retinitis choroiditis treatment clinical trials

CMV retinitis treatment advances

toxoplasma retinochoroiditis uveitis treatment

retinitis pigmentosa gene therapy treatment advances

acute retinal necrosis viral retinitis herpes treatment

birdshot chorioretinopathy VKH vogt koyanagi harada treatment

Vogt Koyanagi Harada syndrome uveitis choroiditis treatment

sarcoidosis tuberculosis choroiditis uveitis posterior

ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace && e…

~/retinitis_choroiditis/build_pptx.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE';
pres.title = 'Retinitis & Choroiditis: Basic to Advanced';
pres.author = 'Orris Medical AI';

// ─── COLOR PALETTE ───────────────────────────────────────────────
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const PALE      = 'E8F4FA';
const RED_ACC   = 'E05A5A';
const GREEN_ACC = '4CAF7D';

// ─── MASTER HELPERS ──────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════
//  SLIDE 1 – TITLE
// ═══════════════════════════════════════════════════════════════════
addTitleSlide(pres,
  'Retinitis & Choroiditis\nBasic to Advanced',
  'Pathophysiology · Clinical Features · Diagnosis · Treatment · Recent Advances'
);

// ═══════════════════════════════════════════════════════════════════
//  SLIDE 2 – TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════
addContentSlide(pres, 'Outline of Presentation', [
  { text: '1. Anatomy & Terminology', bold: true },
  { text: '   Retina, Choroid, Uvea – structural overview', sub: true },
  { text: '2. Classification of Retinitis & Choroiditis', bold: true },
  { text: '   Infectious vs non-infectious; choriocapillaritis vs stromal choroiditis', sub: true },
  { text: '3. Infectious Retinitis – Viral', bold: true },
  { text: '   CMV, Acute Retinal Necrosis, Progressive Outer Retinal Necrosis', sub: true },
  { text: '4. Infectious Retinitis – Parasitic & Fungal', bold: true },
  { text: '   Toxoplasma, Histoplasmosis, Candida, Pneumocystis, Cryptococcus', sub: true },
  { text: '5. Retinitis Pigmentosa & Inherited Dystrophies', bold: true },
  { text: '6. Infectious Choroiditis', bold: true },
  { text: '   TB, Syphilis, Ebola, HIV-related', sub: true },
  { text: '7. Non-Infectious (White Dot) Choroiditis Syndromes', bold: true },
  { text: '   MEWDS, APMPPE, Serpiginous, Birdshot, PIC, MFC, VKH', sub: true },
  { text: '8. Clinical Trials & Recent Advances (PubMed 2021-2026)', bold: true },
  { text: '9. Summary & Key Pearls', bold: true },
]);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 1
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 1, 'Anatomy & Terminology');

addTwoColSlide(pres,
  'Retina & Choroid – Structural Overview',
  'Retina (10 layers)',
  [
    'Innermost layer of the eye – neural tissue',
    'Retinal Pigment Epithelium (RPE): phagocytoses shed photoreceptor outer segments',
    'Photoreceptors (rods & cones): transduction of light → neural signal',
    'Müller cells, bipolar, ganglion cells form neural circuitry',
    'Blood supply: inner retina from central retinal artery; outer retina (RPE + photoreceptors) from choriocapillaris',
    '"Retinitis" = inflammation of retinal layers, often necrotising',
    'Hallmarks: white/yellow patches, haemorrhages, vasculitis, vitritis',
  ],
  'Choroid (3 layers)',
  [
    'Vascular coat between sclera and RPE',
    'Layers: choriocapillaris (inner), Sattler\'s layer (medium vessels), Haller\'s layer (large vessels)',
    'Richest blood supply in the body per unit area',
    '"Choroiditis" = inflammation of choroid; may extend to RPE ("chorioretinitis")',
    'ICG angiography is gold standard for choroidal imaging',
    'OCTA reveals choriocapillaris flow voids in active choroiditis',
    'Bruch\'s membrane separates RPE from choriocapillaris',
  ]
);

addContentSlide(pres, 'Key Definitions', [
  { text: 'Retinitis – focal or diffuse inflammation of the retina. Can be infectious (viral, parasitic, fungal, bacterial) or non-infectious.', bold: false },
  { text: 'Choroiditis – inflammation of the choroid. Classified by anatomical layer involved (choriocapillaritis vs stromal) and aetiology.', bold: false },
  { text: 'Chorioretinitis / Retinochoroiditis – combined inflammation; the dominant structure named first (e.g., toxoplasma retinochoroiditis = retina primary target).', bold: false },
  { text: 'Panuveitis – inflammation of all uveal layers + retina (e.g., Acute Retinal Necrosis, VKH disease).', bold: false },
  { text: 'White Dot Syndromes – heterogeneous group of idiopathic inflammatory conditions characterised by discrete white/yellow lesions at the level of the outer retina, RPE or choroid.', bold: false },
  { text: 'Immune Recovery Uveitis (IRU) – paradoxical worsening in CMV retinitis after ART-mediated immune reconstitution.', bold: false },
]);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 2
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 2, 'Classification of Retinitis & Choroiditis');

addTableSlide(pres, 'ICG Angiographic Classification of Choroiditis (Kanski 10e)', 
  ['Class', 'Subtype', 'Examples'],
  [
    ['1A', 'Primary Choriocapillaritis\n(trigger unknown)', 'MEWDS, APMPPE, Serpiginous choroidopathy, MFC, PIC'],
    ['1B', 'Secondary Choriocapillaritis\n(pathogen triggers immune response)', 'Acute syphilitic posterior placoid chorioretinitis (ASPPC)\nTB-related serpiginous choroiditis'],
    ['2A', 'Primary Stromal Choroiditis\n(stroma is target)', 'Birdshot retinochoroidopathy (HLA-A29)\nVogt–Koyanagi–Harada disease\nSympathetic ophthalmia'],
    ['2B', 'Secondary Stromal Choroiditis\n(secondary to systemic inflammation)', 'Sarcoidosis\nTubercular chorioretinitis\nSyphilitic chorioretinitis'],
  ]
);

addTwoColSlide(pres,
  'Classification of Retinitis',
  'Infectious Retinitis',
  [
    { text: 'Viral:', bold: true },
    { text: '  CMV retinitis (most common in AIDS)', sub: true },
    { text: '  Acute Retinal Necrosis (HSV/VZV)', sub: true },
    { text: '  PORN – Progressive Outer Retinal Necrosis (VZV)', sub: true },
    { text: '  Rubella, Measles/SSPE, West Nile, Ebola, Zika', sub: true },
    { text: 'Parasitic:', bold: true },
    { text: '  Toxoplasma retinochoroiditis (most common cause worldwide)', sub: true },
    { text: 'Fungal:', bold: true },
    { text: '  Candida, Histoplasma, Cryptococcus, Pneumocystis', sub: true },
    { text: 'Bacterial:', bold: true },
    { text: '  Syphilitic retinitis, TB retinitis', sub: true },
  ],
  'Non-Infectious Retinitis',
  [
    { text: 'Inherited Dystrophies:', bold: true },
    { text: '  Retinitis Pigmentosa (most common hereditary retinal degeneration)', sub: true },
    { text: '  Cone-rod dystrophy, Leber congenital amaurosis', sub: true },
    { text: 'Autoimmune / Inflammatory:', bold: true },
    { text: '  Birdshot retinochoroidopathy', sub: true },
    { text: '  Sarcoid retinitis', sub: true },
    { text: 'Paraneoplastic:', bold: true },
    { text: '  CAR (cancer-associated retinopathy)', sub: true },
    { text: 'Drug-induced:', bold: true },
    { text: '  Chloroquine/hydroxychloroquine maculopathy', sub: true },
    { text: '  Rifabutin-associated uveitis', sub: true },
  ]
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 3 – VIRAL RETINITIS
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 3, 'Infectious Retinitis – Viral');

addContentSlide(pres, 'CMV Retinitis – Introduction & Risk Factors',
  [
    { text: 'Aetiology:', bold: true },
    { text: '  Cytomegalovirus (CMV) – member of Herpesviridae. Primary infection in immunocompetent is usually subclinical; retinitis from reactivation of latent virus in immunocompromised.', sub: true },
    { text: 'Epidemiology:', bold: true },
    { text: '  Most common opportunistic intraocular infection in AIDS (CD4+ <50 cells/µl is strongest risk factor).', sub: true },
    { text: '  Also occurs post-transplant, haematological malignancy, prolonged immunosuppression.', sub: true },
    { text: '  Incidence has fallen dramatically since introduction of HAART/ART, but prevalence remains high.', sub: true },
    { text: 'Risk associations:', bold: true },
    { text: '  HIV-related retinal microangiopathy (cotton-wool spots + haemorrhages) is a marker for increased CMV retinitis risk.', sub: true },
    { text: '  CD4+ <100 cells/µl: discontinue antiviral therapy when CD4+ reaches >100–150 cells/µl.', sub: true },
    { text: 'Without treatment, blindness is essentially inevitable.', bold: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.489 | Wills Eye Manual'
);

addTwoColSlide(pres,
  'CMV Retinitis – Clinical Features',
  'Presentation & Findings',
  [
    'Reduced vision (macular involvement) or floaters',
    '"Pizza pie" or "Margherita pizza" appearance: dense white retinal infiltration + flame haemorrhages along vascular arcades',
    'Two patterns: Fulminant (confluent, haemorrhagic) vs Indolent (granular, peripheral, less haemorrhagic)',
    'One eye usually affected initially; progresses to both in 50% if untreated',
    'Minimal vitritis in active phase (contrast with ARN)',
    'Optic neuritis may result from direct spread',
    'Frosted branch angiitis (FBA) in ~6%',
    'Retinal detachment (RD) – major morbidity: up to 50% in advanced cases',
  ],
  'Complications',
  [
    { text: 'Immune Recovery Uveitis (IRU):', bold: true },
    { text: '  Paradoxical inflammation after ART-mediated immune reconstitution; residual viral antigen triggers vigorous immune response', sub: true },
    { text: '  Manifestations: severe vitritis, CMO, ERM, neovascularisation; can progress to phthisis', sub: true },
    { text: 'Retinal necrosis → RRD: irregular pigmentation, atrophy, retinal holes', sub: true },
    { text: 'Cataract (late stage)', sub: true },
    { text: 'CMV anterior uveitis (iridocyclitis): elevated IOP, corneal endotheliitis, sectoral iris atrophy in immunocompetent', sub: true },
  ]
);

addContentSlide(pres, 'CMV Retinitis – Diagnosis & Treatment',
  [
    { text: 'Diagnosis:', bold: true },
    { text: '  Clinical appearance is usually pathognomonic in the correct context', sub: true },
    { text: '  Vitreous/aqueous PCR for CMV DNA (gold standard when in doubt)', sub: true },
    { text: '  CD4+ count and plasma HIV-RNA levels', sub: true },
    { text: 'Systemic Treatment:', bold: true },
    { text: '  ART (antiretroviral therapy) – mainstay of management; restores innate CMV suppression', sub: true },
    { text: '  IV Ganciclovir: 5 mg/kg BD × 2–3 weeks induction, then maintenance', sub: true },
    { text: '  Oral Valganciclovir: 900 mg BD induction, 900 mg OD maintenance – comparable efficacy to IV ganciclovir', sub: true },
    { text: '  Foscarnet, Cidofovir: for ganciclovir-resistant CMV', sub: true },
    { text: 'Intravitreal Treatment:', bold: true },
    { text: '  Ganciclovir 2 mg / Foscarnet 2.4 mg intravitreal injections for immediate macular-threatening disease', sub: true },
    { text: '  Ganciclovir intravitreal implant (Vitrasert) – sustained local delivery for up to 6–8 months', sub: true },
    { text: 'Retinal Detachment:', bold: true },
    { text: '  PPV + silicone oil is treatment of choice; laser demarcation for prophylaxis', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.491'
);

