PURPOSE:The term white dot syndromes (WDS) has historically grouped multiple non-infectious posterior uveitis (NIPU) entities based on a similar funduscopic appearance of "white dots." Despite decades of use, the clinical relevance of this umbrella terminology has been questioned. This perspective critically examines whether WDS remains a valid conceptual and diagnostic construct in the era of advanced retinal and choroidal imaging. DESIGN:Perspective review. METHODS:Critical interpretation of the available literature on imaging and current pathophysiological evidence, combined with observations collected using cutting edge imaging technology (structural high-resolution optical coherence tomography (OCT), OCT angiography, and indocyanine green [ICG] angiography [ICGA]) for 6 of the NIPU classically considered as WDS: multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis with panuveitis (MFCPU), punctate inner choroiditis (PIC), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and birdshot chorioretinitis (BSCR). RESULTS:Although these diseases share some overlapping clinical features, multimodal imaging reveals profound differences, with each entity having distinct anatomic features on multimodal imaging. OCT angiography (OCTA) demonstrate distinct patterns of tissue involvement-from photoreceptor/retinal pigment epithelium (RPE) injury in MEWDS, to Bruch's membrane disruption in MFCPU and PIC, to profound choriocapillaris ischemia in APMPPE and SC, and deep stromal choroidal infiltration in BSCR. ICGA further differentiates these entities by choroidal perfusion characteristics, distinguishing true vascular non-perfusion from other inflammatory reactions leading to tissue damage. Imaging-based hypotheses of immunopathogenesis suggest that these entities may arise from different immunopathogenic pathways-transient outer retinal inflammation (MEWDS), possible antigenic exposure from structural disruptions (MFCPU/PIC), primary inflammatory inner choroidal vascular occlusive process (APMPPE), a possible autoimmune or autoinflammatory choroidal ischemic mechanism (SC), and a likely Human Leukocyte Antigen (HLA)-A29-associated autoimmune response affecting the inner retina and choroid (BSCR) CONCLUSIONS: The label WDS, originally based on appearance alone, does not take into consideration major biological and prognostic differences among these NIPU. Current imaging-guided hypotheses of immunopathogenesis suggest that these conditions should no longer be grouped under a single classification. A paradigm shift toward disease-specific terminology is warranted to improve diagnostic precision, guide management, and reflect presumed pathophysiological diversity.

PURPOSE:To report a series of patients with HLA-B27-associated uveitis presenting with atypical features, highlighting uncommon patterns and associated diagnostic challenges. METHOD:Retrospective Chart Review. RESULT:A total of nine patients with HLA-B27-associated uveitis were included, predominantly males in the third to fourth decade, with most having underlying HLA-B27-associated spondyloarthropathy. The majority presented with anterior and intermediate uveitis with disproportionately severe vitritis (grade 3-4+), exceeding typical spillover inflammation, with pars plana exudates in some cases. One patient was misdiagnosed as endogenous endophthalmitis and underwent vitrectomy. Fundus view was obscured in three eyes due to dense vitritis, and posterior segment findings included serous retinal detachment, pars plana exudates, glaucomatous optic atrophy, and choroidal neovascular membrane. CONCLUSION:HLA-B27-associated uveitis can present with atypical features, including significant vitritis and posterior segment involvement, leading to diagnostic dilemmas. This case series highlights the need for a high index of suspicion and accurate anatomical classification to guide appropriate management.

Purpose To develop imaging and consensus-based guidelines for the application of multimodal imaging in the clinical diagnosis, monitoring and detection of complications in Behçet disease (BD) uveitis. Design International expert consensus agreement using the nominal group technique (NGT) guided by systematic literature review. Participants International uveitis and retina experts participating in the Multimodal Imaging in Uveitis (MUV) taskforce. Methods A committee of experts reviewed the published literature on imaging in BD uveitis, along with representative multimodal imaging datasets of active, resolved and late-stage uveitis in BD. All cases in these datasets met the Standardized Uveitis Nomenclature (SUN) diagnostic criteria. Imaging modalities included color fundus photography (CFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), fundus autofluorescence (FAF), indocyanine green angiography (ICGA), and OCT angiography (OCTA). NGT sessions were conducted to define consensus-based key imaging descriptors of active and resolved BD uveitis, along with the complications and sequelae. Main Outcome Measures Identification of reproducible multimodal imaging features of active and resolved BD uveitis. Results The experts agreed that CFP, FFA and OCT are the most relevant imaging modalities in the management of BD uveitis, with particular emphasis on ultra-widefield imaging. Characteristic findings on CFP include vitreous haze, retinal infiltrates, optic nerve head inflammation, and prominent retinal vasculitis with possible occlusion. FFA was deemed critical in assessing vascular, macular and optic nerve head leakage, thereby indicating disease activity. OCT is helpful in detecting and characterizing cystoid macular edema, partial thickness inner retinitis (smudge-sign), subretinal fluid, and overlying vitreous condensation. FFA and OCT assist in demonstrating disease resolution, and detection of late changes such as retinal non-perfusion, neovascularization, epiretinal membrane formation and retinal atrophy. The experts concluded that FAF, ICGA and OCTA have limited role in disease. Based on these findings, consensus-based statements were generated and voted upon by the MUV taskforce. Conclusion Incorporation of consensus-based imaging guidelines by MUV, particularly CFP, FFA and OCT, enhances diagnostic evaluation, improves assessment of disease activity, assessment of treatment response, and detection of complications in BD uveitis. These recommendations provide a structured framework for optimal multimodal imaging use in BD uveitis and aid future refinements of diagnostic criteria.

