Ophthalmologic Exam Research Articles

Prophylactic Laser Retinopexy and Scleral Buckle Placement for Retinal Detachment Prevention in Pierson Syndrome: A Retrospective, Case Series Study.

To report the impact of prophylactic 360° laser retinopexy and scleral buckle placement for retinal detachment (RD) prophylaxis in patients affected by Pierson syndrome (PS). This retrospective case series included 11 PS patients (2015-2024), analyzing demographic data, ophthalmological exams, and genetic testing. Prophylactic interventions were compared with post-RD surgical interventions based on RD occurrence and timing. A one-sample proportion test evaluated outcome differences. This study of 11 PS patients evaluated the effectiveness of prophylactic 360° laser retinopexy and scleral buckle (SB) placement. Ten patients carried the LAMB2 c.440A>G mutation and had associated findings of thyroid and renal disease. All retinal detachments (RDs) were combined tractional retinal detachment (TRD) and rhegmatogenous retinal detachment (RRD) due to posterior tears. Eight eyes with TRD-RRD were actively treated with laser retinopexy and SB; six (75%) experienced re-detachments. In contrast, seven eyes with TRD-RRD were treated prophylactically, with 86.6% of eyes treated with laser retinopexy and 100% of those receiving additional SB placement maintaining retinal integrity over an average follow-up of 3.4 years. Prophylactically treated eyes had significantly fewer RD recurrences compared to those treated surgically after RD onset (p < 0.01), highlighting the benefits of early combined intervention in PS. This study's results suggest a potential role for prophylactic laser retinopexy and subsequent scleral buckle placement to prevent RD among patients with a confirmed diagnosis of Pierson syndrome.

P-1002. Congenital Syphilis: Are We Doing Too Much?

Abstract Background The resurgence of syphilis and its risks to neonates has been reported nationally. Sixty to ninety percent of infected infants can be asymptomatic at birth. Effective early identification and treatment of congenital syphilis is paramount. The American Academy of Pediatrics (AAP) offers guidelines for categorizing risk of congenital syphilis and outlines recommended and optional testing for completed workup. Literature on adherence to these guidelines is limited. We hypothesized that unnecessary imaging and labs were obtained on infants without an impact in their management. Number of congenital syphilis cases per year and divided by diagnostic category. Methods We conducted a retrospective study of all infants with a diagnosis of congenital syphilis admitted at MemorialCare Miller Children’s and Women’s Hospital, an urban tertiary referral center, from Jan 2017 – Dec 2023 (IRB # MHS 361-23). Infants were subdivided by congenital syphilis diagnostic category. Data collected for infants included completion of long bone X-ray, head ultrasound, MRI brain, ophthalmologic exams, and lumbar puncture with CSF analysis, as well as if management changes were made based off study results and if any of the studies were abnormal. Number of ophthalmology exams ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP. Results 81 infants were identified in this period. 11 (13.6%) had proven or highly likely, 50 (61.7%) had possible, 14 (17.3%) had likely, and 6 (7.4%) had less likely congenital syphilis. 46 (56.8%) received ophthalmologic exams, all of which did not lead to changes in management. 36 of the 46 ophthalmologic exams (78.3%) were conducted without recommendations from the AAP. 10 out of 19 (52.6%) brain MRIs were ordered without AAP recommendations and did not result in changes in management. 4 out of 62 (7%) long bone x-rays were performed without either AAP recommendation or subsequent changes in management. Similarly, 5 out of 66 (7.6%) lumbar punctures were carried out without adherence to AAP recommendations and did not result in changes in management. 12 out of 15 (80%) head ultrasounds were conducted without AAP recommendation. Number of brain MRIs ordered for each congenital syphilis diagnostic category. The black checkmark indicates if this study was recommended by the AAP. Conclusion Unnecessary labs and imaging were frequently ordered for congenital syphilis work up. Our unit has now undertaken a multi-disciplinary quality improvement project to ensure timely and proper categorization of congenital syphilis risk to ensure appropriate imaging and labs are obtained. Disclosures All Authors: No reported disclosures

