Bilateral subinternal limiting membrane hemorrhage in benzene toxicity.

PURPOSE: To report the clinical and spectral domain optical coherence tomography findings in a patient with bilateral central vision loss and a history of exposure to polyamides. METHODS: The clinical presentation of the patient was documented with color fundus photographs and spectral domain optical coherence tomography. The patient was a 20-year-old male factory worker with no medical history who was initially admitted for workup of hematologic malignancy due to petechiae and fevers. RESULTS: Optical coherence tomography revealed bilateral hemorrhages in the subinternal limiting membrane space resembling Valsalva retinopathy. Complete blood count revealed pancytopenia and marked thrombocytopenia. CONCLUSION: Heavy exposure to benzene, a byproduct of the polyamide-curing process, is known to cause aplastic anemia. Accompanying thrombocytopenia may increase the risk of spontaneous subinternal limiting membrane hemorrhage.

Impact of scanning density on spectral domain optical coherence tomography assessments in neovascular age-related macular degeneration.

PURPOSE: To determine the effect of optical coherence tomography (OCT) B-scan density on the qualitative assessment of neovascular age-related macular degeneration (AMD). METHODS: Data were collected from 59 patients imaged with Topcon 3D OCT-1000 (128 B-scans × 512 A-scans). Custom software was used to generate less dense subsets of scans: 1/16 (eight B-scans), 1/8 (16 B-scans), 1/4 (32 B-scans) and 1/2 (64 B-scans). At each B-scan density, scans were assessed for cystoid spaces, subretinal fluid (SRF), subretinal tissue (SRT) and pigment epithelium detachment (PED). For each sampling density, sensitivity, specificity and predictive values were calculated using the full volume scan (128 B-scans) as the reference standard. RESULTS: For cystoid spaces, the detection sensitivity was 76.3% at 1/16 density; this rose to 89.5% with a 1/4 density. For SRF, the detection sensitivity was 75.0% at a 1/16 density; this increased to 91.1% with 1/4 density. For PED, even at the lowest sampling density (1/16) the detection sensitivity was 86.4%; this rose to 94.9% at 1/4 density. For SRT, detection sensitivity at a 1/16 density was 64.7% and only rose above 90% with the densest sampling subset (1/2). CONCLUSIONS: Use of scanning protocols with reduced sampling densities resulted in decreased detection of key features of neovascular AMD; despite this, a sampling density reduced to 1/4 appeared to allow accurate assessment for most features. Current management of neovascular AMD is dependent on qualitative assessment of OCT images; with the recent proliferation of OCT systems, optimization and standardization of scanning protocols may be of value.

Exfoliating goblet cell hyperplasia mimicking pterygium: a clinicopathological case report.

We present an interventional case report of exfoliating goblet cell hyperplasia mimicking pterygium. A 44-year-old male with bilateral lesions of the nasal bulbar conjunctiva extending over the cornea, consistent with pterygia, underwent surgical excision of the lesion in his left eye. Histopathologic examination revealed an exophytic lesion made up of proliferated goblet cells with benign cytologic features. Some of the goblet cells were atrophic and seemed to be desquamating from the lesion surface. Cytologic examination of a tear specimen collected from the right eye revealed the presence of exfoliated goblet cells admixed with mucin material. The lesion had not recurred three months after surgery. Exfoliating goblet cell hyperplasia, a condition not previously reported on the ocular surface, may mimic pterygium. Histopathologic examination is required to establish the diagnosis.

Visual acuity outcomes after cataract extraction in adult latinos. The Los Angeles Latino Eye Study.

PURPOSE: To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes. DESIGN: Population-based cross-sectional study of adult Latinos. PARTICIPANTS: Two hundred sixty-one participants with cataract extraction. METHODS: Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated. MAIN OUTCOME MEASURES: Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment. RESULTS: Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05). CONCLUSIONS: Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.