Ocular Brugia pahangi Filariasis Complicated by Severe Macular Damage in Thailand: Case Report and Literature Review.

Extralymphatic filariasis caused by filaria of zoonotic origins has been frequently reported in Thailand over recent years. Here, we report the first case of ocular filariasis in a 7.5-year-old Thai boy who initially presented with progressive conjunctival redness and blurred vision in his right eye. A small, slender, coiled worm was found and surgically removed from the right anterior chamber. Histopathological examination illustrated predominant eosinophilic inflammation surrounding the parasite, which showed smooth and thin cuticle, prominent lateral chords, flat and broad muscle cells, one intestine, and two reproductive tubes with unsegmented ova, typically characteristic of a female adult Brugia filarial nematode. The parasite was also molecularly identified as B. pahangi, based on mitochondrial cytochrome c oxidase subunit I sequence analysis. The patient was then empirically prescribed albendazole, systemic prednisolone, and topical methylprednisolone. Unfortunately, his vision did not recover after 2 months due to severe maculopathy, most likely resulting from parasitic infestation and subsequent vitreous inflammation. To the best of our knowledge, this is the first case of ocular infestation by B. pahangi with visual complications that occurred outside a filariasis-endemic area of Thailand. Furthermore, this report provides clinical data on preceding cases of B. pahangi filariasis formally reported in southeast Asian countries, including Thailand and Malaysia, which facilitate a better understanding of the epidemiology of this sporadic zoonotic infection for effective disease elimination.

Posterior segment manifestations of ocular metastasis.

PURPOSE OF REVIEW: This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis. RECENT FINDINGS: Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases. SUMMARY: Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.

Optical Coherence Tomography Angiography Biomarkers in Thai Patients With Diabetic Nephropathy: A Diabetic Eye and Kidney Diseases (DEK-D) Study.

Purpose: To identify optical coherence tomography angiography (OCTA) biomarkers to predict the diabetic nephropathy (DN) and their associations with 24-hour urine albumin levels in diabetic patients. Methods: This cross-sectional, observational study examined 186 eyes from 93 individuals subdivided into three groups according to 24-hour urine albumin levels: no DN, early DN, and late DN. Vessel density (VD), fractal dimension, foveal avascular zone area, intercapillary area, central retinal thickness, and subfoveal choroidal thickness were measured from OCTA images to determine their association with the DN stages. Results: VD values of the superficial capillary plexus, deep capillary plexus, and whole retina were significantly lower in the early DN group compared to the no DN group (adjusted P = 0.042, 0.016, and 0.008, respectively). VD values for the deep capillary plexus and whole retina were significantly decreased in the late DN group compared to the no DN group (adjusted P = 0.025 and 0.021, respectively). Mean fractal dimension, intercapillary area, foveal avascular zone area, central retinal thickness, and subfoveal choroidal thickness were not statistically different among the three groups. Conclusions: VD may be a useful parameter for the early non-invasive screening of DN. Further studies in larger populations are needed to establish a cutoff value for detection. Translational Relevance: This study investigated the association of each retinal vasculature measurement by OCTA and diabetic nephropathy status which could serve as an alternative way to screen for albuminuria.

Granulomatous panuveitis in disseminated sporotrichosis: case report and review of the literature.

PURPOSE: To report a case of intraocular sporotrichosis presenting with bilateral granulomatous panuveitis. METHODS: Observational case report and literature review. CASE PRESENTATION: A 62-year-old woman with a history of polycythemia vera presented with a non-healing ulcer at the left index finger, generalized erythematous papules, and bilateral granulomatous panuveitis. Cultures of skin and amputated finger identified Sporothrix schenckii. The diagnosis of intraocular sporotrichosis secondary to disseminated sporotrichosis was made. Intravenous liposomal Amphotericin B and intravitreal Amphotericin B were used to control systemic and ocular disease resulting in resolution of the skin lesions and intraocular inflammation. CONCLUSIONS: Intraocular sporotrichosis can manifest as bilateral granulomatous panuveitis in the setting of disseminated sporotrichosis. Treatment with intravenous and intravitreal antifungal therapy is useful for controlling intraocular infection.

Intracameral Gnathostomiasis: A Case Report and Literature Review.

PURPOSE: The purpose of this article is to report a case of ocular gnathostomiasis presenting with acute anterior uveitis and uveitis glaucoma. METHODS: observational case report and literature review. RESULTS: A 56-year-old Thai male was referred to a tertiary eye center with acute anterior uveitis and uveitis glaucoma in the right eye. A nematode was found in the right anterior chamber. Surgical removal of the nematode was successfully performed. Gnathostoma spinigerum was the nematode identified on pathological examination. CONCLUSIONS: Early detection of the parasite and timely surgical removal is the key to the management of ocular gnathostomiasis.

Antidrug Antibodies to Tumor Necrosis Factor α Inhibitors in Patients With Noninfectious Uveitis.

