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Background/purpose: To report an atypical case of ocular bartonellosis evaluated longitudinally with multimodal imaging and review the literature on the less common posterior segment manifestations of bartonella infection., Methods: Case report and review of the literature., Results: A 26-year-old man presented with focal choroiditis in the right eye and focal retinitis, a branch retinal artery occlusion, and paracentral acute middle maculopathy in the left eye after a systemic prodrome including headache and lymphadenopathy. Serologic testing revealed positive bartonella immunoglobulin G with a titer of 1:512. The patient was diagnosed with ocular bartonellosis infection and started on systemic doxycycline. The posterior segment findings resolved over the follow-up period, and their resolution was documented with optical coherence tomography., Conclusion: Neuroretinitis is the classic ocular finding in cat scratch disease, but less common presenting findings may include focal choroiditis, retinitis, and branch retinal artery occlusion. To the best of our knowledge, this is the first report of paracentral acute middle maculopathy secondary to a retinitis-associated branch retinal artery occlusion as a presenting sign in ocular bartonellosis.

Purpose: To report a case of panuveitis that developed following COVID-19 vaccination in a patient with a recent history of granulomatous tattoo inflammation., Methods: Case report., Results: A 25-year-old woman with a recent history of biopsy-proven granulomatous tattoo inflammation developed bilateral eye pain and blurred vision 1 week following her second mRNA-1273 COVID-19 vaccination (Moderna, Inc, Cambridge, MA). Examination revealed bilateral panuveitis. Workup for infectious etiologies and sarcoidosis was negative. The intraocular inflammation initially resolved with systemic prednisone therapy but then recurred following tapering, requiring the initiation of mycophenolate mofetil., Conclusion: A case of panuveitis that developed following a COVID-19 vaccination in a patient with a recent history of tattoo inflammation is reported. The temporal relationship between the vaccine and the development of uveitis in this patient may be coincidental and should be interpreted with caution, but multiple vaccines have been associated with uveitis, presumably as a result of their generalized stimulation of the immune system. It is believed that this case of tattoo-associated uveitis may have been exacerbated by the generalized inflammatory effect of COVID-19 vaccination.

Purpose: To report two patients who developed full-thickness macular holes following panretinal photocoagulation for proliferative diabetic retinopathy., Methods: Case series., Results: Case 1 was a 58-year-old woman with Type 1 diabetes mellitus and proliferative diabetic retinopathy and Case 2, a 72-year-old man with Type 2 diabetes mellitus and proliferative diabetic retinopathy. Before panretinal photocoagulation, each patient had an epiretinal membrane and an irregular foveal contour noted on optical coherence tomography. At 2 months follow-up, each patient showed foveal floor thinning and Case 2 also had a lamellar macular hole. At 6 months follow-up, each patient had a full-thickness macular hole. Each were successfully repaired with vitrectomy, membrane peeling, and gas tamponade., Conclusion: The relationship between hole formation and previous panretinal photocoagulation in the patients reported here is unclear and possibly coincidental.

Purpose: To report a case of Purtscher-like retinopathy in a patient with milk-alkali syndrome and pancreatitis., Methods: Case report and review of the literature., Results: A 46-year-old woman presented with decreased vision following discharge from the intensive care unit, where she had been admitted for milk-alkali syndrome secondary to long-term calcium supplementation and over-the-counter antacid use, and pancreatitis. Dilated examination showed ischemic retinal whitening and retinal hemorrhages in the posterior pole bilaterally consistent with Purtscher-like retinopathy. Over three months, the retinopathy resolved and her vision improved., Conclusion: Milk-alkali syndrome is the clinical triad of hypercalcemia, renal failure, and metabolic alkalosis and occurs secondary to the consumption of large amounts of calcium and alkali. The hypercalcemia associated with milk-alkali syndrome may cause pancreatitis, which can lead to Purtscher-like retinopathy.

Purpose: To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography., Methods: Case report., Results: A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography. Subsequent serologic testing revealed a positive QuantiFERON-TB Gold test, whereas workup for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic antitubercular therapy and the lesions regressed. The regression was documented with optical coherence tomography angiography., Conclusion: Case reports of primary intraretinal tuberculosis are uncommon. To the best of our knowledge, this is the first case to demonstrate optical coherence tomography angiography findings of presumed intraretinal tuberculosis.

