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Disparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Advancing dissemination of health information and enhancing health literacy may help not only to reduce healthcare barriers in the underserved populations but also to lessen visual health disparities.

Purpose To report the efficacy of photodynamic therapy (PDT) for management of retinal hemangioblastoma. Design Retrospective case series. Participants Seventeen patients with retinal hemangioblastoma treated with PDT. Methods The medical records of 17 patients with retinal hemangioblastoma treated with PDT were reviewed, and treatment outcomes were assessed. Photodynamic therapy was performed with 6 mg/m2 body surface area of verteporfin infused intravenously over 10 minutes activated by 50 J/cm2 laser light at 689 nm for 83 or 166 seconds. Main Outcome Measures Tumor control, subretinal and intraretinal fluid resolution, and visual outcome. Results Eighteen retinal hemangioblastomas in 17 eyes were treated with PDT. Median patient age was 31 years (mean, 36 years; range, 7–66 years), and median follow-up was 51 months (mean, 61 months; range, 2–144 months). Genetic testing confirmed von Hippel-Lindau disease in 8 of 17 patients (47%). The tumors were unilateral in all patients and unifocal in most patients (n = 13/17 [76%]). The tumor median basal diameter was 3.5 mm (mean, 3.4 mm; range, 1.5–6.0 mm) and median thickness was 2.1 mm (mean, 2.3 mm; range, 1.0–5.0 mm). The tumor location was juxtapapillary in 9 of 18 cases (50%). Associated findings included subretinal fluid (n = 14/17 [82%]) and macular edema (n = 12/17 [71%]). The median number of PDT sessions was 1.5 (mean, 1.8; range, 1.0–4.0). Standard duration of PDT (83 seconds) was used in all cases except 2, in which double duration (166 seconds) was used. Outcomes revealed tumor control in 13 of 18 tumors (72%), partial or complete resolution of subretinal fluid in 10 of 14 eyes (71%), and partial or complete resolution of macular edema in 7 of 12 eyes (58%), and stable or improved visual acuity in 12 of 17 eyes (71%). Photodynamic therapy-related transient exudative response was noted in 4 of 17 eyes (24%). Conclusions Photodynamic therapy is an effective treatment for both juxtapapillary and peripheral retinal hemangioblastomas, providing satisfactory rates of tumor control and visual stabilization and improvement. Patients should be monitored for PDT-related transient exudative response.

Isolated choroidal melanocytosis is a rare condition that appears to be a limited form of ocular melanocytosis. Ocular melanocytosis has been known to be associated with an increased risk of uveal melanoma, and more recently, a similar association has been suggested for isolated choroidal melanocytosis. We describe 3 cases of patients who developed unilateral, multifocal uveal melanoma in the setting of underlying isolated choroidal melanocytosis. All patients developed either two distinct tumors at presentation or a new discrete choroidal melanoma arising from the choroidal melanocytosis over 1 year following treatment of the original tumor by plaque brachytherapy. These cases provide additional evidence of the association between isolated choroidal melanocytosis and uveal melanoma and suggest increased risk of multifocal melanoma in patients with this condition.

Purpose: The aim of the study was to describe choroidal detachments and concurrent scleritis associated with necrotic choroidal metastasis or melanoma. Methods: We conducted a retrospective case series. Results: We report 4 patients with scleritis and choroidal detachment with an underlying malignant choroidal tumor. All patients underwent fine-needle aspiration biopsy for cytopathologic characterization of their choroidal tumor, and they all demonstrated evidence of tumor necrosis. Two patients were diagnosed with choroidal metastasis from lung and esophageal adenocarcinoma. Both patients ultimately expired from systemic metastasis. The remaining 2 patients were diagnosed with choroidal melanoma and were successfully treated with plaque radiotherapy. Conclusion: Choroidal detachment with concurrent scleritis can occur as a rare sequelae of tumor necrosis of an underlying choroidal malignancy.

