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Rubella is an important infectious, vaccine-preventable etiology of congenital defects. The aim of the study was to develop a prediction nomogram to assess the probability of an infant being at risk for congenital rubella based on demographics and ophthalmological findings. This was a cross-sectional sentinel surveillance study conducted at 5 centers spanning pan-India and involved 1134 infants. The diagnosis of rubella was made using standard guidelines. For the construction of the prediction model, laboratory-confirmed cases were grouped as “at-risk” (AR) infants and the discarded cases into “not at risk” (NAR) infants. Univariate analysis (p value cut-off < 0.05) followed by multivariate binary logistic regression model development was performed. The average (median) age of the suspected CRS infants was 3 (IQR 1–6) months, and the average (mean) age of their mothers was 25.8 ± 4.1 years. Out of the total infants, 81 (7.3%) died, 975 (88%) were alive, and 55 (5.0%) were lost to follow-up. The final model showed that the odds of cataract, retinopathy, glaucoma, microcornea, and age of the infant at presentation were 3.1 (2.2–4.3), 4.9(2.3–10.4), 2.7(1.1–5.9), 2.3(1.1–4.7), and 1.1 (1–1.1), respectively, for the AR infant as compared to NAR infant. AUC of final model was 0.68 (95% CI Delong, 0.64–0.72). Bootstrapping for calibration of the model showed satisfactory results. Nomogram, along with a web version, was developed. The developed nomogram would have a wide community-based utilization and will help in prioritizing attention to high-risk children, thereby avoiding loss to follow-up.

Mapping the normal eye proteome in healthy persons is essential to unravel the molecular basis of diseases impacting visual health. The vitreous occupies a large portion of the human eye between the lens and the retina and plays a significant role in vitreoretinal diseases as well as maintaining clarity in the visual field, providing nutrition to the lens, and protecting the eye from mechanical shocks. It comprises four distinct anatomical regions, namely the vitreous core, vitreous cortex, vitreous base, and anterior hyaloid. Among these, the vitreous is attached to other substructures in the eye by the vitreous base, which is its strongest point of attachment. Alterations in vitreous substructures have been reported in several vitreoretinal disorders, including vitreomacular traction, vitreoretinopathies, and age-related macular degeneration. There has been limited knowledge on proteomics variations at a resolution of vitreous substructures, including the functionally and pathophysiologically significant vitreous base. We report here new findings on the proteome map of the vitreous base in normal healthy tissue. We employed a global, unbiased proteomic profiling approach resulting in the identification of 6511 proteins. Of these, 302 proteins were involved in metabolic processes essential for energy utilization. Moreover, we identified several structural and nutrient transport proteins. Notably, the identified proteome repertoire indicates that the vitreous base might possess additional physiological functions and may not be a passive structure. This study constitutes the most extensive catalog of vitreous base proteins to our knowledge and offers novel insights as a baseline for future studies on the pathobiology of various eye diseases. These data also invite us to consider a potentially more active functional role for the vitreous base in eye physiology and visual health.

Success rates of corneal transplantation are particularly high owing to its unique, innate immune privilege derived from a phenomenon known as Anterior Chamber-Associated Immune Deviation (ACAID). Of note, cornea is a transparent, avascular structure that acts as a barrier along with sclera to protect the eye and contributes to optical power. Molecular and systems biology mechanisms underlying ACAID and the immunologically unique and privileged status of cornea are not well known. We report here a global unbiased proteomic profiling of the human cornea and the identification of 4824 proteins, the largest catalog of human corneal proteins identified to date. Moreover, signaling pathway analysis revealed enrichment of spliceosome, phagosome, lysosome, and focal adhesion pathways, thereby demonstrating the protective functions of corneal proteins. We observed an enrichment of neutrophil-mediated immune response processes in the cornea as well as proteins belonging to the complement and ER-Phagosome pathways that are suggestive of active immune and inflammatory surveillance response. This study provides a key expression map of the corneal proteome repertoire that should enable future translational medicine studies on the pathological conditions of the cornea and the mechanisms by which cornea immunology are governed. Molecular mechanisms of corneal immune privilege have broad relevance to understand and anticipate graft rejection in the field of organ transplantation.

