Introduction: This is a retrospective case report of atypical acute retinal necrosis (ARN), describing a rare presentation of ARN in an immunocompetent adult, with choroidal, optic nerve, and orbital inflammation with exudative retinal detachment (ERD), complicated by early rhegmatogenous retinal detachment (RRD). Case report: Examination revealed right eye granulomatous panuveitis, including granulomatous anterior chamber inflammation, dense vitreous haze, and peripheral necrotizing hemorrhagic retinitis. Optical coherence tomography (OCT) showed inner retinal hyperreflectivity, thickened choroid, and ERD. Magnetic resonance imaging (MRI) confirmed inflammation of the optic nerve sheath and orbital tissues. Polymerase chain reaction (PCR) confirmed varicella-zoster virus (VZV) infection. Left eye showed an old peripheral chorioretinal scar. Patient received systemic acyclovir, oral trimethoprim-sulfamethoxazole, along with systemic corticosteroids and intravitreal ganciclovir. Final resolution of ERD and improvement in orbital and intraocular inflammation were observed. The patient subsequently developed early RRD, managed by pars plana vitrectomy (PPV) and silicone oil tamponade. Despite structural stabilization, visual recovery was limited due to late presentation, optic nerve, and choroidal involvement. Systemic investigations excluded alternative causes. Conclusions: ARN with concurrent panocular inflammation, choroidal, and optic nerve involvement is uncommon and may indicate a more aggressive disease course, often associated with poor visual prognosis. This case highlights that ARN with choroidal and optic nerve involvement may follow an aggressive course, requiring early PCR confirmation, intensive antiviral therapy, and timely surgical intervention to prevent severe visual loss

Adalimumab, Anakinra and Tocilizumab in patients with non-infectious Uveitis: A multicenter randomized controlled trial.

Reproductive Life Stages and Female Sex-Specific Patterns in Uveitis Activity: Data From the AIDA Network Uveitis Registry.

Evaluating the Effectiveness of Escalating to Weekly Adalimumab Dosing for the Treatment of Noninfectious Uveitis: A Multicenter Study.

OCT-Based Evaluation of Vitreous Haze in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial

Background: Non-infectious uveitis is commonly treated with corticosteroids, immunosuppressants, and, recently, TNF inhibitors. However, some patients do not achieve adequate control of uveitis with these drugs. This report presents a case of panuveitis associated with spondyloarthritis (SpA) in which both TNF and interleukin-17 (IL-17) inhibitors failed to control uveitis, but tofacitinib, a Janus kinase (JAK) inhibitor, was effective in treating uveitis. Case presentation: A 54-year-old woman visited our hospital with a complaint of blurred vision in her left eye. A small retinal exudate in the inferonasal region in the right eye and 2+ vitreous haze in the left eye were seen. Systemic examinations were performed, but no abnormal findings were detected. The patient subsequently had frequent ocular inflammatory recurrences; thus, Behçet’s disease was suspected, although no characteristic extraocular symptoms were noted. In addition to colchicine, adalimumab was administered, but the patient still showed frequent ocular inflammatory attacks. The patient subsequently developed arthritis and was diagnosed with axial SpA. Despite treatment with infliximab (TNF alpha inhibitor) in or secukinumab (IL-17 inhibitor), ocular inflammatory attacks persisted, resulting in decreased visual acuity attributed to complicated cataracts. After cataract surgery, oral tofacitinib, a JAK inhibitor, was initiated. Afterward, ocular attacks did not occur for more than three years, and her visual acuity remained at 1.0 in both eyes. Conclusions: We examined a case of panuveitis with coexisiting SpA refractory to TNF inhibitor and IL-17 inhibitor, in which JAK inhibitor was successfully effective. JAK inhibitors may be useful for some patients with refractory uveitis.

