RWC Retina Rocks

Join Retina World Congress and friends this Sunday, November 17 at 10 AM Eastern Time for the Retina World Congress Education Live (E-Live) session on "Surgical Innovations in Uveitis"! https://lnkd.in/gGNrfkmk Don't miss this opportunity to hear from global Key Opinion Leaders (KOLs) as they share their insights and latest advancements in the field. Set your reminders and tune in for a session full of groundbreaking information! #RetinaWorldCongress #ELive #Uveitis #SurgicalInnovations #GlobalKOLs #EyeCare #ophthalmology #retinaspecialist

Frosted branch angiitis This healthy 16YO female presented with several days of bilateral blurred vision. There was no past ocular or medical history. Vision was 20/25 OD and 20/30 OS. Anterior segments were normal. - Optos imaging (image 3, top) of her right eye shows a frosted branch appearance to a retinal vein in the superior midperiphery, with more diffuse vasculitis seen in her left eye (image 1). Swept-source OCT through the left macula shows some hyperreflective inner retinal thickening around the inflamed veins (image 2, arrows). Bloodwork for bartonella, syphilis and sarcoid was ordered. - She returned one week later with new blurred vision in her left eye. Vision was 20/25 OU. Although findings were stable OS, new diffuse frosted branch changes were present OD (image 3, bottom). Her bloodwork returned negative and she was started on oral prednisone 60mg daily. The vascular changes were improving 10 days later (image 4) - Frosted branch angiitis is a retinal vasculitis that gets its name from the involved vessels resembling branches of a tree that are “frosted” with snow (Kleiner et al, AJO 1988;106:27-34). Although these findings may be isolated, they are often considered more of a phenotype that can be found in a multitude of inflammatory conditions, most commonly CMV retinitis. The inflammation is usually very responsive to steroids and the visual prognosis is generally good, although some can develop secondary anterior and posterior segment neovascularization from widespread ischemia. - Go to www.retinarocks.org/cases for frosted branch cases. - [This case can be found on www.retinarocks.org in the Image Gallery, Frosted branch folder, Frosted branch HZM-20230317] - Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. - Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap). Retina Rocks is the official image bank for the Retina World Congress (@RetinaWorldCongress). #frostedbranch #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #savingsightsavinglives #RetinaWorldCongress

Choroidal metastasis Mimicker Alert!?? Today’s case was submitted by Ankit Jain (@drankitjain2008), Navneet Mehrotra (@mehrotra_navneet) and Manish Nagpal (@drmanishnagpal). This previously healthy 30YO female presented with several weeks of decreased vision in her left eye. Vision was 20/20 OD and 20/60 OS. MultiColor imaging shows bilateral multifocal variably sized yellow-white choroidal lesions throughout each posterior pole (images 1 and 2). A large serous detachment occupies the entire left macula which is confirmed on SD-OCT. Fluorescein angiography (image 3) of the right eye shows some speckled subretinal hyperfluorescence overlying a choroidal lesion in the distal inferotemporal macula. Angiography of the left eye shows similar but more extensive hyperfluorescence overlying the superior and superotemporal choroidal lesions, likely responsible for the serous macular fluid. An extensive medical workup revealed widely metastatic pulmonary adenocarcinoma, and she was subsequently referred to oncology. She was then unfortunately immediately lost to follow up. Although uveal melanoma is the most common primary intraocular malignancy, metastatic choroidal tumors are the most common intraocular malignancies. Lung and breast cancer are the most common sources. The extensive multifocal lesions in each of our patient’s eyes are unusual, since most patients have 1-2 choroidal lesions (Shields et al Retina 2020;40:204-213). Go to www.retinarocks.org/cases for more metastasis cases. [This case can be found on www.retinarocks.org in the Image Gallery, Cancer 3 Metastases folder, Metastases ZTI-20240111] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). Keep reading ?????? #choroidalmetastsis #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress

Bear tracks (Group-type congenital pigmented nevi of the RPE) Grit and ?? it! Today’s case was submitted by Sharat Hegde (@hegdesharath). This healthy 10YO female presented with these asymptomatic bilateral lesions. Vision was 20/20 OU. Fundus photography of her right eye shows multiple bear track lesions scattered throughout the posterior pole (image 1 . The lesions are hypo-autofluorescent (image 2). Similar findings were noted in the left eye (not shown). Group-type congenital pigmented nevi of the RPE (bear tracks) is a relatively rare congenital condition characterized by well-demarcated, hyperpigmented, flat, variably sized RPE lesions that resemble bear footprints. Histopathologically, these lesions are similar to congenital hypertrophy of the RPE (CHRPE), with increased numbers of pigment granules in normal-sized RPE cells. These lesions are benign and cause no visual symptoms. The major fluorophore in fundus autofluorescence (FAF) is lipofuscin, which is intraliposomal RPE material generated as byproducts of outer segment metabolism. The outer retina overlying these bear track lesions shows varying degrees of atrophy. This leads to less lipofuscin production with hypo-FAF. Although bear tracks and the typical CHRPE lesions (large, round, unilateral, with depigmented lacunae with age) are not associated with systemic abnormalities, the multifocal, often bilateral and small comet-shaped lesions with familial adenomatosis are associated with colonic polyps and cancer (Romania et al Ophthalmology 1992;99:911-913). Go to www.retinarocks.org/cases for more CHRPE and bear track cases. [This case can be found on www.retinarocks.org in the Image Gallery, RPE hypertrophy + CHRPE + Bear tracks folder, RPE hypertrophy IRW-20240524] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress).

Idiopathic chorioretinal folds Folds below This 61YO male presented without visual complaint. He was a +6 diopter hyperope OD and +5 diopter hyperope OS. Vision was 20/200 OD from refractive amblyopia and 20/40 OS. Triton color imaging and swept-source OCT shows bilateral chorioretinal folds (images 1 and 2). Optos fundus autofluorescence (FAF) shows variable hyper- and hypo-FAF changes from the folds, and fluorescein angiography shows alternating transmission and blocking defects (image 3). Chorioretinal folds appear clinically as often subtle horizontal and oblique subretinal folds. There are extensive intra- and extra-ocular causes for chorioretinal folds. The typical findings for idiopathic chorioretinal folds are usually a mild/moderate hyperopic prescription with bilateral and symmetric folds. The folds are thought to result from flattening of the macular sclera. When unilateral, an MRI is often indicated to rule out an orbital mass. Typical idiopathic chorioretinal folds, as in our patient,? require no workup and usually cause no symptoms. - Go to www.retinarocks.org/cases for more chorioretinal folds cases. - [This case can be found on www.retinarocks.org in the Image Gallery, Chorioretinal and Retinal folds (also see Hypotony) folder, Chorioretinal folds KZO-20201028] - Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. - Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). - #chorioretinalfolds #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress

Vitreous cyst in a patient with RP RP with a little a-‘cyst’-ance ?? Today's Retina Foundation case of the week case was submitted by Anand Temkar (@dr.vitreous.humorous) and Manish Nagpal (@drmanishnagpal). This 31YOF with a known history of retinitis pigmentosa (RP) presented with 2 days of decreased vision OD. There was a history of trauma to her right eye at 2 years of age. Vision was counting fingers OD and 20/120 OS. Slit lamp examination OD revealed a non-central corneal scar and anterior synechia consistent with the prior trauma. MultiColor? imaging shows bilateral RP intraretinal pigment migration and narrowed arterioles (images 1 and 2). A free-floating vitreous cyst is noted inferiorly OD (image 1). Vitreous cysts are extremely rare, idiopathic and usually diagnosed as an incidental finding. Likely originating from a ciliary body cyst (Dhull et al, Ophthalmology Retina 2020;4:1208), they can be either congenital or acquired. Acquired cysts have been associated with numerous ocular disorders including trauma and retinitis pigmentosa as in our patient. Go to www.retinarocks.org/cases for more vitreous cyst cases. [This case can be found on www.retinarocks.org in the Image Gallery, Vitreous 8 Cyst folder, Vitreous cyst NZP-20240821] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #vitreouscyst #rp #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress

West Nile virus uveitis Today’s case was submitted by Lisa Faia. - This 51YO female presented with a recent history of floaters in her left eye. There was no significant past ocular or medical history. Vision was 20/30 OS, and the right eye was normal. - Optos RG imaging shows clumps of vitreous floaters over the posterior pole, extending into the inferior periphery (image 1, top). A few retinal hemorrhages are noted in the temporal midperiphery and faint, small atrophic multifocal scars are seen inferotemporally. Fluorescein angiography (image 1, middle) better shows these multifocal scars with late staining. There is late optic nerve leakage and variable focal staining of the retinal vessels. OCT scanning shows mild cystoid edema (image 1, bottom). - We were concerned for possible herpes viral retinitis, and she was started on valtrex, had an anterior chamber tap and uveitis work up. The tap came back negative for herpes viruses. West Nile titers were ordered, and these came back positive for IgG (2.48) and low but detectable for IgM (0.10). Valtrex was stopped, and Durezol QID OS was started with a slow taper. - When she returned 6 weeks later, the vitreous was clear, and linear clumps of atrophic scars followed the retinal vessels (image 2). The scars were hyper-autofluorescent with small rims of increased autofluorescence. - The West Nile virus is an RNA virus acquired through the bite of a mosquito that fed on an infected bird. Although most infections are asymptomatic, about 20% will develop fever, weakness, headache, myalgia nausea and skin rash. Multifocal chorioretinitis with or without vitreous inflammation is the most common ocular finding, occurring in about 80% of cases. Acutely there are usually about 10-50 deep, 200-1000 micron yellow-white, scattered or radiating curvilinear clustered lesions which are relatively depigmented upon resolution. Treatment of the primary viral infection is supportive. See a great review on this topic by Garg and Jampol (Surv Ophthalmology 2005;50:3-13). - Go to www.retinarocks.org/cases for more West Nile cases. - [This case can be found on www.retinarocks.org in the Image Gallery, West Nile folder, West Nile UIB-] - Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. - Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap). Retina Rocks is the official image bank for the Retina World Congress (@RetinaWorldCongress). - #westnile #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #savingsightsavinglives #RetinaWorldCongress

When life gives you blurry vision and TB, just call it a unique perspective! Chronic ICSC with exudative retinal detachment and concomitant TB Today's Retina Foundation case of the week case was submitted by Anand Temkar (@dr.vitreous.humorous), Navneet Mehrotra (@drnavneetmehrotra) and Manish Nagpal (@drmanishnagpal). This 39YO male presented with 4 months of bilateral vision loss. He was diagnosed elsewhere with chronic idiopathic central serous chorioretinopathy (ICSC) and was placed on azathioprine and spironolactone 3 months earlier. There was no history of steroid use or injections. Vision was 20/120 OD and 20/200 OS. MultiColor imaging shows macular pigmentary changes that extend in a gutter inferiorly OD (image 2). Diffuse macular pigmentary changes are noted in his left eye that communicate with an inferior exudative retinal detachment (image 1). OCT scanning shows shallow subretinal fluid with hyperreflective shed outer segments, outer retinal hyperreflective foci and RPE detachments. Fluorescein angiography shows bilateral multifocal subretinal blot leakage (image 3). A broad area of ischemia is present overlying the inferior detachment OS. Mantoux skin testing (15x18mm) and QuantiFERON-TB Gold testing were positive. Chest CT showed fibrotic strands in right lung. He was referred for systemic antituberculosis treatment. A week later, his local ophthalmologist reported that this vision and retinal findings improved but he was then lost to followup. Our patient presented with severe bilateral idiopathic central serous chorioretinopathy (ISCS) with multifocal leaks in each eye and a secondary exudative detachment in his left eye. There are rare case reports of TB occurring in patients with ICSC, and these are likely coincidental findings (Khan et al, BMJ Case Rep 2017:bcr-2016-216471). Go to www.retinarocks.org/cases for more ICSC and TB cases. [This case can be found on www.retinarocks.org in the Image Gallery, ICSC HSR-20240628 folder, ICSC HSR-20240628] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Keep reading ?????? Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #icsc #exudativeretinaldetachment #tb #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress

Subretinal drusenoid deposits Read this if you want to learn something! This 70YO female was referred for asymptomatic age-related macular degeneration (AMD). Vision was 20/30 OD and 20/25 OS. Triton color imaging of the right (image 1) and left (image 2) eyes shows symmetrical ribbon subretinal drusenoid deposits (SDD). On swept-source OCT, these lesions appear as hyperreflective material mostly between the RPE and ellipsoid zone (EZ). SDD are polymorphous light-gray interconnected accumulations located above the RPE. They are present in about one quarter of older adults with healthy maculas and in more than half of those with early to intermediate dry AMD. They can appear as an array of dots, interconnected reticular bands (as in our patient), or confluent lesions (Suzuki and Spaide, AJO 2014;157:1005-1012). The dot variant is associated with macular neovascularization (MNV) and the confluent with macular atrophy (Zhou et al, Ophthalmology 2016;123:1530-1540). Clinically they are often mistaken for conventional drusen and consist of similar, yet distinct lipid-rich material found in soft drusen. They are localized to rods, unlike typical soft drusen which are more central and cone based. As with drusen, SDD are dynamic and can grow, shrink, resolve, or even recur. Since they are located above the RPE, they are best visualized with blue or green illumination. On OCT they appear in 3 stages (Zweifel et al, Ophthalmology 2010;117:303-312) growing upwards from the RPE towards the external limiting membrane: stage 1 diffuse deposition of granular hyperreflective material between the RPE and the EZ, stage 2 material alters the EZ contour, and stage 3 conical appearance breaking through the EZ. Rod function seems to be preferentially affected, and there is an associated increased risk of delayed dark adaptation, macular atrophy and types 2 and 3 MNV. In fact, type 2 neovascularization in the setting of AMD occurs almost solely in eyes with subretinal drusenoid deposits. Keep reading In addition to large drusen and pigmentary abnormalities, SDD are the 3rd risk factor for progression to late AMD (Agron et al, Ophthalmology 2022;129:1107-1119). For recent review, see Wu et al, Progress Retinal Eye Research 2022;88;101017. Go to www.retinarocks.org/cases for more SDD cases. [This case can be found on www.retinarocks.org in Image Gallery, AMD 03 Subretinal drusenoid deposits (SDD) folder, AMD SDD ZWD-20210119] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is image bank for the Retina World Congress (@RetinaWorldCongress). #subretinaldrusenoiddeposits #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress

Ocular amyloidosis What exactly am I looking at? ?? Today’s case was submitted by Mariano Cotic (@dr.cotic), Natasha Gerschovsky (@natigerschovsky), Madeleine Saint Martin (@dra.saintmartin), Enzo Dilascio (@enzodilascio), Marcelo Zas (@zas.oftalmologo) and Pablo Chiaradia (@dr.chiaradia).? ? ? ? ? ? ? ? ? ? ? ? This 65YO male presented with chronic bilateral vision loss. Vision was 20/200 OD and 20/100 OS. There was no past medical history. Optos color RG imaging of his right eye shows diffuse whitish, spider web-like fibrillar vitreous debris (image 1). In vivo corneal confocal microscopy reveals amyloid deposits. Similar findings were present in his left eye (not shown). Sequential therapeutic and diagnostic vitrectomy surgeries were performed on each eye. Vitreous and conjunctival biopsies were positive for amyloid deposits. Each fundus appeared normal postoperatively and vision improved to 20/20 OU. Despite the normal fundus appearance, OCT scanning shows residual vertical amyloid deposits resting on the foveal internal limiting membrane (image 2). Vitreous amyloidosis is a rare disorder where usually bilateral vitreous opacities appear as fine, fibrillar, and often whitish or translucent deposits which can reduce vision as the opaque amyloid material accumulates. OCT can reveal pathognomonic fine vertical needle-like hyperreflective deposits extending into the vitreous from the internal limiting membrane (Tasiopoulou et al, Ophthalmology Retina 2021;5:99-101). It is almost always related to mutant transthyretin (TTR), a plasma protein carrier of thyroxine and vitamin A, often associated with familial amyloid polyneuropathy (Venkatesh et al, Ophthalmology 2017;124:1014-1022). Systemic amyloidosis can also cause ocular manifestations including conjunctival, temporal artery, extraocular muscle, trabecular meshwork and cranial nerve deposition (Reynolds et al, Retina 2018;38:1371-1376). Our patient’s systemic workup was negative. Genetic testing for TTR was ordered and is pending. [This case can be found on www.retinarocks.org in the Image Gallery, Amyloidosis folder, Amyloidosis XLH-] Keep reading ?????? Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #amyloidosis #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress