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Backgrounds PCR is a proper technique that significantly improves toxoplasmosis diagnosis. However, a more sensitive technique is required. This study compared real-time PCR with nested PCR using B1, SAG-4, and MAG-1 bradyzoite genes to diagnose toxoplasmosis in toxoplasmic retinochoroiditis patients. Methods Blood samples were collected from 10 patients with active toxoplasmic chorioretinal lesions and 10 healthy individuals. Blood samples including peripheral blood mononuclear cells (PBMCs), serum and whole blood samples were used for DNA extraction. Serum was also used to detect anti-toxoplasma IgG and IgM antibodies. Nested PCR and real-time PCR were performed using B1, SAG-4, and MAG-1 target genes. Results Five (50%) out of the 10 patients were tested positive for toxoplasmosis with nested PCR using the PBMC samples. All the five patients tested positive with nested PCR were also tested positive for toxoplasmosis with real-time PCR using the PBMC samples. The real-time PCR results demonstrated that 9(90%) out of the 10 patients were positive based on B1 and the remaining one (10%) was positive only based on MAG-1. In general, of the patients, five (50%) were positive using SAG-4 and three (30%) were positive in term of MAG-1 using PBMCs with real-time PCR. Conclusion It appears that PBMC samples have the best performance as the PCR extraction method and are a good source for toxoplasmosis diagnosis. The use of B22 and B23 target genes due to their high sensitivity and specificity along with bradyzoite genes are recommended for toxoplasmosis diagnosis using PBMC samples with real-time PCR.

Purpose To report a case of Toxoplasma retinochoroiditis that was complicated by macular infarction following intravitreal clindamycin injection. Methods A 32-year-old otherwise healthy woman with the diagnosis of reactivation of Toxoplasma retinochoroiditis in her right eye, underwent intravitreal clindamycin injection. Shortly after injection, the visual acuity deteriorated, and the fundus examination revealed an extensive area of macular necrosis accompanied by vascular occlusion. Results The patient was observed. Unfortunately, the condition did not improve over time and resulted in a large area of retinal atrophy. Conclusion Macular infarction should be considered a rare but disastrous complication that can result in severe, irreversible visual loss.

Purpose: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity.Methods: Observational case series.Results: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'.Conclusion: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.

Background Toxoplasmic chorioretinitis may occur as a result of acquired toxoplasmosis or reactivated congenital toxoplasmosis. In this study, Toxoplasma gondii bradyzoite genes along with the B1 gene were evaluated to detect T. gondii DNA in serum and peripheral blood mononuclear cells (PBMCs) of patients with toxoplasmic chorioretinitis. Methods Blood samples were collected from 10 patients (7 cases of active chorioretinal lesions and 3 cases of old chorioretinal scars). The genomic DNA was extracted from the patients’ serum and PBMCs and a polymerase chain reaction (PCR) assay was performed using bradyzoite genes along with B1. The subjects were also evaluated in terms of the T. gondii antibodies. Results The PCR results were positive in four of seven patients (57.1%) with active ocular toxoplasmosis lesions. In three patients (42.8%), the PCR results were positive for MAG-1 and SAG-4 and in one patient (14.3%) the PCR results were only positive for the B1 gene. The PCR results were positive only in the PBMCs, whereas they were negative in the serum samples. Two patients with positive PCR results showed high Toxoplasma immunoglobulin G (IgG) antibody titres. However, none of the patients showed positive Toxoplasma IgM antibodies. Conclusions The PBMCs are suitable for evaluating toxoplasmic chorioretinitis. The present results showed that PCR with bradyzoite genes is useful in the diagnosis of toxoplasmic chorioretinitis in PBMCs.

