Intraocular lens (IOL) calcification is a rare but recognized postoperative complication, particularly affecting hydrophilic IOLs. We report a case of a 19-year-old male with a history of juvenile idiopathic arthritis (JIA) and chronic anterior uveitis who presented with distinctive cartwheel-like opacities on the anterior IOL surface. Nd:YAG capsulotomy was attempted but did not improve optical clarity. Given the preserved visual acuity (20/40) and stable intraocular inflammation, conservative management with close observation was pursued rather than IOL exchange. This case illustrates secondary calcification as the likely mechanism, attributable to chronic ocular inflammation, and emphasizes the challenges in management where intervention may exacerbate uveitic sequelae.

A 15-month-old boy presented with congenital bilateral pedal edema, microcephaly, dysmorphic features, and characteristic chorioretinal lacunae on fundus examination. Whole exome sequencing revealed a de novo heterozygous deletion in the Kinesin Family Member-11 gene, confirmed by cDNA analysis. A diagnosis of microcephaly with or without chorioretinopathy, lymphedema, and mental retardation (MCLMR) syndrome was made based on syndromic presentation and genetic analysis. This case highlights the diagnostic value of genetic testing in children with chorioretinal atrophy and syndromic features for early recognition of MCLMR syndrome to enable multidisciplinary care.

Purpose: To evaluate the performance of Large Language Models (LLMs) on optometry examination questions and compare their accuracy and readability with Bachelor of Optometry students. Methods: A cross-sectional comparative study was conducted using the publicly available, free versions of five LLM models from four platforms (ChatGPT 3.5, ChatGPT 4o, Gemini, CoPilot, and DeepSeek) and a group of 15 third- and fourth-year optometry students. Two sets of multiple-choice questions (20 theoretical and 20 clinical) were administered to both the students and the LLMs. Theoretical questions covered core optometric knowledge, while clinical questions simulated real-life patient scenarios. Responses were graded by senior ophthalmologists for accuracy, and readability was assessed via readable.com using four indices, including Flesch–Kincaid Grade Level, Flesch Reading Ease Score, Coleman Liau Score, and Simple Measure of Gobbledygook (SMOG) Index. Results: The overall scores of the optometry students (28.13 ± 3.33) were comparable to those of the LLMs (29 ± 4.41). In theoretical questions, LLMs (15.40 ± 1.82) performed at par with the students (14.07 ± 2.21), with DeepSeek and CoPilot outperforming students (scoring 17 each). However, in clinical questions, the students performed better, highlighting the limitations of LLMs in context-specific reasoning. Pairwise comparisons of the readability analysis revealed that Gemini and DeepSeek provided significantly most readable explanations, while ChatGPT 3.5 produced the most complex responses. Across models, readability varied for Flesch–Kincaid grade level (P = 0.0213), Flesch Reading Ease Score (P = 0.0014), and SMOG (P = 0.0412), with a nonsignificant trend for Coleman Liau Score (P = 0.0529). Conclusion: LLMs show reasonable accuracy, matching students in theoretical performance but underperforming in clinical reasoning. Gemini and DeepSeek offer superior readability, highlighting their promise as educational tools. Future research should focus on integrating LLMs into curricula while balancing them with hands-on clinical education.

PURPOSE:Ocular tuberculosis (OTB) affecting the posterior segment commonly presents with choroiditis lesions. However, tubercular retinitis (TBR) is a rare and poorly characterized phenotype. This study aims to define the clinical spectrum, multimodal imaging characteristics, natural course of TBR lesions, and differentiate it from similar appearing chorioretinal lesions in OTB. DESIGN:Single-center, retrospective case series. METHODS:The study included patients presenting with lesions clinically suggestive of retinitis. Clinical data, fundus findings, and multimodal imaging (ultrawidefield fundus photography, fluorescein and indocyanine green angiography, and optical coherence tomography [OCT]) were analyzed. The diagnosis of OTB was established based on the Collaborative Ocular Tuberculosis Study criteria, which includes supportive immunological and radiological evidence (positive Mantoux test or interferon-gamma release assay, and chest imaging). All patients received standard four-drug antitubercular therapy (ATT) with adjunctive corticosteroids and were followed for anatomical and functional outcomes. RESULTS:Eight patients (six males; age range: 21-54 years) were included. A total of 37 lesions were identified in 12 eyes (median: 2 lesions per eye). Twenty-five lesions (67.6%) were purely retinal with no choroidal involvement and were classified as TBR. Twelve lesions (32.4%) showed involvement of the choroid, retinal pigment epithelium (RPE), and outer retina, and were classified as tubercular retinochoroiditis (TBRC). All the eyes demonstrated occlusive retinal vasculitis. Fluorescein angiography of TBR lesions demonstrated early central hypofluorescence with circumferential perilesional hyperfluorescence ("moat sign"). On OCT, TBR lesions were intraretinal and characterized by full-thickness hyper-reflectivity and disruption of inner retinal architecture with no choroidal/RPE changes. TBRC lesions showed outer retinal disruption, RPE irregularity with focal defects, and choroidal shadowing. Indocyanine green angiography showed focal hypofluorescence in TBRC lesions, but was unremarkable in TBR. Following ATT, TBR lesions healed without pigmentation or scarring, whereas TBRC lesions resolved with discrete pigmented scars with retinal thinning and RPE disruption on OCT (32.4%) (P = .028s). CONCLUSIONS:The spectrum of posterior segment involvement in OTB includes intraretinal inflammation that can present as TBR and TBRC. These lesions are typically present in eyes with occlusive retinal vasculitis. Features on clinical examination and multimodal imaging help identify the tubercular etiology and differentiate between TBR and TBRC lesions.

