Sensitivity and specificity of Point-of-Care ocular ultrasound for optic neuritis: a hypothesis generating study

Purpose: This retrospective study compares point-of-care ocular ultrasound to MRI in order to establish preliminary data for and identify challenges to a multicenter study into the utility of ocular ultrasound for diagnosing optic neuritis. Methods: Our ultrasound archive was queried to identify subjects suspected of having optic neuritis who underwent ocular ultrasound and MRI of the brain or orbit. Blinded ultrasounds were reviewed by ultrasound faculty. The presence of optic disc elevation, optic nerve, or sheath dilation, and overall impression were recorded and compared to MRI results. Sensitivity and specificity of each ultrasound finding and the overall impression, as well as agreement between the raters, were calculated. Results: Sensitivity and specificity of ultrasound for MRI confirmed optic neuritis was 100 % (95 % CI 54.1-100) and 58.3 % (95 % CI 27.7-84.8). Optic nerve sheath diameter had nearly perfect agreement (κ = 0.8828), however agreement on optic disc elevation (κ = 0.5641), nerve diameter (κ = 0.2174), and overall agreement (κ = 0.1818) were moderate, fair, and poor, respectively. Conclusions: This preliminary study estimates test characteristics of ocular ultrasound for the diagnosis of optic neuritis for the purposes of power analysis and to identify potential pitfalls in preparation for a larger prospective investigation.

Diagnostic algorithm in small pigmented choroid tumors (less than 3 mm thick)

Objectives: The aim of this paper is to present a diagnostic algorithm for a controversial topic in ophthalmic oncology, small pigmented choroidal tumors (<3 mm thick). Material and Methods: Nineteen consecutive patients with a clinical diagnosis of small choroidal pigmented tumors were included in the study. The group of patients studied consisted of 9 patients (47.36%) female and 10 patients (52.64%) male, the age range was 14–68 years. All cases were ophthalmologically evaluated, including best-corrected visual acuity, anterior and posterior segment biomicroscopy, intraocular pressure, binocular indirect ophthalmoscopy, and as additional complementary examinations, ocular ultrasound was performed, which in 100% of the cases was inconclusive, optical coherence tomography, autofluorescence, and angiography in selected cases according to location and symptomatology. In 13 patients (68.50%), transvitreous puncture was performed with or without vitrectomy. Trans-scleral puncture was performed in 6 patients (31.50%), located at the equator (4 patients) and ciliary body (2 patients). Post-surgical follow-up was performed within the first 3 weeks after the procedure and then controlled every 3 months within the 1st year. The material obtained by fine-needle aspiration (FNA) was placed in non-hemolytic preservative liquid. Hematoxylin and eosin, Pas, Masson’s trichrome, and immunohistochemistry (HMB 45, MELAN A, PROT. S-100 base) were performed. Results: The yield of cytologic material was 100% in the sampled patients. The most frequent complication was subretinal hemorrhage in three patients with transvitreous access and two patients with trans-scleral access, in all cases, there was a favorable evolution without requiring further action. In three patients, there were mild vitreous hemorrhages that resolved spontaneously, all of them had undergone transvitreous access. Conclusion: In TPPC of less, we propose a diagnostic algorithm with FNA to obtain cytological sample which allows not only the diagnosis of certainty to indicate treatment but also to determine cytological and molecular prognostic factors that allow classifying melanoma of high or low grade and potentially in case of metastatic disease to indicate systemic treatments. We believe that it is essential to diagnose this type of lesions in which a diagnosis of certainty is required. The alternative is the observation that we consider potentially dangerous in these cases.

It's in the Eye of the Beholder: Ocular Ultrasound Enhanced Monitoring of Neurotoxicity after CAR T-cell therapy

Usually used in emergency settings, bedside sonographic measurement of optic nerve sheath diameter can aid in diagnosing elevated intracranial pressure. We report a case of a 26-year-old male hospitalized for CAR T-cell therapy with Axicabtagene Ciloleucel for treatment of relapsed diffuse large B-cell lymphoma, who developed progressive symptoms of immune effector cell-associated neurotoxicity syndrome. Fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. The patient had a ventriculostomy placed for monitoring and received treatment with steroids and mannitol, as well as tocilizumab. After 7 days in the ICU, the patient recovered with no evidence of long-term neurological deficits.

Ocular glioma in dog: Case report

The objective is to report the case of a Transmontano Mastiff dog, eight year old intact male, 88 kg, with history of visual loss, diffuse corneal edema and secondary glaucoma. The ocular ultrasound examination revealed a hyperechoic structure located in the peripapillary region of the optic nerve, showing an image compatible with intraocular neoplasia. The animal was submitted to the enucleation procedure and anatomopathological analysis of the affected eye was performed. Histological examination revealed glioma of the optic nerve, considering that neoplasms that affect the retina and optic nerve are rarely described in veterinary medicine, as the case presented.

Bilateral Anophthalmia in Feline

Background: Anophthalmia is a rare, congenital condition, defined as the complete absence of the eye bulb due to inadequate growth of the vesicle or optic dome. The malformation can be primary (in the absence of complete), secondary (in the presence of only residual tissue), or degenerative (in which the eye begins to form, but for some reason, it begins to degenerate). This condition is rare in dogs, cats, cattle, and sheep. Microscopic evaluation of orbital tissue for identification is always recommended. The aim of this study was to report a case of bilateral anophthalmia in a domestic cat.Case: A feline male, healthy, Maine Coon breed with 60 days of life was attended at the one veterinary private clinic. The cat, negative for FIV and FeLV, was born in a commercial cattery, belonging to his mother's third litter, healthy litter with the exception of this feline. He arrived with a complaint of not opening his eyelids, like the rest of the litter. In the clinical examination, it was found the normality of vital signs, absence of other visible anatomical abnormalities, only the ocular region was observed with closed eyelids. The initial suspicions were anophthalmia and microphthalmia. The patient was referred for an ocular ultrasound, which showed the complete absence of the right and left eye bulbs. The right and left orbital cavities had only a volume of soft, amorphous, and predominantly homogeneous tissue. After the ultrasound report, the patient underwent a surgical procedure to remove a fragment of tissue from the eye socket, which was sent for histopathological examination to confirm anophthalmia and discard the differential diagnosis of microphthalmia. Microscopy revealed immature, epithelial, and glandular tissue in the middle of discrete and moderate connective tissue, loosely arranged. In some fragments, cartilaginous tissue was also revealed. Thus, the histological findings are compatible with immature, pseudoformed tissues and without neoplastic characteristics. The diagnosis of secondary anophthalmia was reached with use of ultrasound and histological reports.Discussion: Congenital malformations in domestic cats are less frequent than in dogs, some of which are rare, and little reported. Secondary anophthalmia in the reported patient was confirmed by histological and ultrasound examination. Bilateral secondary anophthalmia is characterized by the absence of the eyeball, but with the presence of adjacent tissue. The animal was submitted to an ocular ultrasound examination and the complete absence of ocular bulbs was found. The differential diagnosis of microphthalmia was ruled out because there was no evidence of the eyeball. Microphthalmia is a common congenital ophthalmic disorder in veterinary medicine. Representative fragments were submitted to histopathological examination, where immature, epithelial tissue was found. In some fragments sent for analysis, cartilaginous tissue was observed. The histological findings are compatible with immature, pseudoformed tissues, thus verifying bilateral congenital anophthalmia in the reported animal. The clinical examination in these cases serves to ensure that the animal does not have any other congenital changes, allowing a favorable prognosis in puppies. Based on the information presented, the animal in this study has bilateral secondary congenital anophthalmia, with a favorable prognosis for the patient to live with certain normality, with quality and well-being.

Epithelioid Choroidal Melanoma in a Middle-Aged Filipino: A Case Report

49-year-old male presented with an eight-month history of gradual blurring of vision of the left eye accompanied by eye pain, left-sided headache, eye redness, gradual proptosis and opacification of the cornea. Ocular ultrasound revealed a homogenous echodensities with moderate echogenicity and intermittent loculation occupying the whole vitreous cavity. Chest CT-scan with contrast showed multiple nodules on both lung fields evident of metastasis