PURPOSE:To report a case of recurrent bilateral combined branch retinal vein occlusion (BRVO) and branch retinal artery occlusion (BRAO) with paracentral acute middle maculopathy (PAMM) as the first manifestation of lung adenocarcinoma. CASE REPORT:A 54-year-old male with a history of inferonasal BRVO in the left eye (LE), was referred to our department for blurred vision in the LE. On examination, best-corrected visual acuity was 20/20 in the right eye (RE) and 20/25 in the LE. Fundus examination showed tortuosity and dilatation of the inferotemporal branch vein, cotton-wool spots, retinal hemorrhages, and areas of retinal whitening in both eyes corresponding to a BRVO associated with BRAO and PAMM. A few months later, the patient complained of blurred vision in the RE. Examination revealed a superior temporal BRVO and BRAO. An exhaustive work-up was performed. Results showed a high level of antiphospholipid antibodies. Chest scan showed the presence of a pulmonary mass related to lung adenocarcinoma. The patient underwent a surgical removal of the lung tumoral mass and chemotherapy. The level of antiphospholipid antibodies was back to normal and no recurrence of ocular symptoms was noted after a follow-up of one year. CONCLUSION:The association between retinal vascular occlusions and systemic carcinomas is rare. Malignant tumors may induce a hypercoagulation state and an increased risk of thromboembolic complications including branch retinal vascular occlusions.

OBJECTIVE:This study aims to assess the risk of noninfectious uveitis (NIU) relapse in pediatric patients undergoing adalimumab (ADA) tapering, evaluating potential predictors of such risk. METHODS:We conducted a multicenter retrospective cohort study involving pediatric patients with NIU who underwent ADA tapering due to inactive uveitis. Cox proportional hazards regression was used to analyze risk factors for NIU recurrence. RESULTS:The study cohort comprised 114 patients (65 girls; 57%). Most commonly, patients presented with juvenile idiopathic arthritis-associated uveitis (JIA-U) (52 of 114; 46%) or idiopathic uveitis (46 of 114; 40%). At ADA tapering, 46% of patients (53 of 114) experienced NIU recurrence after an overall median time of 30 weeks (interquartile range [IQR] 15-58 weeks) from the start of ADA tapering. Patients without recurrences were observed for a median of 70 weeks (IQR 48-98 weeks). Multivariate Cox regression analysis showed that a slower ADA tapering schedule was associated with a lower recurrence rate during the waning (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74; P < 0.01). Subgroup analysis of patients with JIA-U indicated that beginning ADA tapering after at least two years of disease inactivity significantly reduced recurrence risk (HR 0.65, 95% CI 0.43-0.95; P = 0.05). Among 59 patients (52%) who discontinued ADA, recurrence rates were similar between fast- and slow-tapering groups (21% vs 33%; P = 0.6), but median time to recurrence was shorter with fast tapering (10 weeks vs 37 weeks; P = 0.05). CONCLUSION:This study highlights the significant clinical impact of ADA tapering on uveitis recurrence risk, recommending a gradual, slow-tapering approach with close monitoring.

A 24-year-old male patient with an unremarkable medical history presented with blurred vision in the right eye (RE) for a few weeks. The best-corrected visual acuity (BCVA) was 20/400 in the RE and 20/20 in the left eye (LE). Ophthalmic examination showed 3+ vitreous cells, snowballs, and multifocal segmental periphlebitis in both eyes. There was a one-disc diameter white lesion inferotemporal to the optic disc associated with hard exudates in the RE. Multimodal imaging findings were consistent with intraretinal granuloma. Workup led to the diagnosis of probable ocular sarcoidosis. Three years later, the patient developed an intraretinal granuloma involving the macula in the fellow eye. Intravitreal antivascular endothelial growth factor was given in association with anti-inflammatory therapy. Final BCVA was 20/200 in the RE and 20/1000 in the LE.

