Retinopathy secondary to flare-up of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) can have widespread ocular manifestations, and posterior segment involvement may be associated with poor visual outcome. We report a clinical flare-up of SLE presenting as combined vascular occlusion in one eye and drusen-like deposits, which is a newly described entity in both eyes. As an ophthalmologist, a knowledge of such presentations helps us identify and possibly help the rheumatologist titrate treatment accordingly, to prevent severe life-threatening systemic complications.

Ocular leptospirosis: lack of awareness among ophthalmologists and challenges in diagnosis.

PURPOSE OF REVIEW: Systemic leptospirosis exists worldwide. But leptospiral uveitis, an important late complication is not identified by ophthalmologists in several countries. RECENT FINDINGS: In the last 18 months numerous publications, especially on epidemiology, surveillances, and novel rapid diagnostic kits to test at the point of care site on leptospirosis have been published from all over the world. However, publications from ophthalmologists are very scarce. Remarkably ophthalmologists should know the global burden of leptospirosis, prevalence of the disease in their country, demographic factors associated, risk factors, and systemic signs to elicit relevant history and travel history. They should be aware of recent advances in investigations to confirm their clinical diagnosis. SUMMARY: It is quite evident from this work that leptospirosis is prevalent worldwide. Ophthalmologists' awareness has to improve to identify the etiological diagnosis. They should have access to simple, less expensive, and less cumbersome laboratory tests.

Leptospiral Uveitis: Usefulness of Clinical Signs as Diagnostic Predictors.

PURPOSE: To analyze the diagnostic predictive ability of clinical variables. METHODS: Demographic and clinical variables of 172 serologically proven leptospiral uveitis patients were compared with 200 controls of non-leptospiral uveitis. Multiple logistic regression analysis identified diagnostic predictors. A receiver operating characteristic curve tested the performance of the model. RESULTS: Of all variables, male gender, farming as an occupation, and clinical features such as non-granulomatous panuveitis, hypopyon, and vitreous infiltration in the absence of retinochoroiditis constituted the predictive parameters, with the sensitivity and specificity of 86% and 90.7%, respectively. CONCLUSIONS: Multiple logistic analysis detected clinically diagnostic predictors that can assist primary care ophthalmologists. Clinical diagnosis can further be confirmed by serology at tertiary care centers.

Anterior Segment Ischemia in Viper Bite.

PURPOSE: To describe the clinical and histopathological features of post viper bite anterior segment ischemia. METHODS: Seven patients with ocular complications following viper bite referred to uveitis clinic had slit-lamp examination, intraocular pressure (IOP) measurement, and fundus evaluation. Iris and fundus fluorescein angiography was performed on 2 patients. Histopathological examination was performed on iris tissues collected during cataract surgery. RESULTS: Strikingly similar clinical findings were noted, including circumpupillary superficial iris atrophy, mid dilated fixed pupil, marked pigment dispersion, low IOP, and cataract. All clinical signs were noted only in the anterior segment; the posterior segment was normal. Histopathology of iris revealed atrophy of iris stroma, necrotic iris pigment epithelium, and infiltration of T lymphocytes and fibrous membrane. Poor visual outcome was noted in patients with low IOP. CONCLUSION: Viper bite victims presented with clinical and histopathological signs of anterior segment ischemia and secondary inflammatory signs mimicking uveitis.

Development and evaluation of NS1 specific monoclonal antibody based antigen capture ELISA and its implications in clinical diagnosis of West Nile virus infection.

BACKGROUND: West Nile virus (WNV) is a neurotropic flavivirus that causes viral encephalitis. Recent epidemics of WNV around the world have been associated with significant rates of mortality and morbidity in humans. The early confirmatory diagnosis of WNV infection is important for timely clinical management and epidemiological control in areas where multiple flaviviruses are endemic. OBJECTIVE: The aim of this study is to develop an monoclonal antibody based antigen capture ELISA for early confirmatory diagnosis of WNV infection with high degree of specificity and sensitivity having no cross reactivity with any of the closely related members of other circulating viruses. STUDY DESIGN: The gene coding for the NS1 protein of WNV was cloned and expressed in pET-28a expression vector. Purified recombinant protein was then utilized for generation of mice monoclonal antibody (Mab) and hyper immune sera (HIS) in rabbit. The sandwich ELISA was developed using the rabbit HIS and mice Mab as capture and detector antibody respectively and the results were compared with real time RT-PCR by evaluating 105 suspected clinical samples. RESULTS: The comparative evaluation of the sandwich ELISA with real time RT-PCR revealed 97% concordance with sensitivity and specificity of 90% and 98% respectively. CONCLUSION: The WN NS1 antigen was detectable in the blood from the first day up to day 9 after the onset of symptoms. The higher sensitivity and specificity of this monoclonal Antibody based sandwich ELISA makes it useful for early diagnosis of WN infection in endemic areas during outbreaks.

