Bilateral Sensorineural Hearing Loss Associated With Nivolumab Therapy for Stage IV Malignant Melanoma.

OBJECTIVES: Present the case of a 67-year-old male with stage IV malignant melanoma who presented with uveitis and sensorineural hearing loss (SNHL) while on nivolumab and review the literature for likely etiologies. METHODS: A retrospective case review was conducted. The current literature was accessed to inquire about possible pathologic mechanisms and treatment options. RESULTS: A 67-year-old male with stage IV malignant melanoma was treated with nivolumab. During therapy, the patient presented with bilateral uveitis, vertigo, and bilateral moderate sloping to moderate-severe SNHL. After 4 cycles of nivolumab, restaging scans showed no evidence of disease. Nivolumab was discontinued. The patient was placed on a 3-week course of systemic high dose steroids and topical steroid eye drops. Both his uveitis and SNHL resolved after treatment. Nivolumab enhances the antitumor activity of T cells by inhibiting the programed death-1 receptor. While nivolumab has shown great promise in the treatment of many types of cancers, it has also been associated with many autoimmune side effects. We propose the etiology of this 67-year-old male's SNHL and uveitis are the result of an autoimmune process secondary to an augmented T cell response induced by nivolumab. CONCLUSION: While immunotherapeutic agents such as nivolumab have shown great promise in the treatment of cancer, one should maintain an awareness and caution of autoimmune side effects such as uveitis and SNHL.

Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study.

To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case-control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM. Epithelialization and Best Corrected Snellen Visual Acuity (BCSVA) were compared between the two groups. At baseline, both groups had comparable age, gender, visual acuity (VA), size and location of corneal ulcer. Patients receiving additional placement of cryopreserved AM had significantly faster epithelialization within 3.56 ± 1.78 weeks vs 5.87 ± 2.20 weeks (p = 0.01) and achieved complete epithelialization in significantly more patients (72.7% vs 23.1% p = 0.04) despite overall larger baseline defect size (32.7 ± 19.5 mm2 vs 21.5 ± 10.7 mm2, p = 0.11). Consequently, the AM group had clinically significant BCSVA (> 3 lines) (81.8% vs 38.4%, p = 0.047) and total VA improvement (log MAR 0.7 ± 0.6 vs 1.6 ± 0.9, p = 0.016) compared to the control group at the time of complete epithelialization. In-office sutureless AM may be an effective adjuvant therapy in treating sight-threatening infectious corneal ulcers by promoting faster corneal epithelialization and overall better recovery of the VA.

Self-retained cryopreserved amniotic membrane in treating acute ocular graft-versus-host-disease (oGVHD).

PURPOSE: To report successful management of acute ocular graft-versus-host disease (oGVHD) by self-retained cryopreserved amniotic membrane (AM). OBSERVATIONS: A 69-year-old male developed acute oGVHD following hematopoietic stem cell transplantation (HSCT) with severe dryness, pain, photophobia, and blurred vision, the right eye worse than the left eye. Despite topical artificial tears, corticosteroids, and bandage contact lens (BCL) for two weeks, his right eye deteriorated with increasing redness and blurred vision and presented with diffuse conjunctival inflammation, severe superficial punctate keratitis, and corneal and limbal epithelial defect. Hence, self-retained cryopreserved AM was applied in the right eye while conventional therapy was continued in the left eye. Placement of self-retained AM for 3-days resulted in resolution of symptoms, reduction in inflammation, and complete re-epithelialization of the corneal and limbal defect with the visual acuity improving from 20/500 to 20/70 in the right eye. In contrast, the visual acuity improved from 20/300 to 20/150 and remained inflamed with conventional therapy in the left eye. One-month post-AM placement, the right eye remained asymptomatic with the visual acuity improved to 20/30 without any additional therapy, whereas the left eye improved to 20/70 with conventional treatment of BCL, loteprednol, and artificial tears. CONCLUSIONS AND IMPORTANCE: This case suggests application of self-retained AM can be an effective treatment to accelerate the restoration of vision and corneal surface health for acute oGVHD.

Severe Inflammation and Hyphema After Micropulse Diode Transscleral Cyclophotocoagulation.

