Risk Factors for Meibomian Gland Disease Assessed by Meibography.

Purpose: To elucidate risk factors for meibomian gland disease (MGD) and understand associated changes in meibography and in relation to ocular surface disease. Patients and Methods: As part of the standard workup for ocular surface disease at a tertiary academic center, 203 patients received an ocular history and lifestyle questionnaire. The questionnaire included detailed inquiries about ocular health and lifestyle, including makeup use, cosmetic eyelid procedures, screen time, and contact lens habits. Subjects also took the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated on meibography and scored by three independent graders using meiboscores. Statistical analysis was conducted to identify significant risk factors associated with MG loss. Results: This retrospective, cross-sectional study included 189 patients (378 eyes) with high-quality images for grading, and the average age was 67 years (77% female). Patients older than 45 years had significantly more dropout than younger patients (p < 0.01). Self-reported eye makeup use did not significantly impact MG loss. Patients with a history of blepharoplasty trended toward higher meiboscores, but the difference was not statistically significant. Self-reported screen time did not affect meiboscores. Contact lens use over 20 years was associated with significant MG loss (p < 0.05). SPEED II scores had no relationship to meiboscores (p = 0.75). Conclusion: Older age is a significant risk factor for MG loss. Any contact lens use over 20 years also impacted MG dropout. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship to the structural integrity of MGs.

Correlation between Frozen Section and Permanent Histopathologic Diagnoses in Adult Orbital Lesions.

Introduction: When indicated, intraoperative use of frozen sections may assist in determining the surgical course or appropriate processing of surgical specimens. Knowing the accuracy of a preliminary frozen section diagnosis is important. The purpose of this study is to determine the rate of correlation between frozen and permanent histopathologic diagnoses of adult orbital lesions, analyze characteristics of discordant cases, and examine the effects of discordance on surgical decision-making. Methods: A 15-year retrospective chart review was conducted at a tertiary care center of all adult patients with orbital lesions for which frozen section and corresponding permanent section tissue diagnoses were obtained. Results: Sixty-five orbital surgeries were performed with a total of 89 frozen sections sampled. In 63 surgeries (96.9%), at least 1 frozen section diagnosis matched the final permanent section diagnosis. Overall, frozen section diagnosis corresponded with permanent section diagnosis in 81 of 89 (91.0%) specimens. Of the 8 (9.0%) specimens from 5 unique patients that did not correlate, the final diagnoses on permanent sections were amyloidosis (5), margin-positive infiltrating breast carcinoma (2), and lymphoid hyperplasia (1). The discrepancy between frozen and permanent sections did not alter care in any patient. Conclusion: Frozen section diagnoses correlate with permanent histopathologic tissue diagnosis in adult orbital biopsies in greater than 90% of cases. Among non-correlated specimens, amyloidosis was the most common diagnosis. Although rare, orbital amyloid disorders may be considered in the differential diagnosis of cases of orbital biopsies with nonspecific findings on a frozen section.

SEROUS MACULAR DETACHMENT ASSOCIATED WITH WALDENSTROM MACROGLOBULINEMIA MANAGED WITH IBRUTINIB: A CASE REPORT AND NEW INSIGHTS INTO PATHOGENESIS.

PURPOSE: To report a case of serous macular detachment in a patient with Waldenstrom macroglobulinemia treated with ibrutinib. METHODS: The patient underwent a complete ophthalmic examination and imaging at presentation and at follow-up visits up to 13 months. RESULTS: At presentation, there were serous macular detachments bilaterally with no dye leakage on fluorescein angiography or vasculature abnormalities on optical coherence tomography angiography. After treatment with ibrutinib, there was near resolution of the patient's retinopathy with an improvement in vision at 13 months' follow-up. CONCLUSION: Serous macular detachments in Waldenstrom macroglobulinemia-associated retinopathy may be due to the disruption of the retinal pigment epithelium pump mechanism by hyperglobulinemia. The favorable course of this patient, treated with the novel tyrosine kinase inhibitor ibrutinib, suggests this may be the preferred treatment for Waldenstrom macroglobulinemia patients with associated retinopathy.

Intraocular lens calculations in patients with keratoectatic disorders.

