PRESUMED INTRARETINAL TUBERCULOSIS: CASE REPORT WITH MULTIMODAL IMAGING INCLUDING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography. METHODS: Case report. RESULTS: A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography. Subsequent serologic testing revealed a positive QuantiFERON-TB Gold test, whereas workup for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic antitubercular therapy and the lesions regressed. The regression was documented with optical coherence tomography angiography. CONCLUSION: Case reports of primary intraretinal tuberculosis are uncommon. To the best of our knowledge, this is the first case to demonstrate optical coherence tomography angiography findings of presumed intraretinal tuberculosis.

A rare presentation of Horner syndrome due to internal jugular phlebectasia.

Horner syndrome occurs due to disruption of the oculosympathetic pathway. We present a case of acquired Horner syndrome in a 30-month-old boy due to phlebectasia of the internal jugular vein. To our knowledge, this rare entity has been reported only once before.

A 'never miss' diagnosis: Ptosis secondary to metastatic breast cancer diagnosed as involutional ptosis and a review of the literature.

We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.

Ocular Anterior Segment Pathology in the Emergency Department: A 5-Year Study.

INTRODUCTION: Patients with ocular complaints frequently present to emergency departments (EDs) for care. Emergency department practitioners are often the first to evaluate these patients and determine the next steps in their care, which can be a challenging task. The purpose of this study is to determine the frequency of anterior segment pathology in the setting of the ED in hopes that this information will be useful in creating more effective management algorithms. METHODS: A retrospective study based on electronic patient charts from the University of California Davis ED that included ophthalmology consults. We reviewed the charts for demographic data, as well as visual acuity (VA), intraocular pressure (IOP), and diagnosis as determined by ED and ophthalmology personnel, respectively. RESULTS: The most common anterior segment diagnoses were uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction/dry eyes/blepharitis/punctate epithelial erosions, and conjunctivitis/epidemic keratoconjunctivitis. Emergency Department personnel measured the VA and IOP in 40.8% and 16.7% of patients, respectively. The ophthalmologist measured the VA and IOP in 78.4% and 95.1% of patients, respectively. The percentage agreement in VA measurement between ophthalmology and ED was 11.8%. The percentage agreement in IOP measurement between ophthalmology and ED was 0.86%. The percentage agreement in diagnosis between ophthalmology and ED was 49.4%. CONCLUSIONS: Most ocular conditions that present in the ED are nonurgent and can be treated in an outpatient setting. However, ED personnel are often unable to obtain the proper "ocular vital signs" (the VA and IOP) and diagnoses. Our findings suggest a need for clear interprofessional discussion in creating an algorithm for triage and the management of eye conditions in the ED to deliver effective care.

Overview of Neurotrophic Keratopathy and a Stage-Based Approach to Its Management.

ABSTRACT: Neurotrophic keratopathy (NK) occurs because of disruption of corneal sensory innervation. There are many etiologies that can lead to NK, such as infection, trauma, topical medication use, cornea surgery, and intracranial tumors among others. We review the current available treatment options and provide a stage-based approach to its management.

Rhino-orbital-cerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B.

PURPOSE: We report a case of rhino-orbital-cerebral mucormycosis (ROCM) with focal anterior cerebritis treated favorably with retrobulbar amphotericin B and systemic antifungals. OBSERVATIONS: A 55-year-old diabetic male presented to the emergency department with left sided proptosis, left temple headache, maxillary sinus pain, and diplopia of 3 days duration. Biopsy results from the left middle turbinate, ethmoid, and maxillary sinus revealed broad and irregular non-septate hyphae consistent with mucormycosis. Despite treatment with intravenous antifungals and endoscopic debridement of the sinuses, his condition did not improve. Disease progression included the development of left ophthalmoplegia and left-sided cerebritis. The patient received retrobulbar injection of deoxycholate amphotericin B with eventual disease resolution, without exenteration. CONCLUSIONS: We present a case of ROCM with associated cerebritis that responded to retrobulbar amphotericin B, without exenteration.

Ectopia Lentis et Pupillae Caused by ADAMTSL4 Pathogenic Variants and an Algorithm for Work-up.

Ectopia lentis is displacement of the lens from its original position. It can be inherited or acquired with isolated or systemic findings. The authors describe a 4-year-old girl with isolated ectopia lentis et pupillae caused by pathogenic variants in the ADAMTSL4 gene and discuss the molecular genetic work-up of individuals with ectopia lentis. [J Pediatr Ophthalmol Strabismus. 2019;56:e45-e48.].

Posterior Segment Complications and Impact on Long-Term Visual Outcomes in Eyes With a Type 1 Boston Keratoprosthesis.

PURPOSE: To determine the spectrum of retinal complications (RCs) in a cohort of eyes with a type 1 Boston keratoprosthesis (KPro). METHODS: All patients (36 eyes of 31 patients) who received a type 1 Boston KPro from January 2004 to December 2015 at the University of California, Davis, were included. Electronic medical records were reviewed for relevant clinical data. Demographic information, initial corneal diagnosis, postoperative course, posterior segment complications, preoperative and final visual acuity were tabulated and analyzed. RESULTS: Posterior segment complications after type 1 Boston KPro were identified in 56% of eyes (n = 20). They included retinal detachment (n = 11; 31%), retroprosthetic membrane (n = 10; 28%), endophthalmitis (n = 7; 19%), cystoid macular edema (n = 5; 14%), epiretinal membrane (n = 4; 11%), vitreous hemorrhage (n = 2; 6%), choroidal detachment (n = 2; 6%), retinal vein occlusion (n = 1; 3%), and macular hole (n = 1; 3%). During the average follow-up period of 53.8 months (median, 57.1 months; range, 1.8-108.7 months) after type 1 Boston KPro, final best-corrected visual acuity improved by a mean of 0.12 logarithm of the minimum angle of resolution (LogMAR) units (range, -2.26 to +2.26) overall. The proportion of eyes with final best-corrected visual acuity better than 20/200 was 2 of 20 (10%) in the group with RCs, in contrast to 7 of 16 eyes (44%) noted among eyes without RCs. CONCLUSIONS: Long-term visual outcomes in eyes after type 1 Boston KPro may depend, in part, on maintaining a healthy posterior pole. Retinal detachment, in particular, may represent a threat to ultimate visual functioning. Regular examination of the peripheral fundus is recommended.