Aggressive conjunctival Kaposi sarcoma as the initial manifestation of acquired immunodeficiency syndrome.

PURPOSE: To report a case of Kaposi sarcoma in a patient with previously undiagnosed Human Immunodeficiency Virus (HIV) infection. OBSERVATIONS: A 23-year-old male patient presented to the eye clinic with complaints of redness of his left eye for the past month. The patient had been seen one day prior to presentation in the emergency department for a neck mass and pneumonia. Exam was notable for a left hemorrhagic, nodular, bulbar conjunctival mass, a right hemorrhagic conjunctival lesion, and violaceous facial skin lesions. Due to suspicion for conjunctival Kaposi sarcoma, HIV and Acquired Immune Deficiency Syndrome (AIDS) serologies were obtained which returned positive. Biopsies of the ocular mass and axillary lymph nodes confirmed Kaposi sarcoma. The patient was started on anti-retroviral therapy and Doxorubicin. The left conjunctival mass initially progressed to cover most of his cornea but eventually regressed by 6 months. CONCLUSIONS AND IMPORTANCE: Ocular involvement of Kaposi sarcoma as the initial manifestation of HIV/AIDS is rare with only a few reported cases. Since the advent of highly active antiretroviral therapy, conjunctival or adnexal Kaposi sarcoma is not commonly encountered by healthcare providers. Concern for Kaposi sarcoma of the conjunctiva in this patient led to the evaluation for HIV/AIDS. It is vital for all healthcare providers to have Kaposi sarcoma in the differential diagnosis of a hemorrhagic conjunctival or adnexal mass and be familiar with its association with HIV/AIDS. If suspected, appropriate counseling and testing should be performed.

Accuracy, repeatability, and clinical application of spherocylindrical automated refraction using time-based wavefront aberrometry measurements.

PURPOSE: To evaluate the clinical utility of spherocylindrical automated refraction (AR) based on time-based wavefront technology compared with subjective manifest refraction (MR) for the purpose of prescribing eyeglasses. DESIGN: Prospective observational case series. PARTICIPANTS: A convenience sample of 105 eyes of 53 patients (ages 19 to 87) with corrected acuity no worse than 20/40(-2). METHODS: Manifest refraction was performed on all subjects followed by three consecutive wavefront measurements at both a 4-mm and 6-mm optical zone using the 3D Wave OPD Scan ARK 10,000 aberrometer. MAIN OUTCOME MEASURES: Repeatability of multiple consecutive ARs; difference in the sphere, cylinder, and axis of AR compared with MR; difference between the corrected visual acuity based on AR- and MR-derived acuity. RESULTS: Repeatability analysis showed that the initial wavefront refraction was not significantly different from the mean of the three refractions. At the 4-mm zone, the absolute value (+/- standard deviation) of the difference between the initial AR compared with the MR was 0.34+/-0.28 diopters (D) for sphere, 0.22+/-0.21 D for cylinder, and 12.5+/-15.8 degrees for axis. At the 6-mm zone, these values were 0.32+/-0.29 D for sphere, 0.25+/-0.24 D for cylinder, and 11.8+/-14.6 degrees for axis. When 4-mm AR visual acuity was superior to MR acuity (19.0% of eyes) it was 0.28+/-0.24 Snellen lines better, and when inferior (53.3% of eyes) it was 0.47+/-0.37 lines worse. When 6-mm AR acuity was superior to MR acuity (16.2% of eyes) it was 0.32+/-0.22 Snellen lines better, and when inferior (60.0% of eyes) it was 0.48+/-0.48 lines worse. The absolute value of the difference in spherical equivalent of the first AR measurement at the 4-mm zone compared with the MR value was 0.33+/-0.23 D, and at the 6-mm zone it was 0.30+/-0.27 D. CONCLUSIONS: The wavefront-derived AR values reflect the physical optical system, but not necessarily subjectively derived values, and the impact of this disagreement on patient satisfaction is unknown. Future studies evaluating this technology and its role in clinical ophthalmology are warranted.

The Ophthalmic Clinical Evaluation Exercise (OCEX).

PURPOSE: New concise tools must be developed to assess reliably and validly the core residency competencies identified by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: Eighteen content experts (residency program directors). METHODS: A 1-page Ophthalmic Clinical Exercise Examination (OCEX) checklist, for use during observed resident-patient interactions, was developed by an American Board of Ophthalmology taskforce. The OCEX checklist was sent to 18 content experts for their review and constructive comments. RESULTS: Experts' comments were incorporated, establishing face and content validity. CONCLUSIONS: The OCEX has face and content validity. It can be used to assess a resident's patient care skills, medical knowledge, and interpersonal skills. Reliability and predictive validity still need to be determined.

Bilateral dislocation of in-the-bag posterior chamber intraocular lenses in a patient with intermediate uveitis.

We present a case of bilateral dislocation of in-the-bag intraocular lenses (IOLs) in a patient with intermediate uveitis. The IOLs dislocated into the vitreous cavity 24 and 41 months postoperatively. A complete pars plana vitrectomy with sutured posterior chamber IOL implantation was performed after each dislocation. The final visual acuity was 20/20(-) in each eye.