A Rare Presentation: Bilateral Necrotizing Scleritis in Primary Sjögren's Syndrome.

PURPOSE: We report a rare and challenging case of bilateral necrotizing scleritis in primary Sjögren's syndrome (pSS). METHODS: Retrospective case report. RESULTS: A 72-year-old diabetic, hypertensive female patient presented with sudden onset of painful red left eye and was noted to have a corneal ulcer with severe thinning. She was managed with topical fortified antibiotics and tissue glue and bandage contact lens. During subsequent follow-ups, she developed necrotizing scleral melts in both eyes. On investigations, antinuclear antibodies were positive in a dilution of 1:160 with 2+ speckled pattern, with antinuclear antibody line immunoassay showing anti SS-A/ Ro52 positive. In view of rapidly developing scleral thinning and impending perforation, she was started on intravenous methylprednisolone 1 g/day for 3 days, along with steroid-sparing immunomodulatory therapy (mycophenolate mofetil 500 mg twice a day). She showed a rapid response to therapy and is currently stable on tapering oral steroids and mycophenolate mofetil. CONCLUSION: This case underscores the unique presentation of pSS, characterized by bilateral necrotizing scleritis. The favorable outcome was attained through prompt immunosuppressive intervention and a collaborative, multidisciplinary approach. Further, this case report addresses a gap in the existing literature concerning pSS-related scleritis. It also emphasizes the crucial role of a rheumatologist in the comprehensive management of this condition.

Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature.

Purpose: To report a case of ocular toxoplasmosis following long-term treatment with adalimumab and review the literature on ocular toxoplasmosis following anti-Tumour necrosis factor-α therapy. Method: A retrospective chart review of A 21-year-old male who developed retinochoroiditis in his left eye following adalimumab therapy combined with oral methotrexate. Result: A known patient of juvenile idiopathic arthritis (JIA) on adalimumab and oral methotrexate for the last four years presented to us with a blurring of vision for the last 15 days. Fundus examination of the left eye revealed severe vitritis and two patches of retinochoroiditis in the inferior part of the fundus. Subsequent investigations confirmed it to be a case of toxoplasma retinochoroiditis, and he responded to anti-toxoplasma treatment. A review of literature on a similar topic revealed five such cases, and the index case was the first such report in patients with JIA. Conclusion: The index case highlights the importance of early recognition and management of opportunistic infections in patients receiving biologicals.

Visual outcome in pediatric uveitis: A retrospective data review in 277 children.

Purpose: This study aimed to describe visual outcomes in cases of pediatric uveitis in an Indian population and to analyze various factors affecting these outcomes. Methods: Single-center, retrospective chart review of 277 cases of uveitis in patients under the age of 18 years. Variables assessed included age and sex distribution, anatomical location of uveitis, systemic associations, complications, and various treatment strategies used, including long-term immunomodulation and surgical management of complications if required. The main outcome was the final visual acuity. Results: At the final visit, 51.5% of the eyes showed improvement in the final visual acuity, while vision remained stable in 28.7% and 19.7% of the eyes showed worsening of vision at the final follow-up. A total of 19.4% of patients were blind in at least one eye at the final visit, and 16 patients (5.77%) remained bilaterally blind at the final follow-up. The presence of cataract (p = 0), posterior uveitis (p = 0.005), and retinal detachment (p = 0.014) were the most significant risk factors for predicting worse visual outcomes. More than half (65.7%) of patients reported a complication at some point in their follow-up, and the most common complication was cataract. In total, 50.9% of patients required long-term immunomodulatory therapy. Conclusion: Pediatric uveitis remains a challenging condition to treat and follow-up, and the visual outcome remains guarded for most patients.

Bilateral Central Retinal Vein Occlusion Associated with Axitinib Therapy: A Case Report.

PURPOSE: To describe a case of retinal vascular occlusion and cerebrovascular accident following axitinib therapy. METHODS: A retrospective chart review. RESULT: A 65-year-old gentleman with a history of renal cell carcinoma and subsequent metastases to the brain was on axitinib at an oral daily dose of 10 mg. The patient reported a loss in vision in the right, followed by the left eye, and suffered an episode of cerebrovascular accident. Retinal examination revealed right eye optic nerve pallor with sclerosed vessels, possibly sequelae of central retinal vein occlusion, and left eye showed multiple retinal hemorrhages in all quadrants with macular edema, suggestive of central retinal vein occlusion. He was not a known hypertensive, his renal carcinoma was in remission, and his other systemic parameters were within acceptable limits. CONCLUSIONS: Axitinib can cause retinal vein occlusions, and clinicians, both oncologists, and ophthalmologists need to be aware of this rare but potentially blinding side effect.

Tofacitinib in Scleritis: A Case Series.

PURPOSE: To report the use of tofacitinib in ten patients with scleritis where the traditional immunomodulation was not successful or could not be used. METHOD: A retrospective chart review. RESULT: Tofacitinib was successful in the treatment of scleritis in patients either recalcitrant to or intolerant to conventional therapy in 9 out of 10 cases reported here. Two patients had developed reactivation of herpetic infection after 1 month of starting tofacitinib. The duration from diagnosis of scleritis to the institution of tofacitinib therapy varied from 1 month to 60 months. Duration of follow-up varies from 2 months to 11 months. CONCLUSION: Tofacitinib can be used as an important future option for managing recurrent and recalcitrant cases of scleritis.

