Intravenous Immunoglobulin for Management of Non-paraneoplastic Autoimmune Retinopathy

Purpose: To report a case of non-paraneoplastic autoimmune retinopathy (npAIR) treated with intravenous immunoglobulin (IVIG). Case report: A 12-year-old boy presented with progressive visual field loss, nyctalopia, and flashing for three months. He had suffered from common cold two weeks before the onset of these symptoms. On the basis of clinical history and paraclinical findings, he was diagnosed with npAIR, and IVIG without immunosuppressive therapy was started. During the one-year follow-up period after the first course of IVIG, flashing disappeared completely. Visual acuity remained 10/10, but nyctalopia did not improve. Multimodal imaging showed no disease progression. Conclusion: Although established retinal degenerative changes seem irreversible in npAIR, IVIG may be a suitable choice to control the disease progression

Herpes Simplex Virus-Associated Anterior Uveitis: Clinical Characteristics, Diagnosis, and Current Aspects on Management

Herpes simplex virus (HSV)-associated anterior uveitis accounts for 5–10% of patients with anterior uveitis and 3–10% of all uveitis patients, and is the most frequent etiology of infectious anterior uveitis. It is chiefly an acute unilateral iritis involving middle-aged individuals with preponderance in females. The clinical features of HSV anterior uveitis may mimic other non-infectious and infectious anterior uveitis entities, particularly at the early stage of the disease. Confirmed prior HSV infection and the presence of characteristic ocular findings such as keratitis, high intraocular pressure, and sectoral or patchy iris atrophy suggest the diagnosis and help to differentiate this condition from other etiologies of anterior uveitis. New diagnostic techniques, including evaluation of intraocular fluids applying polymerase chain reaction for viral DNA and the Goldmann–Witmer coefficient for antibodies against the virus can confirm the diagnosis in cases with no specific signs of HSV anterior uveitis. Oral antivirals and topical corticosteroids have become the main standards for treatment

Torpedo Retinopathy or Chorioretinopathy?

This is a Letter to the Editor and does not have an abstract. Please download the PDF or view the article HTML

The First Reported Case of Ocular Syphilis in an Iranian Patient

Purpose: To report the first case of ocular syphilis in an Iranian patient and discuss its diagnostic challenges. Case Report: A man in his mid-70s presented with progressive bilateral visual and auditory decline. He had previously lived in a Southeast Asian country for 10 years. Prior steroid therapies entailed no inflammation subsidence. His visual acuity at presentation was light perception OU. Funduscopic findings included severe vitritis, severe optic atrophy, diffuse retinal vascular occlusion, and diffuse retinal atrophy OU. Angiography demonstrated diffuse areas of retinal and choriocapillaris atrophy with no active choroiditis. Scaly cutaneous lesions were noted on his palms and soles – atypical findings of secondary syphilis. Serum analysis revealed an underlying syphilis infection. The cerebrospinal fluid sample was reactive to anti-syphilis antibodies, securing a neurosyphilis diagnosis. Two weeks of antibiotic therapy resulted in cutaneous lesions resolution and relative visual improvement despite extensive baseline retinal atrophic damage. Conclusion: Ocular syphilis can mimic numerous ocular inflammatory scenarios. In cases of ocular inflammation that is unresponsive to steroids, reconsidering alternative diagnoses, especially infections with the highest clinical relevance, is necessary. We stress the importance of acquiring patients’ sexual history, regardless of cultural barriers and the rarity of the entity in some regions

Ocular toxoplasmosis presenting as subretinal macrocyst

Purpose: To report a case of unilateral retinal detachment with a large subretinal macrocyst, representing an atypical presentation of ocular toxoplasmosis. Case Report: A healthy 30-year-old woman presented with a two month history of progressive visual loss in her right eye. Funduscopy revealed vitreous condensations, total retinal detachment with a large subretinal orange-red cystic mass and multiple retinal breaks sealed with surrounding retinal scars. B-scan echography showed a large subretinal cyst with non-homogenous tissue echogenicity. Pars plana deep vitrectomy and complete cyst removal were performed. Histopathologic examination of the excised cyst revealed intraretinal toxoplasma cysts containing bradyzoites. Analysis of intraocular fluids by polymerase chain reaction (PCR) and serologic tests also supported the diagnosis. After six months, the retina was completely attached with no signs of inflammation. Conclusion: Toxoplasma retinochoroiditis should be considered in the differential diagnoses of retinal detachment with subretinal cyst

Additional file 1 of Polymerase chain reaction test for diagnosis of infectious uveitis

Supplementary Material

Comparison of loteprednol with fluorometholone after myopic photorefractive keratectomy

Purpose: To compare the efficacy and side effects of loteprednol versus fluorometholone after myopic photorefractive keratectomy (PRK). Methods: One hundred and twenty four eyes of 62 patients who underwent PRK were enrolled in this study. One eye of each subject was randomized to receive loteprednol 0.5% and the fellow eye was given fluorometholone 0.1%. Patients were followed up for three months. Results: There was no significant difference in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal haze, intraocular pressure (IOP), and ocular discomfort and redness between groups at the final visit. At 3 months postoperatively, 20/25 or better UDVA was achieved in 95% of the loteprednol group and 92% of the fluorometholone group (P > 0.05). There was neither visually significant corneal haze nor ocular hypertension (IOP rise > 10 mmHg or IOP > 21 mmHg) in any group. Conclusion: The efficacy and side effects of loteprednol 0.5% and fluorometholone 0.1% after myopic PRK are comparable

Choroidal structure investigated by choroidal vascularity index in patients with inherited retinal diseases

Abstract Purpose To evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI). Methods The present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients’ data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group. Results The IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P < 0.001). Accordingly, the average of TCA and LA were 2.32 ± 0.63 and 1.52 ± 0.44 mm [1] in patients with IRDs, respectively. The measurements for the TCA and the LA were significantly lower in all subtypes of IRD (P-values < 0.05). Conclusion CVI is significantly lower in patients with IRD than in healthy age-matched individuals. Choroidal changes in IRDs may be related to the changes in the lumen of the choroidal vessels rather than the stromal changes