ASCRS News
March 2021
by Liz Hillman
Editorial Co-Director
ASCRS began its Grand Rounds in October 2020 as a monthly CME opportunity for members. The Grand Rounds are hosted in partnership with major academic institutions and feature two challenging cases with panel discussions. Watch the full programs online to hear the panel’s thoughts and how the cases were ultimately handled.
Presented by Duke University Eye Center
Case #1: Regina de Luna, MD, resident, presented on a 79-year-old male with complaints of poor vision in his right eye after cataract surgery. The patient had a TECNIS ZCB00 (24 D; Johnson & Johnson Vision) implanted 2 months prior. He had a history of strabismic amblyopia and was phakic in his left eye. He described starbursts at night and tearing around both eyes. Manifest refraction revealed myopia in his right eye (–2.5 D) and hyperopia in his left (+3.50 D). Topography showed abnormalities in the right eye. Fluorescein staining highlighted diffuse anterior basement membrane dystrophy.
Case #2: Amal Al-Lozi, MD, resident, described a 60-year-old male who presented with late onset fluid in his LASIK flap interface. According to Dr. Al-Lozi, the patient had a complicated ocular history: A Crystalens (Bausch + Lomb) was implanted and later removed, requiring a pars plana vitrectomy and ACIOL implantation; the ACIOL was later removed (left aphakic) due to corneal edema; and he had open angle glaucoma due to steroid response. Dr. Al-Lozi noted severe stromal edema with mild microcystic edema on slit lamp exam. Discussing the differential diagnosis, panelists noted the value of OCT to visualize fluid at the flap interface.
Presented by Baylor College of Medicine, Cullen Eye Institute
Case #1: Elaine Zhou, MD, resident, presented on a 67-year-old man who experienced inflamed pinguecula in his right eye for 4 months; topical steroids did not help. He had prior LASIK and facial skin cancer. He presented with a 4-mm vascular lesion with gelatinous and piliform features.
Case #2: Christina Mamalis, MD, fellow, presented about a 77-year-old man experiencing redness, irritation, and blurry vision in his right eye for 6 months. He was referred for EBMD evaluation. Ocular history included retinal detachment with pars plana vitrectomy and scleral buckle, controlled primary open angle glaucoma, and bilateral pseudophakia. His VA was 20/200-1 in the right eye, 20/40 in the left. Physical exam showed a superiorly peaked pupil, and epithelial changes between 11 and 3 o’clock hours superiorly. Slit lamp examination showed slight thinning, anterior stromal haze, and diffuse epitheliopathy. No epithelial defect was noted with fluorescein staining; a whorl epithelial pattern was observed.
Presented by the John A. Moran Eye Center, University of Utah
Case #1: Mike Murri, MD, resident, described a case of sudden vision loss years after refractive surgery. The 30-year-old presented with right eye pain, blurry vision, redness, photophobia, and monocular diplopia. History included phakic IOL 12 years prior with enhancement in his right eye. The patient reported “issues” with that surgery but no recent trauma. He was 20/30 in the right eye, 20/70 (pinhole to 20/25) in the left. IOP was normal. Manifest refraction was –1.25 D to achieve 20/20 in the left eye with no ability to improve the right. Slit lamp exam revealed a Verisyse lens (Ophtec) with its superior claw disengaged, the optic edge bisecting the visual axis. The lens was not touching the cornea and there was no AC cell.
Case #2: Austin Nakatsuka, MD, clinical fellow, discussed a case of a patient with a large iris defect 1 year after iris melanoma resection. The 66-year-old’s visual acuity was 20/40 with a nuclear/posterior subcapsular cataract. She experienced rapid visual decline, but Dr. Nakatsuka noted no dysphotopsias and an otherwise normal exam. An iris prosthesis was recommended but there were delays due to insurance issues and the patient wanted a quicker intervention.
Watch the full Grand Rounds videos at https://ascrs.org/clinical-education/grand-rounds. Keep an eye out for a new ASCRS Grand Rounds each month.
