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PurposeMaterials and MethodsResultsConclusionTo report a rare case of a toxoplasma chorioretinitis in one eye and peripheral ocular toxocariasis granuloma in the fellow eye of the same patient.Retrospective case report.A 44-year-old male presented with gradual loss of vision over the past weeks. The patient was diagnosed with ocular toxoplasma chorioretinitis recurrence in his right eye and an inactive peripheral granuloma of ocular toxocariasis was found in the left eye. The patient was a farmer who had been involved in animal husbandry throughout his life. The patient was treated with antibiotics for toxoplasma chorioretinitis and kept under follow-up for ocular toxocariasis.Coinfections of zoonoses are related to socioeconomic environment and individual characteristics of the host. Ocular toxoplasmosis and ocular toxocariasis may present with different scenarios. To our knowledge, this is the first case of a coinfection of ocular toxoplasmosis and ocular toxocariasis in the same patient. A thorough ophthalmological examination and detailed anamnesis are important for diagnosis. [ABSTRACT FROM AUTHOR]

Uveitis consists of a group of syndromes characterised by intraocular inflammation, accounting for up to 15% of visual loss in the western world and 10% worldwide. Assessment of intraocular inflammation has been limited to clinician-dependent, subjective grading. Developments in imaging technology, such as optical coherence tomography (OCT), have enabled the development of objective, quantitative measures of inflammatory activity. Important quantitative metrics including central macular thickness and vitreous signal intensity allow longitudinal monitoring of disease activity and can be used in conjunction with other imaging modalities enabling holistic assessment of ocular inflammation. Ongoing work into the validation of instrument-based measures alongside development of core outcome sets is crucial for standardisation of clinical trial endpoints and developing guidance for quantitative multi-modal imaging approaches. This review outlines methods of grading inflammation in the vitreous and retina, with a focus on the use of OCT as an objective measure of disease activity. [ABSTRACT FROM AUTHOR]

To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexae Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre. Skin lesions with signs including eyelid mass, orbital bone destruction, bizarre keratic precipitates, limbal or iris mass, haemorrhagic anterior uveitis, subretinal lesions of uncertain etiology, ischaemic retinopathy, optic neuropathy, and apparent steroid-resistant inflammations should be comprehensively investigated. Ophthalmic involvement in histiocytosis is rare. Clinical manifestations vary from limited single-organ disease to lethal systemic infiltration or malignancy. Radiology may identify lesions for biopsy. Histology with appropriate markers is essential. Oncology advice may be required. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), caused by infection with members of the Mycobacterium tuberculosis-complex, is one of the oldest known infectious disease entities, resulting in the death of millions of humans each year. It also results in a substantial degree of morbidity and mortality in animal species. Extrapulmonary TB is well recognized in humans, and the eye is one site that can be affected. Studies seeking to understand ocular TB have often relied on animal models; however, these have their limitations and may not truly reflect what happens in humans. We wish to raise awareness among ophthalmologists and vision scientists of naturally occurring cases of ocular TB in animals, namely cattle and domestic cats, and the possibilities of gaining further understanding of this presentation of TB by adopting a collaborative approach. This will hopefully improve outcomes for both human and animal patients. [ABSTRACT FROM AUTHOR]

Purpose: We aim to look at the complications encountered by a cohort of pediatric uveitis patients from north India.Methods: Retrospectively, complications seen in patients younger than 16 years diagnosed with uveitis between January 2006 to March 2015 were noted.Results: Data of 104 children, with a mean follow-up of 3.40 ± 2.34 years was studied. Cataract (n = 42, 24.00%), band-shaped keratopathy (n = 32, 18.29%) and Glaucoma/OHT (n = 11, 6.29%) were most encountered complications at presentation. Glaucoma/OHT (29.71%; n = 52), cataract (18.86%; n = 33) and maculopathy (n=12;6.86%) were the most common complications at follow up. Maculopathy (35%) and Glaucoma/OHT (20%) were the most common causes of visual acuity ≤3/60.Conclusions: Cataract is the most critical complication in children with uveitis at presentation and raised intraocular pressure occurs at follow-up, perhaps attributed to the treatment. Maculopathy is the most common cause of blindness in these children. [ABSTRACT FROM AUTHOR]

The pathogenesis of ocular tuberculosis (TB) has remained unclear due to the challenges of performing mechanistic studies on clinical samples. Animal models have the potential to bridge these gaps by providing information about ocular dissemination and localization of mycobacteria, innate and adaptive immune response, and granuloma formation in the eye. Here, we critically review various animal models of ocular TB from the early 20th century to date and derive novel insights into pathogenesis of ocular TB that have direct implications on the diagnosis and treatment of this disease. Future directions on experimental approaches to understanding pathogenesis of ocular TB are also discussed. [ABSTRACT FROM AUTHOR]

Purpose: Identify genes associated with ocular sarcoidosis (OS). Methods: We genotyped 1.1 million genetic variants to identify significant OS associations, defined as those that achieved p < 5 × 10−8 in a genome-wide comparison of OS cases to healthy controls in our European- or African-American cohorts (EA, AA). Potential functional roles of all associated variants were assessed. Results: Eight significant non-HLA variants were found in AA OS cases compared to healthy controls and confirmed as at least suggestive when comparing OS to non-OS cases. Seven of these were within MAGI1 and include transcription factor binding sites and expression quantitative trait loci. Our EA cohort, while showing similar effect sizes at variants within MAGI1, had no significant variants. Association analysis of HLA-DRB1 alleles confirmed association to OS in EA to *04:01. Conclusion: Our results support organ-specific genetic risk in OS in a compelling candidate, MAGI1, known to be associated with barrier function and autoimmunity. [ABSTRACT FROM AUTHOR]

Aim: To review the current literature and publications to assess the clinical features, recommended investigations and treatment for ocular tuberculosis in HIV infected patients. Methods: Literature review. Results: The human immunodeficiency virus (HIV) epidemic affects as many as 37.9 million people. Mycobacterium tuberculosis infection is common in HIV infection and is a leading cause of death and morbidity. Common clinical presentations include anterior uveitis (granulomatous or otherwise), choroidal granulomas/tubercles, chorioretinitis, subretinal abscess, panophthalmitis, retinal detachment and vasculitis. The majority of clinical findings were in the posterior segment, appeared primarily infective (tubercles/chorioretinitis/abscess) and were largely seen in the context of pulmonary tuberculosis or disseminated disease. Current investigational patterns include corroborative tests such as tuberculin skin test or Interferon-γ release assay. Systemic testing includes Computed Tomography, MRI or PET/CT scans. Newer Molecular techniques such as GeneXpert MTB/RIF assay and Line Probe assays (LPA) are increasingly important. Apart from standard ocular anti-inflammatory protocols, anti-tubercular treatment as per the clinical staging (latent or active) needs to be initiated. Initiation of anti-retroviral therapy (ART) is important and can be started soon after ATT. Conclusions: Ocular manifestations within this group are distinct and unique investigational and therapeutic approaches are needed. [ABSTRACT FROM AUTHOR]

