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Advances in imaging and molecular diagnostics of ocular tuberculosis and selected observations from the Collaborative Ocular Tuberculosis Study (COTS)
摘要： Introduction: Ocular tuberculosis (TB) is a rare extra-pulmonary manifestation with protean clinical manifestations. Ocular TB as a cause of potentially blinding disease has been recently recognized by ophthalmologists as well as pulmonologists. In the past decade, there has been a great leap in our understanding of the disease pathogenesis, clinical and imaging features, as well as therapeutic challenges and disease complications. Areas covered: In this expert review, an emphasis has been laid on the recent advances in ocular imaging including wide-field fundus imaging, fluorescein angiography and autofluorescence, enhanced-depth optical coherence tomography, optical coherence tomography angiography, among others, as well as progress in the field of diagnostics such as polymerase chain reaction and other nucleic acid amplification tests. Findings from the Collaborative Ocular Tuberculosis Study (COTS), a multicentric study on ocular TB, have been explained in details. Expert opinion: Due to rapid advances in the field of fundus imaging and laboratory testing, it has become possible to recognize the pathological alterations observed in ocular TB. With further research, it may be possible to generate a consensus on the diagnosis and management of this entity in the future.
关键词： Tuberculosis,optical coherence tomography,choroiditis,fluorescein angiography,serpiginous-like choroiditis,indocyanine green angiography,uveitis
更新于2025-09-23 15:23:52
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Ocular Spot Fluorometer Equipped With a Lock-In Amplifier for Measurement of Aqueous Flare
摘要： Purpose: To evaluate a custom-made ocular fluorometer for detection of intensity of light scatter (ILS) from the anterior chamber (A/C) as an objective measure of aqueous flare. Methods: The fluorometer, equipped with a lock-in amplifier, was employed in the scatter mode to detect ILS from A/C. Measurements were performed with two illumination slit widths of 0.5 and 0.25 mm. The axial resolution at these slit widths were 80 and 200 lm, respectively. Healthy and pseudophakic eyes, with grade 0 Standardization of Uveitis Nomenclature (SUN) score, were employed as control subjects. ILS was also recorded in a cohort of patients who had undergone phacoemulsification and showed grades 1t or 2t on postoperative days 1 and 4. Results: The inter- and intraobserver variabilities in the measurement of ILS were not significant. In cataract patients, ILS was significantly higher on postoperative day 1 relative to healthy eyes. By day 4, ILS decreased significantly and was only marginally different from ILS in quiet pseudophakic eyes or healthy eyes. Eyes with higher SUN scores showed proportionately increased ILS. The receiver-operator characteristic analysis indicated no advantage in using the smaller slit width in discriminating ILS at different SUN scores although it provided higher axial resolution. Conclusions: The lock-in–based spot fluorometer is reliable for measurement of ILS with high precision and accuracy. The measured ILS correlates linearly with SUN scores and can be used to provide a higher granularity for recording aqueous flare.
关键词： ocular fluorometer,lock-in amplifier,SUN grading,light scatter,blood–aqueous barrier,aqueous flare,uveitis
更新于2025-09-23 15:22:29
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Medicine in ophthalmology
摘要： Ophthalmology is often a branch of medicine that is viewed as minor in relation to other specialities. However, there are numerous ophthalmic manifestations of neurological, rheumatological and general medical conditions. Some of these are considered emergencies (see pages xx of this chapter), but often signs are found within the eye that lead to systemic diagnoses requiring further intervention.
关键词： papilloedema,optic neuropathy,Diabetic retinopathy,thyroid eye disease,uveitis,MRCP
更新于2025-09-23 15:21:21
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Cancer-associated retinopathy preceding the diagnosis of cancer
摘要： Background: The early diagnosis of cancer is of crucial importance and a key prognostic factor. Cancer-associated retinopathy (CAR) can be symptomatic prior to other manifestations directly related to malignant tumors. The aim of this study was to show that, in selected cases, ophthalmic findings are consistent enough with the diagnosis of CAR to trigger investigations aimed at detecting a previously unknown malignancy. Methods: This was a monocentric retrospective case series performed in a tertiary referral center. Patients with a diagnosis of CAR were included. Diagnosis was based on the clinical presentation, the visual field and electroretinogram alterations. The clinical presentation, visual field testing and electroretinographic results were analyzed as well as the malignancies identified following the diagnosis of CAR. Follow-up data was collected. Results: Four patients (two men, two women, median age 65.5 years) were included. All patients presented with posterior segment inflammation at initial presentation as well as advanced visual field loss and an extinguished electroretinogram. The best corrected decimal visual acuity was 0.8 or better in both eyes of three patients and decreased to 0.3 OD and O.2 OS in one patient due to a bilateral macular edema. No patient had a previously known history of cancer. Once the diagnosis of CAR was made, investigations aimed at identifying a malignant tumors subsequently led to the diagnosis of two cases of small cell lung tumors, of one prostate carcinoma and of a uterine sarcoma. The treatment of CAR included plasmapheresis, systemic corticosteroids, azathioprine, cyclosporine and periocular or intraocular corticosteroid injections. In all cases the intraocular inflammation resolved, but pigment mottling, diffuse retinal atrophy, optic disc pallor and arterial narrowing were among manifestations observed during the follow-up of the patients. Conclusion: In selected patients, findings suggestive of CAR can be useful for the early detection of a cancer.
