Multifocal Necrotizing Chorioretinitis Following Phacoemulsification Surgery.

INTRODUCTION: Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide. METHODS: We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate. RESULTS: He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal. DISCUSSION: Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.

Comparison of Optomap ultrawide-field imaging versus slit-lamp biomicroscopy for assessment of diabetic retinopathy in a real-life clinic.

PURPOSE: We aimed to assess the agreement between clinical assessment of diabetic retinopathy and Optomap ultrawide-field imaging (UWFI) in a real-life clinic setting. METHODS: Structured examination findings, from diabetic patients attending routine medical retina clinics in July 2011, were retrospectively compared with the grade obtained from Optomap UWFI images, graded independently by two ophthalmologists, taken at the same visit. RESULTS: A total of 84 eyes (42 patients) were examined, and 74 eyes (37 patients) were suitable for analysis. The hospital Eye Service slit-lamp biomicroscopy grades for retinopathy were: no diabetic retinopathy in zero eyes; background retinopathy in 21 eyes; preproliferative retinopathy in 34 eyes; and proliferative retinopathy in 19 eyes. For retinopathy, the agreement between the Optomap UWFI and clinical grading was moderate for both graders (κ=0.57 and κ=0.63), and there was almost perfect agreement between the two graders (κ=0.92). The clinical grades for the presence of photocoagulation scars were: no photocoagulation scars in 46 eyes and photocoagulation scars visible in 28 eyes, indicating substantial agreement between the Optomap UWFI and clinical grading for both graders (κ=0.73 and κ=0.64). There were two instances where proliferative retinopathy was documented clinically but graded as preproliferative by both graders of Optomap UWFI. These were investigated, and neither patient required treatment, ie, the difference in retinopathy grade would not have affected the patient outcomes. CONCLUSION: This study demonstrated moderate agreement between Optomap UWFI and hospital slit-lamp biomicroscopy grading of patients' retinopathy in a real-life medical retina clinic setting. The authors believe that Optomap UWFI is, not only a very useful adjunct to clinical examination in terms of detection and recording of retinopathy, but also, could have a role in standalone "virtual" clinics.

Sarcoidosis presenting as imploding antrum syndrome.

We present a case of a male patient who presented with facial asymmetry and epiphora. A diagnosis of imploding antrum syndrome secondary to sarcoidosis was made on the basis of characteristic computerised tomography features, elevated serum ACE and histopathological findings. We suggest that chronic inflammation within the sinus cavities, due to sarcoid, had caused osteolysis of the sinus walls, subsequently leading to the typical presentation of imploding antrum syndrome.