Importance: Tumor necrosis factor inhibitors (TNFis) can induce antidrug antibody (ADA) formation and loss of therapeutic response. However, the utility of ADA testing and the association between ADAs and treatment response in patients with noninfectious uveitis (NIU) is not well understood. Objective: To assess the frequency of ADAs and their association with drug levels and clinical response in patients with NIU treated with adalimumab or infliximab. Design, Setting, and Participants: This retrospective cross-sectional study included patients diagnosed with NIU who received adalimumab or infliximab and underwent testing for serum drug level and ADAs at the National Eye Institute from September 2017 to July 2021. Exposures: Serum drug level testing with reflex testing for ADA levels was performed. Main Outcomes and Measures: The main outcome was the association between drug levels and ADAs, clinical response, and concurrent antimetabolite use in patients treated with TNFis for NIU. Results: Of 54 patients included in the study, 42 received adalimumab (mean [SD] age, 43.6 [19.6] years; 25 [59.5%] female) and 12 received infliximab (mean [SD] age, 42.7 [20.4] years; 7 [58.3%] male). In the adalimumab group, mean (SD) drug level was 9.72 (6.82) µg/mL, mean (SD) ADA level was 84.2 (172.9) arbitrary units/mL, and ADA frequency was 35.7% (15 of 42 patients). Mean drug level was lower in those with ADAs compared with those without ADAs (mean [SD], 2.8 [2.6] µg/mL vs 13.6 [5.2] µg/mL; difference: 10.8 µg/mL; 95% CI, 8.3-13.2 µg/mL; P < .001). There was a higher mean drug level with concurrent antimetabolite use compared with monotherapy (mean [SD], 11.0 [7.3] µg/mL vs 6.8 [4.5] µg/mL; difference: -4.2 µg/mL; 95% CI, -8.7 to 0.2 µg/mL; P = .06). Multivariable modeling showed that a 1-arbitrary unit increase in ADAs was associated with a -0.02 µg/mL (95% CI, -0.01 to -0.34 µg/mL) difference in mean drug level (P < .001). Favorable clinical response was associated with a threshold drug level above 2.7 µg/mL or an antibody level below 15.2 µg/mL. The mean (SD) drug level in the infliximab group was 27.02 (18.15) µg/mL, and no ADAs were detected. Conclusions and Relevance: In this study, 35.7% of adalimumab-treated patients with NIU had ADAs. The presence of ADAs was associated with lower drug levels, and higher ADA levels were associated with increased risk of TNFi treatment failure. Although limited by the retrospective design, our results suggest that therapeutic drug monitoring may be considered among patients experiencing therapy failure to help exclude ADAs as a potential cause of treatment failure.

The patterns of uveitis and the factors affecting visual outcome from Chulalongkorn University Uveitis Cohort (CU2C): A 5-year longitudinal study protocol.

BACKGROUND: In Thailand, several novel laboratory investigations are recently available to help differentiate the uveitic etiologies. The update on uveitis epidemiological data in Thailand is necessary to better understand the disease burden and provide guidance on management. The current study aims to describe the prevalence and identify factors associated with poor visual outcomes of uveitis patients at a tertiary center in Thailand. METHODS: A 5-year-prospective study of uveitis cases presented at a tertiary referral center in the central region of Thailand is conducted.

Secondary vitreoretinal lymphoma with spontaneous regression.

PURPOSE: To report a patient with vitreoretinal lymphoma (VRL) secondary to systemic diffuse large B-cell lymphoma, who had two episodes of spontaneous regression. OBSERVATIONS: An 80-year-old Nicaraguan male with a history of treated systemic diffuse large B-cell lymphoma presented with decreased vision in his right eye over one year. The patient was found to have subretinal lesions and moderate vitreous opacities in his right eye. Cytological analysis of vitreous confirmed B-cell lymphoma. Following his systemic work-up, spontaneous clinical improvement was noted. There were no vitreoretinal or systemic lymphoma recurrences during one year of follow-up until the patient had new onset decreased vision in the left eye. He was presumed to have a recurrence of VRL supported by optical coherence tomography findings. Repeat systemic workup was negative for reoccurrence and the ocular lesions resolved spontaneously over 4 weeks. CONCLUSIONS: Spontaneous regression of intraocular lymphoma can rarely occur. Multimodal imaging has an essential role in diagnosing and monitoring recurrence of this disease.

ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN DETECTING AND MONITORING INFLAMMATORY CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To investigate the utility of optical coherence tomography angiography (OCTA) for the detection of inflammatory choroidal neovascularization (iCNV) and monitoring their response to treatment. METHODS: A retrospective review of patients with a diagnosis of uveitis and associated iCNV with active exudation was performed. Active iCNV was determined by spectral domain OCT and/or fluorescein angiogram. Spectral domain OCTA outer retina to choriocapillaris slabs was evaluated for the presence of iCNV. Follow-up OCTA images were qualitatively assessed to determine whether regression of iCNV occurred after treatment. RESULTS: Thirteen eyes of 12 patients were included. The etiologies of uveitis include punctate inner choroidopathy (n = 4), multifocal choroiditis (n = 2), presumed sarcoid uveitis (n = 2), tuberculous choroiditis (n = 1), birdshot chorioretinopathy (n = 1), syphilitic uveitis (n = 1), serpiginous choroiditis (n = 1), and idiopathic panuveitis (n = 1). Inflammatory choroidal neovascularization was detected on en face OCTA in 10 of 13 eyes (76.9%). After iCNV treatment, en face OCTA demonstrated complete regression of iCNV in 5 of 10 eyes (50%), partial regression in 2 of 10 eyes (20%), and no regression in 3 of 10 eyes (30%). CONCLUSIONS: Optical coherence tomography angiography is an effective modality for detecting iCNV and could provide detailed visualization regarding location, morphologic structure, and flow of the iCNV and its response to therapy.

Changes in Choroidal Vascularity Index (CVI) in Intermediate Uveitis.

Purpose: To investigate the longitudinal changes in choroidal vascularity index (CVI) in eyes with active and quiescent intermediate uveitis using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: EDI-OCT images of eyes with active and quiescent intermediate uveitis were retrospectively reviewed and binarized using ImageJ software. Choroidal parameters including CVI, total choroidal area (TCA), luminal area (LA), stromal area (SA), and subfoveal choroidal thickness (SCT) were measured and compared between baseline and follow-up visits among eyes with active and quiescent intermediate uveitis. Results: Thirty-eight eyes from 21 patients with active intermediate uveitis and 30 eyes from 17 patients with quiescent intermediate uveitis were included. CVI in eyes with active intermediate uveitis significantly increased from baseline (66.50% ± 3.40%) with resolution of inflammation on follow-up (68.82% ± 3.90%; P < 0.001). In eyes with quiescent intermediate uveitis at baseline eyes, CVI did not significantly change after follow-up (66.34% ± 3.19% to 66.25% ± 3.13%; P = 0.850). Conclusions: CVI significantly increased when active inflammation in intermediate uveitis resolved while CVI remained unchanged at follow-up in quiescent intermediate uveitis. Translational Relevance: CVI may be a useful noninvasive tool to monitor treatment response in intermediate uveitis. Our findings also highlight the involvement of choroidal vasculature in uveitic eyes without any clinical evidence of choroiditis.

Ocular manifestations of dengue.

PURPOSE OF REVIEW: There are an increasing number of publications related to dengue ophthalmic manifestations and multimodality imaging related to dengue. This review summarizes the current literature, describe ocular manifestations, current using of ocular imaging/investigations, and management of ocular dengue. RECENT FINDINGS: Ocular manifestations of dengue can be present in many stages of dengue fever including after the resolution of systemic disease. Most cases of ocular dengue will exhibit an improvement in vision spontaneously over time. Multimodal imaging such as optical coherence tomography, optical coherence tomography angiography, near-infrared imaging, and microperimetry plays an important role in the diagnosis, follow-up, quantitative measure, and help to understand the disease progression. SUMMARY: Dengue fever can lead to a variety of ocular manifestations. The mechanisms underlying dengue-related ocular complications remain unclear. Immune-mediated mechanisms and direct viral invasion are thought to play an important role. Ophthalmologists should carefully assess patients with dengue-related ophthalmic disease because some patients may have poor visual acuity and exhibit refractoriness to treatment. Treatment with systemic corticosteroids may benefit those patients with poor presenting visual acuity, progressive ocular symptoms, and lesions involving the optic nerve and/or threatening the macula.

Assessment of Vascular Change Using Swept-Source Optical Coherence Tomography Angiography: A New Theory Explains Central Visual Loss in Behcet's Disease.

OBJECTIVE: To evaluate retinal vascular structural change in ocular Behcet's using optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). METHODS: An analytic cross-sectional study of 37 eyes of 21 Behcet's uveitic patients was performed. Foveal retinal thickness (FRT), perifoveal hypoperfusion areas in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were measured with swept-source optical coherence tomography and OCTA. FA images were used for assessing the vascular features and correlation. RESULTS: Twenty-one patients were enrolled (52.4% males). The average age at onset was 36.7 ± 12.93 years. The median of disease duration was 5 years (1-25). FRT was 118.1 ± 52.35 µm, which correlated with visual acuity (95% CI -60.47, -13.92). Using OCTA, the area of hypoperfusion in SCP (0.47 ± 0.17 mm2) was smaller than that in DCP (1.94 ± 3.87 mm2) (p < 0.001). Superficial to deep capillary plexus nonperfusion (SCP : DCP) ratio was 0.57 ± 0.27 which had the positive coefficient correlation with visual acuity (95% CI -0.644, -0.015). CONCLUSIONS: OCTA is an alternative noninvasive method to monitor macular ischemia in Behcet. Behcet's uveitis affects DCP more than SCP. Decreasing SCP : DCP ratio and decrease FRT correlates with poor visual acuity. Macular ischemia and DCP loss can be found early and can explain vision loss in Behcet.