Nodular posterior scleritis mimicking choroidal metastasis: a report of two cases

Posterior scleritis is a rare underdiagnosed condition that can potentially cause blindness. Its varied presentations lead to delayed or incorrect treatment. We present here the cases of two patients with nodular posterior scleritis mimicking a choroidal metastasis. Two female patients presented with a sudden unilateral visual loss associated with ocular pain. Fundus examination revealed temporomacular choroidal masses with exudative detachments that, due to angiographic presentation, were suggestive of choroidal metastasis. Systemic examinations were unremarkable. In the two cases, a local or general anti-inflammatory treatment led to the complete recovery of the lesions, which were, thus, considered nodular posterior scleritis. The diagnosis of nodular posterior scleritis has to be evoked in all patients presenting with a choroidal mass in fundus examination. It represents the principal curable differential diagnosis of malignant choroidal tumor

Long-Term Follow-Up After Unilateral Intravitreal Gene Therapy for Leber Hereditary Optic Neuropathy: The RESTORE Study

Background: RESCUE and REVERSE were 2 Phase 3 clinical trials that assessed the efficacy and safety of intravitreal gene therapy with lenadogene nolparvovec (rAAV2/2-ND4) for the treatment of Leber hereditary optic neuropathy (LHON). RESTORE is the long-term follow-up study of subjects treated in the RESCUE and REVERSE trials. Methods: In RESCUE and REVERSE, 76 subjects with LHON because of the m.11778 G>A mutation in the mitochondrial gene ND4 received a single unilateral intravitreal injection of lenadogene nolparvovec. After 96 weeks, 61 subjects were enrolled in the long-term follow-up study RESTORE. The best-corrected visual acuity (BCVA) was assessed over a period of up to 52 months after onset of vision loss. A locally estimated scatterplot smoothing regression model was used to analyze changes in BCVA over time. Vision-related quality of life was reported using the visual function questionnaire-25 (VFQ-25). Results: The population of MT-ND4 subjects enrolled in RESTORE was representative of the combined cohorts of RESCUE and REVERSE for mean age (35.1 years) and gender distribution (79% males). There was a progressive and sustained improvement of BCVA up to 52 months after the onset of vision loss. The final mean BCVA was 1.26 logarithm of the minimal angle of resolution 48 months after the onset of vision loss. The mean VFQ-25 composite score increased by 7 points compared with baseline. Conclusion: The treatment effect of lenadogene nolparvovec on BCVA and vision-related quality of life observed 96 weeks (2 years) after treatment in RESCUE and REVERSE was sustained at 3 years in RESTORE, with a maximum follow-up of 52 months (4.3 years) after the onset of vision loss

Diffuse laser illumination for Maxwellian view Doppler holography of the retina

We describe the advantages of diffuse illumination in laser holography for ophthalmology. The presence of a diffusing element introduces an angular diversity of the optical radiation and reduces its spatial coherence, which spreads out the energy distribution of the illumination beam in the focal plane of the eyepiece. The field of view of digitally computed retinal images can easily be increased as the eyepiece can be moved closer to the cornea to obtain a Maxwellian view of the retina without compromising ocular safety. Compliance with American and European safety standards for ophthalmic devices is more easily obtained by preventing the presence of a laser hot spot observed in front of the cornea in the absence of a scattering element. Diffuse laser illumination does not introduce any adverse effects on digitally computed laser Doppler images.Comment: 9 page

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Visual function and retinal nerve fiber layer thickness in Neuromyelitis optica: a longitudinal and comparative study

Longitudinal studies in multiple sclerosis (MS) show that visual function decreases as a function of time and is correlated with a thickening of the retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT). We determined the outcome of visual acuity and RNFL thickness in Neuromyelitis optica (NMO) in the lack of clinical relapse

Ocular Oscillations in the Neuromyelitis Optica Spectrum

Four French West Indian women complained of oscillopsia and were found to have an acquired eye movement disorder. In 3 of them, different types of nystagmus were found, including upbeat, downbeat, and central form of vestibular nystagmus. One developed opsoclonus-myoclonus syndrome. Three patients had neuromyelitis optica antibodies, and 3 had brainstem abnormalities detected on MRI. Two patients had definite NMO, while the other 2 were considered to be at high risk for developing NMO. Treatment with high-dose systemic corticosteroids, with plasma exchanges, or in combination led to resolution of oscillopsia. We propose that eye movement disorders be added to the neurological manifestations of NMO

Ocular Motor Cranial Nerve Palsies In Pituitary Apoplexy

"Pituitary apoplexy (PA) is caused by sudden pituitary hemorrhage/necrosis and often presents with acute neuro-ophthalmic manifestations, including ocular motor cranial nerve palsies (CNP). We describe the epidemiology and outcomes of CNP in a large single-center cohort of PA patients.

Vertical Diplopia secondary to Skew Deviation with Ocular Tilt Reaction with Multiple Posterior Fossa Metastases

This is a case of multiple brain metastases in the posterior fossa resulting in a skew deviation. Figure 1 : Photograph of the patient demonstrating a spontaneous right head tilt. The patient's head is tilted toward his right shoulder to suppress his diplopia Figure 2 : Ocular movements : There is a left hypertropia in primary position; the hypertropia was worse in right gaze Figure 3 : Lateral gazes : The left hypertropia and the diplopia were worse when the patient looked to the right Figure 4 : Lateral head tilt : The left hypertropia and the diplopia were worse with left head tilt Figure 5: Fundus photographs : Conjugate torsion of both eyes with the upper pole deviated toward the hypotropic eye Figure 6: T1-weighted axial brain MRI : Multiple lesions in the posterior fossa consistent with brain metastasisMTemspoculartiltreaction, VBintracranialtumors, EECintracranialtumors, EECoculartiltreactio

Case Reports of Peripapillary Choroidal Neovascular Membrane in 6 Patients With Intracranial Hypertension

We sought to describe initial features and history of patients diagnosed with peripapillary choroidal neovascularization (PCNV), a rare and challenging complication of chronic papilledema in intracranial hypertensions (IH)

Microcystic Macular Degeneration In Autosomal Optic Neuropathy

Patients with autosomal optic neuropathy (AON) can develop microcystic macular degeneration (MMD). MMD has been linked to trans-synaptic retrograde degeneration or vitreo-macular traction (VMT). We aimed to investigate the prevalence of MMD and describe their relationships with retinal layers thicknesses and visual function in subjects with AON related to dominant optic atrophy or Wolfram syndrome