Ophthalmologic Exam Research Articles

Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study

ObjectivesExplore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.DesignCross-sectional study.SettingData from the Chilean Health National Survey 2009–2010.ParticipantsRegular users of primary care...

Autosomal recessive Alport syndrome caused by a novel COL4A4 splice site mutation: a case report

Alport syndrome (AS) is a genetically heterogenic, structural disorder of the glomerular basement membrane (GBM) due to the mutation of COL4A3, COL4A4, or COL4A5 genes, which clinically presents as progressive hematuric nephritis with ultrastructural changes of the GBM, high tone sensorineural hearing loss, and ocular lesions. About 15% of AS cases have autosomal mutations of COL4A3 and COL4A4 genes, including homozygous and compound heterozygous mutations. Here, we present a case of a two-year-old boy with autosomal recessive Alport syndrome (ARAS) caused by a novel c.193-2A>C COL4A4 mutation. The patient had a delayed motor and sensory development coupled with speech and language delay, megalencephaly, hematuria and proteinuria, and normal tonal audiogram and ophthalmology exam. Extensive genetic, metabolic, and neurologic workup performed at the age of 10 months was unremarkable and patient's megalencephaly was described as familial benign megalencephaly. Kidney biopsy analysis showed characteristic signs of AS. Mutations screening with use of Illumina MiSeq platform revealed that the patient was homozygous for a newly discovered splice acceptor pathogenic variant c.193-2A>C found in COL4A4 at the genomic position chr2:227985866 and both parents were heterozygous carriers. The genetic heterogeneity of AS makes the diagnostic process challenging. Although renal biopsy provides information about the characteristic GBM changes and the degree of renal parenchyma damage (interstitial fibrosis and tubular atrophy ratio), genetic testing is a more sensitive and specific method that also gives insight into potential disease severity and clinical course, and provides the basis for genetic counseling.

Clinico-radiologic profile of a dorsal variant of posterior cortical atrophy in a 55-year old female

Posterior Cortical Atrophy is a group of neurodegenerative disorders characterized by early, prominent and progressive impairment of visuospatial and visuoperceptual functions in the context of relatively preserved memory and insight in the early phases. Initial visual symptoms are vague and peculiar, compelling them to seek ophthalmologic consult. Patients present with simultagnosia and spatial disorientation, which are often missed by routine ophthalmologic and neurologic exams. This causes delay in diagnosis and early recognition of symptoms, as well as thorough examinations of higher cortical function are required to diagnose this disorder. As the disease progresses, Posterior Cortical Atrophy ultimately leads to a more diffuse pattern of cognitive dysfunction. The underlying pathology is believed to be Alzheimer's Disease and a greater level of amyloid plaques is correlated with earlier clinical symptoms of Posterior Cortical Atrophy. The clinical features of reported cases are heterogenous, leading to a classification of different variants and underlying pathologies. We report the serial clinical, cognitive and imaging data of a variant of Posterior Cortical Atrophy primarily affecting the dorsal stream.

1372 A Rare Case of Purtscher's Retinopathy in the Setting of Acute Alcoholic Pancreatitis

INTRODUCTION: Purtscher's retinopathy (PUR) is a rare condition first described in 1910. Occlusive microvasculopathy is characterized by sudden visual loss with multiple areas of retinal whitening in the posterior pole. Associated with acute pancreatitis, connective tissue disorders, renal failure, childbirth, bone marrow transplantation. Proteases like trypsin activate the complement system cascade causing coagulation and leukoembolization of the retinal precapillary arterioles. The emboli lodge in the arterioles producing the clinical appearance of PUR with impaired visual acuity and visual field loss. We present a case of a young female with repeat acute pancreatitis who developed sudden visual changes seconday to PUR. CASE DESCRIPTION/METHODS: 28 yo F with PMH of Etoh abuse, gastritis, Mallory-Weiss tear and prior admissions for pancreatitis presented to ED with emesis and abdominal pain for one day. Exam revealed a diffusely tender abdomen. Labs included lipase (939 U/L) (aspartate aminotransferase = 351 U/L, alanine aminotransferase = 179 U/L, alkaline phosphatase = 133 U/L) and hyperbilirubinemia (1.8 mg/dL). Abdominal U/S showed peripancreatic edema correlating acute pancreatitis along with hepatomegaly and steatosis. On day 1 of admission pt complained of visual disturbances upon awakening. Acute visual changes included blurriness, flashes and floaters which completely resolved by the evening. Bedside ophthalmologic exam revealed multiple cotton wool spots bilaterally. Ophthalmology evaluation revealed macular edema and neurosensory detachment of the macula bilaterally secondary to PUR. Visual field testing showed loss of central field bilaterally with preserved peripheral vision. Acuity was 20/200 bilaterally and received intraocular steroid injections with weekly follow up. Exam at 8 weeks demonstrated improvement to visual acuity to 20/40 bilaterally. DISCUSSION: Purtscher Flecken are variable, polyglonal regions of retinal whitening with a clear zone and are pathognomonic. The treatment for the ocular complications of PuR have not been proven and prognosis depends on the areas of the retina that are affected. Isolated case reports have shown rapid improvement in vision with high dose IV steroids. Steroids help preserve the neuronal membrane and suppress granulocyte aggregation caused by complement activation. Patient's complaining of changes in vision following an episode of acute pancreatitis should undergo eye examination in order to rule out Purtscher-like retinopathy.

Comparison of 1-field, 2-fields, and 3-fields fundus photography for detection and grading of diabetic retinopathy

AimTo evaluate the sensitivity and specificity of 1-, 2-, and 3-fields, nonmydriatic (NM), 45° color photography compared with mydriatic ophthalmoscopy for detection of diabetic retinopathy (DR). MethodsMasked, comparative case series was performed utilizing a group of 128 diabetic patients (256 eyes) with various stages of DR who underwent both 3-fields NM color photography and ophthalmologic examination. In a blinded manner, the same optometrist who read the original 3-fields images for a patient read the 1- and 2-fields photographs on separate dates later. ResultsThe sensitivity and specificity of digital retinal photography compared with dilated ophthalmoscopy were, respectively: 88% and 76% for 1-field; 94% and 69% for 2-fields; and 100% and 79% for 3-fields. The proportion of agreement between fundus photography reading and exam DR diagnosis were 58% for 1-field, 58% for 2-fields, and 77% for 3-fields. Kappa and Cramer's V statistics for 1-, 2-, and 3-fields were 0.55 and 0.60, 0.52 and 0.57, and 0.72 and 0.74, respectively. Three-fields measurement of DR was most similar to the dilated ophthalmological exam overall and across all DR severity levels. ConclusionsCompared to 1- and 2-fields fundus photography, 3-fields is superior for detecting vision-threatening DR. One- and 2-fields have reasonable sensitivity for DR screening.

Paracoccus yeei, a Rare Cause of Ocular Infection

Abstract Objectives Paracocci are nonfermenting obligate aerobes. The genus Paracoccus is classified in the family Rhodobacteraceae and contains 31 species. Gram stains reveal gram-negative cocci, diplococci, or coccobacilli/short rods, sometimes described as having an O shape due to peripheral stain. It may be confused with Neisseria sp. or Moraxella sp. due to oxidase positivity. Paracoccus yeei, a rare cause of infection in patients ranging from 6 weeks to 77 years, has been isolated from abdominal dialysate, wounds (ankle, toe), incision drainage, cerebrospinal fluid, bile, skin, blood, ear, and eye (uveitis, conjunctivitis, corneal transplant graft infection). It is a rare emerging pathogen with low pathogenic potential. Methods A 65-year-old heroin-dependent male with a nonfunctional left eye due to gasoline injury presented with a traumatic injury to the right eye. The ophthalmological exam revealed a central corneal ulcer, hazy pupil, right upper and lower lid swelling, periorbital edema with central vision loss, and conjunctival chemosis. B-scan showed no vitreous debris. Cultures of the ulcer were taken, and fortified tobramycin and fortified vancomycin drops were started. Results Nonhemolytic, whitish-gray, convex colonies, measuring 0.5 to 1 mm in diameter, grew on Columbia sheep blood and chocolate agar plates at 48 hours. Tiny pinpoint colonies were identified on MacConkey agar plate at 3 days. Gram stain revealed a small short gram-negative rod, which was oxidase and catalase positive. Microscan identified the isolate as P yeei. Antibiotic susceptibilities revealed low MICs for beta-lactam antibiotics and higher MICs for cephalosporins. The ulcer healed very well. The patient’s vision improved. The patient was subsequently discharged with instructions to follow up with clinic. Conclusion Our case reinforces the need to consider uncommon pathogens, including P yeei in eye infections and the role of microbiology in correctly identifying the organism where delay or incorrect treatment can lead to permanent damage.

