7,8,9 In addition, HRDs show rapid resolution and reduction in the number following therapies such as antivascular growth factor agents (anti-VEGF) and corticosteroids, which is inconsistent with ...intraretinal lipid. 5 in 2007 observed punctate areas of intense reflectivity (which today we recognize as HRDs) more frequently with chronic CSC compared with acute cases. Since there are very few articles in the literature that describe HRDs in CSC,5,12,13 it is not clear whether the pathogenesis of HRDs in CSC is similar to AMD, DME, and RVO, among other conditions. ...questions still remain – are HRDs formed as a result of inflammation across the entire spectrum of retinal pathologies ranging from AMD, to DME, and CSC? ...far, we do not have data from cytokine or interleukin analysis from intraocular fluids in eyes with HRD to demonstrate higher levels of proinflammatory mediators compared with control subjects (with no or few HRDs).
In order to determine these pathological manifestations, it is imperative to perform good quality imaging using fluorescein as well as indocyanine green angiography, ultrasonography, optical ...coherence tomography (especially enhanced-depth imaging), and other such tools. 6 Another interesting aspect of tubercular posterior scleritis is the high rate of positive test results for detection and isolation of acid-fast bacilli albeit from a remote tissue (such as cervical and mediastinal lymph nodes) (one case had positive acid-fast bacilli from an enucleated sample). ...3 out of 5 cases had tissues amenable to biopsy and histopathology and all of them demonstrated mycobacteria conclusively. A learning message from this analysis is that in patients with posterior scleritis with high suspicion of tuberculosis, an aggressive search for acid fast bacilli, or mycobacterial DNA using nucleic acid amplification techniques could prevent misdiagnosis and help in timely initiation of ATT.
Abstract The choroid is a highly vascular structure; therefore, a wide range of systemic conditions can affect it. Conversely, choroid health may also give us insight into systemic health. With the ...emergence of optical coherence tomography, there has been a surge in the research on choroidal thickness and factors affecting it. Studies regarding the effect of systemic health on the choroid have largely been in the form of cross-sectional, prospective, and case studies. We offer a summary of recent findings on the topic.
Measurement of choroidal thickness at the location of a lesion may have more relevance rather than measuring it at the subfoveal region, especially in pathologies that predominantly result in focal ...choroidal change, such as toxoplasmosis. ...if the disease is focal, one must bear in mind the normal choroidal topographical variations mentioned previously. ...diseases of the pachychoroid spectrum (such as central serous chorioretinopathy), Vogt–Koyanagi–Harada's disease, birdshot chorioretinopathy, among others, result in diffuse thickening of the choroid. ...as a clinician, when applying the results of studies on choroidal thickness for our patients in our clinics, it is imperative to consider the nature of the disease being dealt with and its biological behavior. By combining various factors such as choroidal thickness, volume, reflectivity, CVI, and other aforementioned features, a composite choroidal evaluation may be available in the future, greatly impacting our understanding of disease pathology and improving patient outcomes.
This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome ...coronavirus 2 (SARS-CoV-2).
A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible.
A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients.
The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.
To develop and evaluate a fully automated pipeline that analyzes color fundus images in patients with tubercular serpiginous-like choroiditis (TB SLC) for prediction of paradoxical worsening (PW). In ...this retrospective study, patients with TB SLC with a follow-up of 9 months after initiation of anti-tubercular therapy were included. A fully automated custom-designed pipeline was developed which was initially tested using 12 baseline color fundus photographs for assessment of repeatability. After confirming reliability using Bland-Altman plots and intraclass correlation coefficient (ICC), the pipeline was deployed for all patients. The images were preprocessed to exclude the optic nerve from the fundus photo using a single-shot trainable WEKA segmentation algorithm. Two automatic thresholding algorithms were applied, and quantitative metrics were generated. These metrics were compared between PW + and PW- groups using non-parametric tests. A logistic regression model was used to predict probability of PW for assessing binary classification performance and receiver operator curves were generated to choose a sensitivity-optimized threshold. The study included 139 patients (139 eyes; 92 males and 47 females; mean age: 44.8 ± 11.3 years) with TB SLC. Pilot analysis of 12 images showed an excellent ICC for measuring the mean area, intensity, and integrated pixel intensity (all ICC > 0.89). The PW + group had significantly higher mean lesion area (p = 0.0152), mean pixel intensity (p = 0.0181), and integrated pixel intensity (p < 0.0001) compared to the PW- group. Using a sensitivity optimized threshold cut-off for mean pixel intensity, an area under the curve of 0.87 was achieved (sensitivity: 96.80% and specificity: 72.09%). Automated calculation of lesion metrics such as mean pixel intensity and segmented area in TB SLC is a novel approach with good repeatability in predicting PW during the follow-up.
The choroidal vascularity index (CVI) is a relatively new parameter, calculated off optical coherence tomography (OCT) images, for the quantitative evaluation of choroid vascularity. It is defined as ...the ratio of vascular area to the total choroidal area, presented as a percentage. The choroid is an important vascular bed, often implicated in ocular and systemic conditions. Since the introduction of CVI, multiple studies have evaluated its efficacy as a tool for disease prognostication and monitoring progression, with promising results. The CVI was born out of the need for more robust and accurate evaluations of choroidal vasculature, as prior parameters such as choroidal thickness and choroidal vessel diameter had their limitations. In this review, we summarise current literature on the CVI, explain how the CVI is derived and explore its potential integration into future research and translation into clinical care. This includes the application of CVI in various disease states, and ongoing attempts to produce an automated algorithm which can calculate CVI from OCT images.
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