A 43-year-old immunocompetent male presented with focal macular retinitis with overlying vitritis in the right eye. His BCVA was counting fingers close to face. OCT showed increased intraretinal thickness at the area of retinitis with adjacent hypo reflectivity of the choroid. Serology was positive for IgM and IgG antibodies for toxoplasma. He received oral clindamycin 300 mg 4 times/day for 8 weeks. At 6 weeks, his BCVA was CF 2 metres. Fundus showed complete resolution of retinitis with formation of near, full thickness macular hole with intact overlying ILM. A small hyper reflective scar was seen at the base of the macular hole.

Eye disorders and resulting visual loss are major public health problems affecting millions of people worldwide. In this context, the sclera is an opaque, thick outer coat covering more than 80% of the eye, and essential in maintaining the shape of the eye and protecting the intraocular contents against infection and the external environment. Despite efforts undertaken to decipher the scleral proteome, the functional and structural picture of the sclera still remain elusive. Recently, proteomics has arisen as a powerful tool that enables identification of proteins playing a critical role in health and disease. Therefore, we carried out an in-depth proteomic analysis of the human scleral tissue using a high-resolution Orbitrap Fusion Tribrid mass spectrometer. We identified 4493 proteins using SequestHT and Mascot as search algorithms in Proteome Discoverer 2.1. Importantly, the proteins, including radixin, synaptopodin, paladin, netrin 1, and kelch-like family member 41, were identified for the first time in human sclera. Gene ontology analysis unveiled that the majority of proteins were localized to the cytoplasm and involved in cell communication and metabolism. In sum, this study offers the largest catalog of proteins identified in sclera with the aim of facilitating their contribution to diagnostics and therapeutics innovation in visual health and autoimmune disorders. This study also provides a valuable baseline for future investigations so as to map the dynamic changes that occur in sclera in various pathological conditions.

Ophthalmology and visual health are new frontiers for postgenomic research and technologies such as proteomics. In this context, the optic nerve and retina extend as the outgrowth of the brain, wherein the latter receives the optical input and the former relays the information for processing. While efforts to understand the optic nerve proteome have been made earlier, there exists a lacuna in its biochemical composition and molecular functions. We report, in this study, a high-resolution mass spectrometry-based approach using an Orbitrap Fusion Tribrid mass spectrometer to elucidate the human optic nerve proteomic profile. Raw spectra were searched against NCBI Human RefSeq 75 database using SEQUEST HT and MASCOT algorithms. We identified nearly 35,000 peptides in human optic nerve samples, corresponding to 5682 proteins, of which 3222 proteins are being reported for the first time. Label-free quantification using spectral abundance pointed out to neuronal structural proteins such as myelin basic protein, glial fibrillary acidic protein, and proteolipid protein 1 as the most abundant proteins. We also identified several neurotransmitter receptors and postsynaptic density synaptosomal scaffold proteins. Pathway analysis revealed that a majority of the proteins are structural proteins and have catalytic and binding activity. This study is one of the largest proteomic profiles of the human optic nerve and offers the research community an initial baseline optic nerve proteome for further studies. This will also help understand the protein dynamics of the human optic nerve under normal conditions.

Next-generation sequencing approaches have revolutionized genomic medicine and enabled rapid diagnosis for several diseases. These approaches are widely used for pathogen detection in several infectious diseases. Lyme disease is a tick-borne infectious disease, which affects multiple organs. The causative organism is a spirochete, Borrelia burgdorferi, which is transmitted by ticks. Lyme disease can be treated easily if detected early, but its diagnosis is often delayed or is incorrect leading to a chronic debilitating condition. Current confirmatory diagnostic tests for Lyme disease rely on detection of antigens derived from B. burgdorferi, which are prone to both false positives and false negatives. Instead of focusing only on the human host for the diagnosis of Lyme disease, one could also attempt to identify the vector (tick) and the causative organism carried by the tick. Since all ticks do not transmit Lyme disease, it can be informative to accurately identify the tick from the site of bite, which is often observed by the patient and discarded. However, identifying ticks based on morphology alone requires a trained operator and can still be incorrect. Thus, we decided to take a molecular approach by sequencing DNA and RNA from a tick collected from an individual bitten by the tick. Using next-generation sequencing, we confirmed the identity of the tick as a dog tick, Dermacentor variabilis, and did not identify any pathogenic bacterial sequences, including Borrelia species. Despite the limited availability of nucleotide sequences for many types of ticks, our approach correctly identified the tick species. This proof-of-principle study demonstrates the potential of next-generation sequencing in the diagnosis of tick-borne infections, which can also be extended to other zoonotic diseases.

Recent technical and methodological advances have greatly enhanced genome-wide association studies (GWAS). The advent of low-cost, whole-genome sequencing facilitates high-resolution variant identification, and the development of linear mixed models (LMM) allows improved identification of putatively causal variants. While essential for correcting false positive associations due to sample relatedness and population stratification, LMMs have commonly been restricted to quantitative variables. However, phenotypic traits in association studies are often categorical, coded as binary case-control or ordered variables describing disease stages. To address these issues, we have devised a method for genomic association studies that implements a generalized LMM (GLMM) in a Bayesian framework, called Bayes-GLMM. Bayes-GLMM has four major features: (1) support of categorical, binary, and quantitative variables; (2) cohesive integration of previous GWAS results for related traits; (3) correction for sample relatedness by mixed modeling; and (4) model estimation by both Markov chain Monte Carlo sampling and maximal likelihood estimation. We applied Bayes-GLMM to the whole-genome sequencing cohort of the Alzheimer’s Disease Sequencing Project. This study contains 570 individuals from 111 families, each with Alzheimer’s disease diagnosed at one of four confidence levels. Using Bayes-GLMM we identified four variants in three loci significantly associated with Alzheimer’s disease. Two variants, rs140233081 and rs149372995, lie between PRKAR1B and PDGFA. The coded proteins are localized to the glial-vascular unit, and PDGFA transcript levels are associated with Alzheimer’s disease-related neuropathology. In summary, this work provides implementation of a flexible, generalized mixed-model approach in a Bayesian framework for association studies.

Ophthalmology and visual health research have received relatively limited attention from the personalized medicine community, but this trend is rapidly changing. Postgenomics technologies such as proteomics are being utilized to establish a baseline biological variation map of the human eye and related tissues. In this context, the choroid is the vascular layer situated between the outer sclera and the inner retina. The choroidal circulation serves the photoreceptors and retinal pigment epithelium (RPE). The RPE is a layer of cuboidal epithelial cells adjacent to the neurosensory retina and maintains the outer limit of the blood-retina barrier. Abnormal changes in choroid-RPE layers have been associated with age-related macular degeneration. We report here the proteome of the healthy human choroid-RPE complex, using reverse phase liquid chromatography and mass spectrometry-based proteomics. A total of 5309 nonredundant proteins were identified. Functional analysis of the identified proteins further pointed to molecular targets related to protein metabolism, regulation of nucleic acid metabolism, transport, cell growth, and/or maintenance and immune response. The top canonical pathways in which the choroid proteins participated were integrin signaling, mitochondrial dysfunction, regulation of eIF4 and p70S6K signaling, and clathrin-mediated endocytosis signaling. This study illustrates the largest number of proteins identified in human choroid-RPE complex to date and might serve as a valuable resource for future investigations and biomarker discovery in support of postgenomics ophthalmology and precision medicine.

The annual economic burden of visual disorders in the United States was estimated at $139 billion. Ophthalmology is therefore one of the salient application fields of postgenomics biotechnologies such as proteomics in the pursuit of global precision medicine. Interestingly, the protein composition of the human iris tissue still remains largely unexplored. In this context, the uveal tract constitutes the vascular middle coat of the eye and is formed by the choroid, ciliary body, and iris. The iris forms the anterior most part of the uvea. It is a thin muscular diaphragm with a central perforation called pupil. Inflammation of the uvea is termed uveitis and causes reduced vision or blindness. However, the pathogenesis of the spectrum of diseases causing uveitis is still not very well understood. We investigated the proteome of the iris tissue harvested from healthy donor eyes that were enucleated within 6 h of death using high-resolution Fourier transform mass spectrometry. A total of 4959 nonredundant proteins were identified in the human iris, which included proteins involved in signaling, cell communication, metabolism, immune response, and transport. This study is the first attempt to comprehensively profile the global proteome of the human iris tissue and, thus, offers the potential to facilitate biomedical research into pathological diseases of the uvea such as Behcet's disease, Vogt Koyonagi Harada's disease, and juvenile rheumatoid arthritis. Finally, we make a call to the broader visual health and ophthalmology community that proteomics offers a veritable prospect to obtain a systems scale, functional, and dynamic picture of the eye tissue in health and disease. This knowledge is ultimately pertinent for precision medicine diagnostics and therapeutics innovation to address the pressing needs of the 21st century visual health.

