Ophthalmology Resident, New York University
Research Fellow, Wills Eye Hospital
Research Fellow, Wills Eye Hospital
One of the most dynamic days in the conference circuit is the trainee case presentation session at the Atlantic Coast Retina Club Meeting (ACRC), held this year at the Wills Eye Hospital in Philadelphia. An engaged audience of esteemed faculty were challenged by seventy-three rapid-fire, 3-minute presentations from fellows, residents, and medical students from the Atlantic Coast institutions. It was a bright display of zebra diagnoses, and we will highlight some of the cases below. Ultimately, five presenters were chosen as award winners and received signed copies of textbooks from their revered mentors.
Julia Haller and Carol Shields kicked off with meeting with lively introductions.
In honor of the hosting institution, oncology was strongly represented by a variety of presented ocular lesions that defied norms and dogma. A rare case of a large melanoma visible at the slit-lamp, albeit amelanotic, was seen in a patient with oculocutanous albinism in Meera Sivalingam’s unique case presentation. Classic mushroom or collar-button shaped lesions are not all melanomas, as highlighted in a case presented by Wills resident Michele Markovitz featuring dense echogenicity as a distinguishing factor in a melanoma-like choroidal lesion that ultimately proved to be a metastasis.
A common theme throughout the day was the ability of retinoblastoma to present in adults, as demonstrated by R. Joel Welch’s fantastically-imaged case of an aggressive pan-ocular RB in a 22-year-old female.
A subtle nevus flemmus in a pigmented individual was the key to unlocking a diagnosis of Sturge-Weber with associated choroidal hemangioma in a surprising case of a unilateral exudative retinal detachment in a young black male presented by NYU’s Edmund Tsui. Finally, one must always keep the differential broad in choroidal lesions, as Maura Di Nicola reminded the audience; her case of a choroidal infiltrate initially suspicious for malignancy was ultimately diagnosed as a posterior scleritis with a subtle T-sign on echography.
Several case presentations highlighted not only the challenges of diagnosing and managing patients with pediatric vitreo-retinal disease but also the unique anatomic findings that a developing eye can harbor. Wills’ Jordan Deaner outlined a fascinating history of a young male genetically diagnosed with FEVR with an unusual focus of peripheral vasculature that developed a vasoproliferative tumor requiring cryotherapy and plaque radiation complicated by a combined rhegmatogenous/tractional retinal detachment treated successfully with scleral buckling.
Mid-way through Marianelli Rodriguez’s case presentation of a young patient with peripheral retinal ischemic changes and cutaneous hyper-pigmentary changes, Dr. Carol Shields interrupted, “Check her fingernails!” revealing a diagnosis of dyskeratosis congenita.
An award-winning presentation from MEEI resident Elizabeth Rossin featured beautiful images of persistent fetal vasculature with two stalks; the mature vessels were anastomotic from the posterior pole to the anterior pole and encroached onto the posterior surface the lens.
Sho Yokoyama fabulously dove under the retina and displayed intra-operative videos of direct sub-retinal endoscopic visualization of a branching vascular network in a patient with polypoidal choroidal vasculopathy and demonstrated direct coagulation of a bleeding vessel. Some of the most perplexing cases of the day expectedly came from the field of posterior uveitis.
Jay Wang of MEEI raised the unanswered question if acute zonal occult outer retinopathy (AZOOR) can be associated with optic neuritis by presenting a young patient with painful vision loss, large patches of autofluorescence, visual field loss, and multifocal ERG defects; reminding the audience that AZOOR has been yet associated with multiple sclerosis only.
Atlantic Coast Retina Club 2018 Links: