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BackgroundMethodsResultsConclusionTo compare the treatment outcome and visual prognosis of Vogt-Koyanagi-Harada (VKH) disease presenting as papillitis vs. serous retinal detachment (SRD).Retrospective comparative cohort study of 35 patients with previously unknown VKH diagnosis, followed-up for ≥6 months. Outcomes measured: (1) time to achieve inflammatory control; (2) VKH relapse; (3) ocular complications (glaucoma, sunset glow fundus, cataract, and vision loss ≥2 Snellen lines); and (4) chances for developing a chronic-recurrent disease.Females predominated in both groups: 12/16 (75%) papillitis and 18/19 (94.7%) SRD. The mean age at presentation was 29 ± 12 years in the papillitis and 36 ± 14 years in the SRD group (p = 0.119), with an overall median follow-up of 26 months (6–180 months). The papillitis-onset VKH group’s mean time elapsed between symptoms onset and initial treatment was shorter (2.9 ± 1.0 vs. 4.6 ± 2.8 weeks, p = 0.024). Anterior segment inflammation was lower (56% vs. 79%, p = 0.018), requiring a shorter corticosteroids treatment duration (12.8 ± 16.1 vs. 32.7 ± 34.1 months, p = 0.040), achieving an earlier inflammatory control (1.9 ± 0.6 vs. 4.1 ± 3.2 months, p <0.001) with fewer ocular complications (13% vs. 74%, p <0.001), including sunset glow fundus (SGF) (0% vs. 63%, p <0.001). Conversely, SRD-onset VKH was a risk factor for developing disease relapse (HR: 4.53; 95% CI: 1.31–15.69, p = 0.017), ocular complications (OR: 19.60, 95% CI: 3.24–118.50, p = 0.001), and chronic-recurrent disease (OR: 20.63; 95% CI: 2.24–189.84, p = 0.008).Mexican-mestizo VKH patients with papillitis-onset VKH disease showed earlier inflammatory control, fewer recurrences, and better visual and ocular complication outcomes. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo report a case of Cogan-Like Syndrome following treatment with nivolumab for metastatic cutaneous melanoma.A case report.A 54-year-old female sought a second opinion from us regarding the recently diagnosed uveitis in both eyes. She had a diagnosis of metastatic cutaneous melanoma in the right arm and was undergoing treatment with nivolumab. Four weeks following the initiation of nivolumab therapy, she experienced tinnitus and bilateral sensorineural hearing loss, which was treated with oral and intratympanic steroids. While tapering the oral steroids, she developed iridocyclitis with papillitis in both eyes. This combination of vestibuloauditory symptoms and ocular inflammation was strikingly reminiscent of Cogan’s syndrome. Because of the timing in relation to the nivolumab therapy and the steroid responsiveness of her presentation, this was speculated to be due to immune overactivation from the nivolumab. Given her complex condition, which involved toxicity and multiple metastases, the patient was advised to consider either topical and/or local corticosteroids or intravenous immunoglobulin. The patient chose to persist with corticosteroid therapy.Nivolumab could potentially be linked to an immune-related condition resembling Cogan syndrome. In cases involving patients with a complex condition necessitating nivolumab treatment, the use of topical and/or local corticosteroids or intravenous immunoglobulin, might constitute the sole viable treatment options. [ABSTRACT FROM AUTHOR]

The objective of this study was to look at the clinical outcomes, and to determine the proportion of children with visual recovery after the first demyelinating event of optic neuritis (ON). In this observational study, children with the first clinical event of optic neuritis at an age less than 18 years were evaluated. High-contrast visual acuity, colour vision, Expanded Disability Status Scale (EDSS), Anti-MOG and AQP-4 antibodies were assessed. Of the 55 screened, 45 children (77 eyes), median age-98 months, 30 (67%) bilateral were enrolled. Fifty of 77 eyes (67%) had Snellen visual acuity less than 6/60. Twelve children (27%) were MOG seropositive and 3 had AQP-4 positivity. At median follow up of 35 months, 10 (22%) children had one or more relapses. At follow up, the median (IQR) visual acuity improved from nadir of 2.1 (1–2.7) logMAR to 0 (0–0.18) logMAR and 64/77 eyes (83%) had visual recovery. The diagnosis at last follow up was isolated ON in 39/45 (86.6%), relapsing ON (5, 11%), AQP-4 positive NMOSD (3, 7%), MOG antibody associated demyelination (12, 27%), dual seronegative ON (30,67%) and Multiple sclerosis (1, 2%). Most children with first demyelinating event as ON have a monophasic illness. Despite severe acute-phase visual loss, most eyes with ON will recover good visual functions. The risk of AQP-4 disease and multiple sclerosis is low in this group. • This study observational study looked at visual recovery after optic neuritis in children. • At a median follow up of 35 months, 10 (22%) children had one or more relapses. • Eighty-three percent of affected eyes had visual recovery. • At last follow up, MOG antibody associated demyelination was the cause in 12 (27%). • The risk of AQP-4 disease and multiple sclerosis was less than 10%. [ABSTRACT FROM AUTHOR]

