Meisha L. Raven

Studies on the Histopathology of Temporal Arteritis

Aims: The aim of this paper was to identify the location and to grade the severity of most significant inflammation within positive temporal artery biopsies along with other key clinical and histologic characteristics. Methods: Charts and pathology slides for 70 patients diagnosed with temporal arteritis at the University of Wisconsin (UW) Hospital and Clinics from 1989 to 2015 were reviewed. A subset of 48 specimens was immunostained for CD68 and graded on a scale from 0 to +++; the location of staining was recorded. Results: The most severe granulomatous inflammation was in the media and adventitia in 13% (9/70) of the biopsies; the remaining had uniform full thickness inflammation. Of the slides that were stained with CD68, 94% (45/48) were positive. In 42% (19/45), the stained cells were found mainly in the muscularis and adventitia. Seven percent (3/45) of the slides had staining solely around the internal elastic lamina, and 2% (1/45) had staining limited to the intima. Conclusions: With a few exceptions, granulomatous inflammation in positive temporal artery biopsies is most evident at the media and adventitia or is uniform throughout the layers of the artery. Our study lends support to the theory that the muscularis and adventitia may play an inciting role in the pathogenesis of temporal arteritis.

Multi-modal imaging and anatomic classification of the white dot syndromes

The white dot syndromes (WDS) are a diverse group of posterior uveitidies that share similar clinical findings but are unique from one another. Multimodal imaging has allowed us to better understand the morphology, the activity and age of lesions, and whether there is CNV associated with these different ocular pathologies. The “white dot syndromes” and their uveitic masqueraders can now be anatomically categorized based on lesion localization. The categories include local uveitic syndromes with choroidal pathology, systemic uveitic syndromes with choroidal pathology, and multifocal choroiditis with outer retinal/choriocapillaris pathology with uveitis and without uveitis. Neoplastic and infectious etiologies are also discussed given their ability to masquerade as WDS.

Glistening Intraocular Lens

Author Contributions: Conception and design: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Data collection: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Analysis and interpretation: Skaat, De Moraes, Weinreb, Zangwill, Liebmann Obtained funding: Not applicable Overall responsibility: Skaat, De Moraes, Bowd, Sample, Girkin, Medeiros, Ritch, Weinreb, Zangwill, Liebmann Abbreviations and Acronyms: AD 1⁄4 African descent; ADAGES 1⁄4 African Descent and Glaucoma Evaluation Study; bPPA 1⁄4 beta-zone parapapillary atrophy;

Bulbar Conjunctival Molluscum Contagiosum.

5 Division of Infectious Diseases, Department of Ophthalmology, Oregon Health and Sciences University, Portland, Oregon. 6 Department of Ophthalmology, Kaiser Permanente, Redwood City, California. Financial Disclosure(s): The author(s) have made the following disclosure(s): L.J.H.: Funded by research contracts MedImmune unrelated to the present project. K.L.W.: Research grant Pfizer and provided consulting to Pfizer, UCB, AbbVie, Genentech, Janssen, and Merck Serono; none of his activities were related to the present project. D.S.F.: Grant support Allergan and served as a consultant for ThromboGenics and NightstaRx; Allergan manufactures Zymaxid (gatifloxacin). Funded by a grant from the National Eye Institute (R21EY022989). L.J.H. and N.H.S. were also funded by a Kaiser Permanente Community Benefit grant.

Reversible Cerebral Vasoconstriction Syndrome Presenting With Visual Field Defects.

A 45-year-old woman with a history of depression and anxiety, treated with selective serotonin reuptake inhibitors (SSRIs), experienced acute, recurrent, and severe bifrontal headaches. Over time, she developed a left homonymous hemianopia and mental status changes. MRA revealed segmental vasoconstriction of cerebral arteries in multiple vascular distributions. She was treated with a calcium-channel blocker and magnesium, and there was resolution of her symptoms and cerebrovascular changes. Her clinical course and neuroimaging findings were consistent with reversible cerebral vasoconstriction syndrome. Although rare, this disorder frequently manifests with visual complaints. Although the prognosis is generally favorable, patients with this syndrome require prompt diagnosis and care directed to avoid complications including stroke, seizure, and subarachnoid hemorrhage.

Neurofibromatosis type 1: A neuro-psycho-cutaneous syndrome?

ABSTRACT Neurofibromatosis type 1 (NF1) is an inherited disorder often associated with optic nerve gliomas, low-grade brain tumors, and readily visible signs. Though these features are frequently emphasized, the psychosocial and emotional morbidities are often overlooked. We present a patient with depressive disorder resulting in suicide in a patient with NF1.

