Optic Disc Neovascularization as the Only Sign of Ocular Ischemic Syndrome: A Case Report.

Ocular ischemic syndrome (OIS) features ocular changes occurring secondary to carotid artery occlusive disease (CAOD). We present a unique case of a 64-year-old patient who was referred to the retina clinic due to an incidental isolated finding of left optic disc neovascularization (NVD). The patient was asymptomatic with visual acuity of 6/6 unaided and with normal intraocular pressure bilaterally. Fundus fluorescein angiogram showed hyper-fluorescence on the left optic disc with no areas of capillary dropout. Carotid Doppler and CT angiogram showed significant stenosis within the left proximal internal carotid artery (ICA) and poor visualization of flow in the distal ICA. The patient was urgently referred to the vascular team, and within four months of establishing an OIS diagnosis, she had carotid endarterectomy. As a result, NVD did not show any further progression. This case highlights the importance of community retinal screening by optometrists; that OIS can be asymptomatic, the need to consider CAOD in cases of NVD; and the importance of a multidisciplinary approach.

Patient perceptions and experiences of stereotactic radiotherapy for wet age-related macular degeneration.

PURPOSE: Wet age-related macular degeneration (ARMD) is a leading cause of visual impairment. Anti-vascular endothelial growth factor (VEGF) injections are the mainstay of treatment but require monthly injections and frequent hospital visits. A novel approach to treatment with the use of stereotactic radiotherapy (Oraya IRay) as an adjunct to ranibizumab injections has shown promising results. We explored patients' experiences of receiving Oraya therapy for wet ARMD. METHODS: We present a consecutive case series with objective and detailed reporting of the personal experiences of 5 patients with active wet ARMD treated with Oraya radiotherapy in our unit. We provided all patients who had received one Oraya treatment with a standardized survey composed of 10 questions addressing the experience of receiving this treatment. RESULTS: Generally, patients reported positive experiences of receiving Oraya treatment and perceived this treatment as a better option in comparison with anti-VEGF injections. However, the patients' perceptions of Oraya treatment varied according to patients' previous experiences of anti-VEGF injections and expectations of treatment. CONCLUSIONS: Patients mainly justified their decision to receive Oraya treatment by expecting fewer intravitreal injections, but more research on this topic is needed to suggest new evidence-based treatment protocols for patients with wet ARMD.

Late orbital floor implant migration presenting as recurrent episcleritis.

A 53-year-old patient presented with recurrent epicleritis of the right eye for 6 months and progressive diplopia. He had a past history of orbital floor repair over 30 years. A CT scan showed a radiodense migrated orbital floor sheet implant in the maxillary sinus causing obstruction of the maxillary sinus ostium, secondary maxillary sinusitis with retrobulbar involvement. The silastic orbital implant was removed via a Caldwell Luc approach and resolution of the patient's symptoms and signs quickly ensued. We discuss this late complication of orbital floor fracture repair presenting initially as recurrent episcleritis and maxillary sinusitis with intraorbital extension. This report also emphasizes the importance of history taking.