RARE CASE OF ABIOTROPHIA DEFECTIVA BLEB-ASSOCIATED ENDOPHTHALMITIS.

PURPOSE: To report a rare case of Abiotrophia defectiva bleb-associated endophthalmitis. METHODS: In this case report of a patient with bleb-associated endophthalmitis, the authors describe the features of severe and rapid onset, associated retinitis, and a favorable outcome after aggressive early intervention. RESULTS: A 75-year-old woman presented decreased visual acuity of hand motions with an elevated intraocular pressure of 39 mmHg in the left eye. Her ocular history was notable for severe primary open-angle glaucoma with uneventful trabeculectomy and cataract surgery in both eyes 7 years before. Examination revealed conjunctival injection and an opaque avascular cystic bleb along with anterior chamber cellular reaction with a B-scan ultrasound concerning for vitritis. A. defectiva was isolated from the vitreous tap within 48 hours and confirmed later with 16S ribosomal RNA sequencing. After initial vitreous tap and inject and subsequent pars plana vitrectomy, her best-corrected visual acuity had improved to 20/500 at postoperative week one and then improved to 20/40 at postoperative month 2. Her examination was notable for resolved corneal edema, a deep and quiet anterior chamber, and resolved intraretinal hemorrhages. CONCLUSION: This is one of the first bleb-associated endophthalmitis cases with rapid identification of A. defectiva . A. defectiva was isolated from the initial vitreous tap within 48 hours and confirmed with 16S ribosomal RNA sequencing. This case highlights that rapid identification of A. defectiva may be indicative of a greater bacterial load and should prompt aggressive intervention and that the visual prognosis can be favorable.

A Case of Bilateral Multifocal Choroiditis Associated with BRAF/MEK Inhibitor Use for Metastatic Cutaneous Melanoma.

PURPOSE: To report a case of BRAF/MEK inhibitor-associated multifocal choroiditis that recurred after medication re-exposure and resolved after discontinuing BRAF/MEK inhibition and administering local steroid therapy. CASE REPORT: A 32-year-old woman with metastatic cutaneous melanoma on dabrafenib/trametinib presented with bilateral anterior uveitis and new bilateral multifocal chorioretinal scars. The anterior uveitis resolved after a course of topical steroids. She presented 18 months later with reactivation of bilateral multifocal choroiditis after starting encorafenib/binimetinib 1 month prior. The chorioretinal lesions appeared elevated with associated vitreous cell. Indocyanine angiography showed numerous foci of new choroiditis, more pronounced in the left eye. Encorafenib/binimetinib was discontinued and a subtenon triamcinolone injection was administered to the left eye. Her symptoms improved and the choroiditis resolved. CONCLUSION: BRAF/MEK inhibitors may be associated with ocular toxicity manifesting as multifocal choroiditis. The increasing use of these agents and risk of visual impairment warrants early detection and management.

Bilateral Ampiginous Choroiditis following Presumed SARS-CoV-2 Infection.

PURPOSE: To report a case of bilateral ampiginous choroiditis following presumed SARS-CoV-2 infection. Case Description. A 25-year-old woman presented with metamorphopsia and a paracentral scotoma in her left eye. She endorsed night sweats, headache, and new-onset anosmia beginning 1 week before her visual symptoms. She also had multiple confirmed ill COVID-19 contacts at her workplace before the onset of her symptoms. Funduscopic examination and multimodal imaging revealed placoid lesions in the macula and midperiphery of both eyes consistent with ampiginous choroiditis. COVID-19 antibody testing returned positive for IgG, and an extensive systemic evaluation was otherwise unremarkable. She was treated with oral prednisone and azathioprine with stabilization of the retinal lesions and no progression of her symptoms. CONCLUSIONS: Ampiginous choroiditis is an inflammatory chorioretinopathy with an unknown pathogenic mechanism that often necessitates early immunomodulatory therapy. This report suggests that SARS-CoV-2 infection may trigger chorioretinal inflammation in susceptible hosts.