The Indian health infrastructure is struggling to handle the burgeoning number of people with diabetes. Managing the complications of diabetes in an organized manner through the government health programs is still a distant reality. Here, we describe a program aimed at addressing the problem of diabetic retinopathy in rural areas of Tumkur district in Karnataka. By amalgamating telescreening and our own novel distributive care model, we were able to screen 85% of the registered diabetics in the Government noncommunicable disease clinics and treat 95% of those needing laser therapy. We also describe the importance of using electronic medical records in public health programs which not only increase the efficiency in screening for disease but help in increasing uptake of treatment by tracking defaulters.

The aqueous humor is a colorless, transparent fluid that fills the anterior chamber of the eye. It plays an important role in maintaining the intraocular pressure and providing nourishment to the lens and cornea. The constitution of the aqueous humor is controlled by the blood-aqueous barrier. Though this ocular fluid has been extensively studied, its role in ocular physiology is still not completely understood. In this study, aqueous humor samples were collected from 250 patients undergoing cataract surgery, subjected to multiple fractionation strategies and analyzed on a Fourier transform LTQ-Orbitrap Velos mass spectrometer. In all, we identified 763 proteins, of which 386 have been identified for the first time in this study. Sorbitol dehydrogenase (SORD), filensin (BFSP1), and phakinin (BFSP2) are some of the proteins that have not been previously reported in the aqueous humor. Gene Ontology analysis revealed 35% of the identified proteins to be extracellular, with a majority of them involved in cell communication and signal transduction. This study comprehensively reports 386 novel proteins that have important potential as biomarker candidates for future research into personalized medicine and diagnostics aimed towards improving visual health.

The availability of human genome sequence has transformed biomedical research over the past decade. However, an equivalent map for the human proteome with direct measurements of proteins and peptides does not exist yet. Here we present a draft map of the human proteome using high-resolution Fourier-transform mass spectrometry. In-depth proteomic profiling of 30 histologically normal human samples, including 17 adult tissues, 7 fetal tissues and 6 purified primary haematopoietic cells, resulted in identification of proteins encoded by 17,294 genes accounting for approximately 84% of the total annotated protein-coding genes in humans. A unique and comprehensive strategy for proteogenomic analysis enabled us to discover a number of novel protein-coding regions, which includes translated pseudogenes, non-coding RNAs and upstream open reading frames. This large human proteome catalogue (available as an interactive web-based resource at http://www.humanproteomemap.org) will complement available human genome and transcriptome data to accelerate biomedical research in health and disease.

To study the role of hematological parameters in predicting retinopathy of prematurity (ROP) in preterm neonates. Two hundred forty eight babies less than 34 wk and/or with a birth weight of less than 2,000 g were evaluated. Peripheral blood smear and complete blood count were done on day one of life. Ophthalmological examination was done as per guidelines and grades of ROP classified and followed up till 40 wk of gestation for complete vascularisation. Cases were matched with similar number of controls (n = 67) and the sensitivity, specificity and positive predictive value of different parameters were assessed. The incidence of ROP on screening was found to be 27 %. Sixty seven cases were matched with 67 controls as per birth weight and gestational age. Significant risk factors for ROP included longer duration of ventilation, higher FiO2, culture proven sepsis and apnea requiring pharmacotherapy. The incidence of Stage I was 10.5 % (n = 7), Stage II 58.2 % (n = 39) and Stage III was 31.3 % (n = 21). The absolute nucleated RBC (ANRBC) count was found to be the only parameter which was significantly higher in babies with ROP (p

PURPOSE: Endophthalmitis due to Pyrenochaeta romeroi has not been reported in literature (PubMed, Medline). We report an interesting case of P. romeroi causing chronic endophthalmitis in an immunocompetent lady.METHODS:Retrospective interventional case report. A 25-year-old immunocompetent lady presented with pain and redness in the left eye of 1-month duration. Her best-corrected visual acuity was 6/6 and 6/18 in the right and the left eyes, respectively. Slit-lamp examination of the left eye showed a corneal stromal scar, fibrinlike material in the anterior chamber, few retrolental cells, and normal fundus examination. RESULTS:Aqueous taps on two occasions were negative for bacteria and fungi on routine smear, culture, and nested polymerase chain reaction. As inflammation recurred despite intravitreal voriconazole and amikacin injections, a lensectomy with vitrectomy was done. During vitrectomy, dense flocculent material was seen in the pars plana with only scleral indentation. The flocculent material grew a rare filamentous fungus called P. romeroi. The left eye underwent retinal detachment surgery with silicone oil insertion for a giant retinal tear at 2 months of follow-up. At 6 months of follow-up, her vision in the left eye was stable at 6/24 (Snellen) with no ocular inflammation.CONCLUSION:P. romeroi may need to be added in the list of rare fungi, which cause chronic endophthalmitis.

We report a rare finding of progressive subretinal fibrosis mimicking retinal necrosis in 2 cases of sympathetic ophthalmia. Histopathology of the inciting eye and vitreous biopsy of the sympathizing eye ruled out infections and masquerades. Progression of inflammation and rapid deterioration of vision inspite of maximum immunosuppression are key findings in this variant of sympathetic ophthalmia.

Background Endoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas. Aim To evaluate the safety and efficacy of ECP in the management of refractory glaucomas. Settings and Design Prospective interventional non-comparative study. Materials and Methods Fifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP ≤ 22 mmhg, with or without use of medications. Statistical analysis used Student's t test and repeated measures ANOVA were used to evaluate change in IOP and Student's t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications. Results Patients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 ± 9.16 mmHg to 13.96 ± 7.71 mmHg at last follow-up (P

Purpose: To report 2 successive ocular malignancies in the same eye of a HIV-positive patient at different CD4 counts.Materials and methods: A 36-year-old retrovirus-positive male presented with no perception of light in the left eye of 1 month duration. CD4 counts were 44 cells/mm3. Ultrasonography showed an exudative retinal detachment. Retinal biopsy suggested an intraocular B-cell lymphoma for which he received radiotherapy and chemotherapy. He presented 3 years later with a growth in the left eye with CD4 counts of 360 cells/mm3.Results: Histopathology of enucleated eye showed a low-grade conjunctival squamous cell carcinoma. At 1-year follow-up, there is no mass in the anophthalmic socket.Conclusions: This case highlights the development of 2 ocular malignancies in the same eye of an HIV-positive patient, at different CD4 counts, allowing the authors to speculate on additional factors involved in the development of the second malignancy.

A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.

Purpose: To report a rare case of primary bilateral multifocal choroditis due to disseminated cryptococcus infection in a HIV-positive patient. Methods: Retrospective report. A 30-year-old asymptomatic HIV-positive male referred to us for a routine ophthalmic evaluation had bilateral, multiple choroidal lesions. CSF confirmed cryptococcus by India ink preparation and antigen by latex agglutination. The lesions began to resolve with intravenous amphotericin B and oral fluconazole. Conclusions: Asymptomatic, primary, bilateral multifocal choroiditis due to cryptococcus is rare. A routine ophthalmic examination in HIV-positive patients can alert the treating physician to a possibility of a fatal disease.

To identify and compare the profile of retinopathy of prematurity (ROP) in premature babies in urban and semiurban neonatal intensive care units (NICUs).A prospective study of babies admitted to NICUs of two urban and seven semiurban centres. They were36 weeks of gestational age and were subjected to fundus photography with a RetCam shuttle camera. Photos and NICU details were uploaded on a secure website. Photographs were read by a single observer. Infants were followed till retinal vascularisation was complete, or 45 weeks post conceptional age. Babies developing severe ROP were lasered.500 babies were screened (243, urban group; 257, semiurban group). Incidence of ROP in the urban and semiurban groups was 16.5% (40) and 14.8% (38) respectively. Mean gestational age was 30.90 weeks and 31.53 weeks respectively. Mean birth weight was 1344 g and 1375 g respectively. 28 babies were lasered, 15 and 13 from each group respectively. There was no statistically significant difference between any of the parameters compared. Level of significance was fixed at 0.05.The magnitude of the burden of ROP is comparable between urban and semiurban NICUs stressing the need for effective screening strategies in semiurban and rural areas as well.

Two articles in this issue of the Journal tell a similar story: primary acute myeloid leukemia (AML) may be divided into subclasses according to gene-expression profiles. Given the number of articl...

An estimated 50.7 million people in India have diabetes (1), and 70% of the Indian population live in rural areas (2). Diabetic retinopathy (DR) develops in more than 75% of patients with diabetes within 15–20 years of diagnosis (3,4). We have developed a model of distributive advanced outreach care designed to bring screening and treatment of DR to rural and semi-urban areas of the state of Karnataka in India. Nicknamed Nayana—or beautiful eyes in Hindi—the specially designed advanced eye care treatment unit (AETU) van is custom-built on a cargo chassis from Ashok Leyland Ltd. of India. The van has a 2 + 1 driver's cabin and an insulated air-conditioned treatment chamber. The van carries its own 7-kVA generator, which powers all of the equipment on the van. It also carries routine clinical furniture, a fundus camera with …

The prevalence of diabetes in developing countries is on the increase and along with it the need to provide structured care to avoid the feared long term complications among them loss of vision and blindness due to diabetic retinopathy (DR). The biggest hurdle facing most developing countries is the lack of resources and trained manpower to both screen and treat the large number of people with DR. Countries also face the additional problem of unequal distribution of resources between the urban and rural areas. To overcome these challenges models of mobile diabetic retinopathy screening and treatment aided by the use of telemedicine have been introduced and demonstrated to be popular and effective. The aim of this review article is to describe different mobile diabetic retinopathy screening and treatment models developed in India, which can be readily replicated in developing countries presented with similar difficulties.

AIM: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population METHODS: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. RESULTS: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. CONCLUSION: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population.

To report the ocular and systemic features in patients with definite and presumed sarcoidosis presenting to a tertiary referral eye center in south India.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.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.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.

Aim: To assess the role of mantoux test and ATT in presumed intraocular tuberculosis in South India.Materials & Methods: Retrospective study of 51 records of patients with recurrent uveitis with a documented positive mantoux test and a minimum of 1 year followup from the time of initiation of ATT between January 1997 and May 2008. The main outcome measure was the recurrence of inflammation after 1 year of starting ATT.Results: There was a significant reduction in the number of recurrences of uveitis post ATT (.000).Conclusions: There is a definite role of ATT in latent TB with uveitis.

We describe three patients with bilateral, presumed human immunodeficiency virus (HIV)-induced optic neuropathy. The above diagnosis was made by exclusion of infectious agents and neoplasms by detailed clinical and laboratory investigations. All patients had decreased visual acuity, pale optic discs and constriction of visual fields. Improvement was documented in all three patients for visual acuity and in one patient for visual fields following treatment with highly active antiretroviral therapy (HAART). Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. This article emphasizes the effectiveness of HAART in presumed HIV-induced optic neuropathy.

Cryptococcosis is a common opportunistic infection in immunosuppressed patients. We present a case of cryptococcal meningitis with bilateral papillitis, multifocal choroiditis, and sensorineural hearing loss. The ocular manifestations present in this patient were unusual. The management of such cases poses a challenge because blindness and deafness can be the morbid sequelae.

Aim : To study the utility of interferon-g release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation. Design : Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008. Materials and Methods : QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39). Results : The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively. Conclusions : QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

Posterior polymorphous dystrophy is a rare corneal dystrophy, usually detected by chance. This case series describes the morphologic features in the three different types of posterior polymorphous dystrophy using confocal microscopy.