Faculty Bibliography

Though rare, acute macular neuroretinopathy is a well-described clinical entity. We report for the first time a detailed analysis of macular hyalocyte count and morphology during the acute phase of acute macular neuroretinopathy. We present a case of a 19-year-old man with bilateral acute onset paracentral scotomas in the setting of an antecedent viral infection. Multimodal imaging demonstrated classic features of acute macular neuroretinopathy. Further analysis revealed increased macular hyalocyte count and an activated hyalocyte morphology during the acute phase of the disease course. Multimodal imaging not only allows for greater confidence in a diagnosis and prognosis but also helps to shed light on underlying pathophysiology. The new clinical capability of monitoring cellular behavior, such as hyalocyte count and morphology, in physiological and pathological conditions may prove useful as biomarkers of early disease activity or response to therapy.

Telemedicine is the provision of healthcare-related services from a distance and is poised to move healthcare from the physician's office back into the patient's home. The field of ophthalmology is often at the forefront of technological advances in medicine including telemedicine and the use of artificial intelligence. Multiple studies have demonstrated the reliability of tele-ophthalmology for use in screening and diagnostics and have demonstrated benefits to patients, physicians, as well as payors. There remain obstacles to widespread implementation, but recent legislation and regulation passed due to the devastating COVID-19 pandemic have helped to reduce some of these barriers. This review describes the current status of tele-ophthalmology in the United States including benefits, hurdles, current programs, technology, and developments in artificial intelligence. With ongoing advances patients may benefit from improved detection and earlier treatment of eye diseases, resulting in better care and improved visual outcomes.

BACKGROUND AND AIMS/OBJECTIVE:Extra-intestinal manifestations (EIMs) are a common complication of inflammatory bowel diseases (IBD), affecting up to half of the patients. Despite their high prevalence, information on standardised definitions, diagnostic strategies, and treatment targets is limited. METHODS:As a starting point for a national EIM study network, an interdisciplinary expert panel of 12 gastroenterologists, 4 rheumatologists, 3 ophthalmologists, 6 dermatologists, and 4 patient representatives was assembled. Modified Delphi consensus methodology was used. Fifty-four candidate items were derived from the literature review and expert opinion focusing on five major EIMs (erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis) were rated in three voting rounds. RESULTS:For use in a clinical practice setting and as part of the creation of a prospective registry of patients with EIMs, the panel developed definitions for erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis; identified the appropriate and optimal subspecialists to diagnose and manage each; provided methods to monitor disease course; offered guidance regarding monitoring intervals; and defined resolution and recurrence. CONCLUSIONS:Consensus criteria for appropriate and optimal means of diagnosing and monitoring five EIMs have been developed as a starting point to inform clinical practice and future trial design. Key findings include straightforward diagnostic criteria, guidance regarding who can appropriately and optimally diagnose each, and monitoring options that include patient and physician-reported outcomes. These findings will be used in a national multicenter study network to optimise the management of EIMs.

We report the case of a 13-year-old boy who presented with a 2-month history of left eyelid swelling, ecchymosis, and epiphora. Magnetic resonance imaging revealed a lobulated lesion in the region of the left lacrimal sac extending to the left nasolacrimal duct. Biopsy revealed diffuse large B-cell lymphoma of the lacrimal sac. Chemotherapy was initiated, consisting of rituximab, methotrexate, cytarabine, doxorubicin, cyclophosphamide, and vincristine. The lesion resolved within weeks of treatment, and the patient remained disease free at 1 year. Primary orbital lymphoma is rare in children; primary diffuse large B-cell lymphoma of the lacrimal sac in a child has not been reported previously.

PURPOSE/OBJECTIVE:To compare intraocular pressure measurements by Goldmann applanation tonometer, disposable Goldmann applanation prism, ICare, and Tonopen. MATERIALS AND METHODS/METHODS:A total of 74 patients with varying glaucoma status were examined in our outpatient clinic and intraocular pressure was measured with three tonometers. The disposable Tonojet prism, Tonopen XL, and ICare ic100 were compared with the Goldmann applanation tonometer. RESULTS:There were good intraclass correlation coefficients between intraocular pressure measurements by Goldmann applanation tonometer and disposable Tonojet prisms (0.95), Tonopen (0.83), and ICare (0.77), all P<0.001. The intraocular pressure mean differences between disposable Tonojet prisms and Goldmann applanation tonometer were mean 0.80â–’mm Hg; 95% limits of agreement: -3.35-4.96â–’mm Hg. For Tonopen and Goldmann applanation tonometer: mean -1.67â–’mm Hg; limits of agreement: -8.55-5.21â–’mm Hg. For ICare and Goldmann applanation tonometer: mean 0.44â–’mm Hg; limits of agreement: -8.18-9.06â–’mm Hg. CONCLUSION/CONCLUSIONS:The most reliable modality, with good correlation with the Goldmann tonometer values, was the Goldmann applanation tonometer with disposable Tonojet prisms, followed in descending order by the Tonopen-XL and ICare. There was good interdevice agreement and consistency between all devices. On subgroup analysis, all three modalities were found to be less reliable at extreme IOP values (<10â–’mm Hg and >24â–’mm Hg). These disposable modalities should be avoided in extreme intraocular pressure ranges outside the normal range.

BACKGROUND: Microperforate and imperforate hymens are one of the most common causes of vaginal outflow obstruction in the adolescent population. To date, these hymen anomalies are traditionally treated by hymenectomy with a cruciate excision. CASES(S): We report 2 cases of adolescent women with a microperforate hymen who were successfully and minimally invasively treated with progressive dilation with Hegar cervical dilators until a number 23 dilator was reached under anesthesia in the OR. SUMMARY AND CONCLUSION: Minimally invasive treatment of microperforate hymen with the use of progressive cervical dilators may be an alternative technique to the traditional excisional hymenectomy. Our patients reported satisfaction and minimal postoperative pain or scarring at 2 weeks and 6 months after the procedure. This technique can be an additional option for all women, especially those with cultural beliefs in virginity.

A 70-year-old man with a medical history of metastatic renal carcinoid tumor presented with several months of painless proptosis of the OS. The patient was receiving octreotide and everolimus chemotherapy. MRI revealed a well-circumscribed mass in the left lateral rectus muscle consistent with metastasis. Because the patient was asymptomatic, he was observed and maintained a stable amount of proptosis without diplopia or change in vision.

A 40-year-old male presented with 2 weeks of left facial pain, nasal congestion, dysphonia, and epistaxis along with left-sided epiphora. CT showed a large infiltrative mass centered in the left maxillary sinus with extension into the left orbit, bilateral paranasal sinuses, nasal cavity, and bilateral enlarged cervical lymph nodes. Biopsy results confirmed adult alveolar rhabdomyosarcoma (RMS). Systemic workup confirmed bilateral cervical lymph node metastasis. Currently the patient is undergoing chemotherapy. We describe a rare case of adult paranasal sinus RMS with orbital invasion.