Incidence of Total Blindness After Central Retinal Artery Occlusion With Ocular Neovascularization.

Purpose: To determine the time-based incidence of total blindness after central retinal artery occlusion (CRAO) with secondary ocular neovascularization (ONV). Methods: In this retrospective cohort study, electronic records were queried using ICD-9 and ICD-10 codes to identify patients with secondary ONV post-CRAO. Patients with possible alternative ONV etiologies, previous panretinal photocoagulation (PRP), and/or previous antivascular endothelial growth factor (anti-VEGF) therapy were excluded. Clinical data included demographics, medical comorbidities, ONV manifestations, medical/surgical management, and best-corrected visual acuity (BCVA). Kaplan-Meier analysis was performed with total blindness (defined as a BCVA of no light perception) as the outcome of interest. Results: Of 345 eyes with CRAO, 34 met the inclusion criteria with a mean (±SD) follow-up of 22.0 ± 26.2 months. ONV management included PRP (70.6%), glaucoma drainage implant surgery or transscleral cyclophotocoagulation (32.4%), and intravitreal anti-VEGF therapy (mean 2.8 ± 5.6 injections per patient). The cumulative incidence of total blindness was 49.4% (95% confidence interval, 27.2%-71.6%) at 24 months, with 53.3% of cases occurring within 4 months of ONV onset. Conclusions: Post-CRAO ONV is associated with a high risk for progression from severe vision loss to total blindness. Neovascular glaucoma can present up to 4 months after CRAO, challenging the paradigm of "30-day-glaucoma." Routine gonioscopy should extend through this period, while glaucoma surgery can delay further vision loss. These findings can be used to counsel patients on the importance of follow-up adherence.

Subretinal Abscess Complicated by Post-infectious Retinal Vasculitis Following Strabismus Surgery.

An 8-year-old girl presented with a subretinal abscess after strabismus surgery. This was treated successfully with medial rectus suture removal, pars plana vitrectomy, intravitreal antibiotics, and intravenous antibiotics. Recovery was complicated by acute post-infectious retinal vasculitis after tapering high-dose corticosteroids, requiring an extended corticosteroid regimen over 2 months until resolution. [J Pediatr Ophthalmol Strabismus. 2023;60(3):e26-e30.].

A Rare Case of Congenitally Acquired Ocular Toxocariasis in A Five-Week-Old Infant.

PURPOSE: To report a case of strabismus in a five-week-old infant, likely secondary to a rare occurrence of congenitally acquired ocular toxocariasis. METHODS: Retrospective case report. RESULTS: A five-week-old male infant with left exotropia was referred to pediatric ophthalmology and to a vitreoretinal specialist. Fundoscopic examination revealed a granuloma with associated retinal folds and tractional retinal detachment typical for ocular toxocariasis. Serology revealed positivity for Toxocara antibodies, consistent with the clinical diagnosis of ocular toxocariasis. CONCLUSION: Ocular toxocariasis is typically thought to be secondary to acquired Toxocara infection secondary to fecal-oral transmission. In this case of early-onset strabismus secondary to ocular toxocariasis, it is hypothesized that this is a presentation of congenitally acquired toxocariasis.

Recurrent hematuria in a patient with a previously undiagnosed transitional cell carcinoma of the right ureter after intravitreal bevacizumab (Avastin) injection: a case report.

PURPOSE: To report a case of gross hematuria in a patient with previously undiagnosed urothelial carcinoma of the right ureter after intravitreal bevacizumab (Avastin) injections. METHODS: In this case report and review of the literature, an 81-year-old woman presented with neovascular age-related macular degeneration in the left eye. She was treated with repeated intravitreal bevacizumab (Avastin) injections. After injection, she reported two episodes of gross hematuria. After disclosing this information to her ophthalmologist, bevacizumab treatment was suspended and the hematuria resolved. Urological evaluation revealed no abnormalities. Approximately 1 year later, treatment with intravitreal bevacizumab was resumed. After three injections, she again reported gross hematuria. Urological evaluation at that time revealed a high-grade urothelial carcinoma of the right ureter. A right nephroureterectomy was performed, and bevacizumab treatment was resumed. She did not report any subsequent episodes of hematuria. CONCLUSION: Hematuria has previously been reported with systemic administration of bevacizumab. However, hematuria after intravitreal injections of bevacizumab has not been reported and is most likely occurring as a result of the systemic absorption of the drug. Further investigation of the systemic effects of intravitreal bevacizumab may be warranted.

