Mpox (formerly known as monkeypox), an infectious disease caused by the monkeypox virus (MPXV), has been endemic in regions of Central and Western Africa. In 2022, the global spread of the clade IIb MPXV led to a multinational outbreak, primarily affecting sexual transmission networks among men who have sex with men. Despite interventions, new cases have continued to emerge. In Africa, the spread of a novel strain of clade I MPXV, clade Ib, has prompted a Public Health Emergency of International Concern designation by the World Health Organization in August 2024. This article provides an updated overview of the epidemiology, systemic, and ocular manifestations, highlighting the clinical features, diagnostic testing, and implications relevant to ophthalmologists and eye care providers, including infection prevention and control measures. The ocular manifestations of mpox primarily involve the ocular surface and anterior segment, with presentations ranging from conjunctivitis to severe, vision-threatening keratitis and uveitis. While the 2022 to 2024 Clade IIb outbreak has shown a lower incidence of ocular involvement compared with previous outbreaks, the potential for significant visual morbidity remains. Treatment involves both systemic and topical therapies, with tecovirimat being the primary systemic option, though its efficacy and ophthalmic bioavailability remain under investigation. Ongoing surveillance and research are essential to further understand the epidemiology and ophthalmic features of mpox and, ultimately, to optimize prevention and treatment strategies for patients.

Introduction: Highly Pathogenic Avian Influenza (HPAI) A(H5N1) represents a growing public health challenge, given broadening zoonotic vectors, with a previously reported human mortality rate of roughly 50%. Late March 2024 marked the start of a new outbreak of HPAI A(H5N1) in the United States. While offering unique public health challenges, this outbreak also provides insight into clinical presentation and ocular involvement implications, transmission vectors, and the implementation of successful surveillance strategies. Objectives: This review seeks to highlight current and historical outbreak trends, transmission and ocular tropism significance, and strategies to mitigate viral spread. Methods: A comprehensive narrative literature review was completed using PubMed database as well as local, federal, and international public health press releases. Discussion: The 2024 US outbreak of H5N1 demonstrates the unique adaptability of the virus. Traditionally transmitted to humans via infected poultry, this outbreak marks the first confirmed case of dairy cow-transmitted human infection. Unlike many past H5N1outbreaks, the majority of patients in the current US outbreak have presented with conjunctivitis either alone or alongside systemic symptoms. This ocular-specific disease manifestation offers new clinical and screening implications. Awareness of ophthalmic involvement among physicians and public health organizations can help guide screening candidates and identify potential infections.

Background/objective: Suprachoroidal triamcinolone acetonide (TA) was recently FDA-approved and is emerging as a new alternative to other local therapies for macular edema (ME) associated with noninfectious uveitis (NIU). The objective of this study is to evaluate the preliminary safety and efficacy of suprachoroidal TA in patients with refractory ME secondary to NIU. Methods: This was a retrospective review of a small cohort of patients with refractory ME secondary to NIU treated with suprachoroidal TA from November 2022 to October 2023. Results: Six eyes from five patients with refractory ME secondary to NIU were included in the study. The cohort included two females (40%), and the median age was 62 years (IQR = 8). Ophthalmic diagnoses included intermediate uveitis (n = 2; 40%), birdshot chorioretinopathy (n = 1; 20%), autoimmune retinopathy (n = 1; 20%), and panuveitis (n = 1; 20%). The median logMAR visual acuity was 0.7 (Snellen 20/100) at baseline and improved to 0.3 (Snellen 20/40) during follow-up visits at 1 month and 2–3 months. The median central subfield thickness (CST) was 690 μm at baseline and improved to 367.5 μm and 309 μm at the follow-up visits at 1 month and 2–3 months, respectively. The initial improvement in logMAR visual acuity and CST was less pronounced at follow-up visits at 6–7 months and 11–12 months. Conclusions: This study demonstrates the safety of suprachoroidal TA and efficacy signals, including improvement in visual acuity and ME at 3 months in patients with severe, refractory ME secondary to NIU.

To describe a rare case of presumed bilateral acute idiopathic maculopathy (AIM) in a pediatric patient. An 11-year-old male was evaluated for a “fuzzy Dorito-shaped” spot in the central vision of his right eye (OD) that started 3 days before presenting to our clinic. On examination, best-corrected visual acuity (BCVA) was counting fingers at 5 feet OD, and 20/25 in the left eye (OS). Fundus examination demonstrated a central macular lesion with pigmentary changes OD and mild retinal pigment epithelium (RPE) changes OS. Optical coherence tomography (OCT) imaging showed elevated, irregular RPE with overlying subretinal fluid in the fovea OD and trace ellipsoid zone changes temporal to the fovea OS. Uveitis work-up was unremarkable for any infectious or inflammatory etiologies. Given the severe vision loss in the right eye and the negative infectious work-up, the decision was made to initiate oral corticosteroids in agreement with the patient's family. One week following the initial presentation, the patient developed visual symptoms OS without much improvement OD. The patient was admitted to the hospital, and further work-up revealed elevated coxsackie B3 antibody titers (1:20). Given the characteristic findings on multimodal imaging and elevated coxsackie B3 antibodies, the patient was presumptively diagnosed with bilateral AIM. Over the following 4 months, he would intermittently complain of nonspecific visual complaints such as blurry vision and floaters requiring an increase in corticosteroid dose and addition of immunomodulatory therapy, although the clinical examination and OCT findings remained unchanged. At the patient's follow-up visit 8 months after the initial visit, BCVA was stable at 20/40 OD and 20/30 OS, and OCT demonstrated stable foveal lesions in both eyes. This case report describes a rare presentation of presumed bilateral AIM in a pediatric patient. This prompts further consideration of this condition in pediatric patients, especially after a prodromal flu-like illness.

Purpose: To describe the effect of rotational forces on the vitreoretinal interface in a case of vitreomacular traction. Methods: Retrospective, observational case report. Results: A 66-year-old woman presented with symptomatic vitreomacular traction with reduced visual acuity to 20/60. Optical coherence tomography (OCT) indicated left eye vitreomacular traction. After discussion of treatment options including vitrectomy, the patient elected to proceed with a commercial flight simulator experience given her concerns regarding the risks of surgery or other invasive procedures. A repeat OCT 3 weeks later showed resolution of vitreomacular traction. Long-term follow-up visual acuity returned to 20/25 in the left eye. Conclusions: A separation of the vitreous from the fovea was observed following a commercial flight simulator experience. The machine’s maneuverability and associated 3-dimensional acceleration potential allows force to traverse the vitreous at multiple vectors. It is hypothesized that force vectors perpendicular to the vitreomacular interface contributed to its separation.