Emerging Disease of the Desert: Rise of West Nile Virus Chorioretinitis in Arizona.

Purpose: To present 7 cases of West Nile virus (WNV)-related chorioretinitis in Arizona. Methods: Retina clinic charts with the terms "chorioretinitis" and "West Nile" were selected from April 1, 2012, to February 1, 2023. Results: Seven patients with initial visits between August 2019 and February 2023 were included. The majority of WNV chorioretinitis cases were seen in the last 4 years of the selected dates. Only 1 patient presented before this time but was excluded for inadequate baseline testing. All 7 patients had hospitalization for neuroinvasive disease before clinical presentation. All patients achieved a final visual acuity of 20/25 to 20/70. Conclusions: In the last 4 years of the study period, an uptrend in WNV chorioretinitis was found in our retina clinics in Arizona, reflecting the overall rise in WNV outbreaks across the state. As WNV continues to rise, the eye specialist should have high suspicion for WNV ocular disease, even in states where WNV had been an uncommon entity.

Hunting for Pearls: A Qualitative Analysis of the Reflections of Students Creating Psychiatric Podcasts.

Purpose: This paper aims to explore medical student experiences of creating a peer-to-peer psychiatry educational podcast. Methods: During psychiatry placement, ten year-4 University of Bristol medical students created peer-educational multi-episode podcasts on psychiatric topics. Following completion, they submitted reflective essays on their experiences. Qualitative thematic analysis of these essays was completed by two independent authors. Following data familiarisation, authors independently generated codes that were collated into relevant themes. Upon reaching thematic saturation, findings were collated, and member checking was carried out to confirm the validity of findings. Results: Themes included effective preparation, choosing content, podcast production, enhancing learning, the weight of responsibility and creating educational support networks. All students found podcast creation to be beneficial for personal learning. Conclusion: Exploration of students' experiences creating podcasts can support clearer guidance for medical podcast production, providing opportunities for educators to optimise podcast creation efficiency and educational effectiveness.

Meals and movies: making our microbiota merry.

OBJECTIVE: To investigate the impact of festive cinematic diets on the gut microbiota. DESIGN: Observational (watching films) and creative review. Sadly, we couldn't incorporate any snowball sampling. SETTING: In front of a television, by a blazing log fire. PARTICIPANTS: Everyone: you don't need to be on the nice list! MAIN OUTCOME MEASURES: Microbiota INdex of Comparative Evaluation for Pictorial Infographic Evidence (MINCE PIE) scores (difference between the numbers of microbiota-enhancing and microbiota-detrimental food groups) for foods depicted in twelve festive films. RESULTS: Most festive films featured meals or foods from a typical Western diet, with high sugar and fat content, with overall negative effects on the microbiota. However, some films promoted options containing fibre, beneficial proteins, or polyphenols. These are gifts under the Christmas tree for our microbiota. CONCLUSION: Good balance is needed for our microbiota, and consequently our mental health. Many festive films portray a Western diet that can lead to dysbiosis. Through their action on the gut-brain axis and the influence of media on dietary choices, the festive foods consumed in these films (maybe an extra chocolate biscuit during Love Actually) can be stressful for our microbiota.

Treatment with the direct oral anticoagulants (DOACs) apixaban and rivaroxaban associated with significant worsening of behavioural and psychological symptoms of dementia (BPSD).

We report the cases of two patients who developed worsening behavioural and psychological symptoms of dementia (BPSD), coinciding with starting the factor Xa inhibitor direct oral anticoagulant medications apixaban and rivaroxaban, respectively. Both patients required detaining under the Mental Health Act. Their symptoms improved significantly, within 2 weeks, on switching to alternative anticoagulant therapies and they were both discharged from the acute psychiatric ward. Front-line staff should partake in postmarketing surveillance of medications, completing the Medicines and Healthcare products Regulatory Agency yellow cards for example (UK). There is increasing evidence for an aetiological role of cerebral mitochondrial dysfunction in neuropsychiatric disorders. Development of a rating scale of drugs that are potentially less toxic to cerebral mitochondria could inform national prescribing guidelines and enable safer treatments to be offered to older people, reducing the likely hood of them experiencing apparent BPSD.