The purpose of this review is to summarize the current indications for photodynamic therapy (PDT) in the treatment of retinal diseases and intraocular tumors. The recent introduction of new imaging modalities such as optical coherence tomography angiography and swept-source optical coherence tomography has enabled the quick and non-invasive identification of certain retinal conditions that benefit from PDT. Furthermore, recent reports in the literature have confirmed the role of PDT as an effective treatment modality for selected intraocular tumors. While the use of PDT has decreased since its introduction due to the advent of intravitreal anti-vascular endothelial growth factor therapy, there is still a role for this modality in several retinal conditions and intraocular tumors including central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, choroidal neovascularization associated with choroidal nevus, choroidal hemangioma, choroidal metastasis, and retinal hemangioblastoma. PDT should be employed in the appropriate settings.

Intra-arterial chemotherapy (IAC) for the treatment of intraocular retinoblastoma has gained recognition as a method to improve ocular salvage; however, there is a paucity of evidence supporting treatment factors prognosticating ocular survival.All patients with retinoblastoma treated with IAC at a single institution between December 2008 and December 2019 were evaluated. Patient demographics, tumor classification, prior treatments, procedural data, other non-IAC therapies, adverse reactions, procedural complications, ocular outcomes, and overall survival were assessed via retrospective chart review. Factors suggestive of increased ocular survival were identified via univariate and multivariate analyses. The impact of accrued treatment experience was evaluated by grouping eyes by the respective year, IAC treatment was initiated.Forty-nine eyes of 43 patients were treated for retinoblastoma with IAC (256 total procedures). At least grade 3 neutropenia was observed following 19% of IAC procedures. The risk of neutropenia was not statistically different between single or multidrug IAC. Comparing those who received balloon-assisted intra-arterial chemotherapy (bIAC) in more than two-thirds of cycles to those who did not, the risk of arterial access site complications was not statistically different. Multivariate analysis revealed a significantly lower risk of enucleation associated with treatment era in years (hazard ratio [HR] = 0.52-1.00, p .05) and laser therapies (HR = 0.02-0.60, p .05).Ocular survival rates in patients treated with IAC for retinoblastoma at our institution have increased over time. Accrued treatment experience and programmatic changes have likely contributed. Larger, prospective series may lead to a better understanding of factors that consistently contribute to better ocular salvage.

In the absence of long-term data of the effects of private equity in ophthalmology, this article reviews the role of private equity in other medical specialties as a guide to the future for ophthalmology.Across an array of medical specialties, including anesthesiology, dermatology, emergency medicine, ophthalmology/optometry, radiology, and urology, medical practices are being consolidated into a few larger platform groups. Although there has been a short-term financial success for both private equity firms and senior medical practice partners, there exists broad skepticism from peer-reviewed publications and the national media.Although the impact of private equity on ophthalmology is largely speculative, ophthalmology may follow some of the trends observed in other medical specialties. These trends include increased volume of services, increased profits, improved payer mix, increased payment per patient visit, increased use of midlevel practitioners, decreased physician autonomy, and decreased physician salaries.

Several neoplastic processes can involve the eye, either primarily or secondary to a systemic malignancy. The most common primary tumors of the eye include conjunctival and uveal melanoma, retinoblastoma, conjunctival and intraocular lymphoma, and ocular surface squamous neoplasia. Metastatic spread from systemic malignancies, especially of the breast and lung, also can involve the eye. A combination of ophthalmologic examination, ancillary testing, and cytologic/histopathologic evaluation leads to accurate diagnosis. Management consists of surgery, radiotherapy, chemotherapy, and immunotherapy delivered in various forms.

A 61-year-old man with uncontrolled increased intraocular pressure after cataract surgery was treated with acetazolamide. Three days later, he developed acute chest pain requiring emergency treatment. What would you do next?

