Orbital Complications and Cost Analysis of Enucleation by Myoconjunctival versus Conventional Techniques for Retinoblastoma.

Introduction: The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma. Methods: This retrospective cohort and cost analysis reviewed patients with retinoblastoma treated by primary or secondary enucleation between 2003 and 2021 and a minimum 6-month follow-up. Cases were reviewed for three postsurgical complications: chronic conjunctivitis, implant exposure/extrusion, and cellulitis. Cases were excluded if surgery was performed elsewhere or documentation was incomplete. Treatment costs were estimated based on two sample cases billed in 2021 that manifested the studied complications and represented each of the two surgical techniques. Univariate and multivariate analyses were applied to compare complication rates and treatment costs. Results: Included were 180 eyes (179 patients); 239 eyes (227 patients) were excluded. Patients had median age of 18.9 (0-104.4) months at diagnosis, the majority were male (94, 52%), with unilateral (115, 64%) group D or E (163, 91%) eyes. Enucleation was performed by conventional techniques in 107 eyes (59%) and by myoconjunctival approach in 73 (41%). Orbital complications occurred in 61 eyes (34%) during a median follow-up of 7.9 (0.5-33.7) years, more frequently in the conventional technique group (p = 0.014). The myoconjunctival technique had significantly lower costs for implant price (p < 0.001) and estimated treatment cost, including complication management (p < 0.001). Conclusion: Enucleation by myoconjunctival technique showed significantly less complication burden and treatment cost, indicating advantages over conventional approaches. Study limitations include the retrospective nature, confounders' complexity, and follow-up time variations.

Gender and research productivity of award recipients among Canadian national ophthalmology and affiliate subspecialty societies.

BACKGROUND: Although women remain historically underrepresented in medical achievement awards, gender distribution of award recipients in ophthalmology in Canada remain to be explored based on research productivity metrics. OBJECTIVE: To characterize the gender distribution of award recipients among the main Canadian national ophthalmological societies and subspecialty affiliates based on research productivity, graduate degrees, affiliated institution, and award type. DESIGN: Retrospective, observational study. METHODS: Award recipients were selected from the Canadian Ophthalmological Society (COS), Canadian Association of Paediatric Ophthalmology and Strabismus (CAPOS); Canadian Cornea, External Disease, and Refractive Surgery Society (CCEDRSS); Canadian Council of Ophthalmology Residents (CCOR) Research Proposal Award; and Canadian Glaucoma Society (CGS). The recipients' gender was determined by web search for the gender-specific pronoun, profile photograph check, or using Gender-API. Outcomes included gender distribution of recipients per award, society, year, and training level and differences in research productivity. RESULTS: Thirteen special awards were given to 255 recipients (215 individuals) from 1995 to 2022. In total, 31% of recipients were women, the majority being from Canada. Women had a significantly lower median h-index (2.0 (0-62) women versus 4.0 (0-81) men, p = 0.001) and number of published documents (3.0 (0-213) women versus 8.0 (0-447) men, p < 0.001). On stratified analyses by type of award (research or lifetime achievement) and level of training (trainee or ophthalmologist), significant differences were found for mean h-index and number of publications for awardees within the research category (p = 0.01 and p = 0.02, respectively) and trainee level (p = 0.01 and p = 0.02, respectively). Overall, women's proportion rates in awards did not reach parity in 27 out of the 28 years analyzed. CONCLUSION: Women were confirmed to be historically minored in proportion among the prominent society awards in Canada, with attested research disparity possibly explaining some of this bias. These findings require further confirmation in larger cohorts accounting for additional educational, institutional, and provincial factors. REGISTRATION: Not applicable.

Retinal Ischemic Perivascular Lesions in Individuals With Atrial Fibrillation.