PurposeThe aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19).MethodsA 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000.ResultsThree months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted.ConclusionThe findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis.

The human tongue consists of various kinds of papillae which form its characteristic morphology. Among these papillae, the foliate papillae may become enlarged and inflamed causing a condition called as foliate papillitis. The treatment of this disease includes relieving all causes of trauma such as sharp teeth, ill-fitting dentures, etc., to the region. However, for several patients, the symptoms of foliate papillitis remain even after the conservative treatment is done. For two of these patients, we have used IMDSL dental diode laser of 980 nm to ablate the enlarged foliate papillae to relieve the symptoms of pain. Both the patients were recalled after one month during which time they were free of symptoms with total healing of the ablated site. One year later, during follow-up, both the patients remained symptom free. We believe this is the first time that diode laser has been used for the treatment of foliate papillitis.

Coronavirus Disease 2019 (COVID-19) is a viral disease that can show different clinical findings in different patients, mainly affecting the respiratory tract and progressing with the outcome of pneumonia. Involvement of the virus in different ways, from the brain to the gastrointestinal-genitourinary system, except the respiratory tract, has been reported in so many publications so far. Although eye involvement due to the disease is a relatively rare condition, it may cause visual problems either by the direct neurotoxic effect of the virus, autoimmune reactions, or some vascular pathologies. These findings usually occur in the subacute-advanced period of the disease or after the infection. In this case report, it is aimed to present the magnetic resonance imaging findings and clinical findings of a case with unilateral papillitis without optic neuritis findings in the early period of COVID-19, unlike the others. [ABSTRACT FROM AUTHOR]

A 23-year-old man with a history of migraine and focal seizures, developed painless visual loss in the left eye associated with optic disk edema. There was no recent history of cat exposure except for a cat that lives outside. Initial laboratory studies were negative. magnetic resonance imaging brain and orbits without and with fat suppression and intravenous contrast was normal. The patient admitted to routinely skinning, processing and consuming deer while not wearing gloves, and he also frequently had cuts on his hands while doing so. The serum Toxoplasma gondii IgG antibody returned at >400 (0–7.1 IU/mL) with the IgM at 10.4 (0–7.9 AU/mL). [ABSTRACT FROM AUTHOR]

Purpose: To report a patient previously treated for primary and secondary syphilis who presented with papillitis. The patient was found to have neurosyphilis likely due to inadequate treatment of primary and secondary syphilis. Observations: A 60-year-old male with human immunodeficiency virus (HIV) and hepatitis C was referred for evaluation of blurry vision for the past several months. Anterior segment examination was notable for 1+ diffuse non-granulomatous keratic precipitates and 2+ flare with trace cell in both eyes. Dilated fundus exam revealed grade 2 optic disc edema in both eyes with no evidence of infectious retinitis. He was recently treated for syphilis with a single dose of intramuscular (IM) penicillin. These findings were consistent with syphilitic papillitis likely secondary to neurosyphilis. The patient underwent a lumbar puncture which confirmed the diagnosis of neurosyphilis. He was admitted to the hospital for intravenous (IV) penicillin. He later revealed a prior history of syphilis that was treated 3 years ago and 1 year ago. Conclusions and importance: Ocular syphilis can have a wide variety of presentations. Any patient with syphilis and uveitis should have prompt work up for neurosyphilis. Patients with any stage of syphilis need close follow up with repeat titers after treatment to ensure adequate treatment and prevent progression and permanent ocular or neurologic sequelae.

Increased intracranial pressure is the most common cause of papilledema. Multiple etiologies such as cerebral edema, hydrocephalus, space occupying lesions, infection, and idiopathic intracranial hypertension among others should be considered. Imaging plays a critical role in the detection of pathologies that can cause papilledema. MRI with contrast and CE-MRV, in particular, are key for the diagnosis of idiopathic intracranial hypertension. This review will focus in common and infrequent causes of papilledema, the role of imaging in patients with papilledema as well as its potential mimickers. [ABSTRACT FROM AUTHOR]

Background and Aim: Optic neuritis causes substantial visual impairment and potential long-term visual defects in addition to serving as an important prognostic indicator for future development of demyelinating diseases such as multiple sclerosis. Hence this study was done with the objective to collect data of the clinical profile in patients of optic neuritis. Materials and Methods: A prospective analysis was done for the patients clinically diagnosed with optic neuritis. A total of 60 patients were included in the study. Patients admitted with optic neuritis after taking valid consent detailed history was taken, with documention of onset of visual loss, duration of visual loss, pain and history of any other ophthalmic and neurological symptoms. Results: Of the total 120 eyes of 60 patients were inspected, the left eye was more commonly diagnosed with neuritis and papillitis. DOV was seen as the chief complain in majority of patients with optic neuritis, 21 patients complained of pain with eye movements and twelve patients complained of non specific pain in an around the eye. Four patients had uthoffs phenomenon. Conclusion: All patients treated were treated with ONTT trial and also investigated for cause and follow up done. The results revealed that the prevalence of papillits were almost equal in males and females. Patients responded quickly to ONTT regimen while papillits recovered late. VA improvement after ONTT was statistically significant. Colour vision and contrast also improved. Our study showed that ONTT regimen has benifit in optic neuritis with fast Visual recovery. [ABSTRACT FROM AUTHOR]

A 63-year-old Caucasian man with hypertension, hyperlipidemia, adrenal insufficiency, and history of metastatic spindle cell melanoma previously treated with ipilimumab, presented with unilateral papillitis in the left eye. The disc edema evolved to neuroretinitis with additional MRI findings of perineuritis. Broad laboratory evaluation confirmed active B. henselae infection, and he confirmed exposure to a newly adopted kitten. His vision improved following a course of antibiotics and oral steroids with resolution of clinical findings. To the best of our knowledge, this is the first reported case of cat-scratch neuroretinitis with MRI findings of optic nerve and optic nerve sheath enhancement. [ABSTRACT FROM AUTHOR]

Purpose: The study of papilledema with a novel noninvasive technique such as spectral domain-optical coherence tomography (SD-OCT) provides minute and detailed cross-sectional changes thus giving an insight into the application of biomechanical principles and pathophysiology of disc edema. Methods: We measured average retinal nerve fiber layer (RNFL) thickness and the retinal pigment epithelium/Bruch's membrane (RPE/BM) angle at the temporal and nasal borders of the neural canal opening (NCO) in 30 eyes with papilledema, 30 eyes with papillitis, and 80 control eyes. The inward angulation was considered as positive and the outward as negative. Follow-up was done at 1, 2, 3, and 6 months. The main outcome measures are the average RNFL thickness and the RPE/BM angle. Results: 29 eyes (96.6%) with papilledema had a positive RPE/BM angle (+8.11 ± 3.13). 29 eyes (96.6%) with papillitis had a negative RPE/BM angle (−1.04 ± 3.27). On follow-up at 1 month, both RNFL thickness (P = 0.01) and RPE-BM angle (P = 0.001) reduced significantly in eyes with papilledema; in eyes with papillitis, there was a significant reduction in the RNFL thickness (P = 0.02), but not in the RPE-BM angle (P > 0.05). RNFL thickness in papilledema cases normalized at 3 months whereas RPE/BM normalized at 6 months of follow-up. To detect papilledema, OCT has a sensitivity of 96.66% and specificity of 99.09% on both nasal and temporal sides. Conclusion: After appropriate treatment, the RPE/BM angle in papilledema decreased much later than the RNFL thickness. Hence, the RPE/BM angle in papilledema (positive) can be used to differentiate it from papillitis (negative) and also to monitor the activity of the disease.

Purpose: To describe an atypical case of necrotizing herpetic retinitis (NHR) that presented initially with mild anterior uveitis, optic disc swelling, and peripapillary serous retinal detachment (SRD). Observations: A 48-year-old Asian Indian man presented with blurred central vision and pain in his left eye. Examination revealed mild anterior chamber inflammation, optic disc swelling, and a peripapillary SRD in the affected eye. Multimodal imaging, including widefield fluorescein angiography, showed optic disc leakage and confirmed the presence of a peripapillary SRD, but was otherwise unremarkable with no evidence of retinitis. The patient was diagnosed with presumed Vogt-Koyanagi-Harada disease and was treated with systemic corticosteroids. While there was objective visual improvement initially, the patient subsequently noted peripheral vision loss and was found to have peripheral necrotizing retinitis and occlusive retinal vasculitis in affected eye. Polymerase chain reaction-based testing of aqueous humor detected varicella zoster virus DNA, confirming the diagnosis of NHR. Conclusion and importance: Optic disc edema and peripapillary SRD may precede the development of overt retinitis in some patients with NHR.

