Presumed Choroidal Granuloma Annulare Mimicking Choroidal Lymphoma.

A 71-year-old white male presented with unilateral trace vitreous cell and hypopigmented choroidal lesions, corresponding to hyporeflective areas on optical coherence tomography (OCT). The lesions grew slowly during a period of 2.5 years, but the patient remained asymptomatic. Cutaneous biopsy from the left forearm confirmed granuloma annulare. Given an otherwise unrevealing workup for infectious, inflammatory, and neoplastic processes, the choroidal lesions were considered to be a manifestation of the same disease process. Treatment consisted of posterior sub-Tenon's triamcinolone. After 6 weeks, the lesions appeared atrophic on funduscopy with resolution on OCT. Examination remained stable with no growth or recurrence after 4 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e128-e132.].

Factors associated with atypical postoperative drift following surgery for consecutive exotropia.

PURPOSE: To evaluate the associations of clinical and surgical factors with atypical postoperative drift following surgery for consecutive exotropia. METHODS: A total of 66 patients with consecutive exotropia (≥10Δ at distance), after historical surgery for esotropia were retrospectively identified at a tertiary medical center. All patients underwent unilateral lateral rectus recession (on adjustable suture) with medial rectus advancement and/or resection. Immediate postoperative target angle was 4Δ-10Δ of esotropia at distance, anticipating mild postoperative exodrift. Actual postoperative drift was calculated as change in distance deviation from immediately postadjustment to 6 weeks. Typical drift was defined as 0Δ-9Δ of exodrift. Excessive exodrift was defined as ≥10Δ. Esodrift was defined as 1Δ or more. Univariate and multiple logistic regression analyses were performed to evaluate for associations with a wide range of clinical and surgical factors. RESULTS: Overall there was a median exodrift (4Δ, quartiles 0Δ-10Δ). Of the 66 patients, 18 (27%) showed excessive exodrift; 15 (23%), esodrift. In multiple logistic analyses, larger preoperative distance exodeviation was associated with excessive exodrift (P = 0.01), and non-normal medial rectus attachment status (abnormal [stretched scar, pseudo-tendon], attached to pulley, or behind pulley) was associated with esodrift (P = 0.02). CONCLUSIONS: Approximately half of patients show atypical drift following unilateral surgery for consecutive exotropia, with larger preoperative distance exodeviation associated with exodrift and non-normal medial rectus muscle status with esodrift. Knowing these associations may help when counseling patients regarding surgical outcomes.

Optic disc dysplasia in poland syndrome.

PURPOSE: To report optic disc dysplasia in a case of Poland syndrome. DESIGN: Non-interventional case report. METHODS: A 2-year-old boy with Poland syndrome was referred for ophthalmic evaluation after abnormal optic discs were found on exam. RESULTS: Physical exam at birth revealed right-sided aplasia of the pectoralis major muscle, symbrachydactyly, hypoplastic scapula, and an abnormal third rib. On dilated examination the optic nerve heads were dysplastic. The findings included multiple cilioretinal vessels, situs inversus, inferotemporal excavation, and surrounding pigmentary disturbances. CONCLUSION: Only one case of optic disc anomaly has been reported in Poland syndrome and was described as morning glory syndrome. The optic discs in our patient do not fit well with other optic disc excavation syndromes but are most reminiscent of those in papillorenal syndrome. As both Poland syndrome and papillorenal syndrome share vascular dysfunction as a possible etiology, this case adds to the literature of vascular dysgenesis in Poland syndrome.

The use of acetazolamide during pregnancy in intracranial hypertension patients.

BACKGROUND: Acetazolamide is the mainstay of medical therapy for idiopathic intracranial hypertension (IIH). Its use in pregnant women has not been recommended because of reported teratogenic effects in rodents and rabbits. However, the safety of acetazolamide use during human pregnancy remains unclear. We report the pregnancy and offspring outcomes in women with intracranial hypertension (IH) treated with acetazolamide during pregnancy. METHODS: Data were collected through questionnaires sent to patients with IH and their physicians. The questionnaires focused on IH diagnosis, obstetric history and outcomes, and pediatric outcomes. RESULTS: A total of 101 women with IH were consented (total of 158 pregnancies) and acetazolamide usage before 13 weeks of gestation was reported in 50 pregnancies. The risk of spontaneous abortion was similar to the control group and no major complication was identified in the offspring of women treated with acetazolamide. CONCLUSION: There is no convincing evidence for an adverse effect for acetazolamide use in human pregnancy, even when prescribed prior to the 13th week of gestation. While the liberal use of acetazolamide should be avoided during pregnancy, this medication should remain a treatment option in pregnant women when clinically indicated.