case of overlapping choriocapillaritis syndromes: multimodal imaging appraisal

Purpose: To present a patient with overlapping choriocapillaritis syndromes who first presented as a typical case of multiple evanescent white dot syndrome [MEWDS] and later with characteristic findings compatible with multifocal choroiditis [MFC]

Case Report: A 40-year-old myopic woman presented with a paracentral scotoma OS. Fundus examination revealed pale discolored areas around the optic disc corresponding to faintly hyperfluorescent areas on fluorescein angiography [FA]. On indocyanine green angiography [ICGA] there was extensive peripapillary hypofluorescence and confluent hypofluorescent dots superiorly. According to the clinical picture, a diagnosis of MEWDS was made. In 4 weeks, the visual field reverted to normal together with almost complete regression of hypofluorescence on ICGA. However, 4 months later fundus examination revealed some scars, a finding not typical for MEWDS. Besides, she developed another scotoma 12 months later accompanied by photopsia and the fundus illustrated more numerous scars than one year earlier. ICGA showed hypofluorescent areas corresponding to the scotoma delineated by visual field testing. The pattern of this recurrence clearly corresponded to MFC

Conclusion:This case illustrates an overlap between two entities, MEWDS and MFC in two sequential episodes. FA and fundus autofluorescence accounted for the lesions and optical coherence tomography showed damage to the photoreceptor outer segments, but only ICGA correlated well with functional evolution

Appraisal, work-up and diagnosis of anterior uveitis: a practical approach

This article presents a comprehensive approach of the diagnosis of anterior uveitis and appropriate investigational tests based on clinical signs. Uveitis has classically been presented by uveitis specialists as an obscure and complicated field in ophthalmology that was supposed to be restricted to the happy few who had the knowledge, which in some countries was even prevented from being diffused. The effect was that ophthalmologists turned away from uveitis or were not correctly armed when they chose to take care of uveitis patients. The consequences of this situation often fell upon the patients. Since more than 15 years our group has been represented by the Society for Ophthalmo-Immunoinfectiology in Europe [SOIE], which has been working to alter this image of uveitis and ensure that the knowledge of the basics of uveitis reaches the practicing ophthalmologist. Our firm believe is that up to 70% of uveitis cases, especially anterior uveitis, can be taken care of by the practicing ophthalmologist following a structured approach in the appraisal of the uveitis case. Judging from the attendance obtained, the response to our approach in every country [where we organize courses] has been inversely proportional to the previous disinterest since we started publicizing it

Fluorescein and indocyanine green angiography for uveitis

In recent years enormous progress has been achieved in investigational procedures for uveitis. Imaging is one such example with the advent of new methods such as indocyanine green angiography, ultrasound biomicroscopy and optical coherence compgraphy to cite only the most important. This tremendous increase in precision and accuracy in the assessment of the level and degree of inflammation and its monitoring comes in parallel with the development of extremely potent and efficacious therapies. In view of these developments, our whole attitude in the appraisal and investigation of the uveitis patient has to be adapted and correctly reoriented integrating the recent developments and this is no different for ocular angiography

Differential diagnosis of retinal vasculitis

Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings

Fuchs' Uveitis: Failure to associate vitritis and disc hyperfluorescence with the disease is the major factor for misdiagnosis and diagnostic delay

Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyze the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importane in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnosis were investigated. Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analyzed. The data collected included age, initial and final visual acuities; clinical findings at presentation, mean diagnostic delay, erroneous diagnosis, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications. One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients [11.4%] had bilateral involvement. The mean diagnostic delay was 3.04 +/- 4.30 years. The most frequent clinical signs were vitreous infiltration [97.40%], typical Fuchs' keratic precipitates [94.90%], crystalline lens opacities or cataract [47%], heterochromia [42.60%], ocular hypertension or glaucoma [12.80%]. The mean laser flare photometry value at presentation was 9.85 +/- 6.28 ph/ms. Thirty-nine patients [37.14%] had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%. Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label, Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factors leading to misdiagnosis. Such clinical findings need to be publicized in order to reduce misdiagnosis, and diagnostic delay