The Experts below are selected from a list of 1032 Experts worldwide ranked by ideXlab platform
Amod Gupta - One of the best experts on this subject based on the ideXlab platform.
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collaborative ocular tuberculosis study consensus guidelines on the management of tubercular uveitis report 1 guidelines for initiating antitubercular therapy in tubercular Choroiditis
Ophthalmology, 2021Co-Authors: Rupesh Agrawal, Aniruddha Agarwal, Amod Gupta, Ilaria Testi, Sarakshi Mahajan, Yew Sen Yuen, Onn Min Kon, Talin Barisaniasenbauer, John H Kempen, Douglas A JabsAbstract:Topic An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular Choroiditis. Clinical relevance The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. Methods An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular Choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular Choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like Choroiditis, tuberculoma, and tubercular focal or multifocal Choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Results Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular Choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular Choroiditis. Experts agreed on initiating ATT in tubercular Choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like Choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Discussion Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular Choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
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Enigma of serpiginous Choroiditis.
Indian journal of ophthalmology, 2019Co-Authors: Parthopratim Dutta Majumder, Jyotirmay Biswas, Amod GuptaAbstract:Serpiginous Choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like Choroiditis (SLC) and multifocal serpiginoid Choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with Choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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enhanced depth imaging by high resolution spectral domain optical coherence tomography in tubercular multifocal serpiginoid Choroiditis
Ocular Immunology and Inflammation, 2019Co-Authors: Bruttendu Moharana, Vishali Gupta, Reema Bansal, Aman Sharma, Ramandeep Singh, Amod GuptaAbstract:ABSTRACTPurpose: To report the choroidal changes by enhanced depth imaging optical coherence tomography (EDI-OCT) in tubercular multifocal serpiginoid Choroiditis (MSC).Methods: Prospective study o...
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the creeping choroiditides serpiginous and multifocal serpiginoid Choroiditis
Ocular Immunology and Inflammation, 2014Co-Authors: Emmett T Cunningham, Amod Gupta, Manfred ZierhutAbstract:Serpiginous Choroiditis (SC),1–3 also known as geographic Choroiditis, geographic choroidopathy, geographic helicoid peripapillary choroidopathy, and helicoid peripapillary chorioretinal degenerati...
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dark spot in fibrinous central serous chorioretinopathy masquerading Choroiditis
Ocular Immunology and Inflammation, 2013Co-Authors: Swapnil Parchand, Vishali Gupta, Amod Gupta, Mohit Dogra, Ramandeep Singh, Aman SharmaAbstract:AbstractPurpose: The authors observed that eyes with acute fibrinous central serous chorioretinopathy (CSC) masquerading active Choroiditis had a “dark spot” within the yellow fibrinous deposit. The present study aims to describe this sign as a clinical indicator of acute serofibrinous exudative detachment, thus helping to differentiate it from active Choroiditis.Method: The authors retrospectively reviewed the records of 19 patients of fibrinous CSC masquerading active Choroiditis. Color fundus photographs, fundus fluorescein angiogram (FFA), and optical coherence tomography (OCT) at baseline and follow-up were studied for a dark spot. The systemic steroids were stopped and all patients were followed up.Results: There were 12 men and 7 women with a mean age of 39.8 years. Fourteen patients had received systemic steroids. Funduscopy revealed creamy yellow subretinal lesion/s simulating active Choroiditis lesion in all eyes and exudative retinal detachment in 9 eyes. The dark spot was seen as a round, gray...
Vishali Gupta - One of the best experts on this subject based on the ideXlab platform.
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ultra wide field imaging in paradoxical worsening of tubercular multifocal serpiginoid Choroiditis after the initiation of anti tubercular therapy
Ocular Immunology and Inflammation, 2019Co-Authors: Kanika Aggarwal, Aniruddha Agarwal, Reema Bansal, Aman Sharma, Mangat R Dogra, Ramandeep Singh, Ankit Deokar, Kusum Sharma, Vishali GuptaAbstract:Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid Choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of Choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional Choroiditis lesions, PW and altering the course of therapy in TB MSC.
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enhanced depth imaging by high resolution spectral domain optical coherence tomography in tubercular multifocal serpiginoid Choroiditis
Ocular Immunology and Inflammation, 2019Co-Authors: Bruttendu Moharana, Vishali Gupta, Reema Bansal, Aman Sharma, Ramandeep Singh, Amod GuptaAbstract:ABSTRACTPurpose: To report the choroidal changes by enhanced depth imaging optical coherence tomography (EDI-OCT) in tubercular multifocal serpiginoid Choroiditis (MSC).Methods: Prospective study o...
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An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management
Journal of Ophthalmic Inflammation and Infection, 2018Co-Authors: Aniruddha Agarwal, Rohan Bir Singh, William Foulsham, Kanika Aggarwal, Sabia Handa, Carlos Pavesio, Rupesh Agrawal, Alessandro Invernizzi, Vishali GuptaAbstract:Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous Choroiditis, and multifocal Choroiditis, it may be difficult to differentiate between inflammatory Choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.
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dark spot in fibrinous central serous chorioretinopathy masquerading Choroiditis
Ocular Immunology and Inflammation, 2013Co-Authors: Swapnil Parchand, Vishali Gupta, Amod Gupta, Mohit Dogra, Ramandeep Singh, Aman SharmaAbstract:AbstractPurpose: The authors observed that eyes with acute fibrinous central serous chorioretinopathy (CSC) masquerading active Choroiditis had a “dark spot” within the yellow fibrinous deposit. The present study aims to describe this sign as a clinical indicator of acute serofibrinous exudative detachment, thus helping to differentiate it from active Choroiditis.Method: The authors retrospectively reviewed the records of 19 patients of fibrinous CSC masquerading active Choroiditis. Color fundus photographs, fundus fluorescein angiogram (FFA), and optical coherence tomography (OCT) at baseline and follow-up were studied for a dark spot. The systemic steroids were stopped and all patients were followed up.Results: There were 12 men and 7 women with a mean age of 39.8 years. Fourteen patients had received systemic steroids. Funduscopy revealed creamy yellow subretinal lesion/s simulating active Choroiditis lesion in all eyes and exudative retinal detachment in 9 eyes. The dark spot was seen as a round, gray...
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Tubercular serpiginous-like Choroiditis presenting as multifocal serpiginoid Choroiditis.
Ophthalmology, 2012Co-Authors: Reema Bansal, Vishali Gupta, Amod Gupta, Aman Sharma, Mangat R Dogra, Pradeep BamberyAbstract:Purpose To describe the clinical features, course, and outcome in tubercular serpiginous-like Choroiditis. Design Retrospective cohort study. Participants A total of 105 patients (141 eyes) between May 2002 and July 2010. Methods Patients had the following inclusion criteria: (1) complete clinical records and digital fundus images at baseline and follow-up visits, (2) positive tuberculin skin test or QuantiFERON-TB Gold (Cellestis International Pty Ltd. Chadstone, Victoria, Australia) test result, (3) active serpiginous-like Choroiditis in at least 1 eye, (4) all known causes of infectious (except tuberculosis) and noninfectious uveitis ruled out, and (5) a minimum of 9 months of follow-up from initiation of treatment that included antitubercular therapy (ATT) with oral corticosteroids (93 patients) or corticosteroids alone (12 patients). Main Outcome Measures Clinical characteristics and evolution of Choroiditis lesions from the acute to healed stage, recurrence, visual outcome, and complications. Results Mean age was 33±9.3 years (range, 12–54 years; 75 male and 30 female patients). Serpiginous-like Choroiditis was bilateral (at least 1 eye active) in 66 patients (62.9%). Of 171 affected eyes, 141 (82.45%) had active lesions at presentation. Of 141 eyes, 115 (81.56%) showed vitreous inflammation. Lesions were multifocal in 133 eyes (94.3%), were noncontiguous to optic disc in 122 eyes (86.52%), and involved the macula in 125 eyes (88.65%). Of patients receiving ATT, all showed resolution of lesions and 9 (9.7%) developed recurrences (median follow-up, 21 months). In addition, 12 patients (12.9%) showed continued progression over a median 3.5 weeks after initiation of therapy. Of 12 patients treated with corticosteroids alone, none showed progression but 9 (75%) developed recurrence (median, 26.5 months). Final visual acuity of ≥6/12 was achieved in 108 eyes (76.60%) versus 72 eyes (51.06%) before treatment. Fovea was spared in 95 of 125 eyes (76%) with macular involvement. Five eyes (3.5%) developed choroidal neovascular membrane. Conclusions Tubercular serpiginous-like Choroiditis presented as multifocal serpiginoid Choroiditis affecting predominantly young to middle-aged men. It was frequently bilateral with vitreous inflammation and characterized by multifocal lesions that were noncontiguous to the optic disc and showed serpiginoid spread. Antitubercular therapy significantly reduced recurrences. Lesions responded to combined antitubercular and steroid therapy, usually spared fovea, and had a good final visual acuity. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Reema Bansal - One of the best experts on this subject based on the ideXlab platform.