BACKGROUND:Non-infectious uveitis is a diverse group of inflammatory conditions that collectively account for substantial blindness worldwide. Expert guidelines and results of clinical trials guide treatment, but real-world clinical care is impacted by additional factors. In 2023, an international group of uveitis-specialised ophthalmologists formed the International Study Group for Systemic Immunomodulatory Drug Treatment of Non-Infectious Uveitis to report current practice. METHODS:221 study group members from 53 countries completed a 30-item questionnaire on their management of non-infectious uveitis including: indications for and investigations prior to initiating systemic immunomodulatory drugs, use of conventional and biological drugs, and follow-up of treated patients. RESULTS:Major indications to initiate systemic immunomodulatory drugs were: uveitis not controlled with oral prednis(ol)one (n=208, 94.1%), specific uveitis diagnosis (n=197, 89.1%), and patient intolerance of oral prednis(ol)one (n=186, 84.2%). All members (n=221, 100%) performed pretreatment screens including: blood chemistry (n=217, 98.2%), blood examination (n=207, 93.7%), and Quantiferon assay (n=196, 88.7%). Eight conventional and 14 biological drugs were prescribed: methotrexate was the preferred conventional drug overall (n=126, 57.0%) and for 9 of 11 uveitides, and adalimumab was the preferred biological drug overall (n=216, 97.7%) and for 11 of 11 uveitides. When drugs were combined, methotrexate plus adalimumab was most popular (n=158 of 188 members, 84.0%). Patients with inactive uveitis were typically evaluated and screened for drug toxicity every 6-12 weeks (n=161, 72.9%, and 165, 74.7%, respectively). CONCLUSION:Our report describes practice patterns of a large international group of uveitis specialists treating non-infectious uveitis with systemic immunomodulatory drugs.

Infectious uveitis remains a major cause of global visual morbidity, with significant geographic variability in its epidemiological patterns and clinical presentations. The Asia-Pacific region presents a unique model to study infectious uveitis, due to socioeconomic, environmental, and healthcare diversity within its populations. This narrative review explores the spectrum of infectious uveitides prevalent in the Asia-Pacific region, emphasizing diseases with high endemicity, emerging threats, and those posing notable diagnostic or therapeutic challenges. The review also highlights the critical importance of considering an infectious etiology in the differential diagnosis of uveitis, especially within, or travelers from endemic areas. The associated hosts, transmission vectors, and epidemiology of infectious uveitis, when combined with both the systemic and ocular phenotype can rationalize subsequent investigations and empiric therapy. Highly prevalent causes of infectious uveitis with typical ophthalmic manifestations are diagnosed utilizing consensus diagnostic criteria. However, regionally endemic and emerging diseases frequently present with overlapping clinical features, and their recognition requires the integration of epidemiologic insight with targeted diagnostics. Rare and novel uveitides are also addressed. Molecular diagnostics have transformed pathogen detection but remain inaccessible in many low-resource settings which may contribute to under-reporting. There has been increasing global and regional epidemiological surveillance of infection and seropositivity in both humans and reservoir hosts in the contemporary literature. However, interventional studies for the management of ophthalmic disease remain limited. This review underscores the evolving epidemiology of infectious uveitis in the Asia-Pacific and provides a comprehensive reference to inform clinical suspicion, directed diagnostic investigation, and public health planning.

