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PURPOSE: Pars plana vitrectomy (PPV) is commonly performed for managing complications of uveitis but the anti-inflammatory potential of PPV has not been extensively investigated beyond aqueous/vitreous inflammation. We studied the effect of PPV on resolution of focal posterior segment lesions in tuberculosis-associated uveitis (TBU). DESIGN: Case control study. PARTICIPANTS: Patients with bilateral TBU and active retinal/choroidal lesions in both eyes, and who received PPV in one eye were included. Fellow eyes of same patients, matched for patient characteristics and systemic therapy, were designated as controls. METHODS: Study eyes received 3-port 23-guage PPV, involving removal of nearly the entire vitreous. Part of vitreous sample was used for quantitative polymerase chain reaction (qPCR) for Mycobacterium tuberculosis. Post-operatively, anti-TB and/or systemic corticosteroid therapy was initiated depending on level of clinical suspicion of tubercular etiology, degree of intraocular inflammation and qPCR results. Focal lesions were documented in preoperative and postoperative fundus diagrams. Clinical photographs were taken whenever adequate media clarity was present. MAIN OUTCOME MEASURES: Primary outcome measures were rate of clinical resolution of focal posterior segment lesions and improvement in best-corrected visual acuity (BCVA), at 1 month post-surgery. RESULTS: Thirty-six patients with bilateral posterior segment lesions consistent with TBU were included. Possible and probable TBU (depending on radiographic evidence of TB) were diagnosed in 28 (77.7%) and 4 (11.1%) patients respectively, whereas remaining 4 patients were diagnosed only on basis of qPCR results. Focal posterior segment lesions included retinal vasculitis (n = 27), multifocal-serpigenoid choroiditis (n = 5), multifocal choroiditis (n = 3) and focal choroiditis (n = 1). At one month postvitrectomy, 28 eyes (73.7%) showed complete resolution of focal posterior segment lesions compared to 7 non-vitrectomised eyes (19.4%), while improvement in BCVA was significantly more in study eyes (0.38 logarithm of the minimum angle of resolution [logMAR], P = 0.04), compared to controls (0.12 logMAR, P = 0.17). Time to resolution following vitrectomy was unaffected by duration of disease, pre-operative systemic steroids or grade of vitritis. At 3 months, complete resolution was noted in 29 of 30 study eyes (96.7%) and 25 of 30 control eyes (83.3%). CONCLUSIONS: PPV facilitates faster resolution of focal posterior segment inflammation and BCVA improvement in TBU.

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PURPOSE: To analyze the safety and efficacy of sustained-release intravitreal dexamethasone implant (Ozurdex) in management of TB-associated multifocal serpiginoid choroiditis (MSC). METHODS: Retrospective review of TB-associated MSC patients, treated with anti-TB therapy (ATT) and adjunctive intravitreal Ozurdex. RESULTS: Nine eyes of six patients were included. Four patients required Ozurdex implant for progressive or new lesions following ATT and two for additional systemic contraindications to corticosteroids - hyperglycemia and uncontrolled hypertension, respectively. The mean time to resolution was 9.17 ± 7.71 weeks. The mean follow-up post-injection was 13.11 ± 6.05 months (median 12 months [range 6-24.5 months]). Only one of nine eyes developed recurrent MSC lesions and this was attributed to possible autoimmune etiology. Two eyes (22.2%) developed steroid-induced glaucoma - one required implant removal. CONCLUSIONS: Sustained-release intravitreal dexamethasone is a safe and efficacious adjunctive anti-inflammatory therapy for TB-associated MSC patients with contraindication for systemic corticosteroids or requiring supplemental anti-inflammatory therapy.

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Parasitic infections of the eyes are a major cause of ocular diseases across the globe. The causative agents range from simple organisms such as unicellular protozoans to complex metazoan helminths. The disease spectrum varies depending on the geographic location, prevailing hygiene, living and eating habits of the inhabitants, and the type of animals that surround them. They cause enormous ocular morbidity and mortality not because they are untreatable, but largely due to late or misdiagnosis, often from unfamiliarity with the diseases produced. We provide an up-to-date comprehensive overview of the ophthalmic parasitoses. Each section describes the causative agent, mode of transmission, geographic distribution, ocular pathologies, and their management for common parasites with brief mention of the ones that are rare.

