PURPOSE: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. CASE SUMMARY: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. CONCLUSIONS: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.
Anti-Bacterial Agents ; Blood Cell Count ; Chemistry ; Chorioretinitis ; Dexamethasone ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Intravitreal Injections ; Middle Aged ; Polymerase Chain Reaction ; Prednisolone ; Retinitis ; Toxoplasma ; Toxoplasmosis ; Visual Acuity ; Vitrectomy

PURPOSE: This study sought to describe the different clinical features and presentations of primary ocular toxoplasmosis in a setting not demonstrating an outbreak of disease.METHODS: This was a retrospective review of patients presenting to uveitis management services in Auckland and Hamilton, New Zealand between 2003 to 2018 with uveitis and positive toxoplasmosis immunoglobulin M serology.RESULTS: We identified 16 patients with primary acquired toxoplasmosis infection and ocular involvement. The mean age was 53 years. Systemic symptoms were reported in 56% (9 / 16). Visual acuity was reduced to 20 / 30 or less in 50% of patients (8 / 16). A single focus of retinitis without a pigmented scar was the salient clinical feature in 69% (11 / 16). Optic nerve inflammation was the sole clinical finding in 19% (3 / 16). Bilateral arterial vasculitis was the sole clinical finding in 13% (2 / 16). A delay in the diagnosis of toxoplasmosis of more than two weeks occurred in 38% (6 / 16) due to an initial alternative diagnosis. Antibiotic therapy was prescribed in all cases. Vision was maintained or improved in 69% (11 / 16) at the most recent follow-up visit (15 months to 10 years). Relapse occurred in 69% (11 / 16), typically within four years from the initial presentation.CONCLUSIONS: Primary ocular toxoplasmosis presenting in adulthood is a relatively uncommon cause of posterior uveitis in New Zealand. This condition should be considered in any patient presenting with retinitis or optic nerve inflammation without a retinochoroidal scar. This disease tends to relapse; thus, close follow-up is required.
Cicatrix ; Diagnosis ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Inflammation ; New Zealand ; Optic Nerve ; Recurrence ; Retinitis ; Retrospective Studies ; Toxoplasmosis ; Toxoplasmosis, Ocular ; Uveitis ; Uveitis, Posterior ; Vasculitis ; Visual Acuity

OBJECTIVETo investigate optical coherence tomography (OCT) characteristics of tuberculous serpiginous-like choroiditis (Tb-SLC) and serpiginous choroiditis (SC) and to perform OCT to differentiate between these conditions.

METHODSThis retrospective, case-control study examined consecutively enrolled patients with active Tb-SLC or SC. Patients underwent comprehensive ocular examinations and imaging (OCT, color fundus photography, autofluorescence imaging, fluorescein angiography, and indocyanine green angiography). Findings were examined and compared between eyes with SC and Tb-SLC.

RESULTSNine patients with active Tb-SLC (14 eyes) and 8 with active SC (12 eyes) were included. The following OCT findings were observed significantly more often in the Tb-SLC group than in the SC group: vitreal hyper-reflective spots [5 Tb-SLC eyes (36%), no SC eyes; P = 0.02], intraretinal edema [11 Tb-SLC eyes (79%), 3 SC eyes (25%); P = 0.01], sub-retinal pigment epithelium (RPE) drusenoid deposits [11 Tb-SLC eyes (79%), 2 SC eyes (17%); P < 0.01], and choroidal granulomas [8 Tb-SLC eyes (57%), 2 SC eyes (17%); P = 0.03]. A hyporeflective, wedge-shaped band was observed more often in the SC group [5 Tb-SLC eyes (36%), 9 SC eyes (75%); P = 0.045] than in the Tb-SLC group. The incidence of other OCT signs did not differ between the groups and included outer nuclear layer hyper-reflection, outer retinal tabulation, and choriocapillaris point-like hyper-reflection.

CONCLUSIONVitreal hyper-reflective spots, intraretinal fluid, sub-RPE drusenoid deposits, and choroidal granulomas on OCT images may indicate Tb-SLC. Additionally, a hyporeflective, wedge-shaped band may indicate SC. Therefore, OCT is likely helpful in differentiating between Tb-SLC and SC.

