A rare presentation of Nocardia Choroidal Abscess after Glioblastoma surgery.

PURPOSE: to report the natural history of a rare ocular manifestation of endogenous Nocardia farcinica infection in an immunocompromised patient, with involvement observed in both the anterior and posterior segments of the eye. METHODS AND RESULTS: Given the patient's limited mobility, a handheld fundus camera was utilized for bedside anterior segment and ocular fundus examinations. The findings included visual acuity of hand motion, posterior synechiae, vitreal opacity, and a large choroidal abscess. We monitored the lesion's progression through a series of follow-ups. Despite not employing intravitreal drug therapy, we noted a significant reduction in the lesion's size until the patient's overall health deteriorated. CONCLUSIONS: This case contributes valuable information to our understanding of the natural history of a rare condition like Nocardia endophthalmitis. We highlighted the usefulness of a handheld fundus camera in aiding infectious disease specialists in assessing the immediate response to systemic treatment.

From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections.

In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.

Management of Spontaneous Crystalline Lens Luxation in a Patient Diagnosed with Takayasu's Disease.

Takayasu's disease is a chronic granulomatous arteriopathy that affects large vessels and their major branches. Nonspecific symptoms characterize the early phase, whereas findings of arterial occlusion and aneurysmal formation become manifest later. Ocular signs typically refer to retinal vascular involvement, as Takayasu arteritis or hypertensive retinopathy. We report a case of a 63-year-old woman suffering from Takayasu arteritis that complained of sudden onset of blurred vision in her left eye due to crystalline lens luxation in the vitreous cavity. The patient's past medical history was unremarkable for trauma, personal or familiar collagenopathies. Prompt surgical management was performed and the patient reached 0 LogMAR seven days after surgery. Our case illustrates the concomitant occurrence, never reported before, of two rare conditions in the same patient, namely, Takayasu arteritis and spontaneous lens dislocation. Further research and future knowledge are needed to explain whether Takayasu arteritis could obliquely injure zonular or fibrillar structures and whether these features may be possibly related.

Treatment and Prognosis of Vogt-Koyanagi-Harada Disease: Real-Life Experience in Long-Term Follow-Up.

Background: Vogt−Koyanagi−Harada (VKH) disease is a form of uveitis that is rare in Western countries. The aim of this study was to report on the long-term real-life treatment and prognosis of VKH in Italy. Methods: The clinical features, complications, and final visual acuity were retrospectively evaluated in 38 patients with VKH (mean follow-up: 120 months) globally, according to oral or intravenous corticosteroid treatment at onset and subsequent immunosuppressive therapy. Results: The mean final visual acuity was 0.13 ± 0.4 logMAR, which was a significant increase from the baseline (p < 0.0001). The patients who received intravenous rather than oral corticosteroids relapsed less (p = 0.026), with fewer relapses/patient/month of follow-up (p < 0.0001), and showed less frequent sunset glow fundus (33.3% versus 55%) and more relapse-free cases after induction therapy (p = 0.007). Delayed immunosuppressive therapy (median: 180 days from the onset of symptoms) reduced the rate of sunset glow fundus. The onset of sunset glow fundus was associated with a worse final visual acuity (p = 0.006). Conclusion: The long-term prognosis of VKH is quite good. Intravenous corticosteroids given at the onset of VKH are more effective than oral corticosteroids. Even if it is not given immediately after symptoms onset, immunosuppressive therapy is able to reduce the incidence of sunset glow fundus and to improve the final visual prognosis.

Retinal involvement and ocular findings in COVID-19 pneumonia patients.

Changes in immune and coagulation systems and possible viral spread through the blood-brain barrier have been described in SARS-CoV-2 infection. In this study, we evaluated the possible retinal involvement and ocular findings in severe COVID-19 pneumonia patients. A cross-sectional study was conducted on 46 patients affected by severe COVID-19 who were hospitalized in one intensive care unit (ICU) and in two infectious disease wards, including bedside eye screening, corneal sensitivity assessment and retinography. A total of 43 SARS-CoV-2-positive pneumonia patients affected with COVID-19 pneumonia were included, including 25 males and 18 females, with a median age of 70 years [IQR 59-78]. Except for one patient with unilateral posterior chorioretinitis of opportunistic origin, of whom aqueous tap was negative for SARS-CoV-2, no further retinal manifestation related to COVID-19 infection was found in our cohort. We found 3 patients (7%) with bilateral conjunctivitis in whom PCR analysis on conjunctival swabs provided negative results for SARS-CoV-2. No alterations in corneal sensitivity were found. We demonstrated the absence of retinal involvement in SARS-CoV-2 pneumonia patients. Ophthalmologic evaluation in COVID-19, particularly in patients hospitalized in an ICU setting, may be useful to reveal systemic co-infections by opportunistic pathogens.

Clinical Features of Ocular Syphilis: a Retrospective Clinical Study in an Italian Referral Centre.

Purpose: To describe the clinical characteristics and visual prognosis of ocular involvement in syphilis.Design: A retrospective cohort study.Methods: We studied the charts of 24 patients who visited our Ophthalmological Centre in Rome, Italy. All patients with serological evidence of syphilitic infection were included.Results: Ocular involvement was the first manifestation of syphilitic disease in 96% and Human Immunodeficiency Virus (HIV) seropositivity was found in 29% of the cases. The most frequent ocular manifestation was posterior uveitis. Vitreous involvement was frequent. Patients with papillitis at onset showed better visual outcome with antisyphilitic treatment. Posterior uveitis at onset and HIV seropositivity were negative prognostic factors for visual outcome. HIV-positive patients showed more severe and frequent bilateral course of ocular involvement in syphilis.Conclusions: The ophthalmologist should suspect syphilis in patien ts with uveitis or optic neuropathy associated with high-risk sexual behaviour and/or HIV, or in patients with posterior placoid chorioretinitis, necrotising retinitis, or interstitial keratitis.

Cataract Surgery in HIV Seropositive Patients: Long-Term Follow-Up.

Purpose: To study epidemiology and clinical findings of cataract in HIV+ patients. Methods: A total of 32 HIV+ patients, 11 with uveitis/retinitis before surgery and 21 without, mean follow-up 44.9 ± 36.6 months, and 114 HIV- patients, 57 with uveitis/retinitis before surgery and 57 without, were retrospectively compared. Results: Visual acuity improved in all HIV+ patients (p < 0.001), who were younger (p = 0.01) and more frequently males (p = 0.027). HIV+ patients with uveitis prior surgery improved less (p = 0.046) than HIV- (p < 0.001); their anterior chamber inflammation was similar to baseline. Male sex (p = 0.005), younger age (p < 0.001), dyslipidaemia (p = 0.058), HBV+ (p = 0.037), and unilateral cataract (p = 0.001) were more frequent in HIV+ patients with senile cataract, but they showed the same postoperative course as HIV- patients. Conclusion: Cataract surgery in HIV+ patients is safe and effective. Uveitis prior to surgery did not significantly affect the postoperative course. Systemic comorbidities are more frequent in HIV+ patients with senile cataract than in HIV- subjects.

Ocular Behçet's Disease: Changing Patterns Over Time, Complications and Long-Term Visual Prognosis.

PURPOSE: To investigate demographic, clinical features and complications of Italian patients with ocular Behçet's disease (BD) over time. METHODS: Retrospective study of 385 patients examined from 1968 to 2011, 265 of whom had follow-up ≥ 12 months. RESULTS: A significant increase in the proportion of females (p = 0.03) and anterior uveitis (p < 0.001), and a decrease in the complete type of BD in all patients (p = 0.003) and in males (p = 0.002), and in hypopyon (p = 0.024) were observed over time. Optic neuropathy (p < 0.0001), maculopathy (p = 0.002), retinal detachment, and retinal neovascularization (p = 0.02) decreased over time, with no difference between genders, concomitant with an increase in the use of immunosuppressive drugs (p = 0.003). Visual acuity ≤1/10 was detected more often in males than females (p = 0.003). CONCLUSIONS: A significant shift in clinical manifestations of BD patients was observed over 44 years. Immunosuppressive therapy succeeded in lowering ocular complications. The incidence of ocular BD is increasing in females, but visual prognosis is still worse in males.

Fuchs' Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis.

Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs' Heterochromic Iridocyclitis (FHI). Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis. Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p = 0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p < 0.001) and systemic (p < 0.001) corticosteroids therapy were used less frequently than before referral. Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes.

Contact Lens Care among Teenage Students in Italy: A Cross-Sectional Study.

AIM: To assess the attitude and practice of contact lens (CL) wearers among teenage school students and to evaluate how much the teenagers adhere to the CL care procedures according to the proper care of CL guidelines. METHODS: A cross-sectional descriptive study of Italian teenagers from high schools in Rome who wear CL. We inquired about the different aspects of CL care through a questionnaire. RESULTS: We investigated 3,106 students from high schools in Rome (2% of all Roman high school students), 293 of whom wore CL (9%); 151 (52%) of participants responded, 42 (27.8%) male and 109 (72.8%) female. The mean age was 16.4 ± 1.6 years. 79.5% of students were daily users. 45.7% wore CL more than nine hours/day. 87.4% wore soft CL. 33.1% wore disposable CL; 7.9% weekly CL, 55% monthly CL. Thirty-four percent wore disposable lenses twice or more. 14.5% of students did not wash their hands before handling CL and 52.3% wore CL after it had fallen in the sink. 39.7% rubbed and cleaned CL before storing it. 10% used expired lens care solutions. Only 31.1% changed CL cases every three months. 38.4% wore CL in a swimming pool. 61.6% were having problems: redness (13.9%), itching (7.9%), and foreign body sensation (29.1%). CONCLUSION: Many students don't properly care for their CL. Education regarding proper care and management of CL among users is advised in view of frequency of symptoms and complications reported.

Multi-drug resistance and side-effects in a patient with Behçet's disease.

OBJECTIVES: To report on the clinical course of ocular and extraocular involvement in a multidrug-resistant patient with Behçet's disease (BD). METHODS: A 22-year-old male with BD (bilateral panuveitis and retinal vasculitis, oral ulcers, erythema nodosum, arthralgia, epididymitis) was followed-up from 1999 to 2014. He was treated continuously with corticosteroids in combination with different immunosuppressive therapies (cyclosporine, azathioprine, methotrexate, interferon, infliximab, mycophenolate), which exerted numerous side-effects such as nephrotoxicity, nephrolithiasis, increase of liver enzymes, severe depression with suicidal ideation, severe leucopenia, pulmonary tuberculosis, pulmonary legionellosis, recurrent bronchopneumonia. RESULTS: Despite immunosuppressive and corticosteroid therapies, the patient showed multiple relapses of uveitis and systemic BD lesions and developed severe osteoporosis with multiple vertebral fractures, bilateral cataracts and steroid-associated glaucoma until 2007. Since then he has been treated with prednisone alone, currently at low dosage, remaining free from uveitis and systemic symptoms. His final visual acuity is 9/10 in the right eye and counting fingers in the left one. CONCLUSIONS: BD patients are usually responsive to immunosuppressive drugs. The possibility of a multi-drug resistance as well as of multiple drug-related side effects cannot be disregarded and continuous therapy should be given in order to preserve a useful visual acuity until the disease, either spontaneously or drug-induced, runs into remission.

Uveitis heralding previously unknown luetic and HIV infection. Syphilitic uveitis in an Italian referral center.

PURPOSE: This study was conducted to determine the incidence of luetic uveitis in the last seven years at our uveitis center and to describe the characteristics and the role of uveitis in the diagnosis of syphilitic infection with or without unknown HIV infection. METHODS: We retrospectively reviewed syphilitic uveitis in patients observed at our center between 2004 and 2010. The diagnosis was based on the serological evidence for syphilis, uveitis, exclusion of other etiologies. All patients had HIV testing. RESULTS: We describe 14 new cases of luetic uveitis: 6 co-infected with previously unknown HIV-infection had panuveitis, while the most common presentation in HIV-negative patients was posterior uveitis. CONCLUSIONS: Syphilis has been recognized as reemerging disease. The ocular inflammation can be the first symptom of syphilis. This study underlines the importance of a prompt and correct diagnosis of this ocular disease.

Toxoplasmic retinochoroiditis in an Italian referral center.

PURPOSE: To evaluate the clinical features of ocular toxoplasmosis (OT). METHODS: Retrospective review of 3080 new patients with uveitis was performed to identify patients with active OT. The main outcome measures were ocular features and ocular complications. RESULTS: Active OT was diagnosed in 88 patients (2.85% of all uveitis), 39 male (44.3%) and 49 female (55.7%), at an average age of 20.4+/-14.6 years, lower than in other types of uveitis (p<0.0001). Acquired OT diagnosis was possible in 4 cases (4.5%), while in the others a differentiation between acquired or congenital OT was impossible. Unilateral OT occurred in 76 patients (86.36%), with lesions located inside the vascular arcade in 64 of them (84.2%). Among bilateral cases (12 patients, 13.63%), at least one lesion was central in 9 (75%). Isolated peripheral lesions were observed in 12 out of 88 patients (13.6%). During an average follow-up of 70+/-73.5 months, OT recurrences appeared in 70 patients (79.54%). Mean interval between diagnosis and first relapse was 43.57+/-48.46 months, while it shortened between subsequent relapses (24.44+/-26.5 months; p=0.001). CONCLUSIONS: Ocular toxoplasmosis is a highly recurrent disease, mainly unilateral, with an average age at onset lower than those observed in other types of uveitis. Time between relapses shortens significantly over time.

Infliximab treatment for ocular and extraocular manifestations of Behçet's disease.

PURPOSE: To assess the efficacy and safety of infliximab in the treatment of sight-threatening uveitis and extraocular manifestations in patients with Behçet's disease. METHODS: Twelve patients with Behçet's disease and uveitis were treated with infliximab after unsuccessful therapy with other immunosuppressive drugs. The main outcome measures were as follows: the number of uveitis relapses, the number of Behçet's disease-related extraocular lesions, and the amount of corticosteroids administered during the treatment as well as during an equal prior period of time while the patients were on other immunosuppressive agents. Visual acuity was recorded at the beginning of infliximab therapy and at the end of follow-up, and was defined as stable if it did not change from baseline, increased if it showed at least one line of improvement from baseline, and decreased if it showed at least a one line decrease from baseline. RESULTS: During an average follow-up of 16.67 +/- 7.63 months (median, 15 months), 11 patients (91.6%) showed a reduction in the number of ocular relapses (relapse/month, from 0.35 +/- 0.17 to 0.12 +/- 0.17, P < 0.001). All of the patients (n = 11) who were taking corticosteroids before infliximab were able to reduce the amount of corticosteroids taken daily during infliximab treatment (from 24.33 +/- 10.84 mg/prednisone per day to 8.97 +/- 6.81 mg/prednisone per day, P < 0.001), and all presented with a reduced onset of extraocular manifestations of Behçet's disease (mean total number, from 2.83 +/- 3.61 to 1.51 +/- 2.35, P = 0.039). One patient, who had to stop treatment 2 months after starting because of the onset of pulmonary tuberculosis, showed the same number of relapses during infliximab treatment but was able to reduce the mean daily corticosteroid dose. Visual acuity increased by one or more lines in three eyes (12.5%) and remained unchanged in 87.5% of the eyes. Infliximab-related side effects appeared in four patients (33.3%). CONCLUSIONS: Infliximab was effective in the treatment of uveitis in these Behçet's disease patients, significantly reducing the number of ocular relapses and making possible a significant reduction in the daily dose of corticosteroids administered. Extraocular manifestations of Behçet's disease were also controlled by infliximab. Nevertheless, side effects were not uncommon, and an extensive study of systemic conditions before infliximab administration had to be carried out to exclude systemic infection, particularly prior tuberculosis.