Metastatic neuroendocrine tumors mimicking as primary ocular disease.

PURPOSE: To report two cases of metastatic neuroendocrine tumors masquerading as primary ocular disease. OBSERVATIONS: Case 1 is a 38-year-old man who was referred with subacute onset diplopia and fluctuating ptosis suggestive of myasthenia gravis. Case 2 is a 21-year-old man who presented with blurry vision and was found to have a pigmented ciliary body mass and retinal detachment suggestive of uveal melanoma. Both patients were ultimately diagnosed with metastatic neuroendocrine tumors. CONCLUSIONS AND IMPORTANCE: Neuroendocrine tumors, though rare and infrequently metastatic to the eye and orbit, can initially present with ocular signs. A broad differential and careful consideration of ocular and systemic symptoms are critical in such challenging cases.

Big Data-Based Epidemiology of Uveitis and Related Intraocular Inflammation.

ABSTRACT: Large administrative health databases, nationwide surveys, and the widespread adoption of electronic medical records have led to an increasing availability of health-related data on ocular inflammatory disease, allowing us to elucidate the real-world epidemiology of uveitis and examine patient and systems-level risk factors for the incidence of specific etiologies of uveitis and its complications. Despite the many advantages to using big databases, there are also limitations that clinicians must be aware of when making conclusions and extrapolating to the general population, such as the lack of standardization of nomenclature and coding. As the availability of even more robust datasets increases, clinicians and scientists should be prepared to leverage these tools to improve our understanding of disease pathophysiology and our ability to manage patients with ocular inflammatory disease.

RETINAL TELANGIECTASIA ASSOCIATED WITH OPTIC DISK PIT MACULOPATHY.

PURPOSE: To report a case of optic pit maculopathy with retinoschisis-like edema with a rare finding of retinal telangiectasia. METHODS: Retrospective case report. RESULTS: A 22-year-old white man with a right optic pit presented with blurry vision and was found to have optic pit maculopathy with retinoschisis-like macular edema and retinal telangiectasia along the superior-temporal arcade. The patient underwent pars plana vitrectomy with separation of posterior vitreous and inner retinal fenestration. Upon follow-up, retinal telangiectasia was resolved and retinoschisis-like edema was mostly resolved 2 years after surgery. CONCLUSION: Retinal telangiectasia seen in optic disk maculopathy may be secondary to ischemia induced by the intense stretching of the superficial vascular plexus in the inner retina because of macular edema. In our patient, when traction was relieved following surgical intervention, there was remodeling of the superficial vascular plexus that allowed for resolution of the retinal telangiectasia.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents.

Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures This study evaluated four-letter personality type from each participant. Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) ( p = 0.049), thinking (T) than feeling (F) ( p = 0.027), and judging (J) than perceiving (P) ( p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

Interleukins and cytokine biomarkers in uveitis.

Interleukins and cytokines are involved in the pathogenesis of uveitis of heterogeneous origin. Understanding the basics of the ocular immune privilege is a fulcrum to discern their specific role in diverse uveitis to potentially translate as therapeutic targets. This review attempts to cover these elements in uveitis of infectious, noninfectious and masquerade origin. Insights of the molecular targets in novel therapy along with the vision of future research are intriguing.

Intravenous Prostaglandin E1 Infusion for Acute Central Retinal Artery Occlusion.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of systemic prostaglandin E1 (PGE1) infusion within the first 24 hours of acute central retinal artery occlusion (CRAO). PATIENTS AND METHODS: Best corrected visual acuity (BCVA) was analyzed in a case series of six eyes from six patients (mean age: 69.33 years) with acute CRAO who were treated with twice-daily intravenous infusion of 40 µg PGE1. Therapy continued until the patient no longer experienced visual acuity improvements for 24 hours. RESULTS: Average time to presentation was 8.33 hours (range: 2 to 12 hours). The logMAR BCVA at presentation was 2.73. BCVA at the final visit 1 month after initial presentation was 1.48 (P = .025). All patients experienced vision improvement. No systemic adverse events were experienced. CONCLUSION: Intravenous PGE1 infusion resulted in significant visual improvement in patients presenting with acute CRAO and is well tolerated with few adverse effects. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S5-S8.].

Knockdown of leptin A expression dramatically alters zebrafish development.

Using morpholino antisense oligonucleotide (MO) technology, we blocked leptin A or leptin receptor expression in embryonic zebrafish, and analyzed consequences of leptin A knock-down on fish development. Embryos injected with leptin A or leptin receptor MOs (leptin A or leptin receptor morphants) had smaller bodies and eyes, undeveloped inner ear, enlarged pericardial cavity, curved body and/or tail and larger yolk compared to control embryos of the same stages. The defects persisted in 6-9 days old larvae. We found that blocking leptin A function had little effect on the development of early brain (1 day old), but differentiation of both the morphant dorsal brain and retinal cells was severely disrupted in older (2 days old) embryos. Despite the enlarged pericardial cavity, differentiation of cardiac cells appeared to be similar to control embryos. Formation of the morphants' inner ear is also severely disrupted, which corroborates existing reports of leptin receptor expression in inner ear of both zebrafish and mammals. Co-injection of leptin A MO and recombinant leptin results in partial rescue of the wild-type phenotype. Our results suggest that leptin A plays distinct roles in zebrafish development.