Diabetic Detection from Images of the Eye

This cross-sectional study aims to detect Diabetic Retinopathy (DR) in patients who have had retinal scans and ophthalmological exams. The research makes use of tailored retinal images together with the OPF (Optimum-Path Forest) and RBM (Restricted Boltzmann Machine) models to categorize images according to the presence or absence of DR. In this work, features were extracted from the retinal images using both the RBM and OPF models. In particular, after a thorough system training phase, RBM was able to extract between 500 and 1000 features from the images. The study included fifteen distinct trial series, each with thirty cycles of repetition. The research comprised 122 eyes, or 73 diabetic patients, with a gender distribution that was reasonably balanced and an average age of 59.7 years. Remarkably, the RBM-1000 model stood out as the top performer, with the highest overall accuracy of 89.47% in diagnosis. In terms of specificity, the RBM-1000 and OPF-1000 models surpassed the competition, correctly categorizing all images free of DR symptoms. These findings highlight the potential of machine learning, particularly the RBM model, for self-identifying illnesses. The potential of machine learning models—in particular, RBM and OPF—to automate the diagnosis of diabetic retinopathy is demonstrated by this work. The results show how well the RBM model diagnoses, how sensitive it is, and how well it can be applied for efficient DR screening and diagnosis. This information may be used to improve the effectiveness of systems that identify retinal illnesses

Association of strabismus and congenital cataract in a 2‐year‐old girl

Aims/Purpose: The objective of this study is to evaluate the clinical case of a 2‐year‐old girl referred from pediatrics due to an asymmetric Hirschberg test, analyze the diagnostic findings, and describe the management of her ophthalmological condition.Methods: A detailed clinical evaluation was conducted, including family history, ophthalmologic exams, imaging studies, and genetic tests. The girl was monitored from 8 months to 24 months of age. Eye movement exams, cover test, autorefractometry under cycloplegia, biomicroscopy, metabolic studies, and genetic testing were performed.Results: At 8 months, the patient presented with orthotropia and symmetrical Hirschberg, with marked epicanthus and a normal fundus. At 14 months, the cover test revealed 15° exotropia with alternating dominance. Autorefractometry under cycloplegia showed myopia and astigmatism: right eye ‐2.75 ‐1.50 at 80°, left eye ‐2.00 ‐1.50 at 110°, and she was prescribed glasses. At 15 months, biomicroscopy showed punctate opacities in the lens. The metabolic study was normal, but genetic testing identified a probably pathogenic variant in the MAF gene associated with type 21 cataract. Currently, exotropia is controlled with glasses. The best corrected binocular visual acuity is 0.5.Conclusions: The management of this patient underscores the importance of comprehensive evaluation and multidisciplinary follow‐up in cases of strabismus and congenital cataract with a family history. In this case, rare associations such as congenital cataracts associated with the MAF gene, myopia, and exotropia are found.

Comparing performance in a general ophthalmology exam: Artificial intelligence versus ophthalmologists, residents and general practitioners

Comparing performance in a general ophthalmology exam: Artificial intelligence versus ophthalmologists, residents and general practitioners

Optic nerve sheath enhancement on orbital MRI in giant cell arteritis

BackgroundDifferentiating arteritic anterior ischaemic optic neuropathy (A-AION) due to giant cell arteritis (GCA) from non-arteritic anterior ischaemic optic neuropathy (NA-AION) may pose a diagnostic challenge. Our study aimed to assess...

Utility of Papilledema for Detection of Elevated Intracranial Pressure in Craniosynostosis.

Papilledema is swelling of the optic disk due to fluid accumulation around the optic nerve and is commonly used to detect increased intracranial (ICP) in craniosynostosis. This study aimed to assess the prevalence and utility of papilledema detection in patients with single-suture, multi-suture, and syndromic craniosynostosis and the differences before and after surgical intervention. A retrospective review of ophthalmology examinations of patients diagnosed with craniosynostosis treated between 2008 and 2023 was performed. Demographics, diagnosis, and operative data were collected. A total of 1509 ophthalmology exams of 519 patients were reviewed. The overall rate of papilledema in patients with craniosynostosis was 2.12%. The single-suture and multi-suture involvement rates were 1.15% and 5.81%, respectively. Non-syndromic patients with preoperative and postoperative examinations had an overall rate of 3.13%. Most had single suture involvement, and the average age of papilledema examination was 72 months. Syndromic patients with preoperative and postoperative examinations had an overall rate of 17.65%. The majority had multiple suture involvement, and the average age of papilledema examination was 26 months. The overall papilledema detection rate was low in patients with craniosynostosis. Multi-suture involvement and syndromic diagnosis had increased rates of papilledema. The average age of diagnosis was in older children. Syndromic patients had papilledema examination at a younger age. The authors' findings support the concept that fundoscopic ophthalmologic examination will benefit patients with multi-suture involvement, an associated syndrome, and older age.