Presumed Choroidal Metastasis From Oncocytic Carcinoma of the Parotid Gland: A Case Report.

Purpose: This article reports a case of presumed choroidal metastasis from an oncocytic carcinoma of the parotid gland. Methods: A 70-year-old man with history of an oncocytic carcinoma of the parotid gland presented owing to a 1-month history of progressive blurred central vision shortly after metastatic surveillance workup revealed liver, lung, and spine metastases. Fundus examination of the right eye showed a yellow choroidal mass surrounding the optic nerve and extending inferonasally, which is associated with subretinal fluid involving the foveal center. A-scan and B-scan ultrasonography were remarkable for a dome-shaped choroidal mass with medium-to-high internal reflectivity. Fluorescein angiography revealed pinpoint foci of hyperfluorescence over the choroidal lesion with late leakage. Magnetic resonance imaging of the brain showed evidence of metastatic disease to the cerebellum. While the patient underwent systemic chemotherapy, external beam radiotherapy was used to treat the eye. Results: Four months later, visual acuity improved, the tumor reduced in size, and the subretinal fluid resolved. Systemic workup disclosed no new metastases. Conclusion: Oncocytic carcinoma of the parotid gland is a rare and aggressive malignant neoplasm with frequent recurrences and distant metastases. The current case suggests that oncocytic carcinoma can metastasize to the choroid and, consequently, ocular metastasis surveillance is advised in these patients.

Amyloid-Beta-Related Angiitis with Distinctive Neuro-Ophthalmologic Features.

Amyloid beta-related angiitis (ABRA) is a subtype of cerebral amyloid angiopathy-related inflammation, with distinctive pathology and prognosis compared with cerebral amyloid angiopathy (CAA). On a spectrum of increasing severity, ABRA is considered to be in-between the less aggressive inflammatory-CAA and the more severe primary central nervous system (CNS) angiitis. Whereas retinal pathological changes were described in subjects with primary or secondary CNS angiitis, and non-inflammatory CAA, bilateral posterior pole superficial and peripapillary retinal hemorrhages have not been reported as initial signs in patients with pathology-confirmed ABRA, accompanying neurological spells and characteristic neuroimaging findings.

Silicone oil microbubble found in failed full-thickness macular hole closure.

PURPOSE: To describe a case of failed macular hole closure after vitrectomy with silicone oil tamponade because of a silicone oil microbubble. METHODS: This is a retrospective case review of a single patient's clinical course. RESULTS: Because of the inability of the patient to assume a prone position after vitrectomy for full-thickness macular hole, 1000-centistoke silicone oil tamponade was used at the initial repair. Optical coherence tomography showed persistent full-thickness macular hole with evidence of a silicone oil microbubble within the macular hole. Subsequent vitrectomy with the removal of silicone oil and exchange for 25% sulfur hexafluoride (SF6) gas with attempted prone positioning failed to provide hole closure. Successful hole closure was accomplished after tamponade with 5000-centistoke silicone oil, without prone positioning. No recurrence of the full-thickness defect was seen after the eventual removal of 5000-centistoke silicone oil. CONCLUSION: It is possible that the silicone oil microbubble formation and migration within a full-thickness macular hole defect may contribute to surgical failure.

Comparative evaluation of no dye assistance, indocyanine green and triamcinolone acetonide for internal limiting membrane peeling during macular hole surgery.

