retinitis choroiditis treatment advances

retinitis pigmentosa gene therapy clinical trial

CMV retinitis treatment immunocompromised

uveitis choroiditis biologic treatment

toxoplasma retinitis treatment outcomes

birdshot retinochoroidopathy VKH uveitis immunotherapy

retinitis choroiditis latest clinical trials 2024 2025 gene therapy biologics

serpiginous choroiditis punctate inner choroidopathy treatment

PMID: 38181975

PMID: 38871269

PMID: 38423215

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

~/retinitis-choroiditis-ppt/build.js

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const pres = new pptxgen();
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pres.title = "Retinitis & Choroiditis";
pres.author = "Medical Education";

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// ─── TITLE SLIDE ──────────────────────────────────────────────────────────────
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// ─── OUTLINE SLIDE ────────────────────────────────────────────────────────────
addSlide("Presentation Outline", [
  "Part 1 · What is Retinitis? — Definition, anatomy, classification",
  "Part 2 · Infectious Retinitis — CMV, Toxoplasma, ARN, PORN",
  "Part 3 · Retinitis Pigmentosa — Genetics, pathogenesis, management",
  "Part 4 · What is Choroiditis? — Classification, ICG-based taxonomy",
  "Part 5 · Infectious & Non-Infectious Choroiditis — White dot syndromes",
  "Part 6 · Recent Advances & Clinical Trials (2024–2026)"
], 2);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 1 — RETINITIS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("SECTION 1", "Retinitis — Definition, Anatomy & Classification", 3);

addSlide("What Is Retinitis?", [
  "Inflammation of the retina — the light-sensitive inner layer of the eye",
  "Contains rods, cones, RPE, and retinal vasculature across 10 layers",
  "Outer nuclear layer (photoreceptors) → RPE → Bruch's membrane → Choroid",
  "The term 'retinitis' is sometimes a misnomer (e.g., RP is not inflammatory)",
  "Can be infectious, autoimmune, hereditary, or toxic in origin",
  "Rapid diagnosis essential — most forms lead to irreversible vision loss if untreated"
], 4);

addSlide("Classification of Retinitis", [
  "Infectious (Viral): CMV retinitis, ARN (HSV/VZV), PORN (VZV), Toxoplasma",
  "Infectious (Bacterial/Fungal): Syphilis, TB, Candida, Aspergillus, Cryptococcus",
  "Hereditary / Degenerative: Retinitis Pigmentosa and variants",
  "Autoimmune: Birdshot retinochoroidopathy, VKH disease",
  "Toxic / Drug-Induced: Chloroquine, hydroxychloroquine, thioridazine",
  "Idiopathic: Multifocal retinitis, IRVAN syndrome"
], 5);

// ═══════════════════════════════════════════════════════════════════════════════
// CMV RETINITIS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("CMV RETINITIS", "Most Common Opportunistic Ocular Infection in AIDS", 6);

addSlide("CMV Retinitis — Epidemiology & Risk Factors", [
  "Cytomegalovirus (herpesvirus): latent in general population, reactivates with immunosuppression",
  "Most common opportunistic ocular infection in AIDS patients",
  "Risk threshold: CD4+ < 50 cells/μL (highest risk); screen 3-monthly",
  "Also occurs with organ transplant, chemotherapy, systemic steroids",
  "Since ART, incidence has declined; prevalence remains high due to better survival",
  "Retinal microangiopathy (cotton-wool spots) is a marker predicting CMV retinitis risk"
], 7);

addSlide("CMV Retinitis — Pathogenesis", [
  "Primary CMV infection in childhood/adulthood → establishes latency in mononuclear cells",
  "CD4+ T-cell depletion → loss of immune surveillance over latent virus",
  "Reactivation → hematogenous spread to retinal pigment epithelium and ganglion cells",
  "CMV replicates → full-thickness retinal necrosis starting in one or two foci",
  "Necrotic areas expand circumferentially along vascular arcades",
  "Necrotic retina forms holes → rhegmatogenous retinal detachment (RRD) in up to 50%"
], 8);

addSlide("CMV Retinitis — Clinical Features", [
  "Symptoms: reduced vision (macular involvement), floaters; peripheral onset often asymptomatic",
  "Anterior uveitis mild; vitritis typically mild (severe in immune recovery uveitis)",
  "Classic 'Pizza Pie / Margherita Pizza': dense white infiltration + flame hemorrhages",
  "Starts peripherally (90%), extends along vascular arcades; central in 10%",
  "Indolent pattern: granular, fewer hemorrhages, slow peripheral progression",
  "Immune Recovery Uveitis (IRU) after ART — can progress to phthisis bulbi"
], 9);

addSlide("CMV Retinitis — Investigations & Treatment", [
  "Investigations: Vitreous/aqueous PCR (gold standard), CD4+ count, CMV plasma PCR",
  "ART: mainstay — restores immune control; stop antivirals when CD4 > 100–150 cells/μL",
  "Valganciclovir oral: induction 900 mg BD × 3 weeks; maintenance 900 mg OD",
  "Intravitreal: ganciclovir 2 mg, foscarnet 1.2 mg, or cidofovir 20 μg for near-macula lesions",
  "Vitrectomy + endolaser + silicone oil tamponade: 75% success for CMV-related RRD",
  "Side effect: neutropenia from valganciclovir — treat with filgrastim (G-CSF)"
], 10);

// ═══════════════════════════════════════════════════════════════════════════════
// TOXOPLASMA
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("TOXOPLASMIC RETINITIS", "Most Common Infectious Posterior Uveitis Worldwide", 11);

addSlide("Toxoplasma — Pathogenesis & Triggers", [
  "Toxoplasma gondii: obligate intracellular protozoan; infects via undercooked meat or cat oocysts",
  "Congenital: transplacental transmission → bilateral chorioretinal scars in neonate",
  "Acquired: hematogenous spread → tissue cysts (bradyzoites) in retinal cells",
  "Cyst rupture → tachyzoites released → focal retinal necrosis + immune response",
  "Reactivation triggered by: pregnancy, immunosuppression, HIV (CD4 < 200), older age",
  "In AIDS: CD4 depletion → uncontrolled parasite replication → large multifocal necrosis"
], 12);

addSlide("Toxoplasma — Clinical Features & Treatment", [
  "Classic: 'Headlight in the fog' — active white fluffy lesion adjacent to old pigmented scar",
  "Moderate to severe vitritis and anterior uveitis typical; retinochoroiditis (both layers)",
  "Immunocompromised: large, bilateral, necrotizing retinitis without old satellite scar",
  "Standard: Pyrimethamine + Sulfadiazine + Folinic acid (4–6 weeks)",
  "Alternatives: Co-trimoxazole (TMP-SMX), Clindamycin 300 mg QDS",
  "Adjunctive steroids after 24–48 hrs antibiotics for macular or optic nerve involvement"
], 13);

// ═══════════════════════════════════════════════════════════════════════════════
// ARN & PORN
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("ARN & PORN", "Necrotizing Herpetic Retinitis", 14);

addSlide("Acute Retinal Necrosis (ARN)", [
  "Rare, devastating necrotizing retinitis in otherwise immunocompetent individuals",
  "HSV in younger patients; VZV in older patients; can follow HSV encephalitis",
  "American Uveitis Society Criteria: panuveitis + peripheral retinal necrosis foci",
  "Circumferential spread; occlusive arteritis; contralateral eye involvement 30% (if untreated)",
  "Poor prognosis: >50% achieve only 6/60 due to ischemia or RRD",
  "Treatment: IV aciclovir 15 mg/kg q8h × 10–14 days; then oral × 6–12 weeks; vitrectomy for RRD"
], 15);

addSlide("Progressive Outer Retinal Necrosis (PORN)", [
  "Caused predominantly by VZV in severely immunocompromised (AIDS, CD4 very low)",
  "Key distinction: minimal anterior uveitis and vitritis (unlike ARN and CMV)",
  "Three stages: multifocal deep retinal infiltrates → full-thickness necrosis → atrophy + RRD",
  "Cherry-red spot may appear at macula in early stage; perivenular translucency characteristic",
  "Extremely poor prognosis: no light perception in >50% of affected eyes",
  "Treatment: ART + combined IV & intravitreal ganciclovir + foscarnet; RRD surgery often fails"
], 16);

// ARN vs CMV vs PORN comparison
addTwoColSlide(
  "ARN vs CMV Retinitis vs PORN — Quick Comparison",
  "ARN / PORN",
  [
    "ARN: immunocompetent; HSV (young) / VZV (old)",
    "ARN: panuveitis — severe vitritis",
    "ARN: peripheral necrosis, occlusive arteritis",
    "PORN: severely immunocompromised; VZV",
    "PORN: minimal vitritis, rapid full-thickness necrosis",
    "PORN: prognosis — NLP in >50% eyes"
  ],
  "CMV Retinitis",
  [
    "AIDS (CD4 < 50); CMV reactivation",
    "Mild vitritis (except in IRU)",
    "'Pizza pie' — dense white + flame hemorrhages",
    "Peripheral start (90%); extends centrally",
    "RRD in up to 50% if untreated",
    "Treatment: valganciclovir + ART"
  ],
  17
);

// ═══════════════════════════════════════════════════════════════════════════════
// RETINITIS PIGMENTOSA
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("RETINITIS PIGMENTOSA", "Hereditary Rod-Cone Dystrophy — Most Common Inherited Retinal Disease", 18);

addSlide("Retinitis Pigmentosa — Overview", [
  "Not inflammatory — a misnomer; RP is hereditary rod-cone degeneration (Robbins/Harrison's)",
  "Prevalence 1:3000–1:5000; most common hereditary retinal degeneration worldwide",
  "AD (later onset, RHO mutations most common), AR (earlier), X-linked (earliest/most severe)",
  "Mutations in >100 gene loci: phototransduction, retinoid cycle, photoreceptor structure, cilia",
  "X-linked RP: 90% due to RPGR gene mutations (RPGR protein in connecting cilium of rods)",
  "Sporadic forms exist: incomplete penetrance, small families, AR in isolation"
], 19);

addSlide("RP — Pathogenesis (Cellular Level)", [
  "Mutation → rod photoreceptors die first by apoptosis (cone death partly via RIP kinase)",
  "Rod loss → nyctalopia (night blindness) and peripheral visual field loss",
  "Secondary cone loss may occur via loss of rod-derived trophic support factors",
  "RPE degeneration → melanin-laden macrophages migrate around blood vessels",
  "Bone-spicule pigmentation, arteriolar attenuation, waxy disc pallor result",
  "Mutations in RHO (rhodopsin), USH2A, RGPR, EYS genes most frequently identified"
], 20);

addSlide("RP — Classic Triad & Symptoms", [
  "Classic diagnostic triad: bone-spicule pigmentation, arteriolar attenuation, waxy disc pallor",
  "Symptom sequence: nyctalopia → ring scotoma (mid-peripheral) → tunnel vision → central loss",
  "Photopsia (flashing lights) not uncommon; often precedes field loss",
  "AD: 4th–5th decade onset; AR: 2nd–3rd decade; XL: 1st–2nd decade (most severe)",
  "Associated: posterior subcapsular cataract (50%), cystoid macular edema (20–30%)",
  "ERG abnormal before visible fundus changes — early detection tool"
], 21);

addSlide("RP — Syndromic Forms", [
  "20–30% of RP is syndromic — associated with systemic disease",
  "Usher Syndrome: RP + sensorineural hearing loss — most common (MYO7A, USH2A; AR)",
  "Bardet-Biedl: RP + polydactyly + obesity + renal dysfunction + cognitive impairment",
  "Refsum Disease: RP + peripheral neuropathy + cerebellar ataxia + ichthyosis (phytanic acid)",
  "Leber Congenital Amaurosis: severe early-onset RP; nystagmus + poor VA at birth (RPE65)",
  "Kearns-Sayre: RP-like + ptosis + progressive external ophthalmoplegia (mitochondrial DNA)"
], 22);

addSlide("RP — Investigations", [
  "ERG: reduced scotopic rod responses → absent rod response; combined + cone responses later",
  "FAF: hyperautofluorescent ring around fovea; hypoAF in photoreceptor-loss zones",
  "OCT: outer nuclear layer thinning, photoreceptor outer segment loss",
  "Visual fields: ring scotoma, progressive field constriction (Goldmann / Humphrey 30-2/60-4)",
  "OCTA: choriocapillaris flow void in advanced stages",
  "Genetic testing: identifies mutation; essential for gene therapy eligibility"
], 23);

addSlide("RP — Treatment (Current Standard)", [
  "No curative treatment for most forms; goal is slowing progression",
  "Vitamin A palmitate 15,000 IU/day: may slow ERG decline in specific genotypes (evidence mixed)",
  "Carbonic anhydrase inhibitors (oral acetazolamide / topical dorzolamide) for CMO in RP",
  "Anti-VEGF agents for refractory CMO; light protection (amber lenses, <550 nm block)",
  "Chloroquine/HCQ toxicity mimics RP → bull's-eye maculopathy; monitor with OCT + 10-2 fields",
  "FDA-approved: Voretigene neparvovec (Luxturna) for RPE65-mutant retinal dystrophy"
], 24);

// ═══════════════════════════════════════════════════════════════════════════════
// GENE THERAPY CLINICAL TRIALS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("GENE THERAPY", "Clinical Trials in Retinitis Pigmentosa (2023–2026)", 25);

addSlide("Gene Therapy — Approved & Phase 3 Trials", [
  "Voretigene neparvovec (Luxturna): FDA-approved 2017; AAV2-RPE65 subretinal; LCA & RP",
  "Botaretigene Sparoparvovec (AAV5-RPGR): Phase 1/2 RCT (PMID 38871269) — safe, well-tolerated",
  "Botaretigene: improvements in retinal sensitivity + functional vision vs deferred group at Wk 52",
  "LANDSCAPE Phase 2/3 pivotal trial (Beacon Therapeutics): enrollment complete; results 2026",
  "Cotoretigene Toliparvovec (BIIB112/AAV8-RPGR): XIRIUS Phase 2/3 (PMID 38423215)",
  "XIRIUS: low-dose showed significant LLVA improvement vs control; Phase 3 planned"
], 26);

addSlide("Gene Therapy — Emerging Platforms", [
  "Ocugen OCU400 (modifier / gene-agnostic therapy): Phase 3, 140 participants enrolled (2025)",
  "OCU400: two arms — RHO-mutation RP and other-gene RP; 2:1 treatment:control; results 2027",
  "Optogenetics (MCO-010, Nanoscope): introduces channelrhodopsins into surviving retinal cells",
  "MCO-010 RESTORE study: 3-year data (AAO 2025) — mutation-agnostic, applicable in end-stage RP",
  "Subretinal vs suprachoroidal delivery: increasing interest in less-invasive injection routes",
  "CRISPR-based correction: preclinical studies advancing for dominant-negative RHO mutations"
], 27);

// ═══════════════════════════════════════════════════════════════════════════════
// SECTION 2 — CHOROIDITIS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("SECTION 2", "Choroiditis — Definition, Classification & Clinical Entities", 28);

addSlide("What Is Choroiditis?", [
  "Inflammation of the choroid — vascular layer between retina and sclera",
  "Choroid supplies outer retina via choriocapillaris; stromal vessels; Sattler's & Haller's layers",
  "Outer retina (RPE + photoreceptors) entirely dependent on choroidal blood supply",
  "Choroidal inflammation → rapid RPE and outer retinal damage → 'chorioretinitis'",
  "ICG angiography: gold standard imaging — penetrates RPE, directly images choroidal vasculature",
  "Most clinical entities involve both choroid + retina: termed retinochoroiditis or chorioretinitis"
], 29);

addSlide("ICG-Based Classification of Choroiditis (Kanski)", [
  "1A. Primary choriocapillaritis: MEWDS, APMPPE, Serpiginous, MFC, PIC",
  "1B. Secondary choriocapillaritis (pathogen-triggered): Syphilis ASPPC, TB serpignoid",
  "2A. Primary stromal choroiditis: Birdshot (HLA-A29), VKH, Sympathetic ophthalmia",
  "2B. Secondary stromal choroiditis: Sarcoidosis, Tubercular, Syphilitic chorioretinitis",
  "Distinction guides treatment: choriocapillaritis → steroids; stromal → immunomodulation",
  "Infectious causes must be excluded before initiating immunosuppression"
], 30);

// ═══════════════════════════════════════════════════════════════════════════════
// INFECTIOUS CHOROIDITIS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("INFECTIOUS CHOROIDITIS", "Pneumocystis · Cryptococcus · TB · Syphilis", 31);

addSlide("Infectious Choroiditis — Fungal & Bacterial", [
  "Pneumocystis choroiditis: P. jirovecii in AIDS (CD4 very low); yellow-orange lesions, no vitritis",
  "Systemic prophylaxis (TMP-SMX) dramatically reduced incidence vs inhaled pentamidine",
  "Cryptococcal choroiditis: hematogenous or via optic nerve from CNS; multifocal + vasculitis",
  "Aspergillus: IV drug use, transplant, neutropenia; macular predilection; worse prognosis",
  "TB choroiditis: multifocal tuberculomas or serpiginoid pattern; diagnose with QuantiFERON + CXR",
  "Syphilitic ASPPC: large bilateral placoid lesions; IV penicillin G × 10–14 days + steroids"
], 32);

// ═══════════════════════════════════════════════════════════════════════════════
// WHITE DOT SYNDROMES
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("WHITE DOT SYNDROMES", "Idiopathic Non-Infectious Choroiditis", 33);

addSlide("MEWDS — Multiple Evanescent White Dot Syndrome", [
  "Young adult women; often preceded by viral illness or flu vaccination",
  "Unilateral; painless blurring, photopsia, scotomas; dots disappear quickly clinically",
  "Numerous small (100–300 μm) grey-white patches sparing fovea; orange granular fovea",
  "FA: early hyperfluorescence; ICG: hypofluorescent lesions (more than clinically visible)",
  "Self-limited; resolves in weeks; treatment not required; recurrence 10%",
  "Recurrent MEWDS → suspect Multifocal Choroiditis (MFC)"
], 34);

addSlide("APMPPE — Acute Posterior Multifocal Placoid Pigment Epitheliopathy", [
  "Young adults, bilateral; often post-viral (flu-like prodrome); HLA-B7 and HLA-DR2 linked",
  "Large deep yellow-white placoid lesions at posterior pole; subretinal macular fluid",
  "FA: early dense hypofluorescence → late hyperfluorescent staining (classic pattern)",
  "ICG: early and late hypofluorescence = choriocapillaris non-perfusion",
  "Prognosis generally good; 25% limited to 6/15 or worse if fovea damaged",
  "Association with cerebral vasculitis — evaluate neurological symptoms urgently"
], 35);

addSlide("Serpiginous Choroidopathy", [
  "Middle-aged men > women; HLA-B7 associated; bilateral but asymmetrical; chronic recurrent",
  "Serpentine geographic RPE/choriocapillaris atrophy starting peripapillary, extending outward",
  "Active: grey-white fuzzy-bordered lesions; inactive: sharp pigmented atrophic areas",
  "Prognosis poor: ~25% of eyes end with VA < 6/60; MNV is a complication",
  "'Serpignoid' mimics: TB and syphilis — must be excluded before immunosuppression",
  "Treatment: oral steroids + cyclosporine/azathioprine/MMF; anti-VEGF for MNV"
], 36);

