Distribution patterns of torpedo maculopathy: Further evidence of a congenital retinal nerve fiber layer-driven etiology.

With fewer than 100 peer-reviewed cases reported in the world to date, the underlying etiology of torpedo maculopathy has remained elusive. In this literature review, we provide new evidence to better support, reject and unify claims regarding cause, diagnosis, and proper clinical management of this disease. We reviewed 44 case reports and case series, which included 77 patients (after exclusions). We additionally introduced 3 new cases from our clinical practice for a total of 80 cases. Ages at presentation ranged from 6 months old to 73 years old (mean: 24.2 years old). The nasal aspects of torpedo maculopathy lesions pointed toward the optic disc and localized to a kite-shaped region of the temporal macula, correlating with the anatomic junction of the superior arcuate, inferior arcuate, and papillomacular bundles of retinal nerve fiber layer distribution. No patterns were observed among the temporal aspects of the lesions. These findings support a congenital etiology of torpedo maculopathy and a possible influence of the retinal nerve fiber layer in the development of mature retinal pigment epithelium.

Pericentral hydroxychloroquine retinopathy in a Caucasian female.

PURPOSE: To report a rare presentation of the pericentral pattern of hydroxychloroquine (HCQ) retinal toxicity in a Caucasian female. OBSERVATIONS: The patient presented with 20 years of exposure to HCQ, at a daily dose of 5.2mg/kg of actual body weight, and manifested a pericentral-only phenotype of HCQ toxicity, as demonstrated with detailed structural and functional testing. CONCLUSIONS AND IMPORTANCE: Although rare, the pericentral pattern of HCQ toxicity may occur in Caucasian patients in the absence of paracentral changes.

IOP Elevation After Cataract Surgery: Results for Residents and Senior Staff at Henry Ford Health System.

PURPOSE: To determine the incidence of intraocular pressure (IOP) elevation on postoperative day 1 (POD1) after cataract surgery performed by resident surgeons compared with attending surgeons and to examine the influence of associated variables on the incidence of postoperative IOP elevation. PATIENTS AND METHODS: Retrospective review of 2472 consecutive 2.2 to 2.8 mm temporal clear corneal cataract extractions by phacoemulsification performed by either residents or attending surgeons at Henry Ford Health System. Fellow eyes were excluded, resulting in 1847 eyes. IOP measurements of >40, >30, and >23 mm Hg were noted along with incremental IOP elevations of ≥10 and 20 mm Hg over preoperative/baseline IOP. Associated variables included: age, sex, diabetes mellitus, hypertension, glaucoma, glaucoma suspect, uveitis, prior ocular trauma, and vitreous loss at surgery. RESULTS: Resident-performed cataract surgery was associated with statistically significant higher rates of IOP elevation in all categories and in all clinical situations known to be associated with postoperative IOP spike, that is, vitreous loss at surgery, prior ocular trauma, and preexisting glaucoma. CONCLUSIONS: The incidence of postoperative day 1 IOP elevation after phacoemulsification performed by resident surgeons was 2 to 5 times that of experienced cataract surgeons. Variables including vitreous loss at surgery, prior ocular trauma, preexisting glaucoma, glaucoma suspect status, and male sex were significant contributors. Consideration for prophylactic IOP lowering is advised in high-risk patients.

Inadvertent Trypan Blue Staining of Posterior Capsule during Cataract Surgery Associated with "Argentinian Flag" Event.

Trypan blue is common in visualizing the anterior capsule during cataract surgery. Inadvertent staining of the posterior capsule during phacoemulsification is a rare complication and there are few reports in the literature. The proposed mechanism of posterior capsule staining in previous reports includes a compromised zonular apparatus or iris retractors facilitating the posterior flow of trypan blue. We report the first case of trypan blue staining of the posterior capsule associated with the "Argentinian flag" sign. In our case, the "Argentinian flag" allowed the trypan blue to seep between the posterior capsule and the lens, staining the anterior surface of the posterior capsule.

Laser treatment of macular retinoschisis due to acquired optic nerve pit from glaucoma.

Macular retinoschisis can be caused by acquired optic nerve pit from glaucoma. This study evaluated the efficacy of laser treatment for this disorder. We report on five eyes from three patients with macular retinoschisis and a history of glaucoma. Spectral domain optical coherence tomography was used for diagnosis and follow-up. Treatment was performed with barrier laser on the temporal margin of the optic nerve. Following treatment, patients' average vision improved by 1 line on the Snellen chart at average follow-up of 12.3 months. All five eyes showed significant improvement in macular retinoschisis. The tracts connecting the optic pit to the retinoschisis completely closed in three eyes and nearly closed in two eyes. These cases demonstrate that laser photocoagulation is an effective treatment of macular retinoschisis from acquired optic nerve pit. It can serve as first-line treatment before more invasive options such as vitrectomy are considered.

Valsalva-Like Retinopathy Secondary to Pancytopenia following Induction of Etoposide and Ifosfamide.

Etoposide and ifosfamide are chemotherapeutic agents used frequently in the treatment of sarcomas and hematologic malignancies. Ocular side effects are rarely reported. We describe a case of a patient on etoposide and ifosfamide who presented with unilateral vision loss, anemia, and thrombocytopenia. The patient was found to have a large subinternal limiting membrane hemorrhage in the right eye that is thought to be related to his anemia and thrombocytopenia. The hemorrhage resolved spontaneously after 10 days. This case illustrates how bone marrow suppression by chemotherapeutic agents may indirectly contribute to retinal hemorrhages resulting in at least transient vision loss.