Purpose: To contribute a global description of the spectrum of choroidal involvement in tubercular uveitis (TBU).Methods: Retrospective cohort study of TBU patients with choroidal involvement from 25 centers between January 2004 and December 2014. Medical records of patients with a minimum follow-up of 1 year were reviewed.Results: 245 patients were included. The phenotypic variations included serpiginous-like choroiditis (SLC) (46%), tuberculoma (13.5%), multifocal choroiditis (MFC) (9.4%), ampiginous choroiditis (9%), among others. 219 patients were treated with anti-tubercular therapy (ATT) (n = 219/245, 89.38%), 229 patients with steroids (n = 229/245, 93.47%) and 28 patients with immunosuppressive agents (n = 28/245, 11.42%). Treatment failure was noted in 38 patients (n = 38/245, 15.5%). Patients with SLC and ampiginous choroiditis appeared to have superior outcomes on survival analysis (p = 0.06).Conclusion: This study provides a comprehensive description of choroidal involvement in TBU. Patients with SLC and ampiginous choroiditis may have better clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the outcomes of surgical treatment in patients with ocular toxocariasis and identify prognostic factors. Methods: We retrospectively reviewed the medical records of 56 consecutive patients who underwent vitrectomy. Results: The mean follow-up was 20.7 months. Visual acuity (VA) improved in 70.4% of patients by the final visit, but VA was better than Snellen 20/70 in only 31.5% of patients. Preoperative VA was closely correlated with final VA (P = 0.001). Macular involvement was associated with final VA worse than 20/70 (P = 0.03). The most common postoperative complications were ocular hypertension (19.6%) and retinal detachment (12.5%). Seven patients (12.5%) experienced recurrent inflammation postoperatively, but no preoperative factors were associated with recurrent inflammation. Conclusion: Surgical treatment could rescue visual function in patients with ocular toxocariasis but their prognosis was unfavorable. Preoperative VA was associated with final VA, whereas macular involvement was associated with poor visual outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the role of innate immunity in ocular rosacea. Methods: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1-3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction. Results: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups. Conclusion: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the outcomes of surgical treatment in patients with ocular toxocariasis and identify prognostic factors.Methods: We retrospectively reviewed the medical records of 56 consecutive patients who underwent vitrectomy.Results: The mean follow-up was 20.7 months. Visual acuity (VA) improved in 70.4% of patients by the final visit, but VA was better than Snellen 20/70 in only 31.5% of patients. Preoperative VA was closely correlated with final VA (P = 0.001). Macular involvement was associated with final VA worse than 20/70 (P = 0.03). The most common postoperative complications were ocular hypertension (19.6%) and retinal detachment (12.5%). Seven patients (12.5%) experienced recurrent inflammation postoperatively, but no preoperative factors were associated with recurrent inflammation.Conclusion: Surgical treatment could rescue visual function in patients with ocular toxocariasis but their prognosis was unfavorable. Preoperative VA was associated with final VA, whereas macular involvement was associated with poor visual outcomes. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever is an autoinflammatory multisystem disease, which most commonly affects patients from the Mediterranean basin. This review discusses the common polymorphisms in the MEFV gene as well as the role of pyrin in disease pathogenesis. Patients with familial Mediterranean fever typically develop peritonitis, pleuritis, arthritis, and fever. In addition, a number of authors have reported ophthalmic features. These case reports and series are further explored in this review. Colchicine has transformed the prognosis for patients with familial Mediterranean fever. The rationale for the use of colchicine, as well as the evidence for newer biologic agents is also covered. [ABSTRACT FROM AUTHOR]

Intraocular tuberculosis (TB) is an extremely paucibacillary form of extrapulmonary TB. It likely results from bacterial dissemination to the eye from lungs, localization in ocular tissues, followed later by reactivation and appearance of clinical signs. These have been partly demonstrated in the guinea pig model of ocular TB. Alternative hypotheses have been suggested but are not supported by adequate evidence. Mycobacterial recognition by macrophages and dendritic cells probably leads to activation of several immune pathways, primarily the Th1 and Th17 pathways, as in other TB infections. Histopathology of bacteriologically proven ocular TB tissues reveals granulomatous inflammation with central caseous necrosis containing occasional acid-fast organisms. Recent reports have also demonstrated intraretinal granuloma in the vicinity of retinal vessels and T-cell infiltration of epiretinal membranes, in cases of TB retinal vasculitis. [ABSTRACT FROM PUBLISHER]

Purpose: To illustrate the diagnostic importance of syphilis PCR testing on intraocular fluid for atypical presentations. Methods: Retrospective case series. Results: Two cases of atypical intraocular inflammation were confirmed by PCR testing of vitreous for Treponema pallidum DNA. Conclusions: Ocular syphilis may be present in atypical fashion, and delayed treatment may lead to irreversible visual loss. Sampling of intraocular fluid for PCR testing may confirm diagnosis and lead to appropriate treatment. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis-associated uveitis (JIAU) accounts for a sizable proportion of uveitis cases in children and is an important cause of ocular morbidity in uveitis patients in this age group. The authors present the results of a survey conducted to obtain a better understanding of the current views and practices of ophthalmologists involved in the care of children with JIAU. A detailed questionnaire consisting of 54 questions addressing epidemiology, diagnosis, and therapy of JIAU was distributed to 67 uveitis specialists. The responses from 37 completed questionnaires were tabulated for this report. While the experts often agreed on aspects of the epidemiologic and clinical features of JIAU and its complications, considerable diversity of responses was noted-particularly with regard to practice patterns. Regarding diagnostics and disease monitoring, all experts favored ANA testing, whereas two-thirds also suggested HLA-B27 typing. Laser flare photometry was available to and routinely used by almost one-third of the experts. Optical coherence tomography (OCT) was used by more than half. The survey revealed an overall consensus on therapeutic strategies, including the use of both conventional immunosuppressive and biologic agents. Methotrexate was the initial choice for immunosuppression by most respondents. Most would add an anti-TNF-alpha agent following failure of traditional immunosuppressive therapy, and adalimumab was favored by almost half of the experts. Questions addressing the management of individual situations, such as the treatment of macular edema and perioperative management, revealed considerable differences in therapeutic approaches. The results of this survey support the development of international guidelines for the management of JIAU. [ABSTRACT FROM AUTHOR]

