Publications by authors named "Michael T Trese"

123 Publications

Pediatric retina: Lessons from the past and goals for the future.

Authors:
Michael T Trese

Indian J Ophthalmol 2021 Aug;69(8):1983-1985

Chief of Pediatric and Adult Vitreoretinal Surgery, William Beaumont Hospital, Royal Oak, Michigan; Clinical Professor of Ophthalmology at Oakland University, William Beaumont School of Medicine, Rochester, MI, United States.

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http://dx.doi.org/10.4103/ijo.IJO_1800_21DOI Listing
August 2021

CLINICAL OUTCOMES AND TREATMENT COURSE OF EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FOLLOWING THE DEVELOPMENT OF ENDOPHTHALMITIS.

Retina 2021 Jun;41(6):1242-1250

Associated Retinal Consultants, PC., Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, MI.

Purpose: To evaluate the clinical course of patients with neovascular age-related macular degeneration (nAMD) after developing endophthalmitis during their treatment with intravitreal injections.

Methods: Multicenter, retrospective series.

Results: From April 2013 to October 2018, 196,598 intravitreal anti-vascular endothelial growth factor (VEGF) injections were performed, with 75 cases of endophthalmitis (incidence 0.0381%). There was no association between intravitreal anti-VEGF drug (P = 0.29), anesthetic method (P = 0.26), povidone concentration (P = 0.22), or any intraprocedure variable and endophthalmitis incidence. Seventy-two patients (96%) were treated with intravitreal tap and inject , while 3 underwent immediate pars plana vitrectomy. After endophthalmitis resolution, 17 patients (22.7%) were not re-treated for nAMD (in 10 cases due to inactive disease; follow-up, 115 ± 8.4 weeks). Patients required less frequent anti-VEGF injections after infection (7.4 ± 0.61 weeks vs. 11.5 ± 1.8 weeks; P = 0.004). Preinfection logarithm of the minimum angle of resolution visual acuity was 0.585 ± 0.053 (∼20/77). It worsened with endophthalmitis (1.67 ± 0.08, ∼20/935; P < 0.001) and again on postendophthalmitis treatment day 1 (1.94 ± 0.064; count fingers; P < 0.001), but improved after reinitiating nAMD therapy (1.02 ± 0.11; ∼20/209; P < 0.001). Better visual acuity on postendophthalmitis week 1 (P = 0.002) and reinitiation of nAMD treatment (P = 0.008) were associated with better final visual acuity, and streptococcal culture with worse visual acuity (P = 0.028). The postendophthalmitis treatment interval was associated with the anti-VEGF drug used (aflibercept = ranibizumab > bevacizumab; P < 0.001).

Conclusion: Patients with nAMD required fewer injections after endophthalmitis, suggesting a biological change in disease activity. Neovascular age-related macular degeneration became quiescent in 13.3% of eyes. Most achieved better outcomes with anti-VEGF reinitiation.
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http://dx.doi.org/10.1097/IAE.0000000000002998DOI Listing
June 2021

Suspected intrauterine injury causing abusive ocular trauma.

Retin Cases Brief Rep 2020 Sep 29. Epub 2020 Sep 29.

Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.

Purpose: The purpose of this report is to describe a patient who has fluorescein angiographic evidence and retinal changes suspicious for intrauterine abusive ocular trauma.

Methods: A case report of a premature ward of the state with no prenatal care and a presentation suspicious for intrauterine abusive ocular trauma. We performed serial ophthalmologic examinations, reviewed available prenatal history with the infant's social worker, and all relevant hospital notes, laboratory results, and imaging results.

Results: Following initial empiric treatment for possible viral retinitis in the setting of a positive urine CMV, repeat examinations demonstrated fluorescein angiographic evidence and clinical findings suspicious for abusive ocular trauma including neovascularization and no evidence of retinitis; therefore, the child was treated with laser photocoagulation.

Conclusion: At-risk newborns will benefit from an examination of the retinal periphery and wide field fluorescein angiography. Intrauterine abusive ocular trauma should be included in the differential of retinal hemorrhage and avascular retinal periphery. It is imperative for clinicians to recognize this presentation to prevent progression of associated visual morbidity.
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http://dx.doi.org/10.1097/ICB.0000000000001059DOI Listing
September 2020

PERIPHERAL RETINAL ANGIOGRAPHIC FINDINGS IN MACULAR TELANGIECTASIS TYPE 2.

Retina 2021 Mar;41(3):480-486

Associated Retinal Consultants, PC, Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.

Purpose: To evaluate the retinal periphery in patients with idiopathic juxtafoveal telangiectasis or macular telangiectasis Type 2 (MacTel2), using widefield fluorescein angiography.

Methods: Single-center, retrospective, observational case series of 50 eyes of 50 patients with MacTel2 and 50 eyes of 50 age-matched controls.

Results: Thirty-seven eyes in the MacTel2 group (74%) showed peripheral capillary nonperfusion or dropout, compared with 37 eyes in the control group (74%, P = 1.0). Morphologically, the MacTel2 group trended toward having a higher proportion of pruning-type capillary dropout (44%) compared with controls (28%), but this was not statistically significant (P = 0.12). Patients with MacTel2 had a higher incidence of microaneurysms compared with controls (MacTel2 56%; controls 42%; P = 0.048), independent of age or systemic risk factors. There was no difference in the incidence of venous-venous shunts (MacTel2 10%; controls 10%; P = 1.0), arteriovenous shunts (MacTel2 14%; controls 18%; P = 0.60), venous tortuosity (MacTel2 60%; controls 66%; P = 0.58), or arterial tortuosity (MacTel2 54%; controls 68%; P = 0.20), which was mild in most cases.

