Da Meng, MD PhD
Mass Eye and Ear, Boston, MA
ACRC Trainee Session 1
Session 1 of the trainee mystery cases started with Dr. Rolika Bansal, an oncology fellow from Wills, who presented a case of choroidal metastasis from breast cancer with an excellent response to abemaciclib/fulvestrant. This was followed by Dr. Cong Phan, a resident from Dartmouth, who presented a patient with Loeys-Dietz Syndrome with retinal detachment in one eye requiring multiple surgeries, followed by multifocal choroiditis complicated by CNVM in the fellow eye. Dr. Freund and others from the audience raised the important point that multifocal choroiditis is a typical presentation of sympathetic ophthalmia which is likely in this patient given the history.
Dr. Anne Caldwell, a resident from University of Colorado, then presented a case of progressive subretinal fibrosis and uveitis originally described by Dr. Palestine, who is a co-author on this presentation. The audience commented that this is likely a rare form of multifocal choroiditis with subretinal fibrosis. This was followed by Dr. David Fell, a fellow from Tufts/OCB, who presented a case of lipemia retinalis.
Dr. Sidra Zafar, a resident from Wilmer, then shared a case of orbital and choroidal B cell lymphoma presenting with unilateral exudative retinal detachment and choroidal folds. Drs. Pulido and Jampol commented on the importance of further differentiating subtypes of B cell lymphoma with molecular markers given the board spectrum of diseases and their differential responses to treatments. This was followed by Dr. Jonathan Noonan, a fellow from Columbia. He presented a case of bilateral retinal vasculitis likely secondary to a systemic inflammatory process given evidence of cerebral vasculitis on MRI, possibly GPA.
Dr. Jennifer Hu, a fellow from Mass Eye and Ear, shared a case of frosted branch angiitis, a nonocclusive venular involving vasculitis. A presumed viral illness was thought to be the inciting incident, and the vasculitis resolved after systemic steroids. Next up was Dr. Rusdeep Mundae, a fellow from Vitreous Retina Macula Consultants of New York. He presented a case of intra-scleral Miragel remnants causing scleral perforation. Dr. Shields and others in the audience made the diagnosis as soon as the history of RD repair in the 1980s was revealed.
This was followed by Dr. Jeanette Du, a fellow from the Retina Group of Washington, who shared a case of rifabutin associated uveitis. She and the panelists emphasized that the associated segmental retinal arteritis is a nonspecific finding that can also be seen in other uveitic entities. Last but not the least, Dr. Ahsan Hussain, a fellow from Boston University, presented a case of Bing-Neel syndrome, a rare presentation of Waldenstorm’s macroglobulinemia presenting as unilateral disc edema and optic nerve enhancement.
ACRC Trainee Session 4
Dr. Bita Momenaei, a research fellow from Wills, started off the session with a case of retinal achromic patches likely from tuberous sclerosis complex (TSC). Dr. Shields emphasized that TSC must be ruled out if punched out RPE lesions classic of retinal achromic patches are present in a child. This was followed by Dr. Tommaso Bacci from University of Siena, Italy, who shared a case of Erdheim-Chester disease with areas of choroidal hypopigmentation.
Dr. Mellisa Yuan, a resident from Mass Eye and Ear, presented an interesting case of unilateral peripheral nonperfusion and exudation consistent with atypical IRVAN that responded well to laser treatment. Drs. Jampol, Shields and Yannuzzi commented that Coats disease is also likely, but the management would have been the same. Next up was Dr. Samuel Gelnick, a fellow from SUNY Downstate, who presented a case of leukemic retinopathy with concurrent malaria.
Dr. Suveera Dang, a fellow from Northwestern, shared a case of Pseudoxanthoma Elasticum with secondary MEWDS. Dr. Pulido arrived at the diagnosis immediately when the comet lesions were shown on fundus autofluorescence. Next up, Dr. Bivek Wagle, a resident from Ohio State, presented a case of posterior segment cysticercosis treated with laser and cryo with excellent response. Dr. Yannuzzi was fascinated by the associated occlusive vasculitis, which has not previously been reported in the literature.
This was followed by Dr. Meredith Spitz from Geisinger Eye Institute. She presented a case of paraneoplastic autoimmune retinopathy with positive anti-pyruvate kinase M2 antibody. Dr. Jampol cautioned against using autoantibodies other than anti-recoverin to diagnose autoimmune retinopathy given they are commonly detected in healthy population, while Dr. Pulido commented that anti-pyruvate kinase antibody could indeed be a specific marker. Rounding out this session, Dr. Arjun Watane from Yale presented a case of hyperreflective choroidal lesion with finger-like projections in a stellate configuration consistent with stellate multiform amelanotic choroidopathy (SMACH), a newly described disease entity by Drs. Jampol and Freund.
