bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Epilepsy Following Traumatic Brain Injury: A Systematic Review and Meta-analysis
Authors: Sui Songtao , Sun Jinbo , Chen Xiqi , Fan Feng
Published: February 2023

Background:

Limited evidence has explored the impact of traumatic brain injury (TBI) on posttraumatic epilepsy with control cohort for comparison. In addition, we could not find any review to identify the effect of TBI on the outcomes. Thus, we conducted this study to compare the risk of epilepsy between individuals with TBI and without TBI.

Methods:

Systematic and comprehensive search was carried out in the following databases and search engines: EMBASE, Cochrane, MEDLINE, ScienceDirect, and Google Scholar from 1954 until January 2022. The Newcastle Ottawa (NO) Scale was utilized to assess the risk of bias. Meta-analysis was carried out using the random-effects model, and pooled odds ratio (OR) along with 95% CI was reported.

Results:

In total, we included 10 studies satisfying inclusion criteria. Most studies had good to satisfactory quality. The pooled OR was 4.25 (95% CI, 1.77-10.25; I
2 = 100%), indicating that the individuals with TBI had 4.25 times higher risk of having epilepsy than individuals without TBI, and this association was statistically significant (P = .001). Subgroup analysis based on the years of follow-up revealed that the patients within 5 years post-TBI had the highest risk of epilepsy (pooled OR = 7.27; 95% CI, 3.61-14.64).

Conclusion:

Individuals with TBI had a significantly higher risk of epilepsy than the individuals without TBI, irrespective of the duration of the injury. Hence, long-term follow-up of the individuals with TBI is necessary to prevent any adverse consequences.
A Network Analysis of the PART-O at 1 and 2 Years After TBI: A Veterans Affairs Model Systems Study
Authors: West Samuel J. , Klyce Daniel W. , Perrin Paul B. , Juengst Shannon B. , Dams-O'Connor Kristen , Vargas Tiffanie A. , Grover Ria , Finn Jacob A. , Eagye CB , Agtarap Stephanie D. , Chung Joyce S. , Campbell Thomas A.
Published: February 2023

Objective:

The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years (T
1 and T
2) postinjury.

Participants:

Participants (N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC).

Setting:

Five VA PRCs.

Design:

Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study.

Main Measures:

PART-O.

Results:

Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between “spending time with friends” and “giving emotional support” to others. This association was more than twice as strong at T
2 as at T
1. The “out of the house” item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity). When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T
1, and the internet was the strongest connector at T
2.

Conclusion:

Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment.
Research Letter: Traumatic Brain Injury Among Veterans Accessing VA Justice-Related Services
Authors: Holliday Ryan , Smith Alexandra A. , Kinney Adam R. , Forster Jeri E. , Bahraini Nazanin , Monteith Lindsey L. , Brenner Lisa A.
Published: February 2023

Objective:

Risk for traumatic brain injury (TBI) within both the Veteran population and among individuals with a history of criminal justice involvement is notably high. Despite this, research examining TBI among Veterans with a history of criminal justice involvement (ie, justice-involved Veterans) remains limited. The sequelae of TBI can impact justice-involved Veterans' engagement in Department of Veterans Affairs (VA) justice-related services (ie, Veterans Justice Outreach and Health Care for Re-entry Veterans), thus potentially increasing risk for recidivism and impacting psychosocial functioning. As such, further understanding of TBI risk among justice-involved Veterans has the potential to inform the need for tailored screening and interventional efforts within VA justice-related service settings. We sought to better understand relative risk for TBI diagnosis among male and female Veteran recipients and nonrecipients of VA justice-related services.

Setting:

Electronic medical record data for Veterans accessing VA services from 2005 to 2018.

Participants:

1517 447 (12.48% justice-involved) male and 126 237 (8.89% justice-involved) female Veterans.

Design:

A cross-sectional examination of national VA electronic medical record data. Sex-stratified analyses were conducted to examine relative risk of TBI diagnosis based on use of VA justice-related services.

Main Measures:

Documented TBI diagnosis was the main outcome. Covariates included VA service use, age, race, and ethnicity.

Results:

Both male and female Veterans using VA justice-related services were more likely to have a documented TBI diagnosis in their electronic VA medical record. Associations were attenuated, yet maintained significance, in all adjusted and sensitivity models.

Conclusions:

Given potential risk for TBI, enhancing and tailoring care for justice-involved Veterans may be critical to facilitating rehabilitation and reducing recidivism. Examination of existing services within justice-related settings and methods of augmenting care is an important next step.
Research Letter: Prevalence of Spine Injuries Among US Military Personnel With Combat-Related Concussion
Authors: MacGregor Andrew J. , D'Souza Edwin W. , Dougherty Amber L. , Fraser John J.
Published: February 2023

Objective:

To describe the prevalence of spine injuries among US service members with combat-related concussion.

Design and Participants:

A retrospective review of medical records for US service members injured during combat operations in Iraq and Afghanistan between 2002 and 2020. The study sample included 27 897 service members categorized into 3 groups: concussion with loss of consciousness (LOC, n = 4631), concussion non-LOC (n = 5533), and non-concussion (n = 17 333).

Main Measures:

Spine injuries were identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and classified by body region and nature of injury using the Barell injury diagnosis matrix. Differences in prevalence of spine injuries by concussion group were evaluated using χ2 tests.

Results:

Spine injuries were most prevalent among service members with concussion LOC (31.1%), followed by concussion non-LOC (18.3%), and non-concussion (10.0%, P < .001). Sprains and strains were the most prevalent spine injury category, with injuries to the cervical, thoracic, and lumbar regions significantly more prevalent in the concussion groups (P values < .001), particularly individuals with LOC compared with non-concussion.

Conclusion:

The US military personnel with combat-related concussion, especially individuals with LOC, may also have spine injuries. Routine assessment for spine injury is recommended during concussion screening because this may impact clinical management and rehabilitation.
Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood
Authors: Wilson Judith , McGiffin Jed N. , Smith Michelle , Garduño-Ortega Olga , Talis Elina , Zarate Alejandro , Jenkins Natalie , Rath Joseph F. , Bushnik Tamara
Published: February 2023

Objective:

To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood.

Setting:

The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City.

Participants:

A total of 143 individuals with TBI or their family members.

Design:

An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test.

Main Measures:

Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories.

Results:

Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor.

Conclusion:

Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.
Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring
Authors: Seddon Ian A. , Rahimy Ehsan , Miller John B. , Charles Steve , Kitchens John , Houston Samuel Kenney
Published: February 2023

Purpose:

To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education.

Methods:

The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2).

Results:

Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000.

Conclusion:

Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.
ADVANTAGES OF OPTICAL COHERENCE TOMOGRAPHY AS A HIGH DYNAMIC RANGE IMAGING MODALITY IN SUBRETINAL HYPERREFLECTIVE MATERIAL
Authors: Montolío-Marzo Santiago , Gallego-Pinazo Roberto , Palacios-Pozo Elena , Dolz-Marco Rosa
Published: February 2023

Purpose:

To describe the utility of high dynamic range optical coherence tomography imaging to study subretinal hyperreflective material (SHRM) in patients with age-related macular degeneration.

Methods:

Clinical information including visual acuity and optical coherence tomography images (Heidelberg Engineering GmbH, Heidelberg, Germany) of patients undergoing antiangiogenic treatment for neovascular age-related macular degeneration and showing SHRM at baseline were retrospectively reviewed. Contrast between strong signal structures (high dynamic range image) reclassifying SHRM as hyperreflective (HyperR), isoreflective, and hyporeflective was increased. The patients at baseline, 3, 6, and 12-months follow-up were evaluated.

Results:

Forty-four eyes were classified as 15 HyperR (34.1%), 21 as isoreflective (47.7%), and eight as hyporeflective (18.2%). During follow-up, hyporeflective SHRM disappeared in all cases, isoreflective SHRM faded in 16 cases (76.2%); HyperR SHRM remained in all cases. Hyporreflective SHRM showed a greater visual acuity improvement than HyperR SHRM group (P = 0.033). After 12-month follow-up, only the hyporeflective and isoreflective groups significantly reduced the presence of fluid in 37.5% (P = 0.250) and 46.62% (P = 0.006) of the patients, respectively; outer retinal layers were disrupted more frequently in the presence of HyperR SHRM (ellipsoid zone, P = 0.16; external limiting membrane, P = 0.007).

Conclusion:

Contrast-enhanced optical coherence tomography images enabled us to classify SHRM according to its reflectivity, showing groups with different disappearance rates, visual acuity improvement, and outer retinal layer disruption. This easy-to-access tool may be helpful as a prognostic factor in neovascular age-related macular degeneration cases.
ANALYSIS OF VASCULAR CHANGES OF FUNDUS IN BEHCET UVEITIS BY WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND FUNDUS FLUORESCEIN ANGIOGRAPHY
Authors: Guo Suo , Liu Hui , Gao Yu , Dai Lingyu , Xu Jing , Yang Peizeng
Published: February 2023

Purpose:

To investigate vascular changes of fundus in quiescent Behçet uveitis (BU) based on widefield swept source optical coherence tomography angiography and fluorescein angiography (FA).

Method:

This case–control study included 33 patients with quiescent BU (57 eyes)and 35 healthy people (60 eyes) as the control. All participants underwent the widefield swept source optical coherence tomography angiography, and patients with BU additionally underwent the FA. The quantitative analysis of the widefield swept source optical coherence tomography angiography assessed the vessel density of nine anatomical locations in the fundus. Vascular leakage and retinal nonperfusion on FA were assessed in patients with BU.