Conclusion: We note a high incidence of peripheral vascular and retinal findings in both patients with MacTel2 and age-matched controls, using widefield fluorescein angiography. Patients with MacTel2 had significantly more microaneurysms, independent of age or other systemic risk factors.
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http://dx.doi.org/10.1097/IAE.0000000000002981DOI Listing
March 2021

Retinal Vascular Abnormalities in Phakomatosis Pigmentovascularis.

Ophthalmol Retina 2019 12 16;3(12):1098-1104. Epub 2019 Jul 16.

Associated Retinal Consultants, P.C. Oakland University School of Medicine, William Beaumont Hospital, Royal Oak, Michigan.

Purpose: To describe the spectrum of retinal vascular abnormalities in patients with phakomatosis pigmentovascularis (PPV).

Design: Multicenter, retrospective, noncomparative, consecutive case series.

Methods: Eligible patients underwent detailed retinal examination including indirect ophthalmoscopy. Ultra-widefield fundus imaging, including color fundus photography and angiography, was performed using standardized protocols, and findings were recorded and reviewed and analyzed.

Participants: Three patients with a clinical diagnosis of PPV are presented.

Results: Evaluation of all patients (n = 6 eyes of 3 patients) with widefield fluorescein angiography showed several retinal vascular abnormalities, including peripheral retinal nonperfusion (n = 3 eyes), peripheral vascular leakage (n = 3 eyes), aberrant retinal vessels (n = 1 eyes), vascular tortuosity (n = 1 eyes), and disruption of the foveal avascular zone including fovea plana (n = 3 eyes). In addition, 2 eyes demonstrated peripheral retinal vascular straightening and leakage similar to the features of familial exudative vitreoretinopathy. One of the patients was a carrier of a somatic GNA11 R183C pathogenic variant that has been associated with PPV.

Conclusions: Fluorescein angiography, especially with widefield capability, reveals numerous retinal vascular abnormalities in patients with PPV. Considering the association of GNA11 pathogenic variants with PPV and allied disorders, these observations may suggest a role of guanine-binding proteins (G-proteins) in retinal vascular development. Supplemental material available at www.ophthalmologyretina.org.
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http://dx.doi.org/10.1016/j.oret.2019.07.004DOI Listing
December 2019

ETIOLOGY AND CLINICAL CHARACTERISTICS OF MACULAR EDEMA IN PATIENTS WITH FAMILIAL EXUDATIVE VITREORETINOPATHY.

Retina 2020 Jul;40(7):1367-1373

Department of Ophthalmology, William Beaumont School of Medicine, Associated Retinal Consultants, Royal Oak, Michigan.

Purpose: To describe the etiology and clinical characteristics of macular edema (ME) in patients with familial exudative vitreoretinopathy.

Methods: Observational, retrospective case series of 30 patients (34 eyes) with ME and familial exudative vitreoretinopathy who underwent spectral-domain optical coherence tomography imaging between 2009 and 2016. Baseline and follow-up optical coherence tomographies were correlated with color fundus photography and fluorescein angiography.

Results: The average age was 20.6 years (6.6-68.7). Eighteen eyes exhibited cystoid ME (52.9%), 14 noncystoid ME (41.2%), and 2 eyes (5.9%) with both. Macular edema was foveal in 52.9% (n = 18). Eighteen of 24 eyes (64.3%) with an available fluorescein angiography showed leakage from ME. The most common structural feature was posterior hyaloidal organization/contraction (n = 15). Sixteen eyes were treated with topical or intravitreal steroids (n = 6), intravitreal anti-vascular endothelial growth factor (n = 3), or pars plana vitrectomy with membrane stripping (n = 7). There was no difference between mean preoperative and postoperative LogMAR visual acuity (0.63 [20/85] vs. 0.87 [20/148], P = 0.35) after vitrectomy despite a statistical improvement in the mean central foveal thickness (596 mm vs. 303 mm, P = 0.04).

Conclusion: Macular edema in familial exudative vitreoretinopathy occurs most commonly because of traction. Vitrectomy is effective for relieving tractional forces with anatomical improvement.
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http://dx.doi.org/10.1097/IAE.0000000000002623DOI Listing
July 2020

Surgical Management of Suprachoroidal Hemorrhage in Younger Patients.

Ophthalmic Surg Lasers Imaging Retina 2019 07;50(7):454-458

Suprachoroidal hemorrhage (SCH) is a rare but serious complication that may accompany nearly any ocular surgery. In contrast to SCH in adults, the incidence and management of SCH in the pediatric population is poorly defined. Herein, the authors describe their experience managing SCH in patients of a younger age group, characterize this rare complication using multimodal imaging, and review the current literature on the subject. In this retrospective case series, two patients developed intraoperative SCH during cataract extraction once rendered aphakic. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:454-458.].
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http://dx.doi.org/10.3928/23258160-20190703-08DOI Listing
July 2019

Correlating Changes in the Macular Microvasculature and Capillary Network to Peripheral Vascular Pathologic Features in Familial Exudative Vitreoretinopathy.

Ophthalmol Retina 2019 07 4;3(7):597-606. Epub 2019 Mar 4.

Department of Ophthalmology, Shiley Eye Institute and Jacobs Retina Center, University of California, San Diego, La Jolla, California. Electronic address:

Purpose: To evaluate the macular microvasculature in patients with familial exudative vitreoretinopathy (FEVR) using OCT angiography (OCTA) and to assess for peripheral vascular changes using widefield fluorescein angiography (WFA).

