Sunlight and ultraviolet radiation-pertinent retinal implications and current management

Unprotected and prolonged exposure to ultraviolet (UV) light from sunlight, lasers, and arc welding leads to outer retinal damage. The photoreceptors and retinal pigment epithelium located in the posterior pole are particularly susceptible to this radiation. Classically known as solar retinopathy, this disorder frequently affects young individuals who have clear lenses and a propensity toward observing solar eclipses. Various imaging techniques aid the clinician in diagnosis, even if patients cannot recall an exposure event. By far the most utilized technique is optical coherence tomography that, in tandem with fluorescein angiography, and fundus autofluorescence, is crucial in ruling out other conditions. Fortunately, the prognosis of acute UV retinopathy is favorable, as most cases fully recover; however, a significant percentage of patients suffer from chronic sequelae: reduced acuity and lifelong central/paracentral scotomas. Thus, education toward understanding UV exposure risks, coupled with either abstinence or proper eye protection, is critical in preventing macular damage. We outline the various etiologies responsible for UV-induced retinopathy, describe the limited treatments available, and provide recommendations to minimize the potential devastating ophthalmic consequences as our society increases its reliance on UV-emitting technology and further engages in solar eclipse viewing

The Current Online Face of U.S. Academic Ophthalmology

Purpose To evaluate the comprehensiveness and navigation ease of online content from Web sites of U.S. academic ophthalmology departments. Design Cross-sectional analysis of 117 U.S. academic ophthalmology department Web sites from October 1 to October 31, 2017. Methods Data were obtained on various categories, including: clinical access and subspecialty services, social media, patient support and accessibility, residency and fellowship details, and research and faculty characteristics. Percent of Web sites possessing each feature was calculated. In addition, a comparison of content completeness and navigation metrics of Web sites between the US News and World Report top 13 ranked departments and the remaining 96 that possess an ophthalmology residency was performed. Results Greater than 80% of Web sites list a basic core of information online: address, contact information, resident and faculty characteristics, and clinical expertise. However, only 69.2% have capabilities to donate online and 59.8% supply educational material for common eye conditions. Less than half of institutions list emergency and trauma, oncology, and low-vision rehabilitation services; only 49.6% provide a social network platform. Strikingly, accessibility features are limited; scalable text, changeable color, and multilingual capabilities are available in 20.5, 4.3, and 8.5% of Web sites, respectively. In the comparison of top 13 departments with the remaining 96, the high-ranking departments possess more Web site features, but are just as efficient to navigate. Conclusion U.S. academic ophthalmology departments in 2017 provide a basic foundation of online content, but few contain abundant features from the viewpoints of different users

Glycolytic reliance promotes anabolism in photoreceptors

Vertebrate photoreceptors are among the most metabolically active cells, exhibiting a high rate of ATP consumption. This is coupled with a high anabolic demand, necessitated by the diurnal turnover of a specialized membrane-rich organelle, the outer segment, which is the primary site of phototransduction. How photoreceptors balance their catabolic and anabolic demands is poorly understood. Here, we show that rod photoreceptors in mice rely on glycolysis for their outer segment biogenesis. Genetic perturbations targeting allostery or key regulatory nodes in the glycolytic pathway impacted the size of the outer segments. Fibroblast growth factor signaling was found to regulate glycolysis, with antagonism of this pathway resulting in anabolic deficits. These data demonstrate the cell autonomous role of the glycolytic pathway in outer segment maintenance and provide evidence that aerobic glycolysis is part of a metabolic program that supports the biosynthetic needs of a normal neuronal cell type

Toxic Keratoconjunctivitis from Coral Reef

The final, published version of this article is available at https://doi.org/10.1159/000517350A 25-year-old woman presented with right eye pain, lid edema, conjunctival injection and chemosis, and mild corneal epitheliopathy after exposure to fluid content from an aquarium coral reef. Topical moxifloxacin and prednisolone were started 4 times daily, with full clinical resolution after 2 weeks. Toxin-mediated keratoconjunctivitis may occur after exposure to zoanthid coral reef, particularly in aquarium enthusiasts. Topical corticosteroids in tandem with topical antibiotics appear to be effective in mild disease. However, in severe cases that exhibit corneal infiltrates and stromal thinning, close observation is warranted in case of possible keratolysis

Systemic lymphoma masquerading as Vogt-Koyanagi-Harada syndrome: Report of a case with multimodal imaging and histopathology.

PurposeTo report a case of systemic diffuse large B cell lymphoma presenting with ocular manifestations and neurologic findings resembling Vogt-Koyanagi-Harada syndrome.ObservationsA 51-year-old Caucasian man presented with headache, ear pain, and blurry vision in both eyes. He was found to have bilateral exudative retinal detachments. After a short period of initial improvement with high dose systemic corticosteroid, his condition significantly worsened. An extensive work-up, including a kidney biopsy, led to a diagnosis of systemic diffuse large B cell lymphoma. He had excellent recovery following treatment with appropriate chemotherapy.Conclusions and importanceSystemic malignancy may present with ocular manifestations and may masquerade as another diagnosis. An unexpected clinical course may suggest an alternative diagnosis. A broad systemic work-up including an evaluation for malignancy should be considered for patients presenting with unexplained exam or systemic findings

Outcomes of primary rhegmatogenous retinal detachment repair with extensive scleral-depressed vitreous removal and dynamic examination.

There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: "extensive" removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that "extensive" removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair