UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A PATIENT WITH HAND-FOOT-MOUTH DISEASE: A CASE REPORT.

PURPOSE: To demonstrate a rare cause of acute, focal chorioretinitis. METHODS: Review of slit-lamp fundoscopy, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography. RESULTS: Slit-lamp examination revealed parafoveal microaneurysms, parafoveal intraretinal hemorrhages, and outer segment irregularity in the left eye. Fundus photographs demonstrated retinal hemorrhages and a greyish-whitish sheen in the central parafoveal area. Optical coherence tomography was notable for a small pocket of outer segment and retinal pigment epithelium disruption and irregularity in the central foveal area of the left eye. Fluorescein angiography revealed increased focal macular leakage within a larger central area of leakage and staining. CONCLUSION: Unilateral acute idiopathic maculopathy and, specifically, coxsackievirus-related chorioretinitis should be considered in the differential diagnosis of atypical maculopathy.

Low-intensity/high-density subthreshold microPulse diode laser for chronic central serous chorioretinopathy.

PURPOSE: To evaluate the visual outcomes and macular thickness change in patients with symptomatic chronic central serous chorioretinopathy after treatment with a subthreshold MicroPulse diode laser. METHODS: In this retrospective, interventional case series, 10 patients were treated with the subthreshold 810-nm diode MicroPulse laser. Selected patients had symptomatic disease that may or may not have involved the foveal center. The MicroPulse laser was applied to the areas of leakage seen on fluorescein angiogram, over the areas of clinical neurosensory detachment, and/or pigment epithelial detachments. Pretreatment and posttreatment vision, change in maximum macular thickness, number of treatment sessions, and number of laser spot applications were recorded. Patients were excluded if they did not attend follow-up, had other confounding macular diseases, were using steroid medications, or application of another treatment modality had been used (i.e., photodynamic therapy or anti-vascular endothelial growth factor medication). RESULTS: Ten patients met the inclusion criteria, with 1 patient treated in both eyes. Three patients were excluded for lack of follow-up, one for the use of systemic steroids, and one for treatment with anti-vascular endothelial growth factor injection. Maximum macular thickness decreased after subthreshold MicroPulse laser treatment between 20 µm and 338 µm (mean = 97 µm decrease, P = 0.0046) in 11 treated eyes. CONCLUSION: Subthreshold diode MicroPulse laser is a potential treatment option for patients with symptomatic chronic central serous chorioretinopathy.

Acute Retinal Necrosis with Multiple Viral Infections: A Case Report.

A 52-year-old male presented with acute retinal necrosis in his left eye. Slit lamp examination revealed stellate keratic precipitates and cells in the anterior chamber and vitreous. Funduscopy of his left eye revealed multiple yellow deposits. Pathological examination of the vitreous showed both small, reactive lymphocytes and a few macrophages. IL-6 and IFN-γ were elevated in the vitreous. Microdissected macrophages from the vitreous revealed DNAs from multiple viruses. The patient responded to oral valacyclovir. We conclude that multiple viral infections can be involved in the pathogenesis of acute retinal necrosis and that adequate anti-viral therapy has a beneficial effect on disease progression. However, retinal detachment can be a consequence for a poor visual outcome.

Lash ptosis in congenital and acquired blepharoptosis.

OBJECTIVE: To determine the prevalence of lash ptosis (LP) in eyes with congenital and acquired blepharoptosis. METHODS: We retrospectively graded photographs of 228 eyes from 174 patients with congenital or acquired blepharoptosis for LP. We used a 4-point rating scale for LP, in which 0 indicates no LP; 1, minimal; 2, moderate; and 3, severe. A prospective evaluation of LP in 30 eyes from 15 patients without blepharoptosis (control eyes) was also performed. RESULTS: A total of 107 eyes (in 87 patients) demonstrated congenital blepharoptosis and 121 eyes (in 87 patients) had acquired blepharoptosis. A moderate to severe rating of LP (rating, >/= 2) occurred in 60.7% of eyes with congenital blepharoptosis, 28.9% of eyes with acquired blepharoptosis, and 6.7% of control eyes. Lash ptosis (rating, >/= 1) was present in 91.6% of eyes with congenital blepharoptosis, 83.5% of eyes with acquired blepharoptosis, and 33.3% of control eyes. The mean LP rating was 2.1 for eyes with congenital blepharoptosis, 1.3 for eyes with acquired blepharoptosis, and 0.6 for control eyes. CONCLUSIONS: Lash ptosis was common in the patients with blepharoptosis. Moderate to severe LP occurred more commonly in all forms of blepharoptosis compared with normal eyes, with more frequent and more severe LP demonstrated in eyes with congenital blepharoptosis.

Lymphoplasmacytic lymphoma isolated to an extraocular muscle.

A 44-year-old woman presented with a 1-month history of right-sided tearing, redness, and chronic headache. Clinical examination was notable for 4-mm proptosis and decreased visual acuity OD. Orbital CT demonstrated isolated enlargement of the right lateral rectus. Surgical biopsy was undertaken after an unsuccessful trial of oral steroids. Histopathology and immunophenotyping demonstrated a lymphoplasmacytic lymphoma. External beam radiation induced regression of the lymphoma with decreased proptosis and improved visual acuity.

Stability of RNA from the retina and retinal pigment epithelium in a porcine model simulating human eye bank conditions.

PURPOSE: To assess RNA stability after death in a porcine model to simulate current human eye bank techniques. METHODS: Eye bank time interval data were collected from 191 donor specimens: death to refrigeration, enucleation, and tissue processing. A control porcine eye was enucleated, retina and RPE isolated, and specimens frozen (-80 degrees C). Fourteen porcine eyes remained at room temperature for 2 hours and then cooled to 4 degrees C. Retina and RPE were isolated and frozen (-80 degrees C) at 5, 12, 24, 29, 36, 48, and 72 hours. Four globes remained in a moist chamber, five whole and five sectioned globes were immersed in RNAlater (Ambion, Austin, TX) at 5, 12, 24, or 48 hours. RNA was isolated. The 28S and 18S rRNA peaks were analyzed by electrophoresis. RT-PCR was performed on each sample. Messenger RNA for GAPDH, beta-actin, mouse rhodopsin from retina (mRHO), and RPE-65 (from RPE) were analyzed with gel electrophoresis. RESULTS: The average time from death to refrigeration was 4.2 hours, to enucleation 6.4 hours, and to tissue processing 10.7 hours. RT-PCR gel electrophoresis patterns from retinal tissue had bands of similar intensity at each interval from beta-actin, GAPDH, and RHO. Band patterns from RPE demonstrated decay of the RT-PCR gene products after 5 hours. This decay was delayed by at least 24 hours with the use of RNAlater. The 28S rRNA decay was similar for retina and RPE. CONCLUSIONS: Retinal tissue RNA can be analyzed within the time constraints of current eye bank tissue processing, whereas analysis of RPE necessitates either rapid processing or use of RNAlater. These results should aid in future studies in which eye bank tissue is used for RNA analysis.