BACKGROUND:Retinal vasculitis (RV) is a complex inflammatory condition that affects the retinal vessels, often presenting as perivascular sheathing, vascular leakage, and occlusion. Despite its well-documented clinical and angiographic features, the definition and classification of RV remain inconsistent across clinical and research settings. This lack of uniformity has led to challenges in diagnosis, management, and understanding of research findings. Thus, this scoping review aims to objectively identify any ambiguity in the terminology of RV and discuss possible reasons for it, laying the groundwork for a subsequent panel of experts to provide consensus definitions for RV through a Delphi process. METHODS:This review included 97 studies. The authors extracted and summarised data on the definitions and diagnostic criteria used for RV, the definitions used for subtypes of RV (e.g. isolated, idiopathic, undifferentiated, primary RV), the imaging modalities used for RV diagnosis, and any references to existing guidelines. RESULTS:The results confirmed a significant degree of ambiguity in RV terminology. Among the 17 papers that explicitly defined RV in their methodology, four distinct definitions emerged. We also found that the terms' idiopathic,' 'primary,' and 'undifferentiated' RV were often used interchangeably, despite reflecting distinct aspects of the disease. Notably, all 52 studies that noted the diagnostic modalities used included fluorescein angiography, although the usage of other modalities was contentious. CONCLUSION:There are significant inconsistencies and ambiguities in defining and classifying RV, highlighting the need for a standardized, consensus-based framework to improve clarity and consistency in both research and clinical practice.

Herpes simplex virus (HSV) can affect both the central nervous system and the eye, most notably as herpes simplex encephalitis and the less common but vision-threatening acute retinal necrosis (ARN). The authors report a 13-year-old boy who developed ARN shortly after confirmed herpes simplex encephalitis despite appropriate systemic antiviral therapy. He presented with light perception vision, vitritis, retinal necrosis, and retinal detachment in the left eye, with HSV-1 detected by polymerase chain reaction from vitreous fluid. Intravitreal antiviral therapy was promptly administered, followed by early pars plana vitrectomy with silicone oil tamponade and 360-degree peripheral retinal laser, resulting in retinal reattachment and improvement of visual acuity to 20/200. After subsequent cataract extraction and silicone oil removal, visual acuity further improved to 20/80. This case emphasizes the importance of close ophthalmic monitoring in patients recovering from herpes simplex encephalitis, because ocular disease may develop rapidly even under systemic antivirals. It also underscores that early combined medical and surgical intervention can preserve meaningful vision in pediatric ARN complicated by retinal detachment. Such reports contribute to the limited literature linking herpes simplex encephalitis and ARN in children and highlight the potential for favorable outcomes with timely management.

PURPOSE:Scleritis, a severe inflammatory condition of the sclera, causes significant ocular pain and potential tissue damage. Often linked with systemic diseases, scleritis can be either infectious or noninfectious. Despite its clinical importance, the global incidence and detailed epidemiology of scleritis are poorly understood due to its heterogeneity and rarity. This systematic review and meta-analysis aim to elucidate the worldwide incidence and epidemiological trends of scleritis, examining variations across geographic regions, etiologies, and time periods. DESIGN:Systematic Review and Meta-analysis. CLINICAL RELEVANCE:Understanding scleritis epidemiology is crucial for enhancing diagnostic accuracy and treatment, especially concerning systemic illnesses commonly associated with this condition. Identifying epidemiological trends can inform healthcare policies and resource allocation, improving patient outcomes. METHODS:We systematically reviewed literature across databases, including Embase, PubMed, Virtual Health Library, The Cochrane Library, and medRxiv. Population-based, cohort, case-control, cross-sectional, and claims database studies reporting the frequency, prevalence, or incidence of scleritis diagnosed through clinical or imaging techniques, were included. The screening was based on titles and abstracts, followed by a full-text review. We assessed the risk of bias using standardized tools and systematically extracted data for qualitative and quantitative synthesis. This review is registered with PROSPERO (CRD42022330948). RESULTS:This review included 74 studies with 169,871 scleritis patients. The incidence was 2.67 per 100,000 in ophthalmological centers and 1.38 per 100,000 in broader population-based studies, both showing a decreasing trend over time. The patient population was predominantly female (67.24%), with an average age of 48.3 years. Epidemiological patterns were significantly influenced by etiology, geographic region, and publication period, with idiopathic cases being the most common. Scleritis was notably associated with systemic diseases such as rheumatoid arthritis, granulomatosis with polyangiitis, Sjögren's syndrome, sarcoidosis, and infectious agents like Mycobacterium tuberculosis and herpes virus. CONCLUSION:This is the most extensive study on scleritis to date, providing comparative insights across geographic regions, age groups, and genders. Our meta-analysis highlights significant regional differences in scleritis incidence, reflecting variations in medical practice, access to care, and potential genetic and environmental factors. These findings underscore the need for further research to explore these patterns and their global health implications.