To compare clinical findings and visual outcomes of vitreous hemorrhage (VH) associated with uveitis in adults versus children. A retrospective comparative study. There were 36 adults (44 eyes) and 10 children (12 eyes). Median age was 35 years in the adult group and 9.5 years in the pediatric group. VH was the presenting manifestation of the underlying uveitis in 45.7

Aims/Purpose: To describe the clinical pattern of uveitis masquerade syndrome (UMS).Methods: A retrospective descriptive monocentric study between January 01, 2007 and December 31, 2022.Results: Over a 15‐year period, we identified 89 cases (124 eyes) among 3,000 cases of uveitis, with a final diagnosis of UMS, i.e. a rate of 3%. Thirty cases (33.7%) were neoplastic UMS and 59 cases (66.3%) were nonneoplastic UMS. The mean age was 40 ± 19 years (extremes; 7 – 80 years), including 43 men (48.3%) and 46 women (51.7%). Ocular involvement was unilateral in 61% of cases. Time to diagnosis ranged from 1 day to 10 years, with an average of 4.7 months. Etiologies of neoplastic UMS were malignant tumors (19 cases; 63%), including vitreoretinal lymphoma (7 cases; 37%), uveal melanoma (6 cases; 31%), ocular metastases (5 cases; 26%) and one case of leukemia, benign tumours (8 cases; 26.6%) and paraneoplastic syndromes (3 cases; 10%). Hereditary retinal dystrophies were the main etiology of non neoplastic UMS (17 cases; 28.8%), followed by rhegmatogenous retinal detachment (7 cases; 11.8%). Prior to the final diagnosis, a therapeutic mistake was found in 19% of cases including prescribing topical and/or systemic corticosteroids and immunosppressive therapy.Conclusions: In our series, vitreoretinal lymphoma and hereditary retinal dystrophies were the main etiologies of UMS. Meticulous analysis of the patient's history and ocular clinical and imaging findings is mandatory to avoid diagnostic and therapeutic mistakes

Laser instruments are widely used in various fields, leading to an increasing number of accidental eye injuries. Macular neovascularization (MNV) is a rare complication of laser pointer maculopathy. We report the case of a 16 year old boy with an unremarkable medical history who presented to our department with a three-week history of decreased vision in his left eye (LE). On examination, visual acuity (VA) was 20/25 in the right eye (RE) and 20/400 in the LE. Fundus examination revealed bilateral yellowish macular lesions. In the LE, the lesions exhibited a linear pattern and were associated with a subfoveal serous retinal detachment. Multimodal imaging confirmed the presence of MNV in the LE, linked to high energy laser exposure. The patient initially refused an intravitreal injection. On re examination eight days later, MNV had exudation increased, and VA had further worsened. A single intravitreal injection of bevacizumab was performed, with subsequent improvement of VA to 20/62 and resolution of exudative changes on OCT.

PURPOSE:This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A).METHODS:We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity.RESULTS:Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes.CONCLUSION:This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease.

Purpose: To analyze the clinical spectrum of patients with presumed tubercular uveitis in a referral eye clinic in Qatar. Methods: We retrospectively reviewed the clinical records of 50 patients (80 eyes) diagnosed with presumed ocular tuberculosis who presented to the uveitis clinic, department of Ophthalmology Hamad Medical Corporation, Qatar, from January 2014 till December 2019. Results: Mean age at presentation was 34.5 +/- 9.3 years. Forty one patients were males (82%) and 30 patients had bilateral involvement (60%). Forty eyes (50%) had posterior uveitis, 21 eyes (26.3%) intermediate uveitis, 11 eyes (13.7%) panuveitis, and 8 eyes (10%) anterior uveitis. Ocular findings included vitritis in 82.5% of eyes, retinal vasculitis in 46.3% (92% of which were occlusive in nature), multifocal choroiditis in 18.8%, serpiginous-like choroiditis in 11.3%, Most common complications at presentation or during follow-up included macular edema in 32 eyes (40%), preretinal or optic disc neovascularization in 29 eyes (36.3%) and vitreous hemorrhage in 17 eyes (21.3%). Anti-tubercular treatment was provided to 46 patients (92%). Systemic corticosteroids and corticosteroid sparing agents were associated, respectively, in 39 patients (78%) and 14 patients (28%). After 1 year of follow up, inflammation was controlled, with a significant improvement in visual acuity (p < 0.0001). Conclusions: In Qatar, tubercular uveitis has a broad spectrum of ocular features, with posterior and intermediate uveitis being the most common anatomic forms. Vitritis, multifocal choroiditis without or with a serpiginous-like pattern, and occlusive retinal vasculitis are the most common ocular findings. Main sight-threatening ocular complications are macular edema, posterior segment neovascularization, and vitreous hemorrhage.

