Depression in Uveal Melanoma Survivorship: Examining Psychological Predictors of Adjustment in the First Year Following Diagnosis.

BACKGROUND: A rare cancer, uveal melanoma (UM) affects 5 in 1 million adults annually. Research on predictors of mental health in UM survivors is scarce. PURPOSE: In this prospective study, we tested models that postulate interactions between illness perceptions and coping processes in predicting depressive symptoms 1 year following UM diagnosis. METHODS: Participants' approach- and avoidance-oriented coping processes and illness perceptions specific to control and chronicity were assessed. Participants (N = 107) completed assessments prior to diagnosis (T0), and 1 week (T1), 3 months (T2), and 12 months after UM diagnosis (T3). RESULTS: At T1, a significant avoidance coping × chronicity perception interaction (b = 1.84, p = .03) indicated that the link between higher avoidance coping and greater T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions (b = 17.13, p < .001). Chronicity perceptions at T2 interacted significantly with approach-oriented coping at all time points; the link between higher approach coping and lower T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions at T2. Interactions between control perceptions and coping did not significantly predict T3 depressive symptoms. CONCLUSIONS: Findings lend partial support to predictive models that consider the combined, interacting influence of chronicity perceptions and coping processes on depressive symptoms in survivors of eye cancer.

The present study sought to identify psychological factors that were associated with depressive symptoms in adults diagnosed with uveal melanoma, a rare cancer. Understanding risk factors for depressive symptoms in cancer survivors is important, as heightened depressive symptoms have been shown to be associated with worse mental, physical, and disease-related outcomes in various cancer populations. In this study, uveal melanoma patients at University of California, Los Angeles were given questionnaires before their diagnosis, as well as 1 week, 3 months, and 1 year later. These questionnaires asked patients about their mental health, their efforts to cope with their cancer, and how they viewed their cancer. Adults with uveal melanoma were more likely to experience depressive symptoms 1 year after diagnosis when they had viewed their illness as more chronic in nature and also engaged in higher levels of cancer-related avoidance coping or lower levels of approach coping 3 months after their diagnosis. Findings highlight the impact that coping and perceptions of one's illness can have on mental health in the year following an uveal melanoma diagnosis. Future work should test whether mental health interventions targeting coping behaviors and/or illness perceptions can help to prevent or reduce depressive symptoms in uveal melanoma survivors.

Extrascleral extension of choroidal melanoma after iodine-125 brachytherapy treatment: a case series.

BACKGROUND/OBJECTIVES: The purpose of this study is to report cases of choroidal melanoma that developed extrascleral tumour recurrence after treatment with iodine-125 brachytherapy. SUBJECTS/METHODS: In this single-institution retrospective observational case series, all instances of biopsy-confirmed orbital melanoma after known intraocular melanoma were reviewed. Tumour characteristics, clinical course, time to recurrence, cytogenetics of initial tumour and recurrence, and presence of intraocular recurrence were documented. RESULTS: Five cases of orbital melanoma following treatment with plaque radiotherapy are described. Tumour staging was Ia (1), IIa (2), and IIb (2). The primary lesion in four of the five appeared to have undergone complete regression for an average of 2 years, with the orbital melanoma developing after this interval. Recurrence of the intraocular tumour was seen in conjunction with an extrascleral component in two cases. Four cases ultimately underwent enucleation or exenteration; three had evidence of direct extension of tumour through the sclera. Four cases in this series had molecular characteristics associated with high metastatic risk (three patients with monosomy 3, one with BAP1 mutation). CONCLUSIONS: High-risk tumour biology may predispose to late appearance of extrascleral melanoma despite optimal treatment and adequate control of the intraocular tumour. Extended follow-up with detailed orbital examination and imaging is recommended for this population.

RETINAL DETACHMENT IN EYES WITH BOSTON TYPE 1 KERATOPROSTHESIS: Surgical Techniques and Mid-Term Outcomes.

PURPOSE: To evaluate the mid-term outcomes of pars plana vitrectomy performed for retinal detachment (RD) repair after Boston Type 1 keratoprosthesis (KPro) implantation. METHODS: Retrospective review of medical records of KPro implanted at the Stein Eye Institute presenting with RD and treated by pars plana vitrectomy. Functional success was defined as a postoperative visual acuity maintained within 2 Snellen lines of the corrected distance visual acuity measured before the development of the RD (baseline) and anatomical success as an attached retina after the pars plana vitrectomy. Kaplan-Meyer survival analyses were performed. RESULTS: Among the 224 KPro performed, 28 (15.2%) RD were identified; of which, 21 (9.4%) were included. The mean follow-up was 42.5 ± 27.3 months. Vitreoretinal proliferation was present in 18 of 21 eyes (85.7%). Surgical techniques were adapted to the complex anterior segment anatomy of KPro eyes. Anatomical success was achieved in 18 of 21 eyes (85.7%). Functional success occurred in 17 of 21 eyes (81.0%), and 5 of 21 eyes (23.8%) reached 20/400 or better visual acuity at the final follow-up. The KPro was retained in 11 in 21 eyes (52.4%). The retention rate decreased from 94.7% at 1 year to 53.5% at 5 years. The most frequent complications were retroprosthetic membrane (47.6%) and corneal melt (23.8%). CONCLUSION: Modified pars plana vitrectomy techniques resulted in relatively good mid-term anatomical, functional, and retention rate outcomes, given the severity of RD at presentation and the numerous preoperative comorbidities of KPro eyes.

Visual impairment and depression in uveal melanoma: Optimism and pessimism as moderators.

OBJECTIVE: Uveal melanoma, a rare eye cancer, presents potential vision loss and life threat. This prospective, longitudinal study interrogated the predictive utility of visual impairment, as moderated by optimism/pessimism, on depressive symptoms in 299 adults undergoing diagnostic evaluation. METHOD: Depressive symptoms (Center for Epidemiologic Studies Depression Scale), subjective (Measure of Outcome in Ocular Disease vision subscale) and objective (logarithm of the minimum angle of resolution) visual impairment, and optimism/pessimism (Life Orientation Test-Revised) were assessed before diagnostic evaluation and 1 week, 3 months, and 12 months after diagnosis. Multilevel modeling, with repeated measures (Level 1) nested within individuals (Level 2) and imputation of missing data (Blimp software), was performed. RESULTS: Depressive symptoms were significantly more elevated 1 week after diagnosis in cancer patients (n = 107) versus patients not diagnosed with cancer (n = 192). Higher subjective (but not objective) visual impairment predicted greater depressive symptoms (p < .001). Across the entire sample, the two-way (Optimism/Pessimism × Subjective Visual Impairment) interactions were statistically significant (ps < .05), but not the three-way interaction (with diagnosis). The positive association between subjective visual impairment and depressive symptoms was significant at low and moderate levels of optimism (ps < .001), but not at high optimism (p > .05). The association was significant at high and moderate levels (ps < .001), but not low (p > .05) levels of pessimism. CONCLUSIONS: Elevated depressive symptoms are evident in adults who do (vs. do not) receive a diagnosis of uveal melanoma but appear to remit within 3 months. Perceived impaired vision, especially coupled with low optimism or high pessimism, predicts depressive symptoms over time, with implications for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A prospective study of cancer-related benefit finding in uveal melanoma patients.

Little is known about contributors to the psychosocial impact of uveal melanoma, a rare cancer. Predictors and outcomes of benefit finding, a potentially favorable outcome, were investigated. Adults (n = 107) completed assessments prior to diagnosis of uveal melanoma and one week, three months and 12 months after diagnosis. Path analyses with the full information maximum likelihood estimation method were conducted. Objective disease impact on vision did not predict benefit finding (p > .05). Approach-oriented coping prior to diagnosis and one week later significantly predicted greater benefit finding 12 months later (p < .01). Avoidance-oriented coping at three months moderated the concurrent relationship of benefit finding and positive affect at 12 months (p < .001). This first study of predictors of benefit finding in uveal melanoma patients suggests that greater approach-oriented coping prospectively predicts higher benefit finding. Further, avoidance may condition the association of benefit finding with psychosocial outcomes.

Glaucoma After Iodine-125 Brachytherapy for Uveal Melanoma: Incidence and Risk Factors.

PRéCIS:: A single-center retrospective review over a 10-year period discovered an 8.6% risk of developing secondary open-angle glaucoma, and a 6.7% risk of neovascular glaucoma after brachytherapy for uveal melanoma. Additional risk factors were identified. PURPOSE: To report the incidence and identify risk factors for secondary open-angle glaucoma and neovascular glaucoma after iodine-125 brachytherapy for uveal melanoma in a tertiary ocular oncology and glaucoma practice. PATIENTS AND METHODS: Eyes of patients who had been diagnosed and treated with iodine-12 brachytherapy for uveal melanoma over a 10-year period were included for review. Secondary open-angle glaucoma was defined as meeting the following criteria: at least 3 measurements of intraocular pressure (IOP) ≥21 mm Hg after the removal of the iodine-125 plaque and an open angle on gonioscopy. Neovascular glaucoma was defined as meeting the following criteria: at least 3 measurements of IOP ≥21 mm Hg and neovascularization of the iris or anterior chamber angle. Cumulative incidence was calculated and survival analysis was used to analyze risk factors for both secondary open-angle glaucoma and neovascular glaucoma. RESULTS: A total of 374 eyes in patients diagnosed with uveal melanoma and treated with Iodine-125 brachytherapy were included in the study. Thirty-one eyes (8.6%) were diagnosed with secondary open-angle glaucoma and 25 eyes (6.7%) were diagnosed with neovascular glaucoma. Multivariate analysis identified the following risk factors for secondary open-angle glaucoma: older age, greater tumor size, iris location of uveal melanoma, higher baseline IOP, ciliary body involvement, and eyes having undergone combined brachytherapy with vitrectomy and silicone oil placement for radiation attenuation. The risk factors for neovascular glaucoma were as follows: greater tumor size, greater number of pack-years smoking history, pseudophakia, and higher grade of radiation retinopathy severity by fluorescein angiogram. CONCLUSIONS: We have identified additional risk factors for the development of both secondary open-angle glaucoma and neovascular glaucoma in patients with uveal melanoma who have undergone iodine-125 brachytherapy for local tumor control. The risk of secondary glaucoma is substantial. Close ophthalmic monitoring of patients is necessary for detection and timely treatment of glaucoma to maximize visual outcome.

Elevated Endogenous SDHA Drives Pathological Metabolism in Highly Metastatic Uveal Melanoma.

Purpose: Metastatic uveal melanoma (UM) has a very poor prognosis and no effective therapy. Despite remarkable advances in treatment of cutaneous melanoma, UM remains recalcitrant to chemotherapy, small-molecule kinase inhibitors, and immune-based therapy. Methods: We assessed two sets of oxidative phosphorylation (OxPhos) genes within 9858 tumors across 31 cancer types. An OxPhos inhibitor was used to characterize differential metabolic programming of highly metastatic monosomy 3 (M3) UM. Seahorse analysis and global metabolomics profiling were done to identify metabolic vulnerabilities. Analyses of UM TCGA data set were performed to determine expressions of key OxPhos effectors in M3 and non-M3 UM. We used targeted knockdown of succinate dehydrogenase A (SDHA) to determine the role of SDHA in M3 UM in conferring resistance to OxPhos inhibition. Results: We identified UM to have among the highest median OxPhos levels and showed that M3 UM exhibits a distinct metabolic profile. M3 UM shows markedly low succinate levels and has highly increased levels of SDHA, the enzyme that couples the tricarboxylic acid cycle with OxPhos by oxidizing (lowering) succinate. We showed that SDHA-high M3 UM have elevated expression of key OxPhos molecules, exhibit abundant mitochondrial reserve respiratory capacity, and are resistant to OxPhos antagonism, which can be reversed by SDHA knockdown. Conclusions: Our study has identified a critical metabolic program within poor prognostic M3 UM. In addition to the heightened mitochondrial functional capacity due to elevated SDHA, M3 UM SDHA-high mediate resistance to therapy that is reversible with targeted treatment.

Outcomes of Glaucoma Drainage Device Surgery in Eyes with Treated Uveal Melanoma.