Adult ; Case-Control Studies ; Choroiditis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Optical Coherence ; Tuberculosis, Ocular ; diagnostic imaging ; pathology

PURPOSE: The aim of this study was to evaluate the clinical characteristics of children diagnosed as cryopyrin-associated periodic syndrome (CAPS) in Korea. METHODS: Diagnosis was made based on clinical features and confirmed by a mutation in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene. Especially, osteocartilaginous overgrowth in the patella or distal femur was so characteristic that its presence warranted a diagnosis of chronic infantile neurologic cutaneous and articular/NOMID. RESULTS: We observed the clinical features of 9 Korean CAPS patients. All the patients suffered from an urticarial rash with recurrent fever. Among the 9 patients, 6 presented with rash and 4 with fever on the 1st or 2nd days of birth. Eight patients showed myalgia, and 7 patients showed arthralgia in the joints, and 6 patients showed radiologic findings of arthropathy including cupping of the metaphysis, excessive growth of the epiphysis, osteopenia or overgrowth of the cartilage. Four patients showed brain atrophy, enlarged ventricles or leptomeningeal enhancement on magnetic resonance imaging. Intellectual disability was observed in 1 patient. Five patients had eye involvement as conjunctivitis, uveitis, chorioretinitis, avascular area or papillary edema, and 3 patients showed progressive hearing loss. All 9 patients showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). CONCLUSIONS: All the patients carried a mutation on exon 3 of the CIAS1 gene. After the anakinra (interleukin-1 receptor antagonist) therapy, the fever and rash immediately disappeared, and CRP and ESR were improved.
Arthralgia ; Atrophy ; Blood Sedimentation ; Bone Diseases, Metabolic ; Brain ; C-Reactive Protein ; Cartilage ; Child ; Chorioretinitis ; Conjunctivitis ; Cryopyrin-Associated Periodic Syndromes ; Diagnosis ; Edema ; Epiphyses ; Exanthema ; Exons ; Femur ; Fever ; Hearing Loss ; Humans ; Intellectual Disability ; Interleukin 1 Receptor Antagonist Protein ; Joints ; Korea ; Magnetic Resonance Imaging ; Myalgia ; Parturition ; Patella ; Uveitis

PURPOSE: The purpose of this study is to make a distinction between tuberculous serpiginous-like choroiditis and serpiginous choroiditis, and compare their clinical manifestations. METHODS: We retrospectively reviewed thirty eight eyes of twenty-six patients who visited our institution and were diagnosed with serpiginous choroiditis from January 2005 to December 2014. The patients were divided into two groups, tuberculosis serpiginous- like choroiditis (Tb-SLC) and classic serpiginous choroiditis (classic SC), and were analyzed based on the treatment response, previous history of Bacillus Calmette–Guérin (BCG) vaccination, positive results of tuberculin skin test (TST), chest X-ray, anterior and fundus examination, and fluorescein angiography (FAG). RESULTS: Twenty seven eyes of eighteen patients were serpiginous choroiditis and eleven eyes of eight patients were tuberculosis serpiginous-like choroiditis. There were no significant differences in age, sex, or previous history of BCG vaccination between the two groups. The positive result of the tuberculin skin test and abnormality in the chest X-ray were shown to be significantly higher in the Tb-SLC group. Multi-focal lesions involving periphery observed in fundus examination and FAG were significantly higher in Tb-SLC. CONCLUSIONS: In tuberculosis endemic areas such as Korea, tuberculosis serpiginous-like choroiditis should be considered as a differential diagnosis when the patient is suspicious of serpiginous choroiditis. The understanding of various clinical manifestations of tuberculosis serpiginous-like choroiditis may derive accurate diagnosis and treatment, enhancing patient's prognosis.
Bacillus ; Choroid* ; Choroiditis* ; Diagnosis ; Diagnosis, Differential* ; Fluorescein Angiography ; Humans ; Korea ; Mycobacterium bovis ; Prognosis ; Retrospective Studies ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis* ; Vaccination

PURPOSE: To report the predisposing factors and surgical outcomes of intraocular lens dislocation (IOL) after phacoemulsification. METHODS: We performed a retrospective study of 131 eyes in 120 patients who were diagnosed with IOL dislocation after phacoemulsification between January 2008 and December 2013. The main outcomes are possible predisposing factors, characteristics of IOL dislocation, and outcomes of rectification surgery, including visual acuity (VA), and refractive status before and at 3 months after surgery. RESULTS: The main conditions associated with IOL dislocation were as follows: status after vitrectomy (27.5%), long axial length (9.2%), neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy (8.4%), uveitis (6.1%), trauma (5.3%), mature cataract (3.8%), and pseudoexfoliation (2.3%). Mean uncorrected VA improved significantly after rectification surgery (p = 0.00), and best-corrected VA also improved significantly (p = 0.01). Mean value of spherical equivalent tended to decrease, although the decrease was not significant (p = 0.07). Whereas astigmatism showed a significant increase (p = 0.01). 6 eyes (4.6%) were associated with recurrence of IOL dislocation. CONCLUSIONS: Possible major predisposing factors for IOL dislocation are status after vitrectomy, long axial length, Nd:YAG posterior capsulotomy, uveitis, and trauma. The surgical outcome and improvement of postoperative visual acuity were satisfactory.
Astigmatism ; Cataract ; Causality* ; Dislocations* ; Humans ; Lenses, Intraocular* ; Phacoemulsification* ; Posterior Capsulotomy ; Recurrence ; Retrospective Studies ; Uveitis ; Visual Acuity ; Vitrectomy ; Yttrium