Background We previously demonstrated that retinal ischemic perivascular lesions (RIPLs), which are indicative of ischemia in the middle retina, may be a biomarker of ischemic cardiovascular disease. In this study, we sought to determine the relationship between RIPLs and atrial fibrillation, a common source of cardiac emboli. Methods and Results In this case-control study, we identified individuals between the ages of 50 and 90 years who had undergone macular spectral domain optical coherence tomography imaging. Individuals with atrial fibrillation were identified, and age- and sex-matched individuals from the same pool, but without a diagnosis of atrial fibrillation, were selected as controls. Spectral domain optical coherence tomography scans were reviewed by 3 independent and masked observers for presence of RIPLs. The relationship between RIPLs and atrial fibrillation was analyzed using multivariable logistic regression models. There were 106 and 91 subjects with and without atrial fibrillation, respectively. The percentage of subjects with RIPLs was higher in the atrial fibrillation group compared with the control group (57.5% versus 37.4%; P=0.005). After adjusting for age, sex, smoking history, hypertension, diabetes, coronary artery disease, carotid stenosis, stroke, and myocardial infarction, the presence of RIPLs was significantly associated with atrial fibrillation, with an odds ratio of 1.91 (95% CI, 1.01-3.59). Conclusions RIPLs are significantly associated with atrial fibrillation, independent of underlying ischemic heart disease or cardiovascular risk factors. This association may inform the diagnostic cardiovascular workup for individuals with RIPLs incidentally detected on optical coherence tomography scan of the macula.

A bullous variant of central serous chorioretinopathy treated with oral spironolactone / Uma variante bolhosa da coriorretinopatia serosa central tratada com espironolactona oral

ABSTRACT We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes.

RESUMO Relatamos o caso de um homem de 39 anos apresentando perda visual no olho direito há seis semanas. A melhor acuidade visual corrigida foi conta-dedos no olho direito e 20/30 no esquerdo. A fundoscopia demonstrou descolamento de retina direito inferiormente com extensão à fóvea e descolamento macular seroso à esquerda. Após estudos de imagem multimodal, o paciente foi diagnosticado com uma variante bolhosa de coriorretinopatia serosa central e tratado com espironolactona oral associada à fotocoagulação a laser adjuvante. As alterações retinianas resolveram após seis meses. A acuidade visual final foi 20/20 em ambos os olhos.

Anterior segment phenotypic changes in late-onset retinal degeneration with Ser163Arg mutation in CTRP5/C1QTNF5.

PURPOSE: Late-onset retinal degeneration (L-ORD) is a rare retinal dystrophy with anterior segment (AS) abnormalities, including long anterior zonules (LAZ) and iris atrophy. This investigation evaluates AS changes in a L-ORD cohort. METHODS: Prospective, longitudinal study including L-ORD individuals (Ser163Arg) with ocular exam and standard slit-lamp photographs between 2011 and 2022. AS images were merged and assessed for LAZ number and zonule-free zone (ZFZ) radius. Further clinical findings such as iris atrophy patterns were reported descriptively. RESULTS: Twelve eyes of 6 patients (4 males, median age = 60.5 years) were included, showing a median of 160 (11-372) LAZs, mainly localized superiorly (39%) and inferiorly (24%). There was a high inter-ocular correlation (rs = 0.94, p < 0.01), no difference in LAZ count between eyes (p = 0.82), and an inverse relationship between LAZ and age (r = - 0.82; p < 0.05). The ZFZ had median 2.1 mm (1.3-5.4), with no inter-ocular difference (p = 0.31). Iris transillumination defects occurred in 11/12 eyes, with 4 major patterns identified: pupillary ruff rarefaction (10/12), patchy atrophy (6/12), notched defects (6/12), and radial streaks (2/12). In a short-term follow-up of 5.9 years, 4 eyes showed a reduction in LAZ count to median 139.5 (67-169) (p = 0.50) and a concomitant increase in ZFZ measurement to median 2.2 (1.7-2.6) (p = 0.17). CONCLUSION: This study confirms symmetric LAZs count and ZFZ in L-ORD, with ZFZ measurements smaller than in previous cohorts. A reduction in LAZs count and an increase in ZFZ with age were suggested longitudinally, yet findings need further evaluation as follow-up was limited to two cases.