关键词： Paraneoplastic retinopathy,Cancer,Cancer-associated retinopathy,Uveitis
更新于2025-09-23 15:21:01
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Alexandrite laser induced uveitis & pigment dispersion: A case report and review of the literature
摘要： To describe a complication of an upper eyelid alexandrite laser procedure. Observations: A 55-year-old woman presented with left eye blurred vision and photophobia after a left upper eyelid procedure with an alexandrite laser. She had elevated intraocular pressure (IOP), anterior chamber cell and pigment, posterior synechiae, and retroillumination defects in the left eye. She was treated with topical prednisolone and brimonidine. Six months later, although her anterior chamber had cleared and IOP had normalized, the patient reported decreased vision-related quality of life from persistent photophobia. Conclusions and Importance: Alexandrite lasers are commonly used for hair removal and skin depigmentation. When used periocularly without proper eye protection, they have the potential to create irreversible ocular complications. This case demonstrates the importance of proper eye protection with periocular laser procedures.
关键词： Pigment dispersion,Anterior uveitis,Alexandrite laser
更新于2025-09-23 15:19:57
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Nd:YAG Laser Posterior Capsulotomy in Adult Patients with Uveitis
摘要： Purpose: To study the complication rate of Nd:YAG laser posterior capsulotomy in patients with uveitis. Method: Retrospective case note analysis of pseudophakic uveitis patients having undergone Nd:YAG laser posterior capsulotomy between January 2016 and December 2018. Complications documented included uveitis flare, raised intraocular pressure, intraocular lens damage/displacement, cystoid macular edema, and retinal detachment. Results: There were 39 eyes of 38 patients (20M, 18F; age 27–89 years). Mean interval between cataract surgery and laser was 55 months (range 8–286 months). Mean laser energy was 79 mJ (range 33–207 mJ). At 3 months 62% of eyes achieved a 2–5 Snellen line improvement that was maintained at 12 months. Vision was unchanged in 21% of eyes due to preexisting pathology, with no eyes having worse vision. No post-laser complications were documented. Conclusions: Nd:YAG laser posterior capsulotomy is a safe procedure in uveitis patients, resulting in a good improvement in vision.
关键词： pseudophakia,Nd:YAG laser,posterior capsulotomy,complications,Uveitis
更新于2025-09-23 15:19:57
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Statement of the BVA, the DOG, and the RG on treatment of choroidal neovascularization in diseases other than neovascular age-related macular degeneration; Stellungnahme des BVA, der DOG und der RG zur Therapie chorioidaler Neovaskularisationen bei anderen Erkrankungen als der neovaskul?ren altersabh?ngigen Makuladegeneration (Englische Version);
摘要： Choroidal neovascularizations (CNV) occur not only in age-related macular degeneration (AMD), but also in numerous other macular and retinal disorders of varying etiology and, if left untreated, can cause irreversible visual loss. The diagnosis of CNV as well as the indication for treatment should be made in the same way as in neovascular AMD: On initial diagnosis: best-corrected visual acuity, fundus examination, optical coherence tomography (OCT), and fluorescein angiography. At follow-up: best-correct visual acuity, fundus examination, OCT, and, depending on findings, fluorescein angiography. Active CNV should be treated with intravitreal operative medication (IVOM) using vascular endothelial growth factor (VEGF) inhibitors if patients have visual acuity of at least 0.05 or if there is sufficient reason to assume that visual acuity could increase to over 0.05 under treatment. Underlying disorders can include, e.g., high myopia, angioid streaks, central serous chorioretinopathy, active and inactive uveitis of varying etiology, including retinochoroiditis, chorioretinitis, and choroiditis, eye injuries, retinal dystrophies, e.g., best disease and pattern dystrophies, idiopathic CNV, subretinal masses (osteomas, hamartomas, nevi). If CNV is not present as a complication in the above-mentioned disorders, IVOM with VEGF inhibitors should not be performed. Ranibizumab and aflibercept are approved in Germany for the treatment of CNV secondary to pathologic myopia. Ranibizumab has been approved in Germany since 12/2016 for the treatment of CNV in disorders other than neovascular AMD and pathologic myopia irrespective of the underlying disease. The other VEGF inhibitors, aflibercept and bevacizumab, can be used off-label. Due to its overall significantly poorer treatment results, photodynamic therapy (PDT) should only be used in exceptional cases and extrafoveal localization. After one initial intravitreal administration of VEGF inhibitors, further CNV activity should be monitored monthly for the first 6 months (see point 2). In the case of persisting or recurrent activity, repeated IVOM should be performed. Depending on disease course, the follow-up interval might be extended 6 months after the last IVOM. In individual justified cases (e.g., patients requiring frequent re-injections), a different treatment regimen (e.g., treat and extend) can be considered in the further course. If visual acuity drops below 0.05 on anti-VEGF treatment, or no further positive treatment outcome is expected (e.g., in the presence of atrophy and/or fibrosis), treatment should be discontinued, unless there is a clear possibility that visual acuity could increase again to over 0.05 under treatment. If no improvement is seen under therapy with a certain VEGF inhibitor, or if deterioration occurs, one can consider switching to an alternative VEGF inhibitor.
