Sundeep Kasi

HEMORRHAGIC OCCLUSIVE RETINAL VASCULITIS AND NONHEMORRHAGIC VASCULITIS AFTER UNCOMPLICATED CATARACT SURGERY WITH INTRACAMERAL VANCOMYCIN.

Purpose: To describe two cases of vasculitis: one hemorrhagic and one nonhemorrhagic after uncomplicated cataract surgery with intracameral vancomycin. Methods: Retrospective case series. Results: A 74-year-old female and a 54-year-old female developed severe visual loss within 2 weeks of uncomplicated cataract surgery with intracameral vancomycin. The first patient developed a fulminant hemorrhagic vasculitis, whereas the second patient developed a less severe nonhemorrhagic vasculitis. Partial visual recovery and prevention of neovascular glaucoma was achieved using a combination of topical, oral, and intravitreal corticosteroids, along with intravitreal antivascular endothelial growth factor agents in the first patient and a combination of topical and oral corticosteroids alone in the second patient. Conclusion: Hemorrhagic occlusive retinal vasculitis and nonhemorrhagic vasculitis after uncomplicated cataract surgery with intracameral vancomycin have been rarely reported. Early recognition and treatment may prevent devastating visual outcomes.

Accentuation of optical coherence tomography angiography projection artefacts on hyper‐reflective retinal layers

O ptical coherence tomography angiography (OCTA) has been gaining attention with its non-invasive ability to imageocular vessels in adepthresolved manner based on flow. However, it is critical to be aware of potential artefacts when interpreting images. Spaide and colleagues recently described image artefacts observed on OCTA, establishing a common vocabulary (Spaide et al. 2015). Projection artefacts are by far the most common and are usually seen across all retinal layers but more prominently at the level of the hyper-reflective retinal pigment epithelium (RPE), where some of the reflected light travels back through the overlying retinal vessels and simulates blood flow. We hereby describe a case of paracentral acute middle maculopathy (PAMM) where there was accentuation of OCTA projection artefact over areas that corresponded to hyper-reflectivity on en face OCT scans. Inner nuclear layer hyper-reflectivity is the characteristic feature of PAMM lesions on cross-sectional (Rahimy & Sarraf 2014) and en face OCT (Nemiroff et al. 2015; Sridhar et al. 2015). The presented case is a patient with presumed branch retinal vein occlusion and fern-like PAMM lesions distributed around venules (Sridhar et al. 2015) (Fig. 1). Focal accentuation of the superficial vascular flow can be appreciated over the areas of middle retinal hyperreflectivity (yellow arrowheads), which also cause shadowing and obscuration at the deeper slabs (red arrowheads). To further demonstrate this in a normal eye, a second case is presented in Fig. 2. This depicts eccentric Henle’s fibre layer (HFL) reflectivity due to slight temporal displacement of the entry beam. Although the foveal anatomy has not changed, there is an apparent tilt to the horizontal B-scan because of unequal optical path lengths (Lujan et al. 2011). This has resulted in hyper-reflectivity of HFL relative to the outer nuclear layer nasal to the fovea and hyporeflectivity of HFL temporal to the fovea, where distinct demarcations among the outer nuclear layer, HFL, and inner plexiform layer

Loss to Follow-up Among Patients With Neovascular Age-Related Macular Degeneration Who Received Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Importance Loss to follow-up (LTFU) after anti–vascular endothelial growth factor (anti-VEGF) injections increases the risk of vision loss among patients with neovascular age-related macular degeneration (nAMD). Objective To report rates of LTFU among patients with nAMD after anti-VEGF injections and to identify risk factors associated with LTFU in this population. Design, Setting, and Participants This retrospective cohort study of data from 9007 patients who received anti-VEGF injections for treatment of nAMD was performed at an urban, private retina practice with multiple locations from April 1, 2012, to January 12, 2016. Main Outcomes and Measures Rates of LTFU after anti-VEGF injections. Loss to follow-up was defined as receipt of 1 or more injections with no subsequent follow-up visit within 12 months. Results Among the 9007 patients (mean [SD] age, 81.2 [8.8] years; 5917 [65.7%] female; 7905 [87.8%] white), 2003 (22.2%) were LTFU. Odds of LTFU were greater among patients 81 to 85 years of age (odds ratio [OR], 1.58; 95% CI, 1.38-1.82; P < .001), 86 to 90 years of age (OR, 2.29; 95% CI, 2.00-2.62; P < .001), and more than 90 years of age (OR, 3.31; 95% CI, 2.83-3.86; P < .001) compared with patients 80 years of age and younger. Odds of LTFU among African American patients (OR, 1.47; 95% CI, 1.00-2.16; P = .05), Asian patients (OR, 2.63; 95% CI, 1.71-4.03; P < .001), patients of other race (OR, 3.07; 95% CI, 1.38-6.82; P = .006), and patients of unreported race (OR, 2.29; 95% CI, 1.96-2.68; P < .001) were greater than odds of LTFU among white patients. Odds of LTFU were greater among patients with regional adjusted gross income of

BILATERAL OCCIPITAL POLE HYPERTENSIVE STROKE DIAGNOSED WITH MACULAR INTEGRITY ASSESSMENT (MAIA) MICROPERIMETRY

50 000 or less (OR, 1.52; 95% CI, 1.30-1.79; P < .001),

Purtscher's Retinopathy

51 000 to

Making the Jump to 27-Gauge Vitrectomy: Perspectives

75 000 (OR, 1.35; 95% CI, 1.17-1.56; P < .001), and

Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

76 000 to

Bilateral Retinal Problem in a Patient With Alport Syndrome.

100 000 (OR, 1.28; 95% CI, 1.08-1.50; P = .004) compared with patients with incomes greater than

MULTIFOCAL RETINAL INFILTRATES WITH PHLEBITIS AND OPTIC NEUROPATHY IN AN HIV-POSITIVE PEDIATRIC PATIENT.

100 000. Odds of LTFU for patients living 21 to 30 miles (OR, 1.33; 95% CI, 1.05-1.69; P = .02) and more than 30 miles (OR, 1.55; 95% CI, 1.28-1.88; P < .001) from clinic were greater compared with patients who lived 10 miles or less from the clinic. Odds of LTFU were greater among patients who received unilateral injections (OR, 1.44; 95% CI, 1.28-1.61; P < .001) than among patients who received bilateral injections. Conclusions and Relevance We found a high rate of LTFU after anti-VEGF injections among patients with nAMD and identified multiple risk factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.

A PROSPECTIVE, RANDOMIZED TRIAL COMPARING PLAIN GUT TO POLYGLACTIN 910 (VICRYL) SUTURES FOR SCLEROTOMY CLOSURE AFTER 23-GAUGE PARS PLANA VITRECTOMY

Purpose: To describe the utility of microperimetry testing in the diagnosis of a bilateral occipital stroke. Methods: Retrospective case report. Results: A 57-year-old male with hypertension presented with complaints of bilateral blurred central vision and bilateral hypertensive retinopathy with cotton-wool spots. Automated perimetry demonstrated a central scotoma in both eyes that did not respect the vertical midline; however, microperimetry testing revealed a bilateral homonymous hemianopia that suggested cerebrovascular disease which was subsequently confirmed with magnetic resonance imaging. Discussion: In cases of unexplained central visual loss, microperimetry testing may be a useful ancillary test for the diagnosis of cerebrovascular disease.