addSlide("Idiopathic Multifocal Choroiditis (MFC)", [
  "Young to middle-aged women; bilateral asymmetric; chronic recurrent; flu-like onset",
  "Multiple ovoid yellowish-grey lesions (50–350 μm) at posterior pole and periphery",
  "Inactive lesions: sharp margins with pigmented borders — resemble POHS spots",
  "MNV in 25–35%; CMO; subretinal fibrosis; anterior uveitis in 50%; vitritis present",
  "Visual fields show large defects disproportionate to fundus findings (key diagnostic clue)",
  "Treatment: systemic + local steroids; steroid-resistant → cyclosporine/tacrolimus + MMF"
], 37);

addSlide("Punctate Inner Choroidopathy (PIC)", [
  "Young myopic women; both eyes 80%; macular predominance; PIC is likely a variant of MFC",
  "Key: anterior uveitis and vitritis absent or very mild (differentiates from MFC and MEWDS)",
  "Small yellow-white macular spots (fuzzy borders) at inner choroid/outer retina level",
  "MNV develops in up to 40% — major cause of vision-threatening central visual loss",
  "OCTA: subretinal MNV; ICG: vasculitis of small choroidal vessels and choriocapillaris",
  "Treatment: observation unless MNV — then steroids + anti-VEGF (2024 systematic review)"
], 38);

// ═══════════════════════════════════════════════════════════════════════════════
// BIRDSHOT & VKH
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("STROMAL CHOROIDITIS", "Birdshot Retinochoroidopathy & VKH Disease", 39);

addSlide("Birdshot Retinochoroidopathy", [
  "Middle-aged Caucasians; strongest HLA association in ophthalmology: HLA-A29 > 95% positive",
  "Autoimmune T-cell mediated attack on choroidal stroma; bilateral; insidious onset",
  "Multiple cream-coloured choroidal patches radiating from disc, sparing macula initially",
  "FA: extensive vascular leakage; ICGA: persistent hypofluorescence (more lesions than FA)",
  "ERG: initially normal → rod and cone abnormalities with progression; visual field monitoring key",
  "Treatment: steroids; steroid-resistant → cyclosporine/tacrolimus + MMF; anti-VEGF for MNV"
], 40);

addSlide("Vogt-Koyanagi-Harada (VKH) Disease", [
  "Young adults; darkly pigmented races (Japanese, Hispanic, Middle Eastern, South Asian)",
  "Autoimmune attack on melanocytes in choroid, inner ear, skin, meninges — HLA-DR4 linked",
  "4 Phases: prodromal (headache, tinnitus) → uveitic (bilateral serous RD) → convalescent → chronic",
  "Convalescent: sunset glow fundus (diffuse RPE depigmentation), Dalen-Fuchs nodules",
  "Chronic phase: recurrent anterior uveitis; glaucoma, cataract, subretinal fibrosis",
  "Treatment: high-dose IV methylprednisolone → oral taper; cyclosporine/azathioprine/MMF"
], 41);

addSlide("Sympathetic Ophthalmia", [
  "Bilateral granulomatous uveitis following penetrating trauma or surgery to one eye",
  "'Exciting eye' (injured) triggers autoimmune attack on 'sympathizing eye' (uninjured)",
  "Mechanism: melanocyte antigens exposed by trauma → T-cell mediated response (similar to VKH)",
  "Onset: weeks to years post-trauma; early onset has worse prognosis",
  "Features: panuveitis, Dalen-Fuchs nodules, diffuse choroiditis, exudative RD in severe cases",
  "Treatment: systemic steroids + immunosuppression; enucleation of unsalvageable exciting eye"
], 42);