PURPOSE: To report a case of macular hole secondary to presumptive infectious posterior uveitis involving the fovea that spontaneously resolved after medical treatment. CASE SUMMARY: A 33-year-old male visited our clinic for decreased visual acuity in his left eye. He was treated with immunosuppressive therapy including steroid after bone marrow transplantation. Best corrected visual acuity (BCVA) was 0.05 in the left eye. Slit lamp examination showed mild anterior vitritis, and fundus examination showed a macular hole with surrounding whitish infiltration at the fovea. Spectral domain optical coherence tomography (SD-OCT) revealed a full thickness macular hole with surrounding hyper-reflective masses with an infiltration-like appearance involving all retinal layers. Serum anti-toxocara IgG was positive (ELISA), and eosinophil count and immunoglobulin E was elevated. Under diagnosis of presumptive ocular toxocariasis, the patient was treated with albendazole. After medical treatment for toxocariasis, the whitish foveal infiltration became smaller and more discrete. SD-OCT revealed spontaneous closure of the macular hole, and BCVA was improved to 0.4 after a 4-month follow-up. CONCLUSIONS: We report a macular hole complicated by presumptive infectious posterior uveitis that experienced spontaneous closure after medical treatment for underlying infection.
Adult ; Albendazole ; Bone Marrow Transplantation ; Diagnosis ; Eosinophils ; Follow-Up Studies ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Male ; Retinal Perforations* ; Retinaldehyde ; Tomography, Optical Coherence ; Toxocariasis ; Uveitis, Posterior* ; Visual Acuity

PURPOSE: To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. METHODS: A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. RESULTS: The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. CONCLUSIONS: Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.
Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; HIV ; Humans ; Inflammation ; Keratitis ; Medical Records ; Optic Neuritis ; Panuveitis ; Penicillins ; Retrospective Studies ; Serologic Tests ; Syphilis* ; Tomography, Optical Coherence ; Uveitis ; Uveitis, Intermediate ; Uveitis, Posterior ; Vision Disorders ; Visual Acuity

PURPOSE: To report a patient with ocular syphilis, who showed variable ocular manifestations, including optic neuritis and chorioretinitis in both eyes over a short time period. CASE SUMMARY: A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. The fundus of the left eye showed a slightly hyperemic optic disc and multiple yellowish deposits. One week later, visual acuity and fundus lesion improved to 20/20 without a definitive treatment. However, 1 month later, he reported a new deterioration of vision in his right eye to 20/40. The right eye had a relative afferent pupillary defect and the fundus examination showed a blurred optic disc margin. Serological work-up was recommended but the patient refused. He returned 3 weeks later with an improvement in the right eye vision (20/25) and a worsening in the left eye (20/200). The examination revealed an improvement of the previously blurred disc margin in the right eye and newly developed chorioretinitis with vasculitis in the left eye. A serological test was performed. The venereal diseases research laboratory titer was 1:32. The fluorescent treponemal antigen absorbance test as positive for IgG and IgM. He was diagnosed with ocular syphilis and referred to the infectious disease department. He was treated with antibiotics. Six months later, the visual acuity was 20/20 in both eyes and the previous fundus lesions had disappeared. CONCLUSIONS: Ocular syphilis should be considered in patients with atypical and variable clinical course.
Anti-Bacterial Agents ; Chorioretinitis* ; Communicable Diseases ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Optic Neuritis* ; Pupil Disorders ; Scotoma ; Serologic Tests ; Sexually Transmitted Diseases ; Syphilis* ; Vasculitis ; Visual Acuity

A case of a female patient with local and systemic complications of metallosis, following catastrophic wear of a revised hip arthroplasty, is presented. The patient had a history of a fractured ceramic-on-ceramic implant, exchanged with a metal-on-polyethylene prosthesis. Systemic complications included sarcoidosis-like reactions, presenting as granulomatous lung disease, along with chorioretinitis, erythema nodosum, and cardiomyopathy. High local and circulating cobalt and chromium levels established the diagnosis. The patient underwent extensive debridement and implant revision. One year postoperatively, she had no respiratory symptoms or functional impairment. Local and systemic complications of metallosis after hip arthroplasty should be promptly recognized and treated operatively.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Cardiomyopathies ; Ceramics ; Chorioretinitis ; Chromium ; Cobalt ; Debridement ; Diagnosis ; Erythema Nodosum ; Female ; Hip* ; Humans ; Lung Diseases* ; Lung* ; Prostheses and Implants ; Reoperation ; Sarcoidosis, Pulmonary