Results:

Compared with the control group using Mann–Whitney U test, patients with BU had enlargement of foveal avascular zone (P = 0.005, P = 0.04, respectively) and decreased vessel density within a 300 µm width around the foveal avascular zone (P = 0.001, P < 0.0001, respectively) both in the superficial and deep retina. Larger foveal avascular zone size and lower 300 µm width around the foveal avascular zone were correlated with higher logarithm of the minimum angle of resolution best-corrected visual acuity in BU (P ≤ 0.003, P < 0.0001, respectively). Vessel density of choriocapillaris, as the most widely involved of all layers of the retina and choroid, was lower in six locations (P ≤ 0.03–0.0001) in the peripheral fundus of BU compared with the controls. Vascular leakage and retinal nonperfusion in the peripheral fundus were observed in 54.4% and 66.7% of the patients on FA.

Conclusion:

Fovea and peripheral fundus were prone to the damage of ischemia as evidenced by significantly decreased vessel density of capillaries. Combination of swept source optical coherence tomography angiography with FA could accurately evaluate the changes in the retinal and choroidal vasculature in BU.
COMPARING FUNCTIONAL AND VASCULAR LAYER OUTCOMES OF LASER PHOTOCOAGULATION VERSUS SUBTHRESHOLD MICROPULSE LASER FOR DIABETIC MACULAR EDEMA
Authors: Li Gabriel , Ho Mary , Li Sophia , Chen Lijia , Iu Lawrence , Cheung Carol Y. , Brelen Marten , Young Alvin L.
Published: February 2023

Purpose:

To compare the efficacy of conventional laser and subthreshold micropulse laser (SML) in treating diabetic macular edema in terms of functional outcomes and changes in quantitative metrics for the retinal capillary and choriocapillary vascular layers.

Methods:

Fifty-two eyes from 52 patients with treatment-naive, clinically significant macular edema were randomly assigned to the conventional laser group or SML group in a 1:1 ratio. Best-corrected visual acuity, central macular thickness (CMT), and optical coherence tomography angiography scans were measured at baseline, 1, 3, and 6 months after treatment.

Results:

The SML group showed rapid visual recovery, improving from baseline of 0.320 ± 0.31 logarithm of the minimum angle of resolution (20/42 Snellen) to 0.270 ± 0.22 logarithm of the minimum angle of resolution (20/37 Snellen) at 1 month (P = 0.038) and had significant improvements in CMT at 6-month post-treatment (353.88–301.00 µm, P = 0.005). Statistically significant changes were detected across all optical coherence tomography angiography metrics, including vessel density, vessel length density, vessel diameter index, and fractal dimension, at 6 months for both groups in the deep capillary plexus and choriocapillary plexus.

Conclusion:

Subthreshold micropulse laser resulted in early visual recovery and sustained macular thickness improvement in the treatment of diabetic macular edema. Microvascular perfusion parameters, including vessel density, vessel length density, and fractal dimension, improved in the deep capillary plexus and choriocapillary plexus for both treatment groups at 6 months post-treatment.
FUNDUS AUTOFLUORESCENCE IN EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN AND DIFFUSE TRICKLING GEOGRAPHIC ATROPHY
Authors: Bianco Lorenzo , Antropoli Alessio , Arrigo Alessandro , Berni Alessandro , La Franca Lamberto , Saladino Andrea , Bandello Francesco , Battaglia Parodi Maurizio
Published: February 2023

Purpose:

To establish whether extensive macular atrophy with pseudodrusen (EMAP) can be distinguished from the diffuse-trickling phenotype of geographic atrophy (DTGA) secondary to age-related macular degeneration on the basis of its features on blue-light autofluorescence.

Methods:

The authors reviewed our prospectively maintained database to enroll patients with a diagnosis of EMAP, DTGA, and non-DTGA with a minimum follow-up of 1 year. Atrophic areas and growth rates were measured on blue-light autofluorescence images, using the Heidelberg Region Finder tool. Circularity and roundness were chosen as atrophy shape descriptors, extracted using ImageJ, and compared between disease groups.

Results:

A total of 28 EMAP, 27 DTGA, and 30 non-DTGA eyes were included in the analysis. The median follow-up time was around 3.5 years. Extensive macular atrophy with pseudodrusen was characterized by an irregular and elongated shape (low circularity and low roundness) and associated with a fast atrophy growth rate (3.6 mm2/year), compared with non-DTGA. However, these parameters were not significantly different between EMAP and DTGA.