Nimesh A Patel,1 Kenneth C Fan,1 Nicolas A Yannuzzi,1 Jorge A Fortun,1 Luis J Haddock,1 Sonia H Yoo,1 Patrice J Persad,1 Elizabeth A Vanner,1 Sarah P Read,2 Basil K Williams Jnr,1,3 Jayanth Sridhar,1 Thomas A Albini,1 Harry W Flynn Jnr,1 Kendall Donaldson,1 Justin H Townsend1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA; 2Retina Consultants of Hawaii, Aiea, HI, USA; 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USACorrespondence: Justin H Townsend Email jtownsend@med.miamiBackground/Objective: To determine the refractive outcomes after 4-point scleral fixation of the Akreos AO60 intraocular lens with Gore-Tex suture.Methods: This was a single referral center, multi-surgeon, retrospective consecutive case series. A total of 63 eyes met the inclusion criteria for having received surgical implantation of the Akreos AO60 intraocular lens with Gore-Tex suture from August 2014 to December 2018. Exclusion criteria included all ocular pathology that precluded an accurate refraction, concurrent ocular surgery, poor corrected pre-operative visual potential, among other factors. Main outcome measures included post-operative uncorrected visual acuity (VA), best-corrected VA, and spherical equivalent deviation from target.Results: Mean pre-operative BCVA was 0.67 ± 0.64 LogMAR (20/93 Snellen). Mean final post-operative BCVA was 0.17 ± 0.18 (20/28 Snellen) and mean final post-operative UCVA was 0.31 ± 0.22 (20/41 Snellen). Mean post-operative spherical equivalent was − 0.57 D. Mean post-operative astigmatism was 0.85 D.Conclusion: Refractive outcomes after secondary implantation with Akreos AO60 are favorable in eyes with good visual potential.Keywords: Akreos AO60 lens, Gore-Tex, refractive outcomes secondary intraocular lens, scleral fixated IOL

Among a large national sample in the United States, minority race and lower socioeconomic status are associated with higher rates of visual impairment. These findings identify areas requiring improvement in population eye health.

Purpose To determine factors predictive of visual outcome in patients with circumscribed choroidal hemangioma treated with photodynamic therapy (PDT). Design Retrospective case series. Participants Seventy-nine patients with circumscribed choroidal hemangioma treated with PDT. Methods Patients with circumscribed choroidal hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed. Main Outcome Measures Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse. Results Seventy-nine eyes of 79 patients with circumscribed choroidal hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0–10.0 mm); mean thickness was 3.0 mm (range, 1.4–4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0–7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P Conclusions In this comparative analysis, PDT was an effective treatment method for circumscribed choroidal hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.

Purpose To describe the clinical and imaging characteristics, pathologic features, and management options of retinal pigment epithelium (RPE) adenoma/adenocarcinoma. Design Retrospective case series. Participants Fifty-one patients with RPE adenoma/adenocarcinoma. Methods Treatment options for the patients included observation, partial lamellar sclerouvectomy (PLSU), enucleation, and others. Main Outcome Measures Factors related to visual acuity (VA) outcomes (>2 Snellen lines loss, poor final VA [≤20/200], good final vision [≥20/40]), tumor growth, and need for enucleation. Results The mean patient age at diagnosis was 51 years, and the majority of patients were white (40/51, 78%) and female (34/51, 67%). Primary management included observation (29/51, 57%), PLSU (9/51, 18%), enucleation (4/51, 8%), or others (9/51, 18%). Outcomes revealed decreased VA (10/32, 31%), poor final VA (17/32, 53%), good final VA (11/32, 34%), tumor growth (12/25, 48%), and need for enucleation (7/51, 14%). By multivariable analysis, features predictive of decreased VA included increasing baseline tumor thickness (P = 0.01) and presence of vitreous hemorrhage (P = 0.05). Factors predictive of poor final VA included presence of exudative retinal detachment (P = 0.004), baseline VA 20/50 to 20/150 (P = 0.008), and baseline VA ≤20/200 (P = 0.01). Absence of feeding and/or draining vessel was predictive of good VA (P = 0.004). Tumor growth was associated with multiple treatments (P = 0.02). Increased tumor thickness (P = 0.03) and presence of exudative retinal detachment (P = 0.01) were predictive of enucleation. Conclusion RPE adenoma/adenocarcinoma can simulate choroidal melanoma. Greater tumor thickness, vitreous hemorrhage, exudative retinal detachment, and poor baseline VA predict worse visual outcome and greater risk for enucleation.