Aims/Purpose: To describe the pattern of acute retinal necrosis (ARN) in a referral centre in Tunisia, North Africa. Methods: The charts of 22 patients diagnosed with ARN from January 2006 to January 2023 were retrospectively reviewed. Results: The mean age at presentation was 39.2 (range, 12–70) years, sex ratio was 1.75. The mean diagnostic delay was 17.9 days (range 1–60). The mean visual acuity at presentation was 20/400. All patients presented with a mild to moderate anterior uveitis (100%) with granulomatous keratic precipitates in 18 eyes (81%) and ocular hypertension in 4 eyes (18%). Necrotizing retinitis involved >50% of the retina in 36.5%of eyes. Polymerase chain reaction on aqueous humour sample identified varicella zoster virus in 10 eyes (45%), herpes simplex virus‐1 in 4 eyes (18%) and was negative in 8 eyes (22%). All patients received intravenous acyclovir, followed by oral antivirals. Intravitreal injections of ganciclovir were administered in 12 eyes (54.5%). Follow‐up ranged from 1 month to 48 months. The mean final visual acuity was 20/200. Complications included retinal detachment (RD) (31.8%), macular oedema (18%), macular atrophy (22%), epimacular membrane (22%), cataract (27%), optic nerve atrophy (18%) and central retinal artery occlusion (4%). No patient developed bilateral ARN. Prophylactic laser was performed in 7 eyes (32%). RD was treated with pars plana vitrectomy and silicone oil injection in 7 eyes. Conclusions: ARN syndrome in Tunisia is most commonly caused by VZV.

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA). Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls. Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) ( p < 0.001). FAZ was significantly larger (323.09 ± 129.03 μm 2 vs. 245.27 ± 93.15 μm 2 ; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm ( p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 ( p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 ( p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm ( p < 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness ( r = −0.520, p = 0.016) and CFT ( r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters. Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome.

Objectif : décrire et analyser les modifications microvasculaires péripapillaires au cours des neuropathies optiques par la tomographie par cohérence optique angiographie (OCTA). Méthodes : Dans cette étude observationnelle transversale, un nombre de 63 yeux de 48 patients avec différentes causes de neuropathie optique et 36 yeux témoins sains ont été évalués par tomographie par cohérence optique (OCT) et OCTA papillaire (Topcon DRI OCT; Triton) entre janvier 2018 et décembre 2018 au service d’ophtalmologie Fattouma Bourguiba de Monastir. Résultats : Les modifications vasculaires étaient plus fréquentes en cas de neuropathie optique ischémique antérieure aigue non artéritique (NOIAA) qu’en cas d’une névrite optique. Les yeux présentant une atrophie optique avaient une raréfaction capillaire correspondant au secteur d'amincissement des fibres optiques péripapillaires. La densité vasculaire péripapillaire (DVP) était plus faible (p=0,036) en cas d’atrophie optique par rapport aux yeux normaux. Pour les neuropathies optiques ischémiques et pour les névrites optiques rétrobulbaires chroniques, une corrélation positive entre l’acuité visuelle et la DVP a été constatée (p<0,05). Une relation inversement proportionnelle entre la DVP et la durée d’évolution a été notée. A l’étude multivariée l’hypertension artérielle (HTA) était un facteur systémique en corrélation avec l’atteinte microvasculaire péripapillaire. Conclusion : L’OCTA a montré une réduction de la DVP et des modifications vasculaires plus importantes en cas de neuropathie optique ischémique aigue non artéritique qu’en cas de névrite optique œdémateuse. Au stade atrophique la DVP était réduite. L’HTA était un facteur indépendant en corrélation avec l’atteinte microvasculaire péripapillaire.

"Letter to the Editor: Comment on Fauquier A et al "Impact of Initial Management on Disease Evolution in Vogt-Koyanagi-Harada Syndrome: A Retrospective Cohort of 50 Patients"." Ocular Immunology and Inflammation, ahead-of-print(ahead-of-print), pp. 1–2 Disclosure statementNo potential conflict of interest was reported by the author(s).