Long-term visual acuity outcomes after radiation therapy for sporadic optic pathway glioma.

Children with sporadic optic pathway glioma (OPG) commonly experience a decline in visual acuity (VA). This study aimed to quantify long-term VA outcomes after definitive radiation therapy (RT). From 1997 to 2017, 41 patients underwent RT for OPG and had baseline VA testing. All patients underwent serial VA testing every 3-6months during the first 5years and annually thereafter. The cumulative incidence of VA decline or improvement (per eye) was estimated using death as a competing risk. Mean follow-up was 5years. Most tumors (93%) involved the postchiasmatic optic tracts and/or hypothalamus. Of the tumors tested for BRAF alterations (n = 15), 67% had a BRAF fusion. Median time to VA decline was 20months in the eye with worse vision and 22months in the better eye. For the worse eye, the 5-year cumulative incidences of VA decline and improvement were 17.9% [95% confidence interval (CI) 7-32.8%] and 13.5% (95% CI 4.7-26.7%), respectively. For the better eye, the 5-year cumulative incidences of VA decline and improvement were 11.5% (95% CI 3.5-30.7%) and 10.6% (95% CI 2.6-25.2%), respectively. Visual outcomes did not correlate with radiographic evidence of tumor progression. The 5-year cumulative incidence of VA decline was low. VA decline is most likely to occur within the first 2years after RT and is not associated with radiographic progression of disease, highlighting the need for frequent ophthalmologic exams during this period.

The retinal foveal avascular zone as a systemic biomarker to evaluate inflammatory bowel disease control

BackgroundInflammatory bowel disease (IBD) is a systemic inflammatory disease and is classified as Crohn’s disease (CD) or ulcerative colitis (UC) depending on the extent of gastrointestinal tract involvement. IBD can be associated with extraintestinal findings, such as fever, weight loss, arthralgia, and mucocutaneous lesions, as well as hepatic, renal and ophthalmological involvement. Clinical parameters and colonoscopy are used to establish the criteria for controlled or non-controlled disease and subsequent definition of treatment. Our objective in the present study was to compare the area of the foveal avascular zone (FAZ) in patients with a diagnosis of IBD during remission and active disease.Methods144 eyes of 72 patients with IBD were evaluated via a complete ophthalmological exam. Fundus photography and optical coherence tomography/angiography (OCT/OCTA) were performed with a Topcon Triton. The macula and posterior pole were evaluated by binocular indirect ophthalmoscopy and fundus biomicroscopy. The area of the FAZ was determined via manual delimitation of superficial retinal vascular layers from OCTA with image6.net software. To establish disease activity, we considered the Mayo Score, fecal calprotectin levels, colonoscopy results and clinical parameters. All retinal parameters were evaluated in a blinded manner. Means were compared between groups using the Mann–Whitney test.ResultsThe participants had a mean age of 42.26 years and included 28 males (38.88%) and 44 females (61.11%). Among the participants, 37 had a diagnosis of CD (51.38%), and 35 had a diagnosis of UC (48.61%). Twenty-five patients (34.72%) had active disease, and 47 (65.27%) were in remission. The area of the FAZ did not differ significantly between the CD and UC groups (p = 0.91 for the right eye and p = 0.76 for the left eye) but did differ significantly between the remission and active disease groups (p = 0.01 for the right eye and p = 0.02 for the left eye).DiscussionOur study is the first to evaluate the area of the FAZ in patients with IBD via swept-source OCTA. The area of the FAZ did not differ significantly in either eye between the CD and UC groups. However, patients classified as having active disease according to clinical parameters and colonoscopy presented a significant decrease in the area of the FAZ compared with patients in remission. The area of the FAZ is an ophthalmological parameter that can be obtained non-invasively and is increased in ischemic diseases such as diabetic retinopathy. The FAZ may decrease due to vascular engorgement or increased systemic inflammation. This parameter can be used to help determine whether a patient is in remission or active IBD, thus potentially reducing the need for invasive exams during disease follow-up.

Choroiditis in a HIV-infected patient with disseminated cryptococcal infection: A case report and literature review

BackgroundOcular involvement in AIDS patients is a common event mainly caused by inflammation or infection. Despite the high prevalence rate of cryptococcosis in these individuals, ocular features have been occasionally described. Case reportA 20-year-old Brazilian female with HIV infection recently diagnosed was admitted with a respiratory profile presumptively diagnosed as Pneumocystis jirovecii pneumonia; an ophthalmologic exam suggested choroiditis by this agent as well. She was complaining of headaches and blurred vision which led to cryptococcal meningitis diagnosis by a CSF positive India ink stain and Cryptococcus neoformans positive culture. Despite therapy based on amphotericin B plus fluconazole, her clinical state progressively worsened and the patient died one week later. At necropsy, disseminated cryptococcal infection was evidenced in several organs including eyes, which presented bilateral chorioretinitis. ConclusionsCryptococcal ocular involvement in AIDS patients has been occasionally proved among the cases already reported. Thus, the post mortem exam is still pivotal to improve the quality of the clinical diagnosis, especially in limited-resource settings.

Visual impairment in aging and cognitive decline: experience in a Memory Clinic

Visual impairment is common in people living with dementia and regular ophthalmological exams may improve their quality of life. We evaluated visual function in a cohort of elderly individuals and analyzed its association with their degree of cognitive impairment. Participants underwent neurological and neuropsychological exams, neuro-ophthalmological assessment (visual acuity, intraocular pressure, rates of past ophthalmological pathologies, use of ocular correction, treatments and surgeries) and optical coherence tomography (OCT) scan. We analyzed differences in ophthalmological characteristics among diagnostic groups. The final sample of 1746 study participants aged ≥ 50 comprised 229 individuals with Subjective Cognitive Decline (SCD), 695 with mild cognitive impairment (MCI) and 833 with Dementia (Alzheimer disease: n = 660; vascular dementia: n = 92, Lewy body dementia: n = 34; frontotemporal dementia: n = 19 and other: n = 28). Age, gender and education were used as covariates. Patients with Dementia, compared to those with SCD and MCI, presented worse visual acuity (p < 0.001), used less visual correction (p = 0.02 and p < 0.001, respectively) and fewer ophthalmological treatments (p = 0.004 and p < 0.001, respectively) and underwent fewer ocular surgeries (p = 0.009 and p < 0.001, respectively). OCT image quality worsened in parallel to cognitive decline (Dementia vs SCD: p = 0.008; Dementia vs MCI: p < 0.001). No group differences in past ophthalmological disorders or abnormal OCT findings were detected. Efforts should be made to ensure dementia patients undergo regular ophthalmological assessments to correct their visual function in order to improve their quality of life.

84 Ophthalmology exams in suspected child physical abuse: are they overused?

Recent studies suggest that fundoscopic examination may not be necessary in children with suspected physical abuse if the physical exam and neuroimaging show no evidence of intracranial injury. The likelihood of encountering retinal hemorrhages in these children is very low. To review the ophthalmologic examinations conducted in our center in children under 2 years of age with suspected physical abuse. A single-center retrospective chart review was completed using the electronic medical record of the ophthalmology department. We included children aged 0 to 24 months who were evaluated by ophthalmology for suspected physical abuse between May 2014 and June 2018. Charts were identified using the key words “suspected child abuse, physical abuse, shaken baby syndrome, shaken, maltreatment, abuse, retinal hemorrhage, non-accidental injury’’. We excluded children with suspected physical abuse who were not evaluated by ophthalmology. We collected data on patient characteristics, reason for referral, presence or absence of cerebral imaging, results of the imaging and of the ophthalmologic examination, as well as on the timing of these different types of investigations. During the study period, 55 children were evaluated by ophthalmology for suspected physical abuse. The mean age was 6 months, 62% of the children were between the age of 0 and 6 months, and most of the patients were males (67%). Of the 55 children included in our study, 45 children had cerebral imaging. Of those who had cerebral imaging, 30 (66%) did not have any intracranial injuries, and none of these patients had abnormal retinal findings. Conversely, among the 15 with intracranial injuries, 10 had abnormal ophthalmologic exams. Of the 10 children without imaging all had normal ophthalmologic examinations. Of the 45 who had cerebral imaging, 29 had their imaging done before ophthalmologic examination. Of the 29, 12 (41%) had normal imaging and none of these cases were found to have abnormal retinal findings. Of the 16 patients who had ophthalmologic examinations conducted before cerebral imaging, 13 (81%) had both investigations ordered at the same time and 3 (19%) had ophthalmology ordered first. Our study suggests that, in our center, there is some overuse of ophthalmologic examinations in patients with suspected physical abuse and such examinations should not be used as a screening tool for intracranial injury. Optimization of patient trajectory in the investigation of children with suspected physical abuse will be the focus of a future quality improvement project.

