Diagnostic Procedures in Ophthalmology

Determining the cause of intraocular inflammation has important implications both for the treatment and prognosis of uveitic diseases. This chapter describes ocular diagnostic procedures and their indications while mainly focusing on diagnostic vitrectomy. The chapter discusses the history of elective diagnostic procedures; main indications for invasive procedures in the diagnosis of uveitic disease; surgical principles and techniques for each of the diagnostic procedures; descriptions of the various laboratory techniques being used; and selected examples of conditions that may require the use of such techniques

Ocular Adverse Events Induced by Immune Checkpoint Inhibitors: A Comprehensive Pharmacovigilance Analysis

PURPOSE Characterize ocular adverse events (oAEs) caused by immune checkpoint inhibitors (ICIs). METHODS Retrospective analysis of 41,674 cancer patients in the FDA Adverse Event Reporting System (FAERS) pharmacovigilance database receiving anti-PD-1/PD-L1, anti-CTLA-4, or anti-PD-1+ anti-CTLA-4 combination. Reporting odds ratio (ROR) was used to approximate oAE rate across regimens and indications. RESULTS The most common indications were lung cancer (27.3%) and melanoma (22.7%); 76.3% received anti-PD-1/PD-L1 monotherapy. 1,268 patients (3.0%) reported oAEs, namely vision disorders (30.8%), uveitis (15.1%), and retinal, lacrimal, and optic nerve disorders (10.7%, 9.0%, 8.4%). Melanoma showed the highest proportion of uveitis (117/9,471 cases; 1.2%). Addition of anti-CTLA-4 to anti-PD-1 increased the ROR of uveitis from 4.77 (95% CI 3.83-5.94) to 17.1 (95% CI 12.9-22.7). Among anti-PD-1/PD-L1 cases, uveitis was differentially reported in melanoma (ROR 14.7, 95% CI 10.7-20.2) compared with lung cancer (ROR 2.67, 95% CI 1.68-4.23). CONCLUSION ICI-induced oAEs are rare, and uveitis is significantly associated with melanoma and anti-PD-1+ anti-CTLA-4 combination

Wally and the Major [picture] : modern hazard /

Part of the Stan Cross Archive of cartoons and drawings, 1912-1974.; Inscription: "4808 Fri Dec 23 Modern Hazard"--In Ink, right margin; "4731"--In Ink, upper right corner; "5"--In pencil, upper left corner.; Also available in an electronic version via the internet at: http://nla.gov.au/nla.pic-vn4301760

The Great Imitator on the Rise: Optic Disc Involvement in Syphilis Patients

Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. Ocular manifestations, are reported in the literature in 2-10% of the cases can occur at any stage of the disease and may involve any ocular structure. During the last decade the number of syphilis cases has been on the rise in developed countries. As a result, ocular syphilis has become more common too. The purpose of this study was to report the current incidence and characteristics of optic nerve involvement in patients with newly diagnosed syphilis

Bilateral Neuroretinitis and a Unilateral Superior Hemivein Occlusion with Frosted Branch Angiitis Pattern Presenting Simultaneously in Behçet's Disease

Purpose: To report a unique case of Behçet's disease that presented with atypical ocular manifestations. Methods: Case report. Results: A 23-year-old homosexual male presented with bilateral anterior uveitis, vitritis, neuroretinitis and a unilateral superior hemivein occlusion with frosted branch angiitis pattern. These were accompanied by systemic findings of recurrent oral aphthous ulcers, erythema nodosum, and neurological and gastrointestinal involvement. A positive HLA-B51 examination supported the diagnosis of Behçet's disease. Conclusion: Neuroretinitis and frosted branch angiitis may be the clinical manifestations of Behçet's disease and may present simultaneously

Polypoidal Lesions Associated with Choroidal Nevi

Purpose: To investigate eyes with polypoidal lesions associated with choroidal nevi, their multimodal imaging characteristics, and long clinical follow-up. Methods: Multicenter, retrospective case series study of patients with polypoidal lesions overlying choroidal nevi. Demographic and clinical information was recorded. Multimodal imaging including colour fundus photography (CFP), optical coherence tomography (OCT), OCT angiography, fundus fluorescein angiography (FA), indocyanine angiography (ICGA) and A- and B-scan ultrasonography were analyzed for nevus and polypoidal lesion characteristics. Results: Fourteen eyes (14 patients; mean age: 70.3±6.7 years) with polypoidal lesions overlying choroidal nevi were included. The mean follow-up duration was 50.0±27.9 months (range 12-108). All nevi were pigmented on CFP, flat on ultrasonography with a mean basal diameter of 3.8±0.4 mm. In all but one eye, OCT showed a shallow irregular pigment epithelium detachment (SIRE) overlying the nevus. A total of 11/14 eyes (78.6%) had exudative activity, 9 eyes received intravitreal anti-vascular endothelial growth factor (VEGF) injections, and one eye required intravitreal anti-VEGF combined with photodynamic therapy (PDT). Mean visual acuity was 20/32 at baseline and 20/50 at final visit. Conclusions: We present the largest known cohort of eyes with polypoidal lesions associated with choroidal nevi with up to 9 years follow-up. The exudative degree of the polypoidal lesion in this condition is variable and treatment decisions should be taken on an individual basis. We hypothesize that choroidal ischemia due to altered choroidal vasculature rather than Haller layer hyperpermeability plays a role in the formation of polypoidal lesions overlying nevi