Posterior Segment Involvement in Childhood Presumed Trematode Induced Granulomatous Anterior Uveitis.

PURPOSE: To outline posterior segment characteristics of presumed-trematode induced granulomatous uveitis. DESIGN: A cross-sectional case series. METHODS: The study included 56 patients (60 eyes) presented with anterior chamber (AC) granulomas. Involvement of the posterior segment structures has been documented and reported. RESULTS: The mean age of the patients was 11.8 years (range 6-14 years). Posterior segment findings were vitritis in 9 eyes (15%), optic disc granuloma in 2 eyes (3.3%), optic disc hyperaemia in one eye (1.7%), macular oedema in 2 eyes (3.3%), epiretinal membrane in 3 eyes (5%), retinal vasculitis in one eye, a peripheral focus of retinitis in one eye (1.7%), and choroid thickening in 10 eyes (6.7%), with localised choroidal granuloma in one eye (1.7%). CONCLUSION: Presumed trematode-induced anterior chamber (AC) granuloma is not only restricted to the anterior segment of the eye, but posterior segment associations that may threaten vision should also be considered.

Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity.

BACKGROUND: To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. METHODS: This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. RESULTS: A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. CONCLUSIONS: IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.

Characteristics of Childhood Presumed Trematode-Induced Granulomatous Anterior Uveitis Using Ultrasound Biomicroscopy.

PURPOSE: To investigate the UBM characteristics of presumed trematode-induced granulomatous uveitis. DESIGN: Prospective case series. METHODS: Thirty patients who presented with anterior chamber (AC) granuloma were included. UBM Imaging included Cornea, iris, AC angle, posterior chamber, ciliary body, and vitreous base. RESULTS: Thirty eyes were included with a mean age of 12.4 ± 2.5 years. UBM findings were retrocrneal membrane (33%), sub conjunctival nodule (10%), AC granuloma (100%); peripheral anterior synechia, granuloma-like lesion in posterior chamber; ciliary body edema with localized granuloma at specific site (100%), cataract in 30% either localized or generalized, and dot or thread-like high reflection on vitreous base in (20%). CONCLUSION: Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. UBM examinations can demonstrate various pathologic changes of anterior segment of the eye and provide objective evidence for the exact origin of those granulomas.

Association of Longitudinal Changes in Drusen Characteristics and Retinal Layer Volumes with Subsequent Subtype of Choroidal Neovascularisation.

AIM: To investigate the longitudinal correlation between drusen characteristics and retinal layer volumes pre conversion and subsequent type of choroidal neovascularisation (CNV). METHODS: This was a single-centre retrospective study. The study participants were patients with wet age-related macular degeneration (AMD) in one eye who developed wet AMD in the contralateral eye, with at least 2 years of follow-up prior to conversion. The Moorfields Eye Hospital database was searched for eligible patients and their data were recorded. Eyes were classified as occult or classic based on fundus fluorescein angiography. Optical coherence tomography (OCT) images were analysed for drusen characteristics and retinal layer volumes were analysed over time using automated software (Topcon 3D OCT-2000 and Orion, Voxeleron LLC, respectively). All values were obtained at baseline as well as year 1 and year 2 before conversion to wet AMD. RESULTS: Fifty-one eyes with bilateral CNV showed high correlation of type of CNV between eyes (kappa statistic 0.89). A total of 49 wet AMD eyes (29 occult, 20 classic) were analysed for drusen parameters. Two patients with retinal angiomatous proliferation were excluded. Drusen count, area, and volume did not differ by CNV type, but the rates of change of drusen area (p = 0.046) and drusen volume (0.022) were higher in the occult group in the year preceding CNV development. Of the 49 eyes, 17 (10 occult, 7 classic) with available good quality OCT were analysed for retinal layer volumes. There was a progressive reduction in outer nuclear layer (ONL) volume (p = 0.002) and an expansion in outer plexiform layer volume (p = 0.015) in eyes that developed occult CNV. CONCLUSION: Our study shows that rate of increase in drusen load and reduction in ONL are significant features seen in eyes developing occult CNV, highlighting new imaging markers that need to be replicated in larger studies. These markers provide insight into the pathogenesis of CNV and may serve as prognostic indicators, as classic CNV carries a poorer prognosis compared to occult CNV.

Treatment of presumed trematode-induced granulomatous anterior uveitis among children in rural areas of Egypt.

PURPOSE: The purpose of this study is to evaluate the efficacy of systemic antiparasitic medications alone or in combination with surgical aspiration in management of presumed trematode-induced anterior uveitis in children. PATIENTS AND METHODS: Prospective case series. Children who presented with anterior chamber (AC) granuloma were included in the study. All patients received antiparasitic treatment and after 2 weeks; patients were divided based on their clinical improvement in terms of the baseline granuloma area into two groups: group A (<2.5 mm2) who continued on antiparasitic medications only (n = 15) and group B (≥2.5 mm2) who underwent surgical aspiration (n = 15). Basic demographics data, visual acuity (VA), corneal thickness, granuloma area and AC activity (cells and flare) were recorded and analysed. Systemic work-up including stool and urine analysis, full blood count, chest X-ray and schistosomiasis titre were performed. RESULTS: Thirty eyes of 30 patients were included in the study with a mean age of 13.4 ± 2.42 years. All patients were male. Patients were examined and followed at Mansoura Ophthalmic Center, Mansoura University. Both groups showed statistically significant improvement in VA, AC activity, corneal thickness and granuloma area (p-value < 0.001), which was achieved with medical treatment only in group A. However, in group B granuloma required aspiration and did not recur after that. CONCLUSION: Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. Antiparasitic medication alone was found to be effective for small-sized granulomas. Surgical aspiration is an effective adjuvant procedure to treat large-sized ones.