ASCRS News
February 2022
ASCRS Grand Rounds, a CME opportunity for ASCRS members, is hosted in partnership with major academic institutions, featuring two challenging cases with panel discussions. Here’s a recap of cases featured in the October–December 2021 editions of the series. Be sure to watch the full program to hear each panel’s thoughts and how the cases were ultimately handled.
ASCRS Grand Rounds returned as a quarterly program in February 2022, with NYU Langone Department of Ophthalmology presenting. Click here for the latest episodes.
Presented by the University of California, Los Angeles
Case 1: Jae Kim, MD, a cornea and refractive fellow, presented a case handled by Kevin Miller, MD. The case involved a 36-year-old female complaining of being unable to see from her left eye and of light sensitivity. The patient had a history of trauma in the left eye from a fall 2 years prior. She reported being unable to see well from the left eye since this fall. Before the fall she had implantable collamer lenses (ICL) in both eyes. Upon examination, right eye vision was 20/20, while the left eye was hand motion only. The pupil in the left eye appeared somewhat elongated and asymmetric, but a closer look at the slit lamp revealed the patient didn’t have an iris. Dr. Kim said what looked like an iris was actually a reflection of the cortical cataract from the trauma and what looked like the pupil was a PSC.
Case 2: Resident Lyn Shi, MD, presented a case involving a patient who suffered a dog claw injury to her right eye at 9 years old, resulting in a penetrating corneoscleral laceration, iris damage, and traumatic cataract. At the time, the open globe was repaired and the cataract and damaged iris tissue removed. At this point her CDVA was 20/100 postop; she wore +15 spectacles. Three months postop, she developed PCO and had a laser capsulotomy. The patient wore an aphakic contact lens with a painted iris. By age 18, the patient achieved 20/20 vision with this aphakic contact lens, but she developed a high IOP (28 mm Hg) and was put on timolol. By 19, she presented to Dr. Miller complaining of poor vision, photophobia, and discomfort while wearing an artificial pupil contact lens.
Presented by the University of Iowa
Case 1: Ryan Diel, MD, PGY-4, discussed the case of a 69-year-old male who presented with BCVA hand motion only in his right eye, 20/500 vision in the left, and 4+ brunescent cataracts in both eyes. There was no evidence of pseudoexfoliation or history of diabetes or trauma. Cataract surgery went forward, and when a phaco chop technique proved difficult due to the density of the lens, the surgeon decided to use miLOOP (Carl Zeiss Meditec). Phaco proceeded once the cataract was in quadrants. Even still, Dr. Diel pointed out that the “leather”-like cataract pieces took some time to phaco out, and eventually a post-occlusion surge occurred, creating a rent in the posterior capsule.
Case 2: Zachary Mortensen, MD, PGY-3, presented a case that involved a 42-year-old male who 2 years prior suffered blunt trauma to the eye from a piece of metal, resulting in a full-thickness corneal laceration, traumatic cataract, and lens particles in the anterior chamber. He underwent a 23-gauge pars plana vitrectomy with lensectomy. He came back to the clinic, after 2 years of using contact lenses, asking for a secondary IOL. The patient’s inferior laceration was healed with a stromal scar and single interrupted suture. Dr. Mortensen led a discussion of secondary lens choices for this patient, sharing which choice was made and what happened afterward.
Presented by Massachusetts Eye and Ear
Case 1: Kanika Agarwal, MD, clinical fellow in anterior segment, brought the case of a 60-year-old female with granular dystrophy who had three rounds of PTK. She presented with a gradual decrease in vision in her right eye. Her past ocular history included a PKP in her left eye. Her visual acuity was 20/80-1 in her right eye, BCVA 20/50-3. Pachymetry was 579. Exam of her cornea showed irregular epithelium with superior elevated diffuse central deposits of varying depths. The panel discussed management options for this patient and how the case proceeded.
Case 2: Sila Bal, MD, PGY-4, shared the case of a 37-year-old man who presented with burning and redness in both eyes for one night, persisting into the morning. The patient woke up with a pruritic rash on his arms, face, feet, and trunk. He reported diffuse muscle aches and feeling feverish. The patient did not report gastrointestinal issues or cough but had a sore throat. BCVA was 20/25-2 in the right eye and 20/30-2 in the left. Pupils and IOP was normal, external exam was normal, but he had diffuse conjunctival injection with 1+ SPK with no dendrites in both eyes. The patient was initially diagnosed in the emergency room with conjunctivitis and prescribed surface management. Two days later the patient went to the emergency room again with worsening rash (now involving his mouth), and he was admitted for possible Stevens-Johnson syndrome, a dermatology consult, and skin biopsy. By day 4, the patient had trouble opening his eyes; ocular surface exam showed confluent lid margin conjunctival epithelial defect with more extensive bulbar conjunctival staining, approaching the limbus in both eyes.
Watch the full Grand Rounds videos, available to ASCRS members, here.