Molecular diagnosis and ocular imaging of West Nile virus retinitis and neuroretinitis.

PURPOSE: To describe the ocular features of West Nile virus (WNV) infection proven by serology and molecular diagnostic techniques. DESIGN: Prospective case series. PARTICIPANTS: Fifty-two patients who presented to the uveitis clinic with ocular inflammatory signs and history of fever preceding ocular symptoms between January 2010 and January 2012 were enrolled for laboratory diagnosis. Serum samples were collected from 30 healthy controls from the same geographic area. METHODS: Patients were tested for all endemic infectious diseases that can cause ocular inflammation by serology or molecular diagnostics. When patients had positive antibodies for WNV, serum/plasma samples were tested by real-time reverse transcription (RT) polymerase chain reaction (PCR) and RT loop-mediated isothermal gene amplification assays. The PCR product was subjected to nucleotide sequencing. Fundus fluorescence angiography (FFA), optical coherence tomography (OCT), and indocyanine green angiography were performed. Visual prognosis was analyzed. MAIN OUTCOME MEASURES: Clinical signs (retinitis, neuroretinitis, and choroiditis) and ocular complications (decrease in vision). RESULTS: A total of 37 of 52 patients (71%) showed positive results for at least 2 laboratory tests for WNV. Fundus examination revealed discrete, superficial, white retinitis; arteritis; phlebitis; and retinal hemorrhages with or without macular star. The FFA revealed areas of retinal inflammation with indistinct borders, vascular and optic disc leakage, vessel wall staining, or capillary nonperfusion. Indocyanine green angiography confirmed choroidal inflammation in 1 of the patients who was diabetic. The OCT scan of the macula revealed inner retinal layer edema in active inflammation and retinal atrophy in late stage. At the final visit, 43% of patients had visual acuity better than 6/12. CONCLUSIONS: In addition to previously reported clinical signs, retinitis, neuroretinitis, and retinal vasculitis were seen in this population. Atrophy of the inner retinal layer was seen on OCT after resolution of inflammation. Visual prognosis was good in patients with focal retinitis and poor in patients with occlusive vasculitis. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Epiretinal deposits post cataract extraction.

PURPOSE: To report two unusual cases of epiretinal deposit post cataract surgery. METHODS: Retrospective identification of an unusual complication in patients who had cataract extraction recently with intraoperative complications. RESULTS: Two patients were identified with epiretinal deposits after cataract extraction where the posterior capsule barrier was breached. Inflammation was limited to the posterior segment, and investigative workup for infective causes was negative. No intraocular antibiotics had been used. In both the cases, hydroxypropyl methylcellulose was used as the viscoelastic substance. CONCLUSION: The authors report rare posterior segment toxicity in cataract surgeries complicated with intraoperative breach of posterior capsule barrier and hydroxypropyl methylcellulose use.

Serological diagnosis of leptospiral uveitis by HbpA IgG ELISA.

Leptospirosis is a zoonotic disease that is highly prevalent in tropical countries; uveitis is one of the manifestations of leptospirosis. The leptospiral aetiology of uveitis is difficult to predict because of overlapping clinical symptoms with uveitis due to other causes. The objective of this study was to evaluate the leptospiral haemin-binding protein HbpA as a diagnostic antigen for the serodiagnosis of leptospiral uveitis. Serum samples from patients, clinically diagnosed with leptospiral uveitis, were tested by ELISA for anti-HbpA antibodies and compared against the 'gold standard' microscopic agglutination test (MAT). Non-leptospiral uveitis and normal healthy individuals were used as controls. A total of 60 serum samples from patients suffering from leptospiral uveitis were studied, obtained from Aravind Eye Hospital, Madurai. Anti-HbpA IgG antibodies were detected in 92 % of patients clinically diagnosed with leptospiral uveitis, indicating that it is more sensitive than MAT, which had a seropositivity of only 50 %, and better than the commercially available Pan Bio IgM ELISA (81 %). The mean anti-HbpA antibody titre was significantly higher in leptospiral uveitis patients compared with controls (P<0.05). The antigen showed negligible cross-reactivity with non-leptospiral uveitis samples and cataract controls. We conclude that HbpA IgG ELISA identified cases of uveitis with leptospirosis aetiology and proved to be useful in differentiating them from other forms of uveitis.