Ocular Leptospirosis: Report of a Challenging Diagnosis.

PURPOSE: To report a challenging case of serologically confirmed posterior uveitis due to leptospirosis. METHODS: Review of medical records. RESULTS: Thirteen-year-old boy presented focal necrotizing retinochoroiditis after flood exposure. Laboratory work-up confirmed leptospirosis infection and proper antibiotic treatment was done. The patient evolved well. but during late follow-up he developed nummular keratitis. CONCLUSION: Leptospirosis is a possible etiology of necrotizing posterior uveitis. The use of antimicrobial therapy is controversial but was used in this case, in association with corticosteroids, leading to resolution of retinal inflammation. Despite treatment, the patient developed late corneal opacities, which did not lead to visual impairment.

Atypical pattern of ocular toxoplasmosis: recurrent inner foveal toxoplasmic retinitis (rifter).

Failure to recognize the different possible clinical presentations of ocular toxoplasmosis may delay diagnosis and treatment, compromising visual prognosis. The aim of this paper is to describe an atypical pattern of ocular toxoplasmosis, not yet described. Five Brazilian patients, from 4 different referral centers, presented similar atypical pattern of ocular toxoplasmosis characterized by mild vitritis, foveal cavitation involving predominantly all retinal layers associated with adjacent inner retinal necrosis (a necrotizing retinitis with a persisting inner retinal tissue bridge and loss of subjacent retinal layers). The appearance of the OCT image resembling a "rift", led the authors to define this pattern as a Recurrent Inner Foveal Toxoplasmic Retinitis (RIFTER), which can be considered as a new description of an atypical pattern of toxoplasma retinochoroiditis, and clinicians should be aware of it and consider testing for toxoplasmosis in patients with similar findings.

Colombian Ocular Inflammatory Diseases Epidemiology Study (COIDES): Prevalence, Incidence, and Sociodemographic Characterization of Uveitis in Colombia, 2015-2020.

PURPOSE: To describe the prevalence, incidence, and sociodemographic characteristics of uveitis in Colombia based on the National Health Registry of Colombia, the Integrated Social Protection Information System database (SISPRO). METHODS: We performed a cross-sectional study using SISPRO. Along with the International Classification of Diseases, we were able to identify cases of general uveitis (GU), anterior (AU), and posterior uveitis (PU) from 2015 to 2019. For 2020, we used a statistical model for spatial data to predict the prevalence/incidence of the diseases and compared it to the data retrieved in SISPRO. RESULTS: The average prevalence of GU was 14.66 cases per 100,000 inhabitants, while the average incidence rate of GU during the same period was 13.61 cases per 100,000 inhabitants per year. In 2020, there was a noticeable decrease in the incidence and prevalence of GU. Similar trends were observed when analyzing the incidence and prevalence of AU and PU separately. Females accounted for most reported cases, and there was a notable shift towards older age groups (over 50 years) for uveitis occurrence in males and females. Regions such as Bogotá, Antioquia, Valle del Cauca, and the Andean region had higher numbers of cases and a more significant disease burden. CONCLUSIONS: Our study represents Colombia's first population-based characterization of GU, AU, and PU epidemiology. Our results highlight the importance of understanding disease patterns according to sociodemographic factors intrinsic to distinct geographic locations to design better preventive, diagnostic, and treatment approaches in the Colombian population.

Multimodal Imaging Features of the Posterior Segment in Ocular Syphilis and HIV Co-Infection: A Single Center Case Series.

OBJECTIVE: To analyze the frequent multimodal imaging features in posterior syphilitic uveitis. PURPOSE: Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection. METHODS: All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy. RESULTS: 18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement. CONCLUSION: Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.

HTLV-1 uveitis in Colombia, an underrecognized complication of a hitherto neglected condition: a case series.

Three Colombian patients with chronic HTLV-1 infection and severe intermediate and/or posterior uveitis are described. In one case, retinal ablation was necessary due to extensive peripheral degeneration, while the other two were successfully managed with local anti-inflammatory therapy. Gradual resolution of ocular findings was observed in all three patients on follow-up. Uveitis is a rarely recognized late complication of this infection, which represents a diagnostic and therapeutic challenge for clinicians in endemic countries. The real extension of HTLV-1 prevalence in Colombia and the frequency of its ophthalmologic complications remain to be determined.

Retinal microvascular abnormalities, cotton wool-like lesions, and macular edema following COVID-19 in a patient previously vaccinated with AstraZeneca and idiopathic myopathy.

