Retinal Vasoproliferative Tumours in Uveitis.

PURPOSE: To describe a cohort of patients with retinal vasoproliferative tumours (RVPT) seen in the uveitis clinic of a single tertiary eye care institute in India. METHODS: Retrospective Chart Review. RESULTS: In our study of 17 patients with 18 eyes affected by RVPTs, 94.1% showed unilateral involvement, one patient had bilateral RVPTs, and another had two RVPTs in the same eye. The mean age was 36.3 ± 15.1 years (range: 12-63 years), with a male majority (76.4%). The most common location was inferotemporal quadrant (44.4%). The most common associated uveitic condition was intermediate uveitis (50%). Patients were treated with oral corticosteroid (in 94.1%) and immunosuppressive (35.2%) in addition to transconjunctival cryotherapy (in 52.9%) or laser photocoagulation (in 41.1%). Regression of the RVPT was achieved in all cases except one. Visual acuity at time of detection of RVPT ranged from 6/6 to HM. No significant change was noted in the mean best corrected visual acuity pre and post treatment in the study group. CONCLUSION: RVPTs, rare peripheral retinal lesions often associated with intermediate uveitis, require early diagnosis with targeted therapy to prevent vision loss and achieve favorable long-term outcomes with rare recurrences.

Demystifying Ocular Syphilis - A Major Review.

Syphilis, caused by the spirochaete, Treponema pallidum, continues to be a public health challenge globally with its rates steadily increasing in the past few years. The disease is transmitted through small breaks in the skin during sexual contact, or via congenital transmission in utero, either across the placenta or by contact with an active genital lesion during delivery. Estimated 5.7-6 million new cases are detected every year worldwide in the 15-49 years age group. An increased incidence has been reported in most populations with particular clusters in special groups like men who have sex with men, female sex workers, and their male clients. Ocular syphilis has a varied presentation and is considered a great mimicker in all cases of uveitis. The laboratory diagnosis of syphilis is predominantly based on serological tests including TPHA and VDRL. Parenteral penicillin is the cornerstone of treatment for all stages of ocular syphilis.

Clinical profile and management with immunosuppressants and biologics in Behcet's uveitis: A cohort of 25 patients from a tertiary eye care center in South India.

Purpose: To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods: This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results: Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) - adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion: Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes.

Uveitis masquerade syndromes: A case series.

The aim of this series is to report challenges faced in diagnosis of three cases of recurrent or atypical uveitis not responding to conventional treatment. A high index of suspicion, aided by newer techniques, such as cytology, immunohistochemistry, flow cytometry of ocular fluids, and contrast-enhanced magnetic resonance imaging, may be necessary for a prompt diagnosis of uveitis masquerade syndromes.

Pediatric Inflammatory CNV: A Case Series from a Tertiary Referral Centre.

Purpose: To report a case series of pediatric inflammatory choroidal neovascularization (CNV) seen at referral uveitis clinic.Methods: Records of pediatric patients with uveitis and inflammatory CNV between January 2000 and December 2012 were analyzed.Results: Ten eyes of seven patients were included. Mean age 12.6 years, mean follow-up 89.6 months. Three out of seven patients had bilateral CNV. Subfoveal CNV was noted in five eyes, extrafoveal CNV in three eyes and juxtafoveal and peripapillary CNV each in one eye. All patients received corticosteroids; immunosuppressives were used in three patients. Additional anti-VEGF injections were given, in six eyes, anti-VEGF and PDT in one eye and only PDT in three eyes.Conclusion: Pediatric inflammatory CNV though challenging, can be successfully managed with prompt therapy of the underlying uveitic disease, coupled with additional local therapy to selectively target the CNV.

Autoimmune retinopathy: A case report from India.

A first case report of autoimmune retinopathy (AIR) from India. A middle-aged female patient presented with subacute loss of vision in both eyes. Clinical examination revealed a near normal fundus in both the eyes. A presumed diagnosis of nonparaneoplastic AIR was made based on clinical features and suggestive investigations. Early detection and management with steroids or immunosuppression may be beneficial to patients with AIR.

Pattern of Pediatric Uveitis Seen at a Tertiary Referral Center from India.

AIM: To analyze the profile, etiology, complications, medical and surgical management, and visual outcome among pediatric uveitis patients seen at a referral uveitis clinic in India. DESIGN: Retrospective cohort study, tertiary hospital setting. METHODS: Records between January 2007 and April 2010 were reviewed for patients with uveitis who were 0-18 years of age. Uveitis diagnosis was based on SUN criteria; complications, medical and surgical management, and visual outcome were evaluated. RESULTS: Among 190 children with uveitis, 64.2% were boys and 112 had unilateral disease. The median age at presentation was 11 years. Ninety-nine (52%) had anterior, 49 (26%) intermediate, 27 (14%) posterior, and 15 (7.9%) panuveitis. Infectious uveitis was present in 44 patients, of which 21 cases (48%) were posterior uveitis. Parasitic, tuberculous, and viral infectious uveitis was encountered. A total of 174 patients were followed over 315.5 person-years (median = 1.35 years). Seventy-seven (40.5%) children had complications related to uveitis. Forty-six out of 77 complications noted were complicated cataracts. Surgical procedures were done in 46.9% (15%/100 person-years). The visual acuity improved by two Snellen lines in the uveitic eyes, following therapy in 120 children, was stable in 40 children, and worsened in 14 children. Follow-up visual acuity was missing for 16 children. CONCLUSION: A large proportion of pediatric uveitis cases experienced complications of uveitis, mostly prior to presentation for subspecialty management. These often required surgical management, most commonly to clear the visual axis of cataract for visual rehabilitation and to prevent amblyopia. In most cases, tertiary management was associated with visual improvement. The results suggest that subspecialty management can result in improvement of the clinical course of pediatric uveitis.

A rare presentation of pigmented paravenous retinochoroidal atrophy.

A 21-year-old female patient presented with gradual progressive loss of vision in both eyes of 12 years duration. Funduscopic examination revealed bone-spicule pigmentation and choroidal and retinal pigment epithelium atrophy along the vascular arcades, with macular involvement in both eyes. The patient was diagnosed with pigmented paravenous retinochoroidal atrophy which is rare disease, uncommon in females, more commonly affecting the paravascular fundus. Very few cases of macular involvement have been reported.