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This report presented the longitudinal optical coherence tomography angiography (OCTA) findings in a patient with malignant hypertension choroidopathy. An 87-year-old woman presented with acute unilateral central vision loss in the setting of hypertensive emergency. Spectral domain optical coherence tomography showed massive serous macular detachment. OCTA revealed extensive flow loss in the neuroretina and choriocapillaris. With blood pressure (BP) normalization and without any ocular intervention, visual acuity recovered on subsequent visits. Flow loss in the neuroretinal capillaries persisted, but significant improvement in the perfusion of the choriocapillaris was observed. This case demonstrates extensive choriocapillaris flow loss in the acute phase of malignant hypertension, and a temporal relationship between BP normalization, improvement of choriocapillaris perfusion, and decrease of subretinal fluid, providing additional insight into the pathophysiology of this life- and sight-threatening systemic condition.

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Purpose: We report the first case of ocular involvement in TEMPI syndrome, a rare disease characterized by telangiectasias, elevated erythropoietin with erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intra-pulmonary shunting. Observations: A 64-year-old Caucasian man with history of TEMPI syndrome presented with subacute bilateral painless vision loss. Ocular examination showed chronic retinal ischemia with microvascular damage, which was likely associated with the chronic systemic hypoxemia, and spontaneous wax and wane of cystoid macular edema, presumedly related to the systemic bortezomib treatment. Conclusions and importance: Our case demonstrates that pathologic retinal vascular changes could be seen in association with TEMPI syndrome and suggests that a comprehensive ophthalmological examination may be beneficial for these patients.

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Bilateral Tessier type 4 craniofacial clefts are extremely rare and disfiguring malformations with vision-threatening ramifications. To date, there is no consensus in the literature with respect to the ideal surgical technique and management of these patients. Emergent eyelid reconstruction and additional procedures may be required to protect the cornea and avoid further ophthalmic and surgical complications. We present our experience and challenges of managing a case of bilateral Tessier type 4 clefting with an emphasis on oculoplastic considerations.

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PURPOSE: To assess how ocular ultrasound findings correlate with clinical parameters of patients with infectious keratitis and concern for endophthalmitis and to evaluate the usefulness of ultrasound in managing these patients. DESIGN: Retrospective study. PARTICIPANTS: Seventy-three eyes of 73 patients with microbial keratitis who underwent ultrasound to evaluate for endophthalmitis were included. METHODS: Ultrasound images were graded in a masked fashion independently by 2 retina specialists. The degree of vitreous opacities, defined as the largest area within the vitreous cavity occupied by opacities on any single image, were categorized as less than 10%, 10% to less than 50%, 50% to 90%, and more than 90%. The diagnosis of endophthalmitis was defined as severe intraocular inflammation that necessitated obtaining an intraocular culture sample and injection of intravitreal antimicrobials. The demographic and clinical characteristics of this patient cohort were compared. MAIN OUTCOME MEASURES: Vitreous opacities measured quantitatively on ocular ultrasound. RESULTS: The incidence of endophthalmitis in our patients with microbial keratitis who underwent ultrasound was 20.5%. Corneal and intraocular cultures showed positive results in 66.7% and 26.7% of endophthalmitis patients, respectively. A 4-fold increase in the likelihood of treatment for endophthalmitis was observed with increasing vitreous opacity severity (odds ratio, 3.97; confidence interval, 1.9-8.5; P < 0.0001). Endophthalmitis was associated with 50% or more vitreous opacities (P < 0.001), older age (P < 0.001), pseudophakia (P = 0.001), and hypopyon height (P < 0.001). Eye pain, eyelid edema, poor presenting visual acuity, larger corneal ulcer diameter, and causative organisms were not associated with endophthalmitis. CONCLUSIONS: Patients with more severe vitreous opacities on ultrasound were more likely to be treated for endophthalmitis. Patients with microbial keratitis, who were older and pseudophakic, were prone to have more severe vitreous opacities.

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