addContentSlide(pres, 'Acute Retinal Necrosis (ARN)',
  [
    { text: 'Definition:', bold: true },
    { text: '  Rare but devastating necrotising retinitis in otherwise healthy individuals', sub: true },
    { text: '  Cause: HSV-1/2 (younger patients) and VZV (older patients)', sub: true },
    { text: 'American Uveitis Society Diagnostic Criteria:', bold: true },
    { text: '  1. One or more discrete foci of peripheral retinal necrosis (deep yellow-white infiltrates, well-defined borders)', sub: true },
    { text: '  2. Circumferential spread in the absence of treatment', sub: true },
    { text: '  3. Occlusive retinal vasculitis including arteritis', sub: true },
    { text: '  4. Prominent anterior uveitis + vitritis (panuveitis)', sub: true },
    { text: '  5. Rapid progression without treatment', sub: true },
    { text: 'Prognosis:', bold: true },
    { text: '  >50% achieve only 6/60 due to retinal/optic nerve ischaemia or rhegmatogenous retinal detachment (RRD)', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  IV Aciclovir 15 mg/kg every 8 h for 10–14 days → Oral aciclovir 800 mg 5× daily for 6–12 weeks', sub: true },
    { text: '  Oral Valaciclovir / Famciclovir as alternative oral agents', sub: true },
    { text: '  Intravitreal Ganciclovir or Foscarnet as adjunct', sub: true },
    { text: '  Prophylactic laser photocoagulation posterior to lesions reduces RD risk', sub: true },
    { text: '  PPV + silicone oil for established RRD', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.492'
);

addTwoColSlide(pres,
  'Progressive Outer Retinal Necrosis (PORN) vs ARN',
  'ARN (Acute Retinal Necrosis)',
  [
    { text: 'Patients: immunocompetent', bold: true },
    'Cause: HSV (young), VZV (old)',
    'Location: Peripheral, circumferential spread',
    'Vitritis: Prominent (panuveitis)',
    'Vasculitis: Occlusive arteritis – prominent',
    'Haemorrhage: Common',
    'Progression: Rapid without treatment',
    { text: 'Treatment: IV Aciclovir → oral', bold: false },
    'RD risk: Up to 75% without prophylaxis',
    { text: 'PCR: Aqueous/vitreous for HSV/VZV DNA', bold: false },
  ],
  'PORN (Progressive Outer Retinal Necrosis)',
  [
    { text: 'Patients: Severely immunocompromised (CD4+ <10)', bold: true, highlight: true },
    'Cause: VZV predominantly',
    'Location: Multifocal, outer retina, posterior pole early',
    'Vitritis: Absent or minimal',
    'Vasculitis: Absent',
    'Haemorrhage: Less common',
    'Progression: Extremely rapid',
    { text: 'Treatment: IV Ganciclovir + Foscarnet (combination)', bold: false, highlight: true },
    'RD risk: Nearly 70% within weeks',
    { text: 'Prognosis: Very poor; bilateral in >70%', bold: false, highlight: true },
  ]
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 4 – PARASITIC & FUNGAL
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 4, 'Infectious Retinitis – Parasitic & Fungal');

addContentSlide(pres, 'Toxoplasma Retinochoroiditis',
  [
    { text: 'Aetiology:', bold: true },
    { text: '  Most common cause of posterior uveitis worldwide', sub: true },
    { text: '  Toxoplasma gondii (obligate intracellular protozoan); acquired by ingestion of oocysts or undercooked meat', sub: true },
    { text: '  Most ocular toxoplasmosis is reactivation of congenital infection', sub: true },
    { text: 'Classic Clinical Features:', bold: true },
    { text: '  "Headlight in the fog" – focal white fluffy retinitis adjacent to an old pigmented chorioretinal scar', sub: true },
    { text: '  Dense overlying vitritis (vitreous cells and haze)', sub: true },
    { text: '  Unilateral in 80%; may be bilateral in congenital or immunocompromised forms', sub: true },
    { text: '  In AIDS: atypical – multiple lesions, absent scar, no overlying vitritis ("pizza pie" mimicking CMV)', sub: true },
    { text: 'Diagnosis:', bold: true },
    { text: '  Clinical diagnosis in typical cases; supported by Sabin-Feldman dye test, IgG/IgM titres', sub: true },
    { text: '  Aqueous PCR (Toxoplasma DNA) when in doubt or atypical', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  Gold standard: Pyrimethamine 100 mg loading → 25 mg OD + Sulfadiazine 1g QID + Folinic acid + Steroids', sub: true },
    { text: '  Alternatives: Trimethoprim-Sulfamethoxazole (TMP-SMX), Clindamycin, Azithromycin, Atovaquone', sub: true },
    { text: '  Treat for 4–6 weeks; prophylaxis with low-dose TMP-SMX in immunocompromised', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e; PMID 34370174'
);

addContentSlide(pres, 'Fungal Choroiditis / Chorioretinitis',
  [
    { text: 'Presumed Ocular Histoplasmosis Syndrome (POHS):', bold: true },
    { text: '  Triad: (1) Multiple white atrophic chorioretinal "histo spots" ~200µm; (2) Peripapillary atrophy; (3) Absence of vitritis', sub: true },
    { text: '  Endemic in Mississippi River Valley, USA; immune-mediated, not direct infection in most cases', sub: true },
    { text: '  Complication: Macular neovascularisation (MNV/CNV) → anti-VEGF treatment', sub: true },
    { text: 'Pneumocystis Choroiditis (AIDS):', bold: true },
    { text: '  Multiple pale choroidal lesions with yellow hue, no vitritis; bilateral; often asymptomatic', sub: true },
    { text: '  Occurs when <100 CD4+ cells and without TMP-SMX prophylaxis', sub: true },
    { text: '  Treatment: IV Pentamidine or TMP-SMX', sub: true },
    { text: 'Cryptococcus Choroiditis (AIDS):', bold: true },
    { text: '  Multiple choroidal lesions; often with CNS cryptococcal meningitis; severe disc swelling', sub: true },
    { text: '  Treatment: Amphotericin B + Flucytosine, then Fluconazole maintenance', sub: true },
    { text: 'Candida Chorioretinitis:', bold: true },
    { text: '  Fluffy white "string of pearls" vitreous infiltrate; classic in IV drug users, TPN patients', sub: true },
    { text: '  Treatment: Fluconazole (systemic) ± intravitreal Amphotericin B / Voriconazole', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.400-403'
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 5 – RETINITIS PIGMENTOSA
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 5, 'Retinitis Pigmentosa & Inherited Dystrophies');

addContentSlide(pres, 'Retinitis Pigmentosa (RP) – Overview',
  [
    { text: 'Definition:', bold: true },
    { text: '  Clinically and genetically diverse group of inherited diffuse retinal degenerations; initially affects rod photoreceptors, then cones and RPE', sub: true },
    { text: 'Epidemiology:', bold: true },
    { text: '  Most common hereditary retinal degeneration: prevalence 1:3,000–1:5,000', sub: true },
    { text: 'Inheritance Patterns:', bold: true },
    { text: '  Autosomal Dominant (AD): mutations in Rhodopsin gene (most common cause of AD-RP); PRPF31, PRPF3, ROM1', sub: true },
    { text: '  Autosomal Recessive (AR): ABCA4, RPGR, CNGB1, USH2A', sub: true },
    { text: '  X-linked: RPGR gene mutation (90% of XL cases) – most severe form', sub: true },
    { text: '  Sporadic: ~40% of cases; may be any pattern', sub: true },
    { text: 'Syndromic RP (20–30% of cases):', bold: true },
    { text: '  Usher syndrome (RP + sensorineural deafness) – most common cause', sub: true },
    { text: '  Bardet-Biedl syndrome, Refsum disease, Kearns-Sayre (mitochondrial)', sub: true },
    { text: '  Leber Congenital Amaurosis: severe early-onset RP variant (~5%)', sub: true },
    { text: 'Pathogenesis:', bold: true },
    { text: '  Affected genes encode: phototransduction cascade, retinoid cycle, photoreceptor structural proteins, RPE function', sub: true },
    { text: '  ~100+ gene loci identified; ~50% of patients still lack known mutation', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.646'
);

addTwoColSlide(pres,
  'Retinitis Pigmentosa – Clinical Features & Management',
  'Clinical Features',
  [
    { text: 'Classic Triad:', bold: true },
    { text: '  Bone-spicule pigmentation (mid-peripheral, perivascular)', sub: true },
    { text: '  Arteriolar attenuation', sub: true },
    { text: '  Waxy disc pallor', sub: true },
    { text: 'Symptoms:', bold: true },
    { text: '  Nyctalopia / dark adaptation difficulty (earliest symptom)', sub: true },
    { text: '  Peripheral visual field constriction ("tunnel vision")', sub: true },
    { text: '  Photopsia, reduced contrast sensitivity', sub: true },
    { text: 'Associated features: CMO (cystoid macular oedema) in ~20%, posterior subcapsular cataract, myopia, keratoconus', sub: true },
    { text: 'Investigations:', bold: true },
    { text: '  ERG: severely reduced or extinguished rod response (pathognomonic)', sub: true },
    { text: '  Goldman visual fields, FAF (RPE atrophy), OCT (photoreceptor loss)', sub: true },
    { text: '  Genetic testing: important for counselling and eligibility for gene therapy', sub: true },
  ],
  'Treatment & Emerging Therapies',
  [
    { text: 'No cure currently, but multiple emerging treatments:', bold: true },
    { text: 'Vitamin A palmitate 15,000 IU/day: may slow progression (CATT study)', sub: true },
    { text: 'Low-vision aids, protective spectacles (UV/blue light)', sub: true },
    { text: 'Carbonic anhydrase inhibitors (Acetazolamide/Dorzolamide) for CMO', sub: true },
    { text: 'Gene Therapy:', bold: true, highlight: true },
    { text: '  Voretigene neparvovec (Luxturna): FDA/EMA approved 2017/2018 for RPE65-associated RP (biallelic mutations) – landmark first approved ocular gene therapy', sub: true },
    { text: 'Retinal Implants:', bold: true },
    { text: '  Argus II epiretinal implant (Second Sight): approved for severe RP', sub: true },
    { text: 'Stem Cell Therapy:', bold: true },
    { text: '  Under investigation; multiple Phase I/II trials (PMID 37798796)', sub: true },
    { text: 'Optogenetics & neuroprotection: emerging', sub: true },
  ]
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 6 – INFECTIOUS CHOROIDITIS
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 6, 'Infectious Choroiditis');

addContentSlide(pres, 'Tubercular & Syphilitic Chorioretinitis',
  [
    { text: 'Tubercular Chorioretinitis:', bold: true },
    { text: '  Caused by Mycobacterium tuberculosis (haematogenous dissemination)', sub: true },
    { text: '  Classic: small choroidal granulomas (2nd frequency feature after uveitis)', sub: true },
    { text: '  TB serpiginous choroiditis: geographic, serpiginous chorioretinal scars mimicking idiopathic serpiginous', sub: true },
    { text: '  Eales disease: retinal periphlebitis + neovascularisation in young Asian men (TB association)', sub: true },
    { text: '  Diagnosis: Mantoux/TST, IGRA (Quantiferon Gold), CXR; aqueous PCR for M. tuberculosis', sub: true },
    { text: '  Treatment: Standard 4-drug ATT (HRZE × 2 months → HR × 4–10 months) + oral corticosteroids', sub: true },
    { text: 'Syphilitic Chorioretinitis:', bold: true },
    { text: '  Treponema pallidum; the "Great Imitator" – can mimic any uveitis pattern', sub: true },
    { text: '  Acute syphilitic posterior placoid chorioretinitis (ASPPC): single large yellow-orange placoid foveal lesion; associated with HIV co-infection', sub: true },
    { text: '  Necrotising retinitis, vitritis, optic neuritis, panuveitis all possible', sub: true },
    { text: '  Diagnosis: VDRL/RPR (screening) + TPHA/FTA-ABS (confirmatory); LP if neurological involvement', sub: true },
    { text: '  Treatment: IV Benzylpenicillin G 18-24 MU/day × 10-14 days (neurosyphilis protocol)', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e'
);

