To identify potential infectious agents in cases of seasonal hyperacute panuveitis syndrome (SHAPU) from vitreous biopsies of patients with this disorder. A retrospective cohort analysis. Vitreous biopsies were obtained during the course of care from 53 subjects with SHAPU. DNA extraction and whole genome shotgun sequencing was performed using Oxford Nanopore long read sequencing. Sequences were matched against microbial and human databases. Visual outcomes at presentation and at 6 months were recorded. Identification and characterization of metagenomic sequences in vitreous isolates from subjects with SHAPU. Adequate DNA for sequencing was obtained from 32 SHAPU subjects. Fifteen samples yielded bacteria on culture, with 14 S. pneumoniae and 1 S. aureus isolate recovered. Bacterial DNA was detected by whole genome sequencing in 29 of 32 cases. S. pneumoniae was the predominant organism recovered. Bacterial genomic loads ranged up to 10 000 bacteria/human cell, indicating active infection. No pathogens were detected in control samples. Reconstruction of bacterial genome was possible in 7 SHAPU cases and indicated diverse S. pneumoniae subtypes associated with individual cases. Sufficient DNA remained for analysis of torque teno virus by qualitative polymerase chain reaction in 17 cases, of which 13 were positive. Visual outcomes were mixed, with 7 patients having hypotonous eyes at 6 months, but 8 patients having better than 20/200 vision. No relationship could be discerned between presenting bacterial load and visual outcome. The majority of SHAPU cases show molecular evidence for concurrent S. pneumoniae infection. Good visual results are possible in treating SHAPU as endophthalmitis. The authors have no proprietary or commercial interest in any materials discussed in this article.

To determine whether baseline retinal and choriocapillaris (CC) vascular features measured by OCT angiography (OCTA) can predict diabetic retinopathy (DR) progression or visual acuity (VA) decline in a multiethnic longitudinal cohort. Prospective longitudinal cohort study. A total of 309 eyes from 192 patients with type 2 diabetes mellitus were recruited from a tertiary eye center in Singapore. All participants underwent 3 × 3 mm swept-source OCTA imaging at baseline. Quantitative vascular parameters-including vessel density (VD), perfusion density (PD), and CC flow deficit percentage-were obtained from the superficial and deep retinal layers and from the CC. Larger retinal arterioles and venules were analyzed separately from capillary networks. Diabetic retinopathy progression was defined as a ≥2-step increase on the ETDRS severity scale over 2 years, while VA decline was defined as >1-line reduction in best-corrected VA. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to evaluate predictive performance. Progression of DR and VA decline over 2 years, as predicted by baseline OCTA metrics. Over 2 years, 49 eyes (15.9%) demonstrated DR progression. Significant predictors in the superficial layer included larger foveal avascular zone (FAZ) area (odds ratio [OR] = 6.612; P = 0.034), longer perimeter (OR = 1.583; P = 0.002), poorer circularity (OR = 3.23; P = 0.019), higher large-vessel PD (OR = 1.561; P < 0.001) and VD (OR = 2.878; P < 0.001), and lower whole-vessel VD (OR = 0.798; P = 0.010). Adding FAZ perimeter and large-vessel VD improved prediction accuracy (AUC increased from 0.709-0.822). For VA loss, higher superficial large-vessel PD (OR = 1.609; P = 0.002) and lower capillary PD (OR 0.8; P = 0.010) were significant predictors, improving AUC from 0.602 to 0.702. Enlargement and irregularity of the FAZ, along with increased superficial large VD, independently predict DR progression. Incorporating FAZ and large-vessel OCTA parameters enhances prediction models for both DR worsening and vision decline in patients with diabetes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

To develop quantitative biomarkers that characterize the effect of upper eyelid motion (lid-wiper effect) during blinking on corneal epithelial thickness. A retrospective study analyzing corneal epithelium thickness maps through Zernike polynomial decomposition. Three hundred thirty-six maps from 135 healthy eyes of 69 subjects. A total of 5-mm diameter epithelial thickness maps were acquired using spectral-domain OCT. Maps from left eyes were mirror-imaged and pooled with right eyes for analysis. Zernike polynomial decomposition was performed, and average coefficients were obtained. The lowest-order Zernike terms with single-angle dependence-tilt and primary coma-were analyzed as vectors to determine the lid-wiper axes. The lid-wiper gradient (μm/mm) and lid-wiper coma (μm) were calculated by projecting the tilt and coma vectors along their lid-wiper axes. Correlation analysis was performed between the lid-wiper gradient and lid-wiper coma, primary astigmatism, and higher-order aberrations. The lid-wiper gradient and lid-wiper coma, which are quantitative biomarkers of epithelial remodeling in response to the lid-wiper effect. The average epithelial thickness map showed superotemporal thinning with relative inferonasal thickening. Average tilt and coma coefficients were nonzero (P = 0.004 to <0.001). The population centroids (mean ± standard deviation) of the lid-wiper gradient and lid-wiper coma were 0.51 ± 0.57 μm/mm at 298.06 ± 56˚, and 0.21 ± 0.55 μm at 311.59 ± 83.53˚, respectively. The lid-wiper gradient and coma were positively correlated with each other (R 2 = 0.08, P = 0.001). A significant epithelial thickness gradient exists in the average normal cornea, consistent with eyelid blink dynamics described in the literature. The significant but weak correlation between the lid-wiper gradient and coma suggests the lid-wiper effect may be among various factors contributing to higher-order aberrations in the epithelium. The lid-wiper gradient and coma may serve as quantitative biomarkers of epithelial remodeling in response to the lid-wiper effect. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.