Wide-Field Fluorescein Angiography in Patients with Idiopathic Acute Anterior Uveitis.

PURPOSE: To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). METHODS: The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. RESULTS: Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5-18) years in the pediatric group and 42.36 ± 32.07 (range, 24-68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764).     Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. CONCLUSION: Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.

Evaluation of Macular Pigment Optical Density in Eyes with Hyperopic Anisometropic Amblyopia Using Fundus Reflectometry.

Objectives: This study aimed to evaluate the macular pigment optical density (MPOD) scores in eyes with hyperopic anisometropic amblyopia and compare those with their fellow and control eyes using one-wavelength fundus reflectometry. Methods: This cross-sectional study enrolled 33 patients diagnosed with hyperopic anisometropic amblyopia aged 12-40 years. The control group consisted of 36 hyperopic and 42 emmetropic children, age-matched to the patients. Central macular thickness (CMT), MPOD, axial length (AL), best-corrected visual acuity, and refraction errors were measured between the study group and the control group. Results: Eyes with the diagnosis of hyperopic anisometropic amblyopia had significantly higher mean and maximum (max) MPOD scores compared with their fellow eyes as well as hyperopic and emmetropic eyes (p<0.001 for all). The mean AL in eyes with hyperopic anisometropic amblyopia was statistically shorter than that in hyperopic and emmetropic controls (p=0.027, p<0.001, respectively). The mean CMT was found to be thicker in eyes with hyperopic anisometropic amblyopia when compared to their fellow eyes, as well as hyperopic and emmetropic controls, eventhough there was no significant difference was found among the four groups (p=0.052). The mean MPOD levels were significantly correlated with the difference in CMT (r=-0.21, p=0.032), and logMAR visual acuity scores (r=-0.44, p<0.001) in the hyperopic anisometropic amblyopia group. Conclusion: The present study indicates that the MPOD is reduced in eyes with hyperopic anisometropic amblyopia. This reduction may be due to less visual stimulus-induced deterioration of foveal development and microarchitecture in anisometropic amblyopic eyes.

Unilateral macular neovascularization formation during the follow-up of a 15-year-old boy with Bietti crystalline dystrophy and the successful treatment outcome with a single intravitreal ranibizumab injection.

Objective: To report the successful outcome with a single intravitreal ranibizumab injection in a 15-year-old boy with Bietti crystalline dystrophy (BCD) who developed a unilateral macular neovascularization (MNV). Methods: A retrospective case report. Results: A 15-year-old Caucasian boy with Bietti crystalline dystrophy was diagnosed to have a unilateral MNV a year after the initial examination with the help of multimodal imaging and he was treated with a single intravitreal ranibizumab injection. Five months later, visual acuity improved and anatomically a dry-looking macula was noted. Conclusion: MNV is among the rare macular complications of BCD. The present case is the third reported pediatric case with MNV in association with BCD and the first pediatric BCD patient who received a vascular endothelial growth factor inhibitor (anti-VEGF) agent.

Choroidal structural analysis in ultra-high risk and first-episode psychosis.

Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.

Diagnostic and Management Strategies of Bietti Crystalline Dystrophy: Current Perspectives.

Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype-phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.

Ranibizumab or Aflibercept Monotherapies in Treatment-Naive Eyes with Diabetic Macular Edema: A Head-to-Head Comparison in Real-Life Experience.