Aim: To report the ocular and systemic features in patients with definite and presumed sarcoidosis presenting to a tertiary referral eye center in south India. Materials and Methods: Retrospective observational case series. Records of 51 patients with diagnosis of sarcoidosis were retrieved. A complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done in all patients. Results were statistically analyzed using SPSS software. Results: The mean age group was 45.14 ± 10.91 years. Females were more common and 31 cases were biopsy proven. Panuveitis and thoracic involvement was the most common ophthalmic and systemic manifestations of sarcoid respectively. Posterior synechiae, granulomatous keratic precipitates, increased anterior chamber reaction, and cystoid macular edema were significantly more common in those presenting initially to an ophthalmologist. Conclusions: Sarcoidosis is increasingly recognized in south India as well. A complete review of systems with appropriate investigations is essential to prevent ocular or systemic morbidity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical features of ocular sarcoidosis in southern Taiwan. Methods: A retrospective chart review of all patients diagnosed with sarcoidosis in Kaohsiung Veterans General Hospital between 1991 and 2008. Age, sex, clinical features, systemic manifestations, biopsy sites, ocular manifestations, and visual acuity were recorded. Results: A total of 55 sarcoidosis patients were identified. Of these, 19 cases had ocular manifestations, including 5 males and 14 females. Of the total, 41 cases (75%) were confirmed by biopsy. Females were significantly older than males at onset. Posterior segment was involved in 16 cases. In 13 patients, initial presentations were blurred vision ( n = 11) and floaters ( n = 2). Conclusions: Ocular symptoms are a major initial presentation in sarcoidosis. Posterior segment is commonly involved, and may lead to significant visual impairment if not managed properly. Ophthalmologists should be alert to detect these patients early. [ABSTRACT FROM AUTHOR]

The recent publication of diagnostic criteria for ocular sarcoidosis has renewed interest in this enigmatic and often controversial disease. The aim of the present review was to report on the results of a survey of leading ophthalmologists in which we asked them to address some of the most important issues related to the diagnosis and treatment of ocular sarcoidosis. The survey revealed that there is significant uptake and use of the diagnostic criteria for ocular sarcoidosis, although there still remained considerable differences in opinion with regard to whether or not this was an isolated condition affecting only the eye and how this should be diagnosed and appropriately managed. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of eyelid sarcoidosis without systemic manifestations with a three-year follow-up. Methods: A 73-year-old woman presented complaining of a one-year history of swelling and hyperemia in the right upper eyelid. To confirm the diagnosis, we performed an incisional biopsy of the eyelid. Results: Histopathological examination showed a non-caseating granulomatous process suggestive of sarcoidosis. After three years, the patient was asymptomatic and physical and laboratory examination showed no signs of systemic sarcoidosis. Conclusion: The histopathological exam was fundamental for the diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relative impact of the CD86 (B7-2) costimulatory molecule in protection against ocular HSV-1 infection. Methods: BALB/c mice were depleted of CD86 by antibody and depleted mice were examined for their ability to withstand HSV-1 ocular infection. Depleted mice were tested for the presence of virus replication, T-cell activation, survival, and eye disease. Results: Mice that had been depleted of CD86 had significantly higher titers of HSV-1 in their eyes compared to mock-depleted infected mice. However, the levels of corneal scarring between the two groups of mice were similar. Following ocular infection, the levels of class I MHC-restricted cytotoxic T lymphocytes (CTL) were significantly higher in mock-depleted mice than in CD86-depleted mice. Finally, adoptive transfer of primed CD8 + T cells but not CD4 + T cells to CD86-depleted mice resulted in a decrease in peak virus titers in the eyes, such that HSV-1 titers were similar to that of their mock-depleted counterparts. Conclusions: These data demonstrate an important role for CD86 in the development of CTL and reduction of virus replication in the eyes of HSV-1-infected mice. [ABSTRACT FROM AUTHOR]