Purpose: To study the seasonal variability in the occurrence of acute retinal necrosis (ARN) in a series of polymerase chain reaction (PCR)-positive patients. Methods: Consecutive patients clinically diagnosed with ARN and a positive PCR result of aqueous humor during a seven-year period were studied retrospectively. Patients' demographics, causative viral agent(s), and the date of disease onset were extracted from medical records. Results: Twenty eyes of 20 patients were enrolled; the mean age at presentation was 39.6 ± 14.4 (range, 6–62) years. Nine patients were female. The most common causative agent was varicella-zoster virus in 16 patients (80%), followed by herpes simplex virus in two patients (10%). The disease onset was in winter in 10 patients (50%), and the highest incidence was in February (five patients, 25%). The cumulative occurrence of ARN was significantly higher in the first half of the year (winter and spring) compared to the second half of the year (summer and fall) (P = 0.030). In general, seasons with a high incidence of ARN were preceded by cold seasons. Conclusion: In our series, we observed seasonal variability in the incidence of ARN, with the highest incidence during winter and spring. However, further epidemiologic studies in different geographical areas are required to elucidate the true seasonal nature of ARN.

Vogt-Koyanagi-Harada (VKH) disease is a primary autoimmune stromal choroiditis. This review aimed to provide a novel perspective of the disease. We took into account recent developments in the understanding of the disease and crucial progress in investigational modalities of the choroid, which has led to new, simpler diagnostic criteria. We analysed recent novel notions in the literature and new diagnostic tools for VKH. We identified the following updates for VKH disease: (1) A crucial differentiation between the acute initial-onset and the chronic forms of the disease; (2) the integration of new, precise imaging methods to assess choroidal inflammation; (3) the promotion of simplified, more reliable diagnostic criteria for acute initial-onset of the disease, based on the sine qua non presence of diffuse choroiditis, detected with indocyanine green angiography (ICGA) and/or Enhanced Depth Imaging OCT (EDI-OCT); and (4) treatment optimisation through early, vigorous, sustained corticosteroid and nonsteroidal immunosuppression, as the first line of treatment for initial-onset VKH disease, and monitoring subclinical choroidal inflammation during follow-ups. Several studies have shown that most patients could discontinue treatment without an inflammation relapse. ICGA and EDI-OCT represented the methods of choice for precisely monitoring disease evolution. Simplified, precise, new diagnostic criteria allow early diagnosis of VKH. In VKH disease, inflammation exclusively originates in the choroidal stroma. Therefore, in many cases, early, sustained treatment, with dual corticosteroid and nonsteroidal immunosuppressive therapy can result in full "healing", which obviates chronic, uncontrolled, subclinical choroidal inflammation.摘要: 小柳-原田病 (Vogt-Koyanagi-Harada, VKH) 是一种原发性自身免疫性间质性脉络膜炎。本综述旨在为疾病的诊断与治疗提供一个新的视角。我们将该疾病发病机理的最新进展以及针对脉络膜成像的关键进展进行综合考虑, 提出了新的、更简单的诊断标准。我们对新近文献中的新概念和的VKH诊断手段进行了分析与综合, 总结了VKH疾病的最新进展如下: (1) 急性初发和慢性疾病之间的关键区别; (2) 整合新的、精确的成像方法以评估脉络膜炎症; (3) 以弥漫性脉络膜炎的存在为非必要诊断条件, 通过吲哚青绿血管造影 (indocyanine green angiography, ICGA) 和/或EDI-OCT (Enhanced Depth Imaging OCT, EDI-OCT) 成像技术, 确立简化的、更可靠的疾病急性起病诊断标准; (4) 通过早期、足量、持续的皮质类固醇和非类固醇免疫抑制剂的优化治疗方案, 作为初发VKH的一线治疗, 且在随访期间监测亚临床脉络膜炎症。不少研究均表明, 大多数患者停止治疗后炎症不会复发。ICGA和EDI-OCT是精确测病情的首选方法。新的精确、简化的诊断标准有利于VKH在早期得到诊断。在VKH中, 炎症仅起源于脉络膜基质。因此在许多情况下, 早期、持续、联合皮质类固醇和非类固醇免疫抑制治疗可实现完全“治愈”, 从而避免慢性、不受控制的亚临床脉络膜炎。.

