hyperglycemia and uncontrolled hypertension, respectively. The mean time to resolution was 9.17 ± 7.71 weeks. The mean follow-up post-injection was 13.11 ± 6.05 months (median 12 months [range 6-24.5 months]). Only one of nine eyes developed recurrent MSC lesions and this was attributed to possible autoimmune etiology. Two eyes (22.2%) developed steroid-induced glaucoma - one required implant removal.Conclusions: Sustained-release intravitreal dexamethasone is a safe and efficacious adjunctive anti-inflammatory therapy for TB-associated MSC patients with contraindication for systemic corticosteroids or requiring supplemental anti-inflammatory therapy. [ABSTRACT FROM AUTHOR]

We describe a case of right eye tubercular (TB) panuveitis with corneal involvement where repeated intraocular sampling was unsuccessful. Finally, evisceration and histopathology of ocular tissue confirmed the diagnosis of ocular tuberculosis. A chest X-ray showed signs of pulmonary TB. The patient was lost to follow-up but reported 2 months later with the right eyelid margin nodules with surface ulceration. Both eyelid and pulmonary lesions were resolved with anti-TB therapy. [ABSTRACT FROM AUTHOR]

Ocular tuberculosis (TB) commonly causes severe inflammation and vision loss in TB-endemic countries. The mechanism by which tuberculous infection becomes established in the eye is poorly understood. We have developed the zebrafish larva infected with Mycobacterium marinum as a model to study the early pathogenesis of ocular TB. We find that hematogenous bacterial seeding of the eye occurs despite a functional blood retinal barrier. Prototypical early granulomas form in response to bacteria in the eye. These granulomas involve the retinal vasculature and retinal pigment epithelium-choroid complex which are characteristic locations for human ocular TB. We find that peripheral blood monocytes are recruited to the nascent ocular granuloma further suggesting that the immune privileged nature of the eye is breached by this inflammatory focus. [ABSTRACT FROM AUTHOR]

Intraocular tuberculosis (TB) can have several clinical presentations, affecting nearly every tissue of the eye. These clinical signs have specific imaging characteristics which help in associating them with tuberculous etiology. This review enumerates the conventional and emerging imaging techniques for intraocular TB and highlights their clinical application for diagnosis and management of specific clinical presentations. [ABSTRACT FROM AUTHOR]