// ═══════════════════════════════════════════════════════════════════════════════
// DIAGNOSTIC IMAGING
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("DIAGNOSTIC IMAGING", "Multimodal Approach to Retinitis & Choroiditis", 43);

addSlide("Diagnostic Imaging — Key Modalities", [
  "FA (Fluorescein Angiography): retinal vasculature, leakage, neovascularization; window defects at scars",
  "ICG Angiography: gold standard for choroiditis; penetrates RPE; shows choriocapillaris non-perfusion",
  "OCT: outer retinal/RPE structure; retinitis = thickening/necrosis; RP = outer nuclear layer thinning",
  "OCTA: non-invasive choroidal + retinal capillary imaging; MNV detection; choriocapillaris flow voids",
  "FAF: RPE health; hyperAF = stressed RPE; hypoAF = RPE loss; hyperAF ring in RP",
  "ERG: global photoreceptor function; abnormal in RP before visible fundus changes"
], 44);

// ═══════════════════════════════════════════════════════════════════════════════
// RECENT ADVANCES
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("RECENT ADVANCES", "Clinical Trials & Evidence 2024–2026", 45);

addSlide("Recent Advances — Gene & Cell Therapies", [
  "Botaretigene Sparoparvovec Ph 1/2 (NCT03252847): safe, efficacious in XLRP; Phase 3 supported",
  "XIRIUS Ph 2/3 — cotoretigene toliparvovec: low-dose improved LLVA vs control at 12 months",
  "Ocugen OCU400 gene-agnostic Phase 3: 140 participants enrolled 2025; results expected 2027",
  "Optogenetics MCO-010 (RESTORE study): 3-year AAO 2025 data — mutation-agnostic end-stage RP",
  "Luxturna (RPE65) long-term data: sustained visual function improvement at 5+ years post-treatment",
  "CRISPR correction of dominant-negative RHO mutations: preclinical advancement ongoing"
], 46);

addSlide("Recent Advances — Pharmacologic & Imaging", [
  "Dexamethasone implant (Ozurdex) in uveitis/choroiditis: effective IOP control + inflammation (2025 meta-analysis, PMID 40829733)",
  "Interferons (IFN-α/β) for refractory birdshot retinochoroidopathy and viral retinitis (PMID 38727788)",
  "Intravitreal clindamycin + dexamethasone for macular toxoplasma: favorable outcomes (PMID 39813301)",
  "OCTA now standard in PIC/choroiditis workup: detects MNV without dye injection (PMID 38181975)",
  "RELITE (Regenerative Retinal Laser & Light Therapies): new nomenclature + classification 2024 (PMID 39210705)",
  "CRISPR-Cas12a point-of-care assay for fungal endophthalmitis diagnosis (2025)"
], 47);

// ═══════════════════════════════════════════════════════════════════════════════
// DIFFERENTIAL DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════════════
addDivider("DIFFERENTIAL DIAGNOSIS", "Quick Comparison Table", 48);

addSlide("Retinitis — Differential Diagnosis", [
  "CMV Retinitis: AIDS (CD4 < 50), pizza-pie hemorrhages, mild vitritis, periphery first",
  "Toxoplasma: immunocompetent/HIV, headlight-in-fog near old scar, moderate vitritis",
  "ARN: immunocompetent, panuveitis + peripheral necrosis + occlusive arteritis, rapid",
  "PORN: AIDS (severe), minimal vitritis, rapid full-thickness necrosis, NLP in >50%",
  "Retinitis Pigmentosa: hereditary, bone spicules, waxy disc, no inflammation, bilateral",
  "Toxic retinopathy: drug history (chloroquine/HCQ), bull's-eye maculopathy, bilateral"
], 49);

addSlide("Choroiditis — Differential Diagnosis", [
  "MEWDS: young women, unilateral, self-limited evanescent dots, no vitritis; good prognosis",
  "APMPPE: young adults, bilateral, post-viral, large placoids, FA early hypofluorescence",
  "Serpiginous: middle-aged men, peripapillary serpentine, HLA-B7, recurrent, poor prognosis",
  "MFC: young women, bilateral, vitritis, MNV 25–35%, visual fields > fundus changes",
  "PIC: young myopic women, macular, no vitritis, MNV 40%; treat with anti-VEGF",
  "Birdshot: Caucasian, HLA-A29 > 95%, cream lesions, ERG abnormal, bilateral"
], 50);