Purpose: To review the clinical features, diagnosis, treatment modalities, and prognosis of Bartonella-associated neuroretinitis. Methods: This is a narrative review on Bartonella-associated neuroretinitis including general and ophthalmological aspects of the disease. A comprehensive literature review between January 1950 and September 2018 was conducted in PubMed database. Epidemiology, clinical features, diagnosis, treatment, and prognosis of Bartonella neuroretinitis were reviewed. Results: Cat scratch disease (CSD) is a worldwide distributed systemic infectious disease caused by a bacterium, Bartonella henselae (B. henselae) which is usually transmitted to humans through contact with infected cats. Ocular manifestations of CSD are diverse, with neuroretinitis and superficial retinal infiltrates being the most common and typical manifestations. Neuroretinitis typically presents as optic disc edema with a partial or complete macular star in association with mild vitritis. Macular star may be absent at the initial presentation, becoming evident 1–2 weeks after the onset of optic disc edema. Diagnosis of CSD is confirmed by reliable laboratory tests. Neuroretinitis usually has a self-limited course. Antibiotic therapy is required for severe systemic disease and vision-threatening ocular involvement. The adjunctive use of oral corticosteroids may further improve the visual outcome. Conclusions: The diagnosis of Bartonella-associated neuroretinitis is based on typical clinical findings and positive serology. The prognosis is usually favorable in immunocompetent individuals. Keywords: Cat scratch disease, Bartonella henselae, Optic neuritis, Serology, Neuroretinitis

Purpose: To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes. Methods: From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study. Results: Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6–25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV; p = 1.000), extent of retinitis (1–2 quadrant vs 3–4 quadrants; p = 0.326), administration of intravitreal ganciclovir (injected vs not injected; p = 0.332), application of prophylactic laser retinopexy (applied vs not applied; p = 0.326), and subsequent occurrence of RRD. At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%; p = 0.047, and 45.4% vs 0.0%; p = 0.004, respectively). Conclusion: Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.

Purpose: To compare chronic subclinical inflammation induced after implantation of Artisan vs. Artiflex phakic intraocular lenses (pIOLs). Methods: This prospective, comparative, non-randomized study included consecutive patients with moderate to high myopia who underwent Artisan or Artiflex pIOL implantation with standard surgery and postoperative care. Anterior chamber flare was assessed quantitatively using laser flare photometry (LFP) at baseline, 1 week, 1 month, 3 months, 6 months, and 2 years after surgery. Results: PIOLs were implanted in 72 eyes (40 patients); Artisan pIOLs in 16 eyes (Artisan group) and Artiflex pIOLs in 56 eyes (Artiflex group). The mean preoperative anterior chamber flare was 6.5 ± 2.3 (range, 4.2â9.5) photons per millisecond (ph/ms) and 4.2 ± 0.9 (range, 2.5â11.7) ph/ms in Artisan and Artiflex groups, respectively (P = 0.400). In spite of early postoperative rise, the flare value returned to preoperative levels 6 months after pIOL implantation and remained stable up to 2 years. The amount of flare was not statistically different between Artisan and Artiflex groups in any postoperative follow-up (all P > 0.05). The trend in flare changes was not different between the studied groups (ANCOVA, P = 0.815). Conclusion: The inflammatory response induced by implantation of either type of Artisan and Artiflex pIOLs is short-lived without statistically significant difference between the two models. Keywords: Subclinical inflammation, Flare, Phakic intraocular lens, Artisan, Artiflex

To report the spectrum of Vogt–Koyanagi–Harada (VKH) disease in Persians. This is a retrospective chart review of patients diagnosed with VKH disease at four referral centers in Iran. Patients’ demographics, ocular and extraocular manifestations, treatment modalities, complications, and visual outcomes were collected and analyzed. Eighty-eight patients with a mean age of 32.1 ± 12.6 years (range 7–79 years) were studied. Fifty-nine patients (67.0%) were female. Sunset glow fundus was seen in 40.9%, and nummular peripheral chorioretinal scars in 55.7% of eyes. Integumentary findings were noticed in 14.8% of the patients. In patients with acute presentation, exudative retinal detachment was the most common ocular finding (87.8%) followed by optic disk swelling (71.4%). Anterior uveitis and vitritis each were found in about half of the studied eyes. Auditory symptoms were reported by 38.8% of the patients. Overall, immunomodulatory agents were used in 72.7% of the patients. Ocular complications occurred in 36.4% of eyes (mean follow-up 3.8 years, range 6–228 months). Final visual acuity was 20/40 or better in 73.3% of eyes. Four patients (4.5%) were classified as having ‘complete’ type of the disease, 36 (40.9%) ‘incomplete’ type, and 48 (54.5%) ‘probable’ type. In our series, there are clinical features that differ from those reported in other studies. While auditory symptoms occurred in more than one-third of patients, integumentary findings were rather rare. Most patients exhibited the ‘probable’ type of VKH disease. The overall visual prognosis was favorable.

To report the efficacy of mycophenolate mofetil (MMF) as adjunctive therapy for the treatment of multiple sclerosis (MS)-associated uveitis.In this retrospective, interventional case series, patients with MS-associated uveitis who were treated by MMF as an adjunct therapy to systemic corticosteroid were studied. Patients' demographics, clinical course, response to treatment, and complications were assessed.A total of 30 eyes of 15 patients with a mean age of 34.5 ± 8.3 years were studied. In three patients (20%), onset of uveitis preceded the diagnosis of MS. The course of MS was relapsing-remitting in 11 patients (73.3%) and secondary progressive in four patients (26.7%). At 1 year after institution of MMF, all the patients were on oral prednisolone ≤ 7.5 mg/day, all eyes were quiet without macular edema, and 53.3% of eyes gained visual improvement. Supplemental periocular and intraocular injections were needed during the first 6 months after starting MMF therapy. The systemic adverse effects were transient and minor in severity.MMF had beneficial effects on vision and intraocular inflammation with an acceptable safety profile.

Vogt–Koyanagi–Harada (VKH) disease is a primary autoimmune granulomatous choroiditis that begins in the choroidal stroma. The aim of this review was to gather a body of evidence for the concept of a window of therapeutic opportunity, defined as a time interval following initial-onset disease during which adequate treatment will substantially modify the disease outcome and possibly even lead to cure, similar to what has been described for rheumatoid arthritis. We reviewed the literature and consulted leading experts in VKH disease to determine the consensus for the notion of a therapeutic window of opportunity in VKH disease. We found a substantial body of evidence in the literature that a therapeutic window of opportunity exists for initial-onset acute uveitis associated with VKH disease. The disease outcome can be substantially improved if dual systemic steroidal and non-steroidal immunosuppressants are given within 2–3 weeks of the onset of initial VKH disease, avoiding evolution to chronic disease and development of “sunset glow fundus.” Several studies additionally report series in which the disease could be cured, using such an approach. There is substantial evidence for a therapeutic window of opportunity in initial-onset acute VKH disease. Timely and adequate treatment led to substantial improvement of disease outcome and prevented chronic evolution and “sunset glow fundus,” and very early treatment led to the cure after discontinuation of therapy in several series, likely due to the fact that the choroid is the sole origin of inflammation in VKH disease.

Purpose: To compare the subclinical inflammatory response (as measured by anterior chamber flare) induced after standard (3 mW/cm2, 30 min) and accelerated (18 mW/cm2, 5 min) corneal cross-linking (CXL).Methods: In this comparative, non-randomized study, patients with progressive keratoconus who underwent standard or accelerated CXL were studied. Laser flare photometery (FM-600; Kowa, Tokyo, Japan) was used to measure anterior chamber flare preoperatively and at 1 week, 1 month, 3 months, and 6 months after the procedure.Results: Sixty eyes of 60 patients were studied; 30 eyes in each group. Mean baseline flare values were 4.15 ± 1.19 and 4.57 ± 2.17 ph/ms in standard and accelerated groups, respectively (p = 0.228).and after surgery increased in all follow-up measurements in the both groups similarly (P > 0.05).Conclusion: Both standard and accelerated CXL results in induction of a subclinical inflammatory response that persists up to 6 month. The response was similar between the two groups.

