Leptospiral Uveitis: Case Series and Review of Literature.

AIM: To present the clinical features and review of literature of leptospiral uveitis. METHODS: We present clinical features of patients with leptospiral uveitis with positive Leptospira IgM antibodies. RESULTS: Twenty-six eyes of 24 patients, 11 males (45.8%), were included. The mean age was 37.5 ± 15.6 years. 91.7% had unilateral uveitis, 88.5% panuveitis, 11.5% anterior uveitis, 15.4% had hypopyon, 8% had cataract and 3.8% eyes had cystoid macular edema. Vitritis with characteristic vitreous membranes was an important feature. Retinal and choroidal vasculature were preserved on swept-source optical coherence tomography angiography. Mean presenting BCVA was logMAR0.49 ± 0.41, while final BCVA was logMAR0.04 ± 0.13. The mean duration for complete resolution of uveitis was 39.1 ± 15.5 days. 84.6% eyes achieved BCVA 6/6. CONCLUSION: Leptospiral uveitis is an under-reported entity. It may present as anterior uveitis or panuveitis. It must be included in the differential diagnosis of non-granulomatous uveitis. The visual prognosis is usually favorable even in severe cases.

Treatment Outcomes of Presumed Rickettsial Retinitis: Evidence from OCTA Based Quantitative Analysis.

AIM: To quantify retinal ischemia following presumed rickettsial retinitis (RR). To compare outcomes between initial treatment with Doxycycline (Group 1) versus steroids (Group 2). METHODS: Retrospective analysis of patients with presumed RR was done. ImageJ software was used to obtain %area of ischemia on swept-source optical coherence tomography angiography (SS-OCTA). RESULTS: Eleven eyes of 8 patients belonged to Group1 and 6 eyes of 3 patients belonged to Group 2. The BCVA improved from logMAR 0.8 ∓ 0.7 to logMAR 0.06 ∓ 0.08 (p < 0.002) and central foveal thickness (CFT) changed from 479µ ∓ 341.3µ to 163.5µ ∓ 20.5µ (p < 0.005) after a median of 5 weeks in Group 1. In Group 2, BCVA improved from logMAR 1.03 ∓ 0.05 to logMAR 0.23 ∓ 0.23 (p < 0.004) and CFT changed from 286.5µ ∓ 158.8µ to 177.5µ ∓ 25.9µ (>0.05) following a mean of 11 weeks. Mean %area of ischemia was 4.6 ∓ 1.5 in Group 1 and 13.9 ∓ 4.1 in Group 2. CONCLUSION: Analysis of flow deficit on SS-OCTA confirms that treatment with Doxycycline in presumed RR results in less ischemia and quicker recovery than initial treatment with steroids.

Multiple Evanescent White Dot Syndrome Following Adenovirus Vector-Based COVID-19 Vaccine (Covishield).

PURPOSE: To report a case of multiple evanescent white dot syndrome (MEWDS) following adenovirus vector-based Coronavirus disease 2019 (COVID-19) vaccine, Covishield and to present a summary of previously reported cases of MEWDS following COVID-19 vaccines. METHODS: Retrospective case report and review of literature. RESULTS: A 22-year-old Indian female presented with blurred vision, scotomata, and photopsias in her left eye, a day after administration of second dose of Covishield vaccine. Her clinical findings and imaging features confirmed the diagnosis of MEWDS. Her symptoms resolved spontaneously after 2 weeks. CONCLUSION: This is the first reported case of MEWDS following an adenovirus vector-based COVID-19 vaccine. Comparison with previously reported cases of MEWDS following COVID-19 vaccination showed that patients are generally healthy, young to middle-aged women, who develop symptoms after a median time of one week and recover spontaneously over a median period of 4 weeks.

The Efficacy and Safety of Intravitreal Dexamethasone Implant as Anti-inflammatory Monotherapy in the Management of Tuberculosis-associated Intermediate Uveitis.

AIM: To study the long-term efficacy and safety of Ozurdex as anti-inflammatory monotherapy in the management of tuberculosis-associated intermediate uveitis (TBIU). METHODS: Retrospective analysis of eyes with TBIU that received Ozurdex as anti-inflammatory monotherapy with a follow-up of at least 1 year. RESULTS: 13 eyes (2 pseudophakic) of 11 patients were included. Mean BCVA improved from 0.65 to 0.11 at 3 months (p = .0005) and remained 0.11 at 1 year. Mean central foveal thickness improved from 452.87µ to 187.25µ at 3 months (p = .0009) and 184.62µ at 1 year in 8 eyes with CME. Mean vitreous haze improved from 2.38 to 0.11 at 3 months with no recurrences at 1 year. Mean IOP increased from 13.15mmHg to 15.53mmHg (p = .013) at 2 months and reduced to 12.46mmHg by 1 year. None required antiglaucoma medication. One eye underwent cataract surgery. The mean follow-up was 18.4 months. CONCLUSION: Ozurdex is safe and efficacious in TBIU as anti-inflammatory monotherapy in conjunction with antitubercular therapy.