Long-Term Outcomes of Refractive Surgery Performed During the Military.

To evaluate the long-term refractive results of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) performed by the military in a veteran population. Three Department of Veterans Affairs (VA) hospital sites (Puget Sound, Buffalo, and Washington D.C.) obtained IRB approval for this multi-center study. Comprehensive ophthalmologic assessment including refraction and keratometry were obtained at the time of the long-term VA examination and compared to the patients' postoperative military records. Eighty patients (160 eyes) enrolled in this study. At the time of treatment, patients were 21-52 years of age. Long-term post-operative data was available from 4 to 17 years post-operatively. Fifteen percent of the treatment types were LASIK and 85% PRK. At the time of their military post-operative exam (range 3-14 months, mean 4 months), 82% of patients had uncorrected visual acuity (UCVA) of 20/20 or better, and their average manifest refraction was -0.08 D (SD ± 0.48 D). At the time of the long-term ophthalmological exam at the VA medical centers (range 4-11 years, mean of 8.2 years), 49% of patients had an UCVA of 20/20 or better and an average manifest refraction was -0.64 D (SD ± 0.69 D). This is the first long-term study evaluating refractive surgery outcomes up to 17 years in a military population. Our study demonstrates safety after refractive surgery in the military with less than 0.1D increase in myopia per year and strong keratometric stability. Other changes in the eye may be the likely cause for this observed mild refractive shift.

P021 The potential impact of provider gender on IBD management

BACKGROUND: Health maintenance guidelines have been published to ensure optimal clinical outcomes for individuals with inflammatory bowel disease (IBD), with recommendations including the evaluation of bone density, eye, and skin health. However, it has been suggested that there is variability in adherence to health maintenance recommendations. This study evaluated both the gender of providers discussing health maintenance with patients, and the overall rate of physicians' recommendations for Dual-energy X-ray absorptiometry (DXA) scans, vitamin D levels, ophthalmologic exams, and skin protective measures at an urban university medical center. METHODS: A retrospective chart review was performed evaluating all IBD patients seen at a university gastroenterology clinic over a 5-year period was performed. Patients' IBD diagnosis, recommendations for DXA, vitamin D levels, ophthalmologic exams, and skin protective measures (sunscreen and/or dermatology referral) were obtained. Patient and physician gender were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using Fisher's Exact Test with significance set at P &lt; 0.05. The study was approved by the IRB. RESULTS: 393 IBD patients were identified (175 males, 218 females) with mean age of 44.4 (age range: 20–82). 279 (71.0%) had Ulcerative Colitis (UC), 96 (24.4%) had Crohn's disease (CD), 7 (1.8%) with unspecified colitis, and 11 (2.8%) had microscopic colitis. Of the 393 patients, 279 (71.0%) were seen by male providers and 114 (29.0%) were seen by female providers. 249 (63.4%) patients had vitamin D and 110 (28%) had DXA scans performed. Ophthalmologic referrals were offered to 125 (27.8%). 83 (21.1%) were counseled about skin protective measures and given dermatology referrals. Significantly more female providers recommended vitamin D (P = 0.015), DXA screening (P = 0.027), ophthalmologic evaluations (P &lt; 0.0001) and dermatologic referrals (P &lt; 0.0001) compared to male providers. There was no significant difference of the performance of health maintenance recommendations based upon disease type. CONCLUSION(S): This study revealed that there was inconsistent adherence to IBD health maintenance recommendations. While female physicians more frequently recommended vitamin D screening, DXA scans, ophthalmologic examinations, and skin evaluations, there was a clear need to improve screening by all physicians. While this study was limited based upon retrospective design, small sample size, and single institution cohort, it provides a foundation for future research that addresses IBD management. Increased efforts to optimize IBD care will improve overall clinical outcomes.