Retinal Capillary Nonperfusion on OCT-Angiography and Its Relationship to Kidney Function in Patients with Diabetes.

BACKGROUND: Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD). METHOD: A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea. Correlations of RNP and VD with eGFR and albuminuria were analyzed. RESULTS: Participants had a mean age of 72 years, hemoglobin A1c of 8.1%, eGFR of 45 mL/min/1.73 m2, and urine albumin-to-creatinine ratio of 162 mg/g. Mean (SD) RNP was 6.6% (4.2%) and 16.9% (7.7%) in 30° and 60° FOV regions, respectively. eGFR was negatively correlated to RNP in both the 30° and 60° FOV regions (R = -0.69, p=0.004, and R = -0.46, p=0.057, respectively), and correlations were stronger among a subset of 7 participants with evidence of diabetic retinopathy on exam and fundus photos. The estimated GFR was not significantly correlated with vessel density. Urine albumin-to-creatinine ratio was not significantly correlated with RNP or VD. CONCLUSIONS: Our proof-of-concept study showed that lower eGFR was significantly correlated with retinal nonperfusion in participants with diabetes and CKD. Advanced retinal imaging may enhance the noninvasive evaluation of kidney function in diabetes.

Prevalence of Atrial Fibrillation in Patients with Retinal Vessel Occlusion and Its Association: A Systematic Review and Meta-Analysis.

Objective: Recent studies have shown that atrial fibrillation (AF) is more prevalent in patients with retinal vessel occlusion and may be associated with both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO). However, there is no systematic review and meta-analysis to confirm this finding.Methods: We searched the databases of MEDLINE and EMBASE from inception to January 2019. Included studies were published cohort, case-control or cross-sectional studies, and randomized control trials reporting the prevalence of AF in patients with CRAO or CRVO. Data from each study were combined using the random-effects model.Results: Eleven studies were included in our meta-analysis, involving a total population of 12,305 subjects with retinal vessel occlusion. The prevalence of AF ranged from 4.1% to 21.4% (pooled prevalence = 11.5%, 95% CI: 7.0-16.1, I2 = 96.3%). Five studies reported a control group of patients without retinal vessel occlusion. We found that AF is significantly associated with retinal vessel occlusion (pooled OR = 2.24, 95% CI:2.07-2.43, I2 = 0.0%).Conclusion: Our study showed that AF is significantly associated with retinal vessel occlusion. Further studies are needed to fully elucidate the exact mechanism linking AF with CRAO and CRVO.

Polypoidal Choroidal Vasculopathy in Highly Myopic Eyes with Elongated Axial Length.

PURPOSE: To retrospectively review the prevalence of myopia and elongated axial length in eyes with polypoidal choroidal vasculopathy (PCV) and to evaluate treatment response of PCV in highly myopic eyes. PCV has rarely been reported in myopic eyes. METHODS: A retrospective review of all eyes diagnosed with PCV at the clinics of Retina Consultants of Hawaii and the Hawaii Macula and Retina Institute was performed between February of 2007 and April of 2017 to evaluate for eyes with significant myopia and elongated axial length. RESULTS: A total of 282 eyes were diagnosed with PCV by ICG angiography. There were 144 males (59%) and 99 females (41%). 204 patients had unilateral PCV and 39 patients had bilateral PCV. A total of 3 patients with PCV had significant myopia less than -6 diopters or confirmed elongated axial length. One of these patients had bilateral PCV so there were 4 eyes noted with significant myopia and elongated axial length out of 282 eyes with PCV (1.4%). All 3 patients were Asian and presented with active leakage or bleeding related to PCV diagnosed on indocyanine green angiography and optical coherence tomography. Treatments typically used to treat PCV including intravitreal antiangiogenic medications and photodynamic therapy were utilized. CONCLUSION AND IMPORTANCE: High myopia is rare in eyes diagnosed with PCV, even though choroidal neovascularization is a common cause of vision loss in myopic macular degeneration. However, even in highly myopic eyes, PCV may show signs of resistance to antiangiogenic medications.