Clinical spectrum of HLA-B27-associated ocular inflammation.

INTRODUCTION: HLA-B27-associated anterior uveitis is the most common identifiable cause of anterior uveitis in adults worldwide. It is associated with significant ocular morbidity in young patients due to its typically recurrent attacks of inflammation and vision-threatening ocular complications. MATERIALS AND METHODS: This review was compiled using articles identified by searching on PubMed with all relevant keywords such as HLA B27, HLA B27 uveitis, spondyloarthritis, Ankylosing spondylitis, HLA B27 systemic associations. RESULTS: We summarize the current knowledge on the HLA B27 associated uveitis epidemiology, genetics, clinical profile, systemic associations, laboratory investigations, complications and management. CONCLUSION: HLA-B27-associated uveitis is a commonly encountered entity in the uveitic clinic. Its management must be in coordination with a rheumatologist. Early and appropriately intense treatment is essential for optimal visual prognosis.

Tofacitinib in recalcitrant scleritis: First case report from India.

A 65-year-old male presented with redness and pain associated with active necrotizing scleritis in the left eye. He was started on mycophenolate mofetil and oral corticosteroids, to which there was no response detected after 4 weeks. A rheumatology opinion was sought and he was started on tofacitinib, after which there was dramatic clinical improvement. Patients refractory to conventional immunosuppressive therapy can benefit from the new class of immunosuppressive agents, JAK/STAT kinase inhibitors.

COVID-19: Limiting the Risks for Eye Care Professionals.

After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus.

Choroidal thickness evaluation of healthy eyes, central serous chorioretinopathy, and fellow eyes using spectral domain optical coherence tomography in Indian population.

AIM: The purpose of this study is to establish a normative database of subfoveal choroidal thickness (CT) in healthy young Indians using spectral domain optical coherence tomography (SD OCT). Evaluation and comparison of CT of central serous chorioretinopathy (CSC) and fellow eyes were also performed. MATERIALS AND METHODS: This was a prospective, cross-sectional, and observational study. It included 112 normal eyes of 112 healthy volunteers who had no evidence of ocular or systemic disease, 84 CSC eyes with acute, treatment-naïve CSC, and 69 fellow eyes with no evidence of neurosensory detachment or pigment epithelium detachment on SD OCT. Complete history, examination, and SD OCT were performed in all eyes. RESULTS: The mean age of 81 patients (84 eyes) with CSC was 35.04 ± 8.86 years, 69 fellow eyes was 34.61 ± 8.71 years, and 112 healthy volunteers (112 eyes) was 33.16 ± 9.4 years (P < 0.05). The mean subfoveal CT of CSC eyes was 429 ± 74.18 µ, fellow eyes was 360 ± 57.99 µ, and normal eyes was 301.80 ± 46.59 µ (P < 0.001). CONCLUSION: CT varies not only with age, axial length, and refractive error but also with races. Therefore, it is important to establish a normative database in a particular population before carrying out further research in diseased states. CT in CSC eyes is significantly thicker than fellow eyes, and CT of fellow eyes is significantly thicker than normal eyes. This reinforces the fact that choroidal permeability is increased in both eyes of patients with CSC.

COMPARATIVE EVALUATION OF SEQUENTIAL INTRAOPERATIVE USE OF WHOLE BLOOD FOLLOWED BY BRILLIANT BLUE VERSUS CONVENTIONAL BRILLIANT BLUE STAINING OF INTERNAL LIMITING MEMBRANE IN MACULAR HOLE SURGERY.

PURPOSE: To compare the structural and functional outcome of use of autologous heparinized whole blood before staining internal limiting membrane with brilliant blue (BB) versus conventional BB-assisted macular hole surgery. METHODS: Sixty eyes of 60 patients were randomly divided equally in Group A (BB staining using whole blood) and Group B (conventional BB staining). Clinical assessment and spectral domain optical coherence tomography was done at baseline and 3 weeks, 6 weeks, 16 weeks, and 6 months postoperatively. RESULTS: Group A eyes had a significantly higher best-corrected visual acuity as compared with Group B postoperatively (P < 0.001, <0.001, 0.004, 0.04 at 3, 6, 16 weeks, and 6 months). Inner segment/outer segment junction continuity was noted in greater number of eyes in Group A compared with Group B (P = 0.02, 0.002, 0.003, and 0.03 at 3, 6, 16 weeks, and 6 months). Eyes in Group A had significantly higher outer foveal thickness at 3 weeks (P = 0.001) and 6 weeks (P < 0.001) compared with Group B. CONCLUSION: Use of whole blood before staining internal limiting membrane with BB causes earlier and better visual rehabilitation postoperatively, which could be attributed to earlier photoreceptor regeneration as evidenced by inner segment/outer segment junction continuity and increase in outer foveal thickness.