Objectives: To compare the functional and anatomical outcomes of ranibizumab and aflibercept monotherapies given according to a pro re nata (PRN) protocol in treatment-naive eyes with diabetic macular edema (DME) in a real-life clinical setting. Materials and Methods: The medical charts of treatment-naive patients with center-involved DME retrieved from our institutional database were reviewed in this retrospective cohort study. A total of 512 treatment-naive eyes with DME underwent either ranibizumab (Group I; 308 eyes) or aflibercept (Group II; 204 eyes) monotherapy and 462 patients were included. The primary outcome was visual gain over 12 months. Results: The mean number of intravitreal injections within the first year was 4.34±1.83 and 4.39±2.12 in Group I and II, respectively (p=0.260). The mean best corrected visual acuity (BCVA) improvement at 12 months was +5.7 and +6.5 ETDRS letters in Group I and II, respectively (p=0.321). However, among eyes with a BCVA score less than 69 ETDRS letters (54% of the study population), visual gain was more prominent in Group II (+15.2 vs. +12.1 ETDRS letters; p<0.001). Statistically significant decreases in central foveal thickness were observed with both ranibizumab and aflibercept monotherapy (p<0.001), with no significant difference between the groups. (p=0.148). Conclusions: No statistically significant difference was found in visual outcomes at 12-month follow-up between ranibizumab and aflibercept monotherapies using a PRN protocol, although there was a tendency toward slightly better functional and anatomic prognosis in the aflibercept arm.

Evaluation of choroidal vascularity index in systemic sclerosis patients.

OBJECTIVE: To investigate the comparison of choroidal vascularity index (CVI) between patients with systemic sclerosis and healthy individuals. METHODS: This study was designed prospective non-randomized cross-sectional study. Eighty-six eyes (43 patients) with limited cutaneous systemic sclerosis (lcSSc), 60 eyes (30 patients) with diffuse cutaneous systemic sclerosis (dcSSc) and 60 eyes (30 subjects) of age-and sex-matched healthy individuals were recruited. Subfoveal choroidal thickness, CVI and modified Rodnan skin score (mRSS) were evaluated. Enhanced depth imaging- optical coherence tomography scans were binarized using Niblack's autolocal threshold and CVI was determined as the luminal choroidal area/total choroidal area ratio. RESULTS: The mean CCT values were 268.00±68.59 µm, 286.90±70.88 µm, 321.73±94.13 µm in lcSSc group, dcSSc group and control group, respectively. The mean CVI was 61.84±2.84% in lcSSc group, 54.62±5.84% in dcSSc group and 62.41±4.13% in control group (p=0.001). The mean CVI of the SSc patients was 58.91±5.58 and there was significant difference between control group (p<0.001). The mean mRSS was 3.84±2.50 in lcSSc group and 14.07±6.81 in dcSSc group (p<0.001). There was a statistically significant negative correlation between mRSS and CVI (r=-0.448, p<0.001) CONCLUSION: Choroidal vascularity index provides valuable information to monitor the disease progression and lower CVI values seem to be related to the disease severity in patients with systemic sclerosis.

Intravitreal Ranibizumab and Dexamethasone Implant Injections as Primary Treatment of Diabetic Macular Edema: The Month 24 Results from Simultaneously Double Protocol.