A case of recurrent, clinically innocuous, but painful papules involving the tongue dorsum of a 25-year-old man is presented. The lesions were interpreted to represent a transient lingual papillitis. This a poorly understood, but benign and self-limited condition involving the tongue fungiform papillae, which does not appear to be widely recognized. [ABSTRACT FROM AUTHOR]

Immunoglobulin-4 related ophthalmic disease is the most frequently reported in the orbit; however, rare cases of intraocular involvement have been described. We present multimodal imaging findings in a patient with immunoglobulin-4–related ophthalmic disease with papillitis and subretinal lesions, which broaden the spectrum of findings associated with this disease. Purpose: To report a case of IgG4-related ophthalmic disease, which presented with papillitis and subretinal deposits. Methods: Observational case report with multimodal imaging. Results: A 52-year-old man with a history of persistent lymphadenopathy presented with decreased vision in his left eye. Funduscopic examination demonstrated cuticular drusen in both eyes and florid edema of the left optic nerve, along with scattered circumscribed grey-yellow subretinal deposits that were distinct from the cuticular drusen. Swept-source optical coherence tomography demonstrated a hyper-reflective subretinal material corresponding to the grey-yellow subretinal deposits on clinical examination along with diffuse outer retinal disruption. Fundus autofluorescence revealed scattered hypoautofluorescence corresponding to cuticular drusen and also larger patches of hypoautofluorescence corresponding to the grey-yellow subretinal deposits. Fluorescein angiography demonstrated hypofluorescence corresponding to the large subretinal deposits and leakage at the optic nerve. Lymph node biopsy demonstrated IgG4-positive plasma cells and elevated serum IgG4 levels leading to a diagnosis of IgG4-related ophthalmic disease. The patient was treated with oral prednisone with subsequent resolution of the optic nerve edema. Conclusion: We describe multimodal imaging of unique retinal and optic nerve findings associated with IgG4-related ophthalmic disease. Our report broadens the spectrum of ocular involvement associated with IgG4-related disease. [ABSTRACT FROM AUTHOR]

Purpose: The study of papilledema with a novel noninvasive technique such as spectral domain-optical coherence tomography (SD-OCT) provides minute and detailed cross-sectional changes thus giving an insight into the application of biomechanical principles and pathophysiology of disc edema.Methods: We measured average retinal nerve fiber layer (RNFL) thickness and the retinal pigment epithelium/Bruch's membrane (RPE/BM) angle at the temporal and nasal borders of the neural canal opening (NCO) in 30 eyes with papilledema, 30 eyes with papillitis, and 80 control eyes. The inward angulation was considered as positive and the outward as negative. Follow-up was done at 1, 2, 3, and 6 months. The main outcome measures are the average RNFL thickness and the RPE/BM angle.Results: 29 eyes (96.6%) with papilledema had a positive RPE/BM angle (+8.11 ± 3.13). 29 eyes (96.6%) with papillitis had a negative RPE/BM angle (-1.04 ± 3.27). On follow-up at 1 month, both RNFL thickness (P = 0.01) and RPE-BM angle (P = 0.001) reduced significantly in eyes with papilledema; in eyes with papillitis, there was a significant reduction in the RNFL thickness (P = 0.02), but not in the RPE-BM angle (P > 0.05). RNFL thickness in papilledema cases normalized at 3 months whereas RPE/BM normalized at 6 months of follow-up. To detect papilledema, OCT has a sensitivity of 96.66% and specificity of 99.09% on both nasal and temporal sides.Conclusion: After appropriate treatment, the RPE/BM angle in papilledema decreased much later than the RNFL thickness. Hence, the RPE/BM angle in papilledema (positive) can be used to differentiate it from papillitis (negative) and also to monitor the activity of the disease. [ABSTRACT FROM AUTHOR]

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema.

