Intermittent Pain and Blur After PRK

This patient was told nothing could be done about a nodular, keloid-type subepithelial scar.

Abi Tenen, MBBS (Hons), FRANZCO; Andrea Ang, MBBS (Hons), MPH, FRANZCO; Dena Ballouz, MD; Parag A. Majmudar, MD; Allon Barsam, MA(Cantab), MBBS, FRCOphth, FWCRS; and Marguerite B. McDonald, MD, FACS

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Surgeons consider how to manage persistent intermittent pain, blurred vision, and foreign body sensation in an eye with a nodular, keloid-type subepithelial scar 8 years PRK Initial steps in this situation include optimization of the ocular surface Recurrence is possible, so patients should be counseled accordingly CASE PRESENTATION A 36-year-old woman presents with pain, blurred vision, and foreign body sensation in her left eye. Eight years ago, she underwent bilateral PRK for myopia and high astigmatism by another surgeon. The patient has experienced these symptoms intermittently since the surgery, and they have neither improved nor worsened. She was told that the left cornea has a scar and that nothing further can be done. On examination, the patient’s UCVA is 6/7.5+2 OD, 6/9.5+2 OS, and 6/6 with both eyes open. Her manifest refraction is 0 -0.75 x 50º = 6/6 OD and -0.25 -1.25 x 20º = 6/6 OS. The IOP is 10 mm Hg OD and 12 mm Hg OS. A slit-lamp examination of the left eye finds a nodular, keloid-type subepithelial scar with surrounding haze in the paracentral cornea. A reactive ptosis and brow overaction are also present on the left. The right cornea exhibits mild central haze.

How to Succeed in Ophthalmology Residency

Pavlina Kemp, MD; Samuel Tadros, MD; Blake K. Williamson, MD, MPH; and Gary Wörtz, MD

Eyetube

Blake Williamson, MD, MPH, and Gary Wörtz, MD, return for a new season of Ophthalmology off the Grid! This season, the hosts dive into the basics of training and education at the most prestigious programs in ophthalmology across the United States. In this episode, they invite Pavlina Kemp, MD, residency program director at the University of Iowa Department of Ophthalmology and Visual Sciences, and Samuel Tadros, MD, a PGY-4 ophthalmology resident, to share a state of the union on ophthalmology residency. They discuss what it takes to stand out during the application and interviewing process and find success in the field.

Peripheral Firestorm: The Ischemic Retina

Proliferative disease may still be progressing despite good vision.

Apoorva Jadhav, MBBS, DNB; Unnikrishnan Nair, MS, FRCS, FMRF; and Manoj Soman, DNB, FICO, FRCS

Retina Today

A 62-year-old man with a history of diabetes for the past 10 years presented with complaints of bilateral blurred vision for 2 months with a BCVA of 20/30 OU. Findings on color fundus photography were suggestive of proliferative diabetic retinopathy with fibrovascular proliferation around the optic disc and along the vascular arcades (Figure 1). Widefield OCT demonstrated mild alteration of the foveal contour with minimal parafoveal cystic spaces (Figure 2). The left eye also showed internal limiting membrane folds with vitreomacular adhesion. No significant macular edema was noted. Figure 1 Figure 2 Widefield OCT angiography (OCTA) demonstrated extensive peripheral microvascular alterations consistent with a severe ischemic retinopathy (Figure 3). The most striking feature was the presence of large areas of capillary nonperfusion involving the mid- and far-peripheral retina bilaterally. These regions appeared as well-demarcated flow voids on widefield OCTA, indicating significant capillary dropout and retinal ischemia. At the junction of perfusion and nonperfusion, there were multiple abnormal vascular proliferations visualized as bright, irregular, high-flow networks. These frond-like vascular complexes exhibited disorganized branching and looping patterns, characteristic of neovascularization elsewhere.