Morphological characterization of subretinal hyper-reflective material in posterior uveitis using swept-source optical coherence tomography and optical coherence tomography angiography

Purpose: To analyze the structural features of subretinal hyper-reflective material (SHRM) in posterior uveitis using swept-source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (SS-OCTA). Methods: In this observational study, subjects with quiescent posterior uveitis and the presence of SHRM on SS-OCT were subjected to SS-OCTA to identify the presence of an intrinsic choroidal neovascular (CNV) network. OCT features were compared for SHRM harboring CNV (vascular SHRM) with those without CNV network (avascular SHRM) to identify clinical signs pointing toward the presence of CNVM inside SHRM. Results: Forty-two eyes of 33 subjects (18 males; mean age: 29.52 ± 12.56 years) were evaluated. Two-thirds (28/42) of eyes having SHRM on SS-OCT harbored intrinsic neovascular network (vascular SHRM). Increased reflectivity of SHRM (P < 0.001) and increased transmission of OCT signal underlying SHRM (P = 0.03) were suggestive of the absence of CNVM. The presence of intra/subretinal fluid (P = 0.08) and pitchfork sign (P = 0.017) were important markers of vascular SHRM. Conclusion: SHRM is an important OCT finding in eyes with posterior uveitis. Meticulous assessment of SHRM characteristics on SS-OCT can aid in identifying the underlying intrinsic neovascular network.

Experimental autoimmune uveitis and other animal models of uveitis: An update.

Over the past several decades, animal models of autoimmune uveitis directed at eye‑specific antigens (Ags) have been developed. These have allowed researchers to understand the basic mechanisms that lead to these diseases and also recently helped the researchers in translational research for therapeutic interventions. Experimental autoimmune uveitis (EAU) is an animal disease model of human endogenous uveitis and can be induced in susceptible animals by immunization with retinal Ags. Ever since the first description of EAU in mice in 1988, several animal models of uveitis has been described by researchers. Disease‑specific model for cytomegalovirus retinitis and tubercular uveitis has evolved our understanding of these complex entities. Endotoxin induced uveitis is another useful model for anterior uveitis, which is not an autoimmune process and is triggered by injection of bacterial endotoxin (lipopolysaccharides) resulting in a rapid short lasting uveitis. The current article will give an insight into the various EAU animal models and their current implications in translational research. The article will also highlight the different grading systems for EAU in the animal model.

Cytokines and Biologics in non-infectious autoimmune uveitis: Bench to Bedside.

Intraocular infl ammatory eye disease is one of the important causes of ocular morbidity. Even though the prevalence of uveitis is less common in relation to diabetic retinopathy, glaucoma or age related macular degeneration, the complexity and heterogeneity of the disease makes it more unique. Putative uveitogenic retinal antigens incite innate immunity by the process of antigen mimicry and have been shown to be associated in patients with intraocular infl ammatory disease by numerous experimental studies. Laboratory diagnostic tools to aid the etiologic association in intraocular infl ammatory disease have evolved over the last two decades and we are entering into an era of molecular diagnostic tests. Sophisticated novel technologies such as multiplex bead assays to assess biological signatures have revolutionized the management of complex refractory uveitis. Nevertheless, there is still a long way to go to establish the causal relationship between these biomarkers and specifi c uveitic entities. Experimental studies have shown the supreme role of infl iximab in the management of Behcet’s disease. Despite signifi cant experimental and case control studies, the defi ciency of randomized clinical trials using these biologic agents has handicapped us in exploring them as a front line therapy in severe refractory uveitis. Studies still need to answer the safety of these potentially life threatening drugs in a selected group of patients and determine when to commence and for how long the treatment has to be given. This review article covers some basic concepts of cytokines in uveitis and their potential application for therapy in refractory uveitis.

Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury.

Purpose: To identify pre‑operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re‑look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury. Materials and Methods: Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre‑operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded. Results: Median age was 37 years with male predilection (92.9%). Mean follow‑up was 12.9 months. Pre‑operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post‑operative vision based on univariate regression analysis were the presence of RAPD, poor pre‑operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo‑retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes). Conclusion: Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted.

Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore.

Objective: To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score. Materials and Methods: Retrospective case analysis of patients with open globe injuries at a tertiary referral eye care centre in Singapore was performed. Pre‑operative factors affecting final vision outcome in patients with open globe injury and correlation of ocular trauma score in our study with international ocular trauma scoring system was performed. Results: Case records of 172 eyes with open globe injury were analyzed. Mean age was 36. 67 years. Mean follow up was 12.26 m. Males were pre‑dominantly affected. Initial visual acuity was ≥20/40, 20/50 < 20/200, 20/200‑ CF, HM– PL and NLP in 24 (14%), 39 (22.7%), 16 (9.3%), 66 (38.4%) and 27 (15.7%) eyes respectively. Final visual acuity was ≤20/40, 20/50 < 20/200, 20/200‑ 1/200, HM– PL and NLP in 76 (44.2%), 28 (16.3%), 11 (6.4%), 30 (17.4%) and 27 (15.7%) eyes respectively. Ocular trauma score in our study correlates with international ocular trauma scoring system. Conclusion: The present study showed pre‑operative variables such as mode of injury, pre‑operative visual acuity, traumatic cataract, hyphaema, relative afferent papillary defect, vitreous lossand vitreous hemorrhage to be adversely affecting the final vision outcome. Our study showed a good synchrony with international ocular trauma score (OTS) and based on this study we were able to validate application of OTS in Singapore population. Recognizing these factors can help the surgeon in evidence based counseling.

Indocyanine green angiography in posterior uveitis.

Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.

Histopathologically proven siderotic cataract with disintegrated intralenticular foreign body.

Cataract formation may be an indicator of early siderosis and has been associated with intralenticular foreign bodies. We report a unique case of histopathologically proven lens siderosis in a young man with a preceding history of trauma but no signs of retained intraocular foreign body. He presented with a total white cataract with brownish deposits on anterior capsule and underwent cataract surgery for same followed by histopathological staining of anterior capsule for iron deposits. This case illustrates the importance of close monitoring of patients with history of trauma or previous penetrating injury to the eye, albeit no intraocular foreign body, as they might develop ocular siderosis at a later stage.

Prognostic factors for vision outcome after surgical repair of open globe injuries.

Purpose: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries. Materials and Methods: The study was carried out at a tertiary referral eye care center in Central India. In this retrospective study, case records of 669 patients with open globe injuries were analyzed. Different preoperative variables were correlated with the final visual outcome. Exclusion criteria were patients with less than four months follow up, previous ocular surgery, presence of intraocular foreign body or endophthalmitis at the time of presentation. Using statistical tests, the prognostic factors for vision outcome following surgical repair of open globe injuries were studied. Results: Based on the Spearman's Rho correlation analysis, following factors were found to be significantly associated with the final visual acuity at univariate level: age (P<0.001), preoperative visual acuity (P=0.045), mode of injury (P=0.001), and time lag between the injury and surgery (P=0.003). None of the other clinical factors have statistically significant correlation with final visual acuity. On multivariate analysis using binary logistic regression, only age, mode of injury and the time lag between injury and surgery achieved statistically significant results. Conclusion: In the current study, elapsed time between the injury and surgery, age of the patient, preoperative visual acuity and mode of injury were found to be adversely affecting the final visual outcome. Recognizing these factors prior to surgical intervention or intraoperatively can help the surgeon in evidence-based counseling of the trauma victim and family.

Current approach in diagnosis and management of anterior uveitis.

Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.

Recurrent anterior uveitis and healed retinal vasculitis associated with multiple sclerosis.

We describe the occurrence of anterior uveitis with healed retinal vasculitis in an Asian-Indian woman. She had features of anterior uveitis and healed retinal vasculitis. This rare disease in India may be associated with intraocular inflammation.