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Introduction: The emergency department commonly evaluates eye pain and vision loss. Typically, these conditions can be managed outpatient; however, delays can lead to advanced pathology.Case Report: A 48-year-old homeless male presented with left-eye vision loss and pain. His exam revealed monocular decreased visual acuity, corneal ulcer, and hypopyon. The patient was diagnosed with bacterial keratitis and admitted for treatment but left against medical advice. He returned and was admitted for further treatment but was lost to follow-up thereafter.Conclusion: Our case features complicated bacterial keratitis with several treatment interruptions, demonstrating how healthcare disparities contribute to potentially preventable advanced pathology.

Purpose: To report a case of presumed teclistamab-associated sclerouveitis with hypopyon. Methods: Case report. Results: A 62-year-old woman with relapsed refractory multiple myeloma presented with right eye pain and decreased vision 1 week after starting teclistamab and was found to have sclerouveitis with hypopyon. She received intravitreal vancomycin and ceftazidime because of the concern for infectious endophthalmitis, but cultures were negative. Systemic workup for infectious and inflammatory etiologies was unremarkable. Her signs and symptoms improved with topical steroids and a 1-week pause in teclistamab. This case constituted a Naranjo Adverse Drug Reaction Probability Scale score of 5, representing a "probable" association. Conclusion: Teclistamab, a novel bispecific antibody recently approved for the treatment of relapsed or refractory multiple myeloma, may be associated with sclerouveitis with hypopyon. [ABSTRACT FROM AUTHOR]

To report on the value of presence of pigmentation on central anterior lens capsule (PioLe) in HLA B27- associated anterior uveitis (HLA B27-AU). 268 patients (320 eyes) with AU were reviewed. Two diagnostic models to predict probability of HLA-B27-AU were developed. The first model included 6 variables (age, gender, unilaterality, presence of non-granulomatous keratic precipitates, hypopyon, and intraocular pressure (IOP). The second model was developed to investigate the added value of PioLe into the first model. Unilaterality, presence of hypopyon, IOP <21 mmHg and PioLe were characteristic for HLA-B27 positive patients (P≤0.003 for all). All of 6 variables had area under receiver operating characteristic curves (AuROC) ≤ 60, but PioLe reached even higher value (65.5). Diagnostic model I and II had AuROC 76.3% (95%CI, 68.4%-84.2%) and 80.0% (95%CI, 72.6%-87.5%), respectively. Unilaterality, hypopyon, IOP <21 mmHg and presence of PioLe are clinical signs suggesting HLA B27- AU. [ABSTRACT FROM AUTHOR]

Abstract Endophthalmitis is among the most sight-threatening infections in ophthalmology practice. Many microorganisms causing endophthalmitis have been reported. Stenotrophomonas maltophilia is among the rare causes of endophthalmitis and has been reported after cataract surgery, intravitreal injections and ocular trauma. We report a case of S. maltophilia endophthalmitis after keratoplasty, which is a rare entity, in a 63-year-old female patient.

A novel, algorithmic “naming-meshing” system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass all sediment characteristics. For this reason, a literature review of “hypopyon” and “pseudohypopyon” was conducted in MEDLINE/PubMed, Scopus, and Web of Science from 1966 to May 15, 2023. Two issues were clarified: 1) which strategies should the ophthalmologist follow when asked to evaluate an eye with anterior chamber sedimentation to distinguish hypopyon from pseudohypopyon, and 2) in which systemic disorders should a non-ophthalmologist order a prompt ophthalmic consultation to distinguish pseudohypopyon from hypopyon. Pathognomonic characteristics of the sediment were examined; scleral show (warm/cold), location (corneal/anterior chamber/capsular/posterior), visibility (macro/micro/occult-angle), orientation (horizontal/vertical/oblique), number (single/double), shape (convex/triangular/pyramidal/ring/lumpy/inverse), and color (white/yellow/pink/brown/black). Associated findings were then assessed; acute/chronic, spontaneous/provoked, unilateral/bilateral, inflammatory/non-inflammatory, suppurative (non-sterile)/non-suppurative (sterile), granulomatous/non-granulomatous, recurrent/non-recurrent, shifting/non-shifting, and transient/persistent. The type of precipitation was named (naming) and matched (meshing) to a potential list of etiologies (inflammatory, infective, therapeutic, masquerades). Given that (pseudo)hypopyon predominantly afflicts younger patients in their most productive years, clinicians supervising such patients should be aware of all sediment characteristics. The ophthalmologist should never ask non-ophthalmologists to run the full battery of tests in a patient with (pseudo)hypopyon, and rather indicate which type of collection is present, what its pathognomonic feature is, and what the most likely diagnoses to be excluded are.

Endophthalmitis is among the most sight-threatening infections in ophthalmology practice. Many microorganisms causing endophthalmitis have been reported. Stenotrophomonas maltophilia is among the rare causes of endophthalmitis and has been reported after cataract surgery, intravitreal injections and ocular trauma. We report a case of S. maltophilia endophthalmitis after keratoplasty, which is a rare entity, in a 63-year-old female patient. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe a case series of hypopyon after periorbital corticosteroid injection. This was a retrospective, observational case series investigating hypopyon cases after injection of periorbital steroid patients. We presented three patients manifested hypopyon after periocular corticosteroid injection. All three cases were diagnosed as HSV stromal keratitis or endotheliitis and treated successfully with topical steroids as well as systemic and topical antiviral treatment. HSV keratitis is not recommend when treated with periocular corticosteroid injection. Topical corticosteroid is the best choice for HSV stromal keratitis and HSV endotheliitis. [ABSTRACT FROM AUTHOR]

A 38-year-old male with a history of trauma presented to us with pain and decreased vision in the left eye (LE). Previously, the patient had been diagnosed with hypopyon uveitis and was prescribed topical steroids. We performed slit-lamp examination of the LE and found exudates in the anterior chamber (AC) extending from 6 to 9 o'clock, along with circumciliary congestion and pigmented keratic precipitates. We made a diagnosis of infectious anterior hypopyon uveitis; however, all of its causes were ruled out upon the necessary investigations, which returned normal results. The patient was started on topical and oral antibiotics, and subsequently, there was complete hypopyon resolution. Five months later, he presented with similar complaints. An examination revealed a black elevated lesion in the AC at 8 o'clock suspicious of an intraocular foreign body (IOFB), along with 1 mm hypopyon. An X-ray orbit examination confirmed the IOFB presence, and the IOFB was surgically removed from the AC. Three weeks after this surgery, the patient presented with a recurrence of similar symptoms. The nasal pterygium adjacent to the location of the previously removed IOFB was inflamed with an underlying black elevated limbal nodule, which was determined to likely be a remnant of the IOFB in the subconjunctival space. Here, we report a case of penetrating IOFB that was initially detected in the AC. Its remnant extraocular component persisted in the subconjunctival space, and its incomplete removal led to recurrent inflammation.

Objective To improve the knowledge, diagnostic and therapeutic ability of rifabutin associated hypopyon uveitis. Methods Retrospective case series. The ocular clinical features, therapy and follow-up results of 14 AIDS patients (24 eyes) with rifabutin-associated hypopyon uveitis were analyzed. Results Thirteen males and 1 female aged from 24 to 78 years and weighting from 44 to 73 kilograms were included. The means of CD4 + T-lymphocyte counts of the 14 patients were ( 91.07±59.36) cells/μL. Unilateral or bilateral hypopyon uveitis developed in all patients. All cases presented with acute onset of redness, pain, photophobia and blurred vision of the affected eyes. Keratic precipitates, hypopyon and iris posterior synechiae were seen in all patients. The fundus cannot be seen. B-scan ultrasonography showed extensive strong flake echoes in the vitreous. All patients were treated with topical steroids and mydriatic drops. In one case, systemic and topical treatment with steroids was applied. All 14 patients (24 eyes) showed rapid and complete remission of ocular lesions. The relapse occurred in 8 patients. Conclusions With the widespread use of rifabutin, the incidence of rifabutin-associated uveitis is increasing. Ophthalmologists should pay attention to this potential complication. Recognition of rifabutin-associated hypopyon uveitis may prevent unnecessary invasive diagnostic and therapeutic procedures. Timely treatment can greatly improve the vision and reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

Purpose: To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis. Methods: A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019. Results: The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4–13.3; P = 0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9–71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis. Conclusion: Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date.

