Ophthalmology Resident, New York University
Research Fellow, Wills Eye Hospital
Research Fellow, Wills Eye Hospital
We continue our coverage of ACRC Day 1. With a history of a strong representation from retinal imaging experts in the audience, it was no surprise that the quality of retinal imaging presented at the conference was sublime. Yoichi Sakurada presented cover-image worthy fundus photography and fluorescein angiography from an asymptomatic male with a retinal cavernous hemangioma emphasizing non-leaking, ‘cluster-of-grapes’ aneurysmal dilations.
Kareem Moussa of MEEI revealed that autofluorescent gravitational tracts are not specific to chronic central serous chorioretinopathy in a patient with subretinal fluid, multifocal leakage on fluorescein angiography, a thick, wavy retinal pigment epithelial line, and a diagnosis of acute myeloid leukemia.
Spencer Onishi from Geisenger compiled a constellation imaging from a patient with a disc anomaly, macular schisis-like changes, and a potential optic nerve pit, opening a discussion amongst the faculty on the spectrum of optic disc developmental abnormalities and the utility of pars plana vitrectomy in the treatment of symptomatic optic nerve pits.
Hyper-reflective OCT bands of various kinds were repeatedly presented; from Anthony Obeid’s acute macular neuropathy secondary to head trauma to Robert Carroll’s demonstration of paracentral acute middle maculopathy from combined central retinal vein/artery occlusion in a long-distance runner to Alvin Liu’s longitudinal survey of OCT findings in suspected self-induced laser injury.
Sarcoidosis-related pathology was presented by Priya Sharma, VR fellow at OCB/Tufts and Kunal Malik, resident at SUNY Downstate. Dr. Sharma presented two cases with extra-ocular sarcoid and white macular infiltrations, thickened choroids, and pronounced macular hypocyanesence; and Dr. Malik showed a patient with thick, creamy yellow lesions around the disc developing as a pseudosarcoid reaction from cutaneous sarcoidosis responsive to Cellcept.
Some of the most captivating cases featured rare and occasionally bizarre associations. Cindy Cai, resident at Wilmer, received an honor for beautifully displaying an acquired retinal dystrophy with severe RPE atrophy from cobalamine C deficiency.
Aliaa Abdelhakim, resident at Columbia University Medical Center, was awarded for presenting imaging from an ICU-admitted patient on extracorporeal membrane oxygenation (ECMO) with a bullous serous retinal detachment in the illipsalteral eye as internal jugular vein cannulation that improved with steroid treatment and completion of ECMO therapy; and she suggested that the hydrodynamic forces associated with the artificial oxygenation technique perhaps resulted in alteration of normal ocular hydrostatic forces.
Dr. Bailey Freund was very quick to identify dark-without-pressure (DWP) from a single OCT image from a 13-year-old male a dark growing fundus lesion in Rebecca Soares’s mystery case. Dr. Soares highlighted the lack of vitreoretinal traction in the pathology.
High-dose sildenafil may potentially result in a ‘doughnut-shaped maculopathy’ with circular scotomas and corresponding reversible ellipsoid-zone loss, as demonstrated in Brian Shafer’s award-winning case presentation.
As expected, Dr. Jose Pulido quickly guessed West-Nile Virus as the potential etiology of a puzzling white-dot-syndrome case in a patient with incorrectly diagnosed urinary sepsis. Dr. Belinda Leong presented positive WNV serologies and an interesting montage of fundus findings associated with the viral etiology.
Although five cases were chosen as winners, clearly the session was rich with unique, exciting, and puzzling case presentations. We hope the tradition of trainee presentations continues at this illustrious meeting.
Atlantic Coast Retina Club 2018 Links: