Search

To investigate the incidence of and predictive factors for recurrent cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)-negative patients. A retrospective review of HIV-negative patients who were newly diagnosed with CMVR between January 2005 and February 2019. Of 28 patients (44 eyes), 35.9% of eyes had a recurrence of CMVR after discontinuation of anti-CMV therapy. The incidence of CMVR recurrence was 17 per 100 eye-years. The factors significantly associated with CMVR recurrence were eyes with retinitis area of more than 25% (P =.013), absence of vitreous haze (P =.003), neutropenia at presentation (P =.001), and absence of systemic immunosuppression therapy prior to presentation (P =.002). Eyes with a large area of retinitis, absence of vitreous haze, and neutropenia at presentation are predictive of CMVR recurrence while receiving systemic immunosuppression prior to CMVR presentation has a lower risk of CMVR recurrence. [ABSTRACT FROM AUTHOR]

Retinal vasculitis is inflammation of retinal blood vessels typically resulting from infection or immune-mediated inflammatory processes. It may present as isolated ocular inflammation or as a part of severe or potentially fatal systemic disease. Ocular complications of retinal vasculitis include cystoid macular edema, neovascularization, tractional retinal detachment, and vitreous hemorrhage, which all greatly threaten vision. Multimodal imaging and thorough systemic investigations are the main tools for making a precise diagnosis, which aids in predicting disease prognosis and visual outcome as well as preserving a patient's vision and possibly their life. This review aims to discuss the current understanding of retinal vasculitis as well as current diagnostic tools and treatments. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and clinical predictors of ocular involvement in acute herpes zoster ophthalmicus. Methods: A retrospective chart review of 167 patients presenting with acute herpes zoster ophthalmicus at the Outpatient Department of Ophthalmology, Siriraj Hospital, was performed. All skin lesions along the ophthalmic branch of the trigeminal nerve (CN V1) and ocular inflammatory signs were observed and documented. Results: A total of 160 cases were analyzed. The prevalence of ocular inflammation in acute herpes zoster ophthalmicus was 73.1% (117/160). The types of ocular inflammations included conjunctival injection (99.1%), keratitis (51.3%), and iridocyclitis (21.4%). Nasociliary skin lesions (Hutchinson's sign) were the best predictor of ocular inflammation in acute herpes zoster ophthalmicus (p = 0.006, OR = 3.6, 95% CI: 1.5-9.1). Other factors associated with ocular inflammation were a period of longer than 4 days from the onset of rash to an eye examination (p = 0.007, OR = 3.2, 95% CI: 1.4-7.5), and the initiation of systemic acyclovir treatment after 3 days from rash onset (p = 0.037, OR = 2.3, 95% CI: 1.05-4.96). Conclusion: There is a high prevalence of ocular inflammation in acute herpes zoster ophthalmicus, especially among individuals with Hutchinson's sign and delayed systemic acyclovir treatment. General practitioners should be aware of ocular involvement and refer high-risk patients for a complete ophthalmologic assessment. [ABSTRACT FROM AUTHOR]

Purpose: To describe differences in the clinical characteristics of birdshot retinochoroidopathy (BSRC) patients diagnosed early and later in life.Methods: This is a retrospective cohort study. Age was primarily analyzed and 50 years of age at diagnosis was selected as a cut-off point.Results: A total of 144 patients (288 eyes) were included; 68 with early-onset and 76 with late-onset BSRC. The younger group had a statistically significant higher rate of more severe iritis (p = 0.04); an average number of non-steroidal immunosuppressants and biologic agents (NSIB) (p = 0.04); and a prolonged time to initiation of NSIB (p = 0.01). There were only four patients (3%) who had >0.5+ cells in the anterior chamber.Conclusions: Patients with early-onset BSRC carried a higher risk for anterior segment inflammation, had a more prolonged delay to initiation of treatment with NSIB, and required a greater number of NSIBs to achieve remission. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of long-term follow-up of Retisert multiple implantation and dissociation in eyes with chronic noninfectious uveitis.Methods: Review of 187 consecutive Retisert implants. Outcomes of multiple implantation and spontaneous medication pellet-strut dissociation were evaluated.Results: A total of 187 consecutive Retisert implants were reviewed. Eight implants were removed. The prevalence of spontaneous dissociation was 2.6% (5/187). The rate of dissociation increased to 11.11% (2/18) in cases of multiple implants. The mean period between Retisert implantation and spontaneous dissociation was 65.05 months. The mean period between implants in the same eye was 55.25 months. In cases of multiple implantations the old implant was not removed and 17.64% (3/17) of eyes required glaucoma filtering surgery.Conclusion: The rate of spontaneous dissociation of Retisert medication pellet-strut in eyes with single implant for noninfectious uveitis is low, which tends to increase in eyes with multiple implants. [ABSTRACT FROM AUTHOR]

Introduction: Syphilis exhibits a wide range of clinical presentations, mimicking various systemic and ocular diseases. Ocular syphilis, in particular, manifests with multiple presentations, ranging from anterior uveitis to panuveitis, making it a potential differential diagnosis for Behçet’s uveitis. Here, we present a unique case of Behçet’s panuveitis that was undergoing immunomodulatory therapy and was complicated by ocular syphilis. Notably, this case also featured rare cutaneous manifestations associated with secondary syphilis, commonly known as malignant syphilis. Case Presentation: A 38-year-old Thai man with refractory end-stage Behçet’s panuveitis reported a maculopapular rash accompanied by increased intraocular inflammation. The escalation of immunomodulatory therapy, intended to manage the provisional diagnosis of active ocular and cutaneous Behçet’s disease, resulted in clinical deterioration, with the rash transforming into multiple noduloulcerative lesions. Despite negative serologic tests for syphilis at baseline before initiating immunomodulatory therapy, syphilis infection was eventually diagnosed following reevaluation and the observation of spirochetes in a skin biopsy specimen. The patient was treated with intravenous penicillin G, resulting in an improvement in intraocular inflammation and resolution of noduloulcerative rashes. Conclusion: Intraocular inflammation and mucocutaneous lesions in syphilis can mimic the presentation of Behçet’s disease. The introduction of immunomodulatory therapy may alter the clinical picture, leading to a severe and atypical presentation. A high index of suspicion for reevaluating serologic tests or performing tissue biopsies is warranted for an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Tuberculous uveitis (TBU) comprises a broad clinical spectrum of ocular manifestations, making its diagnosis challenging. Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU. Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens, resultant test positivities are low in yield. Immunodiagnostic tests, including the tuberculin skin test and interferon-gamma release assays (IGRAs), can help support a clinical diagnosis of TBU. Unlike the tuberculin skin test, IGRAs are in vitro tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination. Currently, available IGRAs consist of different techniques and interpretation methods. Moreover, newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis. This narrative review collates salient practice points as a reference for general ophthalmologists, such as evidence for the utilization of IGRAs in patients with suspected TBU, and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting., (International Journal of Ophthalmology Press.)