Treatment of metastatic uveal melanoma in 2022: improved treatment regimens and improved prognosis
Purpose of review
Until recently, metastatic uveal melanoma was associated with essentially uniform fatality within months. However, recent developments in screening, improved understanding of the genetic underpinnings of metastatic disease, and pivotal medication approvals have improved the disease's rate of fatality.
Recent findings
Routine implementation of genetic testing at the time of primary tumor treatment via gene expression profiling or chromosomal analysis has identified patients who are at high risk for metastatic disease. Enhanced screening with imaging directed at the liver and lungs has allowed fo...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: SPECIAL COMMENTARIES Source Type: research
Artificial intelligence at the national eye institute
Purpose of review
This review highlights the artificial intelligence, machine learning, and deep learning initiatives supported by the National Institutes of Health (NIH) and the National Eye Institute (NEI) and calls attention to activities and goals defined in the NEI Strategic Plan as well as opportunities for future activities and breakthroughs in ophthalmology.
Recent findings
Ophthalmology is at the forefront of artificial intelligence-based innovations in biomedical research that may lead to improvement in early detection and surveillance of ocular disease, prediction of progression, and improved quality ...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: SPECIAL COMMENTARIES Source Type: research
Leber hereditary optic neuropathy: new and emerging therapies
Purpose of review
To review recent therapeutic advances in Leber hereditary optic neuropathy (LHON).
Recent findings
Idebenone, a synthetic analog of ubiquinone (Coenzyme Q10) is an antioxidant and component of the mitochondrial electron transport chain. Since the initial approval of the drug in 2015 in Europe, recent trials have evaluated its role as prolonged treatment in LHON. Gene therapy has recently emerged as a promising alternative for the treatment of LHON. Among several investigations, RESCUE and REVERSE are two phase 3 clinical trials of gene therapy in patients with LHON in early stages. Results in t...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Current concepts in granulomatosis poly angiitis and the eye
Purpose of review
Granulomatosis with polyangiitis (GPA), a multisystem disease with diverse systemic and protean ocular manifestations. Its pathophysiology, spectrum of the ocular manifestations, changing paradigms in the diagnosis of the disease, recent updates in the treatment patterns are clinically relevant to the treating clinician. They are described in this review.
Recent findings
1.The ocular manifestations are not included in the updated diagnostic criteria of GPA. Hence, high index of suspicion is required when a clinician encounters eye as the first clinical presentation.2.The concentration of in...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Retinal vasculopathy following varicella zoster virus infection
We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed.
Recent findings
Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely aff...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Ocular manifestations of rheumatoid arthritis
This article summarizes the pathophysiology of rheumatoid arthritis and common ocular manifestations that it is associated with: keratoconjunctivitis sicca, episcleritis, scleritis, and peripheral ulcerative keratitis.
Recent findings
Newer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations.
Summary
The eye is a frequent extra-articular site of inflammation in patients with rheumatoid arthritis. Ocular involvement can range from more benign conditions such as keratoconjunctivitis sicca and episcleritis, to potentially vision and globe-threatening diseases li...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Peripheral ulcerative keratitis due to systemic diseases
Purpose of review
To discuss peripheral ulcerative keratitis, with a focus on the evaluation and management of associated systemic diseases.
Recent findings
Peripheral ulcerative keratitis (PUK) is a sight-threatening condition that is often defined by the presence of a crescent-shaped area of peripheral corneal thinning, an epithelial defect, and an inflammatory corneal infiltrate. It is highly associated with rheumatoid arthritis, systemic necrotizing vasculitides like granulomatosis with polyangiitis, and collagen vascular diseases like systemic lupus erythematosus. Undertreated PUK carries a risk of vision l...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Ocular leptospirosis: lack of awareness among ophthalmologists and challenges in diagnosis
Purpose of review
Systemic leptospirosis exists worldwide. But leptospiral uveitis, an important late complication is not identified by ophthalmologists in several countries.
