Massachusetts Eye and Ear Infirmary

To assess factors associated with retinal detachment (RD) in eyes presenting with endogenous endophthalmitis (EE). Multicenter retrospective study of individuals with an EE diagnosis from seven tertiary care centers. Demographics, medical history, ocular examination findings, microbial cultures (blood or intraocular), and management strategies were assessed relative to subsequent RD occurring within 6 months of EE diagnosis. Of note, this study did not distinguish between intraocular cultures without growth and eyes that were not sampled for an intraocular organism. A total of 201 eyes from 171 patients presented with EE. Of these, 22.4% (45/201) had a subsequent RD. Eyes that experienced a subsequent RD had worse presenting visual acuity ( P = 0.006) and lower intraocular pressure at presentation (RD: 13.7 ± 5.4 mmHg vs. No RD: 15.7 ± 6.5 mmHg, P = 0.04). Compared with other forms of bacteremia, S. aureus bacteremia was associated with increased odds of subsequent RD (OR: 6.10, CI: 1.82-20.41, P = 0.003). Eyes with a subsequent RD did not have significantly greater rates of therapeutic pars plana vitrectomy (RD: 11/48, 22.9% vs. No RD: 36/153, 23.5%). Eyes presenting with visual acuity ≤ light perception or S. aureus bacteremia had a higher risk of subsequent RD and may warrant closer surveillance. Although no therapeutic strategies were associated with reduced odds of subsequent RD, a pars plana vitrectomy was not associated with an increased risk of RD, suggesting that it may aid in eyes with lackluster responses to systemic and intravitreal pharmacotherapy.

To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy. This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 µ m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed. Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the "scolex" sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the "scolex" sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls. The "scolex" sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.

Current diagnostic workup for infectious uveitis relies on the use of various immunoassays and polymerase chain reaction (PCR) tests on ocular fluids that are time consuming and not comprehensive, requiring large sample volumes to probe for all causes. To streamline the diagnostic process, improve turnaround time, and target inclusivity, we developed a highly multiplexed pan-ocular-pathogen panel (OcuPan) that can be used for broad-range pathogen detection in only 1 assay, with PCR-level sensitivity and in a timely fashion (12 hours). Here, we assessed the clinical usefulness and performance of this innovative assay as a novel tool for rapid and accurate laboratory diagnosis of infectious uveitis. Laboratory evaluation of a novel diagnostic test and technology PARTICIPANTS AND CONTROLS: A total of 109 patients from 2 centers were included, including 78 infectious uveitis cases and 31 controls. Intraocular samples (n = 108 from patients and 43 from controls) were processed by PCR and the OcuPan diagnostic assay that detects 46 ocular pathogens plus 2 resistance/virulence markers. Clinical sensitivity and specificity, quantification capabilities, and agreement between PCR and the OcuPan assay. The clinical sensitivity and specificity of the OcuPan assay were 50.9% (95% CI, 41.3-60.5) and 100% (95% CI 89.7%-100%), respectively. Sensitivity varied according to the sample matrix tested, with undiluted vitreous having the highest positivity rates (72.4%, 95% CI 55.1-89.7), followed by dilute vitreous (53.3%, 95% CI 34.4-72.3) and aqueous (36.7%, 95% CI 22.7-50.7). There was excellent overall agreement (93.5%) between the OcuPan assay and PCR (kappa of 0.870 ± 0.047; P < .001) with positive (PPA) and negative (NPA) percentage agreements >92% for all targets. PPA was 100% for herpesviruses and Treponema pallidum, whereas the NPA values ranged from 96.6% to 100% for these pathogens. For Toxoplasma gondii, the PPA was 75% and NPA 100%. We also found significant correlation (Spearman ρ = -0.7506, P < .0001) between the quantitative metric for the OcuPan assay and the real-time PCR cycle threshold values. The OcuPan assay offers an all-in-one highly multiplexed detection system for rapid, comprehensive, quantitative, and accurate diagnosis of infectious uveitis.

Air pollution has long been recognized as a threat to human health. There is growing evidence that exposure to air pollution increases the risk of upper airway inflammatory disease including allergic and non-allergic rhinitis, and chronic rhinosinusitis. Recent improvement in air pollution measurement, including wearable pollution monitors, may improve our understanding of patient exposures. In this piece, we summarize salient literature and interventions.

Among patients receiving ongoing intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy who experience stroke or myocardial infarction (MI), evidence is limited on the systemic safety of continuing injections and whether treatment should be paused or modified. To evaluate whether, among patients receiving intravitreal anti-VEGF therapy who experience cardiovascular events (CVE), there exist associations between anti-VEGF treatments administered shortly before or after CVE (peri-CVE) and mortality or major functional outcomes, and to evaluate whether systemic outcomes differ by anti-VEGF agents. This was a retrospective cohort study of TriNetX network deidentified electronic health records (EHR) from 2005 to 2025. This study setting was a multicenter, EHR-based network analysis including individuals with stroke or MI with established anti-VEGF history (≥3 months pre-CVE), matched between those receiving 1 or more anti-VEGF injections within 14 days before or up to 6 weeks after CVE and those with no anti-VEGF from 3 months before to 3 months after. Propensity score matching (PSM) balanced demographics, comorbidities, procedures, systemic medications, laboratory values, and anti-VEGF agent history. Exposures included intravitreal anti-VEGF during the peri-CVE window vs no peri-CVE anti-VEGF. Sensitivity analyses restricted exposure to 14 days or fewer pre-CVE and compared aflibercept, bevacizumab, or ranibizumab with other agents. The primary outcomes were 3-month and 1-year all-cause mortality, poststroke neurologic deficits, and post-MI heart failure. Data were expressed in relative risks (RRs) with 95% CIs. A total of 6073 and 5381 individuals with stroke or MI, respectively, were included before PSM. After PSM (1526 pairs with stroke; exposure [received peristroke anti-VEGF], mean [SD] age, 72.1 [12.9] years; 822 female [53.9%]; control [did not receive peristroke anti-VEGF], 72.7 [13.3] years; 840 female [55.0%]; and 1523 pairs with MI, exposure [received peri-MI anti-VEGF], 71.4 [13.5] years; 809 male [53.1%]; control [did not receive peri-MI anti-VEGF], 71.5 [13.3] years; 798 male [52.4%]), peristroke anti-VEGF was associated with lower mortality at 3 months (RR, 0.39; 95% CI, 0.29-0.53) and 1 year (RR, 0.52; 95% CI, 0.43-0.63) and fewer neurologic deficits at 3 months (RR, 0.64; 95% CI, 0.46-0.89) but not 1 year (RR, 0.79; 95% CI, 0.62-1.01). Peri-MI exposure was associated with lower mortality at 3 months (RR, 0.34; 95% CI, 0.26-0.43) and 1 year (RR, 0.58; 95% CI, 0.49-0.68) and lower heart failure at 3 months (RR, 0.65; 95% CI, 0.46-0.93) but not 1 year (RR, 0.87; 95% CI, 0.68-1.11). Timing-restricted analyses showed similar mortality findings without differences in neurologic deficits or heart failure. In agent-specific comparisons, there were no differences across aflibercept, bevacizumab, or ranibizumab for any outcome. Results of this cohort study reveal that peri-CVE anti-VEGF was not associated with increased mortality or morbidity. Outcomes did not differ among commonly used agents, supporting the safety of continuing intravitreal anti-VEGF therapy without modification during the peri-CVE period.