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Two siblings aged 9 and 15 years with unexplained visual loss had normal pupillary reactions, unremarkable anterior and posterior segment, normal fluorescein angiography, visual evoked potential, and flash electroretinogram (ERG). Spectral domain optical coherence tomography (OCT) showed loss of normal inner segment-outer segment (IS-OS) junction line bump at fovea in one and absent IS-OS junction line at fovea in the other. Characteristic hypovoltaged responses from central macula in multifocal ERG (mfERG) confirmed the diagnosis of occult macular dystrophy (OMD) in both siblings. Marked difference in OCT findings despite same visual acuity indicate that structural changes in OCT might not always correlate with the extent of functional loss. Obvious mfERG changes and very subtle OCT defect in the younger one suggests that functional changes probably appear much earlier than the structural changes. OMD is often underdiagnosed because of lack of high index of suspicion and detailed work up. The patients presented here represent first OMD report from India, one of them being the second youngest reported so far (medline search).

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Posterior scleritis is a great mimicker and can cause irreversible visual loss because of late or misdiagnosis. We report a case of retinal pigment epithelial rip in the event of nodular posterior scleritis that is hardly reported in the literature. The authors hypothesize the rip to be a result of inflammation, exudation and continuing pressure by the fluid or granuloma on the pigment epithelium.

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PURPOSE: To study infectious agents associated with multifocal serpiginoid choroiditis (MSC) based on polymerase chain reaction (PCR) evaluation and specific anti-microbial therapy. METHODS: Retrospective review of medical records. RESULTS: Thirteen patients with MSC were evaluated with PCR for the following organisms: Mycobacterium tuberculosis (MTB), herpes simplex virus 1 (HSV 1), varicella zoster virus (VZV), and cytomegalovirus (CMV). Nine (69.2%) were PCR positive for one or more organisms. Seven (53.8%) were positive for MTB, 3 (23.1%) for CMV (1 positive for both MTB and CMV), and 1 (7.6%) for both HSV 1 and MTB. All 13 patients received anti-TB therapy and corticosteroids. Nine patients completed 6 months follow-up; 6 resolved completely, 2 continued to have active lesions, while 1 CMV PCR-positive patient required additional valgancyclovir therapy. CONCLUSIONS: TB is the most important etiology for MSC in endemic countries. The role of herpes viruses in MSC remains unclear and needs further investigation.

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We report the case of a 6-year-old girl with an unusual petaloid-pattern pigmentary retinopathy associated with nyctalopia and reduction of vision which had been invariably static over the past 5 years. We performed a comprehensive ophthalmic examination including fundoscopy, autofluorescent imaging, electroretinography and optical coherence tomography. There were diffuse retinal pigment epithelium (RPE) washout areas with blotches of pigment distributed in the pattern of a petal with marked chorioretinal atrophy and scar at the fovea. The arterial caliber was normal. Investigations ruled out intrauterine and neonatal infection. Systemically, she was healthy with normal intellect but with 3-month delayed milestones of development. She had used valproic acid for seizure disorder (without any organic central nervous system lesion) from 2-5 years of age. Electroretinography showed extinguished scotopic responses with slight reduction in cone responses. Optical coherence tomography showed a scar with attenuated RPE-choriocapillary complex at the macula. Her clinical profile did not fully match with any previously described pigmentary retinopathies except rod-cone dystrophy and choroidal dystrophy to a certain extent. The pigmentary retinopathy reported here is a combination of a petaloid pattern of pigmentary disturbance, stationary reduction of vision, nyctalopia, normal intellect and marginal delayed milestones. In the absence of such a description in the literature we named this disorder as petaloid-pattern pigmentary retinopathy.

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