Introduction. Terson syndrome is described as intraocular hemorrhage in association with any type of intracranial hemorrhage and is associated with higher mortality rate and vision loss. Intraocular hemorrhage in Terson syndrome may be diagnosed using computed tomography but there are false positive results. Silicone oil which is widely used for internal tamponade of complicated retinal detachments has high attenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging that can mimic intraocular hemorrhage. This report shows that silicone oil is another origin of false positive results in interpreting CT findings for detecting Terson syndrome.Case Report. A 71-year-old diabetic woman presented with loss of consciousness. Brain computed tomography revealed right cerebellar hemorrhage and ventricular hemorrhage and hyperdensity in vitreous cavity of the left eye that was initially interpreted as vitreous hemorrhage. Terson syndrome was the initial diagnosis but ophthalmoscopic examination and brain MRI showed that the left eye had silicone oil tamponade.Conclusion. Without knowing the history of previous vitreoretinal surgery, CT scan findings of intraocular silicone oil may be interpreted as vitreous hemorrhage. In patients with concomitant intracranial hemorrhage, it can masquerade as Terson syndrome.

Background: To identify the clinical ocular signs of uveitis associated with latent tuberculosis. Design: Retrospective case-control study. Participants: Consecutive patients from Singapore National Eye Centre Uveitis over 9 years. Sixty-two patients with uveitis associated with latent tuberculosis were compared with 72 matched controls diagnosed with other known uveitides. Methods: Patients were categorized as: (A) predominantly anterior segment inflammation (anterior uveitides) and (B) predominantly posterior segment inflammation (intermediate, posterior or pan-uveitides). The diagnostic performance of combining these clinical signs with investigations such as interferon-gamma release assay positivity and chest X-ray results suggestive of pulmonary tuberculosis was done using area under the receiver operator characteristic curve. Main Outcome Measures: Sensitivity, specificity and likelihood of association with tuberculosis of various clinical signs. Results: Extensive posterior synechiae and concomitant anterior scleritis in Group A; low-grade anterior chamber activity, retinal phlebitis and severe vitritis in Group B were significantly associated with latent tuberculosis. Combining these clinical signs with a positive interferon-gamma release assay and tuberculin skin test improved the diagnostic performance in both groups (area under the receiver operator characteristic curve for Group A = 0.779; Group B = 0.789). Conclusion: Patients with a combination of suggestive clinical signs with positive interferon-gamma release assay and tuberculin skin test are more likely to be accurately diagnosed with uveitis associated with latent tuberculosis, which responds to anti-tuberculosis therapy.

To study the effect of the duration of anti-tubercular treatment (ATT) on the recurrence of uveitis associated with latent tuberculosis (TB).Retrospective review of all consecutive uveitis patients seen at a single, tertiary institution over 9 years with uveitis consistent with TB, positive tuberculin skin test with other causes ruled out, and a minimum of 6 months follow-up after completion of treatment. Clinical characteristics, treatment type, treatment duration and clinical response were recorded. Our main outcome measure was the effect of ATT duration on the recurrence of inflammation.Of the 182 eligible patients, 46 received ATT of ≥ 6 month's duration; 18 patients defaulted and received6 months treatment. The patients' mean age was 45.3 ± 13.2 years and most were female (n=118, 57.6%) and of Chinese race (n=104, 50.7%). Patients who completed9 months ATT were less likely to develop recurrence compared with those not treated with ATT (OR 0.09; 95% CI 0.01 to 0.76; p=0.027), while adjusting for potential confounders such as patient demographics, anatomical location of uveitis and corticosteroid therapy.Patients with uveitis and latent TB treated with ATT of9 months duration had an 11-fold reduction in the likelihood of recurrence.

PURPOSE The aim of this study was to compare the antiinflammatory effect and ocular surface toxicity of topical nonpreserved methylprednisolone sodium succinate 1% and preserved prednisolone acetate suspension 1% for the management of acute anterior uveitis (AAU). METHODS In this prospective, randomized, investigator-masked, comparative clinical trial, patients with mild-to-moderate noninfectious AAU were assigned randomly to receive either hourly nonpreserved methylprednisolone 1% (group A) or preserved prednisolone 1% (group B) eye drops followed by a 2-week tapering regimen. Anterior chamber cells and flare were clinically evaluated for the objective comparison of the antiinflammatory effect. The main outcome measure was the percentage of patients with a resolution of inflammation (anterior chamber cells