PURPOSE: To describe vision-threatening complications after micropulse diode transscleral cyclophotocoagulation (MP-TSCPC). METHODS: Retrospective case series. Medical charts of patients who underwent MP-TSCPC and developed visually significant inflammation and hyphema after the procedure were reviewed. Patients were seen at the Upstate Medical University Ophthalmology clinic between 2017 and 2019. RESULTS: Out of 64 patients who underwent MP-TSCPC in the defined time period, 2 patients with postprocedure severe inflammation and hyphema were identified. One patient had severe-stage primary open-angle glaucoma (POAG). After MP-TSCPC, the patient was noted to have a large visually significant anterior chamber reaction and hyphema that occupied 80% of the anterior chamber on postprocedure day 1. The patient was treated with topical and oral corticosteroids, and topical atropine. The second patient had uncontrolled severe-stage POAG. The patient underwent MP-TSCPC. After the procedure, the patient was noted to have significant inflammation with fibrin and hyphema that filled 80% of the anterior chamber. The patient was treated with topical steroids. CONCLUSIONS: As with any intervention, complications are inevitable. Recognition of complications and its possible associations allow for better and more individualized risk versus benefit analysis of an intervention. In this case series, exuberant anterior segment inflammation and hyphema occurred in 2 patients who underwent MP-TSCPC. The authors' goal is to raise awareness of severe anterior chamber inflammation and hyphema as complications occurring after laser treatment with a reputation of minimal or no side-effect profile and to better understand this relatively new laser advancement in the treatment of glaucoma.

Management of an Unusual Orbitocranial Penetrating Injury.

BACKGROUND: An intraorbital injury with a blunt penetrating intraorbital foreign body (IOFB) is an unusual cause of penetrating trauma. This type of trauma is considered a surgical emergency given the risk to vision in addition to potential intracranial injuries such as vascular injury, dural laceration, and neurologic injury. A thorough history and physical exam, along with careful radiographic and multidiscipline intervention, is crucial in providing the patient the most appropriate care. Case Presentation. A 66-year-old male presented to the emergency room (ER) after falling down the stairs and suffering an orbitocranial penetrating injury. He underwent urgent fluoroscopy-guided foreign body removal with a multidisciplinary team after a workup revealed no significant ocular or intracranial injuries. The foreign body was removed with an anterior approach without any complications. CONCLUSION: In this study, we demonstrated that IOFB in proximity to orbitocranial structures requires a careful multidisciplinary team approach. An interventional radiology- (IR-) guided approach in extracting the foreign body is essential to prevent further injury. A high dose of intravenous steroid was not used due to initial suspicion of intracranial involvement. Prompt removal decreased risk of further vision loss.

Endogenous Clostridium perfringens Panophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy.

PURPOSE: To report a rapid endogenous fulminating panophthalmitis from Clostridium perfringens in a patient with diverticulitis and proliferative diabetic retinopathy. METHODS: A 61-year-old female with poorly controlled diabetes mellitus, active proliferative diabetic retinopathy, and recent diverticulitis presented with conjunctival injection, ocular discharge, and sudden onset of painful vision loss of the left eye. Patient denied history of ocular trauma, intraocular surgery, or intravenous drug abuse. Examination revealed an erythematous, proptotic eye with restricted extraocular movements, mucopurulent discharge, diffuse corneal edema, and vitreous haze and cell. Orbital computed tomography (CT) confirmed no retained intraocular foreign body. RESULTS: Despite 48 hours of treatment with systemic broad spectrum antimicrobial therapy (vancomycin, meropenem, and amphotericin B), patient underwent enucleation due to declined condition and progressive infection. Patient's culture revealed gram-positive bacillus microbes (Clostridium perfringens). Patient's subsequent CT abdomen showed resolved diverticulitis after antimicrobial therapy. CONCLUSION: Although rare, Clostridium perfringens infection can be a cause of rapid loss of vision from fulminate endogenous panophthalmitis. Urgent extensive systemic work-up to identify potential port of entry from visceral pathology and rapid removal of source of infection are pivotal to avoid high rate of mortality.

The Ex-PRESS Glaucoma Filtration Device Implantation in Uveitic Glaucoma.

PURPOSE: To evaluate the outcomes of the Ex-PRESS Filtration Device in patients with uveitic glaucoma. METHODS: We reviewed 23 eyes, comparing control simple glaucoma patients (n = 11) to uveitic glaucoma patients (n = 12). Intraocular pressure (IOP) and glaucoma medications at the preoperative examination were compared with those at the 6-month and 10-14-month postoperative examination. Surgical success was defined as ≥25% decrease in intraocular pressure without hypotony, and/or decrease in glaucoma medications at 6 months follow-up. RESULTS: Statistically significant reduction in mean IOP from preoperative levels occurred in both groups at 6 months follow-up (p<0.0001) and 10-14 months follow-up (p = 0.0007) and in the mean number of medications in the uveitic glaucoma (UG) group (p = 0.0313). CONCLUSIONS: Surgical success was seen in 10 eyes in the control group (90.9%) and nine eyes (75%) in the UG group (p = 0.314). Ex-PRESS implantation is an effective surgical intervention for the management of uveitic glaucoma.

Multimodal Imaging Assisting the Early Diagnosis of Cat-Scratch Neuroretinitis.

To describe how a multifocal fundus imaging system assisted the early diagnosis of cat scratch neuroretinitis in a case of a 27-year-old male with unilateral visual loss, neuroretinitis, and a peripapillary angiomatous lesion. Multimodal fundus imaging analysis was an essential contributor to the clinical diagnosis of cat scratch neuroretinitis during the early stage of the disease.

Birdshot retinochoroidopathy review.

Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.

Birdshot retinochoroidopathy review / Revisão sobre retinocoroidopatia do tipo "birdshot"

Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.

Retinocoroidopatia do tipo "birdshot" é um tipo de uveíte posterior originalmente descrita na década de 1940. Achados característicos incluem inflamação mínima do segmento anterior, retinocoroidopatia difusa associada à vitreíte e vasculite retiniana. A etiologia da doença ainda não foi completamente definida, entretanto várias modalidades de tratamento têm sido utilizadas com o objetivo de atingir a remissão. O objetivo desta revisão é enfatizar não só a importância do reconhecimento da doença como também discutir novas descobertas relacionadas a mediadores imunes, formas de tratamentos e como monitorar a doença.

Outcome of Multiple Implants and Dissociation of Fluocinolone Acetonide Intravitreal Implant (Retisert) in a Series of 187 Consecutive Implants.

PURPOSE: To evaluate outcomes of long-term follow-up of Retisert multiple implantation and dissociation in eyes with chronic noninfectious uveitis. METHODS: Review of 187 consecutive Retisert implants. Outcomes of multiple implantation and spontaneous medication pellet-strut dissociation were evaluated. RESULTS: A total of 187 consecutive Retisert implants were reviewed. Eight implants were removed. The prevalence of spontaneous dissociation was 2.6% (5/187). The rate of dissociation increased to 11.11% (2/18) in cases of multiple implants. The mean period between Retisert implantation and spontaneous dissociation was 65.05 months. The mean period between implants in the same eye was 55.25 months. In cases of multiple implantations the old implant was not removed and 17.64% (3/17) of eyes required glaucoma filtering surgery. CONCLUSION: The rate of spontaneous dissociation of Retisert medication pellet-strut in eyes with single implant for noninfectious uveitis is low, which tends to increase in eyes with multiple implants.

Excellent early outcomes of the first 100 cruciate-retaining TriathlonTM total knee arthroplasties.

PURPOSE: Total knee arthroplasties typically have excellent survivorship (>95%) at 10 to 20 years. Implant manufacturers are attempting to address patient dissatisfaction with prostheses that recreate natural knee kinematics, which could lead to improved functional scores while still providing stability and durability. The purpose of this study was to review the outcomes of the first 100 consecutive patients who underwent a cruciate-retaining TKA. METHODS: The first 100 consecutive primary total knee arthroplasties using the TriathlonTM total knee system performed by one surgeon between 2005 and 2007 were identified: 56 women and 32 men, mean age of 59 years (range, 31-83 years). Patients were followed for a mean of 36 months (range, 24-61 months). Subsequent procedures and complications were reviewed. RESULTS: The survival rate in the study cohort was 98% (96 of 98 knees). The mean Knee Society objective and functional scores for this cohort was 89 (range, 56-100 points) and 86 (range, 45-100 points) points, respectively, having improved from 59 (range, 34-67 points) and 55 (range, 10-80 points) points preoperatively. All failures occurred within the first 40 cases performed with the new total knee system. The next 60 cases had 100% survivorship. CONCLUSIONS: Excellent clinical outcomes and functional scores were found in patients who underwent a new cruciate-retaining TKA. Functional scores reported at a minimum of 2 years follow-up were comparable and often superior to published results of previous cruciate-retaining knee designs.