关键词： Choroidal neovascularization,Myopia,Retinal dystrophies,Ranibizumab,VEGF inhibitors,Uveitis,Idiopathic CNV,Central serous chorioretinopathy,Angioid streaks,Photodynamic therapy,Subretinal tumors,Aflibercept,Bevacizumab,Eye injuries
更新于2025-09-19 17:15:36
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Comparison of choroidal neovascularization secondary to white dot syndromes and age-related macular degeneration by using optical coherence tomography angiography
摘要： Purpose: To characterize and compare choroidal neovascularization (CNV) secondary to white dot syndromes (WDS) and age-related macular degeneration (AMD) using optical coherence tomography angiography (OCT-A). Methods: This is a cross-sectional study in which we imaged patients with CNV secondary to WDS and AMD with either the Zeiss Angioplex OCT-A or Optovue AngioVue OCT-A. Relevant demographic and clinical characteristics were collected and analyzed. CNV area and vessel density (VD) were measured by three independent graders, and linear regression analysis was subsequently performed. Results: Three patients with multifocal choroiditis and panuveitis, one patient each with birdshot chorioretinopathy, presumed ocular histoplasmosis syndrome, and persistent placoid maculopathy, and eleven patients with AMD with sufficient image quality were included. CNV associated with WDS was significantly smaller than that secondary to AMD (0.56±0.32 vs 2.79±1.80 mm2, β=-2.22, P=0.01), while no difference in VD was detected (0.46±0.09 vs 0.44±0.09, β=0.02, P=0.71). Conclusion: CNV networks secondary to WDS appear to be smaller than those secondary to AMD but have similar VD. OCT-A is a powerful tool to investigate properties of CNV from various etiologies. Larger studies are needed for further characterization and understanding of CNV pathogenesis in inflammatory conditions.
关键词： uveitis,age-related macular degeneration,inflammation,choroidal neovascularization,white dot syndromes,optical coherence tomography angiography,choroidal neovascular membrane
更新于2025-09-19 17:15:36
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Diode laser transscleral cyclophotocoagulation for uveitis-glaucoma-hyphema syndrome
摘要： Rationale: To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). Patient concerns: The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. Diagnoses: Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. Interventions: The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. Outcomes: BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. Lessons: UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.
关键词： acrylic single-piece intraocular lens,uveitis-glaucoma-hyphema (UGH) syndrome,diode laser transscleral cyclophotocoagulation,case report
更新于2025-09-19 17:13:59
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Anterior segment optical coherence tomography in acute anterior uveitis
摘要： Purpose: To analyze the corneal thickness and anterior chamber (AC) angle using anterior segment optical coherence tomography (AS-OCT) in patients with acute anterior uveitis (AAU). Methods: Twenty two patients (24 eyes) were included. All patients underwent complete ophthalmological examination, applanation tonometry and AS-OCT at diagnosis and fifteen days after treatment. Results: Average corneal thickness before treatment was 564.2 ± 44.2 μm, 580.0 ± 44.3 μm and 580.1 ± 2.9 μm, respectively in central, pericentral and paracentral cornea. Fifteen days after treatment a significant decrease of corneal thickness was observed, with 529.5 ± 33.1 μm (p=0.0091) and 542.6 ± 33.6 μm (p=0.0068), respectively in central and pericentral cornea; paracentral corneal thickness (557.8 ± 35.3 μm) thinning did not reach statistical significance (p=0.1253). There was no significant change in temporal AC angle between visits, 44.3 ± 14.4 degrees before treatment and 44.7 ± 14.7 degrees fifteen days after (p=0.9343), and mean intraocular pressure, 10.8 ± 4.5 mmHg before treatment and 12.3 ± 3.0 mmHg fifteen days after (p=0.1874). Conclusion: In the studied group, AS-OCT detected a decrease of corneal thickness after AAU treatment. Temporal AC angle and intraocular pressure did not change during the studied period.
关键词： Corneal pachymetry,Anterior eye segment,Inflammation,Tomography, optical coherence,Uveitis, anterior/diagnosis
更新于2025-09-10 09:29:36