The purpose of this work was to improve the efficacy of triamcinolone acetonide (TA) in the treatment of endotoxin-induced uveitis (EIU) using a polymeric nanoparticulate drug delivery system. Poly( d , l -lactide-co-glycolide) (PLGA) nanoparticles were prepared using a modified emulsification/solvent diffusion method. Processing factors affecting loading and size were also studied. After physicochemical studies including in vitro release, X-ray powder diffraction, differential scanning calorimetry, and scanning electron microscopy, in vivo studies were conducted using nanoparticles sized 195 nm with 3.16% drug loading. Inflammatory factors such as flare, cell, and fibrin were studied in rabbit’s eye over 96 h period, using laser flare meter and slit lamp examination. Inflammatory mediators such as NO, PGE2, cell, and protein were measured quantitatively 36 h after intravitreal injection of endotoxin in aqueous humor, and the therapeutic effects were compared in different groups. Results indicated statistically significant differences between the effect of nanoparticles in the treatment of EIU compared to microparticles of TA and prednisolone acetate (PA). There were no significant differences between the effects of TA injection and TA nanoparticles. In conclusion, sustain release biodegradable TA nanoparticles are potential new topical treatment options which can provide better patient compliance.

To identify the clinical ocular signs of uveitis associated with latent tuberculosis. Retrospective case-control study. Consecutive patients from Singapore National Eye Centre Uveitis over 9 years. Sixty-two patients with uveitis associated with latent tuberculosis were compared with 72 matched controls diagnosed with other known uveitides. Patients were categorized as: (A) predominantly anterior segment inflammation (anterior uveitides) and (B) predominantly posterior segment inflammation (intermediate, posterior or pan-uveitides). The diagnostic performance of combining these clinical signs with investigations such as interferon-gamma release assay positivity and chest X-ray results suggestive of pulmonary tuberculosis was done using area under the receiver operator characteristic curve. Sensitivity, specificity and likelihood of association with tuberculosis of various clinical signs. Extensive posterior synechiae and concomitant anterior scleritis in Group A; low-grade anterior chamber activity, retinal phlebitis and severe vitritis in Group B were significantly associated with latent tuberculosis. Combining these clinical signs with a positive interferon-gamma release assay and tuberculin skin test improved the diagnostic performance in both groups (area under the receiver operator characteristic curve for Group A = 0.779; Group B = 0.789). Patients with a combination of suggestive clinical signs with positive interferon-gamma release assay and tuberculin skin test are more likely to be accurately diagnosed with uveitis associated with latent tuberculosis, which responds to anti-tuberculosis therapy.

Primary intraocular lymphoma (PIOL) is a subset of primary central nervous system (CNS) lymphoma which initially presents in the eye with or without simultaneous CNS involvement (1). It is considered a variant of extra-nodal, non-Hodgkin lymphoma that is usually of an aggressive diffuse large B cell type (1–3). Diagnosis of PIOL requires histopathologic evidence of malignant lymphoma cells in brain biopsy, vitreous or CSF specimen (1, 2). Cytological examination is the mainstay method to detect lymphomatous cells (3, 4). Other ancillary tests like flow cytometry, immunohistochemistry staining, cytokine analysis, and gene rearrangement studies also aid in the diagnosis and further classification of PIOL (1, 4). Optic nerve and optic disc involvement may occur in the PIOL (4, 5). Here, we report a case with an unusual presentation of this malignancy presented as an intraocular mass with involvement of the optic nerve head.

Sir, We read with great interest the case reported by Chao AN et al1 describing the formation of pink hypopyon in endogenous endophthalmitis caused by Klebsiella pneumonia. We were curious about the cause of pink hypopyon as Klebsiella pneumonia per se does not contain any pigment. The authors speculated that pink hypopyon is because of extensive necrosis and haemorrhage caused by this microorganism.1 However, the photomicrograph of aqueous aspirate (Figure 1) does not show intact red blood cells (RBCs) to support their postulation. Is it possible that the RBCs had undergone lysis before fixation? Therefore, the pink colour of hypopyon in this case is probably due to an admixture of hypopyon and RBCs, which is not truly specific and may be seen in patients with severe uveitis of other aetiologies.2, 3 Figure 1 Photomicrograph of aqueous aspirate.