In this case study, the authors describe peculiar bilateral cotton wool-like retinal lesions associated with macular edema in a patient with COVID-19 who was vaccinated with a single dose of AstraZeneca one month earlier. This patient had no pulmonary or systemic cardiovascular complications from COVID-19, as reported in other papers that found retinal lesions. However, the patient was diagnosed with idiopathic myopathy when discovering the SARS-CoV-2 infection. The patient was a 22-year-old white female with no previous history of morbidity, complaining of blurred vision in both eyes seven days after testing positive for SARS-CoV-2 by PCR (using nasal and oral swab) and confirmed through ELISA blood test (IgM positive). There was no ancillary test revealing diabetes mellitus. The patient presented with scattered whitish cotton wool-like lesions and a few hemorrhages on the posterior pole in fundus examination. On spectral domain optical coherence tomography (SD-OCT), there were hyperreflective lesions in the nerve fiber layer, ganglion cell layer, inner nuclear layer, and inner and outer plexiform layers at the site corresponding to the whitish cotton wool-like lesions in the posterior fundus photos. Moreover, the macula of both eyes had intraretinal and subretinal fluid, reversible with corticosteroid therapy. In conclusion, COVID-19 has been associated with capillary disorders at different target sites such as retina, lungs, and central nervous system. Similarly, vaccination against SARS-CoV-2 has been linked to retinal complications in the literature; however, cotton wool-like lesions have not yet been reported. There are many questions yet to be answered about the implications of COVID-19 infection and its vaccines.

Coriorretinopatia de Birdshot: relato de caso e perspectivas sobre o tratamento / Birdshot chorioretinopathy: a case report and perspectives on its treatment

RESUMO A coriorretinopatia de Birdshot é uma uveíte posterior bilateral crônica rara que acomete, preferencialmente, mulheres de meia-idade. O quadro clínico é composto de pouco ou nenhum processo inflamatório de segmento anterior, associado a vitreíte e lesões coriorretinianas ovoides branco-amareladas de característica hiperfluorescente na angiofluoresceinografia e hipofluorescente na angiografia com indocianina verde. O tratamento se dá por meio de corticoides e outras drogas imunossupressoras. Todavia, em alguns casos, a doença é refratária a tal terapêutica, sendo necessário lançar mão de outras drogas, como os agentes biológicos. O presente artigo busca relatar um caso de coriorretinopatia de Birdshot em ajuste de terapia imunossupressora que evoluiu com má resposta às drogas iniciais e bom controle após uso de imunobiológico e discutir as opções terapêuticas disponíveis atualmente.

ABSTRACT Birdshot chorioretinopathy is a rare chronic bilateral posterior uveitis that preferentially affects middle-aged women. The clinical picture is composed of little or no anterior segment inflammatory process, associated with vitritis and yellowish-white ovoid chorioretinal lesions with hyperfluorescent characteristics on fluorescein angiography and hypofluorescent characteristics on green indocyanine green angiography. Treatment is with corticosteroids and other immunosuppressive drugs. However, in some cases, the disease is refractory to such therapy, making it necessary to resort to other drugs such as biological agents. The present article seeks to report a case of Birdshot chorioretinopathy in an adjustment of immunosuppressive therapy that evolved with poor response to the initial drugs and good control after the use of immunobiologicals and discuss the currently available therapeutic options.

Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak, Brazil1.

In 2015, an outbreak of presumed waterborne toxoplasmosis occurred in Gouveia, Brazil. We conducted a 3-year prospective study on a cohort of 52 patients from this outbreak, collected clinical and multimodal imaging findings, and determined risk factors for ocular involvement. At baseline examination, 12 (23%) patients had retinochoroiditis; 4 patients had bilateral and 2 had macular lesions. Multimodal imaging revealed 2 distinct retinochoroiditis patterns: necrotizing focal retinochoroiditis and punctate retinochoroiditis. Older age, worse visual acuity, self-reported recent reduction of visual acuity, and presence of floaters were associated with retinochoroiditis. Among patients, persons >40 years of age had 5 times the risk for ocular involvement. Five patients had recurrences during follow-up, a rate of 22% per person-year. Recurrences were associated with binocular involvement. Two patients had late ocular involvement that occurred >34 months after initial diagnosis. Patients with acquired toxoplasmosis should have long-term ophthalmic follow-up, regardless of initial ocular involvement.

Characteristics, Upon Presentation, of a Cohort of Hispanic Patients with Birdshot Retinochoroidopathy.