INNV-13. OPHTHALMOLOGICAL COMPLICATIONS IN NF-1 PATIENTS RECEIVING MEK INHIBITORS: MD ANDERSON CANCER CENTER EXPERIENCE

Abstract BACKGROUND MEK inhibitors (MEKi) are a novel therapy for plexiform neurofibromas and optic gliomas in Neurofibromatosis type 1 (NF1). Potential ophthalmic complications are MEKi-induced retinopathy (MEKAR) requiring regular ophthalmologic assessments. We assess the importance of screening and ocular adverse events (OAE) in pediatric NF1 patients receiving MEKi. METHODS We reviewed 45 NF1 patients with baseline and follow-up examinations before and post MEKi treatment initiation. Evaluations included comprehensive eye examination, visual acuity, dilated fundoscopic examination, optical coherence tomography (OCT) of the macula and nerve fiber layer, and Humphrey visual field testing. RESULTS Twenty-six (62% male) of 45 patients were included. Median age at treatment was 15 (range 2-23) years. Plexiform neurofibromas were the most common indication for MEKi (n=22). Selumetinib was the most common MEKi (n=19, 77%), then trametinib (n=6, 23%), and mirdametinib (n=1, 4%). Only two patients had to switch to different MEKi. Patients were followed for a mean of 413-days after treatment initiation (range 103-1122 days) for an average of 3.85 ophthalmology exams per patient. No retinopathy was observed at each of the 3–6 month follow-ups. Around 15% of patients experienced dry eye symptoms with none requiring artificial tears for management. Seven patients had pre-existing optic neuropathy. No dose adjustments were needed due to OAEs. One patient’s visual acuity decreased temporarily but returned to baseline and the patient remains on MEKi. CONCLUSIONS Regular ophthalmologic assessments are crucial for NF1 patients undergoing MEKi treatment. Consensus guidelines on frequency of ophthalmologic screening during MEKi treatment are not well reported. In our cohort no patients had MEKAR at regular 3–6 month follow ups. In addition to baseline screening, future larger cohort studies are needed to confirm if decreasing the frequency of retinal exams is safe while on MEKi to inform future clinical screening guidelines for NF1 patients on MEKi.

Do Patients With Candidemia Need an Ophthalmologic Examination?

The Infectious Diseases Society of America recommends a screening dilated retinal examination by an ophthalmologist for all patients with candidemia. Conversely, the American Academy of Ophthalmology recommends against routine screening in patients with candidemia without symptoms. In a collaborative effort between infectious diseases and ophthalmology, we examined the incidence of ocular complications in 308 patients with candidemia and subsequently measured the rate of fundoscopic examinations, risk factors for ocular complications, management changes, and outcomes. Among those who received fundoscopic exams, findings suspicious for ocular candidiasis were found in 12 patients (8%, 12/148). After independent review by ophthalmology and infectious diseases, 3 patients were found to have alternate pathologies that explained their ocular findings. Nine patients (6%, 9/148) were adjudicated as having presumed Candida chorioretinitis. Of these 9 patients, 4 (44%) were asymptomatic, and 2 (22%) were unable to declare symptoms. No patients were definitively determined to have Candida endophthalmitis. Ocular candidiasis was not found to have a statistically significant association with symptoms or comorbidities. Ocular candidiasis was more likely to be found at ophthalmology exams >7 days from first positive Candida blood culture. The number needed to screen to detect presumed Candida chorioretinitis among asymptomatic patients was 20. Based on the available evidence and high risk of morbidity of eye involvement, continued ophthalmological screens seem prudent, but a definitive consensus was found to be challenging given a lack of outcome data. Additional investigations are warranted. Ophthalmology screenings have a higher sensitivity at >7 days from positive blood culture.

Bilateral Idiopathic Neuroretinitis.

