Unilateral, Sectoral Retinal Metastasis of Small-Cell Lung Cancer Mimicking Viral Retinitis.

PURPOSE: To report a case of unilateral, sectoral retinal metastasis of small-cell lung cancer (SCLC) that mimicked cytomegalovirus (CMV) retinitis. METHOD: Case report. RESULTS: A 48-year-old woman presented with a four-week history of a visual field loss in her right eye. She had a past medical history of extensive-stage SCLC with brain metastasis, stable on maintenance atezolizumab for two years. On initial presentation, she was diagnosed with CMV retinitis. No improvement was observed with 4 weeks of oral valganciclovir. Upon referral for a second opinion, her fundus exam appeared compatible with CMV retinitis, and anterior chamber tap for polymerase chain reaction for viral etiologies was performed followed by intravitreal and intravenous ganciclovir without improvement. She was referred for a third opinion, where diagnostic vitrectomy with vitreous and retinal biopsies were consistent with SCLC metastatic to the retina. The patient underwent enucleation of the right eye for definitive pathologic analysis and subsequently was started on additional systemic chemotherapy. CONCLUSION: Retinal metastases are exceedingly rare, particularly retinal metastasis of SCLC. Retinal metastasis should be considered in patients initially diagnosed with viral retinitis who fail to improve despite antiviral therapy, particularly if they have a known history of malignancy. Furthermore, retinal metastasis of SCLC potentially could be misdiagnosed histopathologically as retinoblastoma if the patient's history is unknown and appropriate immunohistochemical stains are not performed.

AN ATYPICAL CASE OF SOLAR MACULOPATHY.

PURPOSE: To present a case of atypical solar maculopathy. METHODS: Case report. RESULTS: A 7-year-old boy who viewed an eclipse 17 months earlier had macular findings blending features of solar and laser pointer maculopathies. The right macula clinically had a central 1,000-µm, slightly irregular round area of pigmentary changes and a tiny outer macular optical coherence tomography defect. In addition, the superior fovea had a hyperreflective mound-like retinal pigment epithelial detachment extending into the outer retina. The left macula contained several, more typical solar maculopathy lesions. CONCLUSION: We describe a unique case of solar maculopathy displaying typical optical coherence tomography findings in both eyes along with a unilateral laser pointer-like hyperreflective retinal pigment epithelial detachment.

AN ATYPICAL CASE OF OPTIC DISK PSEUDO-DUPLICATION WITH PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To present a unique case of optic disk pseudo-duplication with proliferative diabetic retinopathy. METHODS: Case report. RESULTS: A 63-year-old white diabetic man presented with an apparent duplicated optic disk in the superonasal midperiphery of his left eye. A large flat frond of neovascularization fanned out from this structure. Optical coherence tomography scanning showed a noncolobomatous scar with a large plume of blood vessels sprouting from the choroid, thru the retina and branching out into the vitreous. Magnetic resonance imaging scanning revealed a normal left globe and orbit with a single optic nerve. The neovascularization regressed after panretinal photocoagulation and anti-vascular endothelial growth factor therapy. CONCLUSION: We describe a unique case of proliferative diabetic retinopathy associated with pseudo-duplication of the optic disk. This case is unique in the peripheral location of the pseudo-duplication, the presence of spontaneous choroidovitreal neovascularization in proliferative diabetic retinopathy, and the appearance of neovascularization elsewhere mimicking neovascularization of the duplicated disk.

AUTOFLUORESCENCE AND YELLOWING SUBHYALOID BLOOD WITH PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To present a patient with a subhyaloid hemorrhage from proliferative diabetic retinopathy who showed a unique contrast between the fundus autofluorescent patterns of yellow with red blood. METHODS: Analysis of color and autofluorescence fundus photographs of a patient with an aging subhyaloid hemorrhage. RESULTS: The remnants of a resorbing subhyaloid hemorrhage had two layers, a superior yellow portion that was intensely hyperautofluorescent and an inferior relatively hypoautofluorescent red portion. We argue that the yellow appearance of the devitalized blood and fluorophores imaged are related to free-base porphyrins. CONCLUSION: Fundus autofluorescence is a useful modality to image subhyaloid blood and may lend important insights into the fluorophores that hyperfluoresce. The blood breakdown products are potentially toxic and autofluorescence imaging may offer clues to their presence.

REVISED CLASSIFICATION OF THE OPTICAL COHERENCE TOMOGRAPHY OUTER RETINAL BANDS BASED ON CENTRAL SEROUS CHORIORETINOPATHY ANALYSIS.

PURPOSE: To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS: Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS: Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION: Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.

The outer Bruch membrane layer: a previously undescribed spectral-domain optical coherence tomography finding.

PURPOSE: To report a previously undescribed spectral-domain optical coherence tomography finding, the outer Bruch membrane layer. METHODS: Prospective case descriptions. RESULTS: Patients with variable macular abnormalities were examined with spectral-domain optical coherence tomography scanning. All had areas of either retinal pigment epithelial elevation or atrophy with an underlying hyperreflective band that we interpret as the outer Bruch membrane layer. CONCLUSION: The outer Bruch membrane is a consistent optical coherence tomography finding in areas of absent, atrophic, or elevated retinal pigment epithelium.