To compare the characteristics of pediatric patients with pars planitis (PP) who received treatment versus those who were observed without treatment. Retrospective chart review of pediatric patients diagnosed with pars planitis at a tertiary referral center from 2000 to 2024. Out of 158 eyes from 84 patients with PP, 127 (80.4%) eyes received treatment, and 31 (19.6%) eyes were observed. Eyes that were observed presented with less anterior chamber cell (p<0.007), vitreous cell (p=0.0005), vitreous haze (p=0.003), and optic nerve head edema (p=0.03). The untreated group had significantly lower total fluorescein angiography (FA) scores (p<0.0001) than the treated group and specifically scored lower in disc leakage (p=0.006) and retinal capillary leakage (p<0.0001). In the treated group, 66 (52%) eyes developed ocular hypertension and 24 (18.9%) developed glaucoma, whereas the untreated group had no cases of either. Final visual acuity was similar between treated and untreated groups (20/32 vs 20/25, p=0.13), and no untreated eyes developed complications requiring surgery. Not all patients with pediatric PP require treatment. Select mild cases may be safely observed without developing sequelae of chronic inflammation. Proper identification of these patients can reduce side effects and medication burden.

Background/Objectives: Vogt–Koyanagi–Harada (VKH) disease is a bilateral granulomatous panuveitis that can progress to a chronic, relapsing phase. Patients refractory or intolerant to systemic corticosteroids and conventional immunomodulatory therapy pose a major therapeutic challenge, as persistent inflammation can lead to cumulative ocular damage and permanent vision loss. This study assessed the efficacy of tumor necrosis factor-α (TNF-α) inhibitor adalimumab in chronic recurrent VKH disease. Methods: We retrospectively reviewed 16 eyes from 8 patients with chronic recurrent VKH disease who had persistent inflammation despite treatment with corticosteroids and conventional immunomodulatory therapy, and subsequently received adalimumab. Primary outcomes were changes in subfoveal choroidal thickness (SFCT) and systemic corticosteroid dose reduction. Secondary outcomes included visual acuity, inflammatory parameters (anterior chamber cell, flare, and vitreous haze), and central macular thickness (CMT). All outcomes were compared between baseline and 6 months after adalimumab initiation using the Wilcoxon signed-rank test. Results: Mean patient age was 47.6 years and mean follow-up was 31.8 months. SFCT decreased from 326.7 ± 129.1 µm to 231.6 ± 72.9 µm at 6 months (p < 0.001). Systemic steroid dose decreased from 14.7 ± 14.0 mg to 4.1 ± 3.8 mg (p = 0.027). Mean annualized relapse rate decreased from 3.61 to 0.08 episodes/year (p = 0.012). Anterior chamber cell grade decreased from 0.81 ± 0.66 to 0.09 ± 0.20 (p < 0.001). Visual acuity, flare, vitreous haze, and CMT showed no significant change. No serious adverse events occurred. Conclusions: TNF-α inhibition with adalimumab appears effective as steroid-sparing therapy for controlling recurrent inflammation and reducing steroid dependence in patients with chronic recurrent VKH disease refractory to conventional treatment.

To highlight the diagnostic and therapeutic challenges of endogenous candida endophthalmitis in a preterm neonate with aggressive retinopathy of prematurity (A-ROP) and to emphasize the role of multimodal imaging in achieving accurate diagnosis and successful management. We report a case of a preterm infant with A-ROP who presented with yellowish-white macular lesions and vitreous opacities. The initial clinical impression was ocular toxoplasmosis. However, a diagnostic dilemma arose between toxoplasmosis and fungal endogenous endophthalmitis. Optical coherence tomography (OCT) findings and systemic evaluation ultimately supported a diagnosis of Candida endophthalmitis. The infant was treated with intravitreal voriconazole and systemic antifungal therapy. Multimodal imaging, including ultrawide-field fundus photography and OCT, revealed features consistent with fungal chorioretinitis. Notably, OCT demonstrated the characteristic "rain cloud sign," supporting the diagnosis of fungal endophthalmitis. Following three doses of intravitreal voriconazole, there was marked regression of the retinal lesions and complete resolution of the vitreous haze. Endogenous Candida endophthalmitis should be considered in preterm infants with systemic risk factors and posterior segment involvement. Multimodal imaging especially OCT is pivotal in resolving diagnostic dilemmas, distinguishing fungal infections from other differentials such as toxoplasmosis, and monitoring therapeutic response.