addContentSlide(pres, 'Sarcoidosis & HIV-Related Ocular Inflammation',
  [
    { text: 'Sarcoidosis Uveitis/Choroiditis:', bold: true },
    { text: '  Multisystem granulomatous disease; ocular involvement in 25–50% (can be presenting feature)', sub: true },
    { text: '  Posterior: retinal periphlebitis ("candle wax drippings"), choroidal granulomas, CMO, disc oedema', sub: true },
    { text: '  Choroidal granulomas appear as pale yellow nodules; can mimic metastatic disease', sub: true },
    { text: '  Diagnosis: Elevated ACE & lysozyme, CXR/HRCT chest (bilateral hilar LAP), biopsy (non-caseating granulomas)', sub: true },
    { text: '  Treatment: Systemic corticosteroids as first-line; methotrexate, mycophenolate mofetil for steroid-sparing; infliximab for refractory cases', sub: true },
    { text: 'HIV-Related Ocular Disease:', bold: true },
    { text: '  HIV Microangiopathy: retinal cotton-wool spots + haemorrhages; most frequent retinopathy in AIDS (up to 70%)', sub: true },
    { text: '  Associated with declining CD4+ count – marker for increased CMV retinitis risk', sub: true },
    { text: '  Lesions disappear spontaneously; treatment is ART', sub: true },
    { text: '  Kaposi sarcoma (eyelid, conjunctiva), B-cell lymphoma (orbit), opportunistic infections are part of the AIDS ocular spectrum', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e; PMID 37176633'
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 7 – WHITE DOT SYNDROMES / NON-INFECTIOUS CHOROIDITIS
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 7, 'Non-Infectious (White Dot) Choroiditis Syndromes');

addContentSlide(pres, 'MEWDS & APMPPE',
  [
    { text: 'Multiple Evanescent White Dot Syndrome (MEWDS):', bold: true },
    { text: '  Uncommon idiopathic; acute onset; typically young adult females', sub: true },
    { text: '  25–50% report preceding viral illness; influenza vaccination occasionally implicated', sub: true },
    { text: '  Clinical: painless monocular blurring (6/9–6/60), photopsia, scotomas; subtle posterior vitritis in 50%', sub: true },
    { text: '  Fundus: 100–300 µm ill-defined grey-white patches sparing the fovea; "orange granular fovea" (pathognomonic)', sub: true },
    { text: '  Multimodal imaging: FAF shows hyperAF dots (key diagnostic tool); ICG shows hypofluorescent dots; OCT shows IS/OS disruption', sub: true },
    { text: '  Spontaneous recovery over weeks; 10% recur → suspect MFC if recurrent', sub: true },
    { text: '  No treatment required', sub: true },
    { text: 'Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE):', bold: true },
    { text: '  Young adults; bilateral; often follows viral illness (immune-mediated choriocapillaritis)', sub: true },
    { text: '  Multiple cream-coloured placoid lesions at RPE level in posterior pole', sub: true },
    { text: '  FA: early hypofluorescence → late hyperfluorescence (classic pattern)', sub: true },
    { text: '  Usually self-limited; rare CNS vasculitis association (cerebral ischaemia – urgent investigation)', sub: true },
    { text: '  Steroids if CNS involvement or persistent/recurrent', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.508-510'
);

addContentSlide(pres, 'Serpiginous Choroidopathy',
  [
    { text: 'Definition:', bold: true },
    { text: '  Rare, chronic, progressive choroiditis of unknown aetiology; primarily affecting choriocapillaris', sub: true },
    { text: 'Demographics:', bold: true },
    { text: '  Middle-aged adults; no sex predilection; bilateral (often asymmetric)', sub: true },
    { text: 'Clinical Features:', bold: true },
    { text: '  Active lesions: grey-white subretinal infiltrates with pseudopod-like ("snake-like") extensions from prior scarred areas', sub: true },
    { text: '  Lesions extend centrifugally, commonly around the disc and macula', sub: true },
    { text: '  Inactive lesions: chorioretinal scarring with sharp borders, pigment disturbance', sub: true },
    { text: '  Visual loss when fovea involved (may be sudden); CMO can occur', sub: true },
    { text: 'Imaging:', bold: true },
    { text: '  FA: early hypofluorescence → late hyperfluorescence in active disease', sub: true },
    { text: '  FAF: hyperautofluorescence at active edge (key for monitoring)', sub: true },
    { text: '  ICGA: marked hypofluorescence throughout all phases', sub: true },
    { text: '  OCTA: flow void at choriocapillaris level', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  Oral/IV steroids; immunosuppressives (azathioprine, mycophenolate, cyclosporine, tacrolimus); infliximab', sub: true },
    { text: '  Important DDx: TB-related serpiginous choroiditis (treat with ATT first!)', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.510'
);

addContentSlide(pres, 'Birdshot Retinochoroidopathy',
  [
    { text: 'Definition:', bold: true },
    { text: '  Uncommon idiopathic chronic bilateral inflammatory disease; severe retinitis + stromal choroiditis as independent events', sub: true },
    { text: 'Demographics:', bold: true },
    { text: '  Middle-aged women; HLA-A29 positive in >95% (vs 7% general population)', sub: true },
    { text: 'Clinical Features:', bold: true },
    { text: '  Insidious impairment of central vision + floaters, nyctalopia, dyschromatopsia, photopsia', sub: true },
    { text: '  Bilateral vitritis', sub: true },
    { text: '  Multiple ill-defined ovoid cream-coloured choroidal patches (<1DD), postero-pole and midperiphery, radiating from disc', sub: true },
    { text: '  CMO, epiretinal membrane, macular neovascularisation (MNV) can develop', sub: true },
    { text: 'Investigations:', bold: true },
    { text: '  HLA-A29: >95% positive (essential test)', sub: true },
    { text: '  FA: extensive vascular leakage; diffuse macular oedema (fovea often spared)', sub: true },
    { text: '  ICGA: more numerous hypofluorescent lesions than clinically apparent', sub: true },
    { text: '  ERG and visual fields for monitoring', sub: true },
    { text: 'Prognosis:', bold: true },
    { text: '  ~1/3 achieve final VA <6/60; improving with aggressive sustained immunomodulatory therapy', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  Oral corticosteroids, periocular/intravitreal steroids; systemic immunosuppressives (mycophenolate, cyclosporine); biologics (infliximab, daclizumab)', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.513'
);

addTwoColSlide(pres,
  'Vogt–Koyanagi–Harada (VKH) Disease',
  'Clinical Features & Diagnosis',
  [
    { text: 'Multisystem granulomatous autoimmune disease attacking melanocyte-containing tissues', bold: false },
    { text: 'Demographics:', bold: true },
    { text: '  Asian, Hispanic, Middle Eastern individuals; women > men; HLA-DR4 association', sub: true },
    { text: 'Four Stages:', bold: true },
    { text: '  1. Prodromal: meningism, fever, tinnitus, hearing loss, alopecia, vitiligo, poliosis', sub: true },
    { text: '  2. Uveitic: bilateral granulomatous panuveitis, multiple serous retinal detachments, disc oedema', sub: true },
    { text: '  3. Convalescent: sunset glow fundus (diffuse RPE depigmentation), Dalen-Fuchs nodules', sub: true },
    { text: '  4. Chronic recurrent: bilateral granulomatous AU, secondary glaucoma, CNV', sub: true },
    { text: 'Diagnosis: Revised International Criteria (2001)', bold: true },
    { text: '  No preceding penetrating ocular trauma/surgery; no other cause identified; bilateral ocular involvement + ≥2/4 neurological/auditory/integumentary criteria', sub: true },
    { text: 'OCTA/ICG: Reveals choroidal thickening, stromal hypofluorescence, flow voids', sub: true },
  ],
  'Treatment',
  [
    { text: 'High-dose systemic corticosteroids:', bold: true, highlight: true },
    { text: '  IV methylprednisolone 1g/day × 3 days → oral prednisolone 1 mg/kg/day taper over ≥6 months', sub: true },
    { text: 'Early aggressive treatment reduces chronic disease sequelae', sub: true },
    { text: 'Steroid-sparing immunomodulatory therapy:', bold: true },
    { text: '  Azathioprine, mycophenolate mofetil, cyclosporine', sub: true },
    { text: '  Infliximab / adalimumab for refractory cases', sub: true },
    { text: 'Complications to manage:', bold: true },
    { text: '  Secondary glaucoma: medical/surgical', sub: true },
    { text: '  Cataract extraction (post-inflammation)', sub: true },
    { text: '  CNV: Anti-VEGF therapy', sub: true },
    { text: 'Recent OCTA meta-analysis (PMID 38456233):', bold: false },
    { text: '  Confirms choroidal flow voids as reliable marker for disease activity and treatment response monitoring', sub: true, highlight: true },
  ]
);

addContentSlide(pres, 'Other White Dot Syndromes',
  [
    { text: 'Punctate Inner Choroidopathy (PIC):', bold: true },
    { text: '  Young, highly myopic women; small punched-out lesions at inner choroid; NO vitritis (distinguishes from MFC)', sub: true },
    { text: '  Complications: CNV in 40–75%; anti-VEGF therapy effective', sub: true },
    { text: 'Multifocal Choroiditis (MFC):', bold: true },
    { text: '  Similar to PIC but with anterior segment activity, vitritis (50–75%) and more lesions', sub: true },
    { text: '  Lesions: punched-out chorioretinal scars (50–350 µm) in posterior pole + periphery', sub: true },
    { text: '  CNV complication; consider steroid therapy for active inflammation', sub: true },
    { text: 'Sympathetic Ophthalmia (SO):', bold: true },
    { text: '  Bilateral granulomatous panuveitis following penetrating trauma or intraocular surgery to fellow eye', sub: true },
    { text: '  Latency: 90% within 1 year (peak: 4–8 weeks); rarely occurs decades later', sub: true },
    { text: '  Treatment: High-dose systemic steroids ± immunosuppressives; evisceration of the exciting eye within 2 weeks may prevent SO but NOT thereafter', sub: true },
    { text: 'Relentless Placoid Chorioretinitis (RPC / Ampiginous Choroiditis):', bold: true },
    { text: '  Hybrid of APMPPE + serpiginous; hundreds of lesions anterior and posterior to equator; chronic, relentless progression', sub: true },
    { text: '  Progressive Subretinal Fibrosis & Uveitis (SFU):', bold: true },
    { text: '  Myopic young women; subretinal fibrosis → poor visual prognosis; may be spectrum with MFC/PIC', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.508-517'
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 8 – CLINICAL TRIALS & RECENT ADVANCES
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 8, 'Clinical Trials & Recent Advances\n(PubMed 2021–2026)');

addEvidenceSlide(pres, 'Recent Evidence – CMV Retinitis & Viral Retinitis',
  [
    {
      label: 'CMV Retinitis – Antiviral Therapy Meta-Analysis (2025)',
      pmid: 'PMID 39549781',
      detail: 'Systematic review/meta-analysis in Surv Ophthalmol (Putera et al., 2025): Oral valganciclovir equivalent to IV ganciclovir for induction in AIDS-related CMV retinitis; intravitreal therapy provides faster local response but must be combined with systemic ART.',
    },
    {
      label: 'Antiviral Treatment for ARN – Systematic Review (2024)',
      pmid: 'PMID 37774799',
      detail: 'Meta-analysis in Surv Ophthalmol (Putera et al., 2024): IV aciclovir followed by oral antiviral remains standard. Intravitreal ganciclovir/foscarnet as adjunct improves outcomes. Combination prophylactic laser reduces RD incidence.',
    },
    {
      label: 'Viral Retinitis Diagnostics – Advances in Microbiological Diagnosis (2022)',
      pmid: 'PMID 38983563',
      detail: 'Review in Front Ophthalmol (Gueudry & Bodaghi, 2022): Real-time PCR of aqueous/vitreous has transformed diagnosis of herpetic retinitis. Metagenomic next-generation sequencing (mNGS) emerging for refractory/atypical cases.',
    },
    {
      label: 'Corticosteroids & Immunomodulation in Infectious Uveitis (2024)',
      pmid: 'PMID 38330155',
      detail: 'Review (Akhavanrezayat et al., 2024): Careful adjunctive steroid use in viral and parasitic retinitis; steroids contraindicated as monotherapy but improve outcomes in CMV-IRU, toxoplasma retinochoroiditis, and TB uveitis when combined with targeted antimicrobials.',
    },
    {
      label: 'Ocular Pathogen Resistance – Emerging Challenges (2025)',
      pmid: 'PMID 41599633',
      detail: 'Review in Pharmaceuticals (Ather & Conrady, 2025): Ganciclovir-resistant CMV increasing (UL97, UL54 mutations). New agents: Letermovir and Maribavir under investigation for drug-resistant CMV retinitis.',
    },
  ]
);