The electronegative electroretinogram (ERG) is a specific clinical finding usually indicating inner retinal dysfunction occurring post-phototransduction. X-linked retinoschisis (XLRS) and complete and incomplete congenital stationary night blindness (cCSNB, iCSNB) are inherited retinal dystrophies classically associated with electronegative ERGs. Comparing the full-field ERG b:a ratio expands current ERG diagnostic criteria and aids in localising physiological sites and pathological mechanisms. A retrospective review of patients with a clinical diagnosis of iCSNB, cCSNB and XLRS was conducted. ERG and genetic results were analysed. Average b:a ratios between groups were compared, and prevalence of electropositivity was assessed using thresholds of b:a > 1.0 and b:a > 1.50. 53 patients were included, and genetic confirmation was available in 7/24 iCSNB, 3/14 cCSNB and 11/15 XLRS patients respectively. In genetically proven cases, mean b:a ratio in XLRS patients (b:a = 1.04) was significantly higher than cCSNB (b:a = 0.60, p < 0.001) and iCSNB (b:a = 0.60, p < 0.001). An electropositive ERG was significantly more likely to be associated with RS1 than iCSNB (p < 0.001) or cCSNB (p = 0.001) at b:a > 1.0 threshold, and more likely RS1 than iCSNB (p = 0.040) at b:a > 1.5 threshold. Our study highlights the distinct ERG findings between these typically electronegative inner retinal dystrophies. In a clinical setting, the traditional electronegative definition of b:a < 1.0 appears very insensitive to detect XLRS patients. Our data suggests clinical suspicion should remain even in patients with a b:a ratio > 1.50, and highlights the importance of genetic testing in these cases.

With the paradigm changes in antiviral therapy, there are a myriad of emerging controversies in the management of cytomegalovirus retinitis (CMVR). A certain extent of variability exists in the management of CMVR among clinical practices worldwide. Hence, alignment in the management strategy is important towards optimizing the care of CMVR. An international panel of experts (IPE) formulated consensus statements for CMVR regarding to its 1) diagnosis, 2) screening, 3) treatment, 4) management in special populations and 5) emerging technologies. The clinical diagnosis of CMVR relies on patient’s susceptibility due to compromised immune function and characteristic fundus manifestations. Polymerase chain reaction (PCR) of intraocular fluid for detection of CMV is indicated when confirmation is necessary. Oral valganciclovir is the preferred first-line treatment, and intravitreal ganciclovir injection when CMVR threatens to involve the posterior pole. Cessation of maintenance treatment can be considered after 6 months when CMVR remains inactive with immune reconstitution. Immune recovery uveitis (IRU) must be distinguished from CMVR relapse. Screening is recommended for high risk cases. Utilization of telemedicine and artificial intelligence-aided interpretation will help to alleviate the resources required for CMVR screening. Evidence for novel antiviral and immunotherapy have been appraised as second-line treatment options.

IMPORTANCE This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort. OBJECTIVE To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation. DESIGN, SETTING, AND PARTICIPANTS This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed. EXPOSURES COTS calculator to guide initiation of ATT in patients with TBU. MAIN OUTCOMES AND MEASURES Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity. RESULTS Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests. CONCLUSIONS AND RELEVANCE Results of this diagnostic study suggest that the COTS calculator (score >= 4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential improvements in the calculator's sensitivity.

OBJECTIVES:To investigate publicly funded healthcare costs according to faller status and the periods pre- and post-cataract surgeries, and identify factors associated with higher monthly costs in older people with bilateral cataract.METHODS:This prospective cohort study included community-dwelling older people aged 65 and over (between 2012 and 2019); at baseline participants had bilateral cataract and were waiting for cataract surgery in New South Wales (NSW) public hospitals. Participants were followed for 24 months. The study used self-reported and linked data (Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, NSW Admitted Patient and Emergency Department Data Collections) to identify falls, cataract surgeries and healthcare costs incurred by the Australian and NSW Governments, all costs were inflated to 2018-19 Australian dollars (AUD). Median monthly healthcare costs were calculated for faller status (non-faller, non-medically treated faller, medically treated faller) and surgery periods (pre-surgery, post-first surgery, post-second surgery). Costs in the 30 days following a medically treated fall were estimated. A generalised linear model was used to investigate predictors of healthcare costs.RESULTS:During the median follow-up period of 24 months, 274 participants suffered 448 falls, with 95 falls requiring medical treatment. For medically treated falls, the mean cost in the 30 days after treatment was A$3779 (95% confidence interval $2485, $5074). Higher monthly healthcare costs were associated with a higher number of medications, being of the male sex, having one or more medically treated falls and having bilateral cataract surgery. After excluding the cost of cataract surgery, there were no significant differences in healthcare costs between the pre-cataract surgery, post-first eye cataract surgery and post-second eye cataract surgery periods.CONCLUSIONS:To our knowledge, this is the first study investigating publicly funded costs related to falls and cataract surgery in older people with bilateral cataract. This information enhances our understanding of healthcare costs in this group. The patterns in costs associated with falls can guide future government healthcare expenditure on falls treatment and prevention, including timely cataract surgery.