Purpose: To report a case of Vogt-Koyanagi-Harada-like uveitis followed by melanoma-associated retinopathy with focal chorioretinal atrophy and subsequent choroidal neovascularization in a patient with metastatic cutaneous melanoma., Method: Case report. Main outcome measures include external photography, anterior segment photography, ophthalmoscopic examination, fundus photography, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and electroretinography., Results: A 68-year-old man with a history cutaneous melanoma presented with Vogt-Koyanagi-Harada-like uveitis. Work-up revealed a pelvic mass, which was excised and found to be metastatic melanoma. Two years later, the patient developed melanoma-associated retinopathy with focal chorioretinal atrophy and adjacent choroidal neovascularization., Conclusion: Patients with metastatic cutaneous melanoma can develop distinct and sequential paraneoplastic ocular complications. Onset of a Vogt-Koyanagi-Harada-like uveitis may be a good prognostic factor for survival in patients with metastatic cutaneous melanoma., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Purpose: To report a sporadic case of a familial adenomatous polyposis (FAP) discovered in a patient with bilateral retinal pigment epithelial lesions., Methods: Case report., Results: A 30-year-old Asian woman presented for evaluation of bilateral pigmented lesions at the level of the retinal pigment epithelium. She had no personal or family history of colonic polyps or colon cancer. Colonoscopy revealed innumerable adenomatous polyps and genetic testing revealed a mutation in the adenomatous polyposis coli gene consistent with FAP. She subsequently underwent prophylactic total colectomy., Conclusion: The pigmented retinal pigment epithelium lesions of FAP have a characteristic appearance and it is vital for the retinal specialist to be familiar with them. De novo mutations in the APC gene are responsible for 20% to 30% of FAP cases. In the presence of the characteristic retinal pigment epithelium lesions, it is important to send the patient for work up of FAP even in the absence of family history of FAP.

Purpose: To report nine cases of multifocal choroiditis with serpiginous-like peripapillary chorioretinal atrophy., Methods: A retrospective observational case series of eyes with multifocal choroiditis with serpiginous-like peripapillary chorioretinal atrophy. Multimodal imaging findings were reviewed and presented., Results: Fifteen eyes of 9 patients (6 women and 3 men), with a mean age of 48.1 years (median, 46 years; range, 23-74 years), presented with multifocal choroiditis serpiginous-like peripapillary chorioretinal atrophy. All 15 eyes presented with serpiginoid peripapillary changes and had discrete patches of atrophy or punched-out scars in the posterior pole or periphery. Eleven eyes (73.3%) had cone-shaped retinal pigment epithelium elevations on optical coherence tomography, 10 eyes (66.7%) had mild vitritis, and 4 eyes (26.7%) had peripheral curvilinear streak lesions. Three eyes (20%) had choroidal neovascularization. All patients responded well to treatment with systemic immunosuppression, local corticosteroid injections, and/or intravitreal anti-vascular endothelial growth factor injections., Conclusion: Multifocal choroiditis may present with peripapillary chorioretinal changes resembling a serpiginous-like choroiditis in addition to the classic findings of patches of atrophy or punched-out scars in the posterior pole or periphery, cone-shaped retinal pigment epithelium elevated on optical coherence tomography and peripheral curvilinear streak lesions.

Purpose: To report a case of pattern dystrophy in a patient with McArdle disease, a rare autosomal recessive disorder of glycogen metabolism., Methods: Case report., Results: A 29-year-old woman with a history of muscle biopsy-confirmed McArdle disease presented with fundus findings consistent with pattern dystrophy. Multimodal imaging, including optical coherence tomography and fundus autofluorescence, was performed., Conclusion: To our knowledge, this is the third reported case of pattern dystrophy in a patient with McArdle disease.

Purpose: Corneal hysteresis (CH) is lower in glaucomatous eyes. The aim of this study was to determine and compare the change in CH over time between normal, open angle glaucoma (POAG) and diabetic subjects., Methods: We retrospectively analysed records of patients undergoing assessment with the Ocular Response Analyzer (Reichert, Corp., New York, NY, USA). Right eyes with at least 7 measurements were included. Patients with ocular pathology other than POAG were excluded. Two-sample t-tests, chi-squared and logistic regression were used to analyse data., Results: A total of 1418 normal and 322 POAG patients were included. Patients with POAG were significantly older (70.73 ± 11.33 vs. 61.59 ± 16.56 years; p < 0.001), had a longer follow-up (4.14 ± 1.34 vs. 2.72 ± 1.49 years; p < 0.001) and had lower CH (9.58 ± 2.17 vs. 9.95 ± 2.19 mmHg p = 0.01), but there were no gender differences between groups (61.5 vs. 57.7% female; p = 0.21). We observed a significantly greater decrease in CH among patients with POAG (-0.11 ± 0.73 vs. 0.07 ± 2.31 mm Hg/year; p = 0.02). The relation between ∆CH/year and diagnosis persisted after adjusting for age and follow-up time (OR 0.90; 95% CI 0.82, 0.99; p = 0.03). We found CH to be higher in diabetics vs. non-diabetics (10.34 ± 2.04 vs. 9.88 ± 2.19; p = 0.02), but ∆CH/year was not different (0.07 ± 1.27 vs. 0.03 ± 2.10; p = 0.77)., Conclusions: Patients with POAG in this study had a significantly greater rate of CH decline compared to normal. There was no significant difference in rate of CH change in diabetic and non-diabetic patients., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)