Jonathan S. Chang

Candida glabrata Endophthalmitis Transmitted From Graft to Host After Descemet Stripping Automated Endothelial Keratoplasty

This lymphatic finding has not been observed previously by us in either hyperplasias or lymphomas. It must be distinguished from the proliferation of new lymphatics in conjunctival melanomas, which facilitate regional metastases but do not contain elongated compactions of tumor cells.3 In a major hematopathology textbook, the plugging of lymphocytic channels is mentioned in connection with an inflamed appendix.4 A previous report in the Chinese literature documented intralymphatic collections of small lymphocytes only with local disease and a favorable prognosis.5 Typical sites of involvement were the tonsils (2 cases), pharynx (1 case), and appendix (1 case). Perilymphatic chronic inflammation and fibrosis were held responsible for impeding lymphatic circulation and drainage. The current entity must be distinguished from intravascular large B-cell lymphoma, which exhibits pleomorphism of the constituent cells.6

The Spectrum of Pediatric Orbital BB Gun Injuries: A Case Series.

Three cases of pediatric BB orbital injury are reported demonstrating varying outcomes. Pediatric orbital BB injuries have a wide spectrum of clinical outcomes depending on the ocular structures involved. Improved safety education of patients and parents is necessary to reduce the burden of these vision-threatening injuries.

Marfan’s Syndrome with Ectopia Lentis

A 41-year-old man presented with progressive loss of vision in both eyes. He also had elongated digits and pectus excavatum. Evaluation revealed ectopia lentis, which is consistent with Marfan’s syndrome.

Congenital optic nerve pit in trisomy 18.

The authors report the first case of trisomy 18 associated with a clinically detectable optic nerve pit. A female infant with a birth weight of 2,150 g was born by cesarean section to a healthy 40-year-old woman at 38 weeks of gestation. Trisomy 18 had been diagnosed by prenatal genetic testing. Ophthalmologic examination was remarkable for bilateral narrowed palpebral fissures with punctal agenesis, corectopic pupils without reaction to light, bilateral inferior peripapillary retinochoroidal hypopigmentation, and significant optic nerve cupping in the left eye with associated temporal optic nerve pit. It has generally been accepted that optic nerve pits are a congenital anomaly. However, the pathophysiological background of optic nerve pits remains unclear and controversial. This is the first clinical and photographic documentation of an optic nerve pit in a neonate and in Edwards syndrome.The authors report the first case of trisomy 18 associated with a clinically detectable optic nerve pit. A female infant with a birth weight of 2,150 g was born by cesarean section to a healthy 40-year-old woman at 38 weeks of gestation. Trisomy 18 had been diagnosed by prenatal genetic testing. Ophthalmologic examination was remarkable for bilateral narrowed palpebral fissures with punctal agenesis, corectopic pupils without reaction to light, bilateral inferior peripapillary retinochoroidal hypopigmentation, and significant optic nerve cupping in the left eye with associated temporal optic nerve pit. It has generally been accepted that optic nerve pits are a congenital anomaly. However, the pathophysiological background of optic nerve pits remains unclear and controversial. This is the first clinical and photographic documentation of an optic nerve pit in a neonate and in Edwards syndrome.

PROPHYLACTIC PREOPERATIVE LASER RETINOPEXY DOES NOT REDUCE THE OCCURRENCE OF RHEGMATOGENOUS RETINAL COMPLICATIONS IN MACULAR SURGERY.

Purpose: Knowledge on the utility of prophylactic 360° laser retinopexy before pars plana vitrectomy in the absence of peripheral retinal pathology is limited. This study compares the occurrence of rhegmatogenous events in the setting of small-gauge pars plana vitrectomy with and without prophylactic preoperative laser. Methods: Our multicenter, retrospective case–control analysis reviewed patients who underwent epiretinal membrane removal or macular hole repair through 23- or 25-gauge pars plana vitrectomy: 205 controls who did not receive prophylactic laser and 176 cases who received preoperative prophylactic laser retinopexy anterior to the equator. Main outcome measures were the rate and characteristics of postoperative retinal tears and detachments. Patients with previous pars plana vitrectomy or significant retinal disease were excluded. Results: Of those patients with prophylactic laser and those without, there was no significant difference in the number of retinal breaks (1.7% vs. 0.49%, respectively; P = 0.339) or retinal detachments (0% vs. 0.49%, respectively; P = 1.00). Of the lasered group, there was one sclerotomy-related retinal break and two non–sclerotomy-related retinal breaks. Of the nonlasered group, there was one non–sclerotomy-related retinal break and one sclerotomy-related retinal detachment. Conclusion: Preoperative prophylactic peripheral laser retinopexy does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events.

Spontaneous Separation of Macular Epiretinal Membrane Without Peripheral Posterior Vitreous Detachment

Purpose: To describe findings of a patient with spontaneous separation of macular epiretinal membrane (ERM) associated with a limited posterior vitreous detachment. Methods: Case report. Results: A 69-year-old woman presented with metamorphopsia and loss of vision (20/200) in the left eye (OS) secondary to ERM. One month later, the vision improved (20/40−) following spontaneous separation of the ERM. However, residual epiretinal fibrotic membranes were adherent along the vascular arcades, causing persistent disabling metamorphopsia. During vitrectomy, peeling of the membranes from the vascular arcades demonstrated that the peripheral vitreous cortex had not separated around the macula. The metamorphopsia subsequently improved. Conclusions: This case demonstrates a unique finding at the vitreomacular interface, where spontaneous ERM separation was not associated with a peripheral vitreous detachment. The peripheral cortical vitreous remained intact, serving as a scaffold for membrane proliferation along the vascular arcades.

AIMING FOR THE BULLʼS EYE: The Cost-Utility of Screening for Hydroxychloroquine Retinopathy

Background: Throughout medicine, the cost of various treatments has been increasingly studied with the result that certain management guidelines might be reevaluated in their context. Cost-utility is a term referring to the expense of preventing the loss of quality of life, quantified in dollars per quality-adjusted life year. In 2002, the American Academy of Ophthalmology published hydroxychloroquine screening recommendations which were revised in 2011. The purpose of this report is to estimate the cost-utility of these recommendations. Methods: A hypothetical care model of screening for hydroxychloroquine retinopathy was formulated. The costs of screening components were calculated using 2016 Medicare fee schedules from the Centers for Medicare and Medicaid Services. Results: The cost-utility of screening for hydroxychloroquine retinopathy with the 2011 American Academy of Ophthalmology guidelines was found to vary from 33,155 to 344,172 dollars per quality-adjusted life year depending on the type and number of objective screening tests chosen, practice setting, and the duration of hydroxychloroquine use. Screening had a more favorable cost-utility when the more sensitive and specific diagnostics were used, and for patients with an increased risk of toxicity. Conclusion: American Academy of Ophthalmology guidelines have a wide-ranging cost-utility. Prudent clinical judgment of risk stratification and tests chosen is necessary to optimize cost-utility without compromising the efficacy of screening.