Aspergillus flavus endogenous endophthalmitis in an immunocompetent man: treatment outcomes and swept-source optical coherence tomography findings.

A non-diabetic man in his 40s presented with a 4-day history of sudden, painless, rapidly progressive severe vision loss in his right eye. Anterior segment was unremarkable. A dense, solitary vitreous abscess with feathery margins obscured the macula. Retinal haemorrhages, exudates and retinal vasculitis were noted. There was no history of ocular surgery, trauma, intravenous drug abuse or immunocompromise. He received intravenous fluids during a spinal procedure 5 days prior. Prompt diagnostic and therapeutic pars-plana vitrectomy was done and Aspergillus flavus was cultured. Postoperatively, he was treated with oral Voriconazole and four intravitreal Voriconazole injections, till the chorioretinitis lesions had completely healed and was objectively confirmed on follow-up swept-source optical coherence tomography (OCT). He achieved a best-corrected visual acuity of 6/36. A high index of suspicion, early vitrectomy and OCT-based treatment were key to favourable outcomes in this case. Intravenous fluid bottles must be checked for contamination prior to administration.

Choroidal imaging in uveitis: An update.

An important goal of advancements in ocular imaging algorithms and devices has been to improve the image acquisition and resolution of deeper ocular tissues, namely the choroid and its vasculature that are otherwise inaccessible to direct clinical examination. These advancements have contributed to the understanding of the pathophysiology of a number of ocular inflammatory conditions. We focus on the imaging characteristics of clinical conditions where imaging the choroid has improved or radically changed the understanding of the disease, has helped in differentiation of phenotypically similar but distinct lesions, and where imaging features have proven vital for monitoring disease activity. The last two decades have seen some major developments in ocular imaging relevant to uveitis. The current review addresses both the imaging characteristics and their interpretation on conventional modalities such as fundus photography, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence and the recent additions in the armamentarium including optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography.

Bilateral Retinopathy and Optic Neuropathy Associated with Systemic Sclerosis.

PURPOSE: To report a rare case of bilateral retinopathy and optic neuropathy in a patient of systemic sclerosis (SSc). METHODS: Retrospective case report. RESULTS: A 30-year-old South Indian lady presented with bilateral pale disc oedema and telangiectatic disc vessels and bilateral drusen-like deposits (DLDs) in the macula. Fundus fluorescein angiography additionally revealed microaneurysmal dilatation and leakage from peripheral retinal vasculature and patchy choroidal ischemia. She had defective colour vision (OS) and a central scotoma with enlarged blind spot (OD) and centrocecal scotoma (OS). Systemic features and a strongly positive anticentromere antibody led to the diagnosis of limited cutaneous SSc with a score of 12 on the ACR/EULAR criteria. CONCLUSIONS: We describe a rare case of bilateral retinopathy with DLDs and bilateral optic neuropathy in a non-hypertensive patient who was not previously diagnosed as SSc. A prior association of DLDs have not been described in SSc (PubMed Search).

Aspergillus Flavus Necrotising Scleritis following Pars Plana Vitrectomy.

PURPOSE: To report a case of fungal necrotising scleritis following pars plana vitrectomy. Results: A 65-year-old lady underwent phacoemlsificication with posterior capsular rupture and posteriorly dislocated lens in her left eye. On the same day she underwent 20 gauge pars plana vitrectomy and phacofragmentation. Postoperative period was uneventful for up to 6 weeks when she developed necrotising anterior scleritis with suppurative nodules. Scraping from the suppuration confirmed the presence of Aspergillus flavus. She was treated with topical Voriconazole and oral Itraconazole. Conclusion: We describe the first case of fungal necrotising scleritis without intraocular inflammation following pars plana vitrectomy (PubMed Search). Infection should be kept in the differential diagnosis of post-operative necrotising scleritis even in the absence of risk factors like hypopyon or diabetes. Early recognition improves final outcome. Medical therapy should be continued even after presumed cure to take care of residual fungi and prevent recurrences.