Yasha S. Modi

Central Retinal Artery Occlusion: Acute Management and Treatment

Purpose of ReviewThis review will seek to answer if advances in ophthalmic imaging and evolution of treatment modalities have shed further light on the epidemiology, pathophysiology, diagnosis, and acute management of acute central retinal artery occlusion (CRAO).Recent FindingsImaging characteristics of acute CRAO have been further characterized with the use of fluorescein angiography, optical coherence tomography (OCT), OCT-angiography, and indocyanine green angiography. Layer segmentation of OCT imaging has found inner retinal layer hyper-reflectivity to be a common finding in acute CRAO. Non-invasive therapies, fibrinolytic delivery, and surgical interventions for acute CRAO have been further evaluated as potential management tools.SummaryA large body of literature reports very inconsistent treatment success with a wide variety of modalities. Currently, there is no clear evidence supporting the use of fibrinolytics in acute CRAO. Large, multicenter, randomized control trials are necessary to elucidate the role of the various acute treatment options in the management of CRAO.

Dog bite injuries of the eye and ocular adnexa

ABSTRACT Dog bites result in a diverse range of injuries and complications in the periocular region, particularly in school aged children. It is therefore incumbent on the oculoplastic surgeon to be well versed in both acute and long-term management. The intent of this review is to provide a systematic evaluation of the epidemiology, principles of dog bite wound care, and specific considerations related to common patterns of ophthalmic injury. Review of clinical literature from 1976 to 2014. The majority of periocular injuries result from seemingly benign interactions between young children and familiar dogs. Aggressive saline lavage combined with selective debridement of devitalized tissue is essential. High-risk wounds and vulnerable patient groups may benefit from preventive antibiotic coverage as well as appropriate rabies and tetanus prophylaxis. While the nuances of surgical repair are variable given the heterogeneity of presentation, systematic examination and an algorithm-driven approach underlie the optimal management of these complex injuries.

A Multinational Comparison of Anti-Vascular Endothelial Growth Factor Use: The United States, the United Kingdom, and Asia-Pacific

PURPOSE A comparison of anti-vascular endothelial growth factor (anti-VEGF) medication use across multiple countries. CLINICAL RELEVANCE Anti-VEGF medication use is now considered first-line treatment for numerous retinal diseases globally. Exploring medication choices, costs within each healthcare system, policy challenges, emerging treatments, and patient access all provide insight into a newly recognized and major public health issue. METHODS All data presented in this review are available through the published English literature in PubMed, non-peer-reviewed trade publications, and reported surveys. The following search terms were used: anti-VEGF OR bevacizumab OR ranibizumab OR aflibercept OR pegaptanib OR conbercept AND trends OR survey OR cost OR patterns OR preference. Countries with large populations and available data included the United States, United Kingdom, China, India, Korea, Singapore, and Australia. Population and economic statistics were obtained from published reports from the World Bank, World Health Organization, and Commonwealth Fund. RESULTS Anti-VEGF medication use and costs are significant aspects of patient and healthcare system expenditures in each nation and may have an especially large potential economic burden in India and China. Bevacizumab use comprises the majority of anti-VEGF medication use in the United States and Singapore, although aflibercept use is growing rapidly. Paradoxically, data demonstrate that there is a significant trend in medication choice toward ranibizumab and aflibercept among practice settings outside of the United States, such as the United Kingdom, China, South Korea, and Australia. The price of anti-VEGF medications ranged from US

Posterior Scleritis with Choroidal Effusion Secondary to Herpes Zoster Ophthalmicus

30 (ziv-aflibercept) to US

Streptococcus Dysgalactiae Subspecies Equisimilis Endogenous Endophthalmitis Associated with Aortic Valve Abscess

1950 (ranibizumab and aflibercept). Ranibizumabs price ranged from US

Reverse Argentinean flag sign: Intraoperative complication during capsulorhexis

240 in India to US

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

1950 in the United States. Conbercept in China costs approximately US

MACROANEURYSMS ASSOCIATED WITH CONGENITAL RETINAL MACROVESSELS

1150 per dose. CONCLUSIONS Outside of the United States, many nations are using a majority of more expensive anti-VEGF medications, which may lead to increased costs and decreased access. Increasing the availability of safely compounded anti-VEGF medications will likely improve access, create patient/provider choice, and decrease relative healthcare costs for the growing burden of retinal diseases globally.

ATYPICAL CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM COMPLICATED BY PRESUMED RETINAL PIGMENT EPITHELIAL ADENOMA AND EXUDATIVE MACULOPATHY

ABSTRACT Purpose: To describe a case of posterior scleritis with serous choroidal detachment that occurred as an acute complication of herpes zoster ophthalmicus (HZO). Methods: Retrospective case report. Results: A 75-year-old female presented with 3 days of painful, decreased vision in her left eye 1 week after being diagnosed with HZO. She had unilateral crusted vesicular lesions in the V1 dermatomal distribution and corneal pseudodendrites. Funduscopic examination demonstrated a large choroidal detachment in her left eye. B-scan ultrasonography revealed unilaterally thickened sclera consistent with posterior scleritis. She was treated with oral prednisone and a 2-week course of intravenous acyclovir. Two weeks after the initiation of treatment, her vision had improved and she demonstrated complete resolution of her pseudodendrites, posterior scleritis, and choroidal detachment. Conclusions: Prompt recognition and treatment of this unique combination of clinical manifestations of HZO resulted in significant improvement in vision and resolution of the scleritis and choroidal detachment.

PRESUMED FOVEAL BACILLARY LAYER DETACHMENT IN A PATIENT WITH TOXOPLASMOSIS CHORIORETINITIS AND PACHYCHOROID DISEASE

ABSTRACT Purpose: To describe a case of endogenous endophthalmitis from Streptococcus dysgalactiae subspecies equisimilis in the setting of an aortic valve abscess Methods: Retrospective case report. Results: A 72-year-old white male presented with fevers, encephalopathy, and decreased vision in his left eye. His visual acuity was 20/20 in his right eye and finger counting in the left eye. Workup revealed an aortic valve abscess. Examination of his left eye revealed dense anterior chamber fibrin and no view of the retina. B-scan ultrasonography revealed loculated hyperechoic areas consistent with vitreous inflammation. A vitreous tap and injections with vancomycin and ceftazidime were performed. Visual acuity worsened to no-light perception 5 days later. Vitreous and blood cultures grew Streptococcus dysgalactiae subspecies equisimilis. He received another intravitreal injection of vancomycin with no improvement. Conclusions: Streptococcus dysgalactiae subspecies equisimilis is an emerging pathogen and may cause severe intraocular infections with a poor visual outcome.