PURPOSE: Toxic anterior segment syndrome (TASS) is a noninfectious anterior chamber reaction caused by ocular surgeries. It usually develops within the first 12–48 h after surgery. In case of clinical suspicion of TASS, endophthalmitis as a devastating disease should always be excluded. However, the fact that TASS and endophthalmitis can look the same, but the treatment for each is different. Therefore, distinguishing between the two conditions is an important factor in coping with both diseases. It was aimed to describe the features and clinical management that are considered when distinguishing the cause of unexpected inflammatory response after cataract surgery. METHODS: A retrospective review of medical records of 13 patients who developed TASS in our clinic at Ege University Ophthalmology Department on three different days between July 2022 and December 2022 were included in this study. Anterior segment photographs of those 13 patients and the records of ophthalmological examinations of those patients, including best-corrected visual acuity (BCVA), ocular pressure, biomicroscopic, and fundoscopic examination, were collected. Medical data were evaluated retrospectively. RESULTS: The mean time to onset of clinical symptoms was 27.6 h. The main complaint was pain in nine patients. The primary symptom in the remainder of the patients was blurred vision. Severe hypopyon was seen in 5 cases. Despite the presence of pain and hypopyon, patients who were treated with topical steroids were closely followed up (every 2 h) because they were consecutive patients and had relatively acute onset complaints. Inflammation was regressed after an average of 4 h. No factor causing TASS was found. The BCVA was at the minimum level of 8/10 on the 5th day of surgery. CONCLUSION: When distinguishing TASS from endophthalmitis, severe pain, relatively late onset, hyperemia, and the presence of severe hypopyon usually lead ophthalmologists to the clinical diagnosis of endophthalmitis. However, in this study, most of the patients diagnosed with TASS had severe pain, a significant portion of them had hypopyon, and the onset of the symptoms was relatively late. Close follow-up immediately after suspicion plays a vital role in clinical diagnosis and management accordingly. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood stem cells, characterized by increased formation of immature lymphocytes. Ocular manifestations may vary with ocular, adnexal, and orbital involvement. In this case report, we describe the first case of extramedullary relapse of ALL limited to the anterior chamber of the eye treated with the novel chimeric antigen receptor T (CAR T)-cell therapy and provide a literature review of cases of ALL relapse in the anterior chamber. A 21-year-old male with a history of B-cell ALL presented with a unilateral blurry vision in his left eye. Ocular examination revealed the presence of cells +3 in the anterior chamber and a 1.5-mm hypopyon. Anterior chamber aspiration confirmed a B-ALL relapse. The patient was successfully treated with radiotherapy of his left eye and received CTL-019 transduced T cells (tisagenlecleucel; Novartis) with cytarabine as a bridging chemotherapy treatment. On the last examination, 18 months after the first presentation, the patient presented a complete ocular remission with no systemic or CNS involvement. ALL relapse may involve the anterior chamber of the eye, and an accurate diagnosis is crucial to enable a fast and appropriate treatment. Novel CAR T-cell immunotherapy, combined with ocular irradiation, may be considered in such cases.

Abstract Background Topiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate. Case presentation Two patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases. Conclusions Topiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications.

Lymphangiomas are benign hamartomatous malformations, infrequently seen in the oral cavity. They can cause aesthetic issues and functional impairments if not treated in the initial stages, thus necessitating the need to diagnose early. Two presentations were observed: a 35‑year‑old male with classical frog‑egg appearance involving lower buccal mucosa with macrocheilia for two years, which was diagnostic on mucoscopy and histopathology, confirming acquired capillary lymphatic malformation. The second case was of a 12‑year‑old girl with a gradual appearance of reddish lesions over the tongue and episodic history of bleeding, which was confirmed on mucoscopy, and histopathology is highlighted. Mucoscopy of both the cases showed yellowish‑pink lacunae with a hypopyon‑like feature and surrounding pale septa. We present two cases of oral lymphangiomas with different presentations and highlight the importance of dermoscopy of oral lesions to bypass invasive techniques such as biopsy. [ABSTRACT FROM AUTHOR]

A 38-year-old male with a history of trauma presented to us with pain and decreased vision in the left eye (LE). Previously, the patient had been diagnosed with hypopyon uveitis and was prescribed topical steroids. We performed slit-lamp examination of the LE and found exudates in the anterior chamber (AC) extending from 6 to 9 o'clock, along with circumciliary congestion and pigmented keratic precipitates. We made a diagnosis of infectious anterior hypopyon uveitis; however, all of its causes were ruled out upon the necessary investigations, which returned normal results. The patient was started on topical and oral antibiotics, and subsequently, there was complete hypopyon resolution. Five months later, he presented with similar complaints. An examination revealed a black elevated lesion in the AC at 8 o'clock suspicious of an intraocular foreign body (IOFB), along with 1 mm hypopyon. An X-ray orbit examination confirmed the IOFB presence, and the IOFB was surgically removed from the AC. Three weeks after this surgery, the patient presented with a recurrence of similar symptoms. The nasal pterygium adjacent to the location of the previously removed IOFB was inflamed with an underlying black elevated limbal nodule, which was determined to likely be a remnant of the IOFB in the subconjunctival space. Here, we report a case of penetrating IOFB that was initially detected in the AC. Its remnant extraocular component persisted in the subconjunctival space, and its incomplete removal led to recurrent inflammation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the seasonality, clinical profile, and treatment outcome of Fusarium keratitis.Methods: A retrospective medical chart review of 97 patients with culture-proven Fusarium keratitis at a tertiary eye care institution from January 2018 to December 2019.Results: The median (SD) age at enrollment was 44.6 (16) years; 75 (79.8%) of them were male. Presence of infiltrate less than 4 mm2 at baseline indicated 4.4 times the odds of achieving final BCVA more than 20/60 (95% CI: 1.4-13.3; P=0.008). The absence of surgical management indicated 8.1 times the odds of achieving final BCVA of more than 20/60 (95% CI: 0.9-71.5; P = 0.06). The visual acuity at presentation, duration between symptoms and presentation, history of ocular trauma, previous use of topical medications, and presence of hypopyon were not identified as significant predictors of final BCVA in the multivariable regression analysis.Conclusion: Smaller infiltrate size and absence of surgical management are the significant predictors of good visual outcome. Visual outcome of Fusarium keratitis is poor, and a significant number of patients did not respond to anti-fungal therapy and had to undergo surgeries. To the best of our knowledge, this is the largest case series on Fusarium keratitis to date. [ABSTRACT FROM AUTHOR]

This study aims to report two cases with an uncommon, early manifestation of herpes zoster ophthalmicus which is keratouveitis. The first patient is a 61-year-old female who had presented with painful facial skin eruption and right eye redness without impairment of vision. She was treated initially as herpes zoster blepharoconjunctivitis; however, the disease had progressed to neurotrophic keratitis with severe anterior chamber reaction manifested by a mixture of hypopyon and hyphema. The second patient is a 74-year-old female who had presented after 2 weeks of facial skin eruption with blurring of vision and similar keratouveitic manifestations. Both patients had poor visual outcome due to severe ocular inflammation.

Purpose: To present a case of acute B-cell lymphoblastic leukemia (B-ALL) ocular relapse treated with chimeric antigen receptor T-cell (CAR T) therapy. Methods: A retrospective case review was evaluated. Results: A 69-year-old woman with a history of B - ALL presented with bilateral hypopyons and 3+ anterior chamber cells that responded to topical prednisolone. Six months later, she developed recurrent hypopyons, iris neovascularization, and iris nodularity in both eyes. A fine-needle aspiration biopsy confirmed ocular infiltration of B-ALL. A single infusion of CAR T therapy resulted in remission of the systemic and ocular findings. The clinical course was complicated by cytokine release syndrome and neurotoxicity, which improved with medical management. The patient remained in remission for 7 months after a single CAR T infusion. Conclusions: CAR T therapy may be effective in treating systemic leukemia and uveal infiltration, with an ocular side-effect profile and visual outcomes. The systemic side effects of CAR T therapy may be managed medically., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article., (© The Author(s) 2024.)

We report a case of keratitis with double hypopyon in a 70-year-old man to illustrate differences between corneal ulcer and corneal abscess. [ABSTRACT FROM AUTHOR]

Although the colour of both "non-infectious hypopyon" and "pseudohypopyon" are generally "white" or "greyish-white" in appearance, "yellow hypopyon" is encountered in microbial panophthalmitis [[3]]. Keywords: Color; Endophthalmitis; Hypopyon; Neoplastic; Precipitation; Pseudohypopyon; Sediment; Tumoral EN Color Endophthalmitis Hypopyon Neoplastic Precipitation Pseudohypopyon Sediment Tumoral 1 3 3 10/10/22 20221006 NES 221006 This comment refers to the article available at https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-022-02277-2 Background Given the recent attention on the distinction of "hypopyon" from "pseudohypopyon" for an early diagnosis of sight-threatening ocular or systemic diseases, especially for neoplastic masquerading syndromes, the recent article of Sukon et al. published in BMC Ophthalmology is most timely [[1]]. [Extracted from the article]

To report a case an iris juvenile xanthogranuloma presenting with hypopyon. A 45-day-old infant was referred to our clinic for unilateral hypopyon. Slit-lamp examination revealed a 2 mm hypopyon in the left eye while visible areas of the iris were normal. Fundus examination was normal. Topical corticosteroids and antibiotics were initiated. The hypopyon regressed to 0.5 mm after 2 weeks of treatment. The now visible peripheral iris revealed an inferotemporal yellow-brown iris mass. Clinical findings were consistent with juvenile xanthogranuloma of the iris. The patient was referred to the pediatrics department which revealed no systemic involvement. Two months after total regression of hypopyon, the baby presented with a 3 mm spontaneous hyphema causing 50 mmHg intraocular pressure. The patient was followed with topical corticosteroids and antiglaucomatous drops until the hyphema was resolved. ocular involvement, which is the most common extracutaneous 15 manifestation of juvenile xanthogranuloma, should be considered in the differential diagnosis of hypopyon and/or hyphema in young children. [ABSTRACT FROM AUTHOR]

Purpose: We present a novel case of a neurotrophic keratopathy associated inflammatory hypopyon that resolved after initiation of therapy with cenegermin (Oxervate; Dompe, Milan, Italy), a recombinant human nerve growth factor (rhNGF). This finding illustrates the potential of cenegermin in advanced inflammatory neurotrophic disease. Observations: A 60-year-old female with a history of herpes zoster keratitis was evaluated in our clinic for stage 2 neurotrophic keratopathy. One month later, she presented emergently with a large epithelial defect, infiltrate, and hypopyon. Three separate sets of corneal cultures returned negative. She was treated with oral antivirals and aggressive topical antibiotics with no clinical improvement. Given the presumed diagnosis of stage 3 neurotrophic keratopathy with a sterile hypopyon, she was started on cenegermin 6 times daily for 8 weeks in the absence of a corticosteroid. By 2 weeks after starting cenegermin, the epithelial defect, infiltrate, and hypopyon sizes had improved. Within 4 weeks of starting cenegermin, the hypopyon had clinically resolved. The patient was subsequently started on topical corticosteroid drops for the last 4 weeks of cenegermin therapy. Examination at the conclusion of 8 weeks of cenegermin treatment revealed a closed epithelium and minimal scar. Best-corrected visual acuity with contact lens overrefraction was 20/70. Over the course of 7 months of continued follow-up, the cornea remained epithelialized without recurrent corneal infiltration or hypopyon. Conclusions and importance: While cenegermin has been previously shown to be an effective treatment for neurotrophic keratopathy associated epithelial defects, resolution of a neurotrophic keratopathy associated inflammatory hypopyon with cenegermin is novel.

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood stem cells, characterized by increased formation of immature lymphocytes. Ocular manifestations may vary with ocular, adnexal, and orbital involvement. In this case report, we describe the first case of extramedullary relapse of ALL limited to the anterior chamber of the eye treated with the novel chimeric antigen receptor T (CAR T)-cell therapy and provide a literature review of cases of ALL relapse in the anterior chamber. A 21-year-old male with a history of B-cell ALL presented with a unilateral blurry vision in his left eye. Ocular examination revealed the presence of cells +3 in the anterior chamber and a 1.5-mm hypopyon. Anterior chamber aspiration confirmed a B-ALL relapse. The patient was successfully treated with radiotherapy of his left eye and received CTL-019 transduced T cells (tisagenlecleucel; Novartis) with cytarabine as a bridging chemotherapy treatment. On the last examination, 18 months after the first presentation, the patient presented a complete ocular remission with no systemic or CNS involvement. ALL relapse may involve the anterior chamber of the eye, and an accurate diagnosis is crucial to enable a fast and appropriate treatment. Novel CAR T-cell immunotherapy, combined with ocular irradiation, may be considered in such cases. [ABSTRACT FROM AUTHOR]