Neuroretinitis (NR) is a rare inflammatory condition characterized by sudden vision loss, optic disc edema and macular star appearance predominantly affecting individuals in their third and fourth decades of life. This paper describes the case of 33-year-old Caucasian man with no significant medical history complaining of decreased vision for about a week. The ophthalmological exam revealed best-corrected visual acuity (BCVA) for the right eye (RE) of 0.8 (decimal notation) and of 0.9 for the left eye (LE). Intraocular pressure (IOP) was 20 mmHg in RE and 18 mmHg in LE. Slit-lamp examination of both eyes (OU) showed no evidence of intraocular inflammation in the anterior chamber or vitreous cavity. Examination of the posterior pole of the right eye showed bilateral papilledema with an incomplete macular fan pattern. Despite extensive laboratory tests, including serologic and imaging investigations, a definitive etiology remained unclear. It is very important to differentiate NR from other optic nerve disorders, requiring careful clinical evaluation and observation of the evolution of symptoms.

8203 A Solitary Fibrous Tumor Mimicking a Non-functional Pituitary Macroadenoma

Abstract Disclosure: L. Bernacet Rivera: None. S. Omay: None. A. Huttner: None. S.E. Inzucchi: None. Background: A solitary fibrous tumor (SFT), also known as hemangiopericytoma (HPC), is a rare subset of soft tissue tumors of mesenchymal origin. This type of tumor tends to have aggressive behavior and a high risk of recurrence. Approximately less than 1% of central nervous system (CNS) tumors have been identified as part of this subtype. Case Presentation: A 73-year-old female with medical history of primary hypothyroidism, myelodysplastic syndrome (MDS), and IgM kappa MGUS initially presented to her primary care physician for evaluation of progressive visual loss over several weeks, accompanied by worsening headaches. Ophthalmologic exam revealed bitemporal hemianopsia which prompted urgent imaging. Pituitary MRI with IV contrast revealed a solid sellar mass with suprasellar extension measuring 1.8 x 1.3 x 1.9 cm. The lesion was noted to superiorly displace the optic chiasm as well as to cause mild impingement of the anterior cerebral arteries. Patient was urgently referred to neurosurgery and endocrinology for further evaluation. Initial neuroendocrine laboratory assessment, performed at 8 am, revealed a cortisol 16.5 ug/dL, free T4 1.2 ng/dL, TSH 0.77 mIU/L, prolactin 9.9 ng/mL, IGF-1 17 ng/mL, the latter value consistent with adult growth hormone deficiency. Her LH and FSH were 4.3 mIU/mL and 12.6 mIU/mL, respectively, lower than expected for a post-menopausal woman. She underwent a transnasal transsphenoidal resection of the sellar lesion. Surgery was difficult due to the fibrous nature of the tumor, for which complete resection was not achieved. Post-operative course was complicated by thrombocytopenia due to MDS. Hormonal workup following surgery was consistent with central adrenal insufficiency, hypogonadotropic hypogonadism, and central hypothyroidism. Pathology showed densely cellular spindle cell neoplasm with a collagenous background consistent with hemangiopericytoma. She underwent fractionated radiotherapy and tumor has since remained stable in size. Her visual symptoms resolved quickly following surgery. Discussion: SFT is an aggressive mesenchymal tumor which rarely appears in the sellar region. There are no identified brain MRI findings that would suggest the nature of this tumor. As a result, endocrinologists should be aware of this rare condition while evaluating pituitary neoplasms. Presentation: 6/3/2024

Ophthalmologic symptoms as the first manifestation of primary complete empty sella syndrome- case report

