Clinical Outcomes of Symptomatic Horseshoe Tears After Laser Retinopexy.

Purpose: To determine the clinical course of patients treated for acute symptomatic horseshoe retinal tears (HSTs). Methods: A retrospective chart review was performed of patients presenting between January 2014 and December 2021 with acute onset of floaters and/or flashes who were found to have horseshoe retinal tear HRT(s) without retinal detachment (RD). Patients were included if they had at least 3 months of follow-up. Exclusion criteria were a rhegmatogenous RD (RRD) at initial presentation, asymptomatic HST(s), operculated hole, atrophic hole, retinal dialysis, history of trauma, or previous retinal surgery. Charts were reviewed for subsequent new HST(s), progression to RRD, and development of epiretinal membrane (ERM). Characteristics, including age, sex, eye laterality, phakic status, high myopia, lattice degeneration, and vitreous hemorrhage (VH) at initial presentation, were also noted. The main outcome measures were the percentage and timing of subsequent new HST(s), progression to RRD, and development of ERM. Results: The study included 216 eyes (199 patients). The mean age was 60.4 years. Of the eyes, 27.3% had lattice degeneration and 6.5% high myopia. At presentation, 25.9% of eyes had a VH. Twenty-seven eyes (12.5%) experienced new tear(s); 63.0% occurred between 1 month and 3 months. Progression to RRD occurred in 15 eyes (6.9%); 53.3% occurred within 3 months. On multivariate logistic regression, VH was a significant risk factor (odds ratio, 6.48; P = .002) for progression to new HST(s) or RRD. Conclusions: Eyes treated for acute symptomatic HSTs require ongoing follow-up. Although new retinal tears and progression to RRD tends to occur within 3 months, these events can occur later.

Current Concepts of the Uveitis-Glaucoma-Hyphema (UGH) Syndrome.

PURPOSE: To discuss the pathophysiology, etiology, and current management strategies of uveitis-glaucoma-hyphema (UGH) syndrome. METHODS: Literature review. RESULTS: The classic UGH syndrome associated with anterior chamber intraocular lenses (ACIOL) have decreased in incidence with the modernization of IOL design and surgical techniques. The current UGH syndrome is increasing in prevalence largely related to a parallel increase in late onset dislocations of intraocular lenses (IOLs) and the developing techniques to remedy that condition. The modern features of UGH can present as cystoid macular edema, intraocular pressure elevation typically not attributed to UGH, and recurrent vitreous hemorrhage, unlike the original description as described by Ellingson in 1978. Medical management to control inflammation, reduce intraocular pressure, and reduced the bleeding diathesis are mainstays of therapy. However, surgery with IOL repositioning or exchange should be reserved for cases that are refractory to or progressing despite medical treatment. CONCLUSIONS: UGH syndrome is an increasingly common, poorly understood, and often subtle, manifestation of an anatomic disturbance post intraocular surgery that persists with continued evolution of intraocular surgical techniques and new imaging modalities to aid in its diagnosis.

Presumed retinal pericapillary astrocytic hamartoma: multimodal imaging findings of a novel hamartomatous lesion.

PURPOSE: To describe the multimodal imaging findings of retinal lesions that clinically resemble retinal astrocytic hamartomas (RAHs), but also have unique characteristics that we believe represent a novel variant. METHODS: Observational study. Five eyes in five patients with solitary retinal lesion evaluated at the retina division of three institutions. We describe the multimodal imaging findings including fundus photography, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography (OCT), swept-source OCT, swept-source OCT angiography and ultrasonography. RESULTS: The retinal lesions described shared similar appearance to RAHs but demonstrated unique features such as glistening granular appearance on fundus photographs with perivascular hyperreflectivity with OCT and OCT angiography. CONCLUSION: The lesions described herein appear to have unique characteristics that warrant a designation as a novel RAH variant. The name presumed retinal pericapillary astrocytic hamartoma is suggested.

Augmented Posterior Hyaloid Adhesion Associated With Retinal Detachment After Macular Hole Repair.

