Eyelid eversion for visualisation of the upper eyelid lamellae: An anatomical cadaver study

Oculoplastics Paper SessionControversy persists in surgical eyelid anatomy despite the routine use of microanatomical examination in modern eyelid research. The aim of our study was to facilitate visualisation of upper eyelid anatomy by optimising the orientation of cadaveric specimens. We studied the anatomy of everted eyelids, providing an excellent histological view of the posterior approach to the eyelid commonly used in surgery. Non-traumatic separation of the eyelid lamellae provides a new view of the eyelid's lamellar nature. Further application of this model may enhance understanding of the multilayered aspect of the levator aponeurosis. The technique may improve intraoperative understanding of critical eyelid anatomy and promote safer and more effective eyelid surgery.published_or_final_versionThe 26th Asia Pacific Academy of Ophthalmology Congress (APAO 2011), Sydney, Australia, 20-24 March 2011. In British Journal of Ophthalmology, 2011, v. 95 n. 10, p. 1376-137

Concomitant optic nerve transection and chorioretinitis sclopetaria

BACKGROUND: Optic nerve transection and chorioretinitis sclopetaria may occur following blunt ocular trauma. However, simultaneous occurrence has not yet been reported. We report the first case of concomitant optic nerve transection and chorioretinitis sclopetaria. CASE PRESENTATION: A 12- year- old boy with history of BB gun injury to his right eye was referred for loss of vision. His visual acuity was counting fingers at one meter in the right eye and with 3+ relative afferent pupillary defect (RAPD). On slit lamp examination, the right eye appeared normal except for 1+ vitreous reaction. Fundus examination of the right eye revealed a pale disc with superior retinal scar and diffuse submacular fibrosis compatible with chorioretinitis sclopetaria. Orbital CT- scans showed transection of the optic nerve by the BB gun pellet, which was lodged at the orbital apex. CONCLUSION: BB gun injury may cause concomitant optic nerve transection and chorioretinitissclopetaria

Age-related macular degeneration and smoking cessation advice by eye care providers: a pilot study

This is the final version of the article. Available from the publisher via the link in this record.Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.Support for this study was provided in part by a National Eye Institute grant (no. R21-EY019096)

Measurement of TIMP-3 expression and Bruch's membrane thickness in human macula.

An increase or accumulation in tissue inhibitor of matrix metalloproteinases-3 (TIMP-3) protein in Bruch's membrane with ageing in normal eyes, and in age related macular degeneration (AMD) has been previously demonstrated. The purpose of this study was to determine whether the expression of TIMP-3 mRNA increases with age, and to define any relationship between altered expression and Bruch's membrane thickness. Normal eyes were obtained from 30 donors (age range 15-90 years). Full-thickness 8 mm macular punches centred on the fovea were taken to allow removal of the chorioretinal complex, for subsequent nucleic acid extraction. Samples were normalized for RNA degradation using beta-actin reverse transcriptase-polymerase chain reaction (RT-PCR). A competitive RT-PCR was then used to allow measurement of TIMP-3 gene expression in each sample. The tissue adjacent to that used for nucleic acid extraction was processed histologically to allow determination of Bruch's membrane thickness. Bruch's membrane thickness was found to increase with age (P < 0.01), but TIMP-3 expression, as measured by competitive RT-PCR, was not significantly increased with age (P = 0.19). An inverse correlation was noted between TIMP-3 expression and Bruch's membrane thickness after controlling for age (P = 0.032). The results of this study suggest that TIMP-3 expression does not alter significantly with age. Therefore, accumulation of the TIMP-3 protein must occur by a mechanism other than increased expression. TIMP-3 protein levels may still prove to contribute to events associated with ageing in the macula, such as matrix remodelling in Bruch's membrane. Further studies are required to elucidate the precise interactions and turnover of the TIMP-3 protein, and resulting changes in the control of matrix metalloproteinase activity in the ageing macula

Unusually delayed presentation of persistent Descemet’s membrane tear and detachment after cataract surgery

Melina I Morkin,1,2 Rehan M Hussain,2 Ryan C Young,2 Tracy Ravin,2 Sander R Dubovy,2 Eduardo C Alfonso2 1Department of Ophthalmology, Shiley Eye Center, University of California – San Diego, San Diego, CA, 2Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA Abstract: A 51-year-old male who had undergone phacoemulsification in his left eye 11 months prior presented with complaint of sudden onset of blurred vision in the same eye. Review of his clinical course, slit-lamp exam, pachymetry, and specular endothelial microscopy led to the diagnosis of acute hydrops caused by Descemet’s membrane dehiscence at the site of the incision. He was initially managed with medical treatment and observation. In the subsequent months of follow-up, the corneal edema and the patient’s visual acuity did not improve. Intracameral gas injection was performed 7 months after presentation, but because of persistent corneal edema and nonattached Descemet’s membrane, penetrating keratoplasty was performed. Histopathologic examination confirmed the diagnosis. The patient has had a clear corneal graft since then. Although Descemet’s membrane detachment is a rather common complication after intraocular surgery, its unusually delayed presentation can also occur, and should not be confused with pseudophakic bullous keratopathy. Many mechanisms have been studied for the development of early tears and detachments after cataract surgery, but little is known about late presentations. The authors explore possible causes, and highlight the importance of instructing patients to avoid eye rubbing and any other type of trauma to the cornea after intraocular surgery. Keywords: Descemet’s membrane tear, detachment, cataract surgery, phacoemulsificatio

Bilateral papillopathy as a presenting sign of pheochromocytoma associated with von Hippel–Lindau disease

Veeral Shah, Leonid Zlotcavitch, Angela M Herro, Sander R Dubovy, Zohar Yehoshua, Byron L LamBascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USAAbstract: A 7-year-old girl presented with decreased vision in both eyes for 1 month. Examination showed visual acuity of 20/50 and 20/60, no afferent pupillary defect, cecocentral scotomas, and bilateral optic disc edema with extensive peripapillary and macular exudates. Magnetic resonance imaging showed multiple cortical and subcortical white matter lesions. Both the laboratory workup and the systemic examination were unrevealing. However, on follow-up, the patient showed episodic elevations of blood pressure as high as 240/160. Further workup revealed elevated urine catecholamines and a right supra-adrenal mass proven to be a pheochromocytoma by histopathologic analysis. The paroxysmal hypertension resolved, and the visual acuity, visual fields, fundus exam, and neuroimaging improved. The patient was lost to follow-up until age 18 when she developed shortness of breath and was found to have multiple pulmonary metastases identified as pheochromocytoma by biopsy. Genetic testing identified a 3p25-26 (c.482 G>A) VHL gene chromosomal mutation consistent with von Hippel–Lindau disease genotype. Multiple peripheral retinal vascular dilations and small retinal capillary hemangioblastomas were also found. This case highlights the importance of recognizing the lability of blood pressure often seen with pheochromocytomas, which may mask the underlying cause of hypertensive papillopathy and retinopathy, a diagnosis of low clinical suspicion in the pediatric population. The case also underscores the importance of thorough systemic workup, including genotyping to detect conditions where pheochromocytoma may be the presenting sign of the disease, such as multiple endocrine neoplasia 2A and 2B, von Hippel–Lindau disease, von Recklinghausen disease, tuberous sclerosis, and Sturge–Weber syndrome.Keywords: hypertensive encephalopathy, VHL, pheochromocytoma, paroxysmal hypertensio

Swept-Source Optical Coherence Tomography Angiography of an Amalric Choroidal Infarction in a Rare Presentation of Giant Cell Arteritis With Bilateral Corneal Edema

A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].info:eu-repo/semantics/publishe

Swept-Source Optical Coherence Tomography Angiography of an Amalric Choroidal Infarction in a Rare Presentation of Giant Cell Arteritis With Bilateral Corneal Edema.

A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].info:eu-repo/semantics/publishe