Endoscopic Endonasal Resection of Orbital Apex Cavernous Hemangioma: 2-Dimensional Operative Video.

A 52-yr-old woman was referred to a tertiary medical center for evaluation of 2 yr of progressive visual symptoms and 1 yr of retro-orbital pressure. Her ophthalmologic exam was unrevealing except for mild asymmetrical impairment in color perception. A gadolinium contrast-enhanced magnetic resonance image of the head showed a left extraconal orbital apex lesion consistent with cavernous hemangioma. Computed tomography reveled bony remodeling of the medial-inferior orbital walls with superior orbital fissure expansion. The lesion was endoscopically resected and confirmed by pathological analysis. The endoscopic approach is demonstrated in detail, including correlation with cadaveric anatomic specimens‡. During the approach, a rescue nasoseptal flap was raised in case the orbit required further support after tumor resection, but was replaced as this was not needed. This patient had a brief period of postoperative diplopia, which resolved 1 wk after surgery. Her subjective visual deficits and pressure have also resolved. Advantages of the endoscopic approach include improved direct visualization of the lesion, lack of external skin incisions, avoidance of significant neurovascular retraction, and shorter hospital stays than alternative orbitotomy or craniotomy approaches. This 4-handed approach demands endoscopic expertise of 2 surgeons, and is often performed by rhinology-neurosurgery or rhinology-ophthalmology surgical teams. The risk of postoperative diplopia should be discussed with the patient during informed consent. ‡ Anatomic specimen photography courtesy Dr Peris-Celda.

SUN-LB070 Who Killed the Pituitary?

Background: Pituitary apoplexy can be caused by factors like surgery, pregnancy, drugs including anticoagulants and bromocriptine. Chemotherapy as a causal factor, however, has not often been noted in literature. To our knowledge, there are only 2 case reports implicating chemotherapy drugs as a cause of pituitary apoplexy. 1 Case: 72 year old male with recently discovered squamous cell lung cancer, presented to clinic for assessment of incidental pituitary mass noted on staging imaging. Initial labs showed hypogonadotropic hypogonadism with normal PRL, TSH and HPA axis. Transphenoidal biopsy of mass showed no metastasis. Subsequently, he was started on carboplatin and paclitaxel for lung cancer. Initial course was complicated by deep venous thrombosis treated with enoxaparin. After his sixth chemotherapy cycle, he presented with sudden onset headache and diplopia consistent with sixth cranial nerve palsy. Initial CT head was negative for hemorrhage and stable, though hypoenhancing sellar mass. Sixth nerve palsy was initially thought to be due to microvascular ischemic event. Labs at this time were notable for undetectable PRL, low TSH (0.03 uIU/ml, N 0.35-4.9 uIU/ml), declining ACTH (14 to 9 pg/ml, N 6-50 pg/ml). He developed significant hyponatremia, concerning for central adrenal insufficiency, requiring urgent treatment with stress dose steroids. Pituitary MRI newly showed enlarging sellar mass, defect in dura and retroclival collection, later thought to be necrotic material from apoplectic pituitary. Surgical intervention was deferred as ophthalmology exam showed no pituitary compromise. After 12 days, he was readmitted with atraumatic bilateral subdural hematomas (SDHs) prompting enoxaparin cessation. Imaging at this time also showed decreased size of the mass. Follow up imaging showed resolution of SDHs with interval reduction of mass size. On final review, his presentation was suspected to be secondary to pituitary apoplexy due to chemotherapy in conjunction with enoxaparin, causing retroclival necrotic tissue and meningeal irritation leading to atraumatic SDHs. Given absence of hemorrhage on initial imaging and known vasculopathic effects of agents like carboplatin (analog of cisplatin), chemotherapy induced apoplexy cannot be excluded. In addition, although rapid regression after pituitary apoplexy has been reported rarely, chemotherapy may have a role in rapid shrinkage post apoplexy. 2 Conclusion: This case highlights potential role of chemotherapy in conjunction with anticoagulation in causing pituitary apoplexy and rapid pituitary tumor shrinkage. Reference: 1. Jang, Je Hun et al. Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer Brain tumor research and treatment vol. 6,1: 43-46 2. Jackson, D. L et al. Rapid pituitary apoplexy regression: what is the time course of clot resolution? Case reports in radiology, 2015 Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Altered cortical morphology of visual cortex in adults with monocular amblyopia

