Atlantic Coast Retina Club 2023: Mystery Cases 2

Anand Gopal, MD
Wills Eye Hospital
Philadelphia, PA

The afternoon continued with Session D, which offered a series of stimulating and challenging trainee cases. Asad Durrani, a first-year vitreoretinal fellow at Wills Eye Hospital (WEH), shared a fascinating case of pigmentary retinopathy due to congenital rubella in a patient born before the MMR vaccine. Upon learning of the patient’s negative genetic evaluation and work-up and history of deafness since birth, Dr. Dean Eliott of Massachusetts Eye and Ear Infirmary (MEEI) was quick to clinch the diagnosis.

Next, Colin Richards, a first-year resident at WEH, presented a young woman with bilateral retinal arterial occlusions in the setting of undiagnosed anti-phospholipid antibody syndrome. On formal stoke evaluation, the patient was found to have Libman Sacks endocarditis and multiple bilateral acute cerebral ischemic infarctions, prompting initiation of anticoagulation and immunosuppressive therapy. The discussion highlighted the potentially life-saving importance of prompt and appropriate stroke evaluation in young patients with arterial occlusion.

Next up, first-year vitreoretinal fellow Ines Lains of MEEI presented an intriguing case of zoster chorioretinopathy, an exceedingly unusual manifestation of herpes zoster ophthalmicus. The audience was left stumped, as only a handful of cases have ever been reported in the literature. Hers was then followed by a case of chorioretinitis sclopetaria associated with retinal detachment presented by Scott Shuldiner, a PGY-3 MEEI resident.

Linnet Rodriguez of WEH shared a remarkable presentation of enhanced S cone syndrome with extensive foveal schisis in a middle-aged man with progressive decreased central vision and nyctalopia. As part of a clinical trial, the patient underwent pars plana vitrectomy with hyaloid peel and subretinal delivery of gene therapy. Dr. Rodriguez shared an illuminating surgical video demonstrating the technique. Dr. Yanuzzi remarked that the case was exceptional for its degree of foveal schisis, which resolved after surgery.

Following this discussion, Lauren Cowell of University of Massachusetts Chan Medical School shared a case of Castleman Disease, a rare lymphoproliferative disorder, in a pediatric patient with congenital HIV infection. The session continued with back-to-back MEEI trainee cases, which stimulated lively discourse among the judges. Jennifer Zeigler of WEH closed out the session with a fascinating discussion of high-risk features in retinoblastoma.