Blake Fortes, MD
Stein Eye Institute, UCLA, Los Angles, CA
Session 1
The 10th Annual Pacific Retina Club Retina Update kicked off with a session on artificial intelligence, basic science, pathology, and inherited diseases with Dr. Glenn Yiu starting off the day after concluding the day of presentations the day prior. Dr. Yiu discussed the importance of animal models in advancing basic science research for pharmacologic treatments to combat geographic atrophy (GA). He developed an optogenetic RPE photoablation model in mice that is more specific to the RPE and better replicates GA compared to other GA animal models, which can be employed in the future to better study GA.
Dr. Paul Bernstein emphasized the importance of very long chain polyunsaturated fatty acids (VLC-PUFAs), which are difficult to analyze and have historically been ignored. VLC-PUFAs are found exclusively in the retina and testes and are hypothesized to play a critical role in photoreceptor disc integrity. Previously, there were no synthetic sources of VLC-PUFAs until Dr. Bernstein recently developed them and demonstrated their use in animal models. He showed an improvement in visual function including contrast sensitivity, and ERG readings. VLC-PUFAs could play a role as a potential component of a future AREDS3 formulation.
Dr. Deborah Ferrington reviewed the difficulty in studying AMD. For her research, she employed human donor tissue and demonstrated that RPE mitochondria are damaged with AMD. She specifically found that mitochondria are damaged prior to the development of vision loss presenting a possible target for early therapy. She highlighted multiple ongoing clinical trials that are targeting mitochondria as a possible pharmacologic target.
Dr. Marion Munk discussed tuberculosis-associated immune-mediated inflammatory response. She reviewed the spectrum of ocular TB phenotypes like tubercular granuloma, which responds well to therapy, whereas serpiginous-like retinopathy requires continuous immunomodulatory therapy. She hypothesized that this was likely related to molecular mimicry with TB proteins resembling human ocular proteins. She utilized AlphaFold, an AI system, to compare TB proteins and human ocular proteins and demonstrated that structural similarity is capable of triggering an immune response mediated by TLR 2/3 and 4 with IL-12 being the most common interleukin.
Session 2
Session 2 was a pediatric surgery panel moderated by Dr. J. Michael Jumper with a panel consisting of Dr. Philip Ferrone, Dr. Aaron Nagiel, Dr. Cynthia Toth, and Dr. Irena Tsui. They discussed their approach to multiple cases. The first case was a 5-year-old with a unilateral vitreous hemorrhage with no prior trauma who was born full-term. The patient was initially observed and after resolution of vitreous hemorrhage, inferotemporal vascular dragging with peripheral neovascularization and extensive capillary non-perfusion were present. After PRP to the avascular peripheral retina in the affected eye, PRP was performed to the temporal peripheral retina in the unaffected eye as well.
Case 2 was an 11-year-old girl with right exotropia with progressive vision loss over the last 3 years and a significant epiretinal membrane in the right eye. Workup for toxocariasis and neurofibromatosis were negative. Due to the pigmentary change near the fovea, they suspected a possible combined hamartoma of the retina and RPE. Given the progressive vision loss, they recommended pars plana vitrectomy with membrane peel. Patient underwent PPV/MP and did very well.
Case 3 was a 9-year-old highly myopic boy with vision loss in the left eye for four days with a near total rhegmatogenous retinal detachment and vitreous hemorrhage in the left eye. They evaluated for Stickler’s syndrome by looking for cleft lip/palate, Pierre-Robin sequence, and performing genetic testing. Genetic testing confirmed type 1 Stickler syndrome. They recommended a scleral buckle for the affected eye and then discussed their approach for the fellow eye. They recommended prophylactic laser retinopexy with wide treatment from the equator to the ora serrata circumferentially.
Case 4 was an ROP baby born at GA 23 2/7 weeks, BW 540g status post laser at 35 1/7 weeks performed elsewhere. Patient presented still with Stage 3 plus disease. Fill-in laser and anti-VEGF injection was recommended. The patient ended up receiving only fill-in laser, and later started to develop a retinal detachment (Grade 4A). They elected to proceed with lens-sparing vitrectomy with a primary focus on relieving traction on the ridge. Other key principles of the surgery were to avoid at all costs making any breaks and to get very close to structures because the vitreous behaves more like jello compared to the vitreous of adults. Dr. Nagiel also discussed his preference to sit temporal with the infusion cannula nasally and other trocar cannulas temporally to avoid reaching over and hitting the lens. Another critical point in these cases was to place the trocars 1 mm posterior to the limbus. This was a phenomenal panel and the audience was very engaged!