Emerging Viral Infections Causing Anterior Uveitis

Purpose: To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis

Methods: Review of literature.

Results: Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis.

Conclusions: Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum.     

Three-year visual and anatomic results of administrating intravitreal bevacizumab in inflammatory ocular neovascularization

ObjectiveTo assess the 3-year visual outcome of intravitreal bevacizumab in inflammatory ocular neovascularization.DesignExperimental study.MethodsRetrospective multicenter consecutive case series in 81 patients with inflammatory ocular neovascularization refractory to standard therapy and treated with intravitreal bevacizumab. The outcome measures included improvement of best corrected visual acuity expressed as logarithm of minimum angle of resolution (logMAR) and paired comparison decrease in central foveal thickness by optical coherence tomography.ResultsMean best corrected visual acuity improved from baseline 0.699 (6/30 or 20/101) (SD 0.434) to 0.426 (6/16 or 20/53) (SD 0.428) (n = 81; p < 0.001), a gain of 2.7 lines (median 3 injections; 81 eyes; 81 patients). Paired comparisons revealed significant central foveal flattening at 3 years of 97.9 μm (n = 51; p < 0.001). In a subgroup analysis, visual improvement was significant for ocular histoplasmosis (p = 0.026); multifocal choroiditis (p = 0.05); serpiginous choroiditis (p = 0.028); ocular toxoplasmosis (p = 0.042); and punctate inner choroidopathy (p = 0.015). In a subgroup analysis, foveal flattening was significant for ocular histoplasmosis (p = 0.004); multifocal choroiditis (p = 0.007); serpiginous choroiditis (p = 0.011); and punctate inner choroidopathy (p = 0.001). Of the group, 5 eyes developed submacular fibrosis, 1 eye retinal pigment epithelial tear, and 1 eye macular ischemia in the context of vasculitis.ConclusionAt 3 years, intravitreal bevacizumab sustained significant visual improvement of 2.7 lines and significant foveal flattening of 98 μm in a wide variety of inflammatory ocular diseases without major complications after a median of 3 injections.     

Serpiginous choroiditis-like picture due to ocular toxoplasmosis

PURPOSE: To report an atypical presentation of ocular toxoplasmosis in the form of serpiginous choroiditis-like picture in an immunocompetent individual. METHODS: Case report: A 32-year-old man with blurred vision in the left eye showed serpiginous choroiditis-like appearance. Fundus fluorescein angiography and relevant laboratory tests including anti-toxoplasma serology and polymerase chain reaction (PCR) in aqueous humor were performed. RESULTS: The serology in blood and PCR in aqueous humor were positive for Toxoplasma gondii infection. The patient was treated with anti-toxoplasma antimicrobials and systemic steroids. At the end of six weeks of treatment the fundus lesions had healed well, with good visual recovery. CONCLUSIONS: Serpiginous choroiditis-like picture can be an atypical manifestation of ocular Toxoplasma gondii infection.     

Serpiginous-Like Choroiditis (SLC) – Morphology and Treatment Outcomes

ABSTRACT

Purpose: To study morphology and treatment outcomes in serpiginous-like choroiditis (SLC).

Methods: A retrospective chart review of SLC cases with ≥1-year follow-up. SLC lesions with elongated borders, thin body named dendritic (D-SLC), large lesions still with elongated borders named advanced dendritic (AD-SLC), and lesions with rounded borders, thick body called placoid (P-SLC). History, investigations, treatment response, and relapses were studied.

Results: Thirty-three eyes [D-SLC (n = 14), AD-SLC (n = 13), P-SLC (n = 6)] of 24 patients were studied. Resolution on Fundus autofluorescence achieved at 8.6 months (Range: 4–12 months). 0/16 eyes treated with anti-tubercular therapy (ATT) and 4/11 eyes treated without ATT had at least one recurrence in (D-SLC + AD-SLC) group (p = .019). Mean best corrected visual acuity at final follow-up was 20/20, 20/25, and 20/60 in D-SLC, AD-SLC, and in P-SLC, respectively.

Conclusion: P-SLC has poor visual prognosis compared to AD-SLC and D-SLC. ATT may prevent recurrences in D-SLC and AD-SLC.