Buckinghamshire Healthcare NHS Trust is an NHS trust which runs Wycombe Hospital, Stoke Mandeville Hospital, Amersham Hospital, Buckingham Community Hospital and Thame Community Hospital, in Buckinghamshire, England.
Background Osteochondral lesions of the talus (OLTs) present with variable severity that may relate to lower-limb biomechanics. No composite radiographic tool currently exists to quantify this relationship. This study developed and preliminarily evaluated the Composite Deformity Score (CDS), a five-parameter radiographic index associated with OLT severity, with stratification by lesion location. Methods A prospective cohort of 80 patients with MRI-confirmed OLTs was enrolled (June 2024–June 2025). CDS was derived from five weight-bearing radiographic parameters (LDTA, HAD, MAD, Meary’s angle, and calcaneal pitch), each scored 0–2 and summed. Binary logistic regression assessed the association between CDS and large lesions (> 2 cm²) after adjustment for BMI. Reliability was evaluated using intraclass correlation coefficients (ICC), and subgroup analysis was performed across Raikin lesion zones. Results CDS demonstrated excellent reliability (interobserver ICC = 0.91; intraobserver ICC = 0.92–0.93) and correlated strongly with lesion size (r = 0.74, p < 0.001). Significant differences were observed across lesion locations (p < 0.001), with medial lesions showing the highest CDS (5.4 ± 0.7) and largest lesion burden, while lateral lesions showed the lowest CDS (3.0 ± 1.2). In adjusted analysis, CDS remained independently associated with large OLTs (OR 3.04, 95% CI 1.71–5.40, p < 0.001; AUROC = 0.87). CDS also correlated inversely with AOFAS score (r = − 0.70, p < 0.001). A cutoff of CDS > 6 yielded 81% sensitivity and 84% specificity. Conclusion CDS is a reproducible radiographic scoring tool significantly associated with OLT severity. Its location-specific patterns support biological plausibility and warrant multicenter validation before clinical application.
Purpose To describe a case of posterior scleritis with secondary uveal effusion in which treatment of the underlying inflammatory process unmasked a coexisting peripapillary pachychoroid syndrome (PPS). Methods Report of a 71-year-old patient presenting with decreased visual acuity (20/100) and periocular pain in the right eye (OD). Examination included best-corrected visual acuity (BCVA), slit-lamp and dilated fundus examination, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and contrast-enhanced orbital magnetic resonance imaging (MRI). Laboratory testing was performed. High-dose intravenous methylprednisolone was followed by an oral taper, as well as systemic immunosuppression with subcutaneous methotrexate. Results At presentation, OD showed disc edema, macular serous detachment, and four-quadrant choroidal detachments; the left eye (OS) was asymptomatic with the exception of choroidal folds. MRI demonstrated posterior scleral enhancement and confirmed choroidal detachments. FA showed mottled hyperfluorescence without vasculitis; ICGA showed no choriocapillaritis or stromal granulomas. Following intravenous corticosteroids there was symptomatic improvement, BCVA increased to 20/32, and choroidal detachments resolved. Three weeks later, despite resolution of subretinal fluid, bilateral peripapillary intraretinal fluid/schisis developed. Considering short, hyperopic ocular anatomy, choroidal folds, peripapillary thickening, and steroid exposure, PPS within the pachychoroid spectrum was considered. Gradual corticosteroid de-escalation led to bilateral fluid resolution and final BCVA of 20/25 OD 20/20 OS. Conclusion Posterior scleritis may coexist with PPS, and treatment with corticosteroids may worsen pachychoroid syndrome. Multimodal imaging plays a critical role in distinguishing posterior scleritis from granulomatous choroiditis and is essential in leading to a prompt diagnosis and treatment.
