Nikisha Kothari

Incisions for orbital floor exploration.

AbstractIncisions used for orbital floor exploration continues to remain a topic of controversy. Historically, 3 incisions have been used for orbital floor repair: transconjunctival, subciliary, and subtarsal. Past studies have attempted to stratify the superiority of one incision over the others. Insufficient level of evidence and inconsistent methodology have lead to inconclusive data. Our authors performed a systematic review of literature to assess the quality of evidence in literature and recommend guidelines for incisions for repairing orbital fractures. Thirty-one articles were identified, comprising a total of 4688 incisions. Technique along with individual benefits and complication profiles for each incision is reviewed. Objectivity and follow-up time intervals are necessary parameters for evaluating incisions for orbital floor exploration to further define guidelines.

Untreated bilateral optic nerve sheath meningiomas observed for 27 years.

A 48-year-old woman noted progressive, painless visual loss in her left eye. She was diagnosed with bilateral optic nerve sheath meningiomas (ONSMs), extending across the planum sphenoidale. Radiation was offered, but the patient declined. She has been followed for more than 27 years with stable visual function and neuroimaging findings. Bilateral ONSMs, although usually described as aggressive in nature, may follow a stable clinical course.

RETINAL DETACHMENT SURGERY IN A PEDIATRIC POPULATION: Visual and Anatomic Outcomes

Purpose: Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center. Methods: A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution. Results: A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P < 0.0001). Anatomical success was strongly correlated with visual acuity outcome (P < 0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P < 0.05). The rates of obtaining a final best-corrected visual acuity > 20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P < 0.01) or traumatic RD (28%, P < 0.05). Conclusion: Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.

Retinal detachment associated with atopic dermatitis

Ocular manifestations related to atopic dermatitis include keratoconus, keratoconjunctivitis, cataract, and retinal detachment. The authors report three cases of retinal detachment associated with atopic dermatitis. Although the pathogenesis is poorly understood, chronic blunt trauma may play a role in the development of retinal detachment. In addition, retinal detachments associated with atopic dermatitis may have lower rates of successful retinal detachment repair. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:513-517.].

Spectral domain optical coherence tomography imaging of subretinal bands associated with chronic retinal detachments

We report three patients with subretinal bands associated with retinal detachment in chronic retinal detachments who underwent successful retinal reattachment. Subretinal bands before and after surgery can be identified on clinical examination and spectral domain optical coherence tomography. Removal of subretinal bands is not mandatory to achieve retinal reattachment.

Optical Coherence Tomography Imaging After Surgical Closure of Pediatric Traumatic Macular Holes

Purpose: To date, little attention has been directed to retinal photoreceptor migration after traumatic macular hole surgical repair in the pediatric population. The purpose of this study was to evaluate optical coherence tomography (OCT) findings in the foveae of pediatric patients with history of traumatic macular hole surgical repair. Methods: Retrospective case series of 3 eyes in 3 pediatric patients with traumatic macular hole surgical repair. Spectral domain OCT images were obtained pre- and postoperatively. Results: We report 3 cases of restoration of the ellipsoid zone with good visual acuity outcomes following macular hole closure. Conclusion: Optical coherence tomography findings of an intact ellipsoid zone may be a predictor of visual acuity and explain better surgical outcomes in the pediatric population.

Optical coherence tomography angiography showing perifoveal capillary stability 30 years after fluorescein angiography

Purpose To report the Optical Coherence Tomography Angiography (OCTA) results as a novel non-invasive diagnostic modality which provides useful information regarding the status of blood flow in diabetic retinopathy. The current study is a long-term follow-up of eyes of patients with proliferative diabetic retinopathy managed with panretinal photocoagulation. Observations Two patients with proliferative diabetic retinopathy (PDR) were treated with panretinal photocoagulation (PRP) in both eyes in the early 1980s. Fluorescein angiography performed at the baseline visit and follow-up Optical Coherence Tomography Angiography performed at 30 years after initial PRP treatment showed remarkable stability of the perifoveal capillary network. Visual acuity initially and at last follow-up remained 20/25 or better in these patients. Conclusions and importance Fluorescein angiography and Optical Coherence Tomography Angiography demonstrated that the integrity of the perifoveal capillary network remained remarkably stable at 30 years. Similarly, the visual outcomes were stable inspite of advanced PDR at baseline.

Retinal Arterial Macroaneurysm

Retinal arterial macroaneurysm (RAM) is the outpouching of the wall within the first three orders of the arterial tree. Leakage may occur from the aneurysm or from the surrounding capillaries. If the aneurysm ruptures, then hemorrhage at all levels is possible.

Sickle Cell Retinopathy

Mutations in the β-globin gene result in erythrocytes that undergo sickling in response to hypoxic, acidotic, and hyperosmolar conditions. Sickled erythrocytes are not pliable thereby resulting in mechanical occlusion of arterioles. Arteriolar occlusion is at the core of sickle cell retinopathy as it causes both nonproliferative and proliferative disease.

Branched Retinal Artery Occlusions and Susac Syndrome

A woman in her early 40s presented to the emergency department with multiple scotomas in both eyes and auditory changes in her left ear. On examination, her visual acuity was 20/25 in both eyes. A fundoscopic examination revealed multiple areas of retinal whitening consistent with ischemia secondary to multiple branched retinal artery occlusions (BRAOs). Fluorescein angiography revealed multiple areas of vascular filling defects and hyperfluorescence of the arterial wall of the arterioles (Figure 1A-C). Hyperfluorescence of the arterioles without associated BRAOs, as seen superonasal to the disc and inferotemporally in the left eye on a fluorescein angiographic image (Figure 1D), are classic signs of Susac syndrome. On a T1-weighted fluid-attenuated inversion recovery sequence magnetic resonance imaging scan, scattered hyperintense foci were present in the periventricular white matter and corpus callosum (Figure 2). Branched retinal artery occlusions can occur with many illnesses, but when associated with white matter lesions, hearing loss, and a lack of thromboembolic disease, they suggest the diagnosis of Susac syndrome. The patient started intravenous methylprednisolone sodium succinate, followed by oral prednisone, with improvement of her symptoms.