Posterior-scleritis: Case report of an uncommon immune-related adverse event in the treatment of advanced endometrial cancer.

As Immune checkpoint inhibitors are being expanded for use in gynecologic malignancies, rare immune-related adverse events are more frequently being reported. Here we describe a 63-year-old with Stage IIIB mismatch repair deficient uterine adenocarcinoma who underwent six cycles of carboplatin and paclitaxel with partial response but persistent disease. She was then started on single agent pembrolizumab. After six cycles of pembrolizumab, she developed bilateral vision changes and was diagnosed with posterior scleritis. Pembrolizumab was held and she was treated with oral prednisone, with rapid resolution of symptoms. One month after completion of prednisone, vision changes were again reported and she was restarted on a longer oral prednisone course. She then underwent definitive surgical management consisting of a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy, with final pathology of benign endometrial hyperplasia. She has completed her steroid course without any symptoms. Given her complete pathologic response, she was subsequently placed into surveillance and is currently without evidence of disease. Prompt recognition and treatment of this rare immune-related adverse event led to the prevention of potential permanent, debilitating outcomes.

25-gauge vitrectomy using sulfur hexafluoride and no prone positioning for repair of macular holes.

PURPOSE: To report on the outcomes of 25-gauge pars plana vitrectomy using sulfur hexafluoride and no prone positioning for repair of macular holes. METHODS: Retrospective case series of 44 consecutive patients who underwent pars plana vitrectomy with internal limiting membrane peeling for repair of stages 2 to 4 idiopathic macular holes using 20% to 30% sulfur hexafluoride. No postoperative prone positioning or gas augmentation was used. RESULTS: The macular hole closure rate was 88.6%. There were no differences in the macular hole closure rates between phakic and pseudophakic patients (21 of 23 vs. 17 of 21, respectively) or among stages 2, 3, and 4 macular holes (12 of 13, 20 of 23, and 7 of 8, respectively). In eyes successfully operated on, visual acuity improved from 0.61 logarithm of the minimal angle of resolution (logMAR) (20 of 82) preoperatively to 0.483 logMAR (20 of 61) at 1 month and 0.396 logMAR (20 of 50) at a mean final follow-up of 10.8 months. Adverse effects were elevation of intraocular pressure to >30 mmHg in 7 (13.6%) of 44 patients on the first postoperative day, postoperative retinal detachments in 2 (4.5%) of 44 patients, and progression of cataract requiring cataract surgery in 7 (30.4%) of 23 phakic patients during follow-up. CONCLUSIONS: Macular hole closure rates similar to those achieved using pars plana vitrectomy with perfluoropropane and prone positioning can be achieved using sutureless 25-gauge vitrectomy with sulfur hexafluoride tamponade and no prone positioning for both phakic and pseudophakic patients.

Acute endophthalmitis incidence: intravitreal triamcinolone.

OBJECTIVE: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure. METHODS: Retrospective, noncomparative, consecutive, interventional case series of all patients who had received IVTA at 2 clinical centers between January 1, 2000, and January 30, 2004. RESULTS: A total of 1006 eyes received IVTA. None of the eyes developed acute, culture-positive, postoperative endophthalmitis in the 6 weeks following the procedure. One patient developed acute, culture-negative, postoperative endophthalmitis 4 days after receiving IVTA, resulting in an incidence of 0.10%. In this case, the presenting symptoms were decreased vision and acute conjunctival erythema. The case was notable for the absence of pain or hypopyon. CONCLUSION: Although acute postoperative endophthalmitis may follow IVTA, our experience suggests that this is a relatively uncommon event.

Twenty-year follow-up for scleral buckling.

OBJECTIVE: To the report 20-year follow-up data for patients receiving a scleral buckle for treatment of a primary rhegmatogenous retinal detachment (RRD). METHODS: Nonconsecutive, retrospective case series. We identified 227 eyes with primary RRD who were treated with a scleral buckle, and for whom at least 20 years of follow-up data were available. Results were classified into 3 subgroups: retina reattached with 1 procedure; retina reattached with 1 or more additional vitreoretinal procedures; or retina detached at 20 years. RESULTS: One hundred eighty-six eyes (82%) achieved retinal reattachment with 1 scleral buckling procedure and with a median final visual acuity of 20/40 at 20 years of follow-up. An additional 30 eyes (13%) achieved retinal reattachment after 1 or more additional vitreoretinal procedures, with a median final visual acuity of 20/50. Eleven eyes (5%) were detached at the 20-year follow-up examination, with a final visual acuity in all eyes of no light perception. CONCLUSIONS: Scleral buckling for primary RRD achieves anatomical efficacy and preservation of central vision in the majority of eyes at 20 years' follow-up. The 1-operation success rate was 82%, overall success rate was 95%, and median final visual acuity was 20/40. This study may serve as a basis for comparison with the long-term results of other surgical techniques used in the treatment of primary RRDs.

Retained lens fragments in resident-performed cataract extractions.

PURPOSE: To investigate the incidence, management, and outcome of retained lens fragments following resident-performed cataract extraction. METHODS: A retrospective review of all eyes undergoing cataract extraction by the residents of Baylor College of Medicine over a 4-year time frame (July/95-June/99). RESULTS: A total of 3389 eyes underwent cataract extraction, and 26 patients (0.8%) required pars plana vitrectomy (PPV) for retained lens fragments. One or more vision threatening complications occurred in 19 (73%) of these patients. The most common complications were cystoid macular edema (CME) (8 eyes, 31%) and rhegmatogenous retinal detachment (RRD) formation (6 eyes, 23%). Additional surgical procedures were required for 9 (35%) eyes; the most common were repeat PPV, and placement of focal photocoagulation for diabetic macular edema (4 eyes per each procedure, 15%). Six-month follow-up was available for 16 eyes; of these, best-corrected visual acuity was 20/40 or better in 5 (31%) and 20/200 or worse in 7 (44%). The most common reasons for limited visual acuity were RRD (3 eyes, 19%) and CME (3 eyes, 19%). CONCLUSION: In this retrospective series, the incidence of retained lens fragments following resident-performed cataract extraction was less than 1%. Significant complications, resulting in the need for additional surgical procedures, occurred in most of these eyes, and this was associated with limited visual function at final follow-up. Retention of lens fragments following resident-performed cataract extraction remains an infrequent yet serious complication associated with a guarded visual prognosis.