BACKGROUND AND OBJECTIVE: There remains a low but intractable risk of rhegmatogenous retinal detachment (RRD) after surgical repair of macular holes (MHs). The purpose of this study is to identify potential causes for RRDs after MH surgery. PATIENTS AND METHODS: The authors retrospectively examined a single surgeon series of stage 3 MH repair surgeries during a 5-year period. Clinical data, including preoperative, intraoperative, and postoperative evaluations, were reviewed to determine potential causes of RRD. RESULTS: Of the 332 eyes that received MH surgery, 12 (3.6%) developed postoperative RRD. Seven RRD cases exhibited no evident precursor pathology; however, augmented posterior hyaloid adhesions (APHAs) were found intraoperatively and postoperatively. CONCLUSIONS: In MH surgery, APHA increases risk for RRD. During PPV, the vitreous typically separates to the peripheral vitreous base. Some eyes have APHAs near the equator that cannot be elevated, consistent with strong adhesion. The authors believe the high postoperative RRD rate is due to continued hyaloid elevation after surgery. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:635-638.].

Increased Inner Retinal Layer Reflectivity in Eyes With Acute CRVO Correlates With Worse Visual Outcomes at 12 Months.

Purpose: To determine if inner retinal layer reflectivity in eyes with acute central retinal vein occlusion (CRVO) correlates with visual acuity at 12 months. Methods: Macular optical coherence tomography (OCT) scans were obtained from 22 eyes of 22 patients with acute CRVO. Optical intensity ratios (OIRs), defined as the mean OCT reflectivity of the inner retinal layers normalized to the mean reflectivity of the RPE, were measured from the presenting and 1-month OCT image by both manual measurements of grayscale B-scans and custom algorithmic measurement of raw OCT volume data. OIRs were assessed for association with final visual outcome. Cohort subgroup division for analysis was determined statistically. Results: Eyes with poorer final visual acuity (≥20/70) at 1 year were more likely to have a higher ganglion cell layer OIR than eyes with better final visual acuity (<20/70) at 1 month (manually: 0.591 to 0.735, P = 0.006, algorithmically: 0.663 to 0.799, P = 0.014). At 1 month, eyes with a poorer final visual acuity demonstrated a higher variance of OIR measurements (algorithmically: 0.087 vs. 0.160, P = 0.002) per scan than eyes with better final visual acuity. Conclusions: In acute CRVO, ganglion cell layer changes at 1 month, including increased reflectivity and increased heterogeneity of reflectivity signal as expressed as OIR and OIR variance, were associated with a poorer visual prognosis at 1 year. Technique calibration with larger sample sizes and automated integration into OCT platforms will be necessary to determine if OIR can be a clinically useful prognostic tool.

Choroidal Involvement in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

BACKGROUND AND OBJECTIVE: To evaluate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective study in five eyes of three patients evaluated through multimodal imaging, including enhanced-depth imaging optical coherence tomography (OCT), ultra-wide field color photography, fundus autofluorescence, and fluorescein angiography (FA). Choroidal thickness and structure were evaluated on OCT. RESULTS: During the acute phase, choroidal OCT showed choroidal thickening and a lucency at the level of the inner choroid. Subclinical lesions detected in the retinal periphery using wide-field retinal imaging were isoautofluorescent and corresponded to choriocapillaris filling-defects on FA. At final follow-up, all patients showed resolution of choroidal thickening and the inner choroidal lucency, as well as the disappearance of subclinical lesions. CONCLUSION: These results suggest a transient ischemic choroiditis in APMPPE that may lead to secondary permanent retinal pigment epithelium damage in the posterior pole but not in the retinal periphery.

Gemcitabine associated retinopathy and nephropathy.

PURPOSE: To report a case of presumed gemcitabine-induced retinopathy and nephropathy. METHODS: Case Report. Retrospective chart review. RESULTS: A 64-year-old woman with a recent diagnosis of metastatic cholangiocarcinoma presented with progressive visual loss and renal failure shortly after the initiation of a chemotherapy regimen which included gemcitabine. Clinical examination and fluorescein angiography showed findings of severe retinal ischemia. CONCLUSION: Although gemcitabine chemotherapy has been reported to cause a Purtscher-like retinopathy, we propose in our patient a gemcitabine-induced vasculopathy that lead to significant retinal and renal ischemia.