addEvidenceSlide(pres, 'Recent Evidence – Choroiditis & Uveitis Advances',
  [
    {
      label: 'VKH – OCTA for Disease Monitoring (Systematic Review 2024)',
      pmid: 'PMID 38456233',
      detail: 'Systematic review/meta-analysis (Liang et al., 2024): OCTA reliably quantifies choriocapillaris flow voids in VKH. Abnormal OCTA findings persist even in "quiet" VKH, suggesting subclinical activity – important for treatment decisions.',
    },
    {
      label: 'Sarcoidosis-Related Uveitis – Review (2023)',
      pmid: 'PMID 37176633',
      detail: 'Review in J Clin Med (Giorgiutti et al., 2023): Infliximab effective as steroid-sparing for sarcoid uveitis. New biologics (secukinumab, tocilizumab) in trials. ACE still useful but not specific. Whole-body PET-CT superior for staging.',
    },
    {
      label: 'VKH Disease – Multimodal Imaging Review (2026)',
      pmid: 'PMID 41644040',
      detail: 'State-of-the-art review in Prog Retin Eye Res (Xia et al., 2026): Comprehensive multimodal imaging including widefield OCTA, enhanced depth OCT (EDI-OCT), and en face imaging now recommended for staging and monitoring VKH. Subclinical choroidal changes detected before clinical recurrence.',
    },
    {
      label: 'Posterior Uveitis Management – Practical Tips for Retina Specialists (2023)',
      pmid: 'PMID 37589912',
      detail: 'Review (Paez-Escamilla et al., 2023): Step-up immunosuppression approach validated; systemic biologics (adalimumab – Humira, approved for uveitis) reduce steroid burden and relapses in non-infectious posterior uveitis including choroiditis syndromes.',
    },
    {
      label: 'Advanced Multimodal Imaging in Granulomatous Uveitis (2026)',
      pmid: 'PMID 42279083',
      detail: 'Review in J Clin Med (Capobianco et al., 2026): Ultra-widefield FA, OCTA, and AI-assisted image analysis improving differential diagnosis between TB, sarcoid, and idiopathic choroiditis.',
    },
  ]
);

addEvidenceSlide(pres, 'Recent Evidence – Retinitis Pigmentosa & Inherited Retinal Diseases',
  [
    {
      label: 'Voretigene Neparvovec (Luxturna) Gene Therapy – Long-term Data',
      pmid: 'PMID 34839010',
      detail: 'Schneider et al. (Prog Retin Eye Res, 2022): Multi-year follow-up confirms durable vision improvement with voretigene in RPE65-deficiency. Bilateral subretinal injection preferred; immunosuppression protocol important to prevent immune rejection.',
    },
    {
      label: 'Genetic Therapies for RP – Current Breakthroughs (2025)',
      pmid: 'PMID 40869487',
      detail: 'Pniakowska et al. (J Clin Med, 2025): Active gene therapy trials for >10 RP-causing genes (RPGR, CNGB3, PDE6A, CNGA3). Antisense oligonucleotides (ASOs) for PRPF31. Optogenetics (channelrhodopsin AAV vectors) in Phase I/II trials for end-stage RP.',
    },
    {
      label: 'Stem Cell Therapy for Inherited Retinal Disease – Meta-Analysis (2023)',
      pmid: 'PMID 37798796',
      detail: 'Systematic review/meta-analysis in Stem Cell Res Ther (Chen et al., 2023): Subretinal RPE stem cell transplantation shows early safety signals in Phase I/II trials for RP and Stargardt; 12-month visual acuity improvements in some patients. Further Phase III trials needed.',
    },
    {
      label: 'TUDCA Neuroprotection in Retinal Disorders (2024)',
      pmid: 'PMID 37691227',
      detail: 'Systematic review (Li et al., Curr Neuropharmacol, 2024): Tauroursodeoxycholic acid (TUDCA) exerts neuroprotective effects in RP models; Phase II trials underway. Mechanism: ER stress reduction, anti-apoptotic effects on photoreceptors.',
    },
    {
      label: 'Ocular Toxoplasmosis SS-OCT Biomarkers (2026)',
      pmid: 'PMID 42096258',
      detail: 'Sree Keerti et al. (Ocul Immunol Inflamm, 2026): Swept-source OCT reveals choroidal thickness and structural retinal changes as objective biomarkers for disease activity and treatment monitoring in toxoplasmic retinochoroiditis.',
    },
  ]
);

// ═══════════════════════════════════════════════════════════════════
//  SLIDE – RYAN'S RETINA HIGHLIGHTS
// ═══════════════════════════════════════════════════════════════════
addContentSlide(pres, "Ryan's Retina – Key Concepts & Clinical Pearls",
  [
    { text: 'CMV Retinitis (Ryan\'s Retina, Chapter on AIDS & Retina):', bold: true },
    { text: '  Ganciclovir-resistant CMV retinitis: mutations in UL97 (kinase, ~90%) or UL54 (polymerase, ~10%); switch to Foscarnet or Cidofovir; emerging agent: Letermovir', sub: true },
    { text: '  Ganciclovir intravitreal implant (Vitrasert, 4.5 mg): superior local disease control but NO protection for fellow eye – must combine with systemic valganciclovir', sub: true },
    { text: 'Toxoplasma Retinochoroiditis (Ryan\'s Retina):', bold: true },
    { text: '  TOXO Study (Brazil): long-term TMP-SMX prophylaxis reduces recurrence rate by ~75% in high-risk patients (immunosuppressed, large lesions, near disc/macula)', sub: true },
    { text: '  Intravitreal clindamycin (1 mg) + dexamethasone (400 µg) – effective alternative when systemic therapy not tolerated (Level II evidence)', sub: true },
    { text: 'ARN – Prophylactic Laser (Ryan\'s Retina):', bold: true },
    { text: '  360° laser retinopexy applied posterior to active lesions reduces risk of RD from ~75% to ~35%', sub: true },
    { text: '  PPV with endolaser + silicone oil tamponade is the standard surgical approach for established RRD in ARN', sub: true },
    { text: 'Birdshot Retinochoroidopathy – Adalimumab Trial:', bold: true },
    { text: '  MEAD trial data: adalimumab (anti-TNF) reduces systemic corticosteroid requirement and maintains ERG responses in birdshot; now part of step-up algorithm', sub: true },
    { text: 'Sympathetic Ophthalmia (Ryan\'s Retina):', bold: true },
    { text: '  Evisceration within 2 weeks of inciting injury may prevent SO; after SO is established, enucleation does NOT improve outcome of the fellow eye', sub: true },
  ],
  "Ryan's Retina (6e) – Schachat et al."
);

// ═══════════════════════════════════════════════════════════════════
//  SECTION 9 – SUMMARY
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 9, 'Summary & Key Pearls');

addTableSlide(pres, 'Quick Differential Diagnosis at a Glance',
  ['Condition', 'Vitritis', 'Location', 'Key Feature', 'Treatment'],
  [
    ['CMV Retinitis', 'Mild', 'Peripheral → central', '"Pizza pie" + haemorrhages', 'Valganciclovir + ART'],
    ['ARN', 'Severe', 'Peripheral → posterior', 'Panuveitis; occlusive vasculitis', 'IV Aciclovir → oral'],
    ['PORN', 'Absent', 'Outer retina; multifocal', 'Very rapid; immunocompromised', 'IV Ganciclovir + Foscarnet'],
    ['Toxoplasma', 'Dense', 'Adjacent to old scar', '"Headlight in fog"', 'Pyrimethamine + Sulfa'],
    ['Sarcoid', 'Present', 'Periphlebitis', 'Candle-wax drippings', 'Steroids ± immunosuppressives'],
    ['MEWDS', 'Mild', 'Outer retina, posterior', 'Orange granular fovea; spontaneous resolution', 'Observation'],
    ['APMPPE', 'Mild', 'RPE, posterior pole', 'Early hypofluorescence FA', 'Observation (± steroids)'],
    ['Birdshot', 'Present', 'Choroid, posterior', 'HLA-A29+; cream ovoid lesions', 'Immunosuppressives'],
    ['VKH', 'Present', 'Pan-uveal + systemic', 'Sunset glow; serous RD; poliosis', 'High-dose steroids'],
    ['Serpiginous', 'Absent', 'RPE/choriocapillaris', 'Jigsaw snake-like progression', 'Immunosuppressives; rule out TB'],
    ['RP (Inherited)', 'Absent', 'Mid-peripheral', 'Bone spicule + waxy disc', 'Gene therapy (RPE65); VA: Luxturna'],
  ]
);

addContentSlide(pres, 'Key Clinical Pearls',
  [
    { text: 'CMV retinitis is the most common cause of infectious retinitis in AIDS; CD4+ <50 is the strongest risk factor. Always start ART.', bold: false },
    { text: 'Toxoplasma is the most common cause of posterior uveitis worldwide – "headlight in the fog" next to an old scar is pathognomonic.', bold: false },
    { text: 'ARN requires IV Aciclovir urgently and prophylactic laser retinopexy to prevent devastating RRD.', bold: false },
    { text: 'PORN is ARN in the severely immunocompromised – no vitritis, rapid progression, very poor prognosis.', bold: false },
    { text: 'Birdshot: >95% HLA-A29 positive – this is a near-mandatory test. Visual field (not VA) is the monitoring tool.', bold: false },
    { text: 'VKH mimics posterior scleritis and Harada disease; early high-dose steroids prevent sunset glow fundus and chronic sequelae.', bold: false },
    { text: 'Serpiginous choroidopathy – always rule out TB before immunosuppression; ATT in endemic areas.', bold: false },
    { text: 'Luxturna (voretigene neparvovec) was the first FDA-approved gene therapy for any genetic disease – targets biallelic RPE65 mutations in RP.', bold: false },
    { text: 'OCTA is revolutionising choroiditis evaluation – it detects subclinical choriocapillaris flow voids and reveals activity in "quiet" eyes.', bold: false },
    { text: 'Ganciclovir-resistant CMV: suspect in patients failing therapy; test for UL97/UL54 mutations; Letermovir is a promising new alternative.', bold: false },
  ],
  'Sources: Kanski\'s Clinical Ophthalmology 10e | Wills Eye Manual | Ryan\'s Retina 6e | PubMed 2021–2026'
);

// ─── FINAL SLIDE ──────────────────────────────────────────────────
const finalSl = pres.addSlide();
finalSl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: '100%', h: '100%', fill: { color: DARK_BG } });
finalSl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.4, h: '100%', fill: { color: ACCENT1 } });
finalSl.addShape(pres.ShapeType.rect, { x: 12.9, y: 0, w: 0.4, h: '100%', fill: { color: ACCENT2 } });
finalSl.addText('Thank You', {
  x: 0.7, y: 2.2, w: 11.5, h: 1.5,
  fontSize: 52, bold: true, color: WHITE, align: 'center', fontFace: 'Calibri',
});
finalSl.addText('Questions & Discussion', {
  x: 0.7, y: 3.8, w: 11.5, h: 0.8,
  fontSize: 24, color: ACCENT1, align: 'center', fontFace: 'Calibri',
});
finalSl.addText(
  'References: Kanski\'s Clinical Ophthalmology 10e (Salmon & Kanski) | The Wills Eye Manual (Wolters Kluwer) | Ryan\'s Retina 6e (Schachat et al.) | Goldman-Cecil Medicine | PubMed PMIDs: 39549781, 37774799, 38983563, 38330155, 41599633, 38456233, 37176633, 41644040, 37798796, 40869487, 37691227, 34839010, 42096258',
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    fontSize: 10, color: LIGHT_TXT, align: 'center', italic: true, fontFace: 'Calibri',
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);

// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: '/home/daytona/workspace/retinitis_choroiditis/Retinitis_Choroiditis_Presentation.pptx' })
  .then(() => console.log('SUCCESS: Presentation saved.'))
  .catch(e => { console.error('ERROR:', e); process.exit(1); });

cd /home/daytona/workspace/retinitis_choroiditis && node build_pptx.js 2>&1

ls -lh /home/daytona/workspace/retinitis_choroiditis/Retinitis_Choroiditis_Prese…

adalimumab non-infectious uveitis posterior clinical trial

retinitis pigmentosa optogenetics gene therapy clinical trial 2023 2024 2025

intravitreal dexamethasone implant uveitis macular edema

optogenetics retinal degeneration clinical trial human

sympathetic ophthalmia treatment outcomes immunosuppression

APMPPE serpiginous choroiditis multimodal imaging OCT

~/retinitis_choroiditis/build_extension.js

/**
 * EXTENSION SCRIPT – adds ~20 new slides to the existing presentation
 * Covers: Investigations/Imaging, Drug Protocols, Management Algorithms,
 * Advanced Clinical Trials (MERIT, TRIOZ, VISUAL, MUV), Aspergillus/Coccidio,
 * RP investigations, Syphilis chorioretinitis deep-dive, Emerging Therapies,
 * Approach to Uveitis workup, and updated pearls.
 */

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE';
pres.title  = 'Retinitis & Choroiditis – Extended Module';
pres.author = 'Orris Medical AI';

// ─── PALETTE (identical to base deck for continuity) ─────────────
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const ACCENT2   = 'E8A838';
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const LIGHT_TXT = 'C9D8E6';
const RED_ACC   = 'E05A5A';
const GREEN_ACC = '4CAF7D';
const PURPLE    = '8B6FD6';
const TEAL2     = '1A8C8C';

// ─── HELPERS (copied verbatim) ────────────────────────────────────
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// ══════════════════════════════════════════════════════════════════
//  PART A – INVESTIGATIVE APPROACH (New Sections 10-13)
// ══════════════════════════════════════════════════════════════════

// ─── SECTION 10 – INVESTIGATIONS & IMAGING ───────────────────────
addSectionSlide(pres, 10, 'Investigations & Multimodal Imaging');

addContentSlide(pres, 'Multimodal Imaging in Retinitis & Choroiditis – Overview',
  [
    { text: 'Fundus Photography (FP):', bold: true },
    { text: '  Baseline documentation of lesion morphology, haemorrhage, exudates, pigmentation, vascular changes', sub: true },
    { text: 'Fluorescein Angiography (FA):', bold: true },
    { text: '  Gold standard for retinal vascular leakage, vasculitis, and disc staining', sub: true },
    { text: '  Patterns: early hypofluorescence (choriocapillaritis) vs late hyperfluorescence (active leakage)', sub: true },
    { text: '  Key: "pizza pie" hyperfluorescence in CMV; placoid early block in APMPPE', sub: true },
    { text: 'Indocyanine Green Angiography (ICGA):', bold: true },
    { text: '  Essential for choroidal imaging; detects lesions invisible on FA', sub: true },
    { text: '  Hypofluorescent lesions in Birdshot, MEWDS, VKH, serpiginous throughout all phases', sub: true },
    { text: 'OCT (Optical Coherence Tomography):', bold: true },
    { text: '  Retinal layer analysis: IS/OS disruption, ellipsoid zone loss, SRF, CMO, ERM, RPE changes', sub: true },
    { text: '  EDI-OCT: Enhanced Depth Imaging → choroidal thickness measurement (increased in VKH, decreased after treatment)', sub: true },
    { text: 'OCTA (OCT Angiography):', bold: true },
    { text: '  Non-invasive; detects choriocapillaris flow voids (VKH, MEWDS, Birdshot)', sub: true },
    { text: '  Identifies sub-clinical MNV (macular neovascularisation) without dye injection', sub: true },
    { text: 'Fundus Autofluorescence (FAF):', bold: true },
    { text: '  Hyperautofluorescence at active lesion margins (serpiginous, MEWDS, APMPPE)', sub: true },
    { text: '  Hypoautofluorescence = RPE atrophy / inactive scarring', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e; Baharani et al., Surv Ophthalmol 2022 (PMID 35007618)'
);

addTableSlide(pres, 'FA & ICGA Patterns in Key Choroiditis Syndromes',
  ['Condition', 'FA – Early', 'FA – Late', 'ICGA Pattern', 'FAF'],
  [
    ['CMV Retinitis', 'Hyperfluorescence, leakage', 'Progressive staining', 'Not primary modality', 'N/A'],
    ['Toxoplasma', 'Hyperfluorescence (lesion)', 'Intense leakage + disc stain', 'Hypofluorescence', 'Hypoautofluorescence (scar)'],
    ['MEWDS', 'Hyperfluorescence (dots)', 'Hyperfluorescence', 'Early hypofluorescent dots', 'Hyper AF (multiple dots) – KEY'],
    ['APMPPE', 'Hypofluorescence (block)', 'Hyperfluorescence', 'Hypofluorescence all phases', 'Hyperautofluorescent'],
    ['Serpiginous', 'Hypofluorescence', 'Hyperfluorescence (active edge)', 'Hypofluorescence all phases', 'Hyperautofluorescent active edge'],
    ['Birdshot', 'Extensive vascular leakage', 'Diffuse staining', 'Multiple hypofluorescent spots (>clinical)', 'Hypoautofluorescent spots'],
    ['VKH', 'Multifocal hypofluorescent dots', 'Multiple serous RD; disc stain', 'Stromal hypofluorescence', 'Hypoautofluorescence (RPE)'],
    ['MFC/PIC', 'Hypofluorescence (lesion)', 'Late hyperfluorescence', 'Hypofluorescence; persistent old', 'Hypoautofluorescent lesions'],
  ],
  ACCENT1
);

addContentSlide(pres, 'Systemic Workup for Posterior Uveitis / Retinitis',
  [
    { text: 'Mandatory Blood Tests:', bold: true },
    { text: '  FBC, ESR, CRP, LFTs, RFTs, blood glucose', sub: true },
    { text: '  Syphilis serology: RPR/VDRL + TPHA/FTA-ABS (always rule out "the great imitator")', sub: true },
    { text: '  Quantiferon-Gold (TB-IGRA) / Mantoux; CXR or HRCT chest', sub: true },
    { text: '  HIV Ab/Ag (CD4+ count if positive); TORCH serology (toxoplasma IgG/IgM)', sub: true },
    { text: '  ACE + Serum lysozyme (sarcoidosis)', sub: true },
    { text: '  HLA-A29 (Birdshot); HLA-B51 (Behçet\'s disease)', sub: true },
    { text: 'Specific Microbiological Tests:', bold: true },
    { text: '  Aqueous/Vitreous PCR: CMV, HSV-1/2, VZV, EBV, Toxoplasma DNA', sub: true },
    { text: '  Goldmann-Witmer coefficient (GWC) for local antibody production (toxoplasma, CMV)', sub: true },
    { text: '  Metagenomic NGS: emerging for refractory/undiagnosed uveitis', sub: true },
    { text: 'Imaging:', bold: true },
    { text: '  Chest CT (sarcoidosis, TB, lymphoma), MRI brain (ARN, VKH, SSPE)', sub: true },
    { text: '  Lumbar puncture if CNS involvement suspected (APMPPE, ARN, neurosyphilis, VKH)', sub: true },
    { text: 'Electrophysiology:', bold: true },
    { text: '  Full-field ERG (RP, birdshot, cancer-associated retinopathy)', sub: true },
    { text: '  Pattern ERG, multifocal ERG, VEP as indicated', sub: true },
  ],
  'Systematic approach recommended before initiating immunosuppression – always rule out infectious causes first'
);

// ─── SECTION 11 – DRUG PROTOCOLS ─────────────────────────────────
addSectionSlide(pres, 11, 'Drug Protocols & Treatment Ladders');

addTableSlide(pres, 'Antiviral Drug Protocols – CMV & Herpes Retinitis',
  ['Drug', 'Indication', 'Dose / Route', 'Duration', 'Key Notes'],
  [
    ['Valganciclovir', 'CMV retinitis (induction + maintenance)', '900 mg BD PO (induction)\n900 mg OD PO (maintenance)', 'Induction: 3 wks\nMaintenance: until CD4 >150', 'Equivalent to IV GCV; preferred oral agent; renal dose adjustment required'],
    ['Ganciclovir IV', 'CMV – severe, vision-threatening', '5 mg/kg BD IV', '2–3 weeks induction', 'Myelosuppression (↓WBC/Plt); monitor FBC weekly'],
    ['Foscarnet IV', 'Ganciclovir-resistant CMV; ARN combination', '90 mg/kg BD IV', '2–3 weeks', 'Nephrotoxic; electrolyte imbalances (↓Ca, ↓Mg, ↓K)'],
    ['Cidofovir IV', 'Ganciclovir + Foscarnet resistant CMV', '5 mg/kg IV weekly × 2, then every 2 wks', 'Maintenance', 'Severe nephrotoxicity; must co-administer Probenecid + IV saline'],
    ['Aciclovir IV', 'ARN – first-line induction', '15 mg/kg every 8 h IV', '10–14 days', 'Then oral aciclovir 800 mg 5× daily × 6–12 wks; reduces 2nd eye risk'],
    ['Valaciclovir PO', 'ARN – alternative/step-down', '1–1.5 g TDS', '6–12 weeks after IV', 'Better bioavailability than aciclovir; preferred oral step-down'],
    ['Ganciclovir IVT', 'CMV – immediate macular threat', '2 mg in 0.05–0.1 ml', 'Every 1–2 weeks', 'Always combine with systemic therapy; no fellow-eye protection'],
    ['Letermovir', 'Ganciclovir-resistant CMV (emerging)', '480 mg OD PO/IV', 'Ongoing', 'CMV terminase inhibitor; novel mechanism; currently approved for CMV prophylaxis post-HSCT'],
  ],
  ACCENT2
);

addTableSlide(pres, 'Anti-Parasitic / Anti-Fungal Drug Protocols',
  ['Drug', 'Indication', 'Dose', 'Duration', 'Key Notes'],
  [
    ['Pyrimethamine + Sulfadiazine', 'Toxoplasma – gold standard', 'Pyrimeth 100 mg LD → 25–50 mg OD; Sulfa 1 g QID', '4–6 weeks', 'Add Folinic acid 5–10 mg OD to prevent marrow toxicity; monitor FBC'],
    ['TMP-SMX (Co-trimoxazole)', 'Toxoplasma – alternative; also prophylaxis', '960 mg BD (treatment) or 480 mg OD (prophylaxis)', '4–6 wks (Tx); long-term (prophylaxis)', 'Equally effective; avoid in sulfa allergy; covers PCP simultaneously'],
    ['Clindamycin IVT', 'Toxoplasma – intravitreal alternative', '1 mg/0.05 ml IVT', 'Weekly × 4–6 weeks', 'With IVT dexamethasone 400 µg; for systemic contraindication'],
    ['Amphotericin B IV', 'Candida, Cryptococcus, Aspergillus', '1 mg/kg/day', '2–6 weeks', 'Nephrotoxic; liposomal formulation preferred for renal protection'],
    ['Voriconazole PO/IV', 'Aspergillus, Candida, broad fungal', '400 mg BD LD → 200 mg BD', '4–6 weeks minimum', 'High ocular penetration; broad spectrum; monitor LFTs and QTc'],
    ['Fluconazole PO', 'Candida, Cryptococcus maintenance', '200–400 mg OD', 'Maintenance (indefinite in AIDS)', 'Well-tolerated; use after Ampho B induction for Cryptococcus'],
    ['Pyrimeth + Azithromycin', 'Toxoplasma – alternative', 'Pyrimeth 25 mg + Azithro 500 mg OD', '4–6 weeks', 'For sulfa-allergic patients (PMID 40698108)'],
    ['Isoniazid+Rifamp+Pyrazin+Ethamb', 'TB choroiditis – ATT standard 4-drug', 'Weight-based dosing', '2 months HRZE → 4–10 months HR', 'Add prednisolone 1 mg/kg in TB uveitis; serpiginous TB: longer ATT'],
  ],
  GREEN_ACC
);

addTableSlide(pres, 'Immunosuppressive / Biologic Therapy for Non-Infectious Uveitis & Choroiditis',
  ['Drug', 'Class', 'Indication', 'Dose', 'Key Trial / Evidence'],
  [
    ['Prednisolone', 'Corticosteroid', 'First-line all non-infectious', '1 mg/kg/day → taper', 'Standard of care'],
    ['Methotrexate', 'Antimetabolite', 'Birdshot, sarcoid, VKH (steroid-sparing)', '7.5–25 mg/wk + folic acid', 'Widely used; hepatotoxicity monitoring'],
    ['Mycophenolate Mofetil', 'Antimetabolite', 'VKH, birdshot, MFC, serpiginous', '1–3 g/day BD', 'Well-tolerated; preferred in childbearing age'],
    ['Azathioprine', 'Antimetabolite', 'VKH, sarcoid, serpiginous', '1–3 mg/kg/day', 'TPMT genotyping before initiation'],
    ['Cyclosporine', 'Calcineurin inhibitor', 'Birdshot, VKH, severe posterior uveitis', '2–5 mg/kg/day', 'Nephrotoxic; monitor BP and creatinine'],
    ['Adalimumab (Humira)', 'Anti-TNF biologic', 'Non-infectious uveitis (FDA approved)', '80 mg SC LD → 40 mg Q2W', 'VISUAL I+II trials (PMID 32469621) – reduces relapse and steroid burden'],
    ['Infliximab (Remicade)', 'Anti-TNF biologic', 'Sarcoid, Behçet\'s, refractory birdshot/VKH', '5–10 mg/kg IV Q6–8W', 'Highly effective; TB reactivation risk – screen before use'],
    ['Tocilizumab', 'Anti-IL-6 biologic', 'Refractory uveitic macular oedema', '8 mg/kg IV Q4W', 'Emerging evidence; Phase II trials'],
    ['Dexamethasone Implant (Ozurdex)', 'Intravitreal steroid', 'Uveitic CMO; posterior uveitis flare', '0.7 mg IVT implant', 'MERIT trial (PMID 37318415); TRIOZ trial (PMID 39168590)'],
  ],
  PURPLE
);

// ─── SECTION 12 – MANAGEMENT ALGORITHMS ──────────────────────────
addSectionSlide(pres, 12, 'Management Algorithms');

addFlowSlide(pres, 'Management Algorithm – CMV Retinitis in AIDS',
  [
    [{ text: 'New AIDS Patient with Reduced Vision / Floaters', bold: true, color: MID_BG, fontSize: 15 }],
    [{ text: 'Ophthalmological Assessment: Fundus Exam + FFA + CD4+ Count', color: TEAL2, fontSize: 13 }],
    [{ text: 'CMV Retinitis Confirmed (Pizza-pie pattern; CD4 <50)', bold: true, color: '8B1A1A', fontSize: 14 }],
    [{ text: 'Immediate: Oral Valganciclovir 900 mg BD + ART Optimisation\n(Intravitreal Ganciclovir if immediate macular threat)', color: TEAL2, fontSize: 13 }],
    [{ text: '3-Week Induction → Maintenance 900 mg OD\nMonitor CD4+ count monthly', color: PURPLE, fontSize: 13 }],
    [{ text: 'CD4+ >100-150 cells/µl maintained × 6 months', color: TEAL2, fontSize: 13 }],
    [{ text: 'Discontinue anti-CMV maintenance therapy; continue ART\nMonitor for Immune Recovery Uveitis (IRU)', color: '2D5A1B', fontSize: 13 }],
  ]
);

addFlowSlide(pres, 'Management Algorithm – Acute Retinal Necrosis (ARN)',
  [
    [{ text: 'Patient: Healthy individual, Painful Red Eye + Floaters + Reduced Vision', bold: true, color: MID_BG, fontSize: 14 }],
    [{ text: 'Slit-Lamp: Panuveitis (AU + Vitritis)\nFundus: Peripheral Yellow-White Necrosis + Occlusive Vasculitis', color: TEAL2, fontSize: 13 }],
    [{ text: 'Aqueous PCR: HSV/VZV DNA Confirmed → Diagnose ARN', bold: true, color: '8B1A1A', fontSize: 14 }],
    [{ text: 'Immediate: IV Aciclovir 15 mg/kg every 8 h IV × 10–14 days\n± Intravitreal Ganciclovir/Foscarnet', color: TEAL2, fontSize: 13 }],
    [{ text: 'Prophylactic 360° Laser Retinopexy posterior to lesions (reduces RD: 75% → 35%)', bold: true, color: PURPLE, fontSize: 13 }],
    [{ text: 'Step-down: Oral Valaciclovir 1–1.5 g TDS × 6–12 weeks\nOral Prednisolone if severe inflammation (after anti-viral cover)', color: TEAL2, fontSize: 13 }],
    [{ text: 'Established RRD: PPV + Endolaser + Silicone Oil Tamponade', color: '8B1A1A', fontSize: 13 }],
  ]
);

addFlowSlide(pres, 'Management Algorithm – Non-Infectious Choroiditis (Step-Up Approach)',
  [
    [
      { text: 'Step 1\nTOPICAL & PERIOCULAR STEROIDS\n(mild localised disease)', color: '2D5A1B', fontSize: 12 },
      { text: 'Assess:\nVisual fields, ERG,\nFA/ICGA/OCT at 6-8 wks', color: MID_BG, fontSize: 12 },
      { text: 'If inadequate response\nor bilateral / severe\n→ Step 2', color: '6B3000', fontSize: 12 },
    ],
    [
      { text: 'Step 2\nORAL PREDNISOLONE\n1 mg/kg/day + slow taper', color: TEAL2, fontSize: 12 },
      { text: 'Target:\nQuiescent inflammation\n<5 cells/HPF\nStable VA & fields', color: MID_BG, fontSize: 12 },
      { text: 'If >10mg/day needed\nfor >3 months → Step 3', color: '6B3000', fontSize: 12 },
    ],
    [
      { text: 'Step 3\nSTEROID-SPARING IMMUNOSUPPRESSION\nMMF / MTX / Azathioprine', color: PURPLE, fontSize: 12 },
      { text: 'Duration:\nMinimum 2 years\nof quiescence before\ntaper attempt', color: MID_BG, fontSize: 12 },
      { text: 'If refractory\n→ Step 4', color: '6B3000', fontSize: 12 },
    ],
    [
      { text: 'Step 4\nBIOLOGICS\nAdalimumab / Infliximab\nTocilizumab (CMO)', color: '8B1A1A', fontSize: 12 },
      { text: 'Monitoring:\nOphthalmic review Q4-8W\nSystemic monitoring\n(BP, LFTs, CBC)', color: MID_BG, fontSize: 12 },
      { text: 'Adjuncts:\nIVT Ozurdex for CMO\nAnti-VEGF for MNV', color: TEAL2, fontSize: 12 },
    ],
  ]
);

// ─── SECTION 13 – DEEP-DIVE CLINICAL ENTITIES ────────────────────
addSectionSlide(pres, 13, 'Deep-Dive: Selected Clinical Entities');

addTwoColSlide(pres, 'Syphilitic Chorioretinitis – The Great Imitator',
  'Clinical Patterns',
  [
    { text: 'Can mimic virtually any uveitis pattern – always test', bold: true, highlight: true },
    { text: 'Anterior uveitis (~4% of secondary syphilis)', sub: true },
    { text: '  Granulomatous or non-granulomatous; may have elevated IOP', sub: true },
    { text: 'Acute syphilitic posterior placoid chorioretinitis (ASPPC):', bold: true },
    { text: '  Single large yellow-orange placoid macular lesion', sub: true },
    { text: '  Strongly associated with HIV co-infection', sub: true },
    { text: '  FA: early hypofluorescence → late hyperfluorescence', sub: true },
    { text: 'Necrotising retinitis (mimics ARN/CMV)', sub: true },
    { text: 'Optic neuritis, papilloedema, neuroretinitis', sub: true },
    { text: 'Vitritis, panuveitis, episcleritis', sub: true },
    { text: 'Intermediate uveitis, retinal vasculitis', sub: true },
    { text: 'Congenital syphilis: interstitial keratitis, "salt and pepper" retinopathy, saddle nose deformity', sub: true },
  ],
  'Diagnosis & Treatment',
  [
    { text: 'Always test for HIV and STIs simultaneously', bold: true, highlight: true },
    { text: 'Serology:', bold: true },
    { text: '  Screening: RPR or VDRL (non-treponemal – titre correlates with disease activity)', sub: true },
    { text: '  Confirmatory: TPHA, FTA-ABS (treponemal – remain positive lifelong)', sub: true },
    { text: '  False positives in RPR: TB, leprosy, malaria, collagen disease', sub: true },
    { text: 'CSF analysis if neurosyphilis suspected (visual or neurological symptoms)', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  1st line: IV Benzylpenicillin G 18–24 MU/day continuous or 3–4 MU IV Q4h × 10–14 days', sub: true },
    { text: '  Alternative (penicillin allergy): IV Ceftriaxone 2 g OD × 10–14 days', sub: true },
    { text: '  Follow-up RPR titres at 3, 6, 12 months (fourfold drop = treatment response)', sub: true },
    { text: 'Jarisch-Herxheimer reaction: fever, rigors within 24h of first treatment – reassure and treat symptomatically', sub: true },
  ], ACCENT1, ACCENT2
);

addTwoColSlide(pres, 'Multifocal Choroiditis & PIC – Current Approach',
  'MFC – Multifocal Choroiditis with Panuveitis',
  [
    'Uncommon; usually bilateral but asymmetric; chronic/recurrent',
    'Young/middle-aged women; often preceded by viral illness',
    { text: 'Key finding:', bold: true },
    { text: '  Ovoid yellowish-grey lesions 50–350 µm; posterior pole + periphery', sub: true },
    { text: '  Vitritis in 50% + anterior uveitis', sub: true },
    { text: '  Inactive lesions = punched-out scars resembling POHS', sub: true },
    { text: '  MNV occurs in 25–35%; CMO, subretinal fibrosis (SFU spectrum)', sub: true },
    { text: 'Investigations:', bold: true },
    { text: '  FA: early hypofluorescence, late hyperfluorescence; ICGA: hypofluorescent lesions', sub: true },
    { text: '  OCT: sub-RPE material, outer retina disruption', sub: true },
    { text: '  OCTA: choriocapillaris flow voids', sub: true },
    { text: 'New MUV Guideline (PMID 40288596):', bold: true, highlight: true },
    { text: '  Recommends OCTA + ICGA as standard workup for MFC; FAF for MNV surveillance', sub: true },
  ],
  'PIC – Punctate Inner Choroidopathy',
  [
    'Young, highly myopic women (essentially no males)',
    { text: 'KEY: No vitritis or anterior uveitis – distinguishes from MFC', bold: true, highlight: true },
    'Small (100–300 µm) punched-out lesions at level of inner choroid/RPE',
    'Located at posterior pole; bilateral in ~75%',
    { text: 'MNV (CNV) in 40–75%:', bold: true },
    { text: '  Most common complication; major cause of VA loss', sub: true },
    { text: '  Anti-VEGF (Ranibizumab, Bevacizumab) is first-line treatment', sub: true },
    { text: 'FA: early hypofluorescence → late staining; MNV shows late leakage', sub: true },
    { text: 'OCTA: detects sub-clinical MNV before it causes symptoms', sub: true },
    { text: 'Active PIC lesions: consider short-course oral prednisolone to reduce new lesion formation', sub: true },
    { text: 'New MUV Guideline 2025 (PMID 40288596):', bold: true, highlight: true },
    { text: '  Standardised OCTA protocol for MNV detection and follow-up recommended', sub: true },
  ]
);