Design: Multicenter, retrospective, comparative, observational case series.

Participants: We identified 411 patients with FEVR, examined between September 2014 and June 2018. Fifty-seven patients with FEVR and 60 healthy controls had OCTA images of sufficient quality for analysis.

Methods: Custom software was used to assess for layer-specific, quantitative changes in vascular density and morphologic features on OCTA by way of vessel density (VD), skeletal density (SD), fractal dimension (FD), vessel diameter index (VDI), and foveal avascular zone (FAZ). Widefield fluorescein angiography images were reviewed for peripheral vascular changes including capillary dropout, late-phase angiographic posterior and peripheral vascular leakage (LAPPEL), vascular dragging, venous-venous shunts, and arteriovenous shunts.

Main Outcome Measures: Macular microvascular parameters on OCTA and peripheral angiographic findings on WFA.

Results: OCT angiography analysis of 117 patients (187 eyes; 92 FEVR patients and 95 control participants) demonstrated significantly reduced VD, SD, and FD and greater VDI in patients with FEVR compared with controls in the nonsegmented retina, superficial retinal layer (SRL), and deep retinal layer (DRL). The FAZ was larger compared with that in control eyes in the DRL (P < 0.0001), but not the SRL (P = 0.52). Subanalysis by FEVR stage showed the same microvascular changes compared with controls for all parameters. Widefield fluorescein angiography analysis of 95 eyes (53 patients) with FEVR demonstrated capillary nonperfusion in all eyes: 47 eyes (49.5%) showed LAPPEL, 32 eyes (33.7%) showed vascular dragging, 30 eyes (31.6%) had venous-venous shunts, and 33 eyes (34.7%) had arteriovenous shunts. Decreasing macular VD on OCTA correlated with increasing peripheral capillary nonperfusion on WFA. Decreasing fractal dimension on OCTA correlated with increasing LAPPEL severity on WFA.

Conclusions: Patients with FEVR demonstrated abnormalities in the macular microvasculature and capillary network, in addition to the peripheral retina. The macular microvascular parameters on OCTA may serve as biomarkers of changes in the retinal periphery on WFA.
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http://dx.doi.org/10.1016/j.oret.2019.02.013DOI Listing
July 2019

Ocular Hypertension in Adults with a History of Prematurity.

Ophthalmol Retina 2018 06 1;2(6):629-635. Epub 2017 Dec 1.

Associated Retinal Consultants P.C., Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Department of Ophthalmology, Royal Oak, Michigan. Electronic address:

Purpose: To determine the ocular hypertension (OHT) incidence in patients with a history of prematurity and the effect of intervention for acute retinopathy of prematurity (ROP) in infancy on OHT incidence.

Design: Retrospective case series at a single tertiary referral vitreoretinal practice.

Participants: A total of 407 eyes of 213 patients were included, with ROP stage 0 to 5.

Methods: A retrospective chart review was conducted of patients aged ≥15 years, seen from 1973 to 2013, with a history of premature birth (gestational age <32 weeks). Data were collected from patient charts, including gender, date of birth, gestational age at birth, birth weight, stage of ROP at presentation, management (including laser, cryotherapy, lens-sparing vitrectomy [LSV], or lensectomy-vitrectomy). Ocular hypertension (if present) data included age of onset, timing of glaucoma surgery (if performed), lens status, and last follow-up examination.

Main Outcome Measures: Development of OHT, defined as eyes requiring a glaucoma medication for more than 6 consecutive months or surgical intervention for elevated intraocular pressure.

Results: Of included eyes, 155 (38.1%) developed OHT within 69 years of follow-up. Subgroup analyses revealed an OHT incidence of 23.2% (36/155 eyes) in eyes without a history of any treatment for acute ROP (spontaneously regressed), 23.3% (10/43 eyes) in eyes that underwent ablative therapy alone, and 58.5% (76/130 eyes) in eyes requiring acute incisional retinal surgery (P < 0.01). Stage 4 eyes had a lower OHT incidence compared with stage 5 eyes (40.5% [17/42] vs. 66.7% [54/81], P < 0.01); however, among stage 4 and stage 5 eyes, phakic eyes at last follow-up had a decreased OHT incidence compared with aphakic eyes (27.8% [5/18] vs. 69.8% [60/86], P < 0.01).

Conclusions: Patients with a history of extreme prematurity are at an increased risk of OHT and glaucoma, even if they did not receive acute ROP treatment. More severe acute ROP is associated with higher incidence of OHT, and this is associated with an increased incidence of incisional surgical intervention. Awareness of the increased lifelong risk of adverse ocular sequelae in patients with a history of prematurity will help guide appropriate monitoring.
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http://dx.doi.org/10.1016/j.oret.2017.10.005DOI Listing
June 2018

Longitudinal Examination of Fellow-Eye Vascular Anomalies in Coats' Disease With Widefield Fluorescein Angiography: A Multicenter Study.

Ophthalmic Surg Lasers Imaging Retina 2019 04;50(4):221-227

Background And Objective: Retinovascular anomalies in the fellow eyes of patients with Coats' disease have been described, but the clinical significance is unknown, as well as whether these lesions progress over time.

Patients And Methods: This is an international, multicenter, retrospective, observational cohort study of fellow-eye abnormalities on widefield fluorescein angiography in patients with Coats' disease.

