Subretinal Fluid in Eyes with Active Ocular Toxoplasmosis Observed Using Spectral Domain Optical Coherence Tomography

Purpose To describe the clinical finding of subretinal fluid (SRF) in the posterior pole by spectral domain optical coherence tomography (SD-OCT) in eyes with active ocular toxoplasmosis (OT). Design Retrospective case series. Participants Thirty-eight eyes from 39 patients with active OT. Methods Eyes with active OT which underwent SD-OCT were reviewed. SRFs in the posterior pole were further analyzed. Main Outcome Measures Presence of SRF; its accompanying features, e.g. retinal necrosis, cystoid macular edema (CME), choroidal neovascularization (CNV); and longitudinal changes of SRF, including maximum height and total volume before and after treatment. Results SRF presented in 45.5% (or 15/33) of eyes with typical active OT and in 51.3% (or 20/39) of eyes with active OT. The mean maximum height and total volume of SRF were 161.0 (range: 23–478) µm and 0.47 (range: 0.005–4.12) mm3, respectively. For 12 eyes with SRF related to active retinal necrosis, SRF was observed with complete absorption after conventional anti-toxoplasmosis treatment. The mean duration for observation of SRF clearance was 33.8 (range: 7–84) days. The mean rate of SRF clearance was 0.0128 (range: 0.0002–0.0665) mm3/day. Conclusions SRF (i.e., serous retinal detachment) is a common feature in patients with active OT when SD-OCT is performed. The majority of SRF was associated with retinal necrosis and reacted well to conventional therapy, regardless of total fluid volume. However, SRF accompanying with CME or CNV responded less favorably or remained refractory to conventional or combined intravitreal treatment, even when the SRF was small in size

Treatment in Latent Tuberculosis Uveitis—Is Immunosuppression Effective or Is Conventional 3- or 4-Drug Antituberculosis Therapy Mandatory?

Background/Aims: Controversy exists regarding 3- or 4 drug antituberculosis therapy (conventional ATT) in uveitis patients having latent tuberculosis (LTB), especially while initiating therapy with corticosteroids and/or other immunosuppressants. Methods: We performed a monocentral retrospective analysis of posterior uveitis patients with latent TB. Latent TB was diagnosed, in case of a positive QuantiFERON®-TB-Gold test and normal chest imaging, after ruling out other causes of infectious and noninfectious uveitis. Patients with active TB were excluded. From 2016 to 2020 we included 17 patients. Ophthalmological evaluation consisted of Best corrected visual acuity (BCVA), slit lamp examination, fundoscopy, OCT, and fluorescein- and indocyaningreen- angiography before and at months 3, 6, 12, 24, and the last follow-up after treatment. Results: Initially, all patients had active posterior uveitis with occlusive (n = 5 patients) and nonocclusive retinal vasculitis (n = 12 patients). Mean follow up was 28 ± 15 months. Therapy was started with systemic corticosteroids (mean prednisolone equivalent 71.3 mg/d) and already after 3 months it could be tapered to a mean maintenance dosage of 8.63 mg/d. Additional immunosuppressive treatment with cs- or bDMARDs was initiated in 14 patients (82%) due to recurrences of uveitis while tapering the corticosteroids <10 mg per/day or because of severe inflammation at the initial visit. While being on immunosuppression, best corrected visual acuity increased from 0.56 logMAR to 0.32 logMAR during follow-up and only three patients had one uveitis relapse, which was followed by switch of immunosuppressive treatment. As recommended, TB prophylaxis with 300 mg/d isoniazid was administered in 11 patients for at least 9 months while being on TNF-alpha-blocking agents. No patient developed active tuberculosis during immunosuppressive therapy. Conclusion: Mainly conventional ATT is strongly recommended—as monotherapy or in combination with immunosuppressives—for effective treatment in patients with uveitis due to latent TB. Although in our patient group no conventional ATT was initiated, immunosuppression alone occurred as an efficient treatment. Nevertheless, due to possible activation of TB, isoniazid prophylaxis is mandatory in latent TB patients while being on TNF-alpha blocking agents

Multimodal Imaging in Birdshot Retinochoroiditis

<p><i>Purpose:</i> To describe retinal vascular changes in Birdshot Retinochoroiditis (BSRC) with multimodal imaging techniques and functional values.</p> <p><i>Methods:</i> In this single-center study, 64 eyes of 32 subjects with BSRC were classified according to disease activity and duration and underwent imaging with spectral domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography angiography (OCTA).</p> <p><i>Results:</i> Mean age of the patients was 60 years (range, 38–74). OCTA revealed capillary loops (58%), telangiectatic vessels (44%), increased intercapillary spaces (52%), altered vascular architecture (53%), and rarefication of C-scans (63%) in retinal layers. Increased rarefications of C-scans (<i>p</i> = 0.0056; <i>p</i> = 0.0046) and altered vascular architecture (<i>p</i> = 0.0120; <i>p</i> = 0.0243) in superficial and deep capillary layers were significantly correlated with disease activity.</p> <p><i>Conclusion:</i> OCTA adds new insights in a multimodal imaging approach of retinal vascular layer visualization in BSRC and may contribute to existing methods for diagnosing severity and potentially progression of the disease.</p

Evaluation of cystoid change phenotypes in ocular toxoplasmosis using optical coherence tomography.

PURPOSE: To present unique cystoid changes occurring in patients with ocular toxoplasmosis observed in spectral domain optical coherence tomography (OCT). METHODS: Forty-six patients (80 eyes) with a diagnosis of ocular toxoplasmosis, who underwent volume OCT examination between January 2005 and October 2012, were retrospectively collected. Review of clinical examination findings, fundus photographs, fluorescein angiograms (FA) and OCT image sets obtained at initial visits and follow-up. Qualitative and quantitative analyses of cystoid space phenotypes visualized using OCT. RESULTS: Of the 80 eyes included, 17 eyes (15 patients) demonstrated cystoid changes in the macula on OCT. Six eyes (7.5%) had cystoid macular edema (CME), 2 eyes (2.5%) had huge outer retinal cystoid space (HORC), 12 eyes (15%) had cystoid degeneration and additional 3 eyes (3.75%) had outer retinal tubulation due to age related macular degeneration. In one eye with HORC, the lesion was seen in the photoreceptor outer segment, accompanied by photoreceptor elongation and splitting. Three eyes presented with paravascular cystoid degeneration in the inner retina without other macular OCT abnormality. CONCLUSIONS: In this study, different phenotypes of cystoid spaces seen in eyes with ocular toxoplasmosis using spectral domain OCT (SD-OCT) were demonstrated. CME presented as an uncommon feature, consistently with previous findings. Identification of rare morphological cystoid features (HORC with/without photoreceptor enlongation or splitting) on clinical examination had provided evidence to previous experimental models, which may also expand the clinical spectrum of the disease. Cystoid degeneration in the inner retina next to the retinal vessels in otherwise "normal" looking macula was observed, which may suggest more often clinical evaluation for those patients. Further studies are needed to verify the relevance of cystoid features seen on SD-OCT in assisting with the diagnosis and management of ocular toxoplasmosis

Interferon alpha 2a in IRPB-derived peptide-induced EAU--part I

Clinically, the IFN-&alpha; treated animals exhibited minimal disease, compared to the control group. These findings have been histologically confirmed. Using a variety of monoclonal antibodies, we were not able to demonstrate any differences for panCD44 expression. The similar expression pattern of panCD44 in the retina between control and IFN-&alpha; treated mice indicates that this expression may be not influenced by the applied IFN-&alpha; dosage. The panCD44 homing receptor may be important for the regulation of EAU induction by CD45+ and CD3+ T-cells. Differences have been observed for CD45+ infiltration between control and IFN-&alpha; treated animals. This may be an important hint to characterize their function by markers others than CD8 and CD4 specific antibodies, especially for their T-cell receptor (TCR) expression (&alpha;/&beta; versus &gamma;/&delta;). To identify further differences between IFN-&alpha; treated and control mice our analyses will be extended to antigen presenting cells (APC), especially to dendritic cells (DC) capable to regulate the Th1/Th2 balance. Additionally, these analyses will be extended to cell adhesion molecules and/or homing receptor expression kinetics regulated by chemo-and cytokines. EAU induction experiments are presently performed with an increased IFN-&alpha; dosage correlating with the surface (m2) of human beings to clarify our results

General Characteristics of Patients with Active Ocular Toxoplasmosis.

