Author Correction: Commensal microflora-induced T cell responses mediate progressive neurodegeneration in glaucoma.

The originally published version of this Article contained an error in Figure 4. The bar chart in panel f was inadvertently replaced with a duplicate of the bar chart in panel e. This error has now corrected in both the PDF and HTML versions of the Article.

Commensal microflora-induced T cell responses mediate progressive neurodegeneration in glaucoma.

Glaucoma is the most prevalent neurodegenerative disease and a leading cause of blindness worldwide. The mechanisms causing glaucomatous neurodegeneration are not fully understood. Here we show, using mice deficient in T and/or B cells and adoptive cell transfer, that transient elevation of intraocular pressure (IOP) is sufficient to induce T-cell infiltration into the retina. This T-cell infiltration leads to a prolonged phase of retinal ganglion cell degeneration that persists after IOP returns to a normal level. Heat shock proteins (HSP) are identified as target antigens of T-cell responses in glaucomatous mice and human glaucoma patients. Furthermore, retina-infiltrating T cells cross-react with human and bacterial HSPs; mice raised in the absence of commensal microflora do not develop glaucomatous T-cell responses or the associated neurodegeneration. These results provide compelling evidence that glaucomatous neurodegeneration is mediated in part by T cells that are pre-sensitized by exposure to commensal microflora.

Acute retinal hemorrhage after Pipeline embolization device placement for treatment of ophthalmic segment aneurysm: A case report.

Introduction Ophthalmic segment aneurysms may present with visual symptoms due to direct compression of the optic nerve. Treatment of these aneurysms with the Pipeline embolization device (PED) often results in visual improvement. Flow diversion, however, has also been associated with occlusion of the ophthalmic artery and visual deficits in a small subset of cases. Case report A 49-year-old Caucasian female presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. On follow-up imaging, the patient was found to have a right asymptomatic ophthalmic segment aneurysm. Due to the irregular shape of the aneurysm and history of aneurysmal subarachnoid hemorrhage, the decision was made to treat the aneurysm with a PED. Postoperatively, the patient complained of floaters in the right eye. Detailed ophthalmologic examination showed retinal hemorrhage and cotton-wool spots on the macula. Such complication after PED placement has never been reported in the literature. Conclusion Visual complications after PED placement for treatment of ophthalmic segment aneurysms are rare. It is thought that even in cases where the ophthalmic artery occludes, patients remain asymptomatic due to the rich collateral supply from the external carotid artery branches. Here we report a patient who developed an acute retinal hemorrhage after PED placement.

Exudative Retinal Detachment Reveals Metastatic Bladder Cancer.

PURPOSE: Choroidal metastasis from bladder cancer is very rare, with only a handful of cases cited previously in the literature. We present a case of a patient who presented with a serous retinal detachment and a known history of bladder cancer, which he believed was controlled. Based on the clinical evaluation, his history of bladder cancer, and a retinal consult, a workup was initiated and he was found to have choroidal metastasis from his cancer. CASE REPORT: A 77-year-old white man presented with a 1-week history of blurry vision in his left eye and left-sided frontal headaches. His medical history was significant for medically managed hypertension and controlled bladder cancer, which had been treated with transurethral resection of bladder tumor and Bacillus Calmette-Guerin intravesical treatments. The patient had been a smoker for 35 years but had quit 22 years before presentation. A dilated retinal examination found an inferior serous retinal detachment in the left eye, with areas of subretinal folds and fluid encroaching on the macula on both clinical examination and optical coherence tomography imaging. The patient was diagnosed as having an exudative retinal detachment in his left eye, and he was referred for a retinal consult. Subsequent testing with B-scan and fluorescein angiography was suggestive of metastasis as the cause of the exudative detachment. Based on his history of bladder cancer, a chest X-ray was ordered and revealed a left-sided pleural effusion. A chest computed tomography confirmed the left pleural effusion and better visualized its extent. A thoracentesis with cytology supported the diagnosis of metastases from urothelial carcinoma. The patient's bladder cancer was now classified as stage 4, and he died 2 months later. CONCLUSIONS: This case highlights a rare instance of a choroidal metastasis from bladder cancer. As with previous cases, this is a poor prognostic sign for the patient's survival, and he died shortly after the discovery of the lesion. It is important to consider cancer metastasis in the differential diagnosis when presented with a serous retinal detachment and a known cancer diagnosis, even if the patient believes that his cancer is well managed.

Off-label use of intravitreal triamcinolone acetonide for diabetic macular edema in a pregnant patient.

We present a case of diabetic macular edema in a pregnant patient treated with a single intravitreal injection of triamcinolone acetonomide. Initial presentation and serial examinations after treatment included visual acuity, slit-lamp examination, indirect ophthalmoscopy, and optical coherence tomography. Resolution of visual acuity and macular edema were present six weeks after injection and persisted throughout the duration of the pregnancy without further intervention. No adverse outcomes for either mother or fetus were noted. To our knowledge, this is the first report of intravitreal triamcinolone administration in this patient population to be published in the medical literature.

Endophthalmitis in the era of small gauge transconjunctival sutureless vitrectomy--meta analysis and review of literature.

PURPOSE: The goal of this study was to review, evaluate, and perform a meta-analysis on the current literature that reports rates of postoperative endophthalmitis after small gauge transconjunctival sutureless vitrectomy (TSV) and compare it to 20-gauge pars plana vitrectomy (20G PPV). METHODS: We performed an extensive review of the current literature. We included only large comparative institutional reviews. Meta-analysis of these reviews was performed. RESULTS: We found six large retrospective comparative cases series on the 25-gauge (25G) TSV as compared to 20G PPV. The test for homogeneity for the meta-analysis indicates that the studies are not homogeneous and therefore the evidence is tentative. CONCLUSION: We cannot conclude that 25G TSV has a higher rate of postoperative endophthalmitis compared to the 20G PPV. Future retrospective or prospective trials need to take into consideration multiple factors.

Treatment of subretinal neovascular membrane in a patient with membranoproliferative glomerulonephritis type II.

A 29-year-old woman with membranoproliferative glomerulonephritis type II presented with decreased vision due to choroidal neovascular membrane. She was treated with monthly intravitreal injections of bevacizumab. Although there was dramatic improvement in her vision after the third injection, it continued to improve through the ninth monthly injection. Despite recent reports of renal side effects of systemic bevacizumab, patients with preexisting renal disease treated by the authors did not demonstrate any loss of renal function 1 year after treatment.