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ultra wide field imaging in paradoxical worsening of tubercular multifocal serpiginoid Choroiditis after the initiation of anti tubercular therapy
Ocular Immunology and Inflammation, 2019Co-Authors: Kanika Aggarwal, Aniruddha Agarwal, Reema Bansal, Aman Sharma, Mangat R Dogra, Ramandeep Singh, Ankit Deokar, Kusum Sharma, Vishali GuptaAbstract:Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid Choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of Choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional Choroiditis lesions, PW and altering the course of therapy in TB MSC.
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enhanced depth imaging by high resolution spectral domain optical coherence tomography in tubercular multifocal serpiginoid Choroiditis
Ocular Immunology and Inflammation, 2019Co-Authors: Bruttendu Moharana, Vishali Gupta, Reema Bansal, Aman Sharma, Ramandeep Singh, Amod GuptaAbstract:ABSTRACTPurpose: To report the choroidal changes by enhanced depth imaging optical coherence tomography (EDI-OCT) in tubercular multifocal serpiginoid Choroiditis (MSC).Methods: Prospective study o...
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Tubercular serpiginous-like Choroiditis presenting as multifocal serpiginoid Choroiditis.
Ophthalmology, 2012Co-Authors: Reema Bansal, Vishali Gupta, Amod Gupta, Aman Sharma, Mangat R Dogra, Pradeep BamberyAbstract:Purpose To describe the clinical features, course, and outcome in tubercular serpiginous-like Choroiditis. Design Retrospective cohort study. Participants A total of 105 patients (141 eyes) between May 2002 and July 2010. Methods Patients had the following inclusion criteria: (1) complete clinical records and digital fundus images at baseline and follow-up visits, (2) positive tuberculin skin test or QuantiFERON-TB Gold (Cellestis International Pty Ltd. Chadstone, Victoria, Australia) test result, (3) active serpiginous-like Choroiditis in at least 1 eye, (4) all known causes of infectious (except tuberculosis) and noninfectious uveitis ruled out, and (5) a minimum of 9 months of follow-up from initiation of treatment that included antitubercular therapy (ATT) with oral corticosteroids (93 patients) or corticosteroids alone (12 patients). Main Outcome Measures Clinical characteristics and evolution of Choroiditis lesions from the acute to healed stage, recurrence, visual outcome, and complications. Results Mean age was 33±9.3 years (range, 12–54 years; 75 male and 30 female patients). Serpiginous-like Choroiditis was bilateral (at least 1 eye active) in 66 patients (62.9%). Of 171 affected eyes, 141 (82.45%) had active lesions at presentation. Of 141 eyes, 115 (81.56%) showed vitreous inflammation. Lesions were multifocal in 133 eyes (94.3%), were noncontiguous to optic disc in 122 eyes (86.52%), and involved the macula in 125 eyes (88.65%). Of patients receiving ATT, all showed resolution of lesions and 9 (9.7%) developed recurrences (median follow-up, 21 months). In addition, 12 patients (12.9%) showed continued progression over a median 3.5 weeks after initiation of therapy. Of 12 patients treated with corticosteroids alone, none showed progression but 9 (75%) developed recurrence (median, 26.5 months). Final visual acuity of ≥6/12 was achieved in 108 eyes (76.60%) versus 72 eyes (51.06%) before treatment. Fovea was spared in 95 of 125 eyes (76%) with macular involvement. Five eyes (3.5%) developed choroidal neovascular membrane. Conclusions Tubercular serpiginous-like Choroiditis presented as multifocal serpiginoid Choroiditis affecting predominantly young to middle-aged men. It was frequently bilateral with vitreous inflammation and characterized by multifocal lesions that were noncontiguous to the optic disc and showed serpiginoid spread. Antitubercular therapy significantly reduced recurrences. Lesions responded to combined antitubercular and steroid therapy, usually spared fovea, and had a good final visual acuity. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Fundus autofluorescence in serpiginouslike Choroiditis.
