Vascular co-option in lung cancer metastatic to the eye after treatment with bevacizumab

Abstract Background Chemotherapy with bevacizumab alters the angiogenic environment, and therefore, the growth and spread of metastases. We present a patient with metastatic lung adenocarcinoma to the eye with findings suggestive of retinal vascular co-option. Methods Case report. Results A 57-year-old male, receiving systemic bevacizumab for metastatic lung adenocarcinoma, presented with vitreous opacities and clumped deposits adherent to the retinal vessels. No choroidal metastases were present. Diagnostic vitrectomy yielded cellular evidence of adenocarcinoma, with thyroid transcription factor-1 staining confirming a lung primary. Conclusion The perivascular growth of small foci of metastatic vitreous cells suggests vascular co-option from the native retinal circulation. Similar modification of metastatic disease by bevacizumab has been observed in animal models and selected human cases

Interobserver Agreement Among Uveitis Experts on Uveitic Diagnoses:The Standardization of Uveitis Nomenclature Experience

• PURPOSE: To evaluate the interobserver agreement among uveitis experts on the diagnosis of the specific uveitic disease. • DESIGN: Interobserver agreement analysis. • METHODS: Five committees, each comprised of 9 individuals and working in parallel, reviewed cases from a preliminary database of 25 uveitic diseases, collected by disease, and voted independently online whether the case was the disease in question or not. The agreement statistic, κ, was calculated for the 36 pairwise comparisons for each disease, and a mean κ was calculated for each disease. After the independent online voting, committee consensus conference calls, using nominal group techniques, reviewed all cases not achieving supermajority agreement (> 75%) on the diagnosis in the online voting to attempt to arrive at a supermajority agreement. • RESULTS: A total of 5766 cases for the 25 diseases were evaluated. The overall mean κ for the entire project was 0.39, with disease-specific variation ranging from 0.23 to 0.79. After the formalized consensus conference calls to address cases that did not achieve supermajority agreement in the online voting, supermajority agreement overall was reached on approximately 99% of cases, with disease-specific variation ranging from 96% to 100%. • CONCLUSIONS: Agreement among uveitis experts on diagnosis is moderate at best but can be improved by discussion among them. These data suggest the need for validated and widely used classification criteria in the field of uveitis

Visual Prognosis in Carotid Cavernous Fistula

The case histories of 74 patients seen at the Mayo Clinic for carotid cavernous fistula were reviewed. The presenting signs and symptoms were then considered in conjunction with the final visual prognosis. No initial sign or symptom correlated with a poor final visual acuity

Risk factors for failing sub-Tenon’s triamcinolone acetonide for uveitic macular edema

Abstract Background Sub-Tenon’s triamcinolone acetonide (STA) is less effective than intravitreal corticosteroids in the treatment of uveitic macular edema (ME), but does have some relative advantages, including substantially lower cost and decreased risk of post-injection ocular hypertension. It would be useful for clinicians to know which eyes may respond well to STA and not necessarily require intravitreal therapy. The objective of this study is to identify risk factors for failing STA for the treatment of uveitic ME. Main body A retrospective cohort study was performed. Medical records were reviewed of patients who underwent STA for the treatment of uveitic ME between January 1, 2013, and July 31, 2022, at the University of Colorado Hospital. Uveitic ME was defined by a central subfield thickness (CST) greater than 320 μm or the presence of intra-retinal cystoid spaces on optical coherence tomography (OCT), or by the presence of petaloid macular leakage on fluorescein angiography (FA). Data collected included age, race/ethnicity, sex, history of diabetes mellitus, anatomic classification of uveitis, use of corticosteroids, use of immunomodulatory therapy, presence of intra-retinal fluid on OCT, CST on OCT, and presence of petaloid macular leakage on FA. STA failure was defined as the need for additional therapy within 12 weeks of STA due to persistent or worsening uveitic ME. One hundred eighty eyes from 131 patients were included. Forty-two eyes (23.3%) were considered treatment failures. In univariate and multivariable analysis, higher baseline CST was associated with a higher likelihood of failing STA (OR 1.17 for each 30 μm increase in CST, P = 0.016). Conclusions STA, while not as potent as intravitreal corticosteroids for the treatment of uveitic ME, was still an effective therapy, particularly for patients with lower baseline CST. Given its lower side effect profile and cost compared to intravitreal treatments, clinicians could consider STA as an initial treatment for mild uveitic ME

Deep capillary retinal ischemia and high-titer prothrombin-associated antiphospholipid antibodies: A case series of three patients

Purpose: Acute macular neuroretinopathy has been shown to be due to ischemia of the deep capillary retinal plexus and most cases occur in young women; we hypothesized that there may be an association with antiphospholipid antibodies. Observations: We identified three patients who were diagnosed with deep capillary retinal ischemia after presenting with sudden onset of focal paracentral scotoma who tested persistently positive for antiphospholipid antibodies. All patients had high-titer prothrombin-associated antibodies and two of the three also had low-titer anticardiolipin antibodies. In all patients, the diagnosis was missed at the initial presentation. All patients experienced involvement of both eyes over time with permanent visual deficits and all were female with an average age at symptom onset of 34 years. All patients were using exogenous estrogen and had additional but previously undiagnosed symptoms or signs that may be seen in the antiphospholipid syndrome. One patient was ANA positive with a titer of 1:320, but none had lupus-specific antibodies or clinical features of lupus. Conclusions and Importance: The persistent presence of high-titer prothrombin-associated antiphospholipid antibodies in three women with deep capillary retinal ischemia suggests this may be an important association. Prothrombin-associated antibodies (anti-prothrombin IgG and anti-phosphatidylserine-prothrombin IgG and IgM) as well as the traditional antiphospholipid antibodies (anticardiolipin IgG, IgM and IgA; anti-beta 2 glycoprotein I IgG, IgM and IgA; and the lupus anticoagulant) should be included in the diagnostic work-up of patients diagnosed with deep capillary retinal ischemia. Because of the broader health and treatment implications of high-titer antiphospholipid antibodies, further investigation into this suspected association is warranted. Keywords: Acute macular neuroretinopathy, Paracentral acute middle maculopathy, Antiphospholipid syndrome, Optical coherence tomography angiography, Anti-Phosphatidylserine-prothrombin antibodies, Retinal ischemi

Endogenous Bacterial Retinitis in AIDS

We studied two patients, one with histologically confirmed endogenous bacterial retinitis associated with the acquired immunodeficiency syndrome and a second with ophthalmoscopically identical findings who also responded to antibiotic treatment. Both patients had focal, discrete patches of retinitis that enlarged slowly over weeks and ultimately accumulated large amounts of subretinal fluid and retinal exudate. One patient underwent retinal biopsy after systemic and vitreous cultures were negative. Histopathologic sections showed necrotic retina infiltrated with multiple histiocytes containing intracytoplasmic, iodine-positive, pleomorphic, encapsulated bacterial forms. The organism was not grown from the retinal biopsy specimen. Treatment with antibiotics resulted in improved vision in both patients. Our results indicate that endogenous bacterial infection should be considered in the differential diagnosis of retinitis associated with the acquired immunodeficiency syndrome