PURPOSE OF REVIEW: Intraocular lens (IOL) calculations in patients with keratoconus and other keratoectatic disorders continues to be a challenge for today's cataract surgeon. In this article, we review data published over the past 18 months (June 2018 to January 2020). RECENT FINDINGS: Cataract surgery in keratoconus patients has the potential to greatly improve patients' vision. However, keratoconic eyes are notorious for unpredictable outcomes because of difficulty in obtaining proper preoperative biometry and lack of data and consensus on IOL calculation formulas that can reliable in providing the desired outcome. Recent studies suggest the Barrett II Universal calculation is the most accurate in mild-to-moderate keratoconic eyes. All studies note the level of predictability decreases with the steepness of keratometric readings. Historically, the SRK/T has been shown to provide the most reliable calculations. SUMMARY: There is still no consensus on which formula is best for IOL calculation in keratoconic eyes. On the basis of the most recent literature, we recommend using the Barrett II Universal in conjunction with the SRK/T formula for mild-to-moderate eyes. Preoperative counseling of expectations with the patient is the key to achieving a satisfied patient and avoiding an unpleasant situation in the result of refractive surprise.

Differences in Wait Times for Cosmetic Blepharoplasty by ASOPRS Members.

PURPOSE: Adequate access to subspecialty care is of concern to patients and physicians alike. One measure of availability is the wait time for cosmetic procedures. The authors investigated geographical differences in wait times for cosmetic upper eyelid blepharoplasty of American Society of Ophthalmic Plastic and Reconstructive Surgery members across the country. METHODS: This study surveyed all 533 American Society of Ophthalmic Plastic and Reconstructive Surgery members' practices in the United States based on the publically available contact information (www.asoprs.org). Scripted telephone calls were made requesting self-referred cosmetic upper eyelid blepharoplasty. Wait times until the first available appointment and time until the first available surgery date were collected. RESULTS: Of the membership, 387 (72.6% response rate) respondents offered appointments for cosmetic upper eyelid blepharoplasty. Overall, 84.2% of respondents were male. Practice breakdown was 83.4% in private practice and 16.5% in academic practice. Median wait time until the next available appointment was 14 days (mean 21.2 days, 0-205 days; p = 0.145). Private practice wait time was shorter than academic (median 14 vs. 18 days, mean 19.7 vs. 28.9 days; p =0.004). However, there was wide variability based on region. CONCLUSIONS: Patients seeking cosmetic upper eyelid blepharoplasty have good access to care by American Society of Ophthalmic Plastic and Reconstructive Surgery members. There are variabilities based on academic versus private practice. Further study can evaluate whether similar findings exist for medically necessary functional procedures. This information may help assess the need for additional practitioners.

HLA-A29-POSITIVE BIRDSHOT CHORIORETINOPATHY IN AN AFRICAN AMERICAN PATIENT.

PURPOSE: To report the first documented case of HLA-A29-positive birdshot chorioretinopathy in an African American patient. METHODS: A 51-year-old African American woman presented with a 10-year history of photopsia, progressive decrease in visual acuity, metamorphopsia, and new nyctalopia. Both fundi showed evidence of periphlebitis, arterial attenuation, macular edema, and diffuse chorioretinal atrophy. RESULTS: Fluorescein angiography revealed diffuse vascular leakage, and indocyanine green showed evenly distributed and symmetrical hypofluorescent spots, which were difficult to appreciate on fundoscopy. Workup revealed a positive HLA-A29 and was negative for sarcoid, tuberculosis, and syphilis. CONCLUSION: Birdshot chorioretinopathy overwhelmingly affects non-Hispanic Caucasians, but there have been rare reported cases in other ethnicities including Hispanics and African Americans. This patient's ethnicity may have contributed to the 10-year delay in diagnosis. To our knowledge, this is the first documented HLA-A29 positive case of birdshot chorioretinopathy in an African American. HLA-A29 may be a useful supportive test in cases with classic clinical presentation in non-Caucasian patients to enable the correct diagnose in a timely manner.

Primary Central Nervous System Vasculitis With Optic Nerve Involvement.

A 20-year-old woman presented with headache, decreased vision, eye pain, and urinary retention. During her clinical course, visual acuity declined to 20/800, right eye, and 20/50, left eye, associated with bilateral optic disc edema. Brain magnetic resonance imaging revealed enhancement of the leptomeninges, right optic nerve, and right side of the optic chiasm. Extensive evaluation of the central nervous system (CNS) for an infectious cause was negative. Brain biopsy showed a pattern consistent with vasculitis. The patient was treated with prednisone and cyclophosphamide, resulting in improvement of her vision and systemic symptoms. Primary CNS vasculitis is a rare condition that may affect the anterior visual pathways.

Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis.

BACKGROUND: Syphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis. FINDINGS: This is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G. CONCLUSIONS: The first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection.