Jennifer H. Cao

BIRDSHOT CHORIORETINITIS LESIONS ON INDOCYANINE GREEN ANGIOGRAPHY AS AN INDICATOR OF DISEASE ACTIVITY.

Purpose: To determine whether classical indocyanine green angiography lesions in patients with birdshot chorioretinitis can be used to monitor disease activity. Methods: A retrospective case series was performed on 26 eyes in 26 consecutive patients with birdshot chorioretinitis who had at least one indocyanine green angiography performed during disease activity and another during disease quiescence. Using Photoshop, the mean number, area, and area per spot on indocyanine green angiography were compared between disease activity and quiescence using a paired ratio test. Results: The mean total lesion number, area, and area per spot during disease activity were 75.27 spots, 24,525 pixels, and 364 pixels/spots, respectively. The mean total lesion number, area, and area per spot size during disease quiescence were 28.35 spots (P < 0.01), 7,411 pixels (P < 0.01), and 279 pixels/spot (P = 0.12), respectively. Conclusion: There was a statistically significant decrease in the mean total area and number of lesions between the time of disease activity and disease quiescence (P < 0.01). Our results suggest that indocyanine green angiography has a role not only in diagnosis but also in monitoring treatment effectiveness; lesions can be reversible with treatment and their reappearance may be an indicator of disease relapse.

Increased Submacular Choroidal Thickness in Active, Isolated, Extramacular Toxoplasmosis

origin of the blood circulation of the brain and choroid through the internal carotid artery may play a role. Taking into account that choroidal thickness depends on choroidal blood vessel filling and considering the choroidal blood circulation as an extracranial part of the cerebral blood system may make one infer that decreased cerebral blood circulation may have an effect on both a decreased cognitive function and a reduced choroidal thickness. Our results should be interpreted with limitations in mind; it is not fully clear how well the Mini Mental Status Examination test applied in our study to assess cognitive function. In conclusion, thicker SFCT (or a lesser degree of fundus tessellation) was associated with higher cognitive function and vice versa, after adjusting for ocular and systemic parameters. These results suggest that more research is needed to explore the association between a leptochoroid and a reduced cerebral function.

VISUAL OUTCOME AND POOR PROGNOSTIC FACTORS IN ISOLATED IDIOPATHIC RETINAL VASCULITIS.

Purpose: To describe the clinical course, visual outcome, and prognosis of isolated, idiopathic retinal vasculitis. Methods: Eighty patients (150 eyes) with isolated, idiopathic retinal vasculitis were included. Demographic data, clinical data, complications at the initial visit and during follow-up, fluorescein angiography, and optical coherence tomography findings were collected from the Massachusetts Eye Research and Surgery Institution (MERSI) database from September 2005 to February 2015. Results: Seventy-five (93.7%) patients required treatment with immunomodulatory therapy. Of those 75 patients, 60 (75%) patients were able to achieve durable remission. Factors which were independently significant predictive of poor visual outcome were lower initial visual acuity (OR: 3.78; 95% CI: 1.75–8.16; P = 0.001), cystoid macular edema (OR: 5.54; 95% CI: 1.81–16.99; P = 0.003), and macular ischemia (OR: 5.12; 95% CI: 1.12–23.04; P = 0.036). Conclusion: The majority (67.25%) of our patients enjoyed a good visual outcome (most recent visit best-corrected visual acuity equal to or better than 20/40 and within one line or better from the baseline) with immunomodulatory therapy. We found that cystoid macular edema, macular ischemia, and lower best-corrected visual acuity during the first consultation visit were significant independent risk factors for poor visual outcome.

Birdshot Retinochoroidopathy: Differences in Clinical Characteristics between Patients with Early and Late Age of Onset.

ABSTRACT Purpose: To describe differences in the clinical characteristics of birdshot retinochoroidopathy (BSRC) patients diagnosed early and later in life. Methods: This is a retrospective cohort study. Age was primarily analyzed and 50 years of age at diagnosis was selected as a cut-off point. Results: A total of 144 patients (288 eyes) were included; 68 with early-onset and 76 with late-onset BSRC. The younger group had a statistically significant higher rate of more severe iritis (p = 0.04); an average number of non-steroidal immunosuppressants and biologic agents (NSIB) (p = 0.04); and a prolonged time to initiation of NSIB (p = 0.01). There were only four patients (3%) who had >0.5+ cells in the anterior chamber. Conclusions: Patients with early-onset BSRC carried a higher risk for anterior segment inflammation, had a more prolonged delay to initiation of treatment with NSIB, and required a greater number of NSIBs to achieve remission.

Diagnosis and Management of Cicatricial Conjunctivitis

Cicatricial conjunctivitisis one of the most severe forms of ocular surface disease that can lead to profound loss of vision. The most critical aspect of the care is early recognition and the use of appropriate systemic immunomodulatory therapy. A common misconception is that if the conjunctival biopsy is negative for pemphigoid (i.e., no immunoglobulin deposition at the basement membrane), then it rules out the condition and it is not serious; however, false negatives are common and besides even true negative cases can be just as likely to progress and develop severe disease. Therefore, all cases of cicatricial conjunctivitis with active inflammation, regardless of biopsy results, require treatment to suppress inflammation. Another common misconception is that cicatricial conjunctival disease can be managed with local therapy, however which is rarely the case, and systemic therapy is indicated in nearly all cases. This chapter, contributed by the most preeminent expert and pioneer in this field, presents three cases with varying severity and highlights the latest diagnostic and management strategies.

A Case of Endophthalmitis After Bilateral Medial Rectus Recession

A 9-month-old male infant with a history of Down syndrome underwent bilateral medial rectus recession. Two weeks postoperatively, he developed leukocoria of the left eye with a white opacity posterior to the lens, numerous undulations, necrosis, and hemorrhages in the retrolental space. His contralateral eye had white retinal lesions nasally. Ultrasound examination of the left eye showed a funnel retinal detachment, loculated debris, and a small, central, hyperechoic area concerning for calcification. He underwent enucleation because retinoblastoma could not be definitively ruled out. Given this patients low visual potential, enucleation was a definitive and safe treatment option. Ocular pathology showed significant inflammation and necrosis. There was an area of scleral perforation by a suture adherent to the retina and vitreous, surrounded by inflammatory cells. This case uniquely demonstrates pediatric endophthalmitis following strabismus surgery, secondary to scleral perforation confirmed by histopathological analysis. Care must be taken during scleral passage of sutures to prevent inadvertent scleral perforation and the potential complication of endophthalmitis. [J Pediatr Ophthalmol Strabismus. 2017;54:e37-e41.].

ACCIDENTAL DUPLICATION: Colorado-Retinopathy of Prematurity (CO-ROP) Screening Algorithm: a validation study at a tertiary care center

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jaapos.2017.03.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.