Purpose: To know the clinical and demographic pattern, and the outcome of treatment of Behcet's disease (BD) cases in Nepal Methods: Retrospective series of all the cases of BD who had come over the period of 12 years (Jan 2007–Dec 2015) Tilganga Institute of Ophthalmology. Result: Twenty-one cases were included, 17 (81%) male and four (19%) female. Mean age was 28.88 ± 9.18 years. Mean follow-up period was 3.6 ± 2.6 years. All had nongranulomatous panuveitis. Hypopyon was seen in 13 (61.9%) cases. Small retinal infiltrates in 13 (61.9%) cases and retinal vasculitis in ten (47.6%) cases were seen. Cataract (in 13, 61.9%) and optic atrophy (in 11, 52.4%) cases were present. Oral ulcer was present in 20 (95.2%), genital ulcer in 15 (72%), and skin lesions in 13 (62%) cases. Conclusion: BD affected mainly the most active age group and was predominant in male. Optic atrophy was the leading cause of irreversible vision loss. Despite being a less common condition, BD should be considered in the differential diagnosis of panuveitis cases in the Nepalese population. [ABSTRACT FROM AUTHOR]

Background: Topiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate.Case Presentation: Two patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases.Conclusions: Topiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications. [ABSTRACT FROM AUTHOR]

Hypopyon usually corresponds to the sedimentation of white blood cells, and it signifies severe intraocular inflammation. This key clinical sign may occur in association with a wide variety of infectious, inflammatory, and neoplastic conditions that may be sight- and, occasionally, life-threatening. A careful history and thorough clinical examination are the cornerstones for orienting the differential diagnosis, identifying the causative agent, and initiating prompt and appropriate treatment. This review outlines the clinical characteristics and management of hypopyon in relation with the underlying causative infectious or noninfectious ocular or systemic diseases. [ABSTRACT FROM AUTHOR]

Seasonal Hyperacute Panuveitis (SHAPU) is a seasonal and cyclic uveitic disease reported only from Nepal occurring every odd year. Untreated eyes go blind and phthisis within a week. Circumstantial evidence for the role of moths has been reported earlier. Herein for the first time, we describe a SHAPU case in a healthy young Nepalese patient where the exposure to white moth was followed by the development of the uveitis and the moth hair particles was detected in the corneal and presence was confirmed with anterior segment optical coherence topography.

This case report represents an unusual presentation of Mycobacterium tuberculosis-associated corneal ulcer with hypopyon. A 64-year-old man presented with a hypopyon corneal ulcer in the right eye. His corneal scrapings were negative, and the ulcer was not responding to empirical antimicrobial therapy. A real-time polymerase chain reaction from an aqueous aspirate of the right eye detected 422 copies of M. tuberculosis. Subsequent investigations revealed positive Mantoux and interferon-gamma release assay, supportive radiology. The patient was successfully treated with a course of antitubercular therapy and topical steroids. Hypopyon corneal ulcer, though a rare manifestation of ocular tuberculosis, should be considered in cases not responding to standard antimicrobial therapy.

Seasonal Hyperacute Panuveitis (SHAPU) is an eye disease of unclear aetiology occurring cyclically during the autumn in odd years in Nepal causing blindness within a week. This study is the first of its type to investigate the risk factors of SHAPU. A multicentric national level case–control study was performed during the 2017 SHAPU outbreak. Cases were matched to controls in a 1:3 ratio based on age, sex and geographic area. Questionnaire-based personal interview was used and risk factors were categorized as biological and behavioral. For univariate analysis, frequency, median and interquartile range was calculated. Chi-squared test with/without continuity correction and Fisher's exact test were used. Multivariate conditional logistic regressions were used for all the independent variables for p <0.1 in the univariate analyses. We identified 35 cases and 105 controls; 71.4% were children≤16 years (38-day infant to 50-year-old). All were immunocompetent individuals, males were 57.1% and females 42.9%. Potential risks such as visible moths/butterfly activity, contact with livestock, and attending mass gatherings of people were not reported more frequently in cases vs controls in univariate analyses. Differences in possibly protective factors such as self-reported mosquito net use, light off at night while sleeping, and habit of hands/face washing after physical contact/touch with any insects/butterflies/birds were not statistically significant between both groups. In multivariate model, SHAPU cases were significantly more likely than controls to report physical contact with butterflies/white moths (Adjusted OR:6.89; CI:2.79–17.01,p <.001). Direct physical contact with butterflies/moths was associated with significantly increased odds of SHAPU cases. [ABSTRACT FROM AUTHOR]