Background/aims Acute posterior multifocal placoid pigment epitheliopathy is a rare but important disease that can be associated with life-threatening complications due to cerebral vasculitis. The primary objective was to determine the incidence of neurological complications and risk factors for stroke and transient ischaemic attack (TIA) associated with acute posterior multifocal placoid pigment epitheliopathy. Secondary objectives included the clinical presentation, visual outcomes and recurrence rates. Methods This was a multicentre retrospective case series including 111 eyes from 60 subjects presenting from January 2009 to June 2020. Results Median age at presentation was 29 years (IQR 24.7–35.1) and 36 subjects (60.0%) were male. 20 subjects (33.3%) reported a viral prodrome. Stroke and TIA were observed in seven subjects (11.7%). Older age was the only significant risk factor for stroke/TIA (p=0.042). Vision loss occurred in seven eyes, with four eyes (3.6%) having final visual acuity 6/15–6/60 and three eyes (2.7%) having visual acuity of 6/60 or worse. Recurrence occurred in 10 subjects (16.7%). Conclusions The presence of headache cannot reliably predict those at risk of stroke/TIA. Individuals presenting with acute posterior multifocal pigment epitheliopathy should therefore undergo a clinical neurological review and work-up for cerebral vasculitis as deemed appropriate by the treating ophthalmologist and collaborating neurologist.

center dot PURPOSE: To evaluate the influence of immunomodulatory therapy (IMT) on visual and treatment outcomes of inflammatory choroidal neovascularization (iCNV) in patients affected by multifocal choroiditis (MFC), and to compare them to patients treated with steroids as needed. center dot DESIGN: Multicenter retrospective matched cohort study. center dot METHODS: Patients affected by MFC with iCNV were divided into a IMT group and a "steroids as needed" group and matched according to the time between diagnosis and beginning of systemic treatment. Visual acuity (VA), number of anti-vascular endothelial growth factor (VEGF) intravitreal injections, and number of iCNV reactivations during 2 years of follow-up after treatment initiation were compared between the 2 groups. center dot RESULTS: A total of 66 eyes of 58 patients were included, equally divided into the 2 groups. Patients in the IMT group had a lower relative risk (RR) of iCNV reactivation (0.64, P = .04) and of anti-VEGF intravitreal injection retreatment (0.59, P = .02). Relapses of MFCrelated inflammation were independently associated with a higher RRs of iCNV reactivation (1.22, P = .003). Final VA was higher in the IMT compared to the steroids as needed group (mean [SD], 69.1 [15.1] vs 77.1 [8.9] letters, P = .01), and IMT was associated with greater VA gains over time ( +2.5 letters per year, P = .04). center dot CONCLUSIONS: IMT was associated with better visual and treatment outcomes in MFC complicated by iCNV compared to steroids as needed. The better outcomes of the IMT group and the association between MFC-related inflammation and iCNV reactivations highlight the need for tighter control of inflammation to prevent iCNV relapses and visual loss. (Am J Ophthalmol 2024;262: 62-72. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NCND license ( http://creativecommons.org/licenses/by-ncnd/4.0/ ))

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.

Objective This study aimed to compare the costs and clinical outcomes of treating patients with retinal diseases requiring surgery managed locally in Darwin through a visiting subspecialist ophthalmology service or transferred to interstate tertiary eye centres. Methods A retrospective analysis of a case series of 70 consecutive patients presenting to the Royal Darwin Hospital for vitreo-retinal surgery during the calendar years 2018 and 2019 was performed. Results Twenty-two of the 29 patients in the transfer group had a retinal detachment and five vitreous haemorrhage. The 41 patients managed in Darwin had a range of diagnoses. Surgical success, complications and costs were similar. Conclusion There were excellent clinical outcomes and a minimal insignificant difference in costs.

This article reviews key concepts in the epidemiology, clinical features, diagnosis and management of ocular syphilis. It is not a systematic review or meta-analysis, but highlights the critical clinical features and investigations in patients with ocular syphilis. It reviews the overlap and interplay between ocular and neuro syphilis and provides practical guidance to diagnose and manage patients with ocular syphilis.