An imaging-based treatment algorithm for posterior focal retinitis

Chawla, Rohan; Tripathy, Koushik; Temkar, Shreyas; Venkatesh, Pradeep; Kumar, Atul

doi:10.1177/2515841418774423

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…We use clinical and imaging characteristics to differentiate between these three types of retinitis as described in an earlier paper of ours. 23 Further randomized comparative clinical trials, with a larger sample size, may be necessary for substantiating a standard treatment protocol.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis

Chawla

Balaji

et al. 2020

Ophthalmol Eye Dis

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Objectives: To study the clinical features, optical coherence tomography (OCT) findings, treatment options and follow-up outcomes of post-fever retinitis (PFR). Subjects: A total of 19 eyes of 13 patients, diagnosed with PFR (retinitis following febrile episode) over 2 years were retrospectively studied. Methods: Documented history, baseline clinical features and systemic investigations performed for PFR were reviewed. Fundus findings, foveal architecture on swept-source OCT, the treatment options and the follow-up outcomes including best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were reviewed and analyzed. Results: Common fundus findings included whitish retinitis lesions (100%), macular star (95%, 18eyes), retinal flame-shaped hemorrhages (63%, 12 eyes), inflammatory retinal vessels (30%, 6 eyes), vitreous hemorrhage (one eye) and OCT findings included neuro-sensory detachment (79%, 15 eyes), intraretinal white dots (89.5%,17 eyes). The baseline median log MAR BCVA and CFT were 1.30 (interquartile range (IQR):0.8–1.8) and 423 microns (IQR:182–555). Overall, nine patients (12 eyes) received a combination of oral doxycycline and oral steroids and four patients (7 eyes) received a combination of oral doxycycline, oral steroid and intravitreal anti-vascular endothelial growth factor (IVA). Significant improvement was evident at 8 weeks in median BCVA (0.50, IQR: 0.3–0.8, p < 0.05) and median CFT (223 micron, IQR: 170–256, p < 0.05) though only 26% (5 eyes) attained BCVA > = 6/12. Conclusion: Our study puts forth certain characteristic fundus and OCT features of PFR. A combination of oral doxycycline and oral steroids as a treatment option showed improvement in BCVA and CFT. Additional IVA helps in faster visual recovery in patients presenting with severe macular edema at onset.

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Section: Discussionmentioning

confidence: 99%

Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis

Chawla

Balaji

et al. 2020

Ophthalmol Eye Dis

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“…A small, fast-growing white retinal lesion with diffuse borders should alert the clinician to the possibility of focal retinitis [4]. The most common cause of focal retinitis is Toxoplasma gondii infection; however, other less common causes should be kept in the differential and ruled out according to the patient's history and review of systems.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Focal Retinitis as an Initial Manifestation of Cat-Scratch Disease

Santos¹,

Rodríguez²,

Figueroa³

et al. 2022

Cureus

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We report on a case of focal retinitis as the initial manifestation of cat-scratch disease. A 56-year-old Hispanic woman presented for a routine follow-up examination. A fundus examination of the right eye revealed a white retinal lesion along the inferotemporal artery; this lesion was noted to have progressed after one week of observation. On further inquiry, the patient reported she had seven cats at home, some of which were less than six months old and had recently scratched her. She received empirical treatment for focal retinitis with azithromycin (500 mg daily) and valacyclovir (1 g three times daily), which would cover the most common parasitic, viral, and bacterial etiologies. She was lost to a follow-up examination. However, she continued the same dose of antibiotic and antiviral treatment. Upon her eventual follow-up, three months later, it was noted that the lesion had resolved. The initial work-up revealed that she was positive for Bartonella henselae IgM (1:20) and IgG (1:512), as well as for B. quintana IgG (1:256); however, she was negative for B. quintana IgM. At a four-month follow-up appointment, the B. henselae IgM was negative, the IgG had decreased from 1:512 to 1:64, and the B. quintana antibody test was negative for IgM and IgG, all of which are consistent with an adequately treated case of cat-scratch disease. Focal retinitis can be a rare initial manifestation of cat-scratch disease, which should be considered part of the differential diagnosis in cases of focal retinitis, especially in patients with a history of close contact with young cats. Additionally, oral azithromycin may be considered as a treatment for some cases of cat-scratch-associated focal retinitis.

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