Background/Aim: The most important complication after intravitreal injection (IVI) is endophthalmitis, which can result in severe vision loss. This study aims to investigate the effect of 0.25% povidone-iodine (PI) application before IVI on the incidence of endophthalmitis in patients who received intravitreal antivascular endothelial growth factor (anti-VEGF) injection. Methods: A total of 15345 intravitreal anti-VEGF injections and nine endophthalmitis cases after IVI performed at the outpatient injection room of a single university hospital between January 2017 and January 2020 were included in this retrospective cohort study. Before July 2018, after applying 10% PI around the eyes and 5% PI on the eyes, an eyelid speculum was inserted, and the injection was performed. After this date, in addition to these steps, after placing a speculum and determining the injection site with a caliper, 3-4 drops of 0.25% PI were applied just before injection. Topical antibiotics were not used before or after the injection. Results: Nine cases of endophthalmitis were detected in 3 years. The most common symptoms were vision loss (9/9) and pain in the eye (7/9). All cases had conjunctival hyperemia, cells-hypopyon in the anterior chamber, and cells in the vitreous. The time between injection and re-visiting the clinic due to endophthalmitis symptoms ranged between 2-6 days, and visual acuity varied between hand motion and 0.2. While the number of endophthalmitis cases before July 2018 was 8 (8/8330) in 1.5 years, after the addition of 0.25% PI application to the protocol, only 1 case of endophthalmitis (1/7015) was seen in the last 1.5 years. The rate of endophthalmitis had decreased significantly (P=0.037). Conclusion: Since July 2018, the addition of 0.25% PI to the standard IVI protocol just before injection has significantly reduced endophthalmitis rates. With this method, endophthalmitis rates may be decreased despite the increasing number of IVIs. [ABSTRACT FROM AUTHOR]

Purpose: To report an atypical bilateral hypopyon presentation of syphilitic uveitis. Observations: A 38-year-old male presented with a 2-day history of bilateral progressive visual loss, conjunctival hyperemia, and photophobia. Initial ophthalmologic examination revealed bilateral hypopyon and vitritis that limited the examination of the posterior segment. The physical exam revealed cervical lymphadenopathy, glossal leukoplakia, erythematous maculae on the hard palate, erythematous macular lesions on both palms, onychodystrophy, onycholysis, and psoriasiform plaques on both plantar surfaces, testicular tenderness, and hypopigmented patches on the scrotal and perianal skin. A therapeutic and diagnostic vitrectomy was performed on the right eye, and the intraoperative findings were consistent with severe vitritis and pre-retinal precipitates. The cytopathologic analysis of the right vitreous revealed a mixed inflammatory process composed of lymphocytes, histiocytes, and neutrophils in a proteinaceous background. Laboratory testing revealed positive serum RPR, CSF FTA-Abs and VDRL, and HIV serology. Treatment with a 2-week course of intravenous penicillin G 4 million units every 4 hours and topical corticosteroids resulted in complete resolution of the uveitis. Conclusions and Importance: Bilateral hypopyon uveitis may be a rare presentation of syphilitic uveitis. As with most forms of uveitis, syphilis should be considered in the differential diagnosis of patients presenting with bilateral hypopyon.

Purpose: To report a hypopyon following selective laser trabeculoplasty (SLT). Observations: An 85-year-old woman with primary open-angle glaucoma underwent routine SLT. In the early post-procedural period, she presented with pain and decreased vision, and she was found to have hypopyon, trabeculitis, and corneal edema. The patient was treated with prednisolone acetate and empirically with valacyclovir due to the possibility of herpetic keratouveitis. Work-up for potential etiologies was unrevealing. Her symptoms resolved with treatment, and at eight months follow-up her visual acuity and intraocular pressure had stabilized to her baseline. Conclusions: Though safe, SLT may be associated with rare adverse events requiring intervention. Hypopyon following SLT is extremely rare, and investigation for causes unrelated to the history of SLT should be undertaken as appropriate. Importance: To the best of our knowledge, this is the first report of a hypopyon following SLT in a patient with no history of inflammatory intra-ocular disease.

