Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit

Purpose: COVID?19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post?COVID?19 systemic secondary infections in a tertiary intensive care unit. Methods: Retrospective observational study based on chart review. Results: A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre?existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long?term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non?proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan?retinal photocoagulation. Conclusion: Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post?COVID?19 systemic infections

Clinical utility of 18 Fluorodeoxyglucose (FDG)-PET/CT scans in patients with suspect ocular tuberculosis.

A 38‑year‑old female patient presented with recurrent anterior uveitis. A 18 FDG‑PET scan revealed metabolically active supraclavicular and chest lymph nodes. An aspiration cytology of the cervical lymph node revealed caseating granulomas suggestive of tuberculosis. Case 2: A 58‑year‑old female patient presented with recurrent anterior uveitis. A 18 FDG‑PET scan revealed metabolically active lymph nodes in the neck. A biopsy of the cervical lymph node revealed epithelioid granulomas suggestive of tuberculosis. Both patients were started on standard antitubercular therapy with a subsequent marked reduction of activity. PET/CT scans may suggest the sites of safe high‑yield biopsies.

Ophthalmoscopy in the early diagnosis of opportunistic tuberculosis following renal transplant.

Chronic renal failure is a common sequel of renal inflammatory disease or diabetes mellitus. As a result of the immunosuppression that is induced by uremia, hemodialysis or posttransplant immunosuppressive medication, these patients are at a higher risk of opportunistic infections. Various viral, bacterial and mycobacterial infections have been reported. Tuberculosis is a common systemic opportunistic infection but reports of ocular involvement with pulmonary or disseminated tuberculosis are rare. We report the systemic and ocular findings in two postrenal-transplant patients with pulmonary or disseminated tuberculosis in whom detection of choroidal tubercles led to confirmation of the diagnosis in both patients and was the only specific premortem finding in one. Fundoscopy in this group of patients may help in the diagnosis of opportunistic tuberculosis, its earlier treatment and the consequent reduction of morbidity and mortality.

Ocular features of hantavirus infection.

Hantavirus infections are an emerging infectious disease that is beginning to be recognized both worldwide and in India as a cause of hemorrhagic fever that may present as a pulmonary syndrome or as a renal syndrome. Reports of ocular involvement are rare and include transient myopia, low intraocular pressure, conjunctival hemorrhages and changes of intraocular dimensions. Eleven patients (10 males, one female, mean age 37.6 years) were admitted to the intensive care unit for pyrexia of unknown origin or hemorrhagic fever following exposure to flood waters. Five male patients (mean age 31.6 years) were identified as suffering from hantavirus infection. In one patient, dot and blot intraretinal hemorrhages were seen in the macula of one eye and streak hemorrhages of the disc in the other. In the remaining four, no fundus abnormalities were seen. Ophthalmologists should be aware of these features.

The treatment of ocular tuberculosis: a survey of published literature.

With an expanding awareness of ocular tuberculosis, ophthalmologists are increasingly required to participate in the care of these patients. We conducted a survey of published ophthalmic literature to identify whether the regimens of antitubercular medications prescribed conform to current guidelines. A Medline search for publications (1995-2005) was done and the data were systematically analyzed with respect to demographic features, clinical findings and the antitubercular therapy prescribed. Of the 34 papers (82 patients) available, 33 papers described the prescribed antitubercular therapy. Eighteen papers (54.5%, 46 patients) conformed to guidelines versus 15 papers (45.4%, 32 patients) did not, suggesting that a large proportion of papers do not conform to current guidelines. Wider dissemination of therapeutic guidelines is necessary to encourage rational therapy and minimize therapeutic failures, drug resistance or relapse.

Fundus fluorescein angiography of choroidal tubercles: case reports and review of literature.

The aim of this communication was to report the fundus fluorescein angiography findings in three patients with choroidal tubercles. In all cases, there was a marked peritubercular inflammation. The tubercles themselves showed an initial hypofluorescence or minimal hyperfluorescence that increased in the late phases. Clinicians need to be familiar with these new findings as they may help in the diagnosis of ocular tuberculosis.

Utility of computed chest tomography (CT scan) in recurrent uveitis.

In recurrent uveitis CT scan could be a superior imaging modality when a primary pulmonary pathology is suspected. Two such cases are illustrated.