Incidence of cystoid macular edema with iris-fixated posterior chamber intraocular lenses in patients presenting with lens dislocation.

The aim of this study is to determine the incidence of cystoid macular edema (CME) following repositioning and McCannel iris-suturing of dislocated intraocular lenses. This study is conducted in an urban private practice. A retrospective chart review was performed on consecutive patients who presented with posteriorly dislocated IOLs and underwent iris-sutured posterior chamber (PC) intraocular lens (IOL) placement using the McCannel suture technique by a single surgeon for IOL repositioning from December 2008 to August 2012. All charts were reviewed for etiology of dislocation, time elapsed from cataract surgery, best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and dilated fundus examination. Presence of CME was determined by spectral domain optical coherence tomography (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA). Of the 58 cases reviewed, lens dislocation resulted from trauma in 21 %, zonular incompetence in 17 %, recent intraocular surgery in 12 %, and unknown in 50 %. Mean best-corrected logMAR visual acuity improved from 1.07 preoperatively to 0.52 postoperatively (P < 0.001). The mean follow-up time was 7.8 months. Two cases (3.4 %) of CME occurred postoperatively at a mean follow-up time of 4.5 months. Of these two patients, one had concurrent fragmetome lensectomy at the time of initial surgery. Iris-sutured PC IOL placement in this case series resulted in an improvement in BCVA with a low incidence of CME.

Delayed macular hole formation after demarcation laser photocoagulation for subclinical retinal detachment.

The purpose of this paper is to report a series of macular holes that developed after demarcation laser photocoagulation for subclinical retinal detachments. This observational case series consists of three eyes from three patients seen between 2005 and 2012. Delayed idiopathic macular hole formation occurred following demarcation laser photocoagulation for subclinical retinal detachment. Demarcation laser photocoagulation of subclinical retinal detachments may predispose to macular hole formation.

Ab interno management of blocked Ahmed valve in the posterior segment.

PURPOSE: To report a case of late failure of a posterior segment placed Ahmed valve in a uveitic eye with a corneal graft and a minimally invasive, ab interno approach in restoring valve function, pressure control, and preservation of vision. DESIGN: Case report. METHODS: A 25 gauge trans-conjunctival 3-port pars plana vitrectomy was performed to inspect and clean the ostium of the Ahmed valve of any vitreous debris. The Ahmed valve was not disturbed externally and conjunctival dissection was not performed. A 27-gauge blunt cannula was introduced through the vitrector site and used to cannulate the tube and flush it with balanced salt solution. A bleb was immediately re-established and all instruments were removed requiring no sutures. RESULTS: Intraocular pressure returned to target levels and a filtration bleb was re-established. Corneal graft clarity was restored with resolution of preoperative microcystic edema. Postoperative inflammation was minimal and vision was restored. CONCLUSIONS: A nonfunctioning tube shunt residing in the vitreous cavity may be revised ab interno without disturbing the shunt placement or the conjunctiva under which it resides to re-establish filtration.

Macular hole surgery prognostic success rates based on macular hole size.

BACKGROUND AND OBJECTIVE: To evaluate the correlation between macular hole (MH) surgery outcomes and preoperative factors believed to affect surgical success rates. PATIENTS AND METHODS: A retrospective, consecutive case series was designed to evaluate the correlation between anatomic success and preoperative factors: MH duration prior to surgery, visual acuity (VA), and MH diameter measured by optical coherence tomography (OCT) at the base and the narrowest midpoint. RESULTS: A total of 153 eyes were enrolled. There was no significant difference in mean duration prior to surgery for MH success and failure (P = .13). Mean preoperative VA was significantly better for MH success than failure (P = .03). Mean mid-hole diameter (P < .001) and mean base-hole diameter (P < .001) were significantly less for MH success than failure. Failure rate was 0% among eyes with mid-hole diameter less than 500 microns and 14.9% with mid-hole 500 microns or greater (P < .001). Failure rate was 0% among eyes with base-hole diameter less than 500 microns, 1.4% with base-hole 500 to 999 microns, and 19.1% with base-hole of 1,000 microns or greater (P = .001). CONCLUSION: Preoperative VA, mid-hole diameter, and base-hole diameter are correlated with anatomic success in MH surgery. An excellent surgical prognosis exists for MHs with mid-hole diameter less than 500 microns and base-hole less than 1,000 microns.