The neural mechanism of amblyopia and its impact on the adult brain remain unclear. This hinders effective treatment for adults with this disease. To investigate neuroanatomical differences in cortical morphometry between amblyopic adults and healthy controls, and to explore the structural covariance of abnormal morphometric changes. Prospective. Twenty-one amblyopic adults and 34 healthy controls. 3T MRI, T1 -weighted, MPRAGE sequence. All participants completed ophthalmologic exams to confirm the diagnosis of amblyopia or its absence in the healthy controls, including tests of ocular motility and dilation, fundus exam, autorefraction and synoptophore tests. Cortical volume, thickness, and surface area measurements were obtained using FreeSurfer software. Statistical differences of MRI measures between amblyopic adults and healthy controls were identified using a general linear model with intracranial volume and age as covariates. Monte Carlo simulations were used to correct for multiple comparisons. The structural covariance of abnormal morphometric changes and the relationship between morphometric abnormalities and visual acuity of the amblyopic eye were examined. Compared with healthy controls, amblyopic adults showed reduced cortical volume in left lateral occipital cortex, and decreased cortical thickness in bilateral inferior temporal gyrus and left precentral gyrus (P < 0.05; Monte Carlo corrected). Structural covariance between cortical volume of left lateral occipital cortex and cortical thickness of right inferior temporal gyrus in amblyopic adults was significantly less than in healthy controls (z = 1.73; P < 0.05). Our study identified morphological abnormalities in occipital cortex and in temporal and frontal cortex which are projection fields of visual cortex important for processing of visual form and object location information, and disrupted structural covariance of visual cortex with other brain regions in amblyopic patients. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1405-1412.

Development of a screening eye clinic for Ebola virus disease survivors: Lessons learned and rapid implementation at ELWA Hospital in Monrovia, Liberia 2015.

BackgroundIn the wake of the West African Ebola virus disease (EVD) outbreak of 2014–2016, thousands of EVD survivors began to manifest a constellation of systemic and ophthalmic sequelae. Besides systemic arthralgias, myalgias, and abdominal pain, patients were developing uveitis, a spectrum of inflammatory eye disease leading to eye pain, redness, and vision loss. To investigate this emerging eye disease, resources and equipment were needed to promptly evaluate this sight-threatening condition, particularly given our identification of Ebola virus in the ocular fluid of an EVD survivor during disease convalescence.Methodology/Principal findingsA collaborative effort involving ophthalmologists, infectious disease specialists, eye care nurses, and physician leadership at Eternal Love Winning Africa (ELWA) Hospital in Liberia led to the development of a unique screening eye clinic for EVD survivors to screen, treat, and refer patients for more definitive care. Medications, resources, and equipment were procured from a variety of sources including discount websites, donations, purchasing with humanitarian discounts, and limited retail to develop a screening eye clinic and rapidly perform detailed ophthalmologic exams. Findings were documented in 96 EVD survivors to inform public health officials and eye care providers of the emerging disease process. Personal protective equipment was tailored to the environment and implications of EBOV persistence within intraocular fluid.Conclusions/SignificanceA screening eye clinic was feasible and effective for the rapid screening, care, and referral of EVD survivors with uveitis and retinal disease. Patients were screened promptly for an initial assessment of the disease process, which has informed other efforts within West Africa related to immediate patient care needs and our collective understanding of EVD sequelae. Further attention is needed to understand the pathogensis and treatment of ophthalmic sequelae given recent EVD outbreaks in West Africa and ongoing outbreak within Democratic Republic of Congo.

P015 WHO YOU ARE MAY DEFINE HOW DOCTORS TREAT YOU: GENDER AND RACIAL DISPARITIES IN IBD MANAGEMENT

Patients with inflammatory bowel disease (IBD) require more frequent and varied screening tests in order to reduce patient morbidity and mortality. Beyond colonoscopies, routine skin, ophthalmologic, vitamin D, and DXA evaluations are recommended to reduce IBD complications. This study investigated the rates of health maintenance evaluations in IBD patients and whether demographics impacted patient management in a university medical center. A retrospective chart review evaluating all IBD patients seen at a university gastroenterology clinic over a five-year period was performed. Patient gender, self-categorized race, IBD diagnosis and whether the patient was recommended to get bone (DXA, vitamin D), dermatologic or ophthalmologic evaluations were noted. A database was created using Microsoft Excel. Statistical analysis was performed using a two-tailed Fisher’s Exact Test with significance set at P<0.05. The study was approved by the IRB. Medical records of 393 patients (218 female, 175 male) were reviewed. 279 (71.0%) had ulcerative colitis, 96 (24.4%) had Crohn’s disease, 7 (1.8%) had indeterminate colitis, and 11 (2.8%) had microscopic colitis. 249 (63.4%) had vitamin D levels, 110 (28%) had DXA, 125 (31.8%) had ophthalmologic exams and 83 (21.1%) had skin evaluations. Women received significantly more DXA scans (p=0.007) and vitamin D testing (p=0.049) compared to men. There were no significant differences in performance of skin exams and recommendations (p=0.71) or ophthalmologic exams (p=0.66) between women and men. 204 patients (51.9%) were Caucasian, 100 (29.0%) were African American, 12 (3.1%) were Asian, and 77 (19.6%) were unspecified race. There were no significant differences in vitamin D surveillance in Caucasians with African Americans (p=0.092) or Asians (p=1). There were no significant differences in DXA scans between Caucasians and African Americans (p=0.121) or Asians (p=0.152). On the other hand, skin exams were performed at significantly higher rates in Caucasians compared to African Americans (p<0.0001) and Asians (p<0.0001), as was ophthalmologic screening among Caucasians relative to African Americans (p<0.0001) and Asians (p<0.0001). This study revealed that there was inconsistent adherence to IBD health maintenance recommendations. Women received significantly more testing for bone health compared to men. There was no difference in skin exams and ophthalmologic exams based upon patient gender. Notably, Caucasian patients received significantly more ophthalmologic and skin exams compared to patients of other races. While this study is limited based upon retrospective and single institution design, this study supports recommendations for increased efforts to improve health maintenance recommendations among all patients to optimize clinical outcomes.

Perfil clínico e achados oftalmológicos no Herpes Zoster Oftálmico

ABSTRACT Objective: Herpes Zoster Ophthalmicus (HZO) is caused by varicella-zoster virus (VZV) and commonly affects elderly or immunocompromised patients. It has the potential to generate severe complications such as corneal ulcers, uveitis, retinal necrosis and post herpetic neuralgia. This study aimed to evaluate patients at the acute onset of the disease and describe their clinical profile and ophthalmologic findings. Methods: A cross-sectional study was performed from March 2014 to October 2015. All consecutive patients with the diagnosis of acute HZO (at a vesicle, pustule or crust stage) were enrolled and submitted to an ophthalmologic exam that included ectoscopy, best corrected visual acuity, corneal sensitivity test, slit-lamp examination, Goldmann applanation tonometry and funduscopic examination. Results: Nineteen patients were included. The mean age was 71 years old, ranging from 52 to 88. Ten patients had high blood pressure (52.6%) and nine (47.3%) had diabetes. Visual acuity lowered in comparison to the fellow eye in eleven patients (57%), ranging from one to six lines of vision, due mostly to epithelial keratitis and ocular discharge. Intraocular pressure (IOP) did not varied in most cases compared to the fellow eye. Hutchinson's sign (HS) was present in seven (36%) patients. The correlation between HS and anterior chamber reaction as well as decreased corneal sensitivity was statistically significant with Fisher's test of 0.009 and 0.029 respectively (p<0.05). Conclusion: The clinical profile of our patients was elderly patients with a higher rate of diabetes. Correlation between Hutchinson's sign and anterior chamber reaction as well as decrease in corneal sensitivity was significant. High intraocular pressure or posterior segment complications were not found in any cases.

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography.

To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity - Snellen's table, color vision test - Ishihara's table, fundoscopy, and retinography - red-free). A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.