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Background/Purpose: The purpose of this report was to describe the use of multimodal imaging to establish the diagnosis of Bartonella henselae--associated optic neuropathy in a patient who presented with a central scotoma without overt evidence of optic nerve involvement. Methods: This was a case report. Main outcome measures included clinical, optical coherence tomography, and fluorescein angiography findings. Observations: A 72-year-old woman presented with a 3-day history of central scotoma in the left eye. Her examination was remarkable for faint exudation in the nasal macula of the left eye but was otherwise normal for her age. Spectral domain optical coherence tomography of the macula revealed mild thickening of the papillomacular bundle with scattered small cystoid spaces and several intraretinal exudates, none of which were visible clinically. Fluorescein angiography revealed localized leakage of the inferotemporal optic disc. When prompted, the patient recalled being scratched multiple times by her two pet kittens. Serial testing showed rising anti--B. henselae (B. henselae) immunoglobulin G antibody titers to 1:1,280, confirming the suspected diagnosis of B. henselae--associated optic neuropathy. Conclusion: Bartonella-associated optic nerve involvement can occur without overt evidence of optic disc swelling. Multimodal imaging can be used to suggest the diagnosis and support appropriate serologic testing. [ABSTRACT FROM AUTHOR]

We provide an updated review of pre-selected RNA viruses causing ocular inflammation in humans. RNA viruses such as coronaviruses and arboviruses are reviewed elsewhere. A Google Scholar search was conducted to identify recent publications on ocular inflammation caused by the RNA viruses specified here. Human RNA viruses target a wide range of ocular tissues from the anterior to the posterior. Influenza, measles and mumps cause anterior segment manifestations including conjunctivitis and keratitis, while retinitis and optic neuritis may be seen posteriorly. Newcastle disease and RSV cause conjunctivitis, whereas HIV causes characteristic anterior uveitis. Cataracts, microphthalmos, and iris abnormalities are common in congenital Rubella, while Rubella virus is associated with Fuchs uveitis syndrome. Newer technologies make it possible to detect more than one pathogen if present simultaneously. RNA viruses may produce significant ocular morbidity, and care should be taken to investigate ocular symptoms during disease outbreaks. [ABSTRACT FROM AUTHOR]

Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review aims to provide an update on the etiopathogenesis, clinical presentations, diagnosis and treatment of SO. Reports cited in MEDLINE database, that analyzed SO in at least 5 patients, published prior to December 1st, 2021 were included. Initially, SO was associated with penetrating ocular trauma, however, various studies reported an increased incidence of SO after surgical procedures including vitreoretinal surgeries. Multimodal imaging including fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography have added further insights into the understanding of SO. While pulse dose corticosteroids & immunosuppressive drugs are still the treatment of choice, TNF-α blockers & other biologic drugs represent new promising agents. There is a growing pool of evidence in understanding the pathogenesis of SO. Novel treatment options have provided better prognosis for this potentially blinding condition. [ABSTRACT FROM AUTHOR]

A woman with calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis syndrome; systemic hypertension; and proliferative diabetic retinopathy and a man with systemic hypertension, polymyalgia rheumatica, and neovascular age-related macular degeneration developed bilateral extensive retinal vascular occlusion with intraretinal hemorrhages after bilateral and unilateral intravitreal bevacizumab injections, respectively. Catastrophic retinal vascular occlusion can occur after intravitreal bevacizumab. Purpose: To describe two cases of catastrophic, bilateral retinal vascular occlusion after intravitreal (IVT) bevacizumab injection. Methods: Case series. Main outcome measures included clinical and fluorescein angiography findings. Results: Case 1—A 65-year-old woman with calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis syndrome developed acute, severe, bilateral visual loss 2 weeks after bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and fluorescein angiography revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages, and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2—An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left eye and then right eye approximately 3 weeks after IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. Fluorescein angiography showed diffuse venous leakage. Extensive testing revealed an elevated antinuclear antibody and mildly elevated anticardiolipin antibody. Conclusion: Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion after treatment with IVT bevacizumab. The moderate-to-severe intraocular inflammation in both cases and the contralateral involvement after unilateral IVT injection in Case 2 suggest a possible delayed immune-mediated mechanism. [ABSTRACT FROM AUTHOR]

