Accelerated progression of diabetic retinopathy following severe COVID-19 infection.

Purpose: The impact of SARS-CoV-2 infection on pre-existing retinal pathology is currently unknown. Observations: We present a unique case of rapidly progressing diabetic retinopathy (DR) following severe COVID-19 infection requiring supplemental oxygen and subsequent long-COVID. Conclusions and importance: Following infection with SARS-CoV-2, the associated acute and possible long-term hypoxia has the potential to affect the retina and accelerate the natural course of diabetic retinopathy.

Vitreoretinal Abnormalities during Macular Hole Repair in Alport Syndrome.

PURPOSE: To describe abnormal vitreoretinal findings during macular hole repair in Alport syndrome (AS). METHODS: Case report of preoperative, intraoperative, and postoperative findings related to macular hole surgery in a patient with AS. OBSERVATIONS: A 50-year-old woman with Alport syndrome was found to have bilateral full-thickness macular holes. Surgery was recommended for her left eye given recent onset of vision loss and smaller hole size (313 um). Intraoperatively, the vitreous was found to have fine fibrillar strands and to be abnormally adherent to the retinal surface. There was little to no internal limiting membrane (ILM) present. Vitrectomy was performed with posterior cortical hyaloid peeling and 15% C3F8 gas tamponade. Two months after surgery, the macular hole was successfully closed. CONCLUSIONS: Abnormal vitreous composition and adherence to the retinal surface may contribute to macular hole formation in AS patients. Standard surgical approaches including ILM peeling may not be feasible, though thorough removal of the posterior cortical hyaloid may be sufficient to achieve macular hole closure.

Characterizing the Accessibility and Content of Surgical and Medical Retina Fellowship Program Websites.

Purpose: To assess the accessibility and content of surgical and medical retina fellowship websites. Methods: The websites of all surgical and medical retina fellowship programs were examined. Each program's website was evaluated based on information available on 10 recruitment and 10 training criteria. The presence of the criteria was summed to calculate a total content score (range, 0-20). Also examined were the differences in website content score by number of fellows, geographic location, and Association of University Professors of Ophthalmology (AUPO) compliance. Results: This study identified 102 surgical and 25 medical retina programs. Overall, 91.2% of surgical and 88.0% of medical retina programs had an accessible website. The surgical retina program website contained a mean of 9.8 of the total criteria, including 4.9 recruitment criteria and 5.2 training criteria, with no significant differences by number of fellows, geography, or AUPO status. Medical retina websites contained a mean of 9.3 total criteria, including 4.5 recruitment criteria and 4.9 training criteria. Website content scores for medical retina programs were associated with geography and AUPO status, which was consistent when stratifyed by recruitment and training criteria. Conclusions: Most surgical and medical retina fellowships have an accessible program website. However, there are opportunities to improve the completeness and consistency of information on these websites. Improved websites can help programs attract well-suited candidates and might address multiple inefficiencies in the application process.

CENTRAL RETINAL ARTERY OCCLUSION WITH CILIORETINAL ARTERY SPARING AFTER LASER-ASSISTED IN SITU KERATOMILEUSIS.

PURPOSE: To report a central retinal artery occlusion with cilioretinal artery sparing in a 48-year-old woman after laser-assisted in situ keratomileusis surgery. METHODS: Case history and clinical examination including best-corrected visual acuity, serum markers, slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and optical coherence tomography. RESULTS: A 48-year-old woman underwent routine laser-assisted in situ keratomileusis surgery in both eyes. On postoperative Day 1, vision was 20/20 in both eyes with full visual fields by confrontation. Eight hours after being examined, she reported photopsias and a new visual field defect in the right eye . Visual acuity was 20/40, pinhole 20/20 in the right eye, with restriction of visual field by confrontation. Dilated fundus examination revealed retinal whitening in all quadrants with sparing of the fovea along the distribution of a perfused cilioretinal artery. Optical coherence tomography showed an intact foveal depression with inner retinal layer hyperreflectivity outside the region of the perfused cilioretinal artery. Fluorescein angiography revealed sectoral nonperfusion of the posterior pole with macular sparing along the patent cilioretinal artery. Hypercoagulable workup, carotid imaging, and magnetic resonance imaging of the brain were unremarkable. CONCLUSION: This is the first report of a central retinal artery occlusion with cilioretinal artery sparing occurring on postoperative Day 1 after laser-assisted in situ keratomileusis surgery.