ABSTRACT In this report, we described a rare case of Mycobacterium abscessus subsp. bolletii keratitis in a young healthy male, in the absence of risk factors.

Purpose: To report the clinical experience of uveitis associated with Behçet's disease in a cohort of Egyptian patients. Methods: The present study is a retrospective analysis of the medical charts of patients with Behçet's disease, who were referred to a tertiary eye care center in Egypt between June 2010 and June 2018. Results: The current study included 1301 eyes of 681 patients with Behçet's disease. The mean age of the patients at the time of referral was 27.2 ± 3.9 years. Panuveitis was the most common presentation. About 28% of all involved eyes had a final visual acuity < 20/200, by the last follow-up visit. Conclusion: Behçet's disease is an important cause of uveitis in Egypt, and despite the fact that the prognosis of Behçet's uveitis has globally improved in recent years, the visual outcome in Egypt is still not favorable especially in case of delayed referral to tertiary centers. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical profile of patients with HLA-B27-associated uveitis at 2 Egyptian tertiary eye centers. Methods: A retrospective study reviewing the medical records of all patients with HLA-B27-associated uveitis served at 2 uveitis referral clinics in Egypt between January 2010 and June 2018. Results: The study included a total of 554 patients. Anterior uveitis was the most common type. Ankylosing spondylitis was an important systemic comorbidity in the present study, affecting 27.4% of our patients. Cataract was the most frequent ocular complication. By the conclusion of the study, 6.1% of the affected eyes had a BSCVA poorer than 20/200. Conclusion: The clinical profile of HLA-B27-associated uveitis in our cohort of Egyptian patients is similar to that reported from other regions of the world. In our study, a relatively high rate of cataract was observed. [ABSTRACT FROM AUTHOR]

Purpose: To report clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis.Methods: Retrospective chart review of consecutive culture-proven Curvularia keratitis patients who presented to a tertiary eye care center in north India. Patients with mixed infections with Curvularia as one of the pathogens were also included. Standard case report form was developed to capture demographic information, clinical features, etiology, treatment, and outcome. Binary logistic regression was done to ascertain the effect of identified variables on final visual acuity.Results: Medical records of 97 patients of Curvularia keratitis were reviewed. Median age of patients was 45.3 years. Seventy-nine (79.4%) patients presented during the months of September to November. History of corneal trauma was present in 69.1%. Trauma from sugarcane leaf was identified in 66.1% of cases with corneal trauma with vegetative matter. Presenting visual acuity was worse than 20/60 in 57.8% of patients. Hypopyon and pigmented plaque-like infiltrate was present in 16.5% and 28.8% of patients, respectively. Mixed infection was reported in 14.4% of cases. Median time of antifungal therapy was 24.5 days. Surgical intervention was required in 18.5% cases. Of all, 11.1% patients achieved final VA of more than 20/200 who were managed surgically as compared to 68 (86%) patients who were managed medically. Younger age, absence of comorbidities, and lesser infiltrate size were found associated with good final visual acuity.Conclusion: Working males were most affected by Curvularia keratitis. Corneal trauma with sugarcane leave was the most common predisposing factor in the study area. Most of the cases presented with worse visual acuity but could be managed medically. [ABSTRACT FROM AUTHOR]

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This study aims to report two cases with an uncommon, early manifestation of herpes zoster ophthalmicus which is keratouveitis. The first patient is a 61-year-old female who had presented with painful facial skin eruption and right eye redness without impairment of vision. She was treated initially as herpes zoster blepharoconjunctivitis; however, the disease had progressed to neurotrophic keratitis with severe anterior chamber reaction manifested by a mixture of hypopyon and hyphema. The second patient is a 74-year-old female who had presented after 2 weeks of facial skin eruption with blurring of vision and similar keratouveitic manifestations. Both patients had poor visual outcome due to severe ocular inflammation. [ABSTRACT FROM AUTHOR]