Reversible Retinopathy Associated with Fibroblast Growth Factor Receptor Inhibitor.

We present a case of reversible, pseudovitelliform lesions while a patient was taking pembrolizumab (PDL-1 inhibitor) and erdafitinib (pan-fibroblast growth factor receptor inhibitor) outside of clinical trial protocols. A 61-year-old patient with 3 days of metamorphopsia was found to have pseudovitelliform lesions in both eyes 6 weeks after initiation of erdafitinib. After discontinuation of this drug, his visual complaints resolved and his lesions decreased on optical coherence tomography. To our knowledge, this is the first case depicting reversible macular lesions with use of this newly approved medication outside of clinical trial protocols.

INTRAOCULAR LENS IMBRICATION FOR RECURRENT PUPILLARY CAPTURE AFTER SUTURELESS INTRASCLERAL FIXATION.

PURPOSE: To demonstrate a novel surgical technique (intraocular lens imbrication) for persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation. METHODS: Case report and supplemental digital content demonstrating salient steps of a novel surgical technique. RESULTS: The patient did not suffer any further episodes of pupillary capture after intraocular lens imbrication with aforementioned surgical technique five months after the procedure. Postoperative best-corrected visual acuities were 20/40 in both eyes. CONCLUSION: Intraocular lens imbrication is an effective method to address persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.

Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic.

PURPOSE: To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only. METHODS: Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment. RESULTS: Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). CONCLUSIONS: The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.

AUTOLOGOUS NEUROSENSORY RETINAL TRANSPLANTATION: Bridging the Gap.

PURPOSE: To review the autologous retinal transplantation surgical technique, indications, rationale, and current outcomes of data published to date. METHODS: Review of surgical technique, preoperative and postoperative best-corrected visual acuity, and macular hole (MH) closure rate in studies with at least five eyes. RESULTS: The weighted average macular hole closure rate is 88%, with a MH closure rate ranging from 66.7% to 100%. The weighted average best-corrected visual acuity improved from mean logarithm of the minimum angle of resolution 1.35 (Snellen equivalent of 20/450) preoperatively to mean logarithm of the minimum angle of resolution 1.02 (Snellen equivalent of 20/210) postoperatively. From the largest autologous retinal transplantation case series, 37% of patients gained 3 or more lines of visual acuity after autologous retinal transplantation for primary or refractory MHs and 74% gained 3 or more lines of visual acuity after autologous retinal transplantation for MH-retinal detachments. Functional improvement including negative Watzke-Allen sign and conversion from positive to negative scotoma was reported in large case series. CONCLUSION: Autologous retinal transplantation is a promising technique for closure of large and refractory MHs otherwise difficult to repair with conventional techniques. This technique may allow for replacement of neural tissue in the macula through cell rehabilitation and regeneration through presumed ectopic synaptogenesis, retinal progenitor cell differentiation and integration, and/or retinal progenitor cell material transfer to host neurons.

Supraorbital Nerve and Cavernous Sinus Invasion with Poorly Differentiated Carcinoma of Unknown Primary.

A 50-year-old man presented with a 4-month history of right-sided trigeminal neuropathy in the V1 and V2 distribution, right sixth nerve palsy and Horner syndrome. Magnetic resonance imaging (MRI) showed enhancement and thickening along the right ophthalmic nerve and supraorbital nerve and fullness at the right cavernous sinus extending to Meckel's cave. Evaluation for a primary tumour was negative. Cavernous sinus biopsy showed infiltrating poorly differentiated carcinoma; the patient underwent radiation therapy. To our knowledge this is the only case of poorly differentiated carcinoma involving the supraorbital nerve presenting with trigeminal neuropathy and Horner syndrome in the English ophthalmic literature.

Etiology and treatment outcomes of persistent postoperative inflammation in primary resident-performed cataract surgeries at a large tertiary care public hospital.

PURPOSE: To determine the risk factors, intraoperative and postoperative complications, therapeutic interventions, and visual outcomes for persistent postoperative inflammation in primary resident-performed cataract surgeries. SETTING: Ben Taub General Hospital, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: Primary resident-performed cataract surgeries from January 2012 to June 2015 were analyzed for persistent postoperative inflammation, defined as persistent anterior chamber inflammatory reaction after a standard 1-month topical corticosteroid and nonsteroidal antiinflammatory drug (NSAID) drops taper. Preoperative characteristics, operative complications, therapeutic modalities, and duration of therapy were analyzed. The primary outcome measures were duration of corticosteroid and NSAID therapy, treatment modalities, and postoperative visual outcomes at the 1-month postoperative visit. RESULTS: The study assessed 1290 primary resident-performed cataract surgeries. Persistent postoperative inflammation occurred in 82 eyes (6.6%). The presumed etiology was classified as idiopathic persistent postoperative inflammation, nonadherence to topical therapy, and complicated cataract surgery. Patients with persistent postoperative inflammation were more likely of African American descent, had hypertension, or used aspirin, anticoagulants, or prostaglandins (P = .019, P = .027, P = .028, P = .020, respectively). The complicated cataract subgroup required a longer duration of therapy (P = .021) and was the only subgroup to require injections or systemic corticosteroids. There was no significant difference in postoperative corrected distance visual acuity (CDVA) when comparing patients with persistent postoperative inflammation with those without inflammation or between the subgroups. CONCLUSIONS: The idiopathic and nonadherent subgroups were successfully treated with topical antiinflammatory therapy; the complicated subgroup required longer duration and multiple modalities of treatment. Visual outcomes were comparable to the general cataract population with no differences in postoperative CDVA.

Outcomes and complication rates of primary resident-performed cataract surgeries at a large tertiary-care county hospital.

PURPOSE: To identify the preoperative risk factors, intraoperative events, and postoperative complications increasing the risk for poor visual outcomes in resident-performed cataract surgeries at a tertiary-care county hospital. SETTING: Ben Taub General Hospital, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: Resident-performed cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity (CDVA), which were correlated with preoperative demographics, intraoperative and postoperative events, and resident training level. The data were subdivided into cases without events and cases with events to determine which complications led to poor visual outcomes. RESULTS: The study analyzed 1290 resident-performed cataract surgeries. The mean visual acuity improved significantly after surgery in all patients (P < .001), with 80.5% of patients without complications and 70.7% with complications attaining a CDVA of 20/40 or better (P < .002). Poor visual outcomes were associated with α-antagonist use (P = .043) and pseudoexfoliation syndrome (P = .001). The most common intraoperative complications were vitreous loss (6.7%) and posterior capsule tear (7.0%). The mean postoperative visual acuity did not vary by trainee year, and the rate of dropped nucleus during surgery declined as residents progressed in training (P < .05). All other complication rates were similar between levels of training. CONCLUSION: Despite more complicated cataracts and advanced comorbidities, primary resident-performed cataract surgery in a tertiary-care county hospital system achieved visual outcomes and complication rates similar to those found in other training hospitals.