A case of Vogt–Koyanagi–Harada-like uveitis followed by melanoma-associated retinopathy with focal chorioretinal atrophy and choroidal neovascularization in a patient with metastatic cutaneous melanoma Purpose: To report a case of Vogt–Koyanagi–Harada-like uveitis followed by melanoma-associated retinopathy with focal chorioretinal atrophy and subsequent choroidal neovascularization in a patient with metastatic cutaneous melanoma. Method: Case report. Main outcome measures include external photography, anterior segment photography, ophthalmoscopic examination, fundus photography, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and electroretinography. Results: A 68-year-old man with a history cutaneous melanoma presented with Vogt–Koyanagi–Harada-like uveitis. Work-up revealed a pelvic mass, which was excised and found to be metastatic melanoma. Two years later, the patient developed melanoma-associated retinopathy with focal chorioretinal atrophy and adjacent choroidal neovascularization. Conclusion: Patients with metastatic cutaneous melanoma can develop distinct and sequential paraneoplastic ocular complications. Onset of a Vogt–Koyanagi–Harada-like uveitis may be a good prognostic factor for survival in patients with metastatic cutaneous melanoma. [ABSTRACT FROM AUTHOR]

Nearly 34 million people are currently living with HIV/AIDS: ocular complications are common, affecting 50% to 75% of all such patients at some point during the course of their illness. Cytomegalovirus retinitis is by far the most frequent cause of vision loss in patients with AIDS. Although the prevalence of cytomegalovirus retinitis is decreasing in industrialized countries because of the widespread availability of highly active antiretroviral therapy, between 10% and 20% of HIV-infected patients worldwide can be expected to lose vision in one or both eyes as a result of ocular cytomegalovirus infection. Less frequent but important causes of bilateral vision loss in patients with HIV/AIDS include varicella zoster virus and herpes simplex virus retinitis, HIV-related ischaemic microvasculopathy, ocular syphilis, ocular tuberculosis, cryptococcal meningitis, and ocular toxic or allergic drug reactions. At present, most patients with HIV/AIDS in developing countries who lose their vision have a very limited life expectancy. As antiretroviral therapy makes its way to these countries, however, both life expectancy and the prevalence of blindness related to HIV/AIDS can be expected to increase dramatically.

To report a case of ocular Gnathostomiasis presenting as branch retinal artery occlusion. Observational case report A 22-year-old Asian woman presented to her ophthalmologist with redness, tearing, and decreased vision in her left eye. Examination revealed anterior uveitis and branch retinal artery occlusion associated with both intra-retinal and vitreous hemorrhage. The patient was treated with topical corticosteroids and cycloplegics. After 3 weeks, she presented in our emergency, with further decrease in vision and worsening pain in the left eye. Slit lamp examination revealed a brown colored live worm on the posterior corneal surface, anterior uveitis, multiple iris holes, and vitreous cells. Indirect ophthalmoscopy showed focal retinal hemorrhages, subretinal tracts, and vitreous hemorrhage. Surgical removal of the worm from anterior chamber was done immediately. Branched retinal artery occlusion with intraretinal and vitreous hemorrhage, panuveitis, and multiple iris holes may suggest the presence of an intraocular parasite. [ABSTRACT FROM AUTHOR]

Segmental retinal arteritis results from severe intraocular inflammation and is believed to represent immune deposits within vessel walls. This study further characterizes the structural and angiographic findings of segmental retinal arteritis using optical coherence tomography angiography, localizing the plaque to the vessel wall with corresponding narrowing of the intraluminal area. Purpose: To describe the vascular anatomy and intraluminal flow characteristics of segmental retinal arteritis (SRA) using structural and angiographic optical coherence tomography (OCT). Methods: Retrospective case series of consecutive patients presenting with SRA. All patients were evaluated at presentation with fundus photography, spectral domain OCT, and OCT angiography. One patient was imaged with dense B-scan OCT angiography. Results: Three eyes of three male patients were evaluated. All examinations were consistent with reactivation of ocular toxoplasmosis with an area of active retinochoroiditis adjacent to a focal chorioretinal scar. Spectral domain OCT through areas of SRA noted on clinical examination demonstrated areas of hyperreflectivity circumscribing the affected vessel with a normoreflective lumen. Optical coherence tomography angiography and dense B-scan OCT angiography demonstrated narrowing of the intraluminal flow signal that correlated with areas of segmental hyperreflectivity on spectral domain OCT. Vascular sections proximal and distal to areas of SRA showed normal flow signal. Conclusion: Vessels with SRA demonstrated hyperreflectivity highlighting the vessel wall on spectral domain OCT. Optical coherence tomography angiography showed narrowing of the flow signal within these segments suggesting reduced lumen diameter. Coupling these finding with previous indocyanine green imaging findings in SRA, the collective data suggest the plaques are localized within the vessel wall to either the endothelium or the muscular tunica media without occlusion of the vessel lumen. [ABSTRACT FROM AUTHOR]

