Profound Presentation of Retinopathy in a Patient with Sickle Cell trait and Diabetes Mellitus

This is a Photo Essay and does not have an abstract

The effects of cataract surgery on patients with wet macular degeneration

PURPOSE: To explore whether cataract surgery contributes to the progression of wet age-related macular degeneration (wet AMD). DESIGN: Retrospective cohort study. METHODS: Retrospective review was performed of consecutive patients with wet AMD who underwent cataract surgery at the midpoint of a 1-year study window. A control arm included wet AMD eyes treated with anti-vascular endothelial growth factor (VEGF) injections that did not undergo cataract surgery for a 1-year period. Best-corrected visual acuity (BCVA), number of anti-VEGF injections, and optical coherence tomography (OCT) features were compared between the 2 arms. RESULTS: Forty eyes in the surgical group and 42 in the nonsurgical group were included. BCVA was equivalent in the first half of the study, and became significantly better in the surgical group vs the nonsurgical group (0.23 ± 0.65 vs 0.11 ± 0.59 logMAR improvement, P = .049). There was no change in the number of injections given 6 months before vs after the midpoint in the surgical group (P = .921). The mean OCT central retinal thickness became greater in postsurgical eyes compared to nonsurgical eyes (265.4 ± 98.4 μm vs 216.4 ± 58.3 μm, P = .011). Surgical eyes were more likely to develop new or worse cystoid changes after the study midpoint (13 surgical eyes [54.2%] vs 9 nonsurgical eyes [28.1%], P = .048). CONCLUSIONS: Cataract surgery leads to vision improvement and does not appear to contribute to worsening of wet AMD. However, anatomic changes based on OCT analysis suggest a subclinical susceptibility to postoperative cystoid macular edema or exacerbation of choroidal neovascularization

The first case of intracranial rosai dorfman disease.

Objective: to report an interesting and informative case of an atypical presentation of a rare condition, Rosai Dorfman Disease (RDD) Background: RDD previously known as Sinus Histiocytosis with massive lymphadenopathy (SHML), is a rare, idiopathic disease seen mainly in children and young adults. It typically presents with painless lymphadenopathy, fever, leukocytosis, elevated erythrocyte sedimentation rate, and polyclonal hypergammaglobulinemia. To date only 5 cases of isolated epibulbar disease have been described in the literature. Case, Methods: An 80 year-old African-American woman presented with a history of a right orbital mass and complaints of worsening blurred vision and photophobia in the left eye. Her vision was NLP in the right and 20/60 in the left eye. She had a large, pink lesions under the superior bulbar conjunctiva of both eyes with concomitant cell and flare. MRI orbits, biopsies of right subconjunctival lesion and both retrobulbar lesions. Pathology showed histiocytes with abundant atypical reticular cytoplasm with phagocytosed lymphocytes. Immunohistochemical staining was S-100 positive, CD1a negative, and CD68 positive for histiocytes. Results: Enhancing soft tissue masses posterior to both globes, and masses in the cavernous sinus, cribriform plate, crista Galli, and interhemispheric fissure on either side of the falx, the left optic nerve sheath Conclusions: RDD is associated with massive cervical lymphadenopathy in 90[percnt] of patients, lymphadenopathy is also present inguinal (26[percnt]), axillary (24[percnt]), and mediastinal (15[percnt]). Up to 43[percnt] of patients presented with extranodal pathology, most frequently involving the skin, upper respiratory system, eyelid, orbit, bone, salivary glands, and the central nervous system. Our case is classified as RDD with orbital, uveal, epibulbar and intracranial involvement. The age of presentation is atypical, suggesting that RDD may masquerade as several entities and should be kept in the differential for patients with any combination of orbital masses, idiopathic uveitis, and subconjunctival lesions

Leadership of United States Academic Departments of Ophthalmology: Chairperson Characteristics, Accomplishments, and Personal Insights

PURPOSE: To report on the characteristics, accomplishments, and past experiences of current academic ophthalmology department chairs. DESIGN: Cross-sectional study. METHODS: Setting: A confidential online survey. STUDY POPULATION: Total of 111 chairs of US academic ophthalmology departments. MAIN OUTCOME MEASURES: Chairs\u27 general characteristics, training/former positions held, academic accomplishments, previous organization/committee involvement, motivation/insight, and overall work satisfaction. RESULTS: Fifty-five chair responses were received (96% male, mean age 57 years, mean term 7 years). The majority were American medical graduates (93%), full professors of ophthalmology (93%), and permanent chairs (96%). All completed their residency in the US and 96% completed a fellowship (25% vitreoretinal surgery, 22% cornea and external disease, and 20% glaucoma). On average, chairs authored 98 peer-reviewed articles, 2 books, and 11 book chapters. They were also significantly involved in peer-reviewed journal literature, serving as editors (20%), associate editors (18%), or editorial board members (60%). The majority of chairs indicated they decided to seek their position late in their career, having already become a full (33%) or associate professor (26%), primarily owing to a desire to build and promote an academic ophthalmology department (61%). Chairs regarded their experience as head of service as most important for their current performance as department heads. Their principal advice to aspiring ophthalmology chairs was to focus on developing skills as a clinician, researcher, and educator ( triple threat ). CONCLUSIONS: Overall, academic department chairs are accomplished leaders in ophthalmology and prolific authors with an established academic record. Chairs regarded their previous leadership roles within the department as invaluable to their effectiveness as chair

Roller coaster retinopathy: case report of symptomatic bilateral intraretinal hemorrhages after shaking injury in an otherwise healthy adult

PURPOSE: Traumatic head injuries not involving the eye have been known to cause retinal injury through multiple mechanisms. Abusive head trauma remains the prototypical example. We propose to demonstrate the first case of bilateral multiple retinal hemorrhages in a young healthy adult related to riding multiple theme park roller coasters. METHODS: The patient was evaluated with a complete ophthalmic examination including dilated extended ophthalmoscopy, fluorescein angiography, optical coherence tomography, and fundus photography. RESULTS: The patient was found to have a bilateral symptomatic macular retinopathy characterized by multiple intraretinal hemorrhages. Given the lack of other systemic findings and negative medical workup, her signs and symptoms were thought to be attributed to the same day attendance of a theme park and riding of multiple roller coasters. CONCLUSION: Theme park roller coasters, as well as other attractions, may affect the eye at the vitreoretinal interface. This type of acceleration-deceleration injury should be considered in the differential of an adolescent or adult patient with retinal hemorrhage in the absence of other pathologic processes to explain clinical findings

Profound Presentation of Retinopathy in A Patient with Sickle Cell Trait and Diabetes Mellitus

This is a Photo Essay and does not have an abstract

Familial retinal arteriolar tortuosity and quantification of vascular tortuosity using swept-source optical coherence tomography angiography

Purpose: Familial retinal arteriolar tortuosity (FRAT) is a rare autosomal dominant disorder that is characterized by tortuosity of the second and higher order retinal arterioles. We implement swept-source optical coherence tomography angiography (SS-OCTA) to quantify vessel tortuosity in patients with FRAT. We hypothesize that patients with FRAT will have higher retinal arteriole tortuosity when compared to controls. Methods: Patients were scanned with a SS-OCTA device (Plex Elite 9000, Carl Zeiss Meditec, Dublin, CA). Images of a 12 × 12 mm2 area centered on the fovea were processed, and retinal vessels >23.5 μm in diameter were identified. An automatic tortuosity measurement program written in MATLAB was used to assess vessel tortuosity. Branch points in the vessels were detected and used to separate the vasculature into individual segments. The tortuosity was measured by calculating the arc-chord ratio of each vessel segment, where a minimum value of 1 indicated a straight vessel and higher values corresponded to increasing tortuosity. Results: Two patients (4 eyes) with a known history of FRAT and six controls (12 eyes) were enrolled in the study. The mean tortuosity of all vessel segments (MTVS) in scans of FRAT eyes was on average 1.1244 [range: 1.1044–1.1438] while for control eyes it was 1.0818 [range: 1.0746–1.0872]. Average MTVS of FRAT eyes was significantly higher compared to control eyes (p = 0.03). Conclusions and Importance: Our results are consistent with the hypothesis that patients with FRAT have higher objective measurements of tortuosity compared to controls. Broader applications of this method may be of benefit in other retinal diseases with changes in retinal vessel configuration. Keywords: Familial retinal arteriolar tortuosity, Vascular tortuosity, OCT angiograph

Retinal Capillary Nonperfusion on OCT-Angiography and Its Relationship to Kidney Function in Patients with Diabetes

Background. Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD). Method. A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea. Correlations of RNP and VD with eGFR and albuminuria were analyzed. Results. Participants had a mean age of 72 years, hemoglobin A1c of 8.1%, eGFR of 45 mL/min/1.73 m2, and urine albumin-to-creatinine ratio of 162 mg/g. Mean (SD) RNP was 6.6% (4.2%) and 16.9% (7.7%) in 30° and 60° FOV regions, respectively. eGFR was negatively correlated to RNP in both the 30° and 60° FOV regions (R = −0.69, p=0.004, and R = −0.46, p=0.057, respectively), and correlations were stronger among a subset of 7 participants with evidence of diabetic retinopathy on exam and fundus photos. The estimated GFR was not significantly correlated with vessel density. Urine albumin-to-creatinine ratio was not significantly correlated with RNP or VD. Conclusions. Our proof-of-concept study showed that lower eGFR was significantly correlated with retinal nonperfusion in participants with diabetes and CKD. Advanced retinal imaging may enhance the noninvasive evaluation of kidney function in diabetes

Bilateral Retinal Detachments After Intravitreal Injection of Adipose-Derived ‘Stem Cells’ in a Patient With Exudative Macular Degeneration

A 77-year-old woman with exudative macular degeneration underwent bilateral intravitreal injections of "stem cells" at a clinic in Georgia. One month and 3 months after injection, she developed retinal detachments in the left and right eyes, respectively. Increased awareness within the medical community of such poor outcomes is critical so that clinics offering untested practices that have been shown to be potentially harmful to patients can be identified and brought under U.S. Food and Drug Administration oversight. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:772-775.]