Results: Three hundred fifty eyes of 175 patients with Coats' disease were analyzed. A total of 33 patients (18.8%) demonstrated abnormal fellow-eye findings: 14 (42.4%) telangiectasias, 18 (54.5%) aneurysms, six (18.2%) segmental non-perfusion, six (18.2%) leakage, and two (6.0%) vascular tortuosity. All eyes were asymptomatic, and none of the lesions progressed over time. There was no association between fellow-eye findings with severity of Coats' disease (P = .16), patient age (P = .16), or presence of systemic vascular disease (P = .16).

Conclusions: The vascular abnormalities in fellow eyes of patients with Coats' disease did not progress over time. Observation is a reasonable initial management strategy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:221-227.].
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http://dx.doi.org/10.3928/23258160-20190401-04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615457PMC
April 2019

Vessel Tortuosity Cutoff Values Using the Modified ROPtool May Predict Need for Treatment in Retinopathy of Prematurity.

Ophthalmic Surg Lasers Imaging Retina 2019 04;50(4):215-220

Background And Objective: To quantify vessel tortuosity among infants with retinopathy of prematurity (ROP).

Patients And Methods: This was a retrospective study including 61 RetCam images from 33 infants. The laser treatment (LT) group included 17 infants who underwent laser for ROP. The no-treatment (NT) group included 16 infants. The modified ROPtool was used to calculate mean vessel tortuosity (MVT) and highest vessel tortuosity (HVT) for the participants and for the standard plus disease photograph from the Early Treatment for Retinopathy of Prematurity (ETROP) study.

Results: The median MVT was 1.226 versus 1.056 for the LT and NT groups, respectively (P < .001). The median HVT was 1.346 versus 1.088 (P < .001). An MVT of 1.124 was 96.7% sensitive and 100% specific for identifying infants with treatment-requiring ROP. Both MVT and HVT cutoff values correctly captured plus disease in the standard ETROP trial photograph.

Conclusion: The modified ROPtool can be used to identify infants who have treatment-requiring ROP with a high level of sensitivity and specificity. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:215-220.].
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http://dx.doi.org/10.3928/23258160-20190401-03DOI Listing
April 2019

The Natural History of Congenital X-Linked Retinoschisis and Conversion between Phenotypes over Time.

Ophthalmol Retina 2019 01 24;3(1):77-82. Epub 2018 Aug 24.

Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan; William Beaumont School of Medicine, Oakland University, Rochester, Michigan. Electronic address:

Purpose: To evaluate the natural history of congenital X-linked retinoschisis (CXLRS) and to assess disease stability or progression over time.

Design: Retrospective case series at a single-center, tertiary care, pediatric retina practice.

Participants: One hundred two eyes of 51 patients with CXLRS.

Methods: The clinical examinations, fundus photographs, and OCT images of all patients with CXLRS were assessed. Eyes that initially demonstrated combined retinoschisis-retinal detachments and those with large, centrally overhanging schisis cavities were excluded from the analysis (n = 49) because they underwent surgery, which precluded observation of the natural disease course.

Main Outcome Measures: Stability or conversion of CXLRS phenotype over time.

Results: Fifty-three eyes met inclusion criteria for observation of natural disease history over time. At the time of diagnosis, 7.5% of eyes showed type 1 disease (n = 4), 17% showed type 2 disease (n = 9), 66% showed type 3 disease (n = 35), and 9.5% showed type 4 disease (n = 5). Mean length of follow-up was 7.4 years. A total of 7.5% of eyes demonstrated a combined retinoschisis-retinal detachment requiring surgery (n = 4), whereas 1.8% demonstrated a large, centrally overhanging schisis cavity requiring surgery (n = 1). Overall, 83% of eyes (n = 44) remained the same type without conversion or development of a complication requiring surgery. The remaining 17% of eyes (n = 9) experienced some type of change from their baseline diagnosis, with 7.5% (n = 4) converting between phenotypes and 9.5% (n = 5) demonstrating a complication requiring surgery; 3.75% of eyes (n = 2) converted from type 2 to 3 and 7.5% of eyes (n = 4) converted from type 3 to a combined retinoschisis-retinal detachment with mean time to conversion of 4.07 years.

Conclusions: This longitudinal study conveyed the natural history of CXLRS. Congenital X-linked retinoschisis displayed long-term stability in 83% of eyes with conversion or progression of the disease to a more severe phenotype in the remaining cases. Type 3 CXLRS was a risk factor for the development of a combined retinoschisis-retinal detachment and may benefit from closer follow-up.
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http://dx.doi.org/10.1016/j.oret.2018.08.006DOI Listing
January 2019

Predictors of Endophthalmitis after Intravitreal Injection: A Multivariable Analysis Based on Injection Protocol and Povidone Iodine Strength.

Ophthalmol Retina 2019 01 25;3(1):3-7. Epub 2018 Sep 25.

Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan; William Beaumont School of Medicine, Oakland University, Rochester, Michigan. Electronic address:

Purpose: To determine the incidence of endophthalmitis after anti-vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection.

Design: Retrospective, single-center cohort study.

Participants: All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017.

Methods: Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were reviewed carefully in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol.

Main Outcome Measures: Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs).

Results: A total of 154 198 anti-VEGF injections were performed during the period of interest, resulting in 58 cases of endophthalmitis (0.038% [1:2659]). After adjustment for confounders, both 2% lidocaine jelly (odds ratio [OR], 11.28; 95% CI, 3.39-37.46; P < 0.001) and 0.5% Tetravisc (Ocusoft, Richmond, TX; OR, 3.95; 95% CI, 1.15-13.50; P = 0.03) use were independent risk factors for endophthalmitis after injection. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, use of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of endophthalmitis after injection. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept).