Background/Objectives: To evaluate the real-world efficacy and safety of switching from adalimumab originator (Humira®, AbbVie) to SB5 biosimilar (Adalloce®, Samsung Bioepis) in patients with noninfectious uveitis. Methods: This retrospective study included 18 patients (32 eyes) who switched from adalimumab originator to SB5 for nonmedical reasons with at least 6 months follow-up. Clinical outcomes-best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber (AC) cell grade, vitreous haze grade, central macular thickness (CMT), and macular volume (MV)-were assessed at baseline and 2, 4, and 6 months post-switch. Ultra-widefield fluorescein angiography (UWFA) findings were compared at approximately 4 months. Pre- versus post-switch comparisons employed Wilcoxon signed-rank tests. Results: Mean patient age was 45.7 ± 13.4 years, with mean follow-up of 16.8 ± 5.9 (range, 9-29) months. No significant changes were observed in BCVA, IOP, AC cell grade, vitreous haze grade, CMT, or MV at any timepoint versus baseline (all p > 0.05). No uveitis recurrence occurred based on predefined criteria including AC cell grade, vitreous haze grade, BCVA, and UWFA findings. Five patients (28%) re-switched to the originator after a mean of 24 (range, 4-64) weeks due to injection-site discomfort (n = 2) or extremity rashes (n = 3). No other adverse events were observed. Conclusions: Switching from adalimumab originator to SB5 biosimilar maintained clinical stability with comparable efficacy and safety in patients with noninfectious uveitis, supporting its use as a cost-effective alternative.

This study aims to document a rare and aggressive instance of Aspergillus endophthalmitis following phacoemulsification, emphasizing the diagnostic complexities, therapeutic constraints, and clinical prognosis associated with this condition. A 76-year-old male patient presented to our institution on postoperative day 5 (POD 5) following cataract surgery, manifesting acute-onset right ocular pain accompanied by substantial visual impairment that had developed on POD 4. Comprehensive clinical evaluation revealed severe anterior chamber inflammation, hypopyon, and vitreous haze. An emergency pars plana vitrectomy was performed, accompanied by scleral-fixated intraocular lens (IOL) implantation. Vitreous samples were collected for microbiological analysis. Microbiological culture of the vitreous specimen confirmed the presence of Aspergillus species. The patient was subsequently treated with a multimodal antifungal regimen, including systemic voriconazole, intracameral irrigations, and topical antifungal agents. Despite these aggressive therapeutic measures, the infection progressed to no light perception vision, necessitating enucleation due to unrelenting pain and inflammation. Histopathological examination revealed extensive necrotic inflammatory changes. This case highlights the aggressive pathogenesis of Aspergillus endophthalmitis, its limited responsiveness to conventional therapeutic interventions, and the critical importance of early suspicion of fungal etiology in postoperative infections.

ABSTRACT Purpose Acute retinal necrosis (ARN) is a severe and vision-threatening complication of herpesvirus infection, characterized by rapid progression and significant visual morbidity. While intravenous acyclovir remains the cornerstone treatment, adjunctive therapies such as intravitreal antivirals and surgical interventions may reduce complications. Methods This retrospective study analyzed 18 ARN cases from two reference hospitals in São Paulo, Brazil, over a seven-year period (2017–2024). Results The cohort primarily consisted of female patients (57.9%), with a mean age of 51.4 years. The majority (83.3%) were immunocompetent and 94.4% had unilateral initial manifestation. Retinal detachment was the most common complication, occurring in 50% of cases, followed by vitreous haze (11.1%) and phthisis bulbi (11.1%). Visual acuity (VA) outcomes were generally poor, with 61.1% of patients experiencing deterioration, 27.8% showing improvement, and only 11.1% maintaining their initial VA. The mean initial VA was < 20/200, emphasizing the severity of disease presentation and the consequences of delayed diagnosis and referral. Conclusion In this case series, ARN occurred predominantly in immunocompetent individuals and carried a high risk of retinal detachment, further complicating visual prognosis. The high rate of retinal detachment observed, despite standard antiviral therapy, raises the possibility that delays in diagnosis or referral may have influenced outcomes. Further research is warranted to optimize treatment protocols for this rare yet devastating condition, particularly in mitigating the risk of retinal detachment and improving long-term visual outcomes.