PURPOSE: To compare efficacy of simultaneously administered intravitreal dexamethasone implant (DEX implant) and ranibizumab (simultaneous double protocol) injections with ranibizumab monotherapy for diabetic macular edema (DME) at month 24. METHODS: This is a prospective, consecutive, clinical interventional study. Naïve eyes with DME were randomized into two groups: 34 eyes received simultaneous double-protocol therapy and 34 eyes received ranibizumab monotherapy. The primary efficacy endpoint was change in visual acuity in month 24. The secondary efficacy endpoints were to evaluate gain of ≥15 letters, morphological changes and central foveal thickness. Decreased vision from DME (study eye BCVA, 20/40 or worse Snellen equivalent using ETDRS testing), the presence of DME with ≥300 µm foveal intraretinal cystoid spaces (within 1000 µm of the centre of the fovea), subfoveal neuroretinal detachment (SND), intraretinal hyperreflective foci (HRF, within 500 µm of the centre of the fovea) or foveal lipid exudates and external limiting membrane (ELM) and ellipsoid zone (EZ) disruption (within 500 µm of the centre of the fovea) on SD-OCT were eligible to enrol. RESULTS: The mean baseline BCVA was 48 ± 23 letters in double protocol group and 52 ± 14 letters ranibizumab monotherapy group (p = 0.416). The mean number of ETDRS letters changed from baseline at 12 months versus change from baseline at month 24 in double protocol group and ranibizumab monotherapy group were +21.6 versus +20.2 and +9.6 versus +9.1, respectively. At the month 24 time point, 65.4% of patients in double protocol group and 26.2% of patients in ranibizumab monotherapy group had gained ≥15 ETDRS letters in BCVA from baseline (p < 0.001). The external limiting membrane (ELM) and ellipsoid zone (EZ) integrity were better in the double protocol group in comparison to ranibizumab monotherapy group at month 24. In addition, there was no statistically significant increase in the proportion of patients with epiretinal membrane in double protocol group at month 24, by the contrast with ranibizumab monotherapy group (p = 0.06 and p = 0.04 in the double protocol and ranibizumab monotherapy groups, respectively). From baseline to month 24, the mean central foveal thickness (CFT) was 672 ± 293 µm reduced to 278 ± 84 µm in double protocol group and was 631 ± 279 µm reduced to 356 ± 108 µm in ranibizumab monotherapy group (p < 0.001 and p < 0.001). From baseline to month 24, 38% (13/34) of eyes in double protocol group and 18% (6/34) of eyes in ranibizumab monotherapy group had at least 5 mmHg of IOP elevation (p = 0.012). Two grades or more increased cataract density were detected 27% (6/22) of eyes in the double protocol group and in 12.5% (3/24) of eyes in the ranibizumab monotherapy group from baseline to month 24 (p = 0.032). CONCLUSION: According to the improvements in visual acuity and morphological changes achieved at month 24, the simultaneous double protocol therapy can be an effective treatment option for DME with inflammatory biomarkers on OCT or/and decreased visual acuity.

Acute Multifocal Placoid Pigment Epitheliopathy-like Presentation following the First Dose of BNT162B2 COVID-19 Vaccination.

PURPOSE: To report a case with acute posterior multifocal placoid pigment epitheliopathy (APMPPE)-like presentation following the first dose of BNT162b2 COVID-19 vaccination. CASE REPORT: An otherwise healthy 45-year-old woman presented with a headache and blurred vision in her right eye 7 days after the administration of first dose of mRNA (BNT162b2) COVID-19 vaccine. Fundus examination of the right eye revealed multiple discrete yellow-white placoid lesions at the level of deep retinal layers throughout the posterior pole, while left fundus was unremarkable at that time. Swept source-optical coherence tomography (SS-OCT) showed subretinal fluid together with an appearance of bacillary layer detachment at the right macula. A detailed systemic evaluation was carried out without any positive finding. Two weeks after the initial eye examination, similar multiple placoid lesions were observed in her left eye. Fundus lesions almost totally resolved without any treatment bilaterally 5 weeks after the onset of initial symptoms. CONCLUSION: To the best of our knowledge, this is the first report of APMPPE-like presentation described after the BNT162b2 COVID-19 vaccination. Previous COVID-19 vaccination should be kept in mind in the differential diagnosis of APMPPE disease spectrum.

Evaluation of the corneal biomechanical properties and corneal thickness in patients with Graves' orbitopathy.

