Melanoma-Associated Spongiform Scleropathy Adjacent to a Choroidal Nevus.

Melanoma-associated spongiform scleropathy contiguous to a choroidal nevus was an incidental finding in a 57-year-old woman whose eye was removed for a separate choroidal-ciliary body melanoma. All previously reported cases of melanoma-associated spongiform scleropathy, except for one, have been found adjacent to posterior uveal melanoma. The mechanism of scleral degeneration in melanoma-associated spongiform scleropathy is unknown. Few cases of posterior uveal nevi have been reported since the description of spongiform scleropathy, making assessment of the specificity of the degeneration to melanoma alone difficult. The presence of melanoma-associated scleropathy adjacent to a choroidal nevus indicates that the condition is not exclusively linked to posterior uveal melanoma.

CAVERNOUS HEMANGIOMALIKE CHANGES IN A CHOROIDAL MELANOMA AFTER BRACHYTHERAPY.

PURPOSE: To describe a degenerative vascular change in a treated choroidal melanoma that clinically simulated late treatment failure. METHODS: Observational case report. RESULTS: A 79-year-old man with choroidal melanoma treated 15 years earlier with iodine-125 brachytherapy demonstrated substantial increase in size of this once stable tumor. The eye was removed because of concern of late treatment failure. Histologically, the tumor consisted of melanocytes with no mitotic activity and virtually no Ki-67 expression. Roughly half the lesion was composed of cavernous blood-filled spaces lined by bland CD34+ and CD31+ endothelial cells. CONCLUSION: Late degenerative changes in the vasculature of treated uveal melanoma can result in tumor enlargement, which may raise clinical concerns over treatment failure and neoplastic potential.

Spontaneous resolution of ophthalmologic symptoms following bilateral traumatic carotid cavernous fistulae.

A 38-year-old woman developed bilateral carotid cavernous fistulae (CCF) following a motor vehicle collision. Her initial ophthalmologic findings included periorbital edema, palsies of the left oculomotor and abducens nerves, and residual dilated pupils. She subsequently developed significant optic disc edema and retinal vascular dilation bilaterally. Patients with similar injuries typically require neurosurgical or vascular intervention. In this case, the patient's signs resolved spontaneously by 21 months after onset, leaving no residual ocular deficits.

Rapidly enlarging choroidal melanoma: perioperative treatment implications.

PURPOSE: The purpose of this study was to describe a case of a rapidly enlarging choroidal melanoma that necessitated perioperative adjustment in treatment. METHODS: Observational case report. RESULTS: A 48-year-old white woman presented with decreased vision and floaters and was found to have a choroidal melanoma in her left eye. After discussion of risks and benefits of treatment, the patient elected radioactive plaque insertion. Intraoperative examination revealed that the choroidal melanoma had increased in height precluding plaque treatment. CONCLUSION: This case highlights the importance of intraocular examination and an informed consent that provides contingency therapies at the time of surgery.

Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial.

PURPOSE: To assess the prevalence of hypotony in patients with severe forms of uveitis. METHODS: The Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized study, enrolled 255 patients. Patients with hypotony at the baseline visit were identified. RESULTS: Twenty (8.3%) of 240 patients with sufficient data had hypotony. Hypotony was more common in patients with uveitis ≥5 years duration (odds ratio [OR] = 5.0; p < .01), and in eyes with a history of ocular surgery (vitrectomy vs. none, OR = 3.1; p = .03). Hypotony was less in patients with older age of uveitis onset (>51 years vs. <51 years, OR = 0.1; p = .02), in Caucasian patients (OR = 0.1; p < .01) compared to African American patients. Hypotonous eyes were more likely to have visual impairment (OR = 22.9; p < .01). CONCLUSIONS: Hypotony is an important complication of uveitis and more commonly affects African-American patients, those with uveitis onset at a younger age, and those with longer disease duration. It is associated with visual impairment.

Acute retinal necrosis associated optic neuropathy.

Acute retinal necrosis (ARN) syndrome is characterized by severe intraocular inflammation, occlusive vasculopathy and peripheral retinal necrosis. Vision threatening complications of this syndrome include retinal detachment, macular oedema and ischaemia and optic neuropathy. Optic nerve involvement may be the presenting sign of ARN and this condition should be included in the differential diagnosis of acute papillitis. Several mechanisms may lead to ARN associated optic neuropathy including vasculitis, optic nerve ischaemia and direct optic nerve invasion by the herpes virus. We review optic nerve involvement during ARN and present its incidence, pathogenesis, differential diagnosis and treatment.

Association between abnormal contrast sensitivity and mortality among people with acquired immunodeficiency syndrome.

PURPOSE: To investigate the relationship between contrast sensitivity (CS) and mortality among people with acquired immunodeficiency syndrome (AIDS); and to explore the hypothesis that abnormal CS is a marker of systemic, life-threatening microvascular disease. DESIGN: Longitudinal, observational cohort study. METHODS: We evaluated 3395 eyes of 1706 individuals enrolled in the Longitudinal Study of the Complications of AIDS (1998-2008). CS was evaluated as a risk factor for death, and was compared to the presence of systemic diseases characterized by microvasculopathy (diabetes, cardiovascular disease, stroke, renal disease) and to laboratory markers of those diseases. Abnormal CS was defined as logCS <1.5 (lower 2.5th percentile for a normal control population). RESULTS: CS was abnormal in 284 of 1691 (16.8%) study participants at enrollment. There was a positive relationship between the presence of abnormal CS at study entry and mortality (relative risk 2.0, 95% confidence interval 1.7-2.3, P < .0001). Abnormal CS was related to the presence of cardiovascular disease, stroke, and renal disease (all P values

Neurosensory retinal detachment of the macula in retinal phototoxicity documented by optical coherence tomography.

PURPOSE: To report a neurosensory detachment documented by optical coherence tomography in operating light microscope-induced retinal phototoxicity. METHODS: A 53-year-old man had a pars plana lensectomy, core vitrectomy, and posterior chamber sutured intraocular lens implantation in his right eye. The surgery lasted >3 hours. RESULTS: On postoperative Day 13, best-corrected visual acuity was 20/100. There was retinal pigment epithelial atrophy in the superior macula with subtle pigmentary clumping on its borders. Fluorescein angiography revealed staining in the area of retinal pigment epithelium atrophy with blockage of underlying choroidal fluorescence by the border hyperpigmentation in a pattern typical of phototoxicity. Optical coherence tomography documented a large, central neurosensory detachment. The central macular thickness was 731 µm. Best-corrected visual acuity in the right eye on postoperative Day 31 had improved to 20/60, and the optical coherence tomography had minimal subretinal fluid with a central macular thickness of 226 µm. On postoperative Day 78, there was no subretinal fluid, best-corrected visual acuity was 20/50, and the central macular thickness was 191 µm. Four months postoperatively, best-corrected visual acuity was 20/30. CONCLUSION: Microscope light-induced retinal phototoxicity may be associated with a neurosensory detachment.