Angiostrongylus cantonensis, commonly known as the rat lungworm, is mostly found in Asia, the Pacific Basin, and the Caribbean, but is also endemic in Hawai'i, especially on the Island of Hawai'i. Ocular angiostrongyliasis is an uncommon but previously reported complication associated with permanent vision loss. This is the first reported case of ocular angiostrongyliasis involving the retina or posterior segment of the eye in the US. A 24-year-old male from Chicago visited the Island of Hawai'i, where he worked on a farm and ate a vegetarian diet. When he returned to Chicago, he became sick and was hospitalized for eosinophilic meningitis. One month later, he developed a retinal detachment which required surgical repair involving a pars plana vitrectomy. During the reattachment of the retina during surgery, a live motile was identified nematode in the subretinal space. An endolaser probe immobilized and killed the nematode, and it was subsequently extracted through the sclerotomy. Thermal scars around all retinal holes including the retinotomy site were made to stabilize the retina, and perfluoropropane gas was injected to achieve temporary tamponade. Thereafter, the patient's cerebrospinal fluid returned positive for angiostrongylus cantonensis antibodies. During extended follow-up, the patient eventually lost all vision in the affected eye due to recurrent retinal detachment. This case of ocular angiostrongyliasis demonstrates the importance of obtaining travel history from endemic areas, knowing the risk of developing eosinophilic meningitis, and understanding the risk of permanent vision loss in cases involving the retina.

Purpose Mothers’ own milk (MOM) feedings reduce the risk of multiple potentially preventable morbidities of prematurity in very low birthweight (VLBW: 1500 g birthweight) infants, including necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia and neurodevelopmental problems. Although bioactive components in MOM suggest a favorable impact on retinopathy of prematurity (ROP), this relationship remains undetermined. There is a lack of consensus in the literature regarding the protective effect associated with MOM. Objective This study compared dose of MOM received by VLBW infants who did and did not require treatment …

Purpose: We evaluated sparing of normal structures using 3-dimensional (3D) treatment planning for proton therapy of ocular melanomas.Methods and Materials: We evaluated 26 consecutive patients with choroidal melanomas on a prospective registry. Ophthalmologic work-up included fundoscopic photographs, fluorescein angiography, ultrasonographic evaluation of tumor dimensions, and magnetic resonance imaging of orbits. Three tantalum clips were placed as fiducial markers to confirm eye position for treatment. Macula, fovea, optic disc, optic nerve, ciliary body, lacrimal gland, lens, and gross tumor volume were contoured on treatment planning compute tomography scans. 3D treatment planning was performed using noncoplanar field arrangements. Patients were typically treated with 3 fields, with at least 95% of planning target volume receiving 50 GyRBE in 5 fractions.Results: Tumor stage was T1a in 10 patients, T2a in 10 patients, T2b in 1 patient, T3a in 2 patients, T3b in 1 patient, and T4a in 2 patients. Acute toxicity was mild. All patients completed treatment as planned. Mean optic nerve dose was 10.1 Gy relative biological effectiveness (RBE). Ciliary body doses were higher for nasal (mean: 11.4 GyRBE) than temporal tumors (5.8 GyRBE). Median follow-up was 31 months (range: 18-40 months). Six patients developed changes which required intraocular bevacizumab or corticosteroid therapy, but only 1 patient developed neovascular glaucoma. Five patients have since died: 1 from metastatic disease and 4 from other causes. Two patients have since required enucleation: 1 due to tumor and 1 due to neovascular glaucoma.Conclusions: 3D treatment planning can be used to obtain appropriate coverage of choroidal melanomas. This technique is feasible with relatively low doses to anterior structures, and appears to have acceptable rates of local control with low risk of enucleation. Further evaluation and follow-up is needed to determine optimal dose-volume relationships for organs at risk to decrease complications rates. (C) 2016 Elsevier Inc. All rights reserved.

PURPOSE:To describe the experience of authors using intravitreal bevacizumab (IVB) for eyes with recurrent vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy.METHODS:Chart review was performed on eligible eyes from the Illinois Retina Associates' patient database that had at least 6 months of follow-up after receiving IVB in the operative eye for recurrent VH after vitrectomy for proliferative diabetic retinopathy.RESULTS:Twelve eyes of nine patients were included in the study and none required repeat vitrectomy for recurrent VH. Mean follow-up was 22 months (range, 8-42). A mean of 8.1 IVB (range, 1-18) were given. The mean number of recurrent VH was 4 (range, 2-8), and a mean of 3.5 of these VHs (range, 1-8) were clear at the appointment after an injection, typically in 4 to 6 weeks. Patients with history of multiple recurrent VH received prophylactic IVB, and repeated injections at regular intervals were associated with increased time period without recurrent VH.CONCLUSION:Intravitreal bevacizumab was a safe and effective adjunct in this series for the management of recurrent VH after vitrectomy for proliferative diabetic retinopathy. No patients required repeat vitrectomy for recurrent VH, and prophylactic IVB was associated with longer periods of clear vitreous in the late postoperative period.

