@article {1586, title = {Association Between Baseline Macular Morphologic Features on Optical Coherence Tomography and Visual Outcomes in Patients with Vogt-Koyanagi-Harada Disease.}, journal = {Ocul Immunol Inflamm}, volume = {33}, year = {2025}, month = {2025 Feb}, pages = {263-270}, abstract = {

PURPOSE: The choroidal thickening and serous retinal detachments that characterize Vogt-Koyanagi-Harada (VKH) disease can be imaged in detail using spectral domain optical coherence tomography (SD-OCT). Whether specific qualitative and quantitative SD-OCT features at presentation were associated with visual outcomes in a randomized controlled trial comparing methotrexate to mycophenolate for steroid-sparing control of uveitis were evaluated.

METHODS: An exploratory subanalysis of data from the FAST trial in which SD-OCT images from VKH participants were analyzed for presence/absence of bacillary detachments, retinal pigment epithelium (RPE) folds, and internal limiting membrane (ILM) fluctuations was performed. A modified RPE undulation index was calculated to provide a quantifiable surrogate marker for choroidal folds.

RESULTS: SD-OCT images were available from 158 eyes with VKH. At baseline, bacillary detachments were present in 23.5\% of eyes, RPE folds in 22.8\% of eyes, and ILM fluctuations in 35.2\% of eyes. For each 0.1 unit increase in modified RPE undulation index, there was an associated 0.13 increase in mean logMAR BSCVA at baseline. None of the SD-OCT features were associated with BSCVA at the 6-month primary endpoint. Indeed, mean final BSCVA was similar in those with and without the SD-OCT features of interest at baseline, and was between 0.1 and 0.2 logMAR (Snellen visual acuity 20/25 to 20/30).

CONCLUSIONS: While eyes with VKH may present with a variety of SD-OCT imaging pathology prior to starting immunosuppression with methotrexate or mycophenolate mofetil, final visual outcome in our study was excellent. With appropriate immunosuppression, good visual outcomes are possible in VKH.ClinicalTrials.gov Identifier NCT01829295Date of Registration: April 11, 2013.

}, keywords = {Adult, Female, Fluorescein Angiography, Humans, Immunosuppressive Agents, Macula Lutea, Male, Methotrexate, Middle Aged, Mycophenolic Acid, Retinal Detachment, Retinal Pigment Epithelium, Tomography, Optical Coherence, Uveomeningoencephalitic Syndrome, Visual Acuity}, issn = {1744-5078}, doi = {10.1080/09273948.2024.2391420}, author = {Sundararajan, Miel and Rathinam, Sivakumar R and Thundikandy, Radhika and Kanakath, Anuradha and Balamurugan, S and Vedhanayaki, R and Miller, D Claire and Lim, Lyndell L and Suhler, Eric B and Al-Dhibi, Hassan A and Arellanes-Garcia, Lourdes and Reddy, Amit K and Feng, Shu and Doan, Thuy and Porco, Travis C and Shantha, Jessica G and Acharya, Nisha R and Gonzales, John A} } @article {976, title = {Detection of Leptospirosis Genome from the Aqueous Humor of a Patient with Bilateral Uveitis.}, journal = {Ocul Immunol Inflamm}, year = {2022}, month = {2022 Apr 29}, pages = {1-3}, abstract = {

BACKGROUND: Leptospira species are difficult to culture. Thus, when there is suspicion for an infectious etiology to uveitis, bacterial cultures may fail to identify Leptospira. We describe a case of leptospirosis-associated uveitis that evaded culture and molecular assays. DNA sequencing of the aqueous fluid showed the presence of Leptospira spp.

METHODS: Retrospective case review of clinical and laboratory features of a patient with ocular leptospirosis is presented.

RESULTS: DNA sequencing identified the genome of Leptospirosis spp. in the aqueous humor.

CONCLUSION: Metagenomic sequencing, by virtue of its unbiased nature, can be a helpful adjunctive test when a strong clinical suspicion for intraocular infection persists despite negative routine culture and molecular assays.

}, issn = {1744-5078}, doi = {10.1080/09273948.2022.2067779}, author = {Gonzales, John A and Sundararajan, Miel and Qian, Ying and Hwang, Thomas and Doan, Thuy} } @article {871, title = {Changes to ophthalmic clinical care during the coronavirus disease 2019 pandemic.}, journal = {Curr Opin Ophthalmol}, year = {2021}, month = {2021 Aug 26}, abstract = {

PURPOSE OF REVIEW: Given the impact that society as a whole, and medicine specifically, has experienced as a result of the COVID-19 pandemic, an examination of clinical care changes enacted in the field of ophthalmology is of interest to the specialty.

RECENT FINDINGS: In order to adapt to the reality of the COVID-19 pandemic, measures, such as broadening telehealth capabilities, adopting universal masking, careful sanitation procedures, applying virtual teaching in academic environments, and deferring elective surgeries were put in place. These were aimed at reducing person-to-person spread of SARS-CoV-2. Though best efforts were made at triaging ophthalmic emergencies during these times, unfortunate delays in care were observed in some circumstances. Finally, a prospective study interrogating the risk of spread at slit lamp distances for short periods of time was encouraging, suggesting low risk of transmissibility, though limited by a small case-positive sample size.

SUMMARY: Significant changes have been made in the design and delivery of ophthalmic care during the COVID-19 pandemic. Some of these, such as telemedicine, may provide value in a postpandemic world.

}, issn = {1531-7021}, doi = {10.1097/ICU.0000000000000797}, author = {Sundararajan, Miel and Schallhorn, Julie M and Doan, Thuy and Seitzman, Gerami D} }