Purpose: To report a patient who developed bilateral uveitis and papillitis during dabrafenib and trametinib treatment for metastatic cutaneous melanoma. Material and Methods: Retrospective chart review. Results: A patient under treatment for metastatic cutaneous melanoma with dabrafenib and trametinib presented to our clinic with 1 month of bilateral visual blurring complaint. At ophthalmological examination, bilateral uveitis and papillitis were observed. After stopping dabrafenib and trametinib and initiating topical steroid administration, intraocular inflammation and papillitis improved in 2 months. Final visual acuities were 20/20 in both eyes. Conclusion: Mitogen activated protein kinase (MAPK) inhibitors Dabrafenib anf trametinib can lead to ocular toxicity. Patients should be informed for the need of consecutive eye examinations. [ABSTRACT FROM AUTHOR]

Abstract Background Leptospirosis is a zoonosis commonly prevalent in tropical countries. Clinical course of leptospirosis varies from mild to severe disease. Here we present a case of leptospirosis complicated with Guillain-Barre Syndrome (GBS), papillitis, and Thrombotic Thrombocytopenic Purpura(TTP). Case presentation A 21-year-old Asian male presented with fever, myalgia, oliguria and dyspnoea where he was managed as for leptospirosis complicated with pulmonary haemorrhages and acute renal failure. Leptospirosis was confirmed by Microscopic Agglutination Test(MAT) with a fourfold rise in antibody titre between acute and convalescent serum. The highest antibody titre was against Leptospira antigen serogroup Semaranga (strain Patoc) (1:1280) followed by serogroup Australis (strain Australis) (1:640) and serogroup Autumnalis (strain Bankgkinang) (1:320). Two weeks later he developed blindness, ascending weakness of lower limbs with global areflexia and an acute inflammatory demyelinating polyradiculopathy(AIDP) variant GBS was confirmed with nerve conduction studies. TTP complicated the picture several days later. He was initiated on plasmapheresis where clinical improvement was seen after 14 cycles. He had an incomplete neurological recovery with permanent vision loss but completely recovered from TTP. He also had permanent renal impairment. Conclusion Leptospirosis should be suspected and treated empirically in the relevant clinical settings where it can present with an atypical clinical picture as in our case with an acute febrile illness followed by GBS as well as TTP.

Purpose: To assess the choroidal vascularity index (CVI) in birdshot chorioretinopathy (BSCR) patients.Methods: The CVI was calculated as the ratio of luminar area to the total subfoveal choroidal area on enhanced-depth imaging optical coherence tomography. Intraocular inflammation was defined by the presence of macular edema and/or vitritis and/or vasculitis and/or papillitis.Results: Eighty BSCR patients and 22 healthy controls were included. Foveal choroidal thickness was lower in the BSCR compared with the control group (p < 0.001). CVI was not different between the two groups. CVI was significantly higher in BSCR patients with inflammatory activity (p = 0.004). Using a multivariate linear regression model, longer disease duration was associated with lower CVI (p = 0.038), whereas the presence of papillitis was associated with a higher CVI (p = 0.003).Conclusions: The CVI was not different between the BSCR and the control group. However, the CVI may be used as a new tool for monitoring inflammatory activity in BSCR. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of uveitis and papillitis in a patient with cryopyrin-associated periodic syndrome. Methods: Case report. A 44-year-old white woman with a long history of inflammatory arthritis, diffuse erythematous rashes and hives, and hearing loss was referred to the Massachusetts Eye Research and Surgery Institution for an evaluation of chronic ocular inflammation. She was diagnosed with bilateral papillitis and uveitis after a comprehensive eye examination, which included dilated fundoscopy, optic nerve ocular coherence tomography, fluorescein angiography, indocyanine green angiography, and B-scan ultrasonography. She was later diagnosed with cryopyrin-associated periodic syndrome, an interleukin-1–driven autoimmune disease, as confirmed by genetic testing. Soon after starting treatment with anakinra, a human interleukin-1 receptor antagonist, she experienced rapid improvement of her ocular and systemic symptoms, including rash, uveitis, and arthritis. Results: Cryopyrin-associated periodic syndrome–associated ocular inflammation in remission with anakinra 100-mg daily subcutaneous injection. Conclusion: Anakinra is a very effective treatment for both cryopyrin-associated periodic syndrome and cryopyrin-associated periodic syndrome–associated ocular inflammation. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of pronounced papillitis with diminished venous outflow and vitreous inflammation in a 50-year-old man who was later found to have clinical and serological manifestations of dermatomyositis. Observations: A 50-year-old man presented with papillitis associated with venous congestion and intraocular inflammation. He was normotensive, not on medications, and without known heritable hypercoagulable or inflammatory disease. Review of systems revealed axial and proximal muscle pain involving the lower back, hip, and thigh, and he developed a transient rash of the scalp. His evaluation including infectious, hypercoagulable, and inflammatory etiologies was negative except for a significantly elevated Mi-2 antibody titer. Treatment with intravenous and oral steroids improved the papillitis, visual acuity and visual field deficit. Conclusions: Significant papillitis and retinal venous stasis with intraocular inflammation may be associated with dermatomyositis. Importance: Rapidly progressive optic disc edema with associated inflammation and venous stasis requires a broad work up for infectious, hypercoagulable, and autoimmune etiologies for targeted therapy and visual preservation. To the best of our knowledge, this may be the first reported clinical presentation of dermatomyositis manifesting initially with papillitis and retinal venous congestion, based upon elevated Mi-2 antibodies and additional clinical features.