We describe the novel optical coherence tomography finding of foveal outer retinal hyperreflectivity occurring in eyes with idiopathic multifocal choroiditis. Purpose: To describe three patients with idiopathic multifocal choroiditis (MFC) who showed foci of foveal outer retinal hyperreflectivity on optical coherence tomography. Methods: Retrospective review of electronic health records and multimodal imaging from three patients with MFC. Results: Three consecutive white patients with MFC (two male and one female) presented with unilateral foveal outer retinal hyperreflectivity in the eye with active MFC. In all cases, the lesions persisted for at least 1 month. Optical coherence tomography demonstrated finger-like projections of hyperreflectivity extending from the retinal pigment epithelium and through disrupted interdigitation and ellipsoid zones into the outer nuclear layer, with some aspects of the lesions reaching the inner limiting membrane. Visual recovery varied in the three affected eyes. Conclusion: Foveal outer retinal hyperreflectivity is a novel optical coherence tomography finding in eyes with active MFC. Additional studies will be required to address the prevalence and prognostic importance of foveal outer retinal hyperreflectivity. [ABSTRACT FROM AUTHOR]

The authors discuss red flags that should have prompted a search for an infectious cause before initiating systemic corticosteroids treatment in this patient, as well as poor prognostic factors in ocular syphilis. 12 Green MB, Agranat JS, Davoudi S, Sanayei N, Ness S. Penicillin responsive presumed seronegative ocular syphilis in a patient with human immunodeficiency virus: a case report and review of the literature. Syphilis has been a constant companion of mankind for many centuries and yet the exact origin of the disease remains unknown.[1] There are currently two main theories regarding the disease's origin.[2] According to the New World theory, also referred to as the Columbian theory, syphilis was endemic to the Caribbean and was probably brought to Europe after the first visit by Columbus in 1492. [Extracted from the article]

Efficacy of rituximab treatment in Vogt-Koyanagi-Harada disease poorly controlled by traditional immunosuppressive treatment. The authors concluded that in contrast to systemic RTX,[7],[8] subconjunctival RTX appeared to show no therapeutic benefit in their patients with active scleritis. The authors showed that these TRPM2 mediated inflammatory effects are inhibited by RTX in ARPE-19 cells, and specifically that RTX treatment lowered specific oxidant, apoptotic, and inflammatory cytokine mediators - each of which contribute to LPS-induced ARPE-19 cell death. Rituximab (RTX) is a recombinant, chimeric monoclonal antibody directed against the cell surface protein CD20, which is present predominantly on more mature B-cells[1],[2] and to a much lesser extent on a small subset of CD3 + T-cells.[3] Targeting of CD20 by RTX results in depletion of circulating B-cells,[4] an approach used initially to treat B-cell malignancies and more recently for an increasing number of autoimmune conditions. [Extracted from the article]

Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Classical I Klebsiella pneumoniae i (c I KP i ) is a common Gram-negative nosocomial pathogen well-known to cause pneumonia, urinary tract infections, meningitis and sepsis in immunocompromised hosts.[1] Approximately 100 years after the identification of c I KP i by the German pathologist and microbiologist Carl Friedländer in 1882, Liu et al[2] described a series of seven patients from Taiwan with a particularly aggressive form of I KP i associated with hepatic abscesses, sepsis, and distant organ metastasis - including endophthalmitis. Endogenous endophthalmitis associated with pyogenic liver abscess caused by Klebsiella pneumoniae. 16 Li S, Yu S, Peng M. Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases. [Extracted from the article]