Geographic atrophy: where we are now and where we are going.

PURPOSE OF REVIEW: Age-related macular degeneration (AMD) affects a significant percentage of the elderly population and end-stage disease classified by either geographic atrophy (GA) or neovascular AMD (nvAMD) is one of the leading causes of vision loss worldwide. Despite the fact that there are currently treatments for nvAMD, there are no treatments in practice to prevent disease onset or progression of GA. This topic is at the forefront of ophthalmic research demonstrated by the recent advances in disease characterization, genetic and environmental risk factor classification, biomarker discovery and mechanism of pathogenesis categorization. There are also numerous clinical treatment trials underway, targeting proposed pathways and biomarkers associated with GA that are promising. RECENT FINDINGS: With several clinical trials of potential treatments underway and numerous recent publications on disease diagnosis and classification, the understanding of GA pathogenesis has increased substantially. Although the exact mechanism of pathology is still elusive, recent literature has highlighted the utilization of current and new ophthalmic imaging modalities and discovery of objective and functional markers that can lead to earlier diagnosis and treatment. SUMMARY: Herein, we will provide an overview and discussion of the current status of GA including advances in mechanism of pathogenesis, diagnosis, classification and current treatment modalities.

Lens and Peripheral Retinal Relationships During Vitrectomy: Comparison of 23-, 25-, and 27-Gauge Vitrectomy and Curved Endolaser Probes.

Purpose: This work aims to compare spatial relationships between the crystalline lens and vitrectomy instruments of different gauges. Methods: Eight phakic eyes recovered from deceased donors were used after fixation. Valved trocars (27-gauge, 25-gauge, and 23-gauge) were sequentially placed in the superotemporal quadrant 4 mm posterior to the limbus in each eye. Intraocular relationships of vitrectomy and curved endolaser probes were measured for each gauge. Results: There were no significant differences in maneuverability between instruments of different gauges. The mean distance from instrument to lens at the geometric center of the globe was 5.5 mm. Vitrectomy probes of all gauges could access the peripheral retina on both sides of the sclerotomy in the 3 to 4 o'clock position adjacent to the sclerotomy without touching the lens. The instruments could be advanced without lens touch to contact the retina within at least 2 mm of the ora serrata 180° away from the insertion site. Conclusions: Vitrectomy and curved endolaser probes achieved similar maneuverability relative to the lens regardless of gauge. This study confirms that small-gauge vitrectomy instruments have a considerable range of safe access to the peripheral retina in phakic eyes from a single sclerotomy.

Characterization of Pseudomonas aeruginosa isolates from patients with endophthalmitis using conventional microbiologic techniques and whole genome sequencing.

PURPOSE: To demonstrate antibiotic susceptibility and genomic virulence factor profiles of Pseudomonas aeruginosa isolates from patients with culture-confirmed endophthalmitis. METHODS: Clinical isolates from patients diagnosed with pseudomonas endophthalmitis were included. Laboratory antibiotic susceptibility testing and whole genome sequencing was performed on all isolates. RESULTS: In the current study, 8 patients had vitreous culture-confirmed endophthalmitis due to P. aeruginosa. All isolates were multi-drug resistant but sensitive to ceftazidime and each fluoroquinolone tested. Whole genome sequencing revealed a total of 179 unique genes. The most common type of virulence genes included those involved in adherence and the secretion system. Seven of 8 (88%) isolates were of the cytoinvasive phenotype (exoST) and no isolates contained exoU. CONCLUSIONS: P. aeruginosa associated endophthalmitis is often multi-drug resistant and demonstrates a variety of virulence factors with those involved in adherence and the secretion system being the most common.

Bilateral, Solitary, Extramacular Vitelliform Retinal Lesions in a Patient With Best Disease.

Purpose: This work describes the first published case of Best vitelliform macular dystrophy (BVMD) with bilateral, solitary, extramacular retinal lesions. Methods: A case report is presented. Results: An 8-year-old girl with a family history of BVMD was referred for suspicious peripheral retinal lesions. Multimodal imaging disclosed bilateral, solitary, extramacular lesions consistent with the vitelliform lesions found in BVMD. There were no abnormalities in the macula. Conclusions: This is the first documented case of solitary, bilateral, extramacular vitelliform lesions in BVMD.

DIFFUSE PERIPAPILLARY CHOROIDAL MELANOMA THAT EVOLVED FROM A SMALL PRESUMED CHOROIDAL NEVUS SUCCESSFULLY TREATED WITH GAMMA KNIFE RADIOTHERAPY.

PURPOSE: To report a case of diffuse peripapillary choroidal melanoma which began as a small choroidal nevus and was successfully treated with gamma knife radiotherapy. METHODS: Observational case report. RESULTS: A 31-year-old visually asymptomatic man presented for a routine eye examination and was noted to have a small choroidal nevus. Six years later, the lesion had become a diffuse juxtapapillary choroidal melanoma with a thickness of 1.9 mm. Given the peripapillary location of the tumor with involvement of about 6 clock hours of the disk, Leksell Gamma Knife radiotherapy was performed. At 5.5 years after radiation therapy, visual acuity remained 20/20. The lesion thickness had decreased to 1.5 mm, and there was no interval growth of any margins. CONCLUSION: Small choroidal nevi carry low malignant potential but still deserve photographic documentation when possible with regular follow intervals. Gamma knife radiotherapy can be considered for tumors abutting the optic nerve, especially when plaque radiotherapy may be technically difficult.