We have developed a murine model to investigate the pathogenesis of acquired ocular toxoplasmosis. Tachyzoites of PLK strain of Toxoplasma gondii were intracamerally inoculated under anesthesia into the right eyes of naive or perorally preinfected C57BL/6 and MRL-MpJ mice. Clinical and histopathological observations of responses to intraocular infection were analyzed. Ocular inflammation from Toxoplasma gondii is dose-dependent in both strains of mice. After inoculation of fifty parasites, no evidence of inflammation was observed in the eyes of naive mice. The eyes of naive mice that received 500 or 5,000 parasites developed inflammatory changes by day 6 post challenge. By day 8, the changes progressed to moderate to severe intraocular inflammation. Histologic analysis of the ocular lesions demonstrated mononuclear cell infiltration and necrosis predominantly in the anterior segment of the eyes of the naive mice. Inoculation of 50,000 tachyzoites induced a destructive ocular inflammatory response and was uniformly lethal to the mice by approximately one week after challenge. In contrast, eyes from mice previously orally infected with Toxoplasma gondii and that received a 50 or 500 parasite intracameral challenge revealed no inflammation, but the eyes receiving 5,000 parasites demonstrated necrotic focal retinochoroiditis with vitreitis by day 8 after challenge. The murine model reproduces some features of ocular toxoplasmosis in humans and may be suitable for large-scale controlled studies of the pathogenesis and therapeutics of acquired ocular toxoplasmosis as well as for study of the mechanisms of immune privilege in the eye. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of pyogenic granuloma associated with ocular acne rosacea. Design: Case report. Methods: Interventional case report. Results: The patient developed an unusual lesion of the conjunctiva and limbus, histologically confirmed to be pyogenic granuloma. Excision of the lesion resulted in symblepharon formation, adhesions between lid margins, tarsal conjunctiva, and cornea, and reductions in visual acuity. The patient underwent surgical separation of the corneal lid adhesions with a mucosal autograft for the tarsal conjunctiva and an amniotic membrane graft for the cornea with good results. Conclusions: Ocular rosacea is a common condition but such excessive and unusual fibrotic healing responses following excision of pyogenic granulomas have not been previously reported. This case demonstrated significant morbidity and decreased visual acuity. However, early recognition and effective surgical management can lead to good visual outcomes. [ABSTRACT FROM AUTHOR]

Aim: To identify risk factors for the development of ocular tuberculosis in patients with disseminated tuberculosis. Methods: A retrospective case-control study. The authors studied all admitted patients with disseminated tuberculosis in two subgroups: patients who developed ocular tuberculosis and those who did not. The potential risk factors analyzed included age, sex, presence of diabetes mellitus, and preexisting immunosuppression. Results: Of 47 patients, 26 patients (55.3%) developed ocular tuberculosis. Ocular tuberculosis was significantly associated with the presence of preexisting immunosuppression (p = .005) using a logistic regression model. Diabetes mellitus, age, and sex were not risk factors. Conclusions: Preexisting immunosuppression is a risk factor. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence and clinical features of ocular tuberculosis in patients with the acquired immune deficiency syndrome (AIDS). Design: Prospective cross-sectional study. Methods: Detailed history and ocular examination of 46 patients (92 eyes) in the outpatient department of an AIDS clinic. Results: Seventeen of 46 (36.9%) patients had clinical and radiological evidence of pulmonary tuberculosis. Of these, four (23.5%) showed findings consistent with ocular tuberculosis. Lesions included tubercles (1 eye of 3 patients) and chorioretinitis (1 eye of 1 patient). Commonly, these patients had evidence of abdominal tuberculosis. Hemorrhages, cotton-wool spots, herpes zoster ophthalmicus (HZO), cytomegalovirus retinitis (CMVR), and disc edema were other non-tubercular AIDS-related lesions and were seen in seven of the remaining 42 patients (16.2%). Conclusion: Ocular tuberculosis was a common finding in this study and was found in profoundly immunocompromised patients with disseminated tuberculosis. Diagnosis of ocular tuberculosis may help reduce HIV/tuberculosis co-infection mortality. [ABSTRACT FROM AUTHOR]

A 27-year-old female, on anti-tubercular therapy for miliary tuberculosis for 1 week, presented with gradual diminution of right eye vision for 4 months. Right eye visual acuity was counting fingers at 15 cm. Right fundus showed a yellowish-white vascularized lesion, 4 disc diameters in size, overlying the optic disc and associated neurosensory macular detachment. The left eye was normal. A Mantoux test was negative. The authors diagnosed presumed optic disc tuberculoma in the right eye. Oral prednisolone in tapering doses was added to the anti-tubercular therapy. The optic disc lesion regressed with residual scarring and vision became 20/30 at 7 months. [ABSTRACT FROM AUTHOR]