PURPOSE: To evaluate the corneal biomechanical properties and central corneal thickness in patients with Graves' orbitopathy (GO). METHOD: A total of 132 eyes of 66 patients with GO and 108 eyes of 54 healthy subjects were enrolled. Eyes with GO were classified as high score clinical activity score (CAS, ≥ 3) (Group 1, n = 64) and low CAS score (< 3) (Group 2, n = 68). Corneal biomechanical parameters [corneal hysteresis (CH), corneal resistance factor (CRF)], Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) levels were measured with Ocular Response Analyzer (ORA, Reichert Ophthalmic Instruments, Buffalo, NY) and compared between the groups. RESULTS: The mean CH values were found as 9.6 ± 1 mmHg in Group 1, 10.2 ± 0.9 mmHg in Group 2, and 11.4 ± 1.7 mmHg in the Control Group (p < 0.001). In post hoc analysis the mean CH was significantly lower in Group 1 than Group 2 and Control Group (Group 1-Group 2, p < 0.001; Group 1-Control Group, p < 0.001). The mean CRF was found as 10.5 ± 2.1 in Group 1, 10.4 ± 2.2 in Group 2, and 10.43 ± 2.0 in the Control group. There was no statistically significant difference between the groups in CRF measurements (p = 0.959). The mean IOPcc values were found as 17.1 ± 3.6 mmHg in Group 1, 15.8 ± 4.0 mmHg in Group 2 and 15.2 ± 4.1 mmHg in the Control Group. The IOPcc and IOPg measurements between all groups were statistically significant (p = 0.009, p = 0.027, respectively). CONCLUSIONS: Corneal biomechanical measurements were different in the GO patients with varying CAS scores compared to healthy individuals.

The place of dexamethasone implant in patients with Vogt-Koyanagi-Harada disease who experienced systemic treatment-related hepatic dysfunction: A case series.

We presented our observation with dexamethasone (DEX) implant in six eyes of three patients with Vogt-Koyanagi-Harada (VKH) disease who experienced hepatic dysfunction due to the systemic immunosuppressive therapy during their follow-up. Three cases who could not continue with the azathioprine (AZA) or adalimumab (ADA) treatment due to elevated liver enzymes were given consecutive bilateral DEX implant injections during the follow-up. In the first case, oral AZA was discontinued due to an elevation of the liver enzymes at the 2nd month of AZA treatment, and then she received five bilateral DEX implant administrations during the follow-up of 61 months without any intraocular pressure rise or disease recurrence. The remaining two patients had an elevation of the liver enzymes when ADA treatment was added to the prophylactic isoniazid therapy and they each received three bilateral DEX implant administrations within a year again without any complications and disease recurrence. DEX implant can be a safe and effective alternative for individuals with VKH disease whose systemic treatment is ceased due to adverse effects of the systemic treatment and intravitreal therapy with DEX implant can be beneficial to achieve a recurrence-free follow-up.

Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease.

Objectives: To evaluate the frequency and treatment response of eyes with bacillary layer detachment (BLD) in acute Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT). Materials and Methods: We retrospectively reviewed the medical records of 58 eyes of acute VKH patients with at least 6 months of follow-up between January 2009 and March 2021. SD-OCT, color fundus photographs, and fluorescein angiography images were analyzed in all patients. Results: The study included 58 eyes of 29 patients. BLD was detected in 33 of the 58 eyes (56.9%) at baseline. Mean serous retinal detachment (SRD) height was 918.50±336.64 µm in the BLD group and 215.33±167.83 µm in the group without BLD (p<0.05). A positive correlation was found between SRD height and the presence of BLD (r=0.783, p<0.05). BLD was significantly more common in patients with a baseline SRD height greater than 500 µm (p<0.05). As subfoveal central choroidal thickness (CCT) could not be measured by enhanced depth imaging-OCT at baseline due to extreme choroidal thickness in all eyes, the earliest post-treatment CCT measurements were analyzed. At the completion of pulse steroid therapy, mean CCT was 425±82.87 µm in the BLD group and 385.58±82.87 µm in the group without BLD (p=0.04). The mean time to BLD resolution was 12.88±6.5 days (range: 2-26). Conclusion: BLD is a common tomographic finding in eyes with acute VKH disease and can be differentiated from the associated SRD through careful SD-OCT analysis. Though it is mostly observed in patients with more serious disease, the presence of BLD has no negative effect on long-term visual function.

Optociliary Shunt Vessels or Neovascularisation of the Optic Disc: Fluorescein Angiography Versus Optical Coherence Tomography Angiography.