Subjects in diabetic macular edema clinical trials in the United States are disproportionately White and male, compared with the population undergoing treatment for diabetic macular edema.

A 16-year-old girl noted worsening redness and photophobia of the right eye that had previously been treated unsuccessfully with sequential courses of topical antibiotics and topical corticosteroids. Clinical examination revealed diffuse flakelike thickening of the iris surface, pupillary margin, and anterior chamber angle, suggesting diffuse iris melanoma. Anterior segment optical coherence tomography depicted the mass as an epi-iridic deposit with "stalagmite" surface appearance. Fine-needle aspiration biopsy confirmed an atypical histiocytic proliferative disorder consistent with juvenile xanthogranuloma. Aggressive topical corticosteroid treatment was started. There were no systemic findings. Following therapy, the lesion resolved completely.

We report a case series of 12 eyes that underwent retinal detachment (RD) repair after secondary implantation of Akreos AO60 intraocular lens (IOL) with a subset experiencing the complication of IOL opacification. Major predisposing risk factors for retinal detachment included trauma (42%), prior vitrectomy (33%), and ectopia lentis (17%). Opacification developed in two eyes with gas tamponade and three with silicone oil tamponade. Two eyes required explantation of the IOL. Permanent visually significant Akreos AO60 lens opacification is a possible complication weeks after retinal detachment repair and can occur regardless of tamponade agent.

We report the case of a 9-month-old girl with bilateral retinoblastoma who had incomplete tumor resolution after selective ophthalmic artery infusion chemotherapy (SOAIC). Systemic chemotherapy, rarely used as salvage therapy after SOAIC, with systemic carboplatin, etoposide, and vincristine achieved complete and sustained regression in both eyes.

Purpose:To analyze risk of nevus transformation into melanoma per millimeter increment.Methods:Retrospective analysis of 3,806 choroidal nevi for transformation into melanoma per incremental millimeter thickness (flat [≤1.0 mm], thin [1.1–2.0 mm], thicker [2.1–3.0 mm], and thickest [>3.0 mm])Results

Purpose:To use multimodal imaging for identification of risk factors for choroidal nevus transformation into melanoma.Methods:Retrospective chart review of 3806 consecutive choroidal nevi with imaging and 2355 choroidal nevi with additional follow up to identify factors predictive of transformation

Neoplasms of the retinal pigment epithelium (RPE) are rare tumors that can simulate choroidal melanoma, but clinical and imaging characteristics often differentiate these lesions. We report a 70-year-old male with an abruptly elevated pigmented lesion that arose at the site of congenital hypertrophy of the RPE and demonstrated associated exudation, as well as feeding and draining vessels, suggestive of RPE adenoma. Optical coherence tomography showed retinal elevation with serous retinal detachment adjacent to the mass, and ultrasonography revealed an abruptly elevated, moderately echodense mass of 6.4-mm thickness. Fluorescein ­angiography showed early tumor hypofluorescence, late ­tumor hyperfluorescence with staining and leakage, and ­retinal vessels buried under the mass, suggestive of a retinal tumor. The patient was monitored with the presumed diagnosis of RPE adenoma, but 3 months later, the growth was documented and fine-needle aspiration biopsy revealed choroidal melanoma. Management with I-125 plaque radiotherapy was performed leading to tumor regression and a thickness of 4.6 mm.

[ Ophthalmic Surg Lasers Imaging Retina. 2021;52:682–683.]

AimTo characterise combinations of multimodal imaging risk factors and predictive value for choroidal nevus transformation into melanoma.MethodsThis is a retrospective review of multimodal imaging features for 3806 choroidal nevi from 1 January 2007 through 1 January 2017. Kaplan-Meier estimates and Cox regression analyses were used to calculate 5-year percentages of growth to melanoma and HR.ResultsUsing multimodal imaging, six risk factors predictive of choroidal nevus transformation into melanoma were identified, namely tumour thickness >2 mm, subretinal fluid, symptoms of visual acuity loss to 20/50 or worse, orange pigment, hollow acoustic density and tumour largest basal diameter >5 mm. Kaplan-Meier 5-year estimated tumour growth was found in 1% of nevi with no risk factors, 11% (range 9%–37%) with one factor, 22% (12%–68%) with two factors, 34% (21%–100%) with three factors, 51% (0%–100%) with four factors and 55% (0%–100%) with five factors. HR for growth was 0.1 with no factor, 2.1–7.8 with one factor, 1.8–12.1 with two factors, 4.0–24.4 with three factors, 4.6–170.0 with four factors and 12.0–595.0 with five factors. The highest HR with each combination of two, three, four or five risk factors always included symptoms of visual acuity loss and orange pigment.ConclusionSix risk factors for choroidal nevus transformation into melanoma by multimodal imaging have been identified. Risk for transformation into melanoma is 1% when no factors are present, and approaches 100% with specific combinations of three or more risk factors. Understanding how combinations of factors influence risk of transformation into melanoma can guide counselling and treatment decisions.

Purpose T' trunk, along with hemi-hypertrophy of the left side of the face and left upper limb, presented for evaluation of an intraocular mass of the left eye (OS). Anterior examination OS showed diffuse episcleral and iris melanocytosis. Fundus examination OS showed diffuse choroidal melanocytosis as well as an elevated choroidal lesion. B-scan ultrasonography demonstrated a hollow lesion, and the patient was diagnosed with choroidal melanoma OS in the setting of phakomatosis pigmentovascularis with overlap of SWS and KTS. Fine-needle aspiration biopsy confirmed the diagnosis, and Iodine-125 plaque radiotherapy was performed. Conclusion Individuals with clinical features suggestive of phakomatosis pigmentovascularis, SWS or KTS should undergo a complete ophthalmological evaluation for the presence of ocular melanocytosis and uveal melanoma.

Purpose: To describe a rare occurrence of acute vision loss and diffuse alveolar hemorrhage following a treatment of injectable gluteal cosmetic filler. Patient and methods: A 20-year-old female underwent a cosmetic injection of unknown components for gluteal augmentation. Within hours she developed progressive shortness of breath secondary to diffuse alveolar hemorrhage. She presented to ophthalmology 6 weeks later with a history of bilateral decreased vision. Clinical examination revealed cotton wool spots and retinal hemorrhages. Fluorescein angiography demonstrated macular vascular pruning and an enlarged foveal avascular zone. Results: The patient was observed and vision did not improve after 8 months of follow-up. Conclusion: These findings were attributed to a Purtscher-like retinopathy secondary to systemic inflammation induced by the filler and/or direct microembolization of the injected material or fat. To the best of the authors’ knowledge, this is the first documented case of diffuse alveolar hemorrhage and ischemic bilateral vision loss in a patient undergoing gluteal augmentation with dermal filler.