Pembrolizumab is a programmed cell death protein 1 (PD-1) monoclonal antibody used in the treatment of metastatic melanomas. Severe ocular complications appear in less than 1% of the patients and require early treatment. We present the case of a patient diagnosed with a BRAF mutated metastatic melanoma. Ocular pain and a blurred vision appeared after treatment and the patient visited the ophthalmology emergency room, where he was diagnosed with acute anterior uveitis (AAU), synechiae, and bilateral papillitis. The patient was treated with topical corticosteroids, prednisone, and mydriatics, which immediately improved the patient's status. Therefore, when an ocular inflammatory disease exists, immune checkpoint inhibitor treatments must be ruled out as possible causes.

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Background/Purpose: To present a novel case of paracentral acute middle maculopathy associated with bilateral optic disk swelling. Methods: Retrospective case report. Results: A 67-year-old woman presented with sudden onset of central vision loss and subsequent bilateral optic disk edema, retinal vessel attenuation, and anterior uveitis. Cerebrospinal fluid analysis showed signs of inflammation. Spectral domain optical coherence tomography demonstrated the pathognomonic hyperreflectivity of the middle retinal layers consistent with paracentral acute middle maculopathy. Swept-source optical coherence tomography angiography with custom vessel analysis demonstrated a 18.3% decrease in the deep retinal vascular density and 2.4 times increase in absent flow area in the affected eye compared with the fellow eye. Conclusion: This case demonstrates a novel association between paracentral acute middle maculopathy and bilateral optic disk swelling secondary to central nervous system inflammation and possible infection. Although spectral domain optical coherence tomography is valuable in detecting paracentral acute middle maculopathy, optical coherence tomography angiography with vessel analysis can provide additional insight into the disease mechanism. [ABSTRACT FROM AUTHOR]

Patients with syphilis can present with optic disc oedema (ODE) without visual compromise, which has been primarily attributed to papilloedema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. We report four cases of ODE in the setting of syphilis with preserved visual function, normal intracranial pressure, and no enhancement of the optic nerve or sheath on magnetic resonance imaging. We propose the term "incipient syphilitic papillitis" for cases presenting with ODE, preserved vision and absence of optic nerve sheath enhancement, which is likely a more common presentation than syphilitic optic perineuritis. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The author designed an optimal treatment strategy in patients with opisthorchosis papillitis complicated by development of cholangitis. MATERIAL AND METHODS. Retrospective analysis of treatment results of 384 patients with opisthorchosis lesions of bile ducts was made. The patients were divided into randomized groups associated with applied surgical approaches. RESULTS. There was revealed an advantage of staged method of surgery performance. Practicability of application of minimally invasive and organ-saving methods was shown in initial stages of disease. Clinical version of classification of opisthorchosis papillitis were presented. СONCLUSIONS. Treatment management of patients with opisthorchosis papillitis should be based on the process stage and it should be maximally organ-saving.

OBJECTIVE. The study identified peculiarities of clinical manifestations of opisthorchosis papillitis depending on the stage of disease. MATERIAL AND METHODS. Features of diagnostics were based on analysis of medical data of 384 patients with opisthorchosis papillitis. There were investigated and statistically processed 23 clinical signs, 9 laboratory indices and data of 9 methods of instrumental diagnostics. RESULTS. Generalized and isolated analyses of signs allowed doctors to determine their diagnostic significance. The instrumental methods of diagnostics gave an opportunity to reveal this pathology in contrast to data of clinical manifestations. The inner diameter of major duodenum papilla was used in order to determine the stage of opisthorchosis papillitis. CONCLUSIONS. Specific clinic-laboratory signs for papillitis indication weren’t found. The most preferable instrumental method of diagnostics appeared to be the endo-ultrasound investigation, which gave a possibility to visualize lumen and walls of papilla and perform a needle biopsy of its deep structures.

