Kenneth J. Wald

Optical coherence tomography features of acute central serous chorioretinopathy versus neovascular age-related macular degeneration.

Objective To compare the optical coherence tomography (OCT) features of acute central serous chorioretinopathy (CSC) versus neovascular age-related macular degeneration (AMD), and to determine if OCT features can distinguish between these two entities. Methods A retrospective, observational study of 50 eyes with CSC and 50 eyes with neovascular AMD. Stratus OCT line scans (5 mm) were reviewed for presence of subretinal/intraretinal fluid and retinal pigment epithelium detachment. The height of the fluid and detachments were measured using the OCT manual callipers, and the morphology of the highly reflective line was described. Results Intraretinal fluid (IRF), pigment epithelial detachment (PED), irregularities, thickening and attenuation of the highly reflective line were more often associated with AMD. When present, the PED was significantly greater in AMD than CSC. Patients with CSC were more likely to have subretinal fluid (SRF), and when present, the SRF height was significantly greater in CSC. Patients CSC also had more hypertrophic outer retinal changes on OCT compared with AMD. Conclusion Neovascular AMD and acute CSC have distinguishing features on OCT that may help clinicians to differentiate accurately between the two conditions primarily using OCT.

Acute Posterior Multifocal Placoid Pigment Epitheliopathy as a Choroidopathy: What We Learned From Adaptive Optics Imaging

Acute Posterior Multifocal Placoid Pigment Epitheliopathy as a Choroidopathy: What We Learned From Adaptive Optics Imaging Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a posterior uveitis included in the spectrum of white dot syndromes. It usually affects young healthy individuals who develop photopsias, paracentral scotomas, and decreased vision. Clinically, APMPPE presents with multiple, bilateral, gray-white, placoid lesions that evolve over several weeks, leaving foci of hypopigmentation and pigment clumping. We describe an analysis of multimodal imaging of APMPPE using both ultra–wide-field imaging (200Tx; Optos) and adaptive optics (AO) imaging (rtx1; Imagine Eyes).

Spontaneous resolution of unilateral vitreomacular traction.

Vitreomacular traction (VMT) caused visual symptoms in two healthy young adults but spontaneously resolved within four weeks without any sequelae. Optical coherence tomography (OCT) and fundus photographs proved vital in documenting the rare complete resolution of VMT. It is prudent to monitor for spontaneous resolution of VMT in young healthy adults.

Gemcitabine Associated Retinopathy And Nephropathy

PURPOSE To report a case of presumed gemcitabine-induced retinopathy and nephropathy. METHODS Case Report. Retrospective chart review. RESULTS A 64-year-old woman with a recent diagnosis of metastatic cholangiocarcinoma presented with progressive visual loss and renal failure shortly after the initiation of a chemotherapy regimen which included gemcitabine. Clinical examination and fluorescein angiography showed findings of severe retinal ischemia. CONCLUSION Although gemcitabine chemotherapy has been reported to cause a Purtscher-like retinopathy, we propose in our patient a gemcitabine-induced vasculopathy that lead to significant retinal and renal ischemia.

Subclinical facioscapulohumeral muscular dystrophy masquerading as bilateral Coats disease in a woman.

is unlikely to be explained on the basis of deep intronic mutations or regulatory element mutations given the normal results of reverse transcription–PCR. Normal reverse transcription–PCR results also rule out the possibility of gene rearrangement as a potential cause. Therefore, the causative mutation must reside in an as yet unannotated gene or intergenic regulatory element within the minimal linkage interval. Capture of this interval for subsequent next-generation sequencing is an attractive strategy that we are actively pursuing. Mutations in MFRP were first reported in patients with severe hyperopia. While severe hyperopia is a major feature of PM, the anterior segment involvement in patients with MFRP mutations indicates that the phenotype is best described as nanophthalmos. In addition, another MFRP mutation was described in patients who, in addition to PM, have retinitis pigmentosa, foveoschisis, and optic disc drusen. Therefore, our finding of a novel mutation in 2 patients with the classic nonsyndromic PM phenotype represents the first evidence to date that MFRP is a bona fide nonsyndromic PM gene. While it is premature to draw any meaningful genotypephenotype correlation for MFRP-related PM, it is noteworthy that our missense mutation is milder than the truncating mutations that characterize the mutational spectrum of nanophthalmos and syndromic PM. Two other findings are worth highlighting. First, exclusion of linkage to MFRP and chromosome 2q37.1 in family 6 suggests the presence of yet another locus for this genetically heterogeneous condition. Second, the fact that none of the ethnically Saudi families have linkage to MFRP suggests a low frequency for mutations in this gene in this population. Both findings should encourage further research in the genetics of PM in Saudi Arabia, which is likely to identify important effectors of embryonic eye development.

Increased Inner Retinal Layer Reflectivity in Eyes With Acute CRVO Correlates With Worse Visual Outcomes at 12 Months

Purpose To determine if inner retinal layer reflectivity in eyes with acute central retinal vein occlusion (CRVO) correlates with visual acuity at 12 months. Methods Macular optical coherence tomography (OCT) scans were obtained from 22 eyes of 22 patients with acute CRVO. Optical intensity ratios (OIRs), defined as the mean OCT reflectivity of the inner retinal layers normalized to the mean reflectivity of the RPE, were measured from the presenting and 1-month OCT image by both manual measurements of grayscale B-scans and custom algorithmic measurement of raw OCT volume data. OIRs were assessed for association with final visual outcome. Cohort subgroup division for analysis was determined statistically. Results Eyes with poorer final visual acuity (≥20/70) at 1 year were more likely to have a higher ganglion cell layer OIR than eyes with better final visual acuity (<20/70) at 1 month (manually: 0.591 to 0.735, P = 0.006, algorithmically: 0.663 to 0.799, P = 0.014). At 1 month, eyes with a poorer final visual acuity demonstrated a higher variance of OIR measurements (algorithmically: 0.087 vs. 0.160, P = 0.002) per scan than eyes with better final visual acuity. Conclusions In acute CRVO, ganglion cell layer changes at 1 month, including increased reflectivity and increased heterogeneity of reflectivity signal as expressed as OIR and OIR variance, were associated with a poorer visual prognosis at 1 year. Technique calibration with larger sample sizes and automated integration into OCT platforms will be necessary to determine if OIR can be a clinically useful prognostic tool.

A Modified Iris Suture Technique for In-the-bag Intraocular Lens Dislocation.

Supplemental Digital Content is Available in the Text.

Delayed macular hole formation after demarcation laser photocoagulation for subclinical retinal detachment

The purpose of this paper is to report a series of macular holes that developed after demarcation laser photocoagulation for subclinical retinal detachments. This observational case series consists of three eyes from three patients seen between 2005 and 2012. Delayed idiopathic macular hole formation occurred following demarcation laser photocoagulation for subclinical retinal detachment. Demarcation laser photocoagulation of subclinical retinal detachments may predispose to macular hole formation.