APPLICATION OF ADJUNCTIVE TOPICAL MITOMYCIN-C IN SCLEROSTOMY REVISION FOR REFRACTORY IDIOPATHIC UVEAL EFFUSION SYNDROME.

BACKGROUND/PURPOSE: To describe the use of topical mitomycin-C in sclerostomy revision for recalcitrant idiopathic uveal effusion syndrome. METHODS: A 50-year-old healthy man presented with painless, gradual vision loss in the right eye. He underwent multimodal retinal imaging with wide-field fundus photography, spectral domain optical coherence tomography, and B-scan and A-scan ultrasonography. He was found to have idiopathic (non-nanophthalmic) uveal effusion syndrome with choroidal and serous retinal detachments in the right eye and a peripheral choroidal detachment in the left eye. Central vision became threatened in the right eye. Medical treatment with oral corticosteroids and surgical treatment with choroidal drainage through sclerostomies and sclerostomy revision were administered. RESULTS: Initial treatment with systemic corticosteroids was ineffective. Subsequent choroidal drainage through sclerostomies only partially resolved the effusion. Later sclerostomy revision with application of topical mitomycin-C led to complete resolution with anatomical stability maintained after at least 42 months of follow-up. CONCLUSION: Successful use of topical mitomycin-C in sclerostomy revision has not previously been reported in idiopathic (non-nanophthalmic) uveal effusion syndrome. We propose that topical mitomycin-C may be considered as a potential therapeutic adjunct in the treatment of refractory idiopathic uveal effusion syndrome before further sclerostomy procedures are attempted in additional quadrants of the eye.

Effect of full-time vs volunteer faculty supervision on resident cataract surgery complications.

PURPOSE: To examine the effect of teaching experience of supervising surgeons on resident cataract surgery intraoperative complication rates. SETTING: Zuckerberg San Francisco General Hospital, University of California San Francisco, USA. DESIGN: Retrospective chart review. METHODS: Cataract surgeries performed by University of California San Francisco (UCSF) ophthalmology residents from 2010 to 2017 were reviewed. Only cases supervised by anterior segment attendings with more than 10 years of postresidency surgical experience were included. Cases were categorized as being supervised by either full-time UCSF teaching attendings or volunteer private practice attendings. Cases were graded as low risk (0 risk factors), intermediate risk (1 risk factor), or high risk (≥2 risk factors) based on 8 preoperative and intraoperative risk factors. Complication rates were compared between the 2 attending groups among varying risk grades. RESULTS: Of 1377 cases, 101 developed complications. Among low-risk cases, full-time teaching attendings (25/619 [4.04%]) had a similar complication rate to volunteer attendings (17/387 [4.39%]) (odds ratio [OR] 0.92; P = .79). In intermediate-risk cases, full-time teaching attendings (28/195 [14.36%]) had slightly worse complication rates than volunteer attendings (10/88 [11.36%]) (OR 1.63; P = .45). High-risk cases had the highest complication rates, with the complication rates of full-time teaching attendings (16/72 [22.22%]) somewhat lower than those of volunteer attendings (5/16 [31.25%]) (OR 0.64; P = .48). CONCLUSIONS: For low-risk resident-performed cataract surgeries, supervision by full-time faculty and volunteer attendings yielded similar complication rates; thus, residency programs might safely recruit volunteer attendings to supervise low-risk cataract surgeries to support resident training. The analysis of higher-risk cases was limited by a low surgical volume.

Glass intraocular foreign body removal with a nitinol stone basket.

PURPOSE: Glass intraocular foreign bodies (IOFBs) complicate up to 14% of all IOFB cases and require specialized instruments for removal. We present a case of ocular trauma with two large glass IOFBs removed using a nitinol stone basket (NSB) designed for kidney stone extraction in the ureter and calyces. OBSERVATIONS: An adult male suffered a restrained motor vehicle accident. Radiographic computed tomography identified a 9-mm polygonal IOFB within the posterior segment of the right eye. A staged procedure was performed with repair of the ruptured globe followed by 23-gauge pars plana vitrectomy, pars plana lensectomy, and removal of the IOFBs using a NSB. CONCLUSION: At post-operative month one, visual acuity was correctable to 20/60. The retina remained attached and the patient was recovering without complication. IMPORTANCE: Large glass IOFBs are poorly gripped by standard ophthalmic forceps due to their smooth surface, large size, and irregular shape. The NSB is an effective instrument for controlled removal of glass IOFBs. Further customized design may adapt this device for additional intraocular procedures.