Conclusion:

Our study found that EMAP and DTGA cannot be effectively differentiated on fundus autofluorescence. In both diseases, the macular atrophic area has a major vertical axis, fringed borders, and fast progression.
ROLE OF OPTICAL COHERENCE TOMOGRAPHY IN MANAGEMENT OF ACUTE POSTERIOR VITREOUS DETACHMENT AND ITS COMPLICATIONS
Authors: Wang Rui , Lovenberg Christine , Hess Olivia , Todorich Bozho
Published: February 2023

Purpose:

Currently, no consensus exists on the role of optical coherence tomography (OCT) imaging in the setting of acute posterior vitreous detachment (PVD). The authors outline the clinical utility of OCT in the management of acute PVD and its complications.

Methods:

Literature review of OCT findings in association with acute PVD and report of illustrative cases.

Results:

Optical coherence tomography imaging in the setting of acute PVD can provide details of vitreoretinal interface that are difficult to appreciate on biomicroscopy alone including partial PVDs, focal vitreoretinal adhesions and traction, and subclinical macular changes. The presence of vitreous hyperreflective dots on OCT in the premacular space, especially if severe, is highly correlated with the presence of peripheral retinal breaks and development of epiretinal membrane. Advancements in OCT technology, including enhanced vitreous imaging OCT, swept-source OCT, wide-angle OCT, and widefield OCT, allow for increased resolution and expanded field of imaging of the vitreoretinal interface.

Conclusion:

Optical coherence tomography imaging is an emerging standard of care in the setting of patients presenting with new flashes and floaters. The authors highlight the benefits of OCT imaging in patients with acute PVD, which includes recognition of the status of the vitreoretinal interface, assistance in identifying high-risk PVDs, and performance of risk assessment that predict future macular pathologic condition.
Membranous Encapsulation of an Akreos IOL Following Scleral Fixation masquerading as opacification.
Authors: Passo Ross M. , Thanos Aristomenis
Published: February 2023

Purpose:

To report of case of membranous encapsulation of a scleral-fixated Akreos intraocular lens (IOL) that was successfully treated with vitrectomy and membranectomy without IOL exchange or removal.

Methods:

Case report.

Patient:

A 58-year-old woman with a history of bilateral chronic anterior and intermediate uveitis underwent scleral fixation of Akreos IOL for dislocated 3-piece IOL in the vitreous cavity. She presented one year later with progressively worsening vision (decreased to 20/200) and was found to have a complete encapsulation of the IOL.

Results:

The patient underwent successful vitrectomy and membranectomy with return of vision to 20/25 within three months of surgery.

Conclusion:

There are numerous case reports of opacification after scleral fixation of Akreos IOL. To our knowledge, this is the first report of complete encapsulation of the IOL with a membrane of this type and character. The etiology for this patient’s presentation is unclear, but was presumed to be related to her history of chronic intraocular inflammation.
Unilateral Annular Choroidal Effusions as a Rare Presentation of Harada’s Disease
Authors: Xu Jia , Agranat Joshua S. , Chen Xuejing
Published: February 2023

Purpose:

To report a rare presentation of Harada’s disease that initially presented as a unilateral ring of choroidal effusions.

Methods:

Retrospective chart review.

Results:

A 42-year-old Trinidadian woman presented with a serous retinal detachment overlying a unilateral ring of choroidal effusions in the absence of any systemic symptoms. Visual acuity (VA) was hand motion with a relative afferent pupillary defect. Biometry revealed an axial length of 21.12mm and a thickened sclerochoroidal complex. Fluorescein angiography (FA) did not demonstrate pinpoint leakage or subretinal pooling classically seen in Harada’s disease. Oral steroids improved the VA to 20/50 and laboratory testing and head imaging returned non-revealing. After 2 months of incomplete steroidal treatment due to nonadherence, the patient represented with bilateral decreased VA, anterior uveitis, serous detachments, and diffuse pinpoint leakage on FA consistent with the early stage of Harada’s disease.

Conclusions:

This is a case of a unilateral presentation of Harada’s disease with an impressive ring of choroidal effusions before developing a classic bilateral appearance. Possible contributions to the initial presentation include choroidal venous congestion in the setting of a borderline short eye and thickened sclerochoroidal complex.
Method of Povidone-Iodine Application and Endophthalmitis Risk
Authors: Spaide Richard F.
Published: February 2023

Purpose:

To evaluate the proportion of patients developing endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents according to the mode of povidone-iodine (PI) antisepsis.

Methods:

A retrospective review of the anti-VEGF injections given in a 7-year period at a community based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI either as two drops, one drop, or just a dot of PI administered with a cotton tipped applicator to the site prior to injection.

Results:

There were 113610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis (P=.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference (P=.39, chi-square test).

Conclusion:

The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that “more is not better” in PI antisepsis in terms of endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose related.
Acute Atypical Endophthalmitis Following Intravitreal Sustained-release Dexamethasone Implant: A Case Series
Authors: Brendan Chin Yi Yao , Yeo Tun Hang , Maheshwar Bakthavatsalu , Zhou Wen Ting , Ajeet Wagle Madhav , Lekha Gopal , Lim Tock Han
Published: February 2023

Purpose:

To present three cases of acute endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex®) with atypical presentation and to discuss the management of these patients.

Methods:

A retrospective case series of three patients with endophthalmitis following intravitreal sustained-release dexamethasone (Ozurdex®) implantation who presented between July 2020 to August 2020.

Results:

Two out of three patients who were treated with topical steroid and antibiotic therapy alone showed favorable outcomes and were managed without the need for intravitreal antibiotics or implant removal. One patient who showed initial response to topical therapy subsequently required pars plana vitrectomy, implant removal and a single empirical dose of intra-vitreal antibiotics and anti-fungal agent due to persistent inflammation.

Conclusion:

Post intravitreal Ozurdex® endophthalmitis although a rare entity can present with atypical features of a painless white eye and a delayed onset intraocular inflammation. Although all cases of endophthalmitis should be treated as infective until proven otherwise, it is fair to consider a trial of conservative treatment with topical steroids and antibiotics initially with close monitoring. In cases with poor response to topical therapy, pars planar vitrectomy and implant removal should be strongly considered.
Ruptured Retinal Arterial Macroaneurysms Associated with Hemorrhagic Bacillary Layer Detachments
Authors: Doobin David , Sharma Tarun , Horowitz Jason
Published: February 2023

Background/Purpose:

Bacillary layer detachments (BALAD) are a recently recognized form of retinal detachment involving a splitting of photoreceptors at the inner segment myoid zone, with separation of the external limiting membrane and ellipsoid zone on optical coherence tomography (OCT). A growing number of disease processes are recognized to cause BALAD, and here we present three of the first cases of hemorrhagic retinal artery macrrALAD on OCT. Various management strategies were employed.

Conclusions:

Hemorrhagic retinal arterial macroaneurysms can be associated with BALAD, seen best on OCT. This is most likely secondary to the rapid accumulation of intraretinal fluid during the hemorrhage, which leads to an avulsion at the inner segment myoid zone - a site of inherent structural weakness in the photoreceptors. Visual recovery may be improved in instances of hemorrhagic macroaneurysms associated with BALAD, similar to other disease entities where BALAD occurs, though further research is needed.
The Evolution of Full Thickness Macular Hole After Short Exposure to High Powered Hand-held Laser Pointer
Authors: Keshet Yariv , Weseley Peter E. , Ceisler Emily J. , Ngo Wei Kiong , Salcedo Alfredo , Walia Jay , Spaide Richard F.
Published: February 2023

Purpose:

To report a case of a full thickness macular hole (FTMH) after exposure to an extremely powerful handheld laser pointer.

Methods:

We evaluated a 14-year-old male with a laser induced FTMH one month after a momentary exposure to a 5000 mW blue laser pointer. Imaging modalities including fundus color, autofluorescence, and spectral domain optical coherence tomography (SD-OCT), acquired both at our clinic and by the referring physician soon after the injury, are used to describe the clinical evolution of the case.

Results:

Soon after the injury an intensely white, circular opacification of the retina approximately 400 µm in diameter was seen in the fovea. Early SD-OCT images showed full thickness hyperreflectivity, likely representing tissue necrosis. One month later, a FTMH and eradication of the retinal pigment epithelium at its base were evident in the fundus color, autofluorescence and SD-OCT images.

Conclusion:

High power laser pointers have become easily available online. The presenting findings after exposure to such high-power devices are distinct from those reported after exposure to weaker laser pointers. While long exposure to weaker lasers typically produces extensive, calligraphic figures and yellow placoid lesions involving only the outer retina, in our case a very brief exposure led to focal, full-thickness injury of the fovea.
Full title: Acute Exudative Polymorphous Vitelliform Maculopathy as the initial presentation of Human Immunodeficiency Virus Infection
Authors: Niegowski Laëtitia Jessy , Rachiq Issam Er , Amoroso Francesca , Souied Eric H. , Miere Alexandra
Published: February 2023

Purpose:

To describe the occurrence of acute exudative polymorphous vitelliform maculopathy (AEPVM) as the initial presentation in a human immunodeficiency virus (HIV) positive patient.

Methods:

Observational case report of one patient and literature review.

Results:

An active 21-year-old Caucasian woman presented at our emergency department with anterior segment complaints. Her best corrected visual acuity (BCVA) was 20/20 in both eyes. Fundus examination revealed numerous, polymorphous bleb-like lesions at the posterior pole, corresponding, on structural imaging (optical coherence tomography, OCT) to subretinal detachments (SRD). The bleb-like lesions on infrared imaging were slightly autofluorescent on fundus autofluorescence (FAF). Swept source OCT Angiography showed signal attenuation due to the presence of subretinal fluid in the choriocapillaris segmentation. Multimodal imaging findings were suggestive for AEPVM. Hence, a systemic blood workup was performed. The workup returned positive for HIV and an antiviral therapy was introduced.

Conclusion:

The fortuitous diagnosis of HIV having as the initial presentation AEPVM in an asymptomatic patient highlights the value of a thorough clinical examination and multimodal imaging in correctly diagnosing this rare disorder and its cause. This case report could prove helpful to clinicians faced with this rare scenario.
Chronic Central Serous Chorioretinopathy in the Pediatric Population: A Case Series
Authors: Stoffer John N. , Ebert Jared J. , Di Nicola Maura , Isernhagen Blake A. , Sood Arjun B. , Dundervill Robert F. , Williams Basil K.
Published: February 2023

Purpose:

To describe 3 cases of chronic central serous chorioretinopathy (CSCR) in the pediatric patient population.

Methods:

Retrospective case series.

Results:

We report three pediatric patients with CSCR. All patients initially presented following failed vision screens or during routine office examinations. All patients presented with macula-involving subretinal fluid and multimodal imaging features consistent with chronic central serous chorioretinopathy. At last-follow-up, 1 patient had minimal residual subretinal fluid, 1 patient had a small recurrence of subretinal fluid, and 1 patient had persistent subretinal fluid.

Conclusions:

While CSCR classically occurs in adults, it can be seen in pediatric patients. Given the rarity of this condition in the pediatric population, CSCR may go undetected and underreported with diagnosis resulting from failed vision screens.
Surgical demonstration of pressure differential through an optic disc pit
Authors: Rice James C , Scholtz Raoul P , Joseph Joseph
Published: February 2023

Purpose:

To demonstrate intraoperative dynamic flow through an optic disc pit

Methods:

Retrospective interventional case report

Results:

Surgical management of an optic disc pit involved standard 25-gauge pars plana vitrectomy, induction of posterior hyaloid separation with triamcinolone stain, temporal peripapillary laser and SF6 gas. Intraoperatively a remnant of stained vitreous at the optic disc head prolapsed into the optic disc pit with higher intraocular pressure but was drawn back into the vitreous cavity as the intraocular pressure was lowered. This clearly demonstrated a pressure differential across the pit.

Conclusion:

Communication between the vitreous cavity and the perineural space of the optic nerve is described histologically. Our case demonstrated dynamic flow through the optic disc pit with intraoperative fluctuation of intraocular pressure.
Paracentral acute middle maculopathy associated with eosinophilic granulomatosis with polyangiitis
Authors: Boynes Antony C , Gin Thomas J , Gin Trevor
Published: February 2023

Purpose:

To present a case of paracentral acute middle maculopathy (PAMM) associated with transient loss of vision from eosinophilic granulomatosis with polyangiitis (EGPA)-associated ischaemic vasculitis.

Methods:

Case report and review of literature

Results:

A 52 year-old man presented with recurrent episodes of amaurosis of the right eye. A diagnosis of EGPA was established with the combination of late-onset asthma, peripheral eosinophilia, patchy parenchymal consolidation and diffuse pansinusitis. Fundus examination displayed cotton wool spots in the right eye. Optical coherence tomography (OCT) of the macula showed features of paracentral focal inner nuclear layer/outer plexiform layer hyperreflectivity consistent with PAMM. He was treated with corticosteroids and cyclophosphamide. At 2-months following treatment his EGPA was in remission, the patient reported no recurrence of visual symptoms. Dilated fundoscopy revealed resolution of the cotton wool spots. A repeat OCT macula showed resolution of PAMM.

Conclusion:

Our case supports sublethal hypoxia of the middle retinal layers as the underlying mechanism for PAMM. Ophthalmologists should be cognizant to look for PAMM on OCT in patients presenting with transient visual loss and be aware of EGPA-associated ischaemic vasculitis as a rare cause of amaurosis.
Spatial pattern of retinal pigment epithelium tear development and progression after anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration
Authors: Fukui Takuma , Ishikawa Keijiro , Shiose Satomi , Kano Kumiko , Mori Kenichiro , Notomi Shoji , Sonoda Koh-Hei
Published: February 2023

Purpose:

To demonstrate the spatial pattern of retinal pigment epithelium (RPE) tear development and progression following anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD).

Methods:

We retrospectively reviewed six eyes with nAMD that showed RPE tears after administration of intravitreal anti-VEGF agents and were followed up for 12 months. The patterns of RPE tear development and progression were evaluated by analyzing positional relationships among the locations of the choroidal neovascularization membrane (CNVM) and pigment epithelial detachment (PED) area at baseline and the tear area via spectral-domain optical coherence tomography (SD-OCT), color photography, fluorescein angiography, and fundus autofluorescence images.

Results:

Pre-tear OCT images revealed fibrovascular PED in all eyes, one of which showed complications of hemorrhagic PED after treatment. In five eyes, RPE tears developed at the PED edge located on the opposite side of the CNVM. In the eye showing hemorrhagic PED, the RPE tear developed along the wide area of the PED edge. The torn RPE monolayer contracted toward the side of the CNVM in all eyes and RPE loss involved the fovea in five eyes that showed significantly worse visual acuity (VA) after 12 months in comparison with the baseline value before the tear (logMAR VA; 0.3 vs. 1.29; P < 0.02).

Conclusion:

The location of CNVM in PED determines the spatial pattern of RPE tear development and progression and helps to predict the visual outcome after RPE tears.
Tocilizumab resolves refractory macular edema associated to retinitis pigmentosa.
Authors: Méndez-Martínez Silvia , Barón Nieves Pardiñas , de Asís Bartol-Puyal Francisco , Arias del Peso Borja , Ruiz del Tiempo María Pilar , Arnal Álvaro Lesta , Moreno Oscar Ruiz , Ruiz Javier Manero , Júlvez Luis Pablo
Published: February 2023

Purpose:

The aim of this report is to describe the resolution of refractory cystoid macular edema (CME) associated to retinitis pigmentosa (RP) with intravenous tocilizumab in three patients.

Methods:

Retrospective study of a series of consecutive cases of patients treated with off-label intravenous tocilizumab (anti IL6) for CME refractory to acetazolamide 250 mg for 3 months. Patients were diagnosed with RP by fundus appearance, electrophysiology, visual fields, and genetic testing. A complete ophthalmic examination, including spectral domain optical coherence tomography (SD-OCT) was performed.

Patients:

Three patients with RP and CME refractory to acetazolamide 250 mg for 3 months were treated with monthly intravenous tocilizumab for at least six months.

Results:

All patients resolved CME and improved visual acuity after the third month of intravenous tocilizumab, resolving systemic and ocular adverse events related to previous treatments for CME. Tocilizumab was well tolerated with no other adverse events.

Discussion:

CME causes visual impairment in RP, but current treatments are usually deficient. Tocilizumab has been successfully used as treatment for refractory CME in uveitis, retinal dystrophies, and autoimmune retinopathies. This article reports, for the first time, the long-term resolution of refractory CME in RP with intravenous tocilizumab.
Acute post-traumatic endophthalmitis secondary to Bacillus pumilus/safensis
Authors: Etheridge Tyler , Swiston Cole , Harrie Roger P. , Bernstein Paul S.
Published: February 2023

Purpose:

To report a case of post-traumatic endophthalmitis secondary to Bacillus pumilus/safensis.

Methods:

Observational case report of a single patient.

Results:

A 62-year-old man presented with a traumatic corneal laceration due to baling wire while working on a sheep farm. Appropriate corneal laceration repair with injection of intravitreal antibiotics (ceftazidime, clindamycin, and vancomycin) was performed. A single organism, identified as either Bacillus pumilus or Bacillus safensis, was isolated from the vitreous aspirate. A subsequent pars plana vitrectomy, pars plana lensectomy, anterior capsulotomy, and fluid air exchange was required due to severe inflammatory reaction from retained lens material, retinal edema, and vitreous opacities. Vision improved from hand motion to 20/60 at the three-month follow-up visit.

Conclusion:

We describe a case of acute post-traumatic endophthalmitis secondary to Bacillus pumilus/safensis.

Précis: The authors describe a case of acute post-traumatic endophthalmitis secondary to Bacillus pumilus/safensis, which was successfully managed with intravitreal antibiotics, pars plana vitrectomy, pars plana lensectomy, anterior capsulotomy, and fluid air exchange.
Combined central retinal vascular occlusion as the presenting feature in β-thalassemia with iron deficiency anemia
Authors: Li Huangdong , Liu Chengyi , Huang Amy Michelle , Zhang Jingyu , Yang Ruiming , Sha Xiangyin , Liu Zhiping
Published: February 2023

Purpose:

To report a case of β-thalassemia trait (β-TT) with iron deficiency anemia (IDA) presenting as a combined central retinal vein and artery occlusion (CCRVAO).

Methods:

Case report. A 22-year-old female presented with sudden-onset blurry vision in the left eye of 3-days duration.

Results:

Best corrected visual acuity was 20/20 and 20/1000 in right and left eyes, respectively. Fundus examination of left eye revealed optic disc edema, macular whitening with a cherry-red spot, markedly dilated and tortuous retinal veins, and hemorrhages both around the disc and extending into the macula and the periphery. Fundus fluorescein angiography (FFA) showed delayed filling of retinal vasculature, dilated and tortuous retinal veins, blocked fluorescence around and beyond the optic disc. OCT scan at presentation showed hyperreflective inner retinal layers with neurosensory detachment. OCTA showed that the vessel densities of superficial and deep capillary plexus were remarkably reduced.