Retina (Philadelphia Pa.), 2012Co-Authors: Amod Gupta, Vishali Gupta, Reema Bansal, Aman SharmaAbstract:Purpose To report the fundus autofluorescence characteristics in serpiginouslike Choroiditis. Methods Twenty-nine patients with presumed tubercular serpiginouslike Choroiditis between November 2008 and January 2010 underwent fundus autofluorescence imaging during the acute stage and at regular intervals till the lesions healed. All patients received antitubercular therapy with oral corticosteroids. The autofluorescence images were compared with color fundus photography and fundus fluorescein angiography. The main outcome measure was fundus autofluorescence characteristics of lesions during the course of the disease. Results The pattern of fundus autofluorescence changed as the lesions evolved from the acute to the healed stage. In acute stage, the lesions showed an ill-defined halo of increased autofluorescence (hyperautofluorescence), giving it a diffuse, amorphous appearance (Stage I, acute). As the lesions began to heal, a thin rim of decreased autofluorescence (hypoautofluorescence) surrounded the lesion, defining its edges. The lesions showed predominantly hyperautofluorescence with stippled pattern (Stage II, subacute). With further healing, the hypoautofluorescence progressed and the lesion appeared predominantly hypoautofluorescent with stippled pattern (Stage III, nearly resolved). On complete healing, the lesions became uniformly hypoautofluorescent (Stage IV, completely resolved). Conclusion Fundus autofluorescence highlighted the areas of disease activity and was a quick imaging tool for monitoring the course of lesions in serpiginouslike Choroiditis.
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continuous progression of tubercular serpiginous like Choroiditis after initiating antituberculosis treatment
American Journal of Ophthalmology, 2011Co-Authors: Vishali Gupta, Reema Bansal, Amod GuptaAbstract:Purpose To describe the frequency, risk factors, management, and outcome of eyes with tubercular serpiginous-like Choroiditis showing continued progression following initiation of antituberculosis treatment. Design Retrospective, comparative, interventional case series. Methods setting : Institutional. P atient population : One hundred ten patients of serpiginous-like Choroiditis with 1) complete records, 2) tuberculin skin test, 3) active lesions in at least 1 eye, and 4) minimum 18 months follow-up. intervention : Based on the positivity of tuberculin skin test, the patients were categorized in Group A (84 patients with positive tuberculin test) and Group B (26 patients with negative tuberculin test). Of the 84 patients in Group A, 19 received systemic corticosteroids while 65 also received 4-drug antituberculosis treatment in addition. All patients in Group B received corticosteroids. Patients with continued progression received an increased dose of corticosteroids with or without immunosuppressive agents. main outcome measure : Development of continued progression. Results There were 61 men and 23 women in Group A and 19 men and 7 women in Group B. Continued progression was observed in 12 patients (14.28%) in Group A and none in Group B (P = .04). Of the 12 patients in Group A showing progression, 11 (16.9%) were receiving antituberculosis treatment and corticosteroids. The lesions responded in all eyes, and final visual acuity of 20/40 or better could be achieved in 10 eyes (75%). Conclusion Continued progression of Choroiditis lesions occurs in 14% of patients after initiating antituberculosis treatment in tubercular serpiginous-like Choroiditis. Increased immunosuppression with continuation of antituberculosis treatment resulted in good outcome.
Aniruddha Agarwal - One of the best experts on this subject based on the ideXlab platform.
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collaborative ocular tuberculosis study consensus guidelines on the management of tubercular uveitis report 1 guidelines for initiating antitubercular therapy in tubercular Choroiditis
Ophthalmology, 2021Co-Authors: Rupesh Agrawal, Aniruddha Agarwal, Amod Gupta, Ilaria Testi, Sarakshi Mahajan, Yew Sen Yuen, Onn Min Kon, Talin Barisaniasenbauer, John H Kempen, Douglas A JabsAbstract:Topic An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular Choroiditis. Clinical relevance The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. Methods An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular Choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular Choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like Choroiditis, tuberculoma, and tubercular focal or multifocal Choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Results Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular Choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular Choroiditis. Experts agreed on initiating ATT in tubercular Choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like Choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Discussion Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular Choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
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ultra wide field imaging in paradoxical worsening of tubercular multifocal serpiginoid Choroiditis after the initiation of anti tubercular therapy
Ocular Immunology and Inflammation, 2019Co-Authors: Kanika Aggarwal, Aniruddha Agarwal, Reema Bansal, Aman Sharma, Mangat R Dogra, Ramandeep Singh, Ankit Deokar, Kusum Sharma, Vishali GuptaAbstract:Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid Choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of Choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional Choroiditis lesions, PW and altering the course of therapy in TB MSC.
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An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management
Journal of Ophthalmic Inflammation and Infection, 2018Co-Authors: Aniruddha Agarwal, Rohan Bir Singh, William Foulsham, Kanika Aggarwal, Sabia Handa, Carlos Pavesio, Rupesh Agrawal, Alessandro Invernizzi, Vishali GuptaAbstract:Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous Choroiditis, and multifocal Choroiditis, it may be difficult to differentiate between inflammatory Choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.
Jyotirmay Biswas - One of the best experts on this subject based on the ideXlab platform.
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Enigma of serpiginous Choroiditis.
Indian journal of ophthalmology, 2019Co-Authors: Parthopratim Dutta Majumder, Jyotirmay Biswas, Amod GuptaAbstract:Serpiginous Choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like Choroiditis (SLC) and multifocal serpiginoid Choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with Choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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Visual rehabilitation of patients with low vision in uveitis
Wolters Kluwer Medknow Publications, 2019Co-Authors: Sarika Gopalakrishnan, Parthopratim Dutta Majumder, Sridharan Sudharshan, Rajiv Raman, Velu Saranya, Jyotirmay BiswasAbstract:Purpose: To elucidate the clinical profile of visual impairment (VI) and rehabilitation of the uveitic patients with irreversible low vision. Methods: Retrospective analysis of visual rehabilitation of patients with uveitis suffering from poor vision with low vision devices (LVD). Results: Most common cause of uveitis was Choroiditis (46.29%), followed by retinitis (25.92%), retinoChoroiditis (18.51%), and chronic panuveitis sequelae (9.25%). Of these 54 cases, 35.18% had moderate VI, 25.92% had severe VI, 20.37% had mild VI, and 18.51% had profound VI or blindness. Statistically significant improvement (P < 0.05) in near vision was seen in Choroiditis (52%) and retinitis (72%), whereas clinically significant improvement in distance vision was found in patients with Choroiditis. Most commonly prescribed LVD was half-eye prismatic spectacle magnifier (22.2%). Conclusion: Rehabilitation of the uveitic patients with low vision is challenging. LVD may be a beneficial tool in these patients to help them perform their day-to-day activities independently
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Quantitative polymerase chain reaction analysis of serpiginous Choroiditis with biopsy-proven testicular tuberculosis
Wolters Kluwer Medknow Publications, 2018Co-Authors: Abhinav Dhami, Ranju Kharel, Jyotirmay BiswasAbstract:We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse Choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid Choroiditis was established and was managed with anti-tubercular therapy and systemic steroids
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Scleroderma-related Choroiditis
Wolters Kluwer Medknow Publications, 2018Co-Authors: Parthopratim Dutta Majumder, Karpagam Damodaran, Amala Elizabeth George, Jyotirmay BiswasAbstract:A 34-year-old female a known scleroderma patient presented to us with ocular manifestations in the form Choroiditis along with optic nerve involvement. Blood investigations were done, and the ocular findings were confirmed by fundus fluorescein angiography. She was successfully managed with systemic steroid therapy. Among the protean ocular manifestations in scleroderma, only a few cases of choroidal involvement have been reported. Further, clinical and histopathological studies may be needed to throw light on the exact etiopathogenesis
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Dengue associated Choroiditis: a rare entity
SpringerOpen, 2017Co-Authors: Harshali Manish Yadav, Parthopratim Dutta Majumder, Jyotirmay BiswasAbstract:Abstract Background We report a case of Choroiditis during dengue fever. Results A 35-year-old female presented with blurring of vision during dengue fever. Her fundus examination revealed yellow deep choroidal lesions at right macula, multiple small, yellowish subretinal macular dots along papillomacular bundle, and hyperemic disc. There was a small retinal hemorrhage at temporal margin of disc. The left eye had similar small discrete lesion superonasal and inferotemporal to macula. Conclusions We report a hitherto undescribed case of Choroiditis in a dengue patient