Quantitative assessment of a Tanzanian integrated conservation and development project involving butterfly farming.

Scientific understanding of the role of development in conservation has been hindered by the quality of evaluations of integrated conservation and development projects. We used a quasi-experimental design to quantitatively assess a conservation and development project involving commercial butterfly farming in the East Usambara Mountains of Tanzania. Using a survey of conservation attitudes, beliefs, knowledge, and behavior, we compared 150 butterfly farmers with a control group of 170 fellow community members. Due to the nonrandom assignment of individuals to the two groups, we used propensity-score matching and weighting in our analyses to control for observed bias. Eighty percent of the farmers believed butterfly farming would be impossible if local forests were cleared, and butterfly farmers reported significantly more participation in forest conservation behaviors and were more likely to believe that conservation behaviors were effective. The two groups did not differ in terms of their general conservation attitudes, attitudes toward conservation officials, or knowledge of conservation-friendly building techniques. The relationship between butterfly farming and conservation behavior was mediated by dependency on butterfly farming income. Assuming unobserved bias played a limited role, our findings suggest that participation in butterfly farming increased participation in conservation behaviors among project participants because farmers perceive a link between earnings from butterfly farming and forest conservation.

Optical coherence tomography features of acute central serous chorioretinopathy versus neovascular age-related macular degeneration.

OBJECTIVE To compare the optical coherence tomography (OCT) features of acute central serous chorioretinopathy (CSC) versus neovascular age-related macular degeneration (AMD), and to determine if OCT features can distinguish between these two entities. METHODS A retrospective, observational study of 50 eyes with CSC and 50 eyes with neovascular AMD. Stratus OCT line scans (5 mm) were reviewed for presence of subretinal/intraretinal fluid and retinal pigment epithelium detachment. The height of the fluid and detachments were measured using the OCT manual callipers, and the morphology of the highly reflective line was described. RESULTS Intraretinal fluid (IRF), pigment epithelial detachment (PED), irregularities, thickening and attenuation of the highly reflective line were more often associated with AMD. When present, the PED was significantly greater in AMD than CSC. Patients with CSC were more likely to have subretinal fluid (SRF), and when present, the SRF height was significantly greater in CSC. Patients CSC also had more hypertrophic outer retinal changes on OCT compared with AMD. CONCLUSION Neovascular AMD and acute CSC have distinguishing features on OCT that may help clinicians to differentiate accurately between the two conditions primarily using OCT.

Spontaneous resolution of unilateral vitreomacular traction.

Vitreomacular traction (VMT) caused visual symptoms in two healthy young adults but spontaneously resolved within four weeks without any sequelae. Optical coherence tomography (OCT) and fundus photographs proved vital in documenting the rare complete resolution of VMT. It is prudent to monitor for spontaneous resolution of VMT in young healthy adults.

Sexual orientation and education politics: gay and lesbian representation in American schools.

In what has sometimes provoked a "culture war" over America's schools, gays and lesbians have sought an expanded voice in the making of education policy. This paper explores the factors that promote gay representation on school boards, how this variable in turn influences gay representation in both administrative and teaching positions, and how all three forms of gay representation relate to school board policies regarding sexual orientation education. Three of the four models drawn from the social movement literature help to explain gay school board representation. In a manner similar to other minority groups, gay representation on school boards directly or indirectly promotes the appointment of gays to administrative and teaching positions and the adoption of policies that address the problems faced by gay and lesbian students in the public schools.