A 56-year-old man with a history of gallbladder carcinoma, hypothyroidism and hypertension was examined by us after developing marked visual loss in his left eye. A left ischaemic type of central retinal vein occlusion (CRVO) with macular oedema was diagnosed. Three months later, a non-ischaemic type of CRVO with no macular oedema developed in his right eye. While the left eye received five intravitreal ranibizumab injections and panretinal photocoagulation, the right central retinal vein occlusion improved spontaneously without any treatment. Ten months after his first visit we noticed optociliary shunt vessel formation in the right eye and neovascularisation of the optic disc in the left eye. Fluorescein angiography and optical coherence tomography angiography were performed at the same visit. The place of fluorescein angiography and optical coherence tomography angiography in distinguishing the optociliary shunt vessel from neovascularisation of the optic disc is discussed.

Vessel density and choroidal vascularity index in patients with Bietti crystalline dystrophy and retinitis pigmentosa.

OBJECTIVE: To evaluate and compare the vessel density (VD) using swept-source optical coherence tomography angiography (OCT-A) and the choroidal vascularity index (CVI) using spectral-domain optical coherence tomography (SD-OCT) in patients with Bietti crystalline dystrophy (BCD) and retinitis pigmentosa (RP). MATERIALS AND METHODS: A cross-sectional retrospective study was conducted on 26 eyes of 13 BCD patients, 26 eyes of 13 RP patients, and 26 eyes of 13 age- and gender-matched healthy individuals. BCD patients were further staged as having early, intermediate, and advanced disease. VD was assessed in five quadrants of the macula (superior, temporal, inferior, nasal, and center) using a modified ETDRS technique with OCT-A. SD-OCT scans were binarized using Niblack's autolocal threshold, and CVI was determined as the ratio of the luminal area to the total choroidal area. RESULTS: A significant difference was found in VD in all quadrants of the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) slabs among the three groups (p < 0.001). A statistically significant difference was noted in the mean VD of temporal and inferior quadrants of the SCP and between the BCD and RP groups (p = 0.005, p = 0.015, respectively). A statistically significant difference was observed in the mean VD of the temporal, inferior, and nasal quadrants between the BCD and RP groups on DCP slabs (p = 0.002, p = 0.003, p = 0.003, respectively). The mean central choroidal thickness was 214.65±87.10 µm in the BCD group, 351.69±67.94 µm in the RP group, and 320.92±59.26 µm in the control group (p < 0.001). We found that CVI was significantly higher in the control group than BCD group (p < 0.001), and it was significantly lower in the BCD group when compared to the RP group (p < 0.001).There was no difference in CVI between RP and control groups (p = 0.948). Furthermore, the CVI was significantly lower in the intermediate and advanced disease stages than the early disease stage in the subgroup analysis of BCD patients (p < 0.001, p < 0.001, respectively). CONCLUSION: CVI is a novel investigative tool to monitor disease progression. The CVI value was lower in BCD and RP patients than in the healthy subjects, and lower CVI values seem to be related to the disease severity in BCD patients. VD was also significantly lower in BCD patients when compared to RP patients, and VD analysis may help clinicians better understand the disease pathophysiology.

Types of Fundus Involvement in Intraocular Tuberculosis.

OBJECTIVE: To evaluate the patients who were treated for intraocular tuberculosis retrospectively and present our findings and share our experience. MATERIAL AND METHODS: This study was a descriptive, cross-sectional, retrospective study. Patients who were followed up with the diagnosis of intraocular tuberculosis in the Ophthalmology and Pulmonary Medicine Departments of Dokuz Eylul University Faculty of Medicine in the last 15 years and received anti-tuberculosis therapy were included. RESULTS: A total of 16 eyes of 10 patients with a diagnosis of intraocular tuberculosis uveitis who were treated with anti-tuberculosis therapy were included in this study. The mean age was 48.1 [14.6] years (mean [standard deviation]). Four were [40%] male and 6 [60%] were female. Patients with tuberculosis uveitis had bilateral involvement (7 of 10 patients [70%]). Intraocular tuberculosis was presented in 7 eyes of 4 patients with serpiginous like choroiditis, 2 eyes of 2 patients with choroidal tuberculomas, 4 eyes of 2 patients with choroidal tubercles (miliary tuberculosis), and 3 eyes of 2 patients with intermediate uveitis. The mean duration from admission to treat- ment was 18.1 ± 17.4 days (range: 6-56 days). All patients in this study received a 4-drug regimen anti-tuberculosis therapy, Paradoxical reaction occurred in 30% of the patients. Eight patients had systemic steroid therapy and 4 had also topical steroid therapy. The mean length of follow-up was 14.7 months (standard deviation = 15.1, range: 6-48 months). Reactivation of intraocular tuberculosis was not observed in any patients. CONCLUSION: High level of suspicion is a must for diagnosing intraocular tuberculosis. A complete ophthalmic examination can be performed in patients with suspected or proven tuberculosis. Early diagnosis and prompt treatment of intraocular tuberculosis can prevent serious complications and loss of vision.

Posterior Segment Manifestations of Cat-scratch Disease: A Mini-review of the Clinical and Multi-modal Imaging Features.

Bartonella henselae, an intracellular gram-negative bacillus, is usually transmitted from infected cats to humans by direct or indirect contact. The bacterium mainly infects erythrocytes and endothelial cells thereby leading to so called cat-scratch disease (CSD) and may present with various localised and/or systemic manifestations. The eye is the most commonly affected organ in disseminated CSD and ocular bartonellosis has been reported in 5-10% of CSD patients. The most well-known clinical feature of ocular bartonellosis is neuroretinitis but various sight-threatening posterior segment lesions involving the optic nerve, retinal vasculature, retinal and choroidal tissues may occur during the disease course. This mini-review aims to overview both the clinical and multi-modal imaging characteristics of posterior ocular segment manifestations of CSD.

Measurement of the active toxoplasma retinochoroiditis lesion size during the disease course with swept-source optical coherence tomography angiography: A retrospective image analysis.

PURPOSE: To measure the lesion size reduction in eyes with active toxoplasma retinochoroiditis during the disease course with swept-source optical coherence tomography angiography (SS-OCTA). METHODS: We retrospectively analysed the chorioretinal lesion size in a group of 14 eyes with a single active toxoplasma retinochoroiditis lesion. SS-OCTA was performed at the baseline and follow-up in all eyes. The 6 × 6 mm choriocapillaris slab images were evaluated with image analysis (MATLAB). The number of black and white pixels in a 1500-µm-diameter circle centred on each active lesion was counted at the time of baseline examination and at the first follow-up visit when the chorioretinal scar formation was noticed. RESULTS: Fourteen eyes with a single active toxoplasmosis retinochoroiditis lesion were included. Ten patients were female and three were male. The mean age was 29.1 ± 14.9 years. Active lesions were at the macula in five eyes, at the periphery in six eyes and juxtapapillary in three eyes. At the initial examination, the lesion area was observed as an area with a decreased flow signal on SS-OCTA. There was the perilesional capillary disruption in superficial and deep capillary plexi together with a diffuse capillary network attenuation and non-detectable flow signal zones in the choriocapillaris slabs. In addition to sulfamethoxazole-trimethoprim and azithromycin combination, oral corticosteroids were only co-administered in five (35%) eyes with macular involvement. The chorioretinal scar formation was observed in 4 to 16 weeks. At the time of inactivity, the original lesion was diminished in size when compared to its baseline in all study eyes (p = 0.001) with a mean black pixel reduction percentage of 21.8%. The reduction was 15.4% in eyes with macular lesion, 31.6% with peripheral lesions and 18.1% with juxtapapillary lesions (p = 0.001, p = 0.032, p = 0.028, p = 0.043, respectively). Visual acuity was correlated with black pixel reduction percentage in eyes with macular lesion (r = 0.56, p < 0.001). CONCLUSION: Healing of the active toxoplasma retinochoroiditis lesion size could be monitored with an OCTA-based image analysis technique. Interestingly, the reduction in the lesion size was lesser in the macular lesions than the peripheral and juxtapapillary lesions following the treatment and this might contribute to the poorer visual outcomes observed in eyes with macular lesions.

The effect of pulse steroid treatment of ten days' long on the improvement of bacillary layer detachment in a patient with Vogt-Koyanagi Harada disease.

Purpose: To illustrate the improvement pattern of bacillary layer detachment (BLD) in a closely monitored patient with Vogt-Koyanagi-Harada (VKH) disease. Methods: Imaging with color fundus photography and spectral domain optical coherence tomography (SD-OCT). Results: The pattern of BLD was noticed better with each passing day under the treatment of ten days' long pulse methylprednisolone (1 g/ day) therapy. Though a meaningful decrease in size and shape of the BLD occurred on the eight day of pulse treatment, it showed resolution at two weeks follow-up, but the associated subretinal serous fluid persisted until the sixth week of treatment. Conclusion: The term BLD has become a widely used description as an OCT finding in some diseases but its evolution with the treatment was less illustrated previously. Thereby, our aim was to share our observation of a patient with VKH disease having BLD, with the ophthalmic community.

COVID-19 Associated Bilateral Acute Iris Transillumination.

Purpose: To report a case of bilateral acute iris transillumination (BAIT) in association with coronavirus disease 2019 (COVID-19).Case report: A 44-year-old woman patient presented with decreased visual acuity, pain, photophobia, and redness in both eyes. The patient reported that she had recent close contact with severe acute respiratory syndrome - coronavirus-2 (SARS-CoV-2) case; also, she mentioned that she was hospitalized for bilateral pneumonia for 14 days. On examination, visual acuity of both eyes was 20/40. Slit-lamp biomicroscopy showed bilateral pigment deposition on the corneal endothelium, 4+ pigment dispersion in the anterior chamber, iris depigmentation with iris transillumination defects. Intraocular pressure was measured as 32 mmHg in right eye and 38 mmHg in left eye. The patient was started on bilaterally topical anti-inflammatory and anti-glaucomatous therapy.Conclusion: It is important to keep in mind that ocular manifestations associated with COVID-19 may include rare entities such as BAIT.

En face optical coherence tomography patterns in patients with angiographically documented uveitic macular edema: a cross-sectional retrospective study.

PURPOSE: To elucidate the en face optical coherence tomography (OCT) patterns of macular edema in eyes with angiographically documented uveitic macular edema (UME) and compare visual acuity (VA), OCT and OCT-angiography (OCT-A) parameters among the morphological subgroups. METHODS: Thirty-nine eyes of 29 patients with angiographically proven UME were enrolled into the study. All patients underwent comprehensive ophthalmological examination including structural OCT and OCT-A in addition to fluorescein angiography. Eyes with UME were divided into three subgroups (petaloid, sunflower and spoke-wheel pattern) with the help of en face OCT imaging. RESULTS: Posterior uveitis was the most common type of uveitis (17 patients; 58.7%), followed by panuveitis (11 patients; 37.9%) and then intermediate uveitis (1 patient; 3.4%). Underlying causes of uveitis were Behçet's disease (13 patients; 44.8%), idiopathic (11 patients; 37.9%), rheumatoid arthritis (2 patients; 6.9%), sarcoidosis (1 patient; 3.4%), inflammatory polyarthritis (1 patient; 3.4%) and psoriatic arthritis (1 patient; 3.4%). The most common en face OCT pattern was petaloid type (25 of 39 eyes; 64.1%). Eleven eyes (28.2%) had sunflower pattern and three (7.7%) spoke-wheel pattern. There were no statistically significant difference among the subgroups regarding the age, VA, central macular thickness and vessel density. CONCLUSION: This study reveals three morphological en face OCT patterns in eyes with UME and en face OCT may find a niche in the UME classification with the accumulation of experience among the uveitis experts.