PURPOSE: To evaluate the anatomical closure rate and visual outcome in patients undergoing pars plana vitrectomy with internal limiting membrane peeling without dye enhancement and with indocyanine green or triamcinolone acetonide assistance. METHODS: This is a retrospective, comparative interventional case series. The electronic charts of 435 eyes of 415 patients with idiopathic macular holes who underwent macula hole surgery were reviewed from January 2003 to April 2010. The patients were assigned to 3 groups: no dye assistance (Group 1), indocyanine green-assisted (Group 2), and triamcinolone acetonide-assisted internal limiting membrane peel (Group 3). The data were recorded for 3-, 6-, and 12-month follow-up visits. Main outcome measures were postoperative visual acuity and macular hole closure. RESULTS: The overall macular hole closure rate with a single surgery was 94.7% (108 of 114). In Group 1: 91.4% (191 of 209), in Group 2: 94.1% (112 of 119), and in Group 3: 95.9% (93 of 97) achieved closure. Closure rate for holes that were ≤400 µm in diameter was 98.8% compared with >400 µm, which was 90.4% (P = 0.001). There was a statistically significant (P < 0.001) improvement from preoperative visual acuity to postoperative visual acuity in all groups across all time points. There was no statistically significant visual acuity difference among three groups. At 12-month follow-up, 77.7% in Group 1, 66.1% in Group 2, and 81.3% in Group 3 achieved 20/50 visual acuity or better. CONCLUSION: The study shows that good anatomical and functional results can be achieved with no dye and with indocyanine green or triamcinolone acetonide dye assistance for internal limiting membrane peeling during macular hole surgery. Overall, visual acuity levels did not differ among groups, although subanalysis of the results suggests subtle indocyanine green toxicity.

Intravitreal implant migration into anterior chamber in a post-vitrectomy eye with central retinal vein occlusion and persistent macular edema.

The authors report the case of a 76-year-old man with a history of central retinal vein occlusion with persistent macular edema in the pseudophakic left eye, which was vitrectomized after complicated retinal detachment surgery. Two weeks after treatment with an intravitreal dexamethasone implant, the implant migrated into the anterior chamber. Visual acuity was hand motion in the right eye and 20/40 in the left eye with corneal edema. One week later, the implant relocated back into the vitreous cavity without surgical intervention, with a marked decrease in corneal edema and improved visual acuity (20/30) in the left eye. Weak zonules and posture change may have caused implant migration in this patient.

Vitreoretinal lymphoma: changing trends in diagnosis and local treatment modalities at a single institution.

UNLABELLED: In this retrospective study on vitreoretinal lymphoma, there was significant change in diagnosis and treatment trends over 17 years at a single institution. Fine needle aspiration biopsy had replaced vitrectomy to collect vitreous sample and external beam radiotherapy in combination with systemic chemotherapy was replaced by intravitreal methotrexate and rituximab, which regressed vitreoretinal lymphoma (VRL) with no relapses or major ocular complications. INTRODUCTION: The purpose of this study was to report the changing trends in treatment (external beam radiotherapy [EBRT] and intravitreal chemotherapy) of VRL and treatment outcomes at a single institution. MATERIALS AND METHODS: A retrospective chart review of vitreous biopsy proven patients was performed. The data analysis included demographics, systemic lymphoma status, ocular symptoms, clinical and immunocytological findings, treatment methods, and response (intravitreal methotrexate 300 µg/0.05 mL, 1000 µg/0.1 mL of rituximab and EBRT 36-45 Gy) and ocular and systemic lymphoma outcomes at last follow-up. RESULTS: Twelve eyes of 8 patients had intraocular B-cell lymphoma (median age, 61 years; range, 50-83). Central nervous system non-Hodgkin's lymphoma (CNS-NHL) was present in 7 of 8 patients. Most common ocular symptoms were diminution of vision in 4 and floaters in 3 patients. Iritis and uveitis were found in 6 eyes and vitritis in 11 eyes. Retinal infiltrates were present in 8 eyes. Immunocytology revealed elevated levels of interleukin (IL)-10 (12,783.5 pg/mL), IL-6 (26.7 pg/mL), and IgH gene rearrangement. Three patients were treated with EBRT, 6 eyes with intravitreal methotrexate (median, 9.5; range, 2-15), and 2 eyes with intravitreal rituximab injections (median, 4; range, 2-6). Two patients developed marked keratitis because of methotrexate toxicity. At median follow-up of 33.5 months (range, 4-96), VRL had resolved in 7 eyes and persistent in 5 eyes. One patient died because of advanced CNS-NHL. CONCLUSION: Intravitreal chemotherapy provided good control rates for VRL patients in our limited series. Patients with associated CNS-NHL had poorer outcomes.