OBJECTIVE: To describe the characteristics, upon presentation, of a cohort of Hispanic patients with birdshot retinochoroidopathy. METHODS: A retrospective chart review of Hispanic patients with birdshot retinochoroidopathy of was performed. The demographic and clinical characteristics were analyzed. RESULTS: Nine patients who met the research criteria for a diagnosis of birdshot retinochoroidopathy were identified and included in the analysis, all of whom were HLA-A29 positive. The median age of the cohort upon presentation was 52 years; 89% of the patients were female, and all were Hispanics. Ninety-four percent of the eyes had an initial visual acuity of 20/50 or better, while 72% had measured 20/25 or better. Sixty-one percent of the eyes had retinal vasculitis, which was bilateral in 83% of the cases. Thirty-three percent of the patients had, upon presentation, evidence of cystoid macular edema, which was always bilateral. All the eyes had the typical birdshot lesions, at presentation. CONCLUSION: Birdshot retinochoroidopathy can be found in Hispanic patients. Our study suggests that the characteristics upon presentation in Hispanics may be similar to those of Caucasian cohorts.

Acute Retinal Necrosis: Is The Current Valacyclovir Regimen Adequate?

Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.

Quality-of-Life and Psychosocial Aspects in Patients with Ocular Toxoplasmosis: A Clinical Study in a Tertiary Care Hospital in Brazil.

PURPOSE: To evaluate quality of life in patients with uveitis-related to toxoplasmosis and its correlation with demographic, ocular involvement and psychosocial aspects.Methods: Data were collected through standardized interviews using a form to collect clinical and demographic data, in addition forms such as HADS, SF-12, NEI-VFQ-25 for health-related quality of life and anxiety and depression symptoms.Results: 81 patients were included with a mean age of 41.5 ± 14.5 years, females (50.6%) They were divided into three categories of best corrected visual acuity in the better seeing eye: normal (0-0.4 logMAR, 60 participants), low vision (0.48-0.9 logMAR, 9 participants) and blindness (>1 logMAR, 12 participants). The mean of VFQ-25 score was 75.5 ± 19.5 and the mean of SF-12 physical and mental components scores were 48.5 ± 7.4 and 52.4 ± 10.6 for health-related quality of life (HRQol). Anxiety symptoms were most prevalente than depression and were found in 38% of the subjects.Conclusions: Slightly more than a quarter of the sample presented impaired vision. It is associated with worsening of the quality of life since it affects mostly mental and related to the vision domains. This affects familiar, social and in addition, labor relations, since the majority of the subjects are in the economically active age group.

Vogt-Koyanagi-Harada disease. Case report and review of the literature / Enfermedad de Vogt Koyanagi Harada. Reporte de un caso y revisión de la literatura

ABSTRACT Vogt Koyanagi Harada disease affects several parts of the body, such as eyes, meninges, ears, and skin. The progressive course of the disease can lead to blindness and deafness. The case is presented of a Hispanic woman (mixed-race) with visual alterations, headache, tinnitus, hearing loss, and posterior uveitis with serous detachments of the retina in both eyes, as well as lymphocytic meningitis. The aim of the present study is to review the literature, the diagnostic strategies, and the appropriate treatment, as well as to update the immunogenetic pathogenesis of the disease.

RESUMEN La enfermedad de Vogt Koyanagi Harada compromete múltiples órganos tales como ojos, meninges, oídos y piel. El curso progresivo de la enfermedad puede llevar a ceguera y cofosis. Se describe un caso de esta enfermedad en mujer hispana (mestiza) con alteraciones visuales, cefalalgia, tinnitus e hipoacusia a quien se le encuentra uveítis posterior con desprendimientos serosos de retina en ambos ojos y meningitis linfocitaria. El objetivo del presente estudio es, mediante una revisión de la literatura, actualizar la patogénesis inmunogenética, conocer las estrategias diagnósticas y el tratamiento apropiado.

Spectral optical coherence tomography findings in an adult patient with syphilitic bilateral posterior uveitis and unilateral punctate inner retinitis.

PURPOSE: To describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient. OBSERVATIONS: In the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer. CONCLUSION AND IMPORTANCE: Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.

Regional Differences in the Clinical Manifestation of Ocular Toxoplasmosis Between the Center and Northeast of Argentina.

Purpose: To compare the clinical characteristics of patients with active episodes of ocular toxoplasmosis from three provinces, Misiones, Santa Fe, and Buenos Aires, Argentina. Methods: Patients with a diagnosis of ocular toxoplasmosis from three databases of four tertiary referral uveitis centers were reviewed. Collected data included presentation of the retinochoroiditis, location of the active lesions, associated inflammatory ocular signs and complications. Results: Three hundred thirty-four patients were included in this study. Bilateral involvement of the ocular disease occurred in 26 patients in Misiones (35.14%), 21 patients (12.8%) in Santa Fe, and 9 patients in Buenos Aires (9.4%) (p < 0.001). Extensive retinitis was observed in 49 patients (66.2%) in Misiones, 39 patients (23.8%) in Santa Fe, and 12 patients (12.5%) in Buenos Aires (p < 0.001). Conclusion: The results indicate that there are differences in the clinical characteristics of ocular toxoplasmosis in patients from Misiones, Santa Fe, and Buenos Aires.