Faculty Bibliography

An 8-year-old girl with a history of type 1 diabetes was referred for an evaluation of pigment changes in the right macula. Curvilinear hypopigmented streaks were noted in the fovea, with corresponding disruption of the photoreceptor layer on spectral domain optical coherence tomography. On further questioning, a history of laser pointer play 2 years prior was elicited, with acknowledgement of direct laser pointing in the child's eye. The family was advised to remove any commercial laser devices from the home, and observation of the pathology was recommended.

PURPOSE/OBJECTIVE:To report a case of bilateral toxic corneal and conjunctival epitheliopathy secondary to administration of filter paper impregnated with lysergic acid diethylamide (LSD) in the inferior conjunctival fornices. METHODS:This is a single case report of an 18-year-old man who presented to the emergency department with acute, bilateral eye pain and redness of 24 hours. The patient admitted to placing folded strips of blotting paper impregnated with LSD into the inferior fornices of his eyes the previous night. RESULTS:The patient was found to have localized bilateral corneal and conjunctival abrasions with underlying subconjunctival hemorrhage. Conjunctival abrasion was "kissing," involving the bulbar and palpebral conjunctiva, corresponding to the presumed location of the filter paper. There was no corneal stromal opacification. He was lost to follow up within 1 week of initial presentation but stated that his symptoms improved. CONCLUSIONS:To the best of our knowledge, this is the first reported case of bilateral hemorrhagic conjunctival abrasion and corneal abrasion secondary to LSD. "Kissing" conjunctival lesions, which have been previously reported with heroin use, should raise suspicion for drug abuse.

PURPOSE/OBJECTIVE: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.

Purpose/UNASSIGNED:To determine if inner retinal layer reflectivity in eyes with acute central retinal vein occlusion (CRVO) correlates with visual acuity at 12 months. Methods/UNASSIGNED:Macular optical coherence tomography (OCT) scans were obtained from 22 eyes of 22 patients with acute CRVO. Optical intensity ratios (OIRs), defined as the mean OCT reflectivity of the inner retinal layers normalized to the mean reflectivity of the RPE, were measured from the presenting and 1-month OCT image by both manual measurements of grayscale B-scans and custom algorithmic measurement of raw OCT volume data. OIRs were assessed for association with final visual outcome. Cohort subgroup division for analysis was determined statistically. Results/UNASSIGNED:Eyes with poorer final visual acuity (≥20/70) at 1 year were more likely to have a higher ganglion cell layer OIR than eyes with better final visual acuity (<20/70) at 1 month (manually: 0.591 to 0.735, P = 0.006, algorithmically: 0.663 to 0.799, P = 0.014). At 1 month, eyes with a poorer final visual acuity demonstrated a higher variance of OIR measurements (algorithmically: 0.087 vs. 0.160, P = 0.002) per scan than eyes with better final visual acuity. Conclusions/UNASSIGNED:In acute CRVO, ganglion cell layer changes at 1 month, including increased reflectivity and increased heterogeneity of reflectivity signal as expressed as OIR and OIR variance, were associated with a poorer visual prognosis at 1 year. Technique calibration with larger sample sizes and automated integration into OCT platforms will be necessary to determine if OIR can be a clinically useful prognostic tool.

Purpose : To study the clinic attendance rates and comorbidities in patients with and without diabetic retinopathy Methods : We conducted a retrospective review of all patients scheduled and attended a retina practice between January 2016 - December 2016. Patient charts were divided into nondiabetics, non-proliferative diabetic retinopathy(NPDR), and proliferative diabetic retinopathy(PDR). Attendance rate was calculated for non-diabetic patients and diabetic patient groups. Additional data collected included: history of prior laser procedures(PRP, focal),history of intra-vitreal injections, presence of DME, comorbidities including HTN,HLD,CVD requiring stent or surgery,CKD requiring dialysis, history of amputation, smoking status. Predictive factors for noncompliance were assessed. Results : There were 14,550 scheduled visits (10344 nondiabetics and 4206 diabetics). The no show rate for nondiabetics was 13.8% and was 10.2% for all diabetics. A subgroup analysis of a total of 1038 diabetic retinopathy patients (484 NPDR, 554 PDR) with 2978(1061 NPDR, 1917 PDR) visits were reviewed, with an overall no show rate of 10.5% in NPDR and 9.3% in PDR. There is a nonsignifiant trend towards higher attendance rates in patients with more scheduled visits (89.3% for 1-3, 92.1% for 4-6, and 93.2% for 7 or more scheduled visits; one-way ANOVA,F=2.06, p=0.13). There is a nonsignificant trend of increasing number of comorbidities associated with higher rates of no show visits (9.4% for 0, 7.9% for 1,10.7% for 2, 11.6% for 3, and 7.7% for 4 comorbidities). Smoking did not significantly affect show rates (nonsmokers 10.4%,former 8.0%,current 8.5%). Higher no show rates are found in NPDR and PDR patients with prior treatment with focal laser (13.4%vs7.8% for NPDR, p=0.013 and 12.1%vs8.7%,P=0.026). Prior treatment with anti- VEGF injections were associated with lower no show rates (6.5%vs10.5%, P< 0.05). Conclusions : Contrary to physician bias, patients without diabetes and those with varying degrees of diabetic retinopathy did not demonstrate differing levels of clinic attendance. Additionally, as the scheduled visits increased, patients with diabetic retinopathy were more likely to show, although this was not statistically significant. Medical comorbidities demonstrated a nonsignificant trend towards lower compliance with clinic attendance, which is important to reconcile when deciding a treatment paradigm

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.

We report a case of iatrogenic creation of an excessive anterior-to-posterior gradient in the setting of an open anterior capsule during capsulorhexis. This complication shows the inverse mechanism of that observed in the Argentinean flag sign. An excessive anterior-to-posterior gradient from an exuberant ophthalmic viscosurgical device fill of the anterior chamber caused radialization of the anterior capsule during creation of a continuous curvilinear capsulorhexis in a nonintumescent lens. We describe this complication as the reverse Argentinean flag sign.

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.