A 34-year-old Caucasian woman with a past medical history of hypertension presented with acute floaters in the right eye (OD) for 1 week. Best-corrected visual acuity (VA) was 20/20 in both eyes. Fundus examination OD (Figure 1 ) revealed a retinal hemangioblastoma (RH) in the temporal midperiphery with a prominent feeding artery and draining vein. A retinal arterial microaneurysm (RAM) was noted within the feeding artery, and subretinal hemorrhage with a cuff of fluid was present. Fundus autofluorescence (Figure 2 ) showed hypoautofluorescence in the area of the RH, RAM, and subretinal hemorrhage. A hyperautofluorescent ring surrounding the hemorrhage suggested shallow subretinal fluid. Early phase fluorescein angiography (Figure 3 ) demonstrated appropriate arterial and venous filling and hyperfluorescence of the RH. The RAM appeared hyperfluorescent, whereas the subretinal hemorrhage blocked. There was no evidence of leakage on late images. Optical coherence tomography (OCT) (Figure 4 ) through the RAM revealed an inner retinal structure with a central lumen and hyperreflective border. Mild outer retinal exudation was also noted. Fovea was normal on OCT. Fundus examination of the left eye was normal. Genetic work-up was negative for von Hippel-Lindau disease. Treatment of the hemangioblastoma was offered, but the patient preferred observation. VA remained stable, and better systemic hypertension control was recommended. [ Ophthalmic Surg Lasers Imaging Retina . 2020;51:365–366. ]

To determine factors predictive of visual outcome in patients with circumscribed choroidal hemangioma treated with photodynamic therapy (PDT).Retrospective case series.Seventy-nine patients with circumscribed choroidal hemangioma treated with PDT.Patients with circumscribed choroidal hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed.Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse.Seventy-nine eyes of 79 patients with circumscribed choroidal hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0-10.0 mm); mean thickness was 3.0 mm (range, 1.4-4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0-7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P0.001), mean tumor basal diameter (5.4 mm vs. 6.2 mm; P = 0.03), mean tumor thickness (2.9 mm vs. 3.2 mm; P = 0.01), cystoid macular edema (CME) involving the foveola (30% vs. 70%; P = 0.001), retinal edema overlying the lesion (39% vs. 61%; P = 0.003), retinoschisis involving the foveola (0% vs. 100%; P = 0.002), lack of CME regardless of foveola involvement at presentation (79% vs. 21%; P0.001), previous treatment (33% vs. 67%; P = 0.04), and CME progression after treatment (0% vs. 100%; P = 0.006). Partial or complete resolution of subretinal fluid was achieved in 93% of patients.In this comparative analysis, PDT was an effective treatment method for circumscribed choroidal hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.

Nimesh A Patel, Parth Shah, Nicolas A Yannuzzi, Zubair Ansari, Jill S Zaveri, Nidhi Relhan, Basil K Williams Jr, Ajay E Kuriyan, Christopher R Henry, Jayanth Sridhar, Luis Haddock, Jorge A Fortun, Thomas A Albini, Janet L Davis, Harry W Flynn JrDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL 33136, USA Purpose: To report the visual outcomes and complications of scleral fixated intraocular lenses (IOLs) using Gore-Tex suture.Methods: The current study is a retrospective noncomparative case series including patients who underwent scleral fixation of IOL (Akreos AO60) using Gore-Tex suture from August 2015 to March 2017 at a university teaching center. Primary outcome measures were visual acuity and complications at last follow-up.Results: The current study included 49 eyes of 48 patients. Mean follow-up duration postsurgery was 6.9 months (range: 0.9–29.4 months). The indications for secondary IOL surgery were dislocated IOL in 16/49 (33%), subluxed IOL in 9/49 (18%), dislocated or subluxed crystalline lens in 9/49 (18%), traumatic cataract in 8/49 (16%), and complicated cataract surgery in 7/49 (14%). Mean best-corrected logMAR visual acuity improved from 1±0.7 (20/200 Snellen equivalent) preoperatively to 0.5±0.5 (20/63 Snellen equivalent) at last follow-up. There were no intraoperative complications noted. Early postoperative complications included significant persistent corneal edema (longer than 1 week) in 4/49 (8.2%), ocular hypertension (intraocular pressure ≥25 mmHg) in 8/49 (16.3%), hypotony (intraocular pressure ≤5 mmHg) in 6/49 (12.2%), cystoid macular edema 3/21 (6.1%), IOL tilt 2/49 (4.1%), hyphema in 2/49 (4.1%), and vitreous hemorrhage in 5/49 (4.8%). There was one case of recurrent retinal detachment. One patient presented with an erosion of the Gore-Tex suture through the conjunctiva resulting in a purulent scleritis 6 months after the initial surgery, and was managed with removal of the IOL, debridement, and cryotherapy. Forty-one of 49 patients completed 3-month follow-up, among which visual acuity improved, deteriorated, or remained same compared to baseline in 27/49 (55.1%), 8/49 (16.3%), and 6/49 (12.2%) eyes, respectively.Conclusion: In the current study, visual acuity outcomes were generally favorable. The complications were largely transient. Significant complications included a suture-related infection, which required removal of the IOL, and a recurrence of a retinal detachment. Keywords: Gore-Tex, secondary intraocular lens, scleral fixation, clinical outcomes