Recent findings
In the last 18 months numerous publications, especially on epidemiology, surveillances, and novel rapid diagnostic kits to test at the point of care site on leptospirosis have been published from all over the world. However, publications from ophthalmologists are very scarce. Remarkably ophthalmologists should know the global burden of leptospirosis, prevalence of the disease in their country, demographic factors associated,...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Incontinentia pigmenti and the eye
Purpose of Review:
Incontinentia pigmenti (IP) is a rare X-linked dominant phakomatosis that predominately presents with dermatologic manifestations but can also cause central nervous system and ocular abnormalities. Awareness of the ocular complications of IP is crucial to identify ocular abnormalities early and prevent permanent vision loss.
Recent Findings:
There have been significant recent advances in ocular diagnostic imaging in IP. Optical coherence tomography (OCT) has helped characterize outer plexiform layer abnormalities in the macula, which can help explain central vision loss in IP patients. OCT ang...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: OCULAR MANIFESTATIONS OF SYSTEMIC DISEASE: Edited by John Gonzales Source Type: research
Optic perineuritis
Purpose of review
This review paper aims at discussing pathogenesis, etiology, clinical features, management, and prognosis of OPN.
Recent findings
Optic perineuritis (OPN) is an inflammatory process primarily involving the optic nerve sheath. Clinically, OPN usually presents with unilateral, gradual decline of visual function, eye pain, and/or pain on eye movements, disc edema and various features of optic nerve dysfunction, including visual field defects. It can mimic typical optic neuritis. In most cases of OPN, the disease is isolated with no specific etiology being identified, however, it can also occur sec...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
Metaplasticity: a key to visual recovery from amblyopia in adulthood?
Purpose of review
We examine the development of amblyopia and the effectiveness of conventional and emerging therapies through the lens of the Bienenstock, Cooper, and Munro (BCM) theory of synaptic modification.
Recent findings
The BCM theory posits metaplastic adjustment in the threshold for synaptic potentiation, governed by prior neuronal activity. Viewing established clinical principles of amblyopia treatment from the perspective of the BCM theory, occlusion, blur, or release of interocular suppression reduce visual cortical activity in the amblyopic state to lower the modification threshold and enable ambl...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
Approach to the diagnosis and management of nutritional optic neuropathies
Purpose of review
Nutritional deficiency is an under-recognized cause of optic neuropathy. The purpose of this review is to discuss how to identify, diagnose, and appropriately manage patients with nutritional optic neuropathy.
Recent findings
Nutritional deficiencies have long been thought to be more prevalent in the developing countries. However, with the advent of bariatric surgery, restrictive/selective diets, and the increase in alcohol dependence, it is not uncommon to see nutritional optic neuropathies in the developed world.
Summary
Although nutritional optic neuropathy can cause severe and debili...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
Rhino-orbital mucormycosis
This article reviews the clinical and radiologic features, treatment, and prognosis of ROM with special emphasis on new and emerging therapies.
Summary
ROM is an angioinvasive fungal infection that affects the sinuses and orbits and may present to ophthalmologists. Clinicians should have a high index of suspicion for ROM, especially in patients with poorly controlled diabetes mellitus or other immunosuppression. Corticosteroid treatment (including the recent COVID-19 pandemic) may be a predisposing risk factor for ROM. (Source: Current Opinion in Ophthalmology)
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
An overview of peripapillary hyperreflective ovoid mass-like structures
Purpose of review
The purpose of this review is to provide an overview of the ophthalmic findings associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both adult and pediatric patients.
Recent findings
PHOMS have recently been identified in a number of different ophthalmic disease entities ranging from nonpathologic to pathologic, including but not limited to anatomic abnormalities (tilting in myopia), optic nerve head drusen, optic disc edema from inflammation (optic neuritis, white dot syndromes), vascular insults (ischemic optic neuropathy, retinal vascular occlusion), and papil...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
Post-cataract surgery optic neuropathy: a chronological narrative review of the literature and speculation on pathogenesis
Purpose of review
To appraise the literature on the incidence of an acute anterior optic neuropathy resembling spontaneous nonarteritic anterior ischemic optic neuropathy (NAION) following uncomplicated cataract surgery and to explore the proposed pathogenesis of both immediate and delayed onset post-cataract surgery optic neuropathy (PCSON).
Recent findings
A number of case reports, case series, and retrospective case-controlled, big data, and population-based studies have identified an apparent association between cataract surgery and the occurrence of an acute anterior optic neuropathy that can either be imme...
Source: Current Opinion in Ophthalmology - October 14, 2022 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean Cestari Source Type: research