Conclusions: The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.
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http://dx.doi.org/10.1016/j.oret.2018.09.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597000PMC
January 2019

Fellow Eye Anti-VEGF 'Crunch' Effect in Retinopathy of Prematurity.

Ophthalmic Surg Lasers Imaging Retina 2018 09;49(9):e102-e104

Background And Objective: Anti-vascular endothelial growth factor (VEGF) therapy is increasing in popularity for treatment of retinopathy of prematurity (ROP). Despite many technical benefits, issues remain prompting further investigation.

Patients And Methods: Retrospective case report and literature review.

Results: A 42-week-old postmenstrual age female with gestational age of 28 weeks and birth weight of 990 g presented with prominent progression of peripapillary purely tractional atypical stage 4A ROP in both eyes following intravitreal bevacizumab therapy in the right eye only.

Conclusion: The authors present the first reported case, to their knowledge, of a "crunch" phenomenon tractional retinal detachment from fellow eye administration of bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e102-e104.].
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http://dx.doi.org/10.3928/23258160-20180907-16DOI Listing
September 2018

Considerations for ophthalmic applications of optogenetics.

Acta Ophthalmol 2018 Dec 31;96(8):e1037. Epub 2018 May 31.

Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan, USA.

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http://dx.doi.org/10.1111/aos.13779DOI Listing
December 2018

Long-Term Outcomes of Total Exudative Retinal Detachments in Stage 3B Coats Disease.

Ophthalmology 2018 06 1;125(6):887-893. Epub 2018 Feb 1.

Long Island Vitreoretinal Consultants, Great Neck, New York. Electronic address:

Purpose: To evaluate the long-term outcomes of treatment of total exudative retinal detachments (ERDs) secondary to Coats disease (stage 3B) and the role of vitrectomy.

Design: Retrospective, observational case series.

Participants: A total of 16 eyes in 16 patients undergoing treatment for total ERDs secondary to Coats disease with at least 5 years of follow-up.

Methods: We reviewed the records of patients with stage 3B Coats disease. The interventions, including the timing of vitrectomy if used, and clinical course were recorded.

Main Outcome Measures: The primary outcome measures were visual acuity at the most recent appointment, whether there was progression to neovascular glaucoma (NVG) or phthisis bulbi, and need for enucleation.

Results: All patients received ablative treatment (photocoagulation or cryotherapy), with 8 having scleral buckling (SB) and 6 having external drainage of subretinal fluid (XD). Of the 12 patients who had pars plana vitrectomy (PPV), 8 had early PPV (EV) in the first year after presenting, and 4 of 8 in the expectant management group had late PPV (late vitrectomy) at a mean of 4.3 years post-presentation for treatment of significant traction retinal detachment (TRD). The other 4 patients of 8 in the expectant management group did not require vitrectomy. Mean follow-up overall was 9 1/2 years. At the date of last follow-up, 50% had no light perception or light perception vision, which was consistent across the subgroups that underwent EV (4/8), late vitrectomy (2/4), or no PPV (2/4). A total of 4 of 16 patients had progression to NVG or phthisis, 1 of whom required enucleation.

Conclusions: In this retrospective series of patients with Stage 3B Coats disease, ablative therapy with a combination of PPV, XD, or SB was effective in preventing progression to NVG or phthisis in the majority of patients, thus preserving the globe. Half of the patients (4/8) in this series who did not undergo PPV in the early vitrectomy group developed late-onset TRD, suggesting a possible role for early prophylactic vitrectomy with possible SB and XD; however, this is balanced by the other half (4/8) in the expectant management group who did not require any vitrectomy.
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http://dx.doi.org/10.1016/j.ophtha.2017.12.010DOI Listing
June 2018

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF THE MACULA AND VITREOMACULAR INTERFACE IN PERSISTENT FETAL VASCULATURE SYNDROME WITH POSTERIOR INVOLVEMENT.

Retina 2019 Mar;39(3):581-586

Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan.

Purpose: To describe the microstructural features of the macula and vitreomacular interface in persistent fetal vasculature syndrome (PFVS) with posterior involvement managed with early vitrectomy or with observation, with functional correlation.

Methods: We retrospectively identified 45 consecutive pediatric patients with PFVS with posterior involvement treated from 2005 to 2016. The eyes that could be imaged with spectral domain optical coherence tomography were included, and images were correlated with best-corrected visual acuity.

Results: Thirty-eight imaging sessions were performed on 10 eyes from 9 patients, including 7 that had been managed with vitrectomy for PFVS-related tractional retinal detachment, and 3 that had been observed. Mean age of the patients who were imaged was 9.1 years and their average length of follow-up was 5.9 years. Best-corrected visual acuities of the eyes imaged ranged from 20/30 to count fingers, with mean best-corrected visual acuity 20/163. All eyes imaged had microstructural anomalies identified. The main anomalous features included posterior hyaloidal organization, vitreoretinal traction, vitreopapillary traction, diminished foveal contour, foveal displacement, and disruption of the ellipsoid zone. Posterior hyaloidal organization (P = 0.043), diminished foveal contour (P = 0.019), and disruption of the ellipsoid zone (P = 0.014) were associated with worse best-corrected visual acuity.

Conclusion: Macular and vitreomacular interface anomalies were identified in all pediatric patients with posterior PFVS imaged with spectral domain optical coherence tomography. These microstructural findings, together with functional measures, may inform the diagnosis and management of PFVS with posterior involvement.
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http://dx.doi.org/10.1097/IAE.0000000000001993DOI Listing
March 2019

Glaucoma after Lens-Sparing Vitrectomy for Advanced Retinopathy of Prematurity.

