BILATERAL SERPIGINOUS-LIKE CHORIORETINITIS ASSOCIATED WITH CILIOCHOROIDAL MELANOMA: A Clinicopathologic Correlation.

PURPOSE: To report the clinicopathologic correlation of a case of bilateral serpiginous-like chorioretinitis (SLC) associated with unilateral ciliochoroidal melanoma. METHODS: A 71-year-old white woman was diagnosed with progressive SLC in both eyes associated with ciliochoroidal melanoma in the right eye. Clinical findings and imaging before and after enucleation in the right eye were correlated to histologic and immunohistochemistry sections. RESULTS: Examination and imaging identified a peripheral bilobed amelanotic lesion with low reflectivity on B-scan ultrasound with an associated exudative detachment in the right eye. Additionally, multiple areas of new SLC lesions in the macula and peripapillary region in the right eye and along the inferior arcade in the left eye were observed. Oncologic evaluation confirmed a Class 2, ciliochoroidal melanoma, and the eye was enucleated. Autoimmune and infectious laboratory evaluations for the etiology of the SLC lesions were negative. Histopathology of the enucleated eye confirmed the diagnosis of uveal melanoma with lymphocytic inflammation at the edges of the tumor itself and in the areas of discrete SLC lesions. Immunohistochemistry identified similar predominantly CD3 and CD8 T cells and fewer CD20 B cells in both regions. CONCLUSION: Serpiginous-like chorioretinitis may present as a paraneoplastic, predominantly T-lymphocyte inflammation associated with intraocular tumor such as uveal melanoma.

Hiring your next partner: AOA critical issues.

Hiring a new partner into an orthopaedic department or group can be a daunting task. A recent American Orthopedic Association symposium sought to address three major aspects of hiring that affect orthopaedic leaders: (1) when to hire-the chairperson's role; (2) generational issues that affect hiring; and (3) the development of an initial compensation package.How does the chairperson recruit new physicians? Hiring a new partner into the academic setting requires a good deal of foresight. There must be an established game plan. Advertising and interviews need to be orchestrated. Chairpersons can find information about candidates from many unique sources. Fit within the department and community is important and must be cultivated. Spouses and families need special attention. Research candidates have individual needs. Perhaps the most important aspect of recruitment is the development of a realistic business plan. This paper provides an overview of factors to consider in managing a new hire.Generational issues are intriguing. Should they affect our hiring practices? It seems clear to established physicians that the new generation of graduates is different from their predecessors. Is this really true? Most everyone is familiar with the terms "Silent Generation," "Baby Boomers," "Generation X," and "Generation Y." Is there anything to be gained by categorizing an applicant? Is it important to hire a replica of one's self? This paper provides a thoughtful overview of generational issues as they apply to hiring new partners.Most department chairpersons are not trained as negotiators. Some preparation and experience are helpful in guiding the process of making an initial offer to a candidate. It is not all about pay. The package includes the guarantee period, expectations for the new hire, mentorship, and resources. How much should new orthopaedic academic hires be paid? Recent benchmark data from the Academic Orthopaedic Consortium suggest a mean income of $282,667 for physicians who have just finished a fellowship. New hires are concerned about call frequency and available time free from work. How much work should be expected from an academic surgeon? Recent survey data from the American Orthopaedic Consortium suggest a mean of 9200 relative value units per year. This article offers some guidelines for the chairperson who needs to formulate an initial offer for a new hire.There is a lot involved in hiring a new partner, as times are changing. This paper offers considerable food for thought about hiring.

Occurrence and prognosis of nonpenetrating injuries in eyes with Verisyse iris-supported phakic intraocular lens.

We report 8 cases of blunt trauma in patients with a Verisyse phakic intraocular lens (pIOL) (AMO). Two cases resulted in dislocation of the pIOL that required repositioning; the other 6 were managed conservatively. In all cases, the outcomes were satisfactory, with no further complications. The cases represent scenarios that patients and physicians might encounter postoperatively and describe ways to manage the complication.

Accurate intraocular lens power calculation after myopic laser in situ keratomileusis, bypassing corneal power.

PURPOSE: To describe a novel method for calculating intraocular lens (IOL) power after myopic laser in situ keratomileusis (LASIK) without using the inaccuracies of the post-LASIK corneal power. SETTING: Department of Ophthalmology, Wake Forest University Eye Center, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA. METHODS: This retrospective chart review comprised 9 eyes of 9 patients who had phacoemulsification after LASIK using our method for IOL calculation. This new method assumes the patient never had myopic LASIK to calculate IOL power and then targets the IOL at the pre-LASIK amount of myopia. The pre-LASIK keratometry values, pre-LASIK manifest refraction, and the current axial length are placed in the Holladay formula, bypassing the post-LASIK corneal power. In theory, assuming that the patient had satisfactory LASIK results, the correct IOL can then be determined. RESULTS: The mean spherical equivalent postoperative refraction was +0.03 diopter (D) +/- 0.42 (SD) (range -0.625 to +0.75 D). In all 9 eyes, our method consistently chose the most accurate and precise IOL compared with other methods. CONCLUSIONS: The new method of calculating IOL power after LASIK provided excellent results and the most accurate and precise results to date.

A case of acanthamoeba keratitis as a result of a cosmetic contact lens.

PURPOSE: To describe a case of Acanthamoeba keratitis that resulted from a cosmetic contact lens purchased from an unlicensed vendor. METHODS: Case report. RESULTS: A 26-year-old man developed Acanthamoeba keratitis from a cosmetic contact lens and ultimately required a penetrating keratoplasty. The patient then developed angle-closure glaucoma and required a trabeculectomy. CONCLUSIONS: This case shows the potential ocular danger involved with unauthorized sale of cosmetic contact lenses.

Ocular surface injury from a microwave superheated egg resulting in a pseudopterygium.

PURPOSE: To describe the first case of ocular surface injury resulting in a pseudopterygium from a microwave superheated egg. METHODS: Case report. RESULTS: A 12-year-old girl sustained an ocular surface injury resulting in a pseudopterygium from a microwave superheated egg. CONCLUSION: Microwave superheated eggs can result in ocular injury. This case illustrates the potential ocular danger involved with microwave ovens.

Delayed enophthalmos following a minimally displaced orbital floor fracture.

We describe a case of an orbital floor fracture resulting in obstruction of the maxillary sinus ostium by herniated orbital contents. Our patient had delayed enophthalmos in a manner similar to silent sinus syndrome or imploding antrum syndrome. Obstruction of the maxillary sinus ostium by orbital contents carries the potential for delayed-onset enophthalmos and therefore suggests an additional indication for orbital floor fracture repair.

Ocular surface injury from a microwave superheated liquid.

PURPOSE: To describe the ocular surface injury resulting from a microwave superheated liquid. METHODS: Case report. RESULTS: A 40-year-old man sustained an ocular surface injury from a microwave superheated liquid. The injury resulted in limbal stem cell damage requiring an autograft limbal stem cell transplantation. CONCLUSIONS: We are unaware of previous reports of microwave superheated liquids resulting in ocular injury. Microwave superheating of liquids is a potential ocular danger that should be brought to the attention of both ophthalmologists and their patients.

Endoscopic transethmoidal decompression of a thrombosed orbital venous malformation.

We describe the case of a 37-year-old woman who experienced a painful thrombosis of an orbital venous malformation. We successfully treated her with surgical decompression via a computer-assisted, endoscopic transethmoidal orbitotomy. Removal of the lamina papyracea and evacuation of the thrombus provided immediate symptomatic relief. Decompression via an endoscopic transethmoidal route provides a more direct and less invasive approach than other techniques.