<p><b>†</b>Central subfield is defined as the subfield in the center of an ETDRS (early treatment diabetic retinopathy study) grid.</p><p>OT = ocular toxoplasmosis; OD = right eye; OS = left eye; VA = visual acuity; d = days; m = months; NA = not available; ONH = optic nerve head, CME = cystoid macular edema; CNV = choroidal neovascularization; SRF = subretinal fluid.</p><p>General Characteristics of Patients with Active Ocular Toxoplasmosis.</p

Case example of huge outer retinal cystoid space (CS) as seen on optical coherence tomography (OCT) in a patient with ocular toxoplasmosis.

<p>Two days after initial presentation [<b>A–N</b>] and at subsequent follow-ups [<b>P–Q</b>] (note: [<b>d–f</b>] is the magnified view of [<b>D–F</b>]). The OCT scans were taken within a 20°×15° (5.8×4.4 mm) area. Distance between adjacent B-scans (B-scans B, C, D, E, G are adjacent; H, I, J are adjacent) was 243 µm. Two days after initial presentation, a membranous structure is seen on OCT. One part of this structure is seen lying over the retinal pigment epithelium (RPE) and forming the floor of the huge outer retinal CS (HORC) [<b>B–E, G</b>], while another part is separated from the RPE by an accumulation of subretinal fluid (SRF) [<b>H–J</b>]. The line representing the external limiting membrane (ELM) is distinct in the area unaffected by HORC; however, it is continuous with the upper border of the highly reflective membranous structure in the area affected by HORC [<b>D–F, d–f</b>]. The photoreceptor inner segment/outer segment junction (IS/OS junction) is distinct in the area unaffected by HORC, becoming less distinct in the area with overlying HORC. Photoreceptor IS/OS disruption and outer segment (OS) irregularity is also observed [<b>E, G–J, e–f</b>]. The retinal thickness map [<b>L</b>], mean HORC height map [<b>M</b>], and the mean maximum SRF height map [<b>N</b>], are shown for the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. The presumed interpretation of the structural changes are also shown (the outer retina is the area between the black arrows) [<b>K</b>]. OCT images obtained 15 days later demonstrate that the HORC is no longer present [<b>O</b>]. Punctate hyperreflective foci are seen in the posterior vitreous overlying this area. The ELM is almost completely distinct in all B-scans. In contrast, the photoreceptor IS/OS junction is still not fully distinct. Irregularity of the PR and outer nuclear layer (ONL) presenting as local hyperreflective foci is seen at the previous junction of the HORCs with the normal retina. This feature persists at subsequent visits [<b>P–Q</b>]. A hyporeflective space between the ELM or presumed IS/OS and inner boundary of the RPE is observed subfoveally, with possible hyperreflective material above RPE. Subsequent OCT images were obtained approximately one month [<b>P</b>] and two months [<b>Q</b>] following initial presentation. No HORC or SRF is seen at these points. The photoreceptor IS/OS junction is more clearly seen, with a thickness value of 68 µm [<b>Q</b>].</p

Subretinal fluid (SRF) in eyes with typical active ocular toxoplasmosis associated with retinal necrosis in the macula as seen on optical coherence tomography (OCT) (Patients 1–8, Table 1).

<p><b>Parts A1-H1</b>: fundus photos (FP) or infrared (IR) images of the macula overlying with early treatment diabetic retinopathy study (ETDRS) grid, for eyes with active OT. Red arrows in each eye indicated areas with active retinitis. <b>Parts A2-H2:</b> mean retinal thickness maps shown in the ETDRS grid corresponding to the overlapped grid in Figure A1-H1. <b>Parts A3-H3:</b> maps of mean SRF height shown in ETDRS grid corresponding to the overlapped grid in Figure A1-H1. 1 = superior outer macula; 2 = temporal outer macula; 3 = inferior outer macula; 4 = nasal outer macula; 5 = superior inner macula; 6 = temporal inner macula; 7 = inferior inner macula; 8 = nasal inner macula; 9 = central subfield.</p