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Uvea Free Papers AIOC in Mobile App Uvea Free Papers AIOC in Mobile App ‘AIOS Edu’ app on your mobile from play store or visit www.aiosedu.org Contents UVEA Resolution of Serpiginous Choroiditis Monitored with Dynamic Play of Fundus Autofluorescence Imaging ----------------------------------------------- 1100 Dr. Annamalai O, Dr. S Bala Murugan, Dr. Aparajita Shinde Role of Endoscopic Ultrasound Guided FNAC in Confirming the Diagnosis of Ocular Tuberculosis ---------------------------------------------------------------- 1103 Dr. Deepa Sharma, Dr. Manisha Agarwal Sakura Study Group: Key Outcomes for Intravitreal Sirolimus in Indian Subjects in Ni-PSU ---------------------------------------------------------------------- 1106 Dr. Rathinam Sivakumar R, Yusuf Ali, Yang Yang, Michelle Chernock Implications of Quantiferon Tb Gold Test in the Management of Uveitis -- ---------------------------------------------------------------------------------------------------1110 Dr. Kalpana Babu Murthy, Dr. Sowmya S Ozurdex Implant in the Treatment of Intermediate Uveitis --------------- 1111 Dr. Swetha Palla, Dr. Tarun Sharma, Dr. Biswas Jyotirmay Does Priming of Steroids Before Initiating Anti-Tubercular Therapy Affect the Final Visual Outcome? ----------------------------------------------------------- 1115 Dr. Rafi Ul Islam, Dr. S Bala Murugan, Dr. Annamalai O The Bothersome Bug in the Eye ---------------------------------------------------- 1118 Dr. Manisha Agarwal, Dr. Sima Das, Dr. Kusum Sharma, Prof Amod Gupta 73rd AIOC 2015, New Delhi UVEA Chairman: Dr. Gupta Amod Kumar l Co-Chairman: Dr. Shishir Narayan Convenor: Dr. Shahana Mazumdar l Moderator: Dr. Reema Bansal Resolution of Serpiginous Choroiditis Monitored with Dynamic Play of Fundus Autofluorescence Imaging Dr. Annamalai O, Dr. S Bala Murugan, Dr. Aparajita Shinde erpiginous choroiditis is a bilateral, chronic and progressive disease of Sunknown etiology characterized by multiple recurrences at intervals of months to years. Fluorescein Angiography (FA) is an invasive investigation for the patient to be subjected to, whenever recurrences are suspected. Fundus Autofluorescence (FAF) is a non-invasive imaging method for in vivo mapping of naturally or pathologically occurring fluorophores of the ocular fundus. The dominant sources are lipofuscin (LF) granules accumulating in the retinal pigment epithelium (RPE). Here, we describe a case report of serpiginous choroiditis and the progression of FAF images over a period of time. 1100 Case History A 25 year old male presented with an insidious onset of painless decrease in vision in the left eye (LE) 2 years ago and sudden, painless decrease in vision in the right eye (RE) for the past 1 week. There was no history of redness, photophobia, flashes and floaters. There was no history of trauma. There was no history of any systemic illness. His general examination suggested that he was a moderately built and nourished person. His BCVA was 6/18 in RE and 6/24p in LE. His anterior segment examination and IOP measurement were normal. Fundus examination showed a flat, yellowish retino-choroidal lesion with geographic borders involving papillo-macular area in the RE and a similar scarred lesion with hyperpigmentation in the LE. Fluorescein angiography (FA) in RE showed hypofluorescent lesion with hyperfluorescent borders during the early phase that became hyperfluorescent and intensified over time. FA in LE showed mottled hyperfluorescence with increased fluorescence in late phase Fundus autofluorescence (FAF) showed a hyperautofluorescent lesion surrounded by a small hypoautofluorescent halo in RE and a hypoauto- Uvea Free Papers fluorescent lesion in the LE Baseline blood investigations were within normal limits. HIV was negative. Mantoux test was negative. Aqueous tap, Vitreous tap for PCR for tuberculosis and viruses were also negative. However, suspecting Figure 1: Colour fundus photograph of both eyes tuberculosis, a trial of anti- tuberculosis therapy (ATT) in the intensive phase and titrated dose of oral steroids was initiated. 1 week later FAF showed a hyperautofluorescent lesion surrounded by a hypoauto- fluorescent halo in RE and a hypoautofluorescent lesion in the LE. Lesions showed improvement. Two weeks later FAF showed hypo- Figure 2: Fluorescein angiography in RE autofluorescent lines surrounding all of the hyperautofluorescent lesions in RE. We continued ATT 1101 with slow taper of oral steroids. Periocular steroids were added. 