Bilateral Ocular Tuberculosis in a Child with Negative Tuberculin Skin Test (TST): A Diagnostic Dilemma.

PURPOSE: To report a case of bilateral ocular tuberculosis (OTB) in a child with negative Tuberculin skin test (TST). METHODS: Case report. OBSERVATIONS: A 12-year-old malnourished systemically asymptomatic boy presented with sudden profound loss of vision in both eyes. Dense vitritis precluded fundus visualization in right eye (RE). In left eye, fundus findings of extensive vasculitis associated with multifocal retinochoroiditis were suggestive of OTB. However, negative TST, normal chest X-ray, and gram negative bacteriuria led to confusion between endogenous endophthalmitis and OTB. Based on strong clinical suspicion and high-resolution chest tomography (HRCT) of thorax which was suggestive of TB-pneumonitis, a diagnosis of presumed OTB was made. A good response to anti-tubercular-treatment and corticosteroids, with resolution of retinochoroiditis lesions, vasculitis, and vitritis, further supported our diagnosis. CONCLUSIONS: This case highlights the importance of keeping a high index of suspicion for TB-associated uveitis in children, based on clinical findings.

Choroidal thickness in Waardenburg syndrome.

Purpose: To assess the choroidal thickness in differently pigmented areas of the fundus in a 46-year-old female with Waardenburg syndrome. Methods: Retrospective, case review. Choroidal thickness was measured using swept-source optical coherence tomography (SS-OCT, Topcon DRI OCT-1 Atlantis) and compared between the pigmented and hypopigmented areas within the same eye and between the two eyes. Results: Best corrected visual acuity (BCVA) was 20/20 in both eyes. The right fundus had a variegated appearance without choroidal hypopigmentation. The left fundus had choroidal hypopigmentation beyond the superotemporal arcade up to the periphery. Subfoveal choroidal thickness was 455 µ in the right eye and 569 µ in the left eye. In the left eye, the comparison of two equidistant points from the foveola along a radial scan passing through the superotemporal hypopigmented area revealed a thinner choroidal thickness (457 µ) compared to the corresponding point in the pigmented inferonasal quadrant (591 µ). Conclusion: Choroidal thickness is decreased in the hypopigmented area of the fundus compared to the pigmented area in subjects with Waardenburg syndrome. The overall thickness of the choroid in such eyes could still be more than the mean value in the normal population.

Changing uveitis patterns in South India - Comparison between two decades.

Purpose: Changing pattern of uveitis in a subset of a population is an important ocular health indicator. Methods: A comparative study was done between uveitis patients of 2013 and 1995 using two proportions Z-test. Results: In 2013, 352 new uveitis cases were examined. Males 56%, females 44%; unilateral 30.4%; bilateral in 69.6%. A specific diagnosis achieved in 66.2%. Anterior uveitis was seen in 35.22%, intermediate uveitis in 30.11%, posterior uveitis in 25%, and panuveitis in 9.65%. There was no significant difference in the incidence of new uveitic cases (1.04% vs. 1.8%). A decline in male preponderance from 64% to 56% (P = 0.0187) was observed. In both studies, anterior uveitis was the most common but human leukocyte antigen-B27 positivity uveitis had increased (29.83% vs. 14.5%; P < 0.05). Intermediate uveitis was the second-most common type instead of posterior uveitis (P = 0.0006). In posterior uveitis cases, etiology was established in 88.6% versus 56.06% cases (P < 0.05). The most common cause of posterior uveitis was tuberculosis (TB) (35.2%). Viral retinitis had increased to 6.81% from 0.76% (P < 0.05). However, a declining trend in cases of toxoplasmosis was observed (P = 0.0545). The cause of panuveitis was comparable in both studies. The prevalence of TB has significantly increased in the present era (22.5% vs. 0.64%; P < 0.0001) and was the proven etiological cause of uveitis in overall 22.5% of which 4.8% cases were of anterior uveitis cases, 7.1% cases of intermediate uveitis cases, 8.8% cases of posterior uveitis cases, and 1.8% of panuveitis cases. Conclusion: A shifting paradigm of uveitis over the past two decades was observed.