Hidden in the Eyes-Recurrence of Systemic Hemopathies Reportedly "In Remission": Six Cases and Review of Literature.

Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient's progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient's ocular symptoms after treatment.

Geographic Atrophy and OCT Angiography: Descriptive Study and Correlation With Autofluorescence.

BACKGROUND AND OBJECTIVE: Geographic atrophy (GA) involves the progressive loss of retinal pigment epithelium (RPE), photoreceptors, and choriocapillaris (CC). CC flow within a GA area is severely impaired in patients with atrophic age-related macular degeneration. The aim of this study was to compare GA area measured on optical coherence tomography angiography (OCTA) (CC nonperfusion area) and on fundus autofluorescence (FAF). PATIENTS AND METHODS: In this prospective, observational, cross-sectional study, OCTA and FAF were performed in patients with GA. On OCTA (CC segmentation), the CC nonperfusion area was measured manually using calipers. On FAF, GA was manually delimited, and the total surface was obtained using Region Finder software. The primary endpoint was to compare the CC nonperfusion area measured on OCTA and on the gold standard method (FAF). RESULTS: Forty eyes of 34 patients with a mean age of 82.63 years ± 9.21 years (range: 66 years to 100 years) were included. The mean GA area measured on FAF and OCTA was, respectively, 2.184 ± 3.045 mm2 and 2.349 ± 3.237 mm2 (P = .035). The mean difference was 0.165 ± 0.290 mm2. A strong correlation was found between both measurements (r = 0.97; P < .0001; confidence interval: 0.98-0.99), although the CC nonperfusion area was larger than the GA area on FAF (P = .035). CONCLUSIONS: In this study, the authors showed that in GA, the CC nonperfusion area correlates linearly with the GA area assessed by FAF. Also, the CC nonperfusion area is larger than the GA area measured by FAF, suggesting that CC degeneration could occur before RPE degeneration in GA. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e222-e228.].

A ciliary body tumor preventing angle closure.

We present a case report of a 60-year-old white woman, found to have advanced angle closure glaucoma in the right eye and appositional closure for about half of the left eye and no glaucoma. The remaining angle of the left eye was open with localized heavy pigmentation of the ciliary body band and trabecular meshwork. Ultrasound biomicroscopy showed a ciliary body tumor displacing the iris root centripetally preventing angle closure.

Pigmentary glaucoma secondary to in-the-bag intraocular lens implantation.

After uneventful phacoemulsification and in-the-bag implantation of an AcrySof SA60AT (Alcon) intraocular lens (IOL), a 52-year-old black man developed pigmentary glaucoma. Slitlamp examination, anterior segment optical coherence tomography, and ultrasound biomicroscopy showed that the posterior surface of the iris was being rubbed by the inferior haptic of the IOL, which was in the bag but deformed. Filtering surgery was needed to control the intraocular pressure. This type of IOL can cause IOL-induced pigmentary glaucoma.

Dome-shaped macula in eyes with myopic posterior staphyloma.

PURPOSE: To describe an unusual feature in myopic eyes responsible for visual loss, which we call a dome-shaped macula. DESIGN: Retrospective, observational case series. METHODS: After observing isolated cases of dome-shaped macula, we analyzed optical coherence tomography (OCT) scans of 140 highly myopic eyes present in our OCT database to find similar cases. Fifteen eyes of 10 patients had a dome-shaped macula. These patients all had undergone fluorescein angiography (FA), indocyanine green angiography (ICGA), and B-scan ultrasonography examinations. RESULTS: The mean refractive error of the affected eyes was -8.25 diopters (D; range, -2 to -15 D). Median visual acuity was 20/50. Recent visual impairment was noted in 11 of the 15 eyes studied, and metamorphopsia was noted in eight eyes. Four eyes were asymptomatic. FA showed atrophic changes in the macular retinal pigment epithelium (RPE) in all eyes, combined with focal points of leakage in seven of the 15 eyes. The dome-shaped appearance of the macula was visible on both B-scan ultrasonography and OCT: a characteristic bulge of the macular retina, RPE, and choroid within the concavity of the moderate posterior staphyloma was present in all eyes. In 10 eyes, OCT also showed a shallow foveal detachment at the top of the dome-shaped macula. CONCLUSIONS: A dome-shaped macula within a myopic staphyloma is an unreported type of myopic posterior staphyloma. The dome-shaped macula often is associated with RPE atrophic changes and foveal retinal detachment, which may explain the visual impairment in these eyes.

Early bacterial keratitis after presbyopic LASIK.

PURPOSE: To report an unusual case of infectious keratitis that occurred after presbyopic laser-assisted in situ keratomileusis (LASIK). METHODS: A 57-year-old woman presented with decreased visual acuity and pain in her right eye 2 days after a bilateral presbyopic LASIK procedure. Slit-lamp examination showed a large corneal infiltrate surrounded by marked corneal inflammation. Corneal scraping grew Propionibacterium acnes. RESULTS: Under topical and systemic antibiotic treatment, the infiltrate slowly resolved. Visual acuity improved from counting fingers at presentation to 20/30 after 8 months of follow-up. CONCLUSIONS: To the best of our knowledge, this is the first description of a P. acnes infection after LASIK and the first case of infection complicating a presbyopic LASIK procedure. Although infectious keratitis occurs rarely after refractive surgery, patients should be informed of the potential risk of visual loss caused by such infections.

Corneal hysteresis, resistance factor, topography, and pachymetry after corneal lamellar flap.

PURPOSE: To measure prospectively the early changes in corneal hysteresis, topography, and pachymetry after the creation of a stromal flap cut without laser photoablation. METHODS: A 37-year-old man was referred for a bioptic procedure to correct for compound myopic astigmatism in the left eye. A 159-microm-thick 8x8.5-mm superior hinged flap was created with a mechanical microkeratome in the left cornea. Changes in the corneal hysteresis, corneal resistance factor, Goldmann correlated intraocular pressure (lOP), corneal compensated IOP, anterior and posterior topography, and optical and ultrasound pachymetry were monitored prospectively before and at 1 hour, 1 day, 5 days, and 25 days after flap creation. The right eye served as a control. RESULTS: In the left eye, corneal hysteresis and corneal resistance factor decreased immediately after the flap cut and remained lower than preoperatively at 1 hour, 1 day, 5 days, and 25 days. Corneal compensated IOP varied significantly less than Goldmann correlated IOP in both eyes. Central flattening of the horizontal meridians was observed on the difference topography maps. The values of the left eye posterior best fit sphere increased after the flap cut. Increased central corneal thickness occurred immediately after the flap cut and decreased over time without returning to its preoperative value. CONCLUSIONS: The creation of a stromal flap can modify the biomechanical properties of the cornea, including a reduction in corneal hysteresis. The topographic changes were consistent with previously reported cases of flap cut in normal corneas.

VHF digital ultrasound three-dimensional scanning in the diagnosis of myopic regression after corneal refractive surgery.

PURPOSE: To perform VHF digital ultrasound scanning and analysis of a case of high-myopic undercorrection in an eye that had undergone multiple surgical interventions for the correction of an initial refraction of -12.00 diopters (D). METHODS: A 49-year-old woman was evaluated after undergoing three surgical interventions for correction of an initial refraction of -12.00 D in the left eye. Automated lamellar keratoplasty (ALK) was followed by arcuate keratotomy (for induced astigmatism) and surface photorefractive keratectomy (PRK). The residual ametropia on presentation was -6.75 -3.50 x 95 degrees. VHF digital ultrasound scanning and analysis was performed. RESULTS: On ultrasound, the ALK interface was clearly visible. Residual stromal thickness beneath the cap was at least 275 microm. The absence of Bowman's layer indicated the region of PRK. New stroma and nascent stromal layers were differentiated within the flap. Neo stromal deposition and central epithelial hyperplasia were determined to be responsible for the myopic shift, as opposed to biomechanical changes. CONCLUSIONS: In this case, refraction, slit-lamp examination, and topography were unable to provide a diagnosis for regression following multiple corneal refractive procedures. By providing layered anatomical mapping, VHF digital ultrasound scanning was able to exclude a diagnosis of ectasia and provide anatomical diagnostic information to explain the clinical observations.

Asymmetric pigmentary glaucoma in a patient with Marfan's syndrome.

BACKGROUND: No relationship between Marfan's syndrome and pigmentary glaucoma has previously been described in the ophthalmic literature. We describe the case of a patient with Marfan's syndrome who had bilateral pigment dispersion syndrome and asymmetrical glaucoma. METHODS: A 34-year-old man with Marfan's syndrome developed pigment dispersion bilaterally. In the right eye, elevated intra-ocular pressure was associated with marked glaucomatous excavation of the right disc and corresponding visual field loss. A localised zonular dehiscence was present at the 6 o'clock position in the right eye. RESULTS: Ultrasound biomicroscopy showed marked iris concavity in the right eye, increased iridolenticular contact and superior subluxation of the right lens, resulting in increased dispersion of pigment unilaterally. This explains the asymmetric pattern of the glaucomatous damage. CONCLUSIONS: Asymmetrical progression of pigmentary glaucoma is uncommon and should prompt a search for some other mechanical factor, which might increase the iridozonular contact on one side or reduce it on the other. The association between the two syndromes in this patient was most likely mechanical due to reduced fibrillin expression throughout the eye and particularly in the iris and the lens zonules, resulting in loss of iris tensile strength and marked iris concavity as well as zonular weakness and partial lens subluxation.