Four-dimensional CT (4D-CT) is a key imaging modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism. Ultrasound (US) is frequently added with the assumption that it enhances diagnostic performance. This study aimed to determine whether incorporating US into a 4D-CT-based evaluation improves diagnostic accuracy and to assess its impact on radiologists' diagnostic confidence. In this retrospective study, we reviewed 80 patients with primary hyperparathyroidism who underwent both 4D-CT and US followed by curative parathyroidectomy. Each case was reviewed twice, once with 4D-CT alone and once with 4D-CT + US, by different neuroradiologists who recorded lesion location and diagnostic confidence using a 5-point Likert scale. Localization accuracy was determined by comparing imaging findings with operative and pathology results. Diagnostic performance was assessed on per-patient and per-lesion bases, with subgroup analyses evaluating gland location, thyroid characteristics, streak artifact, lesion size, and presence of goiter. Paired statistical tests compared performance between modalities. Among 94 abnormal glands, sensitivity increased modestly with the addition of US (88.3% to 91.5%) without statistical significance, and accuracy remained high for both approaches. Radiologist confidence was higher in the combined 4D-CT + US group compared with the 4D-CT-alone group. Although the combined modality increased high-confidence true positives, it also increased high-confidence false positives. This reduced the positive predictive value of high confidence calls in several subgroups. The addition of US to 4D-CT provided the greatest benefit for inferior glands and larger lesions, whereas the trade-off between improved sensitivity and reduced PPV was most pronounced in technically challenging scenarios, including smaller lesions and patients with goiter. In this cohort, adding US to 4D-CT did not significantly improve localization accuracy but did substantially increase radiologist confidence.

To characterise peri-injury systemic health changes in patients with fall-related open globe injuries (OGIs). Retrospective cohort study. 162 patients with fall-related OGIs, identified from a cohort of 1016 consecutive OGIs treated at a single academic medical center between 2016 and 2024. Electronic medical records were reviewed. Patients were included if the injury resulted from a fall and sufficient systemic health data were available. Incidence of new systemic diagnoses, disease exacerbations, and medication changes occurring within 90 days before or after the OGI. Specialist visits within the window and one-year mortality data were secondary measures. Of 1016 OGIs, 223 were fall-related (59.3% female, mean age 73.7 ± 14.3). Of 162 patients meeting inclusion criteria, 103 (63.6%) had at least one new systemic diagnosis likely contributing to the fall. Forty-three patients (26.5%) experienced exacerbation of pre-existing conditions, 28 (65.1%) of which were considered contributory to the fall. A total of 351 medication changes were documented, including medication classes with known fall risk. Seventy patients (43.2%) were seen by a new specialist; 38 of 108 visits (35.2%) were trauma-related, while 70 (64.8%) addressed new non-ocular conditions. Age-stratified one-year mortality rates were: ≤65 years, 9.7%; 66-75, 15.0%; 76-85, 16.7%; >85, 45.0%. Most fall-related OGIs occur in the context of newly diagnosed systemic illness, worsening of chronic disease, or medication changes. These injuries may represent sentinel events signaling underlying health deterioration. Systemic evaluation at initial presentation could facilitate timely referral and management of serious non-ophthalmic conditions.

Fluorescence-guided surgery (FGS) has emerged as a powerful intraoperative tool to visualize tumors in real time, but its precision is often constrained by a fundamental limitation. Conventional FGS relies on fluorescence intensity, a relative measure that cannot distinguish specific probe binding in cancer from non-specific accumulation in other tissues, such as the liver or areas of inflammation. This ambiguity can compromise surgical decision-making. We investigate whether fluorescence lifetime analysis can provide a quantitative parameter that can more effectively distinguish tumor from normal tissues using an anti-CEA-IR800 fluorescent probe in a mouse model of colorectal cancer.

Fluorescence imaging is being widely explored for intraoperative surgical guidance of head and neck cancers, using exogenous and endogenous contrast. However poor tumor contrast due to non-specific probe accumulation of tnon-targetted as well as receptor targeted probes is a major drawback. Here we show using preclinical and clinical studies that fluorescence lifetime (FLT) imaging can significantly improve the sensitivity and specificity for tumor detection using both indocyanine green (ICG) epidermal growth factor receptor (EGFR) targeted near infrared probes. We also show that FLTs in tissue are highly correlated with receptor expression levels, thereby enabling quantification of receptor quantification in vivo. Ongoing efforts in our group towards the translation of FLT imaging for intraoperative image guidance during surgeries of head and neck lesions, including oral and skin cancer will also be discussed.