A diagnosis of β-TT combined with IDA was made after hematologic work-up. The patient was treated with a course of oral iron supplements, vasodilator (Compound Xueshuantong), inhalation of a mixture of 5% carbon dioxide and 95% oxygen, and a nutritional agent (compound anisoine). By six months later, her visual acuity improved to 20/60 in the left eye with complete resolution of all clinical signs.

Conclusion:

CCRVAO is a rare emergency leading to acute vision loss and can manifest in patients with β-TT with IDA. Prompt diagnosis and early management is important to treat underlying systemic disorders and to prevent occurrence of a similar episode in fellow eye.
Giant Intraoperative Corneal Bulla Managed with Bandage Lens Technique During Vitrectomy Surgery
Authors: Yuan Amy , Bonnell Alyssa C. , Rezaei Kasra A.
Published: February 2023

Purpose:

To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively.

Methods:

Retrospective case report with anterior segment optical coherence tomography (AS-OCT).

Results:

A 77-year-old woman with history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy (PPV) and scleral fixated intraocular lens placement. During PPV, a large corneal bulla formed at the site of the main corneal incision, confirmed with AS-OCT. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery.

Conclusion:

This is the first report of corneal bullae formation during PPV that is confirmed by AS-OCT and successfully managed with a bandage contact lens intraoperatively.
Sudden monocular vision loss after sneezing as captured on widefield swept source optical coherence tomography-angiography
Authors: Moon Jade Y. , Garg Itika , Miller John B. , Ludwig Cassie A.
Published: February 2023

Purpose:

We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion following a sneeze. Widefield swept source optical coherence tomography-angiography (WF-SS-OCTA) was used to analyze retinal changes at one-month follow-up.

Methods:

The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and SS-OCTA were obtained.

Results:

Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. SS-OCTA showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion.

Conclusion:

We report the first case of sneeze-induced combined retinal artery and retinal vein occlusion. The retina is a uniquely accessible window that provides insight into human physiology, and SS-OCTA is a powerful tool that can give further insight into the pathophysiology of an occlusion.
Novel retinal findings in a patient with Autosomal recessive Cutis Laxa type 2A
Authors: Abdullah Mohammad , Alabduljalil Talal
Published: February 2023

Purpose:

To report a case of Autosomal recessive Cutis Laxa type 2A with novel retinal findings

Methods:

Case Report

Results:

22-year-old female patient presented with a longstanding history of reduced visual acuity in her right eye. She has generalized redundant skin, downslanting of palpebral fissures, and long philtrum. Ophthalmic examination showed ptosis in her right eye and visual acuity of 20/2000 in the right eye and 20/30p in the left eye. Funduscopic examination showed a round macular scar lesion in the right eye macula and a chorioretinal scar superonasally in the left eye. Multimodal imaging showed macular atrophy in the right eye with speckled hypoautoflorescence of the described lesions. Genetic testing showed a homozygous splice acceptor variant of the ATP6V0A2 gene.

Conclusions:

The natural history of the presented pigmentary lesions is not known and further follow up is needed to assess any progressive nature. Our case adds to the variability of ophthalmic manifestations reported in ARCL2A and therefore to the importance of regular ophthalmic surveillance in patients with Cutis Laxa.
Recurrent optic disc pit maculopathy due to Valsalva's maneuver
Authors: Reis Cyrino Francyne Veiga , Guzzi Marques Joao Pedro , Jorge Rodrigo
Published: February 2023

Purpose:

We report a patient with recurrent optic disc pit maculopathy after Valsalva’s maneuver and discuss its pathophysiology. We also hypothesize the role of Valsalva’s maneuver in its genesis.

Method:

Case report of one patient, male, 12 years old.

Results:

Serous retinal detachment may occur in association with the optic disc pit, a developmental anomaly of the optic nerve head. Histopathologically, it consists of a dysplastic retina herniation into a pocket extending posteriorly through a defect in the lamina cribrosa into the subarachnoid space. These three different compartments – intraocular space, optic nerve head and subarachnoid space – and the dynamic interactions among them should be understood as the key factors for the occurrence of optic disc pit-related serous retinal detachment.

Conclusion:

Based on the possibility that serous retinal detachment secondary to the ODP could be related to the Valsalva's maneuver, we strongly recommend that patients with ODP be advised to avoid intense physical or work activities that may increase abdominal, thoracic and cerebral pressure, and to refrain from playing wind instruments in order to avoid pre, per and post treatment intercurrences.