Minimally Invasive 27-Gauge Vitrectomy for Coats’ Disease Retinal Detachment

Purpose: To describe the use of 27-gauge pars plana vitrectomy in the management of Coats’ disease retinal detachment. Methods: Case report of a 10-year-old female presenting with exudative retinal detachment secondary to Coats’ disease. A two-port, 27-gauge pars plana vitrectomy, with one cannula in the subretinal space, was used to drain subretinal fluid. After resolution of the retinal detachment, a laser was directed to vascular abnormalities, and intravitreal antivascular endothelial growth factor was administered. Results: At 1 year follow-up, her retinal detachment remained resolved, peripheral vision had improved, and visual acuity had stabilized. Conclusions: A 27-gauge vitrectomy can be used successfully in the treatment of exudative Coats’ detachment. The use of valved trocars allows control of intraocular pressure and simultaneous controlled extrusion of subretinal fluid, decreasing the risk of retinal incarceration.

Bilateral Primary Mucinous Carcinoma of the Eyelid.

The aim of this study is to report a case of bilateral primary mucinous carcinoma of the eyelids. This is a case report and literature review. A 71-year-old female presented with primary mucinous carcinoma of the left upper eyelid, which was excised with Mohs surgery. One year later, she developed primary mucinous carcinoma of the right upper eyelid, which was also treated Mohs surgery. Extensive workup was negative for evidence of an unknown primary carcinoma or metastasis. Primary mucinous carcinoma of the eyelids may occur as multifocal tumors, and bilateral disease is not necessarily indicative of metastatic disease.

Is There an Increased Prevalence of Asteroid Hyalosis in Eyes with Uveal Melanoma A Histopathologic Study

During the planning meeting for the Collaborative Ocular Melanoma Study (COMS) prior to the start of patient recruitment in 1986, there was an interest expressed in determining whether a relationship existed between the presence of uveal melanoma (UM) and asteroid hyalosis (AH). To answer this question, the ophthalmic examination form (unlike the pathology form for enucleated eyes) for each COMS patient asked whether AH was present or not. Though an increased prevalence was not found, this result was never published. A recent unpublished study at the University of Wisconsin School of Veterinary Medicine indicated a higher prevalence of AH in canine eyes with UM when compared to control eyes (without tumor) enucleated for goniodysgenesis. This further increased our interest in revisiting the published literature, clinical records, and histopathology slides of the enucleated eyes from the COMS study, as well as the histopathology slides on file in the University of Wisconsin Eye Pathology Laboratory. While cases with both AH and UM were occasionally encountered in the literature, clinically, we could not find a previous study focusing on these two processes. This study was conducted to explore whether such an association exists.

Scleritis with Devastating Consequences

Originally received: April 24, 2016. Final revision: July 18, 2016. Accepted: July 20, 2016. Available online: September 2, 2016. Manuscript no. 2016-858. 1 Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 2 Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 3 Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York. Financial Disclosure(s): The author(s) have made the following disclosure(s): R.R.: Consultant e GLIA, LLC; Guardion Health Sciences; Mobius Therapeutics; Intelon Optics, Inc., Diopsys, Inc.; Gerson Lehrman Group; Sensimed, AG; Aeon Astron Europe, B.V.; Board membership e iSonic Medical; Xoma (U.S.) LLC; Expert testimony e Donahey, Defossez & Beausay; Tanoury, Nauts, McKinney & Barbarino, PLLC; Blume Forte Fried Zerres & Molinari; Lecturer e Santen Pharmaceutical Co., Ltd.; Royalties e Ocular Instruments, Inc.; Equity owner e The International Eye Wellness Institute, Inc. Author Contributions: Conception and design: Teekhasaenee, Suwan, Supakontanasan, Tulvatana, Ritch Analysis and interpretation: Teekhasaenee, Suwan, Supakontanasan, Tulvatana, Ritch Data collection: Teekhasaenee, Suwan, Supakontanasan, Tulvatana Obtained funding: none Overall responsibility: Teekhasaenee Abbreviations and Acronyms: DRS 1⁄4 double-ring sign; LI 1⁄4 laser iridotomy; PEX 1⁄4 pseudoexfoliation; POAG 1⁄4 primary open-angle glaucoma; TEX 1⁄4 true exfoliation syndrome; UBM 1⁄4 ultrasound biomicroscopy. Correspondence: Chaiwat Teekhasaenee, MD, Department of Ophthalmology, Ramathibodi Hospital, Rama 6, Bangkok 10400, Thailand. E-mail: chai1391@ gmail.com.