AIM: We report patient safety and intraocular pressure (IOP) control after placement of a glaucoma drainage device (GDD) in eyes with a history of treated malignant uveal melanoma. METHODS: A retrospective review of the records of patients with uveal melanoma was performed. Outcomes were local tumor recurrence, rate of metastases, and to-nometric success, based on survival curves, defined as IOP < 21 mm Hg. RESULTS: Eleven eyes with choroidal melanoma, 4 with iris melanoma, and 1 with ciliary body melanoma were followed for a median (interquartile range) of 2.1 (1.1-3.2) years. Two subjects developed liver metastases; one had monosomy 3 and tumor gene expression profile class 2. The other case with ciliary body melanoma was negative for monosomy 3. There were no cases of local treatment failure. Mean preoperative IOP decreased from 30.5 ± 7.7 to 15.9 ± 8.1 mm Hg at 1 year after surgery (1-year success rate 80%). CONCLUSIONS: Our case series with a median follow-up of 2 years shows that placing a GDD in patients with treated uveal melanoma does not expose patients to greater risk of local or extraocular recurrence. A larger series and longer follow-up time are required to fully evaluate the safety of GDDs in this clinical scenario.

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology.

BACKGROUND: The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology. METHODS: Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey. RESULTS: Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded "nonactive" template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10. CONCLUSION: This study corroborates prior literature that surgeons' exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.

Clinic-based ultra-wide field retinal imaging in a pediatric population.

BACKGROUND: Pediatric retinal disorders, although uncommon, can be challenging to assess in the clinic setting and often requires an exam under anesthesia. The purpose of our study was to evaluate the use of ultra-wide field retinal imaging in children without sedation in an outpatient clinic. METHODS: We performed a retrospective case series of patients 18 years or younger who received ultra-wide field imaging over a one year period. The age, gender, and clinical course were documented. Color fundus and red-free images were reviewed to assess field of view. Ultra-wide field autofluorescence (UWF-FAF) was evaluated for abnormal autofluorescence patterns and ultra-wide field fluorescein angiography (UWF-FA) was assessed for angiographic phase and field of view. RESULTS: A total of 107 eyes of 55 patients with a mean age of 11.1 years (SD 3.7 years, range 3-18 years) were evaluated. Twenty-seven (49%) patients were male. The most common diagnosis was retinopathy of prematurity (7 of 55 patients, 12.7%) followed by trauma (7.4%), Coats disease (7.4%), and rhegmatogenous retinal detachment (7.4%). The number of quadrants visualized anterior to the equator correlated with patient age (r = 0.4, p < 0.01). On UWF-FA, 6 of 14 patients (43%) had images of the arterial phase captured and 14 of 14 patients (100%) had images of the venous phase or later captured. CONCLUSIONS: We demonstrated that UWF imaging is obtainable in children as young as 3 years old without sedation. UWF fundus photography, UWF-FAF and UWF-FA were useful clinical adjuvants to examination and provide additional information for documenting and monitoring pediatric retinal diseases.

A comparison of the shielding effectiveness of silicone oil vitreous substitutes when used with Palladium-103 and Iodine-125 eye plaques.

PURPOSE: Episcleral eye plaques provide excellent local control of ocular melanoma, but vision sparing remains a significant problem with 30% or more of patients experiencing significant visual acuity degradation. The use of silicone oil shielding with Iodine-125 plaques has previously been reported to improve critical structure sparing. We hypothesized that the use of Palladium-103 would improve the shielding effectiveness of silicone oil due to the strong energy dependence of the photoelectric effect. This Monte Carlo simulation study reports a comparison of the shielding effects of silicone oil when used in conjunction with Pd-103 and with I-125 plaques. MATERIALS AND METHODS: GEANT4 was used to simulate eye plaque treatments to an eye with either water-equivalent vitreous humor, or silicone oil in place of the vitreous humor. Two solid gold plaques, 15 and 23 mm, were simulated loaded with I-125 and with Pd-103 source seeds. Seed activity was normalized such that 85 Gy was delivered to the tumor apex in the water-equivalent cases. Tumor apex dose, central axis dose, and inner sclera dose reductions with silicone oil were evaluated. RESULTS: Silicone oil resulted in an underdosing to the tumor apex of 6.1% and 7.5% in the 15 mm plaque for I-125 and Pd-103, respectively, and 3.4% and 4.3% in the 23 mm plaque for I-125 and Pd-103, respectively. When renormalized to 85 Gy to the tumor apex in all scenarios, silicone oil reduced the dose to the inner sclera 90° from the plaque by 19-32% for the 15 and 23 mm plaques using I-125, and by 33-65% for the 15 and 23 mm plaques using Pd-103. CONCLUSIONS: The combination of silicone oil and Pd-103 eye plaques offers the potential for greatly improved sparing to normal structures compared to Pd-103 plaques alone or I-125 plaques with or without silicone oil.