AIM:to describe and analyze peripapillary microvascular changes in eyes with optic neuropathies using optical coherence tomography angiography (OCTA). METHODS:In this cross-sectional observational study, 63 eyes of 48 patients with different causes of optic neuropathy and 36 healthy control eyes were evaluated by optical coherence tomography (OCT) and OCTA (Topcon DRI OCT; Triton) between January 2018 and December 2018 at the Fattouma Bourguiba ophthalmology department in Monastir. RESULTS:Vascular changes were more frequent in acute non arteritic anterior ischemic optic neuropathy (NAION) than in optic neuritis. Eyes with optic atrophy had capillary rarefaction corresponding to the area of thinning of the peripapillary optic fiber layer (RNFL). The peripapillary vascular density (PVD) was lower (p=0.036) in case of optic atrophy compared to normal eyes. For non arteritic ischemic optic neuropathy and for chronic retrobulbar optic neuritis (NORB), a positive correlation between visual acuity and PVD was observed (p<0.05). An inversely proportional correlation between the PVD and the duration of evolution was noted. In the multivariate study, high blood pressure was a systemic factor correlated with peripapillary microvascular damages. CONCLUSION:OCTA showed a reduction in PVD and greater vascular changes in acute non-arteritic ischemic optic neuropathy than in edematous optic neuritis. At the atrophic stage, the PVD was reduced. Hypertension was an independent factor correlated with peripapillary microvascular damages.

PURPOSE:To provide an overview of pre-selected emerging arboviruses (arthropod-borne viruses) that cause ocular inflammation in humans. METHODS:A comprehensive review of the literature published between 1997 and 2023 was conducted in PubMed database. We describe current insights into epidemiology, systemic and ocular manifestations, diagnosis, treatment, and prognosis of arboviral diseases including West Nile fever, Dengue fever, Chikungunya, Rift Valley fever, Zika, and Yellow fever. RESULTS:Arboviruses refer to a group of ribonucleic acid viruses transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. They mostly circulate in tropical and subtropical zones and pose important public health challenges worldwide because of rising incidence, expanding geographic range, and occurrence of prominent outbreaks as a result of climate change, travel, and globalization. The clinical signs associated with infection from these arboviruses are often inapparent, mild, or non-specific, but they may include serious, potentially disabling or life-threatening complications. A wide spectrum of ophthalmic manifestations has been described including conjunctival involvement, anterior uveitis, intermediate uveitis, various forms of posterior uveitis, maculopathy, optic neuropathy, and other neuro-ophthalmic manifestations. Diagnosis of arboviral diseases is confirmed with either real time polymerase chain reaction or serology. Management involves supportive care as there are currently no specific antiviral drug options. Corticosteroids are often used for the treatment of associated ocular inflammation. Most patients have a good visual prognosis, but there may be permanent visual impairment due to ocular structural complications in some. Community-based integrated mosquito management programs and personal protection measures against mosquito bites are the best ways to prevent human infection and disease. CONCLUSION:Emerging arboviral diseases should be considered in the differential diagnosis of ocular inflammatory conditions in patients living in or returning from endemic regions. Early clinical consideration followed by confirmatory testing can limit or prevent unnecessary treatments for non-arboviral causes of ocular inflammation. Prevention of these infections is crucial.

To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.

Les régions tropicales se caractérisent par un climat chaud et humide favorisant l’émergence ou la résurgence d’ampleur endémique ou épidémique de microorganismes tels que les virus. Les infections virales émergentes chez l’homme sont le plus souvent asymptomatiques, paucisymptomatiques ou sous forme pseudo-grippale. Cependant, des complications sévères, potentiellement mortelles, et des formes chroniques sont possibles. Parmi les infections virales émergentes certaines ont été associées à des atteintes oculaires polymorphes. Il s’agit principalement des arbovirus, du human T-cell lymphotropic virus type 1 (HTLV-1) et du virus de l’Ebola. Le diagnostic d’infection virale émergente doit être évoqué chez tout patient avec atteinte inflammatoire oculaire associée à un syndrome fébrile dans un contexte de séjour en zone d’endémie. Le diagnostic est confirmé par la polymerase chain reaction ou par sérologie. Il n’existe, à l’heure actuelle, aucun traitement antiviral spécifique contre les infections virales émergentes. Le traitement est symptomatique. Le traitement des atteintes oculaires repose principalement sur les corticoïdes. Le pronostic visuel est généralement favorable, mais une altération irréversible de la vision est possible. La prévention des infections virales émergentes est essentielle.