OCTA changes following loading phase with intravitreal aflibercept for DME.

OBJECTIVE: To quantify changes in optical coherence tomography angiography (OCTA) parameters following intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema (DME), and to assess associations between pretreatment OCTA parameters and visual outcomes. DESIGN: Prospective cohort study. METHODS: Twenty-nine patients with DME received 5 monthly intravitreal injections of aflibercept. OCTA data obtained at baseline and at 6 months were compared using the Wilcoxon signed-rank test. OCTA parameters were foveal avascular zone (FAZ) area, FAZ perimeter, FAZ circularity, vessel density in the superficial vascular plexus (segmented into central, inner, outer, and full Early Treatment of Diabetic Retinopathy Study [ETDRS] map regions. Subanalysis divided patients into treatment responders (reduction of central subfield thickness >50 µm over treatment) and nonresponders. Associations between pretreatment OCTA parameters and visual acuity outcomes were analyzed using multivariable linear and logistic regression. RESULTS: A total of 29 patients were included: 25 patients (86.2%) had nonproliferative diabetic retinopathy, and 4 patients (13.8%) had proliferative diabetic retinopathy. Vessel density was reduced in the central (p = 0.004) and inner (p = 0.013) ETDRS map regions. This effect was significant only among treatment responders (central p = 0.002; inner p = 0.017). Pretreatment OCT and OCTA parameters were not associated with final visual acuity outcomes. CONCLUSION: Following intravitreal aflibercept treatment for DME, there was a significant decrease in vessel density of the superficial vascular plexus at the central and inner ETDRS map regions. This was seen only among treatment responders. Observations here are likely to represent the limits of OCTA technology itself, where pretreatment vessel density may have been artifactually overestimated by suspended scattering particles in motion. Pretreatment OCTA parameters did not serve as biomarkers for visual outcome following anti-vascular endothelial growth factor therapy.

Outcomes of Using Sutureless, Scleral-Fixated Posterior Chamber Intraocular Lenses.

Background. Implantation of sutureless, scleral-fixated posterior chamber intraocular lenses (SSFIOL) is a promising option in the surgical management of patients unable to undergo standard cataract surgery due to insufficient capsular support. The purpose of this study was to describe the indications, visual outcomes and complications of SSFIOL implantation.Methods. Retrospective, investigational cohort study of 112 consecutive SSFIOL implantations between July 2013 and August 2017. Pre-operative ocular morbidity, operative indications, postoperative outcomes, complications, and reinterventions were summarized. Visual and refractive outcomes were compared between the pre- and latest postoperative visit using Wilcoxon signed-ranked test.Results. Mean follow-up: 13.0 ± 10.4 months. Primary surgical indication was dislocated IOL due to zonular weakness (77 eyes (68.8%)). At latest follow-up, there was improvement in uncorrected visual acuity (1.3 ± 0.8 to 0.64 ± 0.60 logMAR, p < .01), best-corrected visual acuity (BCVA) (0.6 ± 0.5 logMAR to 0.36 ± 0.40 logMAR, p < .01). Postoperative complications included transient IOP elevation >30 mmHg (26.8%), cystoid macular edema (CME) (14.3%), transient hypotony (13.4%), iris capture (12.5%), uveitis-glaucoma-hyphema (UGH) syndrome (11.6%), vitreous hemorrhage (VH) (6.3%). Operative reinterventions included SSFIOL exchange (3.6%), SSFIOL repositioning (5.4%), SSFIOL removal (2.7%). Ten (8.9%) patients required multiple re-interventions.Conclusion. SSFIOL implantation is a reasonable option for eyes with inadequate capsular support, resulting in visual improvement in most patients. Many of the surgical complications were related to a floppy iris-lens diaphragm (UGH syndrome, iris capture), which were predisposed in eyes with complex pathology. Surgical modifications can be made to minimize the iris-related complications.

Histopathology in a dissecting conjunctival filtering bleb.

CASE REPORT: Four years after trabeculectomy, a patient developed unilateral tearing and presented with an ipsilateral conjunctival filtering bleb that had dissected into the cornea. The corneal portion of the bleb was excised for symptomatic relief. Histopathological examination disclosed dissection of the conjunctival filtering bleb into the cornea between Bowman's layer and the corneal epithelium. The internal portion of the bleb consisted of loose stromal tissue lacking any internal epithelial lining. COMMENTS: A conjunctival bleb dissecting into the cornea is a well-described late complication of trabeculectomy; however, its pathophysiology remains controversial. The subepithelial dissection plane in this specimen supports the concept that the conjunctival filtering bleb may dissect into, as well as "overhang", the limbal cornea.

Orbital cholesterol granuloma and cholesteatoma: significance of differentiating the two.

Cholesteatoma and cholesterol granuloma are relatively rare lesions of the orbit. Both may involve the superior orbit and present with globe ptosis, proptosis, and double vision developing over weeks to years. In addition to their etiology being unknown, the nomenclature regarding these tumors historically has been confusing, with a variety of names being used to describe them. Their histopathology shares numerous similarities but has one key distinguishing feature: The cholesterol granulomas lack an epithelial lining, whereas the cholesteatomas have an epithelial lining. Surgical removal is the treatment of choice for both tumors. It is important to differentiate the two as the prognosis with recurrence differs. Cholesteatoma may recur with the possibility of malignancy found at the time of re-exploration. We present a case of each tumor type, illustrating their similarities and highlighting the histopathologic findings and treatment recommendations.

An infected porous polyethylene orbital implant.

A 75-year-old man underwent enucleation with placement of a porous polyethylene orbital implant (Medpor, Porex Technologies, Fairburn, GA, U.S.A.). Over the next 5 years, he was seen on numerous occasions with socket discharge that was unresponsive to a variety of eyedrops. Exposure and re-exposure of the implant occurred, and the implant was removed. Histopathologic assessment was consistent with an infectious process within the implant. Postoperatively, the patient's symptoms and signs resolved. Porous orbital implant infection is rare. The diagnosis may be delayed as the initial symptoms and signs (discharge, conjunctival inflammation) may easily be attributed to prosthesis wear. With time, and persistence of the symptoms despite numerous treatments, infection should be suspected.

Merkel cell carcinoma masquerading as a chalazion.

CASE REPORT: A 62-year-old woman presented with a large rapidly growing violaceous mass initially diagnosed as a chalazion. Histopathologic examination disclosed Merkel cell carcinoma (MCC). Radiotherapy was not tolerated. Despite chemotherapy, she succumbed to widespread metastases 13 months later. COMMENTS: MCC must be included in the differential diagnosis of solitary eyelid nodules, requiring early and aggressive treatment.

Orbital schwannoma: histopathologic correlation with magnetic resonance imaging.

CASE REPORT: A 45-year-old man presented with an orbital tumour that on MRI was most consistent with a hemangioma. Histopathologic examination disclosed an orbital schwannoma, with cystic and mucinous degeneration complicating radiologic interpretation. COMMENTS: An array of ancillary studies including orbital ultrasonography may be useful in substantiating the diagnosis preoperatively.

Solitary osseous plasmacytoma of the orbit with amyloidosis.

A 40-year-old woman with an orbital lesion presented with a history of slowly progressive proptosis. A thorough systemic workup did not reveal any stigmata of multiple myeloma, and she was treated with a course of orbital radiotherapy. Histopathologic studies of the biopsy specimen revealed a proliferation of neoplastic plasma cells, which produced monoclonal lambda light chains surrounding concretions of congophilic, amorphous material. The lesion was diagnosed as a solitary osseous plasmacytoma of the orbit containing amyloid.