Saumya Shah, MD
Mayo Clinic
The Atlantic Coast Retina Club 2022 was held at the Wills Eye Hospital in Philadelphia, PA. Residents, fellows, and faculty members from various institutions presented unique and mysterious cases, and expert faculty provided lively commentary.
The day started with Dr. Katherine Vega Escobar describing a case of scleral patch graft necrosis secondary to bacterial infiltration in a patient with a ciliochoroidal tumor status post plaque radiotherapy.
Dr. Rebecca Soares presented a case of a patient with floaters where the vitreal deposits had a stalagmite appearance within the posterior hyaloid on SD-OCT that was consistent with ocular amyloidosis. The moderators commented that this was a near pathognomonic finding. It was emphasized that these patients be monitored for glaucoma due to amyloid deposition within the trabecular meshwork, especially after vitrectomy and cataract surgery.
There were a few cases that discussed retinal manifestations of various chemotherapeutic agents utilized for treatment of different malignancies. Dr. William Foulsham presented a mystery case of a patient with a metastatic endometrial cancer with CRVO secondary to lenvatinib, a newer FGFR inhibitor. Dr. Saagar Pandit presented a case of blurry vision in both eyes with bilateral vitritis and subretinal fluid in the setting of stage 4 metastatic melanoma and recently started encorafenib-binimetinib (BRAF/MEK inhibitor).
A few other notable cases included a case by Dr. Ollya Fromal from Wills Eye who described a new association of a Coats-like retinopathy in a patient with known Léri-Weill dyschondrosteosis.
Dr. Jennifer Nadelman presented a case of an African American male with a recent yellow fever vaccination with sudden painless loss of vision in his left eye who had serous macular detachment and choroidal thickening that was thought to be a VKH-type phenomenon related to the vaccination.
Dr. Blake Fortes presented a case of a patient with progressive cognitive decline, bilateral hearing loss, corpus callosum lesions, and retinal arteriolar wall lesions in both eyes who had Susac syndrome, but also with a proliferative retinopathy, thought to be due to beta thalassemia, a true case of Hickam’s Dictum.
Dr. Saumya Shah then presented a mystery case of a surgeon with bilateral vision and hearing loss, peripheral neuropathy and weakness in extremities, unintentional weight loss with ganglion cell thinning and multifocal ERG depression whose workup was only remarkable for elevated inflammatory markers. This remains a mystery case!
Dr. Ali Salman presented a case of a patient with vitreoretinal lymphoma secondary to indolent T-cell lymphoproliferative disorder of the GI tract.
Finally, Dr. Ishrat Ahmed presented a case of a sarcoid choroidal granuloma with a characteristic finding of an undulating crisp border of the lesion on ICG. Dr. Carol Shields commented that the undulating sharp margins are very atypical for malignancies and very consistent with sarcoidosis, a great clinical pearl.
