Intravenous tocilizumab in idiopathic pediatric uveitis with refractory cystoid macular edema - A case report.

A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.

Bilateral Conjunctival Granulomas in a Young Lady with Hypereosinophilic Syndrome - A Case Report.

Purpose: To report an interesting case of bilateral conjunctival granulomas in a young lady with hypereosiniophilic syndrome. Materials & Methods: Retrospective interventional case report Results: A 37-year-old lady presented with irritation and redness in both eyes of 15-day duration. She had a history of abdominal pain and diarrhea since 8 months for which she has been extensively investigated including a positron emission tomography (PET) scan and an ileal biopsy which showed chronic granulomatous inflammation with eosinophils. Ocular examination revealed multiple bilateral conjunctival granulomas. Conjunctival biopsies revealed granulomatous inflammation with plenty of eosinophils and flame figure configuration. Peripheral blood smear showed increased absolute eosinophil count and eosinophilia. Stool analysis was normal. She did not have abdominal symptoms or recurrence of granulomas. Conclusion: The rare association of bilateral conjunctival granulomas with hypereosinophilic syndrome has been described in this report.

Role of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration in the Diagnosis of Intraocular Inflammation in India - Our Experience.

Purpose: To report our experience of using Endobronchial ultrasound-guided transbronchial lymph node aspiration (EBUS-TBNA) in assessing the etiology in uveitis from two tertiary eye-care centers in India. Materials & Methods: Retrospective interventional case series. Results: A total of 99 patients of uveitis who underwent EBUS-TBNA were included in the study. Mycobacterium tuberculosis (MTb) was detected on culture in 5 cases, 3 cases by polymerase chain reaction and caseating granulomas in 25 cases. None of these patients had any symptoms of systemic tuberculosis (TB). Biopsy was inconclusive in eight cases. Granulomatous inflammation was seen in 91 cases. In 51 cases, it was difficult to differentiate between sarcoidosis and TB on biopsy. None of the patients had any significant complications. There was a fair agreement between the biopsy diagnosis and the final ocular diagnosis. Conclusions: In high TB endemic countries, procedures like EBUS-TBNA are useful in obtaining tissue diagnosis of TB when ocular diagnosis may be inconclusive due to paucity of ocular tissue.

Tonic Pupil in Cytomegalovirus Anterior Uveitis in an Immunocompetent Adult Male - A Case Report.

PURPOSE: To report an interesting case of development of tonic pupil in an immunocompetent male with cytomegalovirus (CMV) anterior uveitis. METHODS: Retrospective case report Results: A 30-year-old Iranian healthy male was diagnosed to have Posner-Schlossman syndrome (OS). Aqueous tap was positive for CMV by multiplex Polymerase chain reaction (PCR). Adequate control of inflammation and Intraocular pressures (IOP) were achieved with topical steroids, ganciclovir gel, and antiglaucoma medications. On a follow-up visit, he complained of recent onset of blurring of vision (OS) despite appropriate refractive correction, quiet anterior chamber, and normal IOP. Pupillary examination showed anisocoria (larger pupil in OS). Pupillary constriction (OS) on instillation of 0.125% pilocarpine drops confirmed the diagnosis of a tonic pupil. CONCLUSION: We describe a unique finding of tonic pupil on a follow-up examination in an immunocompetent adult male with CMV anterior uveitis. A prior association has not been described in literature (Medline Search).

Bilateral arterial occlusions masking retinitis in a HIV-positive male.

We report an interesting case of 36-year-old HIV-positive male with uveitis, cilioretinal artery occlusion in OD, and superotemporal branch retinal artery occlusion in OS. Hypercoagulability, cardiovascular, and rheumatologic workups were unremarkable. Aqueous taps were negative for toxoplasma, viruses, and MTb by multiplex polymerase chain reaction. Patches of retinitis were seen on clearing of retinal edema. Serology was positive for toxoplasma and rickettsia. Management included doxycycline, azithromycin, bactrim DS, and oral steroids. Vision improvement to 6/60 and 6/24 in OD and OS refer to the right eye and left eye, respectively, were noted at 4-month follow-up. Infections should be considered in arterial occlusions associated with inflammation in HIV-positive individuals.

Polymerase Chain Reaction and its Correlation with Clinical Features and Treatment Response in Tubercular Uveitis.

PURPOSE: Correlation of results of polymerase chain reaction for Mycobacterium tuberculosis (MTB PCR) with clinical features and treatment response in tubercular uveitis. METHODS: Retrospective case study. RESULTS: Among 56 patients, 31 (55.3%) had acute and 25 (44.6%) had chronic uveitis. Uveitis was unilateral in 40 (71.4%) and bilateral in the remaining 16 (28.6%). Anatomical subtypes of uveitis were: anterior in 10 (13.9%) eyes, intermediate in 9 (12.5%), posterior in 17 (23.6%), and pan uveitis in 36 (50%) eyes. MTB PCR was positive in 24 patients. There was an 80% correlation between clinical response to antitubercular therapy (ATT) and PCR results. Twenty-two patients with positive PCR had a good clinical response. The sensitivity and specificity was 73.3% and 92.3%, respectively. CONCLUSIONS: The diagnosis of intraocular TB requires strong clinical suspicion with corroborative laboratory and radiological evidence. A positive PCR is reliable whereas negative results should be correlated with clinical features. An adequate response to ATT supports PCR results.

Progressive, subretinal fibrosis mimicking retinal necrosis with poor visual prognosis in sympathetic ophthalmia: A rare finding.

We report a rare finding of progressive subretinal fibrosis mimicking retinal necrosis in 2 cases of sympathetic ophthalmia. Histopathology of the inciting eye and vitreous biopsy of the sympathizing eye ruled out infections and masquerades. Progression of inflammation and rapid deterioration of vision inspite of maximum immunosuppression are key findings in this variant of sympathetic ophthalmia.

Clinical Profile of Herpes Zoster Ophthalmicus in a South Indian Patient Population.

PURPOSE: To analyze and compare the clinical profile of herpes zoster ophthalmicus (HZO) patients in a South Indian patient population aged <60 years and ≥60 years and determine the risk factors for recurrence of ocular inflammation. METHODS: Retrospective study of 249 cases between 2006 and 2016 from two tertiary referral eye centres in south india. RESULTS: Out of 249 cases, 189 cases were <60 years (Group 1) and 60 cases were aged ≥60 years (Group2). Presence of diabetes mellitus, increased intraocular pressure(IOP) at the time of active inflammation, use of topical steroids and recurrences were significantly more common in group 1. Significant risk factors for recurrences included corneal, uveal, scleral involvements and increase in IOP. Good vision at presentation was noted in 67.9% of the patients. CONCLUSIONS: Anterior uveitis with or without keratitis was the most common presentation observed in more than 50% cases. The overall visual outcome was good.