ABSTRACT Purpose To differentiate the clinical features of fungal keratitis with predominantly deep stromal and endothelial (FSKE) involvement and HSV Endothelial Keratitis (HEK). Methods Medical records of patients diagnosed with FSKE or HEK between January 2019 and March 2024 were reviewed. We included cases presenting with predominant posterior stromal infiltrates and endothelial exudates that were later confirmed as fungal etiology by microbiology or confocal imaging. These were compared with confirmed HSV endothelial keratitis, diagnosed clinically and/or by PCR (Polymerase Chain Reaction). Results A total of 77 cases were included in the study, of which 45 were of FSKE and 32 of HEK. Hyphate edges, along with satellite lesions and the presence of hypopyon, are more commonly seen in fungal cases (66.6% (FSKE) vs. 3.1%, (HEK) OR = 62.0, p = .0001). Posterior stromal involvement was also significantly higher in fungal cases (46.6% vs. 8.8%, OR = 9.4, p = .001). Exudates over the endothelial surface (Endo-exudates) were defined as fluffy in cases with Fungal keratitis as opposed to HSV, where they were more of multiple dot-like (OR = 4.1, p = .005). An intact epithelium was more frequently noted in HEK (84.3% vs. 60% in FSKE, OR = 3.5, p = .02), with the presence of corneal oedema (46.8% vs. 13.3%, OR = 5.7, p = .001). Sampling of these endo-exudates revealed the presence of fungal filaments in 88.8% of fungal keratitis. Conclusions Hyphate edges, satellite lesions, hypopyon, fluffy endothelial exudates, and posterior stromal involvement strongly suggest fungal aetiology, whereas intact epithelium, corneal edema, and dot-like endothelial exudates favour HSV.

ABSTRACT Purpose The benefits of anti-tubercular therapy (ATT) in treating ocular tuberculosis (TB) are well documented. However, the optimal duration of ATT remains uncertain. We assessed the efficacy of 6-month ATT compared to 9-month therapy in preventing recurrent intraocular inflammation. Design Multi-center, open-label, non-inferiority, randomized controlled trial across three centers in India, Myanmar, and Thailand. Methods Patients aged ≥ 18 years with tubercular posterior uveitis (retinal vasculitis, serpiginous-like choroiditis [SLC] or multifocal choroiditis) were randomized to receive either 6- or 9-month ATT. Systemic corticosteroids were mandatory for SLC and, at the treating physician’s discretion, for other phenotypes. The primary outcome measure was the non-recurrence of inflammation 1 year after ATT. Results Sixty-four patients (64.1% males, median age 38 years [22–70], 43.8% bilateral) were randomized across the three sites during the study period. Thirty patients were assigned to the 6-month arm and 34 to the 9-month arm. Both treatments demonstrated a high non-recurrence rate on intention-to-treat (ITT) analysis (0.94 [0.79–0.99] for 9-month [n = 32] and 0.85 [0.65–0.96] for 6-month treatment [n = 26]). The difference in proportion remained below the non-inferiority margin (0.16) for both the ITT (0.09 [84% CI −0.02 – 0.2]) and per-protocol (0.13 [84% CI 0.01 – 0.25]) analyses. In subgroup analysis, retinal vasculitis appeared to favor 6-month ATT, and SLC 9-months, with the confidence intervals not deviating on bootstrap resampling. No discontinuation due to drug toxicity was reported in either group. Conclusion Six-month ATT is non-inferior to 9-month ATT for treating tubercular posterior uveitis, though it may vary between the different clinical phenotypes.

ABSTRACT Introduction: Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune condition characterized by recurrent conjunctival inflammation and progressive cicatrization, affecting nearly 70% of mucous membrane pemphigoid patients and potentially leading to blindness. Literature suggests an association between OCP and malignancy. Methods: This case series reports on 10 clinically diagnosed OCP patients with solid malignancies seen at the Illinois Eye and Ear Infirmary between January 2019 and January 2025. In addition, a review of current literature on the association between OCP and cancer was conducted using MEDLINE and Google Scholar databases. Results: Six patients had an OCP diagnosis before their cancer diagnosis, three had a cancer diagnosis prior to OCP diagnosis, and one had both simultaneously. Patients diagnosed with cancer after OCP experienced clinically worsening OCP, while those with prior cancer diagnosis had stable OCP. Discussions: Given the potential association with malignancy, patients with OCP or cicatricial conjunctivitis should undergo thorough systemic histories, age-appropriate cancer screenings, and patient education within a multidisciplinary care model to optimize early screening and improve the ocular and overall health outcomes.

ABSTRACT Background Intraocular tuberculosis (OTb) is a sight-threatening manifestation of Mycobaterium tuberculosis infection. It is characterized by a wide spectrum of clinical phenotypes, including anterior uveitis, posterior uveitis, retinal vasculitis, and choroiditis. Diagnosis remains challenging due to its diverse clinical presentations and the absence of standardized criteria. This review summarizes current knowledge on the clinical spectrum, diagnostic modalities, and emerging management strategies for OTb. Methods A comprehensive systemic literature search was conducted on Medline and PubMed to identify relevant studies on ocular tuberculosis. Results Key diagnostic tools include optical coherence tomography (OCT), fluorescein angiography (FA), interferon-gamma release assays (IGRA), polymerase chain reaction (PCR), and high-resolution computerized tomography (HRCT). Management typically involves a combination of anti-tuberculosis therapy (ATT) and corticosteroids, although optimal treatment regimens remain a topic of ongoing debate. Emerging challenges in treatment include paradoxical worsening, drug resistance, and corticosteroid dependency. Recent advancements, such as intravitreal anti-VEGF agents, moxifloxacin, and immunomodulatory therapy, have shown promise in refractory cases. Conclusion A multidisciplinary approach is essential for the timely diagnosis, individualized treatment, and improved visual outcomes in patients with intraocular tuberculosis.