Purpose

To report the case of an adult male with X-linked retinoschisis (XLRS) who presented with cystoid macular edema (CME) that responded consistently to treatment with intravitreal steroids.

Observations

A 39 year old male with unilateral presentation of CME after repair of a retinal detachment secondary to XLRS responded initially to an injection of intravitreal triamcinolone acetonide (IVTA). Central subfield thickness on OCT was reduced. Three months later, the CME recurred and he was unresponsive to topical treatment so repeat IVTA was given, and the CME once again was reduced dramatically. After the next recurrence, intravitreal dexamethasone implant treatment was initiated and successful at treating recurrences in 3 month intervals for 5 additional injections. Finally, an intravitreal fluocinolone acetonide implant was surgically placed with control of CME.

Conclusions and importance

Corticosteroids have never been reported to be effective in CME related to XLRS. Here, we document a case of a man who successfully had decrease of intraretinal fluid and schisis with treatment of intravitreal corticosteroids as demonstrated by spectral domain optical coherence tomography.

Purpose

The accuracy of conventional visual function tests, which emit visible light, decreases in patients with corneal scars, cataracts, and vitreous hemorrhages. In contrast, infrared (IR) light exhibits greater tissue penetrance than visible light and is less susceptible to optical opacities. We therefore compared conventional visual function tests against infrared 2-phton microperimetry (2PM-IR) in a subject with a brunescent nuclear sclerotic and posterior subcapsular cataract before and after cataract surgery.

Methods

Testing using infrared light microperimetry from a novel device (2PM-IR), visible light microperimetry from a novel device (2PM-Vis), conventional microperimetry, and the cone contrast threshold (CCT) test were performed before and after cataract surgery.

Results

Retinal sensitivity assessed using 2PM-IR, 2PM-Vis, and cMP improved by 3.4 dB, 17.4 dB, and 18 dB, respectively. Cone contrast threshold testing improved for the S-cone, M-cone, and l-cone by 111, 14, and 30.

Conclusions and importance

2PM-IR, unlike conventional visual function tests, showed minimal variability in retinal sensitivity before and after surgery. Thus, IR visual stimulation may provide a more accurate means of measuring neurosensory retinal function by circumventing optical media opacities, aiding in the diagnosis of early macular disease.

Purpose

To report a case of cystoid macular edema, uveitis, and vitreomacular traction in a patient with a history of breast cancer and taking anastrozole.

Observations

A 73-year-old female with a history of estrogen receptor-positive breast cancer and treatment with anastrozole presented with bilateral blurry vision, photophobia, and eye soreness. Optical coherence tomography (OCT) of both maculae revealed vitreomacular traction (VMT), an epiretinal membrane, cystoid macular edema (CME) in the right eye, and drusen without subretinal fluid bilaterally. Although later, macular OCT did show evidence of cystoid intraretinal spaces in the left eye as well. Fluorescein angiography showed bilateral petaloid leakage, bilateral slow disc leaking, as well as peripheral leakage in the right eye. Anastrozole was discontinued and, subsequent macular OCT showed release of VMT in the right eye, and eventual resolution of intraretinal cystoid spaces bilaterally.

Conclusions and importance

Stopping of anastrozole was associated in resolution of refractory CME in a patient on aromatase inhibitor therapy for breast cancer. It is therefore important to consider anastrozole and other aromatase inhibitor drugs as possible factors predisposing patients to the development of CME.

