Darin R. Goldman

Congenital simple hamartoma of the retinal pigment epithelium: clinical, optical coherence tomography, and histopathological correlation

Congenital simple hamartoma of the retinal pigment epithelium: clinical, optical coherence tomography, and histopathological correlation

Spontaneous Improvement of Macular Traction Retinal Detachment Associated With Myopic Macular Schisis

High myopia can be associated with a range of pathologic changes within the macula that are now easily appreciated with optical coherence tomography. In the setting of high myopia and a macular traction retinal detachment, the expectation is for progressive worsening over time, and surgical intervention is often undertaken early. The authors present a case of spontaneous improvement of myopic macular detachment, which illustrates the potential value of an initial period of observation in this clinical setting.

Traumatic choroidal rupture with submacular hemorrhage treated with pneumatic displacement.

In a patient with traumatic choroidal rupture involving the macula with poor presenting visual acuity, therapeutic intervention should be considered because the natural history is unfavorable with only about 20% of eyes regaining vision good enough to drive. We present high quality clinical photographs and optical coherence tomography of a 25-year-old healthy female patient with traumatic choroidal rupture and submacular hemorrhage treated with pneumatic displacement. Fundus examination at presentation revealed a large submacular hemorrhage (Figure 1). Pneumatic displacement was performed using 0.4 mL of 100% sulfur hexafluoride (SF6) gas and the patient was instructed to maintain a face down position. There was significant displacement of the hemorrhage outside the macula after 5 days and improvement of visual acuity to 20/70 (Figure 2). At this point, the foveal layers above the resolving hemorrhage, and Fig. 1. Color fundus photograph (top) and optical coherence tomography (bottom) show a large submacular hemorrhage within the macula at presentation. The patient reported being “flicked with a fingernail” in the left eye 3 days before presentation. The RPE layer is intact nasally (white arrowheads) but is obscured subfoveally and temporally because of shadowing by the large submacular hemorrhage (red circle). The presence of hemorrhage in the subretinal space appears hyperreflective where it is hemoglobin-rich (temporal and superficial), and hyporeflective where a serous component is predominant (nasal and deep). The presence of hemorrhage mechanically displaces the retina upward but the retinal layers appear intact, although there may be subtle disruption of the outer layers.

Dramatic Resolution of Extreme Ocular Ischemia in a Case of Takayasu’s Arteritis

Late-stage Takayasus arteritis can result in significant ocular ischemic disease from global retinal hypoperfusion. The authors report the case of a 32-year-old woman with known Takayasus arteritis who presented with severe, late-stage Takayasus arteritis and prominent retinal findings. The systemic burden of the disease is illustrated using computed tomography angiography and magnetic resonance angiography imaging techniques, and the ophthalmic findings are illustrated in a novel fashion using ultrawide-field imaging. Delayed arm-to-retina circulation time, severe peripheral retinal ischemia, and extensive diffuse angiographic leakage were noted. These dramatic findings resolved completely 5 months after surgical revascularization was performed in combination with medical management.

Progressive Outer Retinal Necrosis Secondary to Herpes Simplex Virus Type 2.

Progressive outer retinal necrosis is an aggressive form of necrotizing herpetic retinitis that presents in immunocompromised patients. It is usually secondary to varicella zoster virus or, rarely, herpes simplex virus type 1. The authors report a case of progressive outer retinal necrosis associated with herpes simplex virus type 2 in a patient with a history of congenital herpes. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:xxx-xxx.].

Retinal telangiectasis detected during a vision screening examination in a child with hearing loss led to the diagnosis of facioscapulohumeral muscular dystrophy

A 2-year-old girl with congenital sensorineural hearing loss was found to have retinal exudation and subretinal fluid in her left eye. Further investigation revealed leaking retinal telangiectasias in her left eye and extensive areas of peripheral retinal nonperfusion in both eyes. A clinical diagnosis of facioscapulohumeral muscular dystrophy (FSHD) was confirmed by genetic testing. The patient was followed with serial intraoperative optical coherence tomography (OCT) scans, which demonstrated subretinal fluid in the macula and its subsequent resolution after treatment. She underwent 6 rounds of panretinal photocoagulation and 2 injections of intravitreal bevacizumab, which resolved the subretinal fluid and exudates.

Leaking choroidal nevus treated with focal laser photocoagulation.

PURPOSE To present a case of leaky choroidal nevus that responded favorably to treatment with focal laser photocoagulation, shown by spectral domain optical coherence tomography, fundus autofluorescence, and fundus photography. METHODS Descriptive case report of a 40-year-old male patient with decreased visual acuity because of subretinal fluid associated with a choroidal nevus, which was treated with focal laser photocoagulation. RESULTS Treatment with focal laser photocoagulation to the surface of the choroidal nevus resulted in the resolution of subretinal fluid by 6 weeks. The therapeutic effect remained after 1 year of follow-up with continued improvement in vision and with no growth of the lesion. CONCLUSION Laser photocoagulation can be an effective treatment for symptomatic subretinal fluid associated with a choroidal nevus. Spectral domain optical coherence tomography, fundus autofluorescence, and fundus photography can be helpful in monitoring the treatment response.

Late reopening of an initially successfully closed macular hole after 12 years.

PURPOSE An uncommon late complication after successful initial surgical closure of a full-thickness macular hole is reopening. METHODS A retrospective interventional case report. RESULTS A 58-year-old pseudophakic woman presented with 6 weeks of decreased vision in her right eye. She was found to have a full-thickness macular hole, which was successfully repaired through pars plana vitrectomy, epiretinal membrane peeling, gas-fluid exchange with 25% SF6, and 7 days of face-down positioning. Twelve years later, she presented with new metamorphopsia and visual acuity of 20/50 in the right eye. Examination revealed reopening of the macular hole. CONCLUSION Despite high rates of surgical success, the reopening of initially closed macular holes can occur at any time postoperatively but has been reported more frequently in the first few months, though late reopenings have been observed. This is the latest reopening of a macular hole reported in the literature, occurring 12 years after initial successful surgical closure. This case highlights the importance of long-term follow-up and raises questions about why macular holes can reopen so late after initial successful closure.

Myopic Schisis With Scrolled Posterior Hyaloid

ziness or vertigo, possibly involving vision impairment. A 1917 encyclopedia entry stated that English surgeon and former Beer student James Wardrop coined the term keratitis in an 1808 text. This claim has become conventional wisdom. In fact, Wardrop spoke simply of inflammation or ulcer of the cornea. We could not find the terms keratitis or ceratitis in Wardrop’s works (eReferences 3-18). To date, the first documented use of the term keratitis is by Weller and, in English, by Monteath. Monteath’s English translation became his bestknown work and has left an important lexical legacy.