ABSTRACT Purpose To characterize the course of uveitis in ulcerative colitis (UC) patients following colectomy and assess whether uveitis activity arises and/or persists independently of colonic disease. Methods This is a retrospective case series from a tertiary uveitis referral center. Patients with non-infectious uveitis, a confirmed diagnosis of UC, and a history of colectomy were included. Clinical data were extracted, including demographics, ocular history, treatment regimens, and disease activity. Uveitis flares were defined as the presence of at least 1+ cells or flare in the anterior chamber, 1+ vitreous cells and/or haze or angiographic evidence of active inflammation as noted by the investigators. Results We identified 73 patients with UC-associated uveitis and 11 had a history of colectomy. Post-colectomy uveitis flares occurred in all 11 patients. Notably, eight patients experienced de novo uveitis activity following their colectomy. The remaining three uveitis patients had documented uveitis flares prior to colectomy. A total of 25 flares were documented, including multiple recurrences in three patients. One patient experienced 13 flares and ultimately required enucleation. Excluding this difficult case, patients with long-term follow-up (≥1 year) generally responded to topical steroid therapy. However, several flares occurred despite concurrent immunomodulatory therapy. Conclusion This case series highlights that uveitis flares may persist or recur following colectomy in UC patients, supporting the hypothesis that uveitis activity can occur independently of intestinal inflammation. These findings support the need for continued ophthalmologic surveillance in UC patients post-colectomy.

Guidelines for the Diagnosis, Management, and Study of Autoimmune Retinopathy from the American Academy of Ophthalmology's Task Force.

Advances in imaging retinal inflammation.

We developed and evaluated machine learning models for predicting the risk of recurrent uveitis using baseline clinical characteristics, to inform clinical decision-making and risk stratification. A retrospective analysis was conducted using the Ocular Autoimmune Systemic Inflammatory Infectious Study registry, including 966 patients (1432 eyes) with uveitis. Three machine learning classifiers-random Forest, eXtreme Gradient Boosting, and radial basis function support vector classifier-were trained on preprocessed baseline demographic and clinical data. Predictors were selected through bivariate analysis with false discovery rate correction. Models were optimized using grid search with five-fold stratified cross-validation. Performance was evaluated on a hold-out test set using accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and Shapley additive explanations values for feature importance. The random Forest model achieved the highest test accuracy (0.77), with high specificity (0.93) but modest sensitivity (0.44) for identifying recurrences. eXtreme Gradient Boosting and radial basis function support vector classifier showed comparable accuracies (0.73 and 0.74, respectively) but slightly lower sensitivities. Shapley additive explanation analysis identified vitreous haze, retrolental cells, and noninfectious etiology as key predictors. Learning curves indicated that model performance stabilized with the available sample size, suggesting adequate training data. Machine learning models, particularly random Forest, effectively identified patients at low risk of uveitis recurrence, offering high specificity. However, sensitivity remained limited, highlighting challenges in predicting infrequent events in a heterogeneous disease population.

This study evaluated functional and inflammatory outcomes after pars plana vitrectomy (PPV) in patients with persistent vitreous opacities due to infectious and noninfectious uveitis unresponsive to medical therapy. Twenty-three eyes with noninfectious uveitis and 16 eyes with infectious uveitis were enrolled. Functional and inflammatory parameters were assessed, focusing on best-corrected visual acuity (BCVA), vitreous haze, and inflammation. At 6 months, both vitreous haze and anterior chamber inflammation decreased from severe to minimal levels. BCVA improved in 28 eyes (71.8%), remained stable in five eyes (12.8%), and worsened in six eyes (15.4%). Linear regression analysis showed that preoperative BCVA significantly predicted visual improvement (coefficient = 0.60, 95% confidence interval [CI]: 0.22-0.98, P = 0.003), while etiology (P = 0.217) and lens status (P = 0.201) were not significant factors (R2 = 0.34). Elevated intraocular pressure occurred in five patients, with two requiring trabeculectomy after 3 months. In two cases, epiretinal membrane formation progressed to tractional retinal detachment within 6 months. PPV is an effective treatment for persistent vitreous opacities, resulting in visual improvement and stabilization of inflammation. Postoperative follow-up is necessary due to potential complications and recurrence.