e18502 Background: Ocular adnexal mucosal associated lymphoid tissue lymphomas (MALTomas) are rare with no phase III trials to guide treatment. Typical management has been primary radiation therapy. This retrospective series aims to report the experience of a single institution and add to the current literature. Methods: Using our electronic medical record systems and available paper charts, we identified patients with MALTomas of the lacrimal gland or sac, conjunctiva, and posterior orbital structures. Records were reviewed to determine pathology, staging, treatment information, local and distant control, salvage treatments, and late toxicity. Results: Sixteen patients with ocular adnexal MALTomas had local radiation between 1992 and 2011 for primary or recurrent disease. 50% had lymphoma in the conjunctiva, 25% in the lacrimal sac/gland, and 25% in the posterior orbit. 75% had stage IAE disease, 6% had stage IIAE, and 19% had a positive bone marrow biopsy. One patient received chemotherapy as part of his initial therapy. The median radiation dose was 30 Gy (25.5-36 Gy) delivered with electrons (31%) or photons (69%). After a median follow-up of 34.78 months, two patients had residual/progressive disease, two had contralateral recurrence, and 1 had a distant failure, for local control of 87.5% and overall disease control of 68.75%. Recurrence/progression occurred at a median of 35.45 months. Two patients with residual/progressive disease and one with a contralateral recurrence were followed, successfully salvaged, and are NED. Fourteen patients are still alive and there were no disease-related/toxicity deaths. Seven patients developed cataracts in the treated eye, 2 had radiation retinopathy, 2 had permanent dry eye syndrome, and 1 had severe keratopathy requiring enucleation. Six patients (3.75%) had worsening visual acuity of unclear etiology. Conclusions: Primary radiation therapy for ocular adnexal MALTomas with a median dose of 30 Gy led to excellent local control. Those patients who did recur were successfully salvaged. Radiation was generally well-tolerated with expected cataractogenesis given the dose required to achieve local control with only one patient developing severe keratopathy after receiving the highest dose in this series.

the corneal epithelium, superficial stroma, and Descemet membrane bilaterally.Fundus examination revealed no pigmentation.Dental, oral mucosal, skin, and nail pigmentation were evident (Figure 1F).The diagnosis of argyrosis was confirmed by conjunctival biopsy.It was possibly due to occupational inhalation of silver.The Scheimpflug image displayed hyperreflectivity corresponding to corneal pigment accumulation areas at the superficial layers (Figure 2A andB).Histopathologic examination of the incisional biopsy material revealed subepithelial extracellular silver particles in the lamina propria, which supported the diagnosis of argyrosis (Figure 2C and D).Systemic evaluation results were normal except for the presence of fatty degeneration of the liver. Comment.The most common health effects with prolonged exposure to silver are the development of a characteristic irreversible pigmentation of the skin (argyria) and/or the eyes (argyrosis). 4 Affected areas include hands, eyes, and mucous membranes in most patients.Discoloration of the ocular surface is the main ocular evidence in these patients. 4 A direct relationship was shown between the amount of discoloration and total exposure time. 4 If fine particles of silver are rubbed into the eyes, localized argyrosis may develop over time. 4 Generalized argyria is recognized by a widespread pigmentation of the skin, eyes, and nails and may occur when silver compounds are applied to mucosal surfaces, inhaled, ingested, or injected into the body.Similarly, our patient had conjunctival, corneal pigmentation as well as skin, nail, and dental pigmentation resulting from occupational contact.Although the exact mechanism for black tears is not very clear, we believe that mechanical inoculation (rubbing into the eyes) is the cause. 4 The pigmentation resulting from silver deposits is irreversible.Chelation therapy and dermabrasion are ineffective in removing silver deposits from the body.There is no known effective treatment for argyria.Besides argyria and argyrosis, exposure to soluble silver compounds may lead to other toxic effects such as liver and kidney damage, irritation of the eyes, skin, respiratory tract, and intestinal tract, and changes in blood cells.In systemic evaluation, only fatty degeneration of the liver was detected in our patient.Melanodacryorrhea is extremely rare, and our review of the literature for melanodacryorrhea and argyrosis yielded no results.In the case of melanodacryorrhea, argyrosis should be taken into consideration in the differential diagnosis.

We report a case of culture-positive bacterial endophthalmitis following implantation of a Staar intraocular Collamer lens (ICL). The patient presented 4 days after uneventful sutureless surgery with decreased visual acuity, redness, and photosensitivity. Inflammation increased over the next 24 hours, which prompted a tap for culture and intravitreal injection of antibiotic agents. Vitreous culture was positive for coagulase-negative Staphylococcus epidermidis. One year postoperatively, the uncorrected distance visual acuity was 20/20; persistent anterior vitreous opacities were the only observable sequelae. Bacterial endophthalmitis is a potential complication of ICL implantation. It can be successfully diagnosed and treated if a high degree of suspicion is maintained and if appropriate diagnostic and treatment modalities are used.