Purpose:To describe a diagnostically challenging case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in a young girl, presenting with features mimicking Vogt-Koyanagi-Harada (VKH) syndrome. Methods:An 18-year-old Asian Indian girl presented with sudden bilateral visual diminution and metamorphopsia for three days. Clinical examination and multimodal imaging were performed, including Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT), Fundus Fluorescein Angiography (FFA), Indocyanine Green Angiography (ICG), and Optical Coherence Tomography Angiography (OCTA). Systemic evaluation included the Mantoux test, QuantiFERON-TB Gold, HRCT of the chest, abdominal ultrasonography, and routine blood work. Results:BCVA was 20/40 in both eyes. Fundus examination revealed mild vitritis, multiple serous retinal detachments (SRD), and yellowish placoid lesions at the posterior pole. EDI-OCT showed SRD with bacillary layer detachment and mild choroidal thickening in both eyes. FFA revealed early hypofluorescence with late staining; ICG showed persistent hypocyanescent lesions localized to the posterior pole. OCTA demonstrated choriocapillaris flow voids. Mantoux and QuantiFERON-TB Gold were strongly positive; other systemic investigations were unremarkable. Given the absence of VKH prodromal features and features on multimodal imaging, a diagnosis of APMPPE was made. The patient was observed without corticosteroid therapy, and complete resolution of SRD and bacillary layer detachment occurred within 1 week. Discussion:The initial presentation with bilateral SRDs and BALADs strongly suggested VKH syndrome. However, the absence of systemic prodromal symptoms, combined with characteristic angiographic features, led to a diagnosis of APMPPE. The rapid, spontaneous resolution of these atypical detachments without corticosteroid therapy further confirmed the self-limiting nature of APMPPE, in sharp contrast to the prompt immunosuppression typically required for VKH. Conclusion:APMPPE can rarely present with atypical clinical features such as SRD and BALAD. Clinicians must integrate multimodal imaging with systemic evaluations to accurately differentiate it from VKH syndrome, thereby preventing misdiagnosis and avoiding unnecessary treatment.

A 19-year-old Asian-Indian male presented with decreased vision in the right eye for 3 weeks. He had a prior history of choroiditis and steroid-induced glaucoma with advanced glaucomatous optic atrophy in the left eye. Fundus examination revealed active choroiditis lesions in the right eye and healed pigmented scars with total optic disc cupping in the left eye. The patient was diagnosed as tubercular serpiginous-like choroiditis (SLC) and started on standard four-drug anti-tubercular therapy. Two weeks later, he developed paradoxical worsening with the appearance of new lesions. Intravitreal methotrexate failed to control the inflammation, and intravitreal corticosteroids were contraindicated due to steroid responsiveness. A single intravitreal injection of adalimumab (1.5 mg/0.05 mL) was administered, resulting in rapid regression of active lesions and subsequent healing. This case demonstrates the potential of intravitreal adalimumab as an effective therapeutic option in managing paradoxical worsening in tubercular SLC unresponsive to standard treatment/steroid responsiveness.