ABSTRACT Purpose To compare the clinical effectiveness and safety of subcutaneous adalimumab (SCA) versus intravitreal adalimumab (IVA) in treating active non-infectious uveitis (NIU). Methods This single-center, phase 2 non-inferiority randomized controlled trial included patients with active NIU assigned to receive either SCA (80 mg loading dose, then 40 mg every 2 weeks) or IVA (1.5 mg at baseline, then every 4 weeks). Follow-ups occurred weekly for the first 2 weeks, then every 4 weeks until 26 weeks. Primary outcomes were changes in anterior chamber cell (AC) and vitreous haze (VH) grades at 26 weeks (non-inferiority margin: 0.5). Secondary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), fluorescein angiography (FA) score, and oral prednisone dose. Results A total of 23 patients (43 eyes) were randomized into the SCA (n = 12) or IVA (n = 11) treatment group. IVA was found to be non-inferior to SCA. The upper limit of the 90% confidence interval (CI) for the difference in AC grade change (−0.33 [−0.79 to 0.38], p = 0.440) and VH grade change (−0.34 [−1.15 to 0.47], p = 0.490) remained below the noninferiority margin of + 0.5 grade. No significant differences were found between the two treatment groups for secondary outcomes, including changes in BCVA (p = 0.594), CRT (p = 0.607), FA score (p = 0.318), and oral prednisone dose (p = 0.881). No serious systemic or ocular adverse events (AE) were observed. SCA resulted in a higher number of non-serious systemic AE (21) compared to IVA (5). Conclusions IVA was non-inferior to SCA in treating active NIU and resulted in fewer systemic adverse events.

EndoArt is an artificial endothelial layer device for the management of chronic corneal edema in cases with multiple corneal failed transplants, aiming to restore corneal deturgescence and optical clarity. However, postoperative complications, such as endophthalmitis, remain a significant risk. We report the first case of EndoArt-associated endophthalmitis, although a direct causual link remains uncertain. A 75-year-old woman presented with increasing floaters in the left eye 7 months after EndoArt implantation for corneal endothelial dysfunction following multiple graft failures. At presentation, the best-corrected visual acuity (BCVA) was counting fingers, without ocular pain. Slitlamp examination showed noninjected conjunctiva and well-positioned corneal implant with mild corneal edema. B-scan ultrasonography revealed mild vitreous haze, flat retina. Six weeks before, a corneal transfixing single suture was removed. Right eye was unremarkable. The following day, BCVA in the left eye worsened with the appearance of stromal infiltrate, anterior chamber fibrin, and hypopyon, increased vitreous opacification and vitreous strands, leading to diagnosis of endophthalmitis. The patient underwent prompt vitrectomy, revealing purulent vitreous infiltration and hemorrhagic chorioretinitis. The EndoArt was not removed, as not directly involved in the infection. Staphylococcus epidermidis was identified in the aqueous and vitreous humors. Postoperative local and systemic antibiotics led to a gradual resolution of inflammation. At 2-month follow-up, the BCVA improved to 20/400. This case describes the atypical clinical appearance and the rapid progression of endophthalmitis in a patient with EndoArt. Prompt vitrectomy and a conservative approach, with EndoArt retention, led to infection resolution and preserved corneal clarity. Vigilance, early diagnosis, and a tailored surgical approach are crucial to improving outcomes after artificial corneal endothelial implantation. Here the artifcial corneal endothelium implantation may have helped preserve cornea clarity during endophthalmitis, enably timely vitrectomy and contribuiting to a favorable outcome.

To report a case of early-onset blebitis following Preserflo MicroShunt implantation. Case report. A 73-year-old woman with a history of open angle glaucoma secondary to pseudoexfoliative syndrome in her right eye underwent Preserflo MicroShunt implantation augmented with mitomycin C. Three months postoperatively, she experienced ocular pain and a decrease in visual acuity. Clinical examination revealed conjunctival hyperemia surrounding a whitish filtering bleb, positive conjunctival fluorescein staining, and a positive Seidel sign leading to hypotony. In addition, an inflammatory reaction was observed in the anterior chamber, along with localized vitreous haze. Management included topical antibiotic therapy, removal of necrotic tissue, and explantation of the Preserflo MicroShunt. Staphylococcus capitis was isolated from both conjunctival and implant cultures, confirming the clinical diagnosis of infectious blebitis. Intraocular pressure and visual function were successfully restored after surgery. Blebitis is a rare but potentially serious complication following Preserflo MicroShunt implantation with mitomycin C. Device removal may be necessary to prevent bacterial infection from extending beyond the filtering bleb into the anterior chamber.