addContentSlide(pres, 'Aspergillus Endophthalmitis & Rare Fungal Choroiditis',
  [
    { text: 'Aspergillus Endophthalmitis:', bold: true },
    { text: '  Risk factors: IV drug use, chronic lung disease, organ transplantation, neutropenia', sub: true },
    { text: '  Presentation: Iridocyclitis, vitritis, yellow retinal/subretinal macular infiltrates (earlier macular involvement than Candida)', sub: true },
    { text: '  Occlusive retinal vasculitis is common; rapid progression; endocarditis risk', sub: true },
    { text: '  Treatment: Voriconazole (high ocular penetration) PO/IV + intravitreal Voriconazole; early PPV', sub: true },
    { text: 'Coccidioidomycosis:', bold: true },
    { text: '  Coccidioides immitis via inhalation; severe granulomatous AU + multifocal choroiditis', sub: true },
    { text: '  Endemic in southwestern USA, Mexico; treatment: Fluconazole/Itraconazole', sub: true },
    { text: 'Candida Chorioretinitis – Diagnostic Pearls:', bold: true },
    { text: '  "String of pearls" white vitreous infiltrate = pathognomonic of Candida endophthalmitis', sub: true },
    { text: '  Risk: IV drug abuse, TPN, broad-spectrum antibiotics, immunosuppression, indwelling catheters', sub: true },
    { text: '  Fluconazole systemic + intravitreal Amphotericin B (5–10 µg) or Voriconazole', sub: true },
    { text: '  Early PPV for vitreous involvement; reduces fungal load and improves drug penetration', sub: true },
    { text: 'IDSA Guidelines on Fungal Endophthalmitis:', bold: true },
    { text: '  IV Amphotericin B + Flucytosine for Candida/Cryptococcus; Voriconazole for Aspergillus; resistance screening recommended', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.497–502'
);

addTwoColSlide(pres, 'Sympathetic Ophthalmia – Advanced Concepts',
  'Pathogenesis & Clinical Features',
  [
    'Bilateral granulomatous panuveitis after penetrating ocular trauma or intraocular surgery',
    { text: 'Pathogenesis:', bold: true },
    { text: '  Autoimmune reaction to uveal pigment antigens (S-antigen, IRBP, recoverin) exposed at surgery/trauma', sub: true },
    { text: '  HLA-DR4, HLA-DQw3 associations', sub: true },
    { text: 'Timing:', bold: true },
    { text: '  Shortest recorded: 5 days; 90% within 1 year', sub: true },
    { text: '  Peak risk: 4–8 weeks after injury', sub: true },
    { text: '  Rare cases: decades later after seemingly minor surgery', sub: true },
    { text: 'Exciting eye: worsening panuveitis', sub: true },
    { text: 'Sympathising eye (fellow): initially anterior uveitis → granulomatous panuveitis, multiple choroidal granulomas (Dalen-Fuchs nodules), disc oedema, serous RD', sub: true },
    { text: 'Dalen-Fuchs nodules:', bold: true },
    { text: '  Subretinal granulomatous aggregates of RPE + macrophages; appear between Bruch\'s membrane and RPE', sub: true },
  ],
  'Prophylaxis & Treatment',
  [
    { text: 'CRITICAL POINT:', bold: true, highlight: true },
    { text: '  Evisceration/enucleation of the exciting eye within 2 weeks of injury MAY prevent SO', sub: true },
    { text: '  Once SO is established, removal of exciting eye does NOT improve the sympathising eye prognosis', sub: true },
    { text: 'Treatment:', bold: true },
    { text: '  High-dose oral corticosteroids: Prednisolone 1–1.5 mg/kg/day', sub: true },
    { text: '  Taper slowly over ≥12 months; relapse common on rapid withdrawal', sub: true },
    { text: '  Steroid-sparing: Mycophenolate, Azathioprine, Cyclosporine', sub: true },
    { text: '  Biologics (Infliximab, Adalimumab) for refractory cases', sub: true },
    { text: 'Risk factors for SO after surgery:', bold: true },
    { text: '  Vitreoretinal surgery (highest), repeat procedures, pars planitis surgery, trauma with uveal prolapse', sub: true },
    { text: 'Recent review (PMID 34494974):', bold: false },
    { text: '  Modern immunosuppression protocols achieve long-term remission in >70%; prognosis has markedly improved', sub: true },
    { text: 'OCTA and EDI-OCT now preferred for non-invasive disease monitoring', sub: true },
  ]
);

addContentSlide(pres, 'Retinitis Pigmentosa – Full Investigation Protocol',
  [
    { text: 'Electrophysiology (ISCEV Standards):', bold: true },
    { text: '  Full-field ERG: Reduced/extinguished rod (scotopic) responses earliest; photopic responses late', sub: true },
    { text: '  Pattern ERG (PERG): assesses macular ganglion cell function', sub: true },
    { text: '  Electro-oculogram (EOG): Arden ratio reduced (RPE dysfunction)', sub: true },
    { text: '  Dark adaptometry: prolonged adaptation curve (elevated final rod threshold)', sub: true },
    { text: 'Structural Imaging:', bold: true },
    { text: '  FAF: Abnormal perimacular hyperautofluorescent ring (hallmark) + patchy peripheral hypoAF', sub: true },
    { text: '  OCT: IS/OS (ellipsoid zone) disruption from mid-periphery inward; CMO detection (20%); macular atrophy (40%)', sub: true },
    { text: '  FAF distinguishes RP from normal fundus in 95% as stand-alone test', sub: true },
    { text: '  EDI-OCT: Choroidal thinning in advanced RP', sub: true },
    { text: 'Visual Fields:', bold: true },
    { text: '  Goldmann perimetry: mid-peripheral ring scotoma → tubular vision ("tunnel vision")', sub: true },
    { text: '  Automated (Humphrey 30-2, 60-4): central islands of preserved field', sub: true },
    { text: '  Microperimetry: macular sensitivity for monitoring central function', sub: true },
    { text: 'Genetics:', bold: true },
    { text: '  Next-generation sequencing panels (100+ genes) – identifies causative mutation in ~60% currently', sub: true },
    { text: '  Mandatory for gene therapy eligibility (e.g., RPE65 Sanger sequencing for Luxturna)', sub: true },
    { text: '  Genetic counselling: essential; risk calculation for offspring by inheritance pattern', sub: true },
    { text: '  X-linked carrier females: FAF shows centrifugal hyperautofluorescent lines', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, p.648; Gene therapy trials: PMID 39930178'
);

// ═══════════════════════════════════════════════════════════════════
//  PART B – ADDITIONAL CLINICAL TRIALS & ADVANCES
// ═══════════════════════════════════════════════════════════════════
addSectionSlide(pres, 14, 'Additional Clinical Trials\nPubMed 2021–2026');

addEvidenceSlide(pres, 'Landmark Trials – Uveitic Macular Edema & Intravitreal Therapy',
  [
    {
      label: 'MERIT Trial – Dexamethasone vs MTX vs Ranibizumab (RCT 2023)',
      pmid: 'PMID 37318415',
      detail: 'MERIT RCT (Ophthalmology 2023): Intravitreal dexamethasone implant (Ozurdex) achieved best visual gains at 12 months for uveitic CMO. Methotrexate IVT was safer (no IOP rise). Ranibizumab was least effective. Dex implant becomes preferred for non-infectious uveitic CMO.'
    },
    {
      label: 'MERIT 24-Week Re-treatment Outcomes (RCT 2025)',
      pmid: 'PMID 39612949',
      detail: 'MERIT Group (Ophthalmology 2025): 24-week re-treatment analysis confirms IVT dexamethasone superiority for sustained CMO resolution. IOP elevation in 30% managed medically. Identifies CMO re-treatment criteria: >20% increase in CRT from best response.'
    },
    {
      label: 'TRIOZ Trial – Subconjunctival Triamcinolone vs IVT Ozurdex (RCT Phase III 2025)',
      pmid: 'PMID 39168590',
      detail: 'Phase III RCT in Br J Ophthalmol (Couret et al., 2025): Subconjunctival triamcinolone non-inferior to IVT Ozurdex at 3 months for uveitic/post-op CMO. Fewer IOP spikes with subconjunctival route. Provides a less invasive alternative to intravitreal injection.'
    },
    {
      label: 'VISUAL I+II Trials – Adalimumab for Non-Infectious Uveitis (RCT 2021)',
      pmid: 'PMID 32469621',
      detail: 'Merrill et al. (Ocul Immunol Inflamm, 2021): Post-hoc analysis of VISUAL I (active) and II (inactive) RCTs confirms adalimumab reduces time-to-treatment-failure across ALL non-infectious uveitis subtypes. Most benefit in HLA-B27-associated and Birdshot uveitis. Led to FDA approval of adalimumab for non-infectious uveitis.'
    },
    {
      label: 'Intravitreal vs Systemic Treatment in Cataract Surgery with Uveitis (Meta-Analysis 2023)',
      pmid: 'PMID 36271933',
      detail: 'Meta-analysis Graefes 2023: Perioperative IVT dexamethasone reduces post-cataract CMO flare in uveitis patients equally to systemic prednisolone; IVT route avoids systemic side effects in patients already on long-term immunosuppression.'
    },
  ]
);

addEvidenceSlide(pres, 'Emerging Therapies & Imaging Guidelines 2024–2026',
  [
    {
      label: 'MUV Taskforce – MFC & PIC Imaging Guidelines (Practice Guideline 2025)',
      pmid: 'PMID 40288596',
      detail: 'MUV Taskforce Report 5 (Am J Ophthalmol 2025): Evidence and consensus-based imaging guidelines for MFC and PIC. OCTA for MNV surveillance is now standard; ICGA required to classify choroidal lesion burden. Regular FAF recommended for RPE atrophy monitoring. Standardises follow-up intervals by disease activity.'
    },
    {
      label: 'MUV Taskforce – MEWDS Imaging Consensus (Guideline 2025)',
      pmid: 'PMID 40571046',
      detail: 'MUV Taskforce Report 6 (Am J Ophthalmol 2025): FAF and OCTA are now the essential diagnostic tools for MEWDS. FAF shows hyperautofluorescent dots (present when fundus dots already invisible); OCTA shows choriocapillaris flow voids. ICG also recommended. Diagnosis should include multimodal imaging even when fundus appears normal.'
    },
    {
      label: 'White Spot Syndromes – Advances in Understanding (Review 2023)',
      pmid: 'PMID 37574123',
      detail: 'Cicinelli et al. (Prog Retin Eye Res, 2023): Unifying concept: most white dot syndromes share a common primary target (choriocapillaris) with variable spread to RPE and outer retina. "Two-hit" model proposed (genetic susceptibility + infectious/environmental trigger). OCTA flow voids are the most sensitive marker of active choriocapillaritis.'
    },
    {
      label: 'Optogenetics for Retinal Degeneration – Ethical & Clinical Perspectives (Review 2022)',
      pmid: 'PMID 34724112',
      detail: 'Harris & Gilbert (Graefes 2022): First human optogenetics trial (genetically blind RP patient restored partial vision using intravitreal AAV2-ChrimsonR; NEJM 2021). Challenges include: limited light sensitivity, spectral restriction, and latency. Long-term gene expression durability being studied in ongoing Phase I/II trials.'
    },
    {
      label: 'Gene Therapy Trials for Inherited Retinal Diseases – Frequency Analysis (2025)',
      pmid: 'PMID 39930178',
      detail: 'Ameri et al. (Adv Exp Med Biol, 2025): >60 gene therapy clinical trials active for IRDs as of 2024. RPE65 (Luxturna), RPGR (XL-RP), CNGB3 (achromatopsia), CNGA3, PDE6A, PDE6B are most advanced. Subretinal and intravitreal routes compared; subretinal achieves higher transduction efficiency.'
    },
  ]
);