6 weeks later, FAF showed large hypoautofluorescent areas Figure 3: Fundus autofluorescence of both surrounding all of the hyperauto- eyes fluorescent lesions in RE. We continued ATT with slow taper of oral steroids. Periocular steroids were given At 14 weeks, FAF showed predominantly hypoautofluorescent areas with minimal hyperautofluorescent spots in RE. We continued ATT in the continuation phase with slow taper of oral steroids. At last visit at 9 months, lesions had Figure 4: Fluorescein angiography in LE resolved with large areas of chorio- retinal atrophy and vision improved to 6/9p in RE and 6/18 in LE. Choroidal neovascular membrane was absent at the borders of the scar. 73rd AIOC 2015, New Delhi Figure 5: Colour fundus photograph and Figure 6: Colour fundus photograph and FAF at 1 week FAF at 2 weeks 1102 Figure 7: Colour fundus photograph and Figure 8: Colour fundus photograph and FAF at 6 weeks FAF at 14 weeks DIscussIon Serpiginous choroiditis is a bilateral, chronic and progressive disease of unknown etiology. The lesions involve the outer retina, choriocapillaries and large choroidal vessels. It affects healthy males aged between 30 and 70 years. There is no family history. An association with HLA-B7 has been reported. Three types of SC has been described; Classic or peri-papillary geographic serpiginous choroiditis, macular serpiginous choroiditis, ampiginous choroiditis. Fundus Autofluorescence (FAF) is a non-invasive imaging method for in vivo mapping of naturally or pathologically occurring fluorophores of the ocular fundus. FAF in early stages of the active lesion of serpiginous choroiditis shows hypoautofluorescence due to the masking effect by the deep retinal edema Uvea Free Papers on the normal RPE autofluorescence. After a few days (2-5 days) there is hyperautofluorescence which is due to hypertrophy and hyperplasia of RPE that causes accumulation of fluorophores. Healed lesions appear hypoautofluorescent due to RPE atrophy. In a healed lesion, if hyper- autofluorescent areas are seen in the margins of the hypoautofluorescent lesion it suggests reactivation. conclusIon FAF may be a useful tool for following up patients with SC. Autofluorescence can help to recognize activity or healing in SC. FAF can be repeated several times to monitor the response to treatment so that we can reserve other invasive techniques, such as FA, for cases with suspicious activity disclosed by FAF imaging (like CNVM). After initiation of ATT and steroids, when the size of the lesions increases due to paradoxical reaction, it merits use of hiked up steroids. RefeRences 1. Carreño E, Portero A, Herreras JM, López MI. Assesment of fundus autofluorescence in serpiginous and serpiginous-like choroidopathy. Eye 2012;26:1232-6. 2. Piccolino FC, Grosso A, Savini E. Fundus autofluorescence in serpiginous 1103 choroiditis. Graefes Arch Clin Exp Ophthalmol 2009;247:179-85. 3. Mirza RG, Jampol LM. White Spot Syndromes and Related Diseases. In: Ryan SJ, editor. Retina, 5th ed. New york: Elsevier; 2013. p. 1346-50. Role of Endoscopic Ultrasound Guided fnAc in confirming the Diagnosis of ocular Tuberculosis Dr. Deepa Sharma, Dr. Manisha Agarwal ntraocular tuberculosis presents with myriad of clinical presentations Iwith no definitive pathognomic features. A wide spectrum of clinical signs include anterior granulomatous uveitis, intermediate uveitis, vasculitis or choroiditis, choroidal granuloma and panuveitis. The differential diagnosis most commonly thought for granulomatous uveitis patients is tuberculosis or sarcoidosis. As the treatment differs between the two, it is important to confirm the diagnosis for appropriate management. 73rd AIOC 2015, New Delhi However, confirming the diagnosis of tubercular uveitis has always been a clinical challenge especially in a TB-endemic country like ours. The intraocular specimen is seldom available for definitive diagnosis, also low bacterial counts from these samples amount to negative acid fast bacillus smear examination. A further delay in starting the treatment occurs because of awaited culture report. As a result we often rely on indirect evidences like mantoux and chest X-ray findings. Sarcoidosis which was initially more common in the west is now increasingly being seen in our country presenting with a similar clinical and radiological picture. Therefore we carried out this study wherein a confirmed diagnosis is possible by doing fnac of mediastinal or paratracheal lymph nodes. This was routinely done by bronchoscopy which can cause several complications. In our study endoscopic ultrasound (EUS) was used to study the configuration of lymph nodes and further fine needle aspiration (EUS guided FNAC) was done to attain the tissue for confirming the diagnosis. MAterials AnD MethoDs It is a prospective clinical case series. 30 patients with diagnosis of uveitis, underwent clinical features suggestive of tubercular etiology were enrolled in the study and subjected to this extraocular imaging technique to confirm 1104 the diagnosis. The study was conducted at a tertiary care hospital where patients with
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