Ophthalmology 2018 05 11;125(5):671-675. Epub 2017 Dec 11.

Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Electronic address:

Purpose: To report the incidence of, and factors related to, glaucoma after lens-sparing vitrectomy (LSV) surgery in advanced retinopathy of prematurity (ROP).

Design: Retrospective case series at a single tertiary referral pediatric vitreoretinal practice.

Participants: Four hundred and one eyes from 270 patients were included.

Methods: The medical records of patients who underwent LSV for stage 4A, 4B, and 5 ROP were retrospectively reviewed. Data were collected from patient charts including gender, gestational age at birth, birthweight, stage of ROP at presentation, prior treatment (laser or cryotherapy), subsequent retinal surgeries, presence of glaucoma, time to glaucoma (interval between LSV and the onset of glaucoma), date of lensectomy (if performed), and retinal attachment status at last visit. Lensectomy was considered as a time-dependent covariate in the analysis.

Main Outcome Measures: Incidence of glaucoma and potential risk factors for time to glaucoma.

Results: Among 401 eyes with advanced ROP, 40 eyes (10.0%) had glaucoma during a mean of 3.06±4.11 years of follow-up. The incidence of glaucoma was 6.9% (17/247) in stage 4A, 12.0% (16/133) in stage 4B, and 33.3% (7/21) in stage 5 ROP. Twenty-one percent of eyes (87/401) required lensectomy at a mean of 1.23±2.19 years after LSV. In univariate analysis, having stage 5 ROP (vs. stage 4 ROP) and presence of lensectomy were found to be significantly associated with time to glaucoma (hazard ratio = 6.76, 95% confidence interval = 2.19-20.88, P = 0.001; hazard ratio = 3.06, 95% confidence interval = 1.56-6.0, P = 0.001, respectively). In multivariate analysis, lensectomy was the only significant independent factor associated with time to glaucoma (hazard ratio = 2.76, 95% confidence interval = 1.371-5.581, P = 0.004).

Conclusions: Patients with more severe ROP had a higher incidence of glaucoma after lens-sparing vitrectomy. If a patient required lensectomy owing to progression of ROP and/or presence of lens opacity, then the hazard of having glaucoma significantly increased compared with those without lensectomy.
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http://dx.doi.org/10.1016/j.ophtha.2017.11.009DOI Listing
May 2018

Choroidal neovascular membrane in paediatric patients: clinical characteristics and outcomes.

Br J Ophthalmol 2018 09 7;102(9):1232-1237. Epub 2017 Dec 7.

Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.

Purpose: To analyse the clinical characteristics and treatment outcomes of choroidal neovascular membranes (CNVM) in paediatric subjects at three paediatric retina referral centres.

Methods: Medical charts of patients aged 18 years or less with a diagnosis of CNVM were retrospectively reviewed. The demographic profile, laterality, presenting complaint, corrected vision, underlying pathology, fundus, fundus fluorescein angiogram and optical coherence tomogram (OCT) were analysed. CNVM type, frequency, treatment indications, recurrences and final visual acuity were noted.

Results: There were a total of 35 subjects (43 eyes) with a mean age of 11.2 years. The CNVMs were mostly type 2 (90.0%), classic (90.9%), subfoveal (59.09%) and active (84.1%). Best vitelliform macular dystrophy was found to be the most common association (32.5%). Intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent was the initial therapy of choice in all. Eyes with CNVMs responsive to anti-VEGF alone required a mean of 2.11 injections. Patients with recurrent disease (21.21%) had an average of 1.14 episodes per eye. While 50% of recurrent CNVMs stabilised with repeat anti-VEGF treatment, the remaining patients required photodynamic therapy, laser or surgery.

Conclusion: Paediatric CNVMs in this series differed from those in the adult population with regard to aetiology, OCT and angiographic characteristics, treatment response and rate of recurrence.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310497DOI Listing
September 2018

THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries of Diagnosis and Treatment.

Retina 2017 Dec;37(12):2208-2225

Associated Retinal Consultants, Royal Oak, Michigan.

Purpose: To discuss the latest advances and controversies in the diagnosis and care of infants with retinopathy of prematurity (ROP).

Methods: Literature review.

Results: Retinopathy of prematurity remains a major global issue. Industrialized nations now treat profoundly premature infants with posterior and aggressive disease, and middle-income nations are experiencing ROP epidemics. Remote digital imaging may address the decreasing ratio of ROP providers to premature infants, in addition to improving patient care. Widefield angiography, optical coherence tomography, and the Wnt signaling pathway have provided new insights into ROP pathogenesis. Anti-vascular endothelial growth factor treatment is increasing in popularity, but the dearth of information to guide dosing, unpredictable reactivation, persistent vascular abnormalities, the "crunch" phenomenon, and the presently unknown effects of systemic vascular endothelial growth factor suppression remain issues to continue investigating. Neurodevelopmental delay has been raised as a potential consequence, but the evidence currently is weak. Vitrectomy is the treatment of choice for Stages 4 and 5. Illumination techniques, ab interno incisions, plasmin-assisted vitrectomy, staged surgery in the interest of corneal clearing for advanced Stage 5, and immediate sequential bilateral vitreoretinal surgery, are useful techniques.

Conclusion: We are making progress in ROP management. Our goal as clinicians is to continue expanding the boundaries of our abilities to keep this blinding disease in check globally.
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http://dx.doi.org/10.1097/IAE.0000000000001719DOI Listing
December 2017

Screening and treatments using telemedicine in retinopathy of prematurity.