// ─── SECTION 15 – COMPLICATIONS & SPECIAL POPULATIONS ────────────
addSectionSlide(pres, 15, 'Complications, Special Populations & Pearls');

addTwoColSlide(pres, 'Complications of Retinitis & Choroiditis',
  'Vision-Threatening Complications',
  [
    { text: 'Retinal Detachment (RRD):', bold: true },
    { text: '  ARN: up to 75% without prophylaxis; PPV + SO', sub: true },
    { text: '  CMV retinitis: up to 50% in advanced disease', sub: true },
    { text: '  PORN: nearly 70% within weeks', sub: true },
    { text: 'Macular Neovascularisation (MNV/CNV):', bold: true },
    { text: '  POHS (40%), PIC (40–75%), MFC (25–35%), VKH (chronic phase), Birdshot', sub: true },
    { text: '  Treatment: anti-VEGF (Ranibizumab, Bevacizumab, Aflibercept)', sub: true },
    { text: 'Cystoid Macular Oedema (CMO):', bold: true },
    { text: '  Common in birdshot, VKH, sarcoid, intermediate uveitis, post-CMV IRU', sub: true },
    { text: '  IVT Ozurdex / IVT MTX; systemic immunosuppression; anti-VEGF limited role', sub: true },
    { text: 'Optic Atrophy:', bold: true },
    { text: '  End-stage birdshot, serpiginous, ARN, CMV; irreversible visual loss', sub: true },
    { text: 'Glaucoma (Secondary):', bold: true },
    { text: '  VKH, sarcoid (trabecular granulomas), steroid-induced OHT, CMV anterior uveitis', sub: true },
  ],
  'Cataract & Systemic Complications',
  [
    { text: 'Posterior Subcapsular Cataract (PSC):', bold: true },
    { text: '  RP (very common), corticosteroid-induced, chronic uveitis', sub: true },
    { text: '  Cataract extraction in active uveitis: cover with perioperative IV steroids + IVT dexamethasone', sub: true },
    { text: 'Epiretinal Membrane (ERM):', bold: true },
    { text: '  Post-CMV retinitis, after heavy laser treatment, chronic inflammation', sub: true },
    { text: '  PPV + ERM peel if VA <6/12 with metamorphopsia', sub: true },
    { text: 'Optic Neuritis:', bold: true },
    { text: '  Direct viral spread (CMV, ARN); VKH-associated; sarcoid; syphilis', sub: true },
    { text: 'Drug Side Effects to Monitor:', bold: true },
    { text: '  Chloroquine/HCQ: maculopathy (dose >5 mg/kg/day real weight) – annual OCT + mfERG baseline', sub: true },
    { text: '  Rifabutin: anterior uveitis (hypopyon) – common in HIV patients on prophylaxis', sub: true },
    { text: '  Cidofovir: hypotony (uveitis mechanism)', sub: true },
    { text: '  Corticosteroids: steroid-induced OHT, PSC, systemic diabetes, osteoporosis', sub: true },
    { text: 'Special Populations:', bold: true },
    { text: '  Pregnancy: avoid sulfonamides (Toxo treatment) in 3rd trimester; use spiramycin', sub: true },
    { text: '  Paediatric: congenital toxo, rubella retinopathy, paediatric VKH', sub: true },
  ]
);

addContentSlide(pres, 'HIV/AIDS Ocular Spectrum – Systematic Overview',
  [
    { text: 'Retinal Microangiopathy (most common, 70%):', bold: true },
    { text: '  Cotton-wool spots + haemorrhages; marker for CMV retinitis risk; spontaneous resolution; ART is treatment', sub: true },
    { text: 'CMV Retinitis (most important infectious complication):', bold: true },
    { text: '  CD4+ <50; "pizza pie" retinitis; valganciclovir + ART; discontinue at CD4 >150', sub: true },
    { text: 'Immune Recovery Uveitis (IRU):', bold: true },
    { text: '  After ART in CMV retinitis; severe vitritis, CMO, ERM; treat with IVT or periocular steroids', sub: true },
    { text: 'Toxoplasma Retinochoroiditis (AIDS):', bold: true },
    { text: '  Atypical: multiple lesions, no adjacent scar, minimal vitritis; PCR confirmation helpful', sub: true },
    { text: 'Pneumocystis Choroiditis:', bold: true },
    { text: '  CD4+ <100; pale choroidal lesions; no vitritis; TMP-SMX prophylaxis has nearly eliminated this', sub: true },
    { text: 'Cryptococcal Choroiditis:', bold: true },
    { text: '  Associated with CNS cryptococcosis; multifocal choroidal lesions + papilloedema; Ampho B + Fluconazole', sub: true },
    { text: 'PORN (Progressive Outer Retinal Necrosis):', bold: true },
    { text: '  VZV-driven; CD4+ <10; no vitritis; rapid progression; combination IV ganciclovir + foscarnet', sub: true },
    { text: 'Primary CNS Lymphoma / Intraocular Lymphoma:', bold: true },
    { text: '  Masquerade syndrome; vitritis + subretinal deposits; diagnose by vitreous biopsy for IL-10; treat with methotrexate + radiotherapy', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.487-503'
);

// ─── SECTION 16 – APPROACH TO PATIENT ────────────────────────────
addSectionSlide(pres, 16, 'Approach to a Patient with\nPosterior Uveitis / Retinitis');

addFlowSlide(pres, 'Stepwise Diagnostic Approach to Posterior Uveitis',
  [
    [{ text: 'History: Age, Immunostatus (HIV, transplant), Systemic disease, Travel, Sexual history, TB contacts, Drug history', bold: false, color: TEAL2, fontSize: 13 }],
    [{ text: 'Examination: VA, IOP, Slit lamp (AU), Fundus (pattern recognition: location, borders, haemorrhage, vasculitis)', color: MID_BG, fontSize: 13 }],
    [
      { text: 'Pattern A\nInfectious Retinitis\n(haemorrhagic, necrotic lesions\nHigh vitritis)', color: '8B1A1A', fontSize: 12 },
      { text: 'Pattern B\nIdiopathic Choroiditis\n(White/cream spots, no/mild vitritis\nSelf-limited)', color: TEAL2, fontSize: 12 },
      { text: 'Pattern C\nGranulomatous Choroiditis\n(HNL granulomas, multisystem\nSarcoid/TB/VKH)', color: PURPLE, fontSize: 12 },
    ],
    [
      { text: 'Pattern A workup:\nAqueous PCR (CMV/HSV/VZV/Toxo)\nCD4+ count; Serology', color: '8B1A1A', fontSize: 12 },
      { text: 'Pattern B workup:\nHLA-A29 (Birdshot)\nFA/ICGA/OCT/FAF\nMUV imaging guidelines', color: TEAL2, fontSize: 12 },
      { text: 'Pattern C workup:\nACE/lysozyme, CXR/CT\nQuantiferon-Gold, VDRL+TPHA\nTissue biopsy if needed', color: PURPLE, fontSize: 12 },
    ],
    [{ text: 'Treat specific cause identified → review response at 6–8 weeks with repeat imaging + VA + IOP', color: '2D5A1B', fontSize: 13 }],
    [{ text: 'No response or diagnosis unclear: Vitreous biopsy (cytology, culture, PCR panel, IL-10 for lymphoma)\nConsider metagenomic NGS', color: '6B3000', fontSize: 13 }],
  ]
);

// ─── SECTION 17 – ADVANCED PEARLS & FUTURE DIRECTIONS ────────────
addSectionSlide(pres, 17, 'Advanced Pearls & Future Directions');

addContentSlide(pres, 'Advanced Clinical Pearls for the Specialist',
  [
    { text: 'CMV anterior uveitis in immunocompetent:', bold: true },
    { text: '  Presents as unilateral chronic/recurrent anterior uveitis with elevated IOP + corneal endotheliitis; distinguish from HSV by failure to respond to aciclovir; treat with oral valganciclovir', sub: true },
    { text: 'Frosted Branch Angiitis (FBA):', bold: true },
    { text: '  Striking vascular sheathing; seen in CMV retinitis (~6%), EBV infection, lymphoma, idiopathic (primary FBA – good prognosis); always rule out CMV/lymphoma', sub: true },
    { text: 'SSPE (Subacute Sclerosing Panencephalitis):', bold: true },
    { text: '  Measles-associated CNS degeneration; classical macular grey-white lesion → RPE atrophy scar; onset 6–15 yrs post-measles; fatal; posterior uveitis may be presenting feature', sub: true },
    { text: 'IRVAN (Idiopathic Retinal Vasculitis, Aneurysms, Neuroretinitis):', bold: true },
    { text: '  Rare; arteriolar aneurysms + disc exudates + neuroretinitis; laser photocoagulation to aneurysms + areas of non-perfusion', sub: true },
    { text: 'Acute Idiopathic Maculopathy:', bold: true },
    { text: '  Self-limiting; young adults; Coxsackievirus association; serous macular detachment + oedema → spontaneous resolution; no treatment needed', sub: true },
    { text: 'Relentless Placoid Chorioretinitis (RPC / Ampiginous):', bold: true },
    { text: '  Hundreds of lesions spanning entire retina; chronic, relentless course unlike self-limited APMPPE; sustained immunosuppression required', sub: true },
    { text: '"Sunset Glow Fundus" (VKH):', bold: true },
    { text: '  Pathognomonic of chronic VKH; diffuse RPE depigmentation giving orange background glow; indicates inadequately treated or late VKH; associated with complications including CNV, glaucoma, subretinal fibrosis', sub: true },
  ],
  'Kanski\'s Clinical Ophthalmology 10e, pp.487-520'
);

addContentSlide(pres, 'Future Directions in Retinitis & Choroiditis',
  [
    { text: 'Gene Therapy Pipeline (2025–2026):', bold: true },
    { text: '  Active Phase I/II trials: RPGR (XL-RP), CNGA3 (achromatopsia), CNGB3, RLBP1 (Bothnia dystrophy), ABCA4 (Stargardt) – PMID 39930178', sub: true },
    { text: '  Dual-vector AAV strategies for large genes (USH2A, ABCA4) overcoming 4.7kb AAV packaging limit', sub: true },
    { text: 'Optogenetics:', bold: true },
    { text: '  AAV2-ChrimsonR (AGTC): first Phase I/II success in end-stage RP (NEJM 2021); ongoing Phase III trials', sub: true },
    { text: '  Limitation: requires light goggles; photosensitivity threshold being refined', sub: true },
    { text: 'Stem Cell Therapies:', bold: true },
    { text: '  iPS-derived RPE transplantation (subretinal): Phase II ongoing (Japan and USA)', sub: true },
    { text: '  hESC-derived RPE sheet: Phase I/II showing sustained VA stability at 24 months (PMID 37798796)', sub: true },
    { text: 'AI & OCT-Guided Disease Monitoring:', bold: true },
    { text: '  Deep learning algorithms for automated detection of choroidal granulomas, CNV, and lesion progression in uveitis', sub: true },
    { text: '  AI triage for CMV retinitis screening in HIV clinics (PMID 42279083)', sub: true },
    { text: 'New Biologics Under Investigation:', bold: true },
    { text: '  Secukinumab (anti-IL-17): Phase II for Behçet\'s and non-infectious uveitis', sub: true },
    { text: '  Faricimab (anti-VEGF + anti-Ang-2 bispecific): for neovascular complications of choroiditis', sub: true },
    { text: '  Letermovir / Maribavir: new antivirals for ganciclovir-resistant CMV retinitis (Phase II)', sub: true },
  ],
  'Sources: PMID 39930178, 37798796, 34724112, 40869487, 42279083'
);

// ─── FINAL SLIDE OF EXTENSION ─────────────────────────────────────
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endSl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.4, h: '100%', fill: { color: ACCENT1 } });
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endSl.addText('Retinitis & Choroiditis – Sections 10–17', {
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endSl.addText([
  { text: 'Investigations & Imaging  |  ', options: { color: LIGHT_TXT, fontSize: 14 } },
  { text: 'Drug Protocols  |  ', options: { color: ACCENT2, fontSize: 14 } },
  { text: 'Management Algorithms  |  ', options: { color: LIGHT_TXT, fontSize: 14 } },
  { text: 'Deep-Dives  |  ', options: { color: ACCENT1, fontSize: 14 } },
  { text: 'Clinical Trials  |  ', options: { color: ACCENT2, fontSize: 14 } },
  { text: 'Future Directions', options: { color: LIGHT_TXT, fontSize: 14 } },
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endSl.addText(
  'Key Trials: MERIT (PMID 37318415) | TRIOZ (PMID 39168590) | VISUAL I+II (PMID 32469621) | MUV-5 (PMID 40288596) | MUV-6 (PMID 40571046)\nSources: Kanski\'s 10e | Wills Eye Manual | Ryan\'s Retina 6e | PubMed 2021–2026',
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// ─── WRITE FILE ──────────────────────────────────────────────────
pres.writeFile({ fileName: '/home/daytona/workspace/retinitis_choroiditis/Retinitis_Choroiditis_Extended.pptx' })
  .then(() => console.log('SUCCESS: Extended presentation saved.'))
  .catch(e => { console.error('ERROR:', e); process.exit(1); });

cd /home/daytona/workspace/retinitis_choroiditis && node build_extension.js 2>&1

ls -lh /home/daytona/workspace/retinitis_choroiditis/

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PMID: 39767762

PMID: 36497759

PMID: 38247834