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Purpose: To describe a case of bilateral panuveitis in an 11-year-old girl with autoimmune lymphoproliferative syndrome (ALPS) due to CTLA4 haploinsufficiency. Case Description: A 5-year-old girl developed cervical adenopathy, and autoimmune hemolytic anemia and thrombocytopenia consistent with Evan's Syndrome. She was subsequently diagnosed with autosomal dominant CTLA4 haploinsuffciency and treated with immunosuppressants. Ocular symptoms developed 6 years later when she complained of blurry vision and photophobia. There were 3+ anterior chamber cells and 1+ flare, stellate keratic precipitates, and 3+ vitreous cells in both eyes. On fluorescein angiography, there was staining along the arcades and peripheral perivascular leakage in both eyes. On indocyanine green angiography, there were hypofluorescent spots throughout the posterior pole. The inflammation was partially responsive to topical and oral corticosteroids. Conclusion: Panuveitis may be associated with ALPS due to CTLA4 haploinsufficiency. Retinal and choroidal involvement should be assessed when anterior chamber inflammation is the presenting sign. [ABSTRACT FROM AUTHOR]

Tele-ophthalmology using portable retinal imaging technology, mobile phone and Internet connectivity offers a solution to improve access to diabetic retinopathy (DR) screening services in sub-Saharan African (SSA) countries where the burden of diabetes is increasing and there is limited access to eye care services and specialists. The Zimbabwe Retinopathy Telemedicine Project (ZRTP) established routine DR screening at a hospital-based diabetic clinic in the urban capital city, Harare. A handheld 'point and shoot' digital camera operated by a trained nurse was used to acquire retina images of 203 diabetic patients. A secured 'store-and forward' approach was set up and used for sharing and transfer of images to a retinal specialist at a remote site for reading. This method enabled detection of non-macular DR (11%), diabetic macular oedema (5%), cataract (5%) and glaucoma (6%) among the patients screened. ZRTP demonstrated the utility of tele-ophthalmology for routine retinal screening for diabetic patients in Zimbabwe who have limited access to eye care services. In addition, ZRTP showed how tele-ophthalmology services can provide an empirical framework for providing patient education, and a platform for research in the detection of DR. This approach could be used as a model to address the DR challenges in other countries in SSA. [ABSTRACT FROM AUTHOR]

Background and Objective: This study aimed to investigate clinical characteristics associated with return to pre-endophthalmitis visual acuity (VA) following treatment for presumed infectious endophthalmitis., Patients and Methods: This was a retrospective study of 74 eyes with endophthalmitis and VA recorded ≤ 12 weeks before presentation and 6 months after presentation between 2009 and 2018., Results: Thirty-six of 74 eyes (49%) returned to preendophthalmitis VA. Eyes with a positive intraocular fluid culture had 71.5% lower odds of returning to pre-endophthalmitis VA. Nine of 10 eyes (90%) treated with initial pars plana vitrectomy failed to return to pre-endophthalmitis VA. Endophthalmitis following cataract surgery was a characteristic of eyes that returned to pre-endophthalmitis VA. Symptom duration, time to presentation, and treatment with systemic corticosteroids were not significant predictors of visual recovery., Conclusion: Just under 50% of eyes with presumed infectious endophthalmitis returned to preendophthalmitis VA. A positive intraocular culture is associated with failure to return to pre-endophthalmitis VA. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.] .

Purpose: Report the clinical findings, risk factors, treatment, and visual outcomes associated with  Streptococcus  endophthalmitis in comparison to culture-positive endophthalmitis associated with non- Streptococcus  species., Methods: A retrospective chart review of adults between 18 and 89 years of age diagnosed with exogenous culture-positive endophthalmitis between January 1, 2009, and January 1, 2018, at the Duke Eye Center (Durham, North Carolina) with at least six months of follow-up from time of initial diagnosis was conducted. Clinical data including patient demographics, ocular history, baseline corrected visual acuity (VA) prior to presentation, time to presentation, presenting exam findings, VA at presentation, presumed etiology of endophthalmitis, medical and surgical management, and VA at the six-month follow-up was extracted and statistically analyzed., Results: Fifty-six eyes from 56 patients with culture-positive endophthalmitis were identified. Eyes with  Streptococcus  (n=18) had elevated intraocular pressure (IOP) at presentation (p=0.002), worse mean VA (Snellen) at presentation (20/14159 vs. 20/3098, p<0.001), and worse mean VA (Snellen) at six months (20/3475 vs. 20/235, p<0.001) compared to non- Streptococcus  cases (n=38). Time to presentation (days) (median, IQR) was longer in eyes that underwent glaucoma surgery for both Streptococcus (2241 (836, 3709) vs. 3 (2, 31), p=0.003) and non- Streptococcus  endophthalmitis (1236 (125, 3582) vs. 6 (4, 25), p<0.0001). There was no difference in VA at six months between  Streptococcus  and non- Streptococcus  eyes based on treatment.  Conclusions: Streptococci are rare but important causes of exogenous endophthalmitis, and in our study, they were associated with worse visual outcomes than non- Streptococci . A history of any glaucoma surgery, even procedures performed years earlier, should be elicited when evaluating patients with ocular symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Duke University Health System Institutional Review Board issued approval Pro00091062. Review charts and access patient data components were determined to be in compliance with all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Woodward et al.)