Preoperative fundoscopy versus optical coherence tomography to detect occult maculopathy during cataract surgery preassessment

PURPOSE

To assess the proportion of maculopathy detectable only on optical coherence tomography (OCT) versus slit lamp indirect ophthalmoscopy (SLIO) during cataract assessment.

METHODS

Population: Consecutive patients attending cataract assessments.

DATA COLLECTION

All patients underwent OCT and SLIO. SLIO findings were recorded before reviewing OCT. Scans were examined to compare with recorded SLIO findings.

PRIMARY OUTCOME

analyse the proportion of eyes with maculopathy missed by SLIO.

SECONDARY OUTCOME

to assess the proportion of patients with maculopathy on OCT, the incidence of maculopathy in the fellow eye on OCT and proportion with cataracts too dense to allow SLIO or OCT.

RESULTS

Six hundred twenty-six patients were enroled. Eighty (12.8%) had maculopathy detectable only on OCT which included: 26 (4.2%) epiretinal membrane (ERM), 25 (4%) dry age-related macular degeneration (AMD), 19 (3%) vitreomacular traction (VMT), 5 (0.8%) lamellar macular hole (LMH), 2 (0.3%) cystoid macular oedema (CMO) and 1 (0.2%) wet AMD. 166 (26.5%) had maculopathy on OCT, of which only 48 (7.7%) had known history of maculopathy. In fellow eyes, 29 (4.6%) had significant findings and 29 (4.6%) were unable to have SLIO or OCT due to dense cataract.

CONCLUSIONS

A quarter of the patients had occult maculopathy. One-tenth of the occult maculopathy were missed without OCT, with ERM, dry AMD, VMT, LMH, CMO and wet AMD being the primary missed diagnosis. Less than 5% had occult maculopathy in fellow eye, and <5% had dense cataracts where neither SLIO nor OCT was not possible.

Periocular Granuloma Annulare: A Case Report of a Rare Childhood Disease in an Adult

A 21-year-old female presented to the oculoplastic clinic with a 2-year history of raised lesions in the right upper eyelid and lateral canthus area. Due to their unusual appearance, the patient underwent an excisional biopsy of the lateral canthus lesion. A diagnosis of granuloma annulare was made after histopathology demonstrated palisading epithelioid granulomas with central fibrinoid necrosis and Alician blue positive acid mucin. Granuloma annulare is a benign inflammatory skin condition characterized by firm discolored papules or nodules classically arranged in an annular pattern. Periocular involvement is extremely rare in adults and may pose a diagnostic challenge to ophthalmologists unfamiliar with its presentation and management.

Curious case of chronic corneal oedema

An 89-year-old man with multiple episodes of inferior corneal oedema and low-grade anterior segment inflammation over 18 months was diagnosed and managed as viral keratitis; however, the episodes kept recurring every time treatment, vis-à-vis topical steroids, were tapered or stopped. History of cataract surgery few months prior to onset of the symptoms, lack of other features of viral keratitis, such as keratic precipitates and inferior corneal oedema in the presence of slight pupillary peaking led to the suspicion of either a retained lens fragment (RLF) or other possible iatrogenic insult. This was confirmed by anterior segment optical coherence tomogram, which revealed the RLF in inferior angle; this was removed surgically as an emergency procedure. This resulted in significant improvement in the corneal oedema, as well as marked symptomatic relief confirmed by the patient.

BILATERAL METASTATIC CUTANEOUS MELANOMA TO RETINA AND VITREOUS AFTER IPILIMUMAB TREATED WITH PARS PLANA VITRECTOMY AND RADIOTHERAPY

PURPOSE

To report a patient with bilateral metastatic cutaneous melanoma to the retina and vitreous presenting as a right panuveitis.

METHODS

A 63-year-old woman with metastatic malignant cutaneous melanoma treated with ipilimumab and prolonged high-dose steroids presented with a right panuveitis and right blurred vision. Dilated fundus examination revealed bilateral, off-white, large, globular vitreous opacities and bilateral retinal lesions. These retinal lesions had a pale yellow appearance with a cuff of haemorrhage. The unpigmented appearance of the vitreous opacities raised the suspicion of candida endophthalmitis.

RESULTS

Bilateral, sequential pars plana vitrectomy with pathomorphologic examination of the vitreous specimen demonstrated metastatic melanoma. Ocular radiotherapy followed by cataract surgery resulted in the regression of retinal lesions in both eyes and no recurrence of the vitreous metastases.

CONCLUSION

The development of vitreous and retinal metastases despite a systemic response to ipilimumab identifies the challenge of immunotherapy in an immune privileged site. Treatment is challenging, and outcomes are variable. A local approach of bilateral pars plana vitrectomy, external beam radiotherapy, and subsequent bilateral cataract surgery provided an excellent visual result with no recurrence at 12 months.

One-year real-world outcomes in patients receiving fixed-dosing aflibercept for neovascular age-related macular degeneration

PurposeTo investigate 1-year visual and anatomic outcomes of intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) given at a fixed 8-weekly interval.MethodsRetrospective, single-practice data analysis from an electronic medical record system of 255 eyes (223 patients) with treatment-naïve nAMD receiving 8-weekly aflibercept.ResultsMean logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) improved from 0.66 at baseline to 0.50 at month 11 (P<0.0001). Mean central retinal thickness (CRT) decreased from 311 μm at baseline to 211 μm at month 11 (P<0.0001). Our mean VA gain of eight ETDRS letters was comparable to the VIEW 1 and VIEW 2 Trials' results at the end of year 1. After loading at month 5, mean BCVA was 0.48 (P<0.0001), and mean CRT was 235 μm. At month 5, 143 eyes (56%) were inactive defined by the absence of macular haemorrhage and intraretinal fluid (IRF) and subretinal fluid (SRF) on optical coherence tomography, and 112 eyes (44%) remained active. At month 11, 136 eyes (53%) were inactive, and 119 eyes (47%) remained active. At month 11, 77% of inactive eyes after loading remained inactive, and 77% of the active eyes after loading remained active. At month 11, mean BCVA of the inactive group was 0.51, and mean BCVA of the active group was 0.48 (P=0.54).ConclusionsAflibercept administered by fixed dosing over 1 year improved VA and macular morphology in treatment-naïve eyes. Active lesions at month 11 do not have worse VA outcomes compared with inactive lesions. The macular status after loading is a reliable indicator of disease activity at the end of year 1.