bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract:

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

Abstract

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

Abstract

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

ABSTRACT:

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

Abstract

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

Abstract:

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

ABSTRACT

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

Abstract:

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

Abstract

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

Abstract

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

Abstract

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

Abstract:

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

Abstract

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

Abstract

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

Abstract

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.