Oncologist-led germline genetic testing for uveal melanoma.

PURPOSE: To report the genotype and phenotype of a cohort of unselected uveal melanoma (UM) patients who had germline multi-gene panel genetic testing, including the BAP1 gene, from a large multi-ethnic cancer centre. We describe the central role of the medical genetics clinic in collaboration with oncologists in a mainstreaming model to facilitate genetic testing, counselling and streamlining of patients with hereditary cancer predisposition. METHODS: A retrospective chart review of clinical and genetic findings of unselected UM patients who had germline genetic testing between December 2019 and October 2021 was conducted. Extracted DNA from peripheral blood samples were analyzed with a multi-gene panel that included at least six genes associated with hereditary melanoma. The correlation between the genotype and the phenotype of the cohort was evaluated. Statistical analysis comprised descriptive and comparative statistics with significance assigned at p < .05. The genetics clinic streamlined patients among the relevant oncology clinics for cancer screening in germline BAP1 positive individuals. RESULTS: In unselected UM patients, 3.5% (4/114) tested positive for a BAP1 pathogenic variant. Germline BAP1 status was associated with a family history of mesothelioma (p = .0015) and metastatic disease (p = .017). There were no other significant associations between the patient- or tumour-related characteristics and germline BAP1 results. CONCLUSION: A germline BAP1 mutation was detected in 3.5% of unselected UM patients. The oncologist-initiated and genetics-led mainstreaming model is a straightforward process and can be utilized for offering genetic testing to all UM patients.

A bullous variant of central serous chorioretinopathy treated with oral spironolactone.

We report the case of a 39-year-old male patient who presented with visual loss in the right eye for 6 weeks. The best-corrected visual acuity was counting fingers in the right eye and 20/30 in the left eye. The fundus examination demonstrated a right retinal detachment inferiorly extending to the fovea and a left macular serous detachment. After multimodal imaging study, the patient was diagnosed as having a bullous variant of central serous chorioretinopathy and treated with oral spironolactone associated with adjuvant laser photocoagulation. The retinal changes resolved after 6 months. The final visual acuity was 20/20 in both eyes.

Comparison of multicolor scanning laser imaging and color fundus photography in evaluating vessel whitening in branch retinal vein occlusion.

INTRODUCTION: Few studies have explored Multicolor™ imaging (MCI) in evaluating retinal vascular diseases, particularly branch retinal vein occlusion (BRVO). This study aimed to compare the identification of retinal vessel whitening in BRVO using MCI by scanning confocal laser versus conventional white flash color fundus photography (CFP). METHODS: Paired images of consecutive patients diagnosed with BRVO who underwent same-day MCI and CFP were reviewed. Visualization of vessel whitening on MCI and CFP was graded and scored using a scale by two masked graders. A longitudinal analysis of the vessel grading score was performed to evaluate the vessel whitening detection by MCI. A correlation analysis was conducted between vessel whitening on MCI and the measured area of retinal ischemia on fluorescein angiography to evaluate the MCI performance. RESULTS: Forty-four eyes of 41 patients (mean age 69±14 years; 61% female) were analyzed. MCI demonstrated superior vessel whitening visibility score than CFP (p<0.001). Longitudinal analysis showed no significant changes in vessel whitening visibility scores over a mean follow-up time of 430 ± 648 days (p=0.655). There was a significantly positive correlation between the grading score of vessels whitening by MCI and the area of ischemia by fluorescein angiography (r2=0.15; p=0.036). CONCLUSION: MCI appears to provide a superior detection of whitening BRVO compared to CFP, serving as a rapid and non-invasive correlate of retinal ischemia.

Late-Onset Retinal Degeneration: Clinical Perspectives.

Late-onset retinal degeneration (L-ORD) is a type of retinal dystrophy marked by nyctalopia and subretinal pigment epithelium deposits, which eventually promote retinal atrophy with final visual compromise. L-ORD may also present with changes in the anterior segment, notably long anterior zonules and iris atrophy, distinguishing it from other inherited eye conditions. Although it can clinically simulate age-related macular degeneration, L-ORD has a different course of progression and prognosis, requiring adequate diagnosis for patient counseling. This review summarizes the main clinical, genetic, pathophysiological, diagnostic, and therapeutic aspects of L-ORD to help ophthalmologists identify and manage this rare ocular disease.