Purpose:The Standardization of Uveitis Nomenclature (SUN) criteria were introduced in 2021 to standardize the classification of uveitis subtypes. We evaluated the real-world applicability of these criteria for tubercular uveitis (TBU) using a computational definition mapped to the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) registry. Methods:This observational retrospective cross-sectional study analyzed real-world baseline data from 372 clinician-diagnosed TBU cases within the multinational OASIS registry, all collected from 17 tertiary centers across 8 countries: India, Nepal, Indonesia, Switzerland, Ethiopia, Colombia, Argentina, and Chile. We mapped the SUN criteria to corresponding variables in the OASIS registry, and Boolean operators were used to generate a computational definition for TBU. The sensitivity of the SUN criteria in capturing clinician-diagnosed cases of TBU was evaluated. Results:The SUN criteria identified 15.9% (n = 59) of clinician-diagnosed TBU cases at baseline. Criterion f2 (evidence of TB infection) was met in 70.7% of cases (n = 263), and criterion f1 (TBU-compatible uveitic syndrome) was satisfied in 24.5% of cases (n = 91). Exclusion criterion successfully identified 99.5% of cases (n = 370). By country and anatomical location, cases in India and those with posterior uveitis had the highest concordance at 19.8% (n = 39) and 21.8% (n = 44), respectively. Bilateral TBU was more likely to satisfy the SUN criteria (P = 0.049). Conclusions:SUN classification criteria demonstrated low sensitivity for real-world TBU diagnosis at baseline, which may limit the number of cases available for enrollment in research studies. Further diagnostic refinement, clearer definition of application context, and longitudinal validation are needed to generate diagnostic criteria for clinical application.

PURPOSE:To analyse the evolution of uveitis diagnosis over a 10-year period, emphasizing the change in etiological diagnosis, and the factors associated with recurrences. DESIGN:Retrospective chart review. METHODS:A total of 15,000 patients with uveitis presented at our tertiary care institute in North India between 1992 and 2023. Of these,123 patients completed 10-year follow-up and were included in the study. The data of patients was collected on an offline purpose-built uveitis registry portal: Ocular Autoimmune Systemic Inflammatory and Infectious Study(OASIS). RESULTS:The study included 123 patients (48.78% males; mean age: 29.11 ± 15.22 years). The most common anatomical and etiological diagnosis at presentation were anterior (49/123,34.96%) and idiopathic(59/123,47.97%) uveitis respectively. At the end of 10 years, anterior uveitis remained the most common anatomical diagnosis (43/123,39.83%) while the most common etiological diagnosis was immune-mediated uveitis (50/123,40.65%). An etiological diagnosis could be established in 50.85% (30/59) of patients initially labelled as idiopathic. Tuberculous uveitis (39/44, 88.63%) and Juvenile Idiopathic Arthritis associated uveitis (16/49, 32.65%) were the commonest infectious and immune-mediated aetiologies at the 10-year follow-up. Ninety-six (80.67%) patients experienced multiple episodes of ocular inflammation with a mean recurrence rate of 0.386 ± 0.24 recurrences/year. Anterior uveitis (p = 0.01), the change in etiological diagnosis after the first year (p = 0.03), positive HLA-B27 at baseline (p = 0.04), and the diagnosis of a systemic disease prior to the onset of uveitis were associated with higher recurrences rates (p = 0.03). CONCLUSION:Over 10-year of follow-up, half of the uveitis diagnoses evolved from idiopathic to specific infectious or immune-mediated aetiologies. Our results indicate that patients with a high recurrence rate may benefit from re-evaluation to find the definitive cause of uveitis.

In this report, we describe a challenging case of viral panuveitis with choroidal involvement and exudative retinal detachment (RD). Multimodal imaging, comprising optical coherence tomography, fluorescein angiography, and indocyanine green angiography, confirmed the choroidal involvement in the presence of acute retinitis. Real-time polymerase chain reaction from aqueous fluid helped clinch the diagnosis of herpes simplex virus-1 panuveitis. Treatment with oral valacyclovir, along with topical and oral steroids, resulted in the resolution of exudative RD, retinitis, and choroidal lesions. This case highlights the choroidal involvement as an atypical presentation of viral uveitis.

Fluorescein angiography (FA) has long been a cornerstone for evaluating retinal vascular leakage in diseases like uveitis, diabetic retinopathy, and macular degeneration, but its interpretation relies on subjective grading that can vary between clinicians. With the emergence of artificial intelligence (AI), there is a push to transform this qualitative assessment into objective, quantifiable metrics. We conducted a comprehensive literature search using PubMed, Embase, and Scopus, combining keywords and MeSH terms related to fluorescein angiography leakage, artificial intelligence, and retinal vascular diseases. Studies were included if they assessed FA leakage using manual, semi-automated, or AI-based methods and were peer-reviewed, published in English, and focused on human subjects. Our review charts the evolution from manual grading to modern machine learning techniques that segment and measure leakage using various angiograms. These AI-based approaches enable standardized, reproducible leakage indices that correlate with disease severity, inform treatment decisions, stratify high-risk patients, and facilitate sensitive monitoring of therapeutic response. We also introduce the concept of "minimal residual disease" in this context. By moving from coarse, subjective estimations to precise digital biomarkers, AI-driven FA leakage quantification promises to improve clinical care and research endpoints in retinal disease.