Eye Brain 2016 17;8:147-151. Epub 2016 Aug 17.

Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI.

Several studies have validated the role of telemedicine as a new powerful screening and diagnostic tool for retinal disorders, such as diabetic retinopathy and retinopathy of prematurity. With regard to retinopathy of prematurity, bedside examination with binocular indirect ophthalmoscopy has been the gold standard technique for screening, yet with several limitations. Herein, we review the current evidence that supports the role of telemedicine for the screening of infants with retinopathy of prematurity.
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http://dx.doi.org/10.2147/EB.S94440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398746PMC
August 2016

PROGRESSIVE RETINAL DETACHMENT IN INFANTS WITH RETINOPATHY OF PREMATURITY TREATED WITH INTRAVITREAL BEVACIZUMAB OR RANIBIZUMAB.

Retina 2018 Jun;38(6):1079-1083

Associated Retinal Consultants, Royal Oak, Michigan.

Purpose: Fibrovascular contraction and tractional retinal detachment (TRD) are recognized complications associated with the use of anti-vascular endothelial growth factor agents in vasoproliferative vitreoretinopathies. The authors characterize TRDs that developed after intravitreal bevacizumab or ranibizumab therapy for vascularly active retinopathy of prematurity.

Methods: This is an international, multicenter, interventional, retrospective, case series. Thirty-five eyes from 23 infants were included. Inclusion required anti-vascular endothelial growth factor treatment of Type 1 retinopathy of prematurity with progression to TRD.

Results: Mean gestational age was 26 ± 2 weeks, and mean birth weight was 873 ± 341 g. Mean postmenstrual age on the day of injection was 35 ± 2 weeks. Retinal detachment was noted a mean of 70 days (median, 34; range, 4-335) after injection. Eleven percent detached within 1 week, 23% within 2 weeks, and 49% within 4 weeks. The highest stage of retinopathy of prematurity noted was 4A in 29%, 4B in 37%, and 5 in 34% of eyes. Time to RD negatively correlated with postmenstrual age at the time of injection (Rho = -0.54; P < 0.01). Three TRD configurations were observed: 1) conventional peripheral elevated ridge or volcano-shaped Stage 5 detachment, 2) midperipheral detachment with tight circumferential vectors, and 3) very posterior detachment with prepapillary contraction. Full or partial reattachment was achieved with surgical intervention in 86% of eyes.

Conclusion: Progressive atypical TRD may occur after anti-vascular endothelial growth factor injections for retinopathy of prematurity. The configuration of the detachment varies with the extent of primary retinal vascularization present at the time of treatment.
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http://dx.doi.org/10.1097/IAE.0000000000001685DOI Listing
June 2018

Correspondence.

Retina 2017 05;37(5):e52-e54

1Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan 2Retina and Vitreous of Texas, Houston, Texas 3NYC Retina, New York, New York 4Retina Vitreous Consultants, Pittsburgh, Pennsylvania 5Retina Consultants, Ltd, Chicago, Illinois 6Long Island Vitreoretinal Consultants, Long Island, New York 7Duke Eye Center, Durham, North Carolina 8Children's Hospital of Los Angeles, Los Angeles, California 9Emory Eye Center, Atlanta, Georgia 10University of Occupational and Environmental Health, Kitakyushu, Japan 11Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 12Shiley Eye Institute, University of California San Diego, La Jolla, California 13Moorfields Hospital, London, United Kingdom 14Great Ormond Street Hospital for Children, London, United Kingdom 15Royal Free Hospital, London, United Kingdom 16Kindai University Sakai Hospital, Osaka, Japan 17Retina Associates Southwest, Tucson, Arizona 18Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois 19Bascom Palmer Eye Institute, Miami, Florida 20Foundation Ophthalmic A. de Rothschild, Paris, Neuilly s/Seine, France 21Murray Ocular Oncology and Retina, Miami, Florida 22Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 23Hospital de Olhos do Paraná, Curitiba, Puerto Rico, Brasil 24Austin Retina Associates, Austin, Texas 25Clinica Oftalmologica Kydoft Arauco, Santiago, Chile 26Hospital del Salvador de Santiago, Santiago, Chile 27Asociación Para Evitar la Ceguera en Mexico-Retina Service, Mexico City, Mexico 28Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan 29Department of Medicine, Taiwan and Chang Gung University, College of Medicine, Guishan, Taoyuan, Taiwan 30Casey Eye Institute, Oregon Health and Science University, Portland, Oregon 31Clínica de Enfermedades de los Ojos, Toluca, Mexico 32Asociacion Para Evitar la Ceguera en Mexico-Retina Service, Mexico City, Mexico 33Department of Ophthalmology, School of Medicine, Fukuoka University, Japan 34Vitreo Retinal Surgery, Pennsylvania, Minneapolis, Minnesota 35Bumrungrad International Hospital, Bangkok, Thailand 36Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah 37Doheny Eye Center, University of California Los Angeles, Log Angeles, California 38Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Canada 39Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 40Stanford Byers Eye Institute, Stanford University, Palo Alto, California.

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http://dx.doi.org/10.1097/IAE.0000000000001602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657297PMC
May 2017

Chorioretinal Coloboma Complications: Retinal Detachment and Choroidal Neovascular Membrane.

J Ophthalmic Vis Res 2017 Jan-Mar;12(1):3-10

Department of Ophthalmology, Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.

Purpose: To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV).

Methods: This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit.

Results: Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%).

Conclusion: RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes.
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http://dx.doi.org/10.4103/2008-322X.200163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340060PMC
March 2017

SURGICAL MANAGEMENT OF TRACTIONAL RETINOSCHISIS ASSOCIATED WITH VITREOUS HEMORRHAGE IN RETINOPATHY OF PREMATURITY.

Retin Cases Brief Rep 2019 Winter;13(1):72-74

Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.

Purpose: The tractional retinoschisis is a poorly understood, rare, and likely underappreciated entity in retinopathy of prematurity. The purpose of this article is to describe clinical findings and surgical management of tractional retinoschisis in retinopathy of prematurity, masquerading as Stage 4 retinopathy of prematurity retinal detachment.

Methods: A retrospective review of a single case with literature review and case discussion.

Results: In this report, we describe a child with retinopathy of prematurity and tractional schisis, who initially presented with vitreous hemorrhage and was effectively managed by vitrectomy and inner wall retinectomy. At 5 months after vitrectomy, the child demonstrated complete collapse of the retinoschisis with intact posterior pole and brisk light perception.

Conclusion: Vitrectomy with or without inner wall retinectomy is effective in the management of tractional retinoschisis.
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http://dx.doi.org/10.1097/ICB.0000000000000536DOI Listing
January 2019

Spectral-Domain Optical Coherence Tomography in Older Patients With History of Retinopathy of Prematurity.

Ophthalmic Surg Lasers Imaging Retina 2016 12;47(12):1086-1094

Background And Objective: To characterize the in vivo microstructural features of patients with history of retinopathy of prematurity (ROP).

Patients And Methods: A single-center, retrospective imaging case series during which a chart review was performed of consecutive patients with history of ROP who underwent spectral-domain optical coherence tomography (SD-OCT) with or without enhanced depth imaging. Eyes with time-domain OCT, no light perception, or uninterpretable SD-OCT images were excluded. Main outcome measures included best-corrected visual acuity (BCVA) and exploratory SD-OCT findings.

Results: A total of 186 eyes of 112 patients (mean age: 31.5 years; range: 8 years to 70 years) were imaged. Mean visual acuity was 20/150 (range: 20/20 to light perception). Mean foveal thickness (MFT) and subfoveal choroidal thickness (SCT) measured 270.93 µm ± 56.40 µm and 239.87 µm ± 73.00 µm, respectively. There was a negative correlation between ROP stage and MFT (Rho = -0.19; P = .027), but not with SCT (Rho = -0.03; P = .748). There were negative correlations between BCVA and MFT (Rho = -0.23; P < .01) and SCT (Rho = -0.19; P = .04). Ellipsoid zone (EZ) abnormalities, inner retinal layer thickening, and presence of chorioretinal atrophy were associated with higher ROP stage (P < .001) and poorer visual acuity (Rho = 0.59; P < .001). The presence of retinoschisis (n = 36/186; 19%) was associated with poorer visual acuity (P < .001), but did not correlate with higher ROP stage (P = .17). Epiretinal membrane-like dense hyaloidal organization and vitreoretinal interface abnormalities were seen in 69% (130/186) and 33% (63/186) of eyes, respectively, but were not associated with ROP stage (P = .87) or visual acuity (P = .54). After controlling for EZ abnormalities, foveal hypoplasia, macular schisis, inner retinal thickening, chorioretinal atrophy, and ROP stage, the independent risk factors for poorer visual acuity were EZ abnormalities (Beta = 0.38; P < .001), chorioretinal atrophy (Beta = 0.18; P = .03), and ROP stage (Beta = 0.22; P < .01).

Conclusion: SD-OCT imaging identified a variety of microstructural abnormalities present in patients with history of ROP. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1086-1094.].
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http://dx.doi.org/10.3928/23258160-20161130-02DOI Listing
December 2016

RETINAL VASCULAR TORTUOSITY AND EXUDATIVE RETINOPATHY IN A FAMILY WITH DYSKERATOSIS CONGENITA MASQUERADING AS FAMILIAL EXUDATIVE VITREORETINOPATHY.

Retin Cases Brief Rep 2017 Winter;11 Suppl 1:S187-S190

*Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; †Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan; ‡Department of Ophthalmology, Beaumont Hospital-Southshore Campus, Trenton, Michigan; §Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; ¶Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and **Florida Retina Institute, Jacksonville, Florida.

Purpose: To report a novel presentation of dyskeratosis congenita masquerading as familial exudative vitreoretinopathy.

Methods: Observational case series involving single family and literature review.

Results: A brother and sister were diagnosed with familial exudative vitreoretinopathy at ages 4 and 2, respectively. Both patients were managed with laser photocoagulation. Eight years after the initial presentation, both siblings developed pancytopenia secondary to bone marrow failure. Laboratory work-up revealed severely shortened telomere length in both patients, and genetic testing revealed a missense mutation in the gene that encodes the reverse transcriptase component of telomerase, confirming the diagnosis of dyskeratosis congenita. The father of both children was a carrier of the same mutation, who exhibited marked retinal vascular tortuosity of the second-order vessels.

Conclusion: Dyskeratosis congenita is a severe multisystem disorder, which should be considered in cases of pediatric exudative retinopathies with concurrent signs and/or symptoms of bone marrow failure.
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http://dx.doi.org/10.1097/ICB.0000000000000430DOI Listing
June 2017

Optical Coherence Tomography Angiography Findings in Coats' Disease.

Ophthalmology 2016 Sep;123(9):1964

Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.

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http://dx.doi.org/10.1016/j.ophtha.2016.05.004DOI Listing
September 2016
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