August 25, 2012 Annual Meeting Highlights
Saturday
Retina Image Bank: Image of the Day
Condition: Lymphoma
Photographer: Edwin Ryan Jr MD, VitreoRetinal Surgery, PA
Imaging device: Fundus cameras
Description: Montage of 84-year-old man 12 years post vitrectomy-diagnosed intraocular lymphoma.
Subspecialty Reviews
Reported by Kevin J. Blinder, MD
St. Louis, Missouri
Uveitis Update
Saturday, August 25, 1:00-2:00 PM
Presenter: Narsing Rao, MD
Moderator: Prema Abraham, MD
What a special treat to have Dr. Narsing Rao give us a uveitis update. He makes the complex look simple.
1. Uveitis entities one should not miss
a. Infectious uveitis
i. Treponema Pallidum (Syphilis)
ii. Tuberculosis
iii. Toxoplasmosis
iv. ARN (herpetic infxn)
b. Masquerade syndromes:
i. Primary intraocular lymphoma
2. Syphilitic ocular inflammation
a. "Great masquerader"
b. Treatable
c. VDRL or RPR and FTA-ABS or MHA-TP
d. Should be treated as neurosyphilis
e. Penicillin G IV
3. Tuberculosis
a. Non-endemic areas-USA and Canada high rates of TB have been documented among:
i. HIV-infected individuals
ii. Immigrants, migrants
iii. Elderly population
b. A patient with uveitis and a positive PPD has a 1% likelihood of having TB!
c. A positive PCR result is helpful, and negative cannot rule out ocular TB.
4. Toxoplasmosis
a. PCR of aqueous humor for toxo DNA highly useful.
b. Local therapy intravitreal clindamycin 1mg and dexamethasone 400ug
i. 1-3 injections
5. Primary intraocular lymphoma
a. Intravitreal Methotrexate is a treatment option.
i. 400µg/0.1 ml -- set tapering injection regimen
Glaucoma Update
Saturday, August 25, 2:05-3:05 PM
Presenter: Rohit Varma, MD, MPH
Moderator: Prema Abraham, MD
Dr. Varma gave a very basic glaucoma update.
Diagnosis of COAG made by ON damage and glaucomatous VFs, not by IOP level.
Treatment algorithm: Drops, laser, Trab with mitomycin C or 5FU, Tube, Endolaser cyclophotocoagulation
Dr. Varma's recommendation: When in doubt, refer to glaucoma specialist.
Neuro-ophthalmology Update
Saturday, August 25, 3:10-4:10 PM
Presenter: Anthony Arnold, MD
Moderator: Prema Abraham, MD
Dr. Arnold gave a very entertaining review of some specific neuro-ophthalmologic entities.
1. Optic neuritis
a.Young
b. Female > male
c. Pain with eye movement (92%)
d. Central unilateral visual loss over days
e. APD
f. Risk MS over 15 years with new-onset optic neuritis
i. Overall 50%
ii. 0 MR lesions: 25%
iii. > 1 MR lesion: 72%
g. Treatment: IM interferon beta-1a (Avonex) poss with steroids
i. Reduces attacks
h. Consider IV methylprednisolone to speed visual recovery-NOT ORAL
2. Nonarteritic anterior ischemic optic neuropathy
a. Rapid onset
b. Painless VF loss
c. APD
d. Optic disc edema
3. Arteritic AION: Remember delayed choroidal filling on FFA.
4. "Viagra blindness"
a. Pts using sildenafil > 50 million
b. Prescriptions written for sildenafil > 200 million
c. Tablets dispensed = 2.3 billion
d. Documented cases of NAION in sildenafil users < 75
e. Causality
5. Optic nerve sheath meningioma
a. New treatment of stereotactic conformal fractionated irradiation
i. No damage to brain or ON