Outcomes of cataract surgery in eyes with ocular melanoma treated with iodine-125 brachytherapy.

PURPOSE: To evaluate visual and surgical outcomes of cataract surgery in eyes with a history of iodine-125 (I125) brachytherapy for ocular melanoma. SETTING: Department of Ophthalmology, David Geffen School of Medicine at UCLA and the Stein Eye Institute, Los Angeles, California, USA. DESIGN: Retrospective case series. METHODS: Patients with ocular melanoma treated by I125 brachytherapy who subsequently had cataract surgery were evaluated. The recorded data included tumor size, location, preoperative ocular comorbidities, corrected distance visual acuity (CDVA), operative complications, and brachytherapy-related maculopathy before and after surgery. RESULTS: Thirty-two eyes of 32 patients were included. The mean age at the time of cataract surgery was 66.1 years. The median follow-up was 53.5 months. There were no intraoperative complications. Eighteen eyes (56.3%) had a history of preoperative radiation retinopathy, 10 involving the macula. Between 2 weeks and 4 weeks postoperatively, 22 eyes (68.8%) had an improvement in CDVA (≥2 lines). Seven of 10 eyes that failed to improve had radiation maculopathy. By the last follow-up examination, 13 eyes (40.6%) had improved CDVA, 9 eyes (28.1%) were worse (≥2 lines), and 10 eyes (31.3%) were unchanged (within ±1 line). Of 15 eyes that lost CDVA gains achieved between 2 weeks and 4 weeks postoperatively, 9 eyes had new-onset or worsening maculopathy. Cataract surgery had no effect on local tumor control or distant metastasis. CONCLUSIONS: Cataract surgery after I125 brachytherapy for ocular melanoma improved CDVA in most eyes during the immediate postoperative period. Gains were often lost with further follow-up. Progression of radiation maculopathy was primarily responsible for subsequent visual decline.

Correlation of Immunocytochemistry of BRCA1-associated Protein-1 (BAP1) With Other Prognostic Markers in Uveal Melanoma.

PURPOSE: Prior studies have shown that nuclear reactivity for BRCA1-associated protein-1 (BAP1) yields prognostic information for paraffin-embedded uveal melanomas. Lacking are immunocytochemical studies of BAP1 on fine needle aspiration biopsies of uveal melanoma that correlate with prognosis or other markers of prognosis. Our purpose was to fill this gap. DESIGN: Experimental laboratory study. METHODS: Fine needle aspiration biopsies were performed prospectively on 113 patients with uveal melanomas, garnering limited subsets of cases for comparison. Agreement between immunocytochemistry for BAP1 nuclear staining vs chromosome 3 ploidy analysis and gene expression profiling was assessed by 2 × 2 contingency table analysis. RESULTS: The presence or absence of suppression of nuclear expression of BAP1 was strongly associated (73%, P = .000002) with monosomy and disomy chromosome 3, respectively. BAP1 nuclear expression was also correlated with gene expression profiling. Chromosome 3 ploidy analysis correlated with gene expression profiles. CONCLUSION: When adequate material is obtained, immunocytology using BAP1 is a potentially informative tool for prognostication of uveal melanoma.

Sociodemographic, Medical, and Psychosocial Factors Associated With Supportive Care Needs in Adults Diagnosed With Uveal Melanoma.

Importance: Understanding supportive care needs in patients with cancer is important for developing approaches that enhance quality of life and promote satisfaction with care. Objective: To characterize the nature and frequency of sociodemographic, medical, and psychosocial factors associated with unmet needs in patients with uveal melanoma 1 week and 3 months after diagnosis. Design, Setting, and Participants: This 3-month, prospective, longitudinal survey study was conducted at a university-based ophthalmology practice from June 1, 2007, to July 1, 2011. Data were analyzed in April 2017. Consecutive patients (n = 429) scheduled for diagnostic evaluation for an intraocular abnormality were assessed for eligibility. Participants were ineligible (n = 25) if they were younger than 18 years, had previous advanced cancer, or evidenced cognitive impairment. Of the patients who provided informed consent (n = 306), those subsequently diagnosed with uveal melanoma by an ophthalmologist (n = 107) were included in the analysis. Main Outcomes and Measures: Unmet needs (ie, desire for help in psychological, physical, health information, communication, or social domains) were assessed using the Cancer Needs Questionnaire. Multivariable regression analyses determined factors associated with unmet need severity across 3 months. Results: One hundred seven patients (58 [54%] men; mean [SD] age, 59.0 [12.8] years) completed the baseline assessment. At 1 week after diagnosis, nearly all patients (85 of 86 [99%]) expressed at least 1 unmet need, as did 68 of 79 (86%) 3 months later. The most frequently endorsed needs were in the health information and psychological domains. Patients' unmet needs declined significantly over 3 months (mean [SD] change, -10.0 [14.4]; 95% CI, -6.4 to -13.6; t = -5.6). Sociodemographic and medical characteristics were unrelated to unmet need severity. However, higher prediagnosis instrumental social support (b = -0.2; 95% CI, -0.3 to -0.1; z = -2.8) and lower neuroticism (b = 0.3; 95% CI, 0.1-0.5; z = 2.9) predicted lower unmet need severity 1 week after diagnosis. Having a smaller social network predicted lower unmet need severity 3 months after diagnosis (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.4) as well as a decline in needs from diagnosis to 3 months later (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.3). Conclusions and Relevance: Within 1 week after diagnosis and 3 months later, most patients with uveal melanoma cited important health information and psychological needs. These findings suggest that prior to or at diagnosis, the severity of such needs and psychosocial factors that may be associated can be identified for proactive supportive intervention.

EARLY DETECTION OF RETINAL HEMANGIOBLASTOMAS IN VON HIPPEL-LINDAU DISEASE USING ULTRA-WIDEFIELD FLUORESCEIN ANGIOGRAPHY.

PURPOSE: To study the use of ultra-widefield fluorescein angiography (UWF FA) in the detection and management of retinal capillary hemangioblastomas in patients with von Hippel-Lindau disease. METHODS: This is a retrospective study of patients with von Hippel-Lindau disease who underwent UWF FA using the Optos camera at a single center from June 2009 to May 2015. The clinical use of UWF FA was reviewed, and the number of hemangioblastomas identified on UWF FA was compared with ophthalmoscopy and a simulated seven standard field (7SF) FA montage. RESULTS: Twenty eyes of 10 patients were identified. Only 33% of lesions seen on UWF FA were also found on ophthalmoscopy, and 88% of lesions visualized on UWF FA were located outside the 7SF overlay. In 5 eyes that had gaze steering, 18% of lesions could be visualized only on gaze-steered images. For the 14 eyes with data available, 6 had procedures recommended and 8 eyes observed based on data from UWF FA. One of 20 eyes had a lesion on ophthalmoscopy that was missed by imaging. CONCLUSION: Ultra-widefield FA using the Optos camera is helpful for the evaluation and management of patients with von Hippel-Lindau disease. The UWF FA with gaze steering appears to detect more hemangioblastomas than ophthalmoscopy and conventional angiography.

MACULAR MICROCYSTS IN SCHWARTZ-MATSUO SYNDROME.

PURPOSE: To describe a case of macular microcysts associated with advanced secondary glaucoma from Schwartz-Matsuo syndrome. METHODS: Clinical presentation, color fundus photography, optic disk photography, visual fields, and optical coherence tomography are presented. RESULTS: A 32-year-old woman presented with advanced, unilateral secondary glaucoma associated with a macula-on rhegmatogenous retinal detachment. She was diagnosed with Schwartz-Matsuo syndrome. Spectral domain optical coherence tomography showed macular microcystic changes in the paracentral retina at the level of the inner nuclear layer. CONCLUSION: Macular microcystic changes in the paracentral inner nuclear layer on spectral domain optical coherence tomography have been described in eyes with optic atrophy associated with a variety of diseases. This is the first described case of macular microcysts associated with advanced secondary glaucoma from Schwartz-Matsuo syndrome and may offer insights into the pathogenesis of these microcysts.