Background: Empty sella syndrome (ESS) is a rare condition associated with loss of pituitary gland volume. ESS has a heterogeneous clinical manifestation including endocrine, neurological, and visual deficits. The most common symptoms include chronic headaches and hormonal disturbances associated with hypopituitarism.Aim of the study: To emphasize the role of ophthalmologists in the initial management of intracranial hypertension and the significance of a multidisciplinary approach in the management of ESS.Case report: Primary complete ESS was reported in a 32-year-old male presenting nonspecific ophthalmologic symptoms including ophthalmalgia and subjective worsening of the visual acuity. The ophthalmological exam revealed bilateral optic disk elevation. The subsequent MRI identified a suprasellar cistern invaginating within sella turcica with resulting pituitary gland flattening. A complete empty sella syndrome was confirmed. In addition, idiopathic intracranial hypertension was suspected. The patient was proposed hospitalization in the neurology department for additional testing however, he refused due to personal reasons.Conclusions: To date, only a few papers reported ESS with preliminary ophthalmological symptoms. All patients with nonspecific eye symptoms should have a complex ophthalmological examination. Bilateral optic disk elevation requires urgent imaging of the brain and orbits, and the golden-standard approach remains MRI. During the diagnostic process, the secondary causes of intracranial hypertension including tumor, bleeding, abscess, hydrocephalus, or venous sinus thrombosis must be excluded. Due to the heterogeneous clinical course of ESS, patients require multidisciplinary management and follow-up by endocrinologists, neurologists, neurosurgeons, and ophthalmologists.

Review of emerging trends and projection of future developments in large language models research in ophthalmology

BackgroundLarge language models (LLMs) are fast emerging as potent tools in healthcare, including ophthalmology. This systematic review offers a twofold contribution: it summarises current trends in ophthalmology-related LLM research and...

Social Isolation as a Precipitating Factor for Charles Bonnet Syndrome in a Patient with Mild Visual Deterioration

Charles Bonnet Syndrome (CBS) is characterized by complex visual hallucinations in individuals with acute vision loss, typically affecting older adults. Most CBS cases are observed in patients with sudden severe visual impairment; however, there are limited reports of CBS occurring in individuals with mild visual deterioration, particularly when confounded by sensory deprivation and social isolation. Here, we report a case of CBS in a female in her early 80s, who experienced vivid visual hallucinations during a period of prolonged social isolation following a hip surgery. Although symptomatology initially presented as delirium and psychosis, the diagnosis of CBS was confirmed after a neuropsychiatric evaluation and ophthalmologic exam, which showed mild deterioration in the patient’s macular degeneration, combined with a social history of reduced independence and increased isolation. The case highlights the lesser-known role of sudden lifestyle changes and reduced cognitive engagement in CBS development in cases of mild visual impairment. It also suggests that cognitive and social stimulation may play a crucial role in CBS management, which has limited reports in the current literature.

An Interesting Case of COPD Exacerbation Presenting with Mixed Features of Intracranial Hypertension and Hypercapnic Encephalopathy

Background: Idiopathic intracranial hypertension (IIH or pseudotumor cerebri) has two major morbidities: papilledema with visual loss and disabling headache. Intracranial Venous Hypertension (IVH) is a fundamental mechanism of IIH. Although traditionally considered limiting to the central nervous system, evidence suggests IIH as a systemic disease associated with cardiorespiratory disorders, which has been far less comprehended. Case Report: A 60-year-old female with Chronic Obstructive Pulmonary Disease (COPD) was admitted for dyspnea and developed a coma with a pH of 7.01 and pCO2 of 158 mmHg. She was intubated and had persistent nuchal rigidity, a brief myoclonus episode with a negative electroencephalogram, and negative CT head studies. A Lumbar Puncture (LP) revealed elevated opening pressure (35 cmH2O) with normal Cerebral Spinal Fluid (CSF) studies. Her nuchal rigidity improved after the removal of 40 mL CSF. The ophthalmology examination the next day after her the large volume LP didn’t show visual loss or papilledema. The patient improved clinically and was extubated two days later. Her echocardiogram showed a dilated right ventricle with pulmonary hypertension. The patient was discharged home. Discussion: IIH is different from hypercapnic encephalopathy and characterized by increased intracranial pressure with papilledema, vision loss, and debilitating headache. Hypercapnia-induced increased intracranial venous flow and pulmonary hypertension-caused elevated central venous pressure with consequent outflow resistance lead to IVH. In hypercapnic encephalopathy, the presentation is mostly cognitive changes. In this case, nuchal rigidity with a negative CT head scan triggered the investigation of IIH. Conclusion: A deep understanding of the relationship between COPD and IIH is vital. There is insufficient evidence to recommend routine eye examinations in COPD patients for papilledema and to conduct a pulmonary function test for a newly diagnosed IIH patient. However, we highly suggest a timely ophthalmology exam prior to performing an LP in COPD patients with suspecting IIH to avoid unnecessary procedures and meanwhile improve clinical outcomes.

