Atlantic Coast Retina Club 2023: Attending Cases 4

Sandra Hoyek, MD
Massachusetts Eye and Ear
Boston, MA

On Friday February 3rd 2023, the second session of the ACRC was moderated by Deeba Husain, MD and Elizabeth J Rossin, MD PhD.

Dr. Adrienne Scott, a retina specialist and associate professor of ophthalmology at Wilmer Eye Institute, presented a case of a 12-year-old girl with a history of Loeys-Dietz syndrome who presented for a blunt trauma to the left eye with a proliferative vitreoretinopathy and retinal detachment. Examination of the right eye revealed extensive 360-degree lattice degeneration and a very large retinal break in the body of the lattice. Dr. Scott then discussed the systemic and ocular findings of Loeys-Dietz syndrome. A discussion of whether to treat her only seeing eye ensued. Her management of the right eye consisted of placement of a scleral buckle and laser retinopexy around the atrophic hole only with avoidance of laser in the periphery leading to restoration of vision to 20/40 in the right eye a week later.

Dr. Nauman Chaudhry, a vitreoretinal surgeon from the Retina Group of New England, presented a case of a 58-year-old asymptomatic male with ophthalmomyiasis interna posterior secondary to a retinal infiltration of a migratory larva of botfly. Optical coherence tomography (OCT) showed areas of retinal elevation. The larval entry site might have been percutaneous through the orbit. His 5-year visual outcome was great due to macula sparing.

Dr. Hermann Schubert from New York-Presbyterian/Columbia University Medical Center presented a challenging case of a 39-year-old female patient with fibrotic proliferative diabetic retinopathy. Visual acuity was 20/120 in the right eye and hand motion in the left eye. OCT of the right eye showed detached retina, disorganization of the retinal layers, and epiretinal fibrosis. OCT of the left eye showed retinal detachment. Inspired by Dr. Maria Berrocal, Dr. Schubert performed an anterior panretinal photocoagulation of the left eye followed by a limited vitrectomy to release the anterior-posterior traction. He then discussed the management of this patient with serial bevacizumab injections in both eyes that led to maintenance of visual acuity after 3 years and the importance of a limited approach in these cases.

Dr. Carol Shields from Wills Eye Hospital discussed a case of a 15-year-old girl who presented with possible Coats disease in the right eye. She was small for gestational age and had a history of multiple fractures as well as a family history of leukemia and adenocarcinoma. On examination, she had retinal telangiectasia, exudation, and sclerosed vessels in the right eye. She also had drusen-like deposits, peripheral nonperfusion and retinal pigment epithelial detachments bilaterally. Systemic examination revealed short stature, poor growth, grey hair, ridged fingernails, and small head circumference. Genetic testing revealed a mutation in CTC1 gene consistent with Coats plus syndrome which is part of telomere biology diseases. The bilateral drusen-like deposits, a sign of aging, is unusual in this 15-year-old girl, yet consistent with telomere biology disease.

Dr. Lawrence Yannuzzi from the Vitreous Retina Macula Consultants of New York, presented a perplexing case of white dot syndrome bilaterally with positive laboratory tests for bartonella and syphilis. The patient was treated for syphilis and there was resolution of the white spots with no effect on the retinal pigment epithelium five weeks following treatment. The etiology of this unusual case of syphilitic posterior placoid chorioretinitis with white dot syndrome is unknown: multiple evanescent white dot syndrome (MEWDS) versus epi-MEWDS versus syphilis versus immune-mediated phenomenon. To conclude, Dr. Yannuzzi highlighted the importance of rethinking the disorders associated with white dot syndrome to see whether they are truly due to the primarily causative factor or secondary to an immune-mediated response.