West Coast Retina

Vitrectomy with an internal limiting membrane (ILM) flap has been used in the repair of macular holes (MH). Topical drops have been attempted for smaller MHs with limited data. This study aims to demonstrate the effectiveness of a topical drop regimen in failing MHs after ILM flap surgery. Review of 3 eyes with open MHs after vitrectomy with ILM flap. Preoperative visual acuity, MH size, tamponade used during surgery, time-to-hole closure, and final visual acuity were collected. Average MH size among all eyes was 743.3µm (+ 150.4). At the postoperative visit, the MHs were open. All eyes were started on topical steroid, nonsteroidal, and carbonic anhydrase inhibitor drops twice daily for a mean time of 33 days (+ 11 days). There was successful closure of the MHs with topical therapy in all cases. Topical therapy may aid in post-operative MH closure.

TEST 02 - Elsevier's Scopus, the largest abstract and citation database of peer-reviewed literature. Search and access research from the science, technology, medicine, social sciences and arts and humanities fields.

A 36-year-old male suffered a traumatic open globe injury to his right eye resulting in phthisis. One year later, he developed a sudden progressive decrease in vision in the fellow (left) eye. Examination revealed arteriolar attenuation, multifocal deep subretinal infiltration, retinal edema, and necrosis. The patient underwent diagnostic vitrectomy in the left eye, and diagnostic enucleation of the phthisical right eye after suboptimal response to intravenous corticosteroid, antiviral, and antibiotic therapy. Detailed immuno-histopathological evaluation revealed extensive retinal disorganization with photoreceptor loss, perivascular infiltration, Dalen-Fuchs nodules, and granulomatous inflammation with central necrosis and melanin pigment, suggestive of a rare variant of sympathetic ophthalmia.

ABSTRACT Purpose: To report novel mutations in the FZD4 and LRP5 genes, associated with familial exudative vitreoretinopathy (FEVR), and to correlate with clinical features of 7 FEVR patients. Methods: In this retrospective case series, 7 patients who had undergone genetic panel testing and carried a diagnosis of FEVR were identified. Comprehensive ophthalmic examination and direct DNA sequencing of FEVR-associated genes were performed in all patients. Identified sequence variants were analyzed in silico. Results: Eight mutations were identified amongst the 7 patients, that included 4 FZD4 mutations and 4 LRP5 mutations. Four novel mutations were identified, two in FZD4 (c.615delC, p.Y206MfsX34) and (c.964A>T, p.I322F), and two in LRP5 (c.2585A>T, p.D862V) and (c.1412 + 1 G > A, splice donor). A broad phenotypic spectrum was noted and no clear genotypic-phenotypic correlation was observed. Conclusion: These findings expand the mutation spectrum of FZD4 and LRP5.

To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive series of patients seen at a single vitreoretinal surgery practice. We performed a retrospective review of all patients who were treated for blunt trauma from 2013 to 2020 at a single vitreoretinal practice. Thirteen eyes from 11 patients met the inclusion criteria of possessing ocular trauma secondary to recoil from exercise bands. Presenting visual acuity ranged from 20/16 to HM (median: 20/32). The most frequently observed anterior segment pathologies were traumatic iritis (54%) and angle recession (31%). The most common posterior segment findings were vitreous hemorrhage (54%) and peripheral commotio retinae (54%). Three eyes (23%) required surgical intervention. Follow-up intervals ranged from 0 to 10 months (median: 1.75 months). Visual acuity at last examination ranged from 20/13 to 20/400 (median: 20/40). A wide spectrum of serious ocular injuries requiring medical and surgical intervention can result from this form of blunt ocular trauma. The frequency of this event would be decreased by the use of sports goggles and careful inspection of equipment for wear and over use.

To describe a patient with newly developed paracentral acute middle maculopathy after uncomplicated epiretinal membrane removal. Retrospective chart review. A 74-year-old white man underwent uncomplicated vitrectomy and epiretinal membrane removal in his left eye. One week later, the patient complained of a small paracentral visual field deficit and decreased visual acuity. Spectral domain optical coherence tomography revealed a characteristic hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with paracentral acute middle maculopathy. The patient was closely followed and endorsed subjective improvement of his paracentral visual deficit at 3 months postoperatively. Paracentral acute middle maculopathy, although rare, may be encountered after epiretinal membrane removal.

Paracentral acute middle maculopathy (PAMM) is a recently identified clinical entity with numerous retinal vascular and systemic associations. To our knowledge, this is the first reported case of PAMM associated with idiopathic intracranial hypertension. A case is presented with multimodal imaging. A patient with idiopathic intracranial hypertension is found to have the characteristic clinical, spectral domain optical coherence tomography, and OCT angiography findings associated with PAMM. Paracentral acute middle maculopathy is believed to arise from a microvascular insult to the retinal deep capillary plexus. We add a previously undescribed association with idiopathic intracranial hypertension to the list of etiologies that can cause PAMM.