Atypical Retinal Lesion in a Heart Transplant Patient: Investigation and Management.

BACKGROUND: A cardiac transplant patient presented to the Ochsner ophthalmology clinic with flashes of light in the left eye and a retinal lesion of unclear etiology. CASE REPORT: A 59-year-old male cardiac transplant patient was referred by an outside eye physician. Examination of the anterior chamber of his left eye showed inflammation, and a large hypopigmented lesion was discovered in the nasal retina of the left eye. The patient was admitted to the hospital. Empiric treatment was initiated, and all workup results were negative. During the next several days, the patient's retinal lesion extended. A tap of the eye's vitreous and aqueous fluid yielded no diagnosis. The patient underwent a chorioretinal biopsy through a pars plana vitrectomy. Fluid removed from the vitreous cavity was sent for polymerase chain reaction (PCR) testing, and intravitreal antibiotics were injected. The results of the PCR were negative for all organisms. However, the lesion stabilized, and the patient has remained stable on oral valganciclovir. CONCLUSION: Cytomegalovirus PCR testing has 95% sensitivity in untreated patients but only 48% sensitivity in patients treated with systemic ganciclovir, foscarnet, or both. Cytomegalovirus retinitis was determined to be a possible diagnosis; however, the possibility exists that the patient had developed a fungal subretinal abscess.

Patient self-report of prior laser treatment reliably indicates presence of severe diabetic retinopathy.

PURPOSE: To determine whether patient self-report of prior laser treatment can be used as a reliable tool for assessing the presence of severe diabetic retinopathy. DESIGN: This was a retrospective study on two groups of diabetic subjects. METHODS: One hundred patients with diabetes were recruited from the general eye and retina clinics at the University of Chicago Hospitals. The patients were asked, "Have you ever received laser treatment for your diabetic eye disease (DED)?" A chart review was then conducted noting if the patient had received either focal laser treatment for diabetic macular edema or panretinal photocoagulation for proliferative diabetic retinopathy. Data from the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) were also analyzed. Participant responses to the question "Have you had laser photocoagulation treatment for your eyes?" were analyzed with documentation of photocoagulation scars determined by grading seven-standard field color fundus photographs. RESULTS: In the University of Chicago group, 96 of 100 (96%) of patients were accurate in reporting whether they had received previous laser treatment for DED (sensitivity 95.8%, specificity 96.1%, and positive predictive value 88.5%). In the WESDR analysis, 2,329 of 2,348 (99%) of participants were accurate in reporting whether they had prior laser treatment for DED (sensitivity 96.0%, specificity 99.5%, and positive predictive value 95.6%). CONCLUSIONS: The high sensitivity and specificity of our results validate the use of patient self-report as a useful tool in assessing past laser treatment for severe diabetic retinopathy. Patient self-report may be a useful surrogate to clinical examination or medical record review to determine the presence of severe diabetic retinopathy.

Short-term intraocular pressure trends after intravitreal injection of bevacizumab (avastin).

PURPOSE: To report the changes in intraocular pressure (IOP) after intravitreal injection of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA). DESIGN: Retrospective chart review. METHODS: After the charts of 29 patients who underwent 51 consecutive intravitreal injections of bevacizumab were reviewed, analysis of the short-term effect of bevacizumab injections on IOP was performed. RESULTS: Mean baseline IOP ± SD was 15.1 ± 2.35 mm Hg (range, 10-22 mm Hg). Mean postinjection IOP ± SD was 20.1 ± 4.70 mm Hg (range, 16-31 mm Hg). Mean change in IOP from baseline to ≈30 minutes after bevacizumab injection was 5.0 mm Hg (P = 0.0027). Mean IOP ± SD at the first follow-up visit, which occurred ≈25 days (range, 5-43 days) after injection, was 14.7 ± 2.93 mm Hg (range, 10-20 mm Hg). CONCLUSIONS: Intravitreal injection of bevacizumab seems to be safe from an IOP standpoint in the short term. IOP monitoring immediately after injection may not be necessary.