TOPIC: To assess the role and utility of intraoperative optical coherence tomography (iOCT) guidance during pars plana vitrectomy with chorioretinal biopsy for patients with suspicious chorioretinal lesions. CLINICAL RELEVANCE: Chorioretinal lesions suspicious for malignancy sometimes require surgical biopsy for diagnosis and treatment guidance. Biopsy site selection is currently guided by presurgical imaging, and clinical assessment. We sought to determine whether iOCT provides useful information for biopsy site selection to ensure a diagnostic specimen and assessment of wound repair after biopsy. MATERIALS AND METHODS: DISCOVER is a prospective study examining microscope-integrated iOCT systems in ophthalmic surgery. In this report, we examine all eyes in the DISCOVER study that underwent chorioretinal biopsy. Clinical characteristics, surgical technique, and imaging findings were reviewed. In addition, surgeon feedback data on iOCT utility and value to the procedure was also evaluated. RESULTS: Six eyes were identified within the DISCOVER study that underwent chorioretinal biopsy. iOCT was used to assess retinal and choroidal lesions prior to chorioretinal incision. Following biopsy, iOCT was utilized to assess retinal attachment and wound margin integrity. Additionally, iOCT was performed in real-time during biopsy to ensure proper biopsy depth and position. In 2 cases, preoperative OCT evaluation of retinal lesions was not possible. Utilizing iOCT, comprehensive evaluation of anatomic features was successfully performed prior to biopsy. This facilitated identification of biopsy sites most likely to provide a diagnostic sample based on lesion morphology on iOCT. After completion of chorioretinal biopsy, iOCT verified completeness of biopsy site and the retinal-RPE relationship (e.g., complete apposition, partial detachment). CONCLUSION: Microscope-integrated iOCT provides real-time guidance of biopsy site selection and verification of biopsy site stability following specimen collection.

Purpose

Silicone oil (SO) is often used as an intraocular tamponade in repairs of retinal detachments. It may be associated with complications such as cataract, glaucoma, keratopathy, subretinal migration of oil, fibrous epiretinal and sub retinal proliferations, and oil emulsification. The purpose of this report is to describe a rare phenomenon of intraocular silicone oil migration into the cerebral ventricles, which may later be mistaken for intraventricular hemorrhages on neuroimaging.

Methods

Case report with literature review.

Results

A patient with a history of retinal detachment repair with intraocular SO presented with headaches. Neuroimaging revealed SO migration to the cerebral ventricles. The patient was treated conservatively with symptom management and headaches resolved.

Conclusions

We present a case of intraocular SO migration to the cerebral ventricles and review the current literature. We also propose two mechanisms for this phenomenon.

Retinal degeneration (RD) is a significant cause of incurable blindness worldwide. Photoreceptors and retinal pigmented epithelium are irreversibly damaged in advanced RD. Functional replacement of photoreceptors and/or retinal pigmented epithelium cells is a promising approach to restoring vision. This paper reviews the current status and explores future prospects of the transplantation therapy provided by pluripotent stem cell-derived retinal organoids (ROs). This review summarizes the status of rodent RD disease models and discusses RO culture and analytical tools to evaluate RO quality and function. Finally, we review and discuss the studies in which RO-derived cells or sheets were transplanted. In conclusion, methods to derive ROs from pluripotent stem cells have significantly improved and become more efficient in recent years. Meanwhile, more novel technologies are applied to characterize and validate RO quality. However, opportunity remains to optimize tissue differentiation protocols and achieve better RO reproducibility. In order to screen high-quality ROs for downstream applications, approaches such as noninvasive and label-free imaging and electrophysiological functional testing are promising and worth further investigation. Lastly, transplanted RO-derived tissues have allowed improvements in visual function in several RD models, showing promises for clinical applications in the future.

Purpose

To illustrate the regression of a metastatic lesion through ophthalmic imaging and correlating findings with standard chest imaging and treatment with osimertinib, an oral chemotherapy agent specific to Epidermal Growth Factor Receptor + Non-small Cell Lung Cancer (EGFR+ NSCLC).

Case report

A 63-year-old Asian male presented to ophthalmology with a complaint of left blurry vision. Initial ophthalmic exam revealed a choroidal lesion and imaging results highlighted a spiculated lung mass with brain and bony metastases. Osimertinib was chosen for its specificity and ability to cross the blood-brain barrier. Follow-up ophthalmic and radiographic imaging were repeated over the course of treatment.