A White Retinal Lesion With Calcification in an 11-Year-Old Boy.

An 11-year-old boy was referred to assess a retinal mass in the left eye found on his first routine ophthalmic evaluation. A white, translucent solid lesion with calcification was noticeable in the inferonasal quadrant of the left eye. What would you do next?

PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER AORTIC ANEURYSM REPAIR.

PURPOSE: We report a case of paracentral acute middle maculopathy secondary to cholesterol embolization syndrome after an endovascular aortic aneurism repair (EVAR). METHODS: Functional and anatomical damage was assessed by Snellen visual acuity, fundoscopy, and optical coherence tomography. RESULTS: A 67-year-old man presented with sudden vision loss in the right eye for one day with concomitant livedo reticularis in both feet. His medical history included an abdominal EVAR repair three days before the symptoms. The best-corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Fundoscopy showed intraarteriolar cholesterol plaques (Hollenhorst) bilaterally, and a localized retinal whitening in the right eye. Optical coherence tomography at the lesion site revealed a hyperreflective band on the level of inner nuclear layer. The patient was referred for imaging and complete systemic evaluation. He was then closely followed up by a vascular team, without additional intervention. Retinal stigma partially regressed at six months with visual improvement. CONCLUSION: This case describes paracentral acute middle maculopathy as a rare ocular sign of cholesterol embolization in postoperative intraaortic operations. The diagnosis of this complication led to prompt clinical care with a multidisciplinary approach.

Advances in Retinal Oximetry.

Similar to other organs, the retina relies on tightly regulated perfusion and oxygenation. Previous studies have demonstrated that retinal blood flow is affected in a variety of eye and systemic diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma. Although measurement of peripheral oxygen saturation has become a standard clinical measurement through the development of pulse oximetry, developing a noninvasive technique to measure retinal oxygen saturation has proven challenging, and retinal oximetry technology currently remains inadequate for reliable clinical use. Here, we review current strategies and approaches, as well as several newer technologies in development, and discuss the future of retinal oximetry.

Reticular Pseudodrusen in Late-Onset Retinal Degeneration.

PURPOSE: To characterize the association of reticular pseudodrusen (RPD) with late-onset retinal degeneration (L-ORD) using multimodal imaging. DESIGN: Prospective, 2-center, longitudinal case series. PARTICIPANTS: Twenty-nine patients with L-ORD. METHODS: All patients were evaluated within a 3-year interval with near-infrared reflectance, fundus autofluorescence, and spectral-domain OCT. In addition, a subset of patients also underwent indocyanine green angiography, fundus fluorescein angiography, mesopic microperimetry, and multifocal electroretinography. MAIN OUTCOME MEASURES: Prevalence, topographic distribution, and temporal phenotypic changes of RPD in L-ORD. RESULTS: A total of 29 patients with molecularly confirmed L-ORD were included in this prospective study. Reticular pseudodrusen was detected in 18 patients (62%) at baseline, 10 of whom were men. The prevalence of RPD varied with age. The mean age of RPD patients was 57.3 ± 7.2 years. Reticular pseudodrusen was not seen in patients younger than the fifth decade of life (n = 3 patients) or in the eighth decade of life (n = 5 patients). Reticular pseudodrusen were found commonly in the macula with relative sparing of the fovea and also were identified in the peripheral retina. The morphologic features of RPD changed with follow-up. Two patients (3 eyes) demonstrated RPD regression. CONCLUSIONS: Reticular pseudodrusen is found frequently in patients with L-ORD and at a younger age than in individuals with age-related macular degeneration (AMD). Reticular pseudodrusen exhibits quick formation and collapse, change in type and morphologic features with time, and relative foveal sparing and also has a peripheral retinal location in L-ORD.