Retina Partners

Introduction. Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators for patients and helps to navigate treatment modalities. This is a retrospective chart review of examination and imaging findings for ocular trauma and how they correlate with treatment course and visual acuity (VA) outcomes. Methods. Adult patients with ocular trauma presenting to a single institution between January 2013 and December 2020 were evaluated. Initial examination and imaging findings were compared for associations with each other and with VA outcomes. Results. 136 ocular traumas on 134 patients were included. The median presenting logMAR VA was 2.7 (interquartile range (IQR) 1.2–3.7) with 62% open globe injuries. The most commonly reported finding on initial CT scan was globe deformity (30%), on B‐scan was choroidal detachment (20%), and on ultrasound biomicroscopy was intraocular foreign body, ciliochoroidal effusions, or angle recession (21% each). Worse vision was observed for patients positive for retinal detachment on initial B‐scan compared to those negative for this finding at 6‐month (median logMAR 2.7 vs. 0.5; P < 0.0001) and at final post‐injury evaluation (median logMAR 3.7 vs. 0.4; P < 0.0001). Similarly, worse VA was observed for patients with choroidal detachment on initial B‐scan compared to those without this finding at 6‐month (median logMAR 1.4 vs. 0.5; P = 0.002) and at final post‐injury evaluation (median logMAR 2.0 vs. 0.4; P < 0.0001). If positive conjunctiva/sclera examination findings were identified, 66% had positive findings on B‐scan, whereas if the conjunctiva/sclera examination findings were absent, 41% had positive findings on B‐scan (P = 0.005). If anterior chamber (AC) examination findings were positive, 59% had positive findings on B‐scan, whereas if the AC examination findings were absent, 37% had positive findings on B‐scan (P = 0.03). Discussion. The predictive value of examination findings in this study may offer insight as to long‐term visual prognosis. Positive B‐scan or CT findings should increase suspicion for open globe injuries.

To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections. Multicenter, retrospective series. From April 2013 to October 2018, 196,598 intravitreal anti-vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug (P = 0.29), anesthetic method (P = 0.26), povidone concentration (P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P < 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P < 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P < 0.001). Better visual acuity on postendophthalmitis week 1 (P = 0.002) and reinitiation of nAMD treatment (P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity (P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab > bevacizumab; P < 0.001). Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.

To present the optical coherence tomography angiography and widefield fundus autofluorescence (FAF) imaging findings of a 34-year-old woman with punctate inner choroidopathy and Type 2 neovascularization. In the retrospective case report, optical coherence tomography angiography imaging was performed with the RTVue XR Avanti (Optovue Inc, Fremont, CA) platform, which uses split spectrum amplitude decorrelation angiography to detect flow. Single patient with the diagnosis of punctate inner choroidopathy. Spectral domain optical coherence tomography of the macula showed an inactive submacular scar but optical coherence tomography angiography demonstrated the fine detailed structure of a Type 2 neovascular membrane. Peripheral FAF abnormalities were detected despite the notable absence of these lesions with clinical examination and color fundus photography. These FAF findings were important in guiding clinical follow-up and response to therapy. The FAF lesions resolved with normal follow-up and treatment with oral naproxen. This is the first case report of optical coherence tomography angiography imaging of choroidal neovascularization associated with punctate inner choroidopathy and the first report of widefield FAF abnormalities in punctate inner choroidopathy. Optical coherence tomography angiography may provide a more noninvasive and sensitive imaging system for the evaluation of choroidal neovascularization than traditional fluorescein angiography and may provide a direct gauge of response to therapy. Widefield FAF may improve detection of inflammatory activity of retinal disease and monitoring of disease activity.