Faculty Bibliography

PURPOSE/UNASSIGNED:To describe a rare case of severe anterior and posterior scleritis that led to a diagnosis of high-risk myelodysplastic syndrome. METHODS/UNASSIGNED:We present a case report along with a literature review on cases of paraneoplastic scleritis to highlight commonalities in etiology, presentation, treatment response, and outcomes. RESULTS/UNASSIGNED:A 59-year-old male presented with a severe case of unilateral anterior and posterior scleritis with ciliochoroidal detachment and secondary angle closure. His workup revealed severe macrocytic anemia and thrombocytopenia. A subsequent bone marrow biopsy demonstrated cytogenetic analysis consistent with high-risk myelodysplastic syndrome (MDS). The patient was started on high-dose prednisone but was unable to be tapered below 30 mg without recurrence. Rituximab infusions were initiated followed by resolution of ocular symptoms and a successful taper of prednisone. He initiated chemotherapy and was to receive allogenic bone marrow transplantation. However, while on chemotherapy, he clinically deteriorated and passed away. CONCLUSION/UNASSIGNED:This case of severe scleritis was suspected to be a paraneoplastic syndrome secondary to myelodysplastic syndrome. Paraneoplastic syndromes represent a rare etiology of scleritis. Patients with hematologic abnormalities such as unexplained cytopenias, severe manifestations at presentation, or steroid refractory scleritis may warrant comprehensive evaluation for malignancy, expedited systemic workup with attention to blood counts, and interdisciplinary collaboration between ophthalmology, hematology, and internal medicine. If an underlying malignancy is identified, definitive treatment of the scleritis involves treatment of the cancer.

PURPOSE/UNASSIGNED:We aim to study a case of pathologic myopia with visible light OCT. DESIGN/UNASSIGNED:Case report. SUBJECTS/UNASSIGNED:We recruit 1 patient with pathologic myopia presenting with an acute lacquer crack with submacular hemorrhage (SMH) in the right eye and a chronic lacquer crack in the left eye. METHODS/UNASSIGNED:We acquire visible light OCT images with 1 μm axial resolution. Images are processed to depict spectral centroid shift, and spectral fitting is performed to determine oxygen saturation. Results are compared to clinical imaging. MAIN OUTCOME MEASURES/UNASSIGNED:Visible light OCT images, spectral centroid shift (redshift), oximetry, and spectral fitting. RESULTS/UNASSIGNED:with spectral evidence of an overlying RPE deficit (deficient red shift) and photoreceptor abnormalities. CONCLUSIONS/UNASSIGNED:As visible light OCT technology advances, its application toward well-characterized human retinal pathology can clarify its utility. We describe the first case of visible light OCT applied to pathologic myopia, a primary RPE-BM-choriocapillaris interface disease. We confirm that extravascular hemoglobin can be subject to spectral fitting, and we quantify the oxygen saturation of acute SMH. We further show that structural changes in chronic lacquer cracks can be characterized with this new technology. FINANCIAL DISCLOSURES/UNASSIGNED:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

BACKGROUND AND OBJECTIVE/UNASSIGNED:This study aimed to develop machine learning algorithms to predict visual and anatomic outcomes and treatment frequency in patients with macular edema following central retinal vein occlusion (MEfCRVO) after intravitreal aflibercept injections (IAI). PATIENTS AND METHODS/UNASSIGNED:= 91) trials treated with monthly IAI 2 mg for 24 weeks then pro re nata (PRN) through week 52 were used to develop machine learning algorithms. RESULTS/UNASSIGNED:= 0.76). PRN injection frequency from week 24 to 52 was predicted with high accuracy (AUC = 0.83). Univariate analyses confirmed all predictive factors. CONCLUSION/UNASSIGNED:Machine learning algorithms predicted outcomes and dosing frequency with high accuracy and may help inform patients' and clinicians' expectations during MEfCRVO management.

PURPOSE/OBJECTIVE:We describe a case of bilateral, multiple, branch retinal artery occlusions (BRAO) associated with carotid webs. METHODS:A thorough chart review was conducted for the patient. Relevant literature was systematically reviewed. RESULTS:Eight cases of fibromuscular dysplasia (FMD) associated with retinal artery occlusions have been reported. Two additional cases of FMD with other ocular involvement have been described. No cases of carotid webs associated with retinal artery occlusions were found. CONCLUSION/CONCLUSIONS:Carotid webs, an uncommon variant of FMD, are a recognized causative etiology of arterial, ischemic stroke. The case described here of bilateral, multifocal BRAOs represents a unique manifestation of this variant of FMD. This diagnosis should be considered in the setting of an otherwise unrevealing BRAO workup, as recognition of this association may be sight and life-saving.