Conclusion

After the initiation of osimertinib, ophthalmic and computed tomography imaging highlighted the regression of the ocular metastatic disease and primary malignancy, respectively.Osimertinib is an effective first-line treatment of EGFR+ NSCLC and corresponding metastatic sites. Additionally, ophthalmic imaging can be used to monitor general response to chemotherapy agents when ocular metastasis is identified.

Purpose

To evaluate the potential for artificial intelligence-based video analysis to determine surgical instrument characteristics when moving in the three-dimensional vitreous space.

Methods

We designed and manufactured a model eye in which we recorded choreographed videos of many surgical instruments moving throughout the eye. We labeled each frame of the videos to describe the surgical tool characteristics: tool type, location, depth, and insertional laterality. We trained two different deep learning models to predict each of the tool characteristics and evaluated model performances on a subset of images.

Results

The accuracy of the classification model on the training set is 84% for the x-y region, 97% for depth, 100% for instrument type, and 100% for laterality of insertion. The accuracy of the classification model on the validation dataset is 83% for the x-y region, 96% for depth, 100% for instrument type, and 100% for laterality of insertion. The close-up detection model performs at 67 frames per second, with precision for most instruments higher than 75%, achieving a mean average precision of 79.3%.

Conclusions

We demonstrated that trained models can track surgical instrument movement in three-dimensional space and determine instrument depth, tip location, instrument insertional laterality, and instrument type. Model performance is nearly instantaneous and justifies further investigation into application to real-world surgical videos.

Translational relevance

Deep learning offers the potential for software-based safety feedback mechanisms during surgery or the ability to extract metrics of surgical technique that can direct research to optimize surgical outcomes.

Purpose

This report aims to characterize ocular changes in a case of ocular siderosis with iron toxicity using multimodal imaging and electroretinography.

Methods

A 34-year-old woman presented with ocular siderosis of the left eye following penetrating injury with an iron-containing foreign body. The patient's uncorrected visual acuities were 20/60 and 20/150 in the right and left eye, respectively, with abnormal pupillary function and presence of a cataract in the left eye. She underwent successful intraocular foreign body removal and cataract surgery with no postoperative complications. Cone contrast threshold (CCT), full-field electroretinogram, spectral-domain optical coherence tomography (OCT), and OCT angiography (OCTA) were used to characterize ocular alterations preoperatively and postoperatively.

Results

CCT color vision testing showed abnormal color vision, and OCTA revealed increased vascular flow density associated with the foreign body.

Conclusions

CCT color vision testing, OCTA, OCT, and full-field electroretinogram can characterize retinal changes in cases of ocular siderosis.

Two-photon excitation fluorescence (2PEF) allows imaging of tissue up to about one millimeter in thickness. Typically, reducing fluorescence excitation exposure reduces the quality of the image. However, using deep learning super resolution techniques, these low-resolution images can be converted to high-resolution images. This work explores improving human tissue imaging by applying deep learning to maximize image quality while reducing fluorescence excitation exposure. We analyze two methods: a method based on U-Net, and a patch-based regression method. Both methods are evaluated on a skin dataset and an eye dataset. The eye dataset includes 1200 paired high power and low power images of retinal organoids. The skin dataset contains multiple frames of each sample of human skin. High-resolution images were formed by averaging 70 frames for each sample and low-resolution images were formed by averaging the first 7 and 15 frames for each sample. The skin dataset includes 550 images for each of the resolution levels. We track two measures of performance for the two methods: mean squared error (MSE) and structural similarity index measure (SSIM). For the eye dataset, the patches method achieves an average MSE of 27,611 compared to 146,855 for the U-Net method, and an average SSIM of 0.636 compared to 0.607 for the U-Net method. For the skin dataset, the patches method achieves an average MSE of 3.768 compared to 4.032 for the U-Net method, and an average SSIM of 0.824 compared to 0.783 for the U-Net method. Despite better performance on image quality, the patches method is worse than the U-Net method when comparing the speed of prediction, taking 303 seconds to predict one image compared to less than one second for the U-Net method.