// ═══════════════════════════════════════════════════════════════════════════════
// PATHOMECHANISM SUMMARY
// ═══════════════════════════════════════════════════════════════════════════════
addSlide("Pathomechanism Summary", [
  "Direct viral infection/necrosis: CMV retinitis, ARN, PORN — rapid full-thickness damage",
  "Parasite replication + host immune response: Toxoplasma retinochoroiditis",
  "Choriocapillaris hypoperfusion/occlusion: APMPPE, serpiginous choroidopathy",
  "Autoimmune T-cell attack on stroma: Birdshot (HLA-A29), VKH, sympathetic ophthalmia",
  "Photoreceptor apoptosis from genetic mutation: Retinitis Pigmentosa (>100 gene loci)",
  "Granulomatous infiltration: TB, sarcoidosis, syphilis (treponema-driven)"
], 51);

// ═══════════════════════════════════════════════════════════════════════════════
// TREATMENT PRINCIPLES
// ═══════════════════════════════════════════════════════════════════════════════
addTwoColSlide(
  "Treatment Principles — Retinitis vs Choroiditis",
  "Retinitis",
  [
    "Viral (CMV/ARN): antivirals (valganciclovir, aciclovir, foscarnet)",
    "Toxoplasma: pyrimethamine + sulfadiazine + folinic acid",
    "RP: no cure; VA support, gene therapy for specific mutations",
    "Vitrectomy + silicone oil for RRD in necrotizing retinitis",
    "ART: mainstay for all HIV-related infectious retinitis",
    "Gene therapy: approved (RPE65/Luxturna); RPGR Phase 3 underway"
  ],
  "Choroiditis",
  [
    "Corticosteroids: first-line for most non-infectious choroiditis",
    "Steroid-sparing: cyclosporine, tacrolimus, MMF, azathioprine",
    "Anti-VEGF: for MNV complicating MFC, PIC, serpiginous",
    "Biologics (adalimumab, infliximab): refractory uveitis/choroiditis",
    "Dexamethasone implant (Ozurdex): 2025 meta-analysis supports use",
    "Infectious: treat cause first (ATT for TB, penicillin for syphilis)"
  ],
  52
);

// ═══════════════════════════════════════════════════════════════════════════════
// CONCLUSION
// ═══════════════════════════════════════════════════════════════════════════════
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    "Retinitis = retinal inflammation; Choroiditis = choroidal inflammation — both often coexist",
    "CMV retinitis (AIDS) and Toxoplasma retinochoroiditis are the two most common infectious forms",
    "RP is genetic (not inflammatory); gene therapy (Luxturna, RPGR trials) is the current frontier",
    "ICG angiography is the key investigation for choroiditis; OCT/OCTA revolutionized monitoring",
    "Exclude TB & syphilis before starting immunosuppression for any choroiditis",
    "2024–2026: gene therapy trials, dexamethasone implants, OCTA, optogenetics — transforming care"
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/retinitis-choroiditis-ppt/Retinitis_Choroiditis.pptx" })
  .then(() => console.log("Done: Retinitis_Choroiditis.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/retinitis-choroiditis-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/retinitis-choroiditis-ppt/Retinitis_Choroiditis.p…

cd /home/daytona/workspace/retinitis-choroiditis-ppt && python3 -m markitdown Re…

cd /home/daytona/workspace/retinitis-choroiditis-ppt && python3 -c " from pptx i…

cd /home/daytona/workspace/retinitis-choroiditis-ppt && pip install python-pptx …