The purpose of this article is to present a rare manifestation of ocular tuberculosis (TB). Here, we present a case of a 19-year-old female who came to our department with defective vision in the left eye (LE) for 20 days which was insidious in onset and progressive in nature. The visual acuity in the affected eye was 2/60. Anterior segment examination of both eyes was normal. Fundus examination of LE showed active papillitis with macular edema. Fundus fluorescein angiography showed optic nerve hyperfluorescence with leakage and macular edema in the LE. All other investigations were found to be within normal limits except QuantiFERON-TB Gold and Mantoux which showed an induration of 19 mm. The patient was presumed to be a case of TB of optic nerve head and started on antituberculous therapy. She showed a rapid response to the treatment and her visual acuity improved to 6/9 at the end of 2 months.

Purpose: The aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19)., Methods: A 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000., Results: Three months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted., Conclusion: The findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Furukawa, Suzuki, Nozuki, Kurosaka, Kogawa, Hara and Ueno.)

A 27-year-old male was presented with a decrease in vision in the left eye. Best-corrected visual acuity was 10/10 in the right eye and counting fingers at 2 m in the left eye. On fundus examination, the left optic disc was oedematous and there was a wide yellowish, well-defined placoid lesion between the temporal vascular arcades with mild vitreous inflammation. However, a small yellowish well-defined placoid lesion was detected in the inferior temporal region of the macula in the right eye. He was diagnosed with posterior placoid chorioretinopathy (PPC), papillitis, and neurosyphilis after performing fundus fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, serology for human immunodeficiency virus (HIV) and syphilis, and cerebrospinal fluid examination. Intravenous penicillin treatment was commenced as soon as the diagnosis was established. Seven days after treatment initiation, lesions were partially regressed. PPC and papillitis are rare manifestations of ocular syphilis. In addition, neurosyphilis may also accompany these manifestations. Therefore, syphilis should be considered in the differential diagnosis of patients who have PPC or papillitis and all patients should be tested for HIV coinfection and neurosyphilis. [ABSTRACT FROM AUTHOR]

Introduction Unilateral papillitis and neuroretinitis are uncommon manifestations of ocular Toxoplasma gondii infection and pose particularly challenging diagnosis problems. Due to the limited accessibility of healthcare and poor socioeconomic status of a significant proportion of the population in Democratic Republic of the Congo, knowledge of seroprevalence rates for toxoplasmosis remains key to the health system. When Toxoplasma papillitis or neuroretinitis is suspected, vitreous inflammatory reaction is usually present at various degrees on the initial examination as a diagnosis clue. Case report We report the case of a 37-year-old Congolese man who was managed in the University Hospital of Kinshasa, DR Congo, between October 2017 and April 2019 (18 months). The patient's informed consent was obtained for publication of his data. The patient developed presumed Toxoplasma papillitis with complete absence of vitritis at presentation. He was in good general health and had a known contact with a cat. Ophthalmoscopic examination revealed unilateral inflammation in the left optic disc and peripapillary area coexisting with active juxtapapillary retinochoroiditis that could be confirmed in ocular coherence tomography. A retinochoroiditis scar was present in the right eye. Left visual field was severely altered in automated perimetry. Toxoplasma titer was positive. Anti-HIV (ELISA) antibodies were negative. Rapid and favorable response to appropriate antiparasitic agents was observed without recurrence. Absence of vitritis and retinochoroiditis scar were confirmed during all the follow-up period. Conclusions Papillary toxoplasmosis is rare and potentially serious. Its diagnosis must be sought, even in the absence of vitritis, before taking into account any unilateral papillary edema. Our case report highlights the importance of detailed history and clinical examination to improve diagnostic decision making such as the need for complementary investigations, especially serologic testing, in a country with relatively limited financial resources in public health. [ABSTRACT FROM AUTHOR]

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A 60-year-old man presented with no light perception, ptosis and ophthalmoplegia in the right eye. The right fundus examination showed marked optic disc swelling. Serological tests for infectious and infiltrative diseases were all negative. Serum aquaporin-4 antibodies were negative, but anti-myelin oligodendrocyte glycoprotein (MOG) antibodies were positive. Magnetic resonance imaging revealed an extensive lesion in the right optic nerve with abnormal enhancement in the right orbital apex. His vision and eye movements improved after corticosteroid therapy. This report attests to the wide clinical phenotype possible in anti-MOG disease, including orbital apex syndrome. [ABSTRACT FROM AUTHOR]

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema. [ABSTRACT FROM AUTHOR]

Pembrolizumab is a programmed cell death protein 1 (PD-1) monoclonal antibody used in the treatment of metastatic melanomas. Severe ocular complications appear in less than 1% of the patients and require early treatment. We present the case of a patient diagnosed with a BRAF mutated metastatic melanoma. Ocular pain and a blurred vision appeared after treatment and the patient visited the ophthalmology emergency room, where he was diagnosed with acute anterior uveitis (AAU), synechiae, and bilateral papillitis. The patient was treated with topical corticosteroids, prednisone, and mydriatics, which immediately improved the patient's status. Therefore, when an ocular inflammatory disease exists, immune checkpoint inhibitor treatments must be ruled out as possible causes. [ABSTRACT FROM AUTHOR]

Purpose: To report the diagnosis of acute VKH-like syndrome as a complication from dabrafenib (a serine/threonine inhibitor of BRAF V600) and trametinib (a MEK inhibitor). In combination, these targeted agents have been shown to prolong overall survival and progression free survival in BRAF mutant metastatic melanoma.Methods: Retrospective medical chart review including radiologic and ophthalmologic investigations.Results: A patient with metastatic melanoma being treated with dabrafenib and trametinib for 2 months presented with 1 week of visual blurring. He had developed bilateral optic disc swelling and uveitis that responded to pulsed steroid therapy.Conclusions: VKH-like syndrome is a rare but serious complication of targeted therapy that should be considered when evaluating a patient with visual disturbances on dabrafenib and trametinib therapy. [ABSTRACT FROM AUTHOR]

Optic neuritis is inflammation of the optic nerve, which in a single or repeated attacks can severely and permanently damage visual function. Errors in diagnostic are daily and usually occur because of incomplete diagnostic procedure performed. This manuscript presents a series of 19 patients referred with optic neuritis diagnosis. The diagnosis was confirmed in 15, while four had other changes in the optic nerve or macula. We analyzed the diagnostic specificity of the basic parameters of optic neuritis diagnosis and afferent pupillary defect showed the highest sensitivity. The spectrum of differential diagnoses is shown within this finding. Optic neuritis diagnosis should be established carefully, using usual and available diagnostic methods in ophthalmologic and neurological practice, and if necessary, refer patients to neuro-ophthalmologist, as well as to electrophysiological evaluation and other methods that help differentiate disease.

A 44-year-old woman presented to our clinic with reduced vision in the right eye for two weeks. Visual acuity was 4/10 in the right eye. A swelling optic disc, vascular attenuation in the optic nerve head, a few splinter hemorrhages around the optic disc, and moderate vitritis were detected in the right eye. The left eye was normal. She had a diabetes mellitus (DM) history for five years. Serum IgM and IgG found a high titer for toxoplasmosis. A papillitis was diagnosed that was caused by primary toxoplasmosis without any chorioretinal focus. The patient was treated with an appropriate systemic antibiotics for toxoplasmosis and per oral corticosteroid. Optic disc swelling resolved within four weeks. Visual acuity was 9/10 two months later. We aimed to emphasize that the unusual placement of toxoplasmosis should be kept in mind in the differential diagnosis of papillitis in diabetic patients. [Arch Clin Exp Surg 2015; 4(2.000): 111-113]

Purpose: Evaluating the ocular manifestation and fundus fluorescein angiography (FA) findings of patients with Behçet's disease as well as the relationship between visual acuity and angiographic findings.Methods: Retrospective chart review of patients with Behçet's disease seen at the Farabi Eye Hospital.Results: Forty-six patients (92 eyes) with mean age of 33.41 ± 10.67 were included. The most frequent presenting symptom and sign were reduced vision (76%) and uveitis (87%), respectively. Panuveitis was the most frequent type of uveitis (76%). Among patients with FA, vasculitis was the most common finding (87%) and it was significantly more severe among patients with visual acuity less than 20/200. Macular leakage (P = 0.001), arterial narrowing (P = 0.000), and posterior retinal vasculitis (P = 0.002) on FA were all associated with worsening final visual acuity.Conclusion: The most common ocular findings in Behçet's disease were panuveitis and vasculitis. Location of vasculitis, arterial narrowing, and macular leakage on initial FA may predict visual prognosis. [ABSTRACT FROM AUTHOR]

Competing Interests: No potential conflict of interest was reported by the authors.