Ali Salman, MD
Mayo Clinic
The final session of Atlantic Coast 2022 consisted of the toughest cases the faculty in attendance had seen over the past year. Dr. Carol Shields shared a fascinating and dramatic case of a patient who presented with unilateral glaucoma and anterior uveitis with profound heterochromia. The iris was completely engulfed with a flesh colored lesions with neovascularization. The patient was found to have primary iris/ciliary body lymphoma after FNAB. Dr. Shields discussed the utility of FNAB in the workup of patients with ciliary body and iris lesions. The patient had an excellent response to systemic chemotherapy with complete resolution of the iris lesion and a return to its normal color.
Next, Dr. Jasmine Francis shared a case of a patient with uveal melanoma whose recurrence years after treatment was heralded by the detection of cell-free DNA in the serum. In the discussion that ensued a lot of excitement was shared about the significant potential for liquid biopsy to aid in earlier detection of disease. Dr. Francis performs this in all of her patients and once more widely available will almost certainly aid clinicians in detecting any recurrence of disease.
Dr. J. Fernando Arevalo then presented the second known case of HIV proliferative retinopathy presenting as peripheral ischemic retinopathy with neovascularization. He discussed to consider HIV in patients with nondiabetic proliferative retinopathy.
Dr. Dean Eliott then shared beautiful photos of multicolored crystals in the aqueous and vitreous in an aphakic patient with unilateral elevated IOP. This was a challenging case for the audience, but ultimately the diagnosis of phacolytic glaucoma in a patient with Marfan’s syndrome with a dislocated crystalline lens was reached.
Next, Dr. Hermann Schubert presented a case of a patient with a giant retinal tear who was treated with laser retinopexy and gravitational positioning with no surgical intervention. He shared the history of treating retinal pathology with bilateral patching, and its continued utility today in patients who are not amenable to procedural/surgical intervention, especially with formed vitreous.
Dr. Dimosthenis Mantopoulos presented an unusual case of chronic uveitis in an HIV patient. In the setting of recovering CD4 cell counts and CMV viremia, the patient was ultimately diagnosed with chronic immune recovery uveitis.
And perhaps the most unique case, a case without any retina findings, was presented by Dr. Sunir Garg. A patient that was 3 years removed from macular hole surgery presented to his clinic with subacute eye injection, who, upon close examination had a translucent fiber under the conjunctiva. The patient was taken to the OR and the fiber was found to be persistent 6-0 plain gut suture that had not dissolved upon histopathologic confirmation.
The audience was stunned and no one had seen a case of gut suture persist like this.