HGG-45. HIGH GRADE GLIOMA PRESENTING AS A SYNCHRONOUS CANCER IN A PATIENT WITH DIFFUSE LARGE B CELL LYMPHOMA: A UNIQUE TREATMENT DILEMMA

Abstract BACKGROUND Patients with synchronous tumors pose significant treatment dilemmas. We present a pediatric patient found to have concomitant Diffuse Large B-cell Lymphoma (DLBCL) and a High Grade Glioma (HGG). His unique presentation and family history uncovered a familial diagnosis of Lynch Syndrome. CASE A 7-year-old male presented with acute appendiceal rupture. Surgical resection identified an appendiceal mass consistent with localized DLBCL. While undergoing staging evaluations, the patient complained of new onset blurry vision with normal neurologic and ophthalmologic exams. Subsequent imaging was concerning for a high-grade lesion. Biopsy confirmed HGG and he underwent gross total resection. Family history included a brother with relapsed leukemia status post bone marrow transplant and multiple first cousins with lymphoma and gastrointestinal cancers. RESULTS While awaiting genetics and mutational analysis, we initiated treatment. The HGG was treated with focal radiation to the tumor bed starting 2 weeks after resection. Lymphoma therapy was initiated concurrently per the REBOOT regimen with the goal of decreasing doxorubicin dosing during radiation. Lumbar punctures and intrathecal chemotherapy were deferred until completion of radiation. Biopsy of residual abdominal masses following consolidation 1 showed &amp;lt;5% viable cells and therapy was intensified to ANHL1331, Group C1. Evaluation of both lesions identified hypermutation (mutational burden &amp;gt; 150mutations/Mb). Two unique germline mutations of PMS2 were also identified, consistent with Lynch syndrome. After completion of above therapy, the patient received maintenance therapy with nivolumab checkpoint inhibition. The patient developed severe neutropenia leading to cessation of nivolumab and quick progression of his HGG. CONCLUSION Synchronous tumors pose significant treatment dilemmas given the need to treat multiple lesions while balancing side effects. While checkpoint inhibitors may provide a way to address multiple lesions, our patient had unacceptable side effects limiting the utility of this therapy.

Correlations Between the Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Serum Lipid Fractions With Neovascular Age-Related Macular Degeneration.

Introduction Age-related macular degeneration, a chronic and progressive disease, is one of the leading causes of vision loss globally among the elderly population. Multiple hypotheses have been proposed regarding its pathogenesis, including the presence of lipid metabolism alteration. Dysfunctional lipid handling within retinal pigment epithelial cells has been implicated in the accumulation of lipofuscin and subsequent induction of oxidative stress and inflammation, all contributing to retinal degeneration. The present study aims to comparatively analyze the serum lipid fractiondistributions in patients with neovascular age-related macular degeneration (AMD) and controls. Materials and methods A retrospective study was carried out between January 2021 and December 2023 on 91 naïve patients with neovascular AMD and 90 controlsadmitted for routine cataract surgery. All subjects underwent a comprehensive ophthalmological exam, including ophthalmoscopy and optical coherence tomography (OCT) with central macular thickness (CMT) measurement. A complete blood count with differential and lipid fractions values was analyzed. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were comparatively analyzed between the control group and the test group. Results The groups were comparable in terms of age (73.84 ±7.52 years for the neovascular AMD group vs 72.1±10.92 years in controls; p=0.8) and gender distribution (p=0.243). The mean NLR and PLR values were slightly higher in the AMD groupbut not statistically significant (p=0.51, p>0.99, respectively). Comparative analysis of lipid profile fractions showed significantly higher HDL-C values in the exudative AMD group compared to normal subjects (61.27±19.4 mg/dL vs 50.99±7.86 mg/dL, p=0.006). Also, the proportion of subjects with HDL-C>60 mg/dL was higher in the exudative AMD group (p=0.014). There were no significant differences in total cholesterol (189.77±53.39 mg/dL vs 190.43±37.84 mg/dL, p=0.681), LDL-C, and TG. Logistic regression analysis showed that serum HDL-C and HDL-C values >60 mg/dL are significantly associated factors with neovascular AMD. However, there is no statistical correlation between the values of these biochemical parameters and visual acuity or CMT in the neovascular AMD patient group. Conclusions There were no correlations between NLR and PLR with neovascular AMD in the study group. Higher HDL-C valuesexceeding 60 mg/dL were associated with neovascular age-related macular degeneration and could represent a possible therapeutic target in neovascular AMD.

Endoscopic endonasal resection of symptomatic Rathke's cleft cysts: outcomes of the strategy to maintain the fenestration open.

The study intends to clarify the optimal endoscopic endonasal surgical strategy for symptomatic Rathke's cleft cysts (RCCs). We retrospectively analyzed patients with RCCs that underwent EEA surgery. The strategy for surgical and reconstruction method selection was presented. Patients were split into groups of fenestration open or closed. Pre- and postoperative symptoms, imaging, ophthalmologic, and endocrinologic exams were reviewed. The incidence of complications and the recurrence rates were determined. The 75 individuals were all received primary operations. The fenestration closed group contained 32 cases, while the fenestration open group contained 43 cases. The median follow-up period was 39 months. The three primary complaints were headache (n = 51, 68.00%), vision impairment (n = 45, 60.00%), and pituitary dysfunction (n = 16, 21.33%). Of the 51 patients with preoperative headaches, 48 (94.12%) reported improvement in their symptoms following surgery. Twenty-three out of 45 patients (51.11%) experienced an improvement in visual impairment. Pituitary dysfunction was found improved in 14 out of 16 individuals (87.50%). There was no discernible difference in the rate of symptom alleviation between both groups. There were three patients (3/75, 4.00%) had cyst reaccumulation. One of them (1/75, 1.33%), which needed reoperation, was healed using pterional approach. In term of complications, cerebral infections occurred in two patients (2/75, 2.67%). Both of them recovered after antibiotic treatment. No postoperative cerebrospinal fluid rhinorrhea occurred. One patient (1/75, 1.33%) in the open group experienced epistaxis. There was no persistent hypopituitarism or diabetes insipidus (DI). Analysis of headache related factors showed that the presence of wax like nodules was related to it. RCC was successfully treated with endoscopic endonasal surgery with few problems when the fenestration was kept as open as feasible. Preoperative identification of T2WI hypointense nodules may be a potential reference factor for surgical indication.

The Riddle of the Double Vision-A Rare Case of Intracranial Tumor: When Imaging Resolves the Mystery.

A 77-year-old-man with arterial hypertension, diabetes mellitus type II presented at our clinic for a routine ophthalmological exam. He complained of intermittent double vision. The ophthalmic examination revealed paralysis of III (n. oculomotorius) and VI (n. abducens) cranial nerves with ptosis, deficit in elevation and abduction of the left eye. The patient underwent urgent MRI imaging of the brain/orbits and paranasal sinuses, and urgent neurological assessment. MRI revealed a volume-occupying process, starting from the posterior wall of the left maxillary sinus with perineural diffusion and involvement of the homolateral trigeminal nerve, intracranial spread in the medial cranial fossa and involvement of the cavernous, sphenoidal sinuses and the orbital apex on the left side. Biopsy was performed, and the histology resulted in sinonasal squamous cell carcinoma with intracranial spread.

Equine keratomycosis due to Aspergillus flavus in Argentina

A 9-year-old gelding presented a corneal ulcer unresponsive to treatment in his right eye. The trauma was caused by vegetal material. The ophthalmologic exam revealed paraxial corneal opacity, whitish discharge, peripheral oedema, congestion of conjunctival vessels and corneal angiogenesis. Microscopic examination of smears revealed the presence of neutrophils and fungal hyphae. On day 3 of culture, several small white fluffy colonies that rapidly turned to pale green were detected. These colonies were isolated to study their micro and macromorphology. Microscopic examination revealed the presence of colourless, thick-walled, roughened conidiophores, ranging from 340 to 1650 μm in length, with globose to sub-globose vesicles, ranging from 22 to 48 μm in diameter. Vesicles had one or two series of phialides. Conidia were globose, olive-green with slightly rough, thin walls that ranged from 3 to 7 μm in diameter. Molecular identification was also performed. Both techniques confirmed the presence of Aspergillus flavus complex. Topical treatment with natamycin resulted in healing within 10 days. To our knowledge, this is the first case of equine keratomycosis reported in Argentina.