A patient treated for retinoblastoma developed vitreous floaters 15 years later and was referred for recurrence with vitreous seeding. Clinical examination demonstrated a regressed scar and numerous calcified vitreous opacities with a “clear zone” on ultrasonography. The final diagnosis was asteroid hyalosis in an eye with regressed retinoblastoma. [ J Pediatr Ophthalmol Strabismus . 2019;56:e41–e44.]

Purpose To describe the clinical course of a patient with a Boston Keratoprosthesis type I who developed a localized posterior pole retinal detachment secondary to a macular hole. Observations A 73-year-old patient with a Boston Keratoprosthesis developed a localized posterior pole retinal detachment secondary to a macular hole. The retinal detachment was repaired with a 23-gauge pars plana vitrectomy, membrane peel, fluid-air exchange and 18% C 3 F 8. Retinal reattachment was achieved but the macular hole remained open. Conclusions and importance A posterior pole retinal detachment secondary to a macular hole can be repaired using standard techniques despite the limited view through a Boston Keratoprosthesis.

Hemorrhagic occlusive retinal vasculitis (HORV) is a condition associated with intraocular vancomycin during surgical intervention, most frequently following bilateral sequential cataract surgery. Because of the high rate of ophthalmic vascular complications in this condition, gonioscopic evaluation for identification of neovascularization of the angle and iris is essential. Careful examination can reveal previously asymptomatic and unassociated lesions of the iris or ciliary body. We present the case of a 71-year-old female who was diagnosed with a ciliary body melanoma secondary to complete ophthalmic examination associated with HORV. She reported decreased vision to light perception in the left eye (OS) following sequential, bilateral cataract surgery. Fundus examination OS demonstrated diffuse retinal vasculitis, retinal ischemia, and extensive hemorrhage. Evaluation included inflammatory and coagulopathy laboratory evaluation, carotid ultrasonography and magnetic resonance imaging (MRI) of the brain and orbits, all of which proved unrevealing, except for an enhancing mass OS on MRI. Further evaluation revealed a pigmented mass with features of melanoma in the anterior chamber angle extending into the ciliary body. Fine needle aspiration biopsy revealed high risk cytogenetic characteristics, and plaque radiotherapy was successfully employed. Keywords: Ciliary body, Hemorrhagic occlusive retinal vasculitis, Intracameral vancomycin, Malignant melanoma, Plaque radiotherapy, Uvea

Purpose To describe the clinical and imaging findings and treatment options in a series of patients with iris microhemangiomatosis. Design Retrospective observational case series. Methods Setting : Single institution. Study Population : Twenty-two eyes of 14 consecutive patients with iris microhemangiomatosis were reviewed. Observation Procedures : Clinical examination and slit-lamp photography were performed on every patient. Anterior segment optical coherence tomography (AS-OCT), anterior segment optical coherence tomography angiography (AS-OCTA), anterior segment intravenous fluorescein angiography (AS-IVFA), and ultrasound biomicroscopy were performed when possible. Main Outcome Measures : Clinical and imaging features and treatment strategies. Results Twenty-two eyes of 14 patients with iris microhemangiomatosis were included in this series. Mean patient age was 70 years (range, 58–82 years), and all patients were white. The iris hemangiomatosis appeared as subtle, multifocal, ectatic vascular channels arranged circumferentially at the pupillary margin. Iris color was blue (n = 19 eyes) or green (n = 3 eyes), and the features were unilateral (n = 6 patients) or bilateral (n = 8 patients). Additional features included reduced visual acuity (n = 13 eyes), hyphema (n = 12 eyes), and glaucoma (n = 7 eyes). There was no history of ocular trauma or systemic vasculopathic conditions. AS-OCT documented the fine tuft at the pupillary margin, AS-OCTA showed vascular flow, and AS-IVFA demonstrated pupillary margin vascular lesions with mild staining. Observation was advised in 20 cases (91%), and argon laser photocoagulation was required for repetitive hyphema in 2 cases (9%). Conclusion Iris microhemangiomatosis is a rare ocular condition, often manifesting with spontaneous unilateral hyphema and/or secondary glaucoma. AS-IVFA confirms the diagnosis, and intervention with laser photocoagulation is necessary in only 9% of eyes.

BACKGROUND AND OBJECTIVE: Retinal nonperfusion is closely associated with vision-threatening complications such as neovascularization and macular edema. The purpose of this study is to investigate the reliability of a calculated ischemic index (ISI) by means of intergrader and intragrader agreement on ultrawide-field fluorescein angiography (UWFFA) in common retinal vascular diseases. PATIENTS AND METHODS: Eight trained graders evaluated 15 UWFFA images provided digitally and re-graded on a different day. They included five eyes with diabetic retinopathy (DR), five with branch retinal vein occlusion (BRVO), and five with central retinal vein occlusion (CRVO). To assess intergrader and intragrader agreement and variability among different diseases, the replicate inter- and intragrader standard deviations (SDs) and coefficients of variation (CVs) were calculated. RESULTS: Mean ISI was 46% for images of DR, 26% for images of BRVO, and 61.3% for images of CRVO. Combined intragrader and intergrader replicate SDs were 17.8% for DR, 3.8% for BRVO and 13.0% for CRVO. Combined intragrader and intergrader replicate coefficients of variation were 38.6% (percent of mean ISI) for DR, 14.7% for BRVO, and 21.2% for CRVO. CONCLUSION: Intergrader and intragrader variability was high when assessing DR. This may be due to the chronic nature of DR progression, which can lead to patchy areas of ischemia. Intergrader and intragrader variability was better for CRVO and best for BRVO. This may be due to the acute or subacute nature of retinal vein occlusions. [ Ophthalmic Surg Lasers Imaging Retina . 2015;46:618–622.]

Purpose: Acute retinal necrosis (ARN) is a panuveitis syndrome that may lead to severe complications such as cystoid macular edema (CME). There is no consensus about the best treatment. We report one case of CME secondary to ARN managed with intravitreal aflibercept. Case report: A 41-year-old woman with a history of successfully treated varicella-zoster virus-associated ARN developed an epiretinal membrane (ERM) and underwent pars plana vitrectomy, ERM removal, inner limiting membrane peel, and lensectomy. After surgery, the retinal architecture improved and the visual acuity returned to 20/20. Six months later, she developed nontractional CME, which was treated monthly with triple-dose intravitreal aflibercept (2 mg). She gained 3 lines of vision and CME resolution was achieved. Discussion: Cystoid macular edema is a late complication of ARN that may affect vision. Some off-label therapies have been reported to be useful in CME secondary to ARN, including pegaptanib and interferon-α-2. Since interferon-α-2a is not currently available for ophthalmic use in Spain, aflibercept was the first choice. This soluble protein blocks the placental growth factor and all isoforms of vascular endothelial growth factor (VEGF); its half-life is prolonged and its affinity to VEGF-A is more than 100-fold greater than bevacizumab, pegaptanib, or ranibizumab. After each injection, macular thickness decreased consistently and visual acuity improved 3 lines after the treatment. Conclusions: Intravitreal aflibercept is effective in the management of acute nontractional CME secondary to ARN.