PURPOSE/OBJECTIVE:We present a patient with a primary vasoproliferative tumor (VPT) accompanied by vitreous haze and an epiretinal membrane (ERM). We report for the first time the vitreous cytokine profile from an eye with a primary VPT to explore the relationship between intraocular inflammation and these tumors. METHODS:Retrospective chart review of a single patient case. RESULTS:25-gauge pars plana vitrectomy with membrane peel and vitreous biopsy was performed. Peripheral vitreous shave exposed an inferior grey-red mass located at the ora serrata, consistent with VPT. Treatment with confluent, long duration endolaser was performed. Vitreous cytology was negative for malignancy. A 13-cytokine panel (Associated Regional and University Pathologists, Inc. Laboratories, Salt Lake City, UT) revealed elevated interleukin 6 (13.3 pg/mL; normal <=2.0) and interleukin 8 (6.0 pg/mL; normal <=3.0). At one month post-operative, visual acuity improved from 20/40 to 20/25 OD, with mild anterior vitreous inflammation and regression of the VPT. CONCLUSION/CONCLUSIONS:Pro-inflammatory and pro-angiogenic cytokines were elevated in the vitreous of this patient's eye with a primary VPT. We suggest that the endothelial cells and macrophages which comprise VPTs could secrete these cytokines into the vitreous, resulting in vitreous haze and an overzealous fibrotic response manifested as ERM formation.

PURPOSE/OBJECTIVE:To evaluate anti-vascular endothelial growth factor (VEGF) treatment patterns and long-term visual acuity (VA) outcomes in retinal vein occlusion (RVO) in routine clinical practice. DESIGN/METHODS:Retrospective observational study of the Vestrum Health Retina database. SUBJECTS/METHODS:Treatment-naïve eyes with a diagnosis of macular edema secondary to branch RVO (BRVO) or central RVO (CRVO) between January 2014 and November 2021. METHODS:Patient eyes were identified in the database using International Classification of Diseases, Clinical Modification codes, and free text searches of Vestrum's 'Exam Findings' field for macular edema. Eyes included for analysis were required to have ≥ 1 intravitreal anti-VEGF injection and ≥ 3 months of follow-up. MAIN OUTCOME MEASURES/METHODS:Treatment patterns and VA outcomes up to 60 months (5 years) of follow-up. Mean VA change stratified by the tertile of the number of anti-VEGF injections received over 60 months. RESULTS:22 365 BRVO and 18 064 CRVO eyes were included in the analysis; ∼70% had ≥ 12 months follow-up and ∼10% had ≥ 60 months follow-up. The mean number of anti-VEGF injections for BRVO and CRVO, respectively, were 6.9 and 7.0 in year 1 and 3.7 and 3.9 in year 5. Mean VA gains from baseline for BRVO and CRVO, respectively, were 11.5 and 9.7 Early Treatment Diabetic Retinopathy Study letters at month 12 and 8.2 and 5.3 letters at month 60. BRVO and CRVO eyes with fewer injections (tertile 1) tended to have lower VA gains compared with eyes that received more injections (tertile 3). Of available eyes at 60 months, 68% of BRVO and 71% of CRVO eyes had received ≥ 1 anti-VEGF injection in year 5 of follow-up. Overall, 24% of BRVO and 5% of CRVO eyes received focal/grid-pattern laser, whereas 14% of both BRVO and CRVO eyes received intravitreal corticosteroids at any time during follow-up over 60 months. CONCLUSIONS:In this retrospective analysis of the Vestrum database, VA gains were observed after anti-VEGF treatment. These were lower in patients with longer follow-up times and higher in patients who received a higher number of injections, suggesting a need for long-term monitoring of eyes with RVO.

PURPOSE OF REVIEW/OBJECTIVE:Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality globally, and retinal imaging modalities (old and new) are being explored as noninvasive tools to predict latent atherosclerosis and cardiovascular disease. This review focuses on the emerging promise of fundoscopy, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) in CVD prognostication. RECENT FINDINGS/RESULTS:High-quality studies have established the utility of vessel-based parameters and discrete conditions diagnosable via fundoscopy in subclinical atherosclerosis detection or CVD prediction. Recent research shows OCT measurements of different retinal layers and specific imaging findings (such as retinal ischemic perivascular lesions) are widely accessible and objective biomarkers for incipient CVD and ensuing risk. Myriad OCTA metrics appear to reliably inform on current CVD burden and cardiovascular risk. Fundoscopy, OCT, and OCTA all have a growing body of literature supporting their utility as adjuncts in CVD prediction and risk stratification.

Since the Artificial Intelligence Committee of the American Society of Retina Specialists developed the initial task force report in 2020, the artificial intelligence (AI) field has seen further adoption of US Food and Drug Administration-approved AI platforms and significant development of AI for various retinal conditions. With expansion of this technology comes further areas of challenges, including the data sources used in AI, the democracy of AI, commercialization, bias, and the need for provider education on the technology of AI. The overall focus of this committee report is to explore these recent issues as they relate to the continued development of AI and its integration into ophthalmology and retinal practice.