Subretinal fibrosis and uveitis syndrome associated with ulcerative colitis

Background and aims We report a case of subretinal fibrosis and panuveitis syndrome as an extraintestinal manifestation of ulcerative colitis. Materials and methods We present an interventional case report of a 40-year-old female patient with inactive ulcerative colitis referred to our center for refractory uveitis in her right eye. Results/findings She was diagnosed with subretinal fibrosis and uveitis syndrome after work-up ruled out tuberculosis, bartonellosis, Lyme disease, and sarcoidosis. Right eye multifocal choroiditis and panuveitis syndrome with subretinal fibrosis was diagnosed, and posterior pole subretinal fibrosis caused a 90% loss of visual efficiency. She had concurrent dermatological manifestations but no gastrointestinal symptoms. One year of immunosuppressive therapy with methotrexate (7.5 mg/week) controlled ocular inflammation. Two colitis episodes, with no visual involvement, were recorded during follow-up. Her final, right-eye, best-corrected visual acuity remained stable at 0.160 due to scarring sequela after 7 years of follow-up. Interpretation/Conclusion Subretinal fibrosis and uveitis syndrome can occur as a sight-threatening extraintestinal manifestation of ulcerative colitis. The authors declare having no proprietary interests.     

Clinical Profile,Treatment, and Visual Outcome of Serpiginous Choroiditis

The purpose of this study was to report the clinical profile and management of patients with serpiginous choroiditis in a tertiary care referral center in India. In a retrospective cohort study, 107 eyes of 70 patients with serpiginous choroiditis seen between January 1995 and December 2002 were analyzed. Systemic steroids and immunosuppressives were the mainstay of therapy. Antituberculous and antiviral drugs were used in selected cases. There was male preponderance (7:3). Age at presentation ranged from 11 years to 52 years (mean 30.3 ± 9 years); 52.9% had bilateral involvement. Vision improved or maintained in 86% eyes and deteriorated in 15 eyes (14%). The main cause of decrease of vision was macular involvement. Improvement in vision and resolution of lesions in patients with serpiginous choroiditis can occur with combination therapy of systemic steroids and immunosuppressive agents. Serial examination at regular intervals is needed to monitor the disease progression, recurrences, and involvement of the other eye.     

Presumed multifocal cryptococcol choroidopathy prior to specific systemic manifestation

Purpose: Disseminated cryptococcosis is a major cause of morbidity and mortality in immunocompromised individuals, especially those with the acquired immunodeficiency syndrome (AIDS). Early diagnosis and treatment greatly improves the outcome, so clinical clues that lead to prompt diagnosis are important. Methods: Three patients with AIDS in whom multifocal choroiditis and choroidal lesions were the initial signs of disseminated cryptococcosis were treated with systemic amphotericin B and flucytosine. All of the patients had a systemic work-up that included evaluation of the cerebral spinal fluid (CSF). Results: All three patients who were seen with the choroidal lesions as the presenting sign were noted to have either positive titers for cryptococcus or cultures that grew cryptococcus in the CSF. The choroidal lesions are presumed to be due to cryptococcus as no histopathologic or microscopic studies were available for ocular tissues. The choroidal lesions started to resolve one to three months after systemic treatment with amphotericin B and flucytosine. Conclusion: Primary choroidal lesions in patients with AIDS may herald severe systemic disseminated disease. Funduscopic examination, however, may detect disseminated cryptococcal disease before other overt clinical manifestations, thereby allowing prompt institution of effective therapy. This revised version was published online in September 2006 with corrections to the Cover Date.     

Choroidal tubercles with tuberculous meningitis

We found choroidal tubercles in two children with meningitis. This finding supposed an important clue in establishing a tuberculous etiology. Following, we discuss the evolution and fluorescein angiographie findings of choroidal tubercles. As many authors have remarked, a thorough fundus examination is of great value in cases of fever of undetermined origin and meningitis. Choroidal tubercles can also be the first sign of a common pulmonary or extrapulmonary tuberculosis.     

Intraocular coccidioidomycosis

A case of unsuccessfully treated coccidioidomycosis with intraocular manifestations is presented. Fever, skin lesions and a variety of constitutional symptoms dominated the clinical course. At autopsy there were extensive systemic dissemination and conspicuous intraocular lesions involving the uveal tract. The ocular and systemic features and the immunologic aspects of Coccidioidomycosis are discussed. Previously reported intraocular cases are reviewed and compared to our case.     

Serpiginous choroiditis

Serpiginous choroiditis is a rare, usually bilateral, chronic, progressive, recurrent inflammation of the choroid, retinal pigment epithelium, and choriocapillaris of unknown etiology. Based on clinical presentation, it can be classified into 1) peripapillary, 2) macular, and 3) ampiginous types. The clinical course, regardless of the presentation, is progressive with multiple recurrences leading to potentially significant visual loss. Visual outcome is directly related to the involvement of the para-fovea and fovea by the lesions or secondary choroidal neovascularization. The histological findings of the lesions are atrophy of the choriocapillaris, retinal pigment epithelium and photoreceptor cells, and moderate diffuse lymphocytic infiltrates throughout the choroid. Multiple etiologies including autoimmunity, infection, vasculopathy, and degeneration were proposed but none is well supported by clinical and laboratory evidence. Fluorescein and indocyanine green angiography have been useful in the assessment of the extent and the activity of lesions. Due to the insidious and progressive clinical course, an assessment of treatment outcomes needs long term follow-up. Currently, treatment with immunosuppressive and alkylating agents have shown possible efficacy in small case series. Larger clinical studies and interventional trials are required to further our understanding of the pathogenesis, etiology, and for the evaluation of treatment strategies.