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A Call to Improve Ocular Morbidity During Inpatient Psychiatric Stays

Kamal Gupta

Jennifer Aye, DO – Resident , Beaumont Health

Cole Richardson, DO – Ophthalmology Resident, Beaumont Hospital, Taylor

Marla Price

Himanshu Aggarwal


Ulcerative Bacterial keratitis is an infection of the cornea hallmarked by an epithelial defect with an associated infiltrate and can include; conjunctival injection, tearing, ocular pain, discharge, corneal edema and loss of vision. When there is additional corneal thinning it is considered a corneal ulcer. Corneal ulcers can cause scarring, perforation, endophthalmitis, and even loss of the eye. The incidence of yearly cases of corneal ulcers is estimated to be between 30,000-75,000. Risk factors for developing corneal ulcers include; contact lens wear, trauma, ocular surface disease, and bullous keratopathy. We are presenting a classic case of Pseudomonas aerginosa corneal ulcer secondary to contact lens misuse that occurred during an inpatient stay. We discuss the epidemiology and cost of bacterial corneal ulcers, and the implications this case has on improving ocular morbidity during inpatient stays.



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A Case of Serous Macular Detachment as a Result of Herpes Zoster Ophthalmicus

Michael de Guzman, DO – Administrative Chief Resident, Ophthalmology, St. John's Episcopal Hospital


Title: A Case of Serous Macular Detachment as a Result of Herpes Zoster Ophthalmicus Author: Michael de Guzman, D.O. St. John’s Episcopal Hospital, Department of Ophthalmology, Far Rockaway, NY 11691 Introduction: A serous macular detachment describes a condition where there’s a development of a well-circumscribed serous detachment of the sensory retina. This is characterized by an accumulation of subneural retinal fluid in the macular region causing separation between the retinal pigment epithelium and the underlying choroid. The most common symptoms are unilateral blurred vision, metamorphopsia, and micropsia. This is typically known to occur primarily in idiopathic, macular degenerative, malignant, or autoimmune cases. In a thorough literature search, there has not been a clear correlation between herpes zoster ophthalmicus and serous macular detachment. I believe this to be one rare case, as my patient’s vision and macular fluid improved after aggressively treating his zoster infection, but subsequently recurred after discontinuing treatment. Case Description: A 29-year-old male with a history of congenital HIV was consulted for herpes zoster ophthalmicus of the right eye. Upon examination, the patient’s visual acuity (VA) was 20/30 and had multiple vesicular lesions along the CN V1 dermatome with a normal appearing fundus. He was admitted for intravenous treatment. In the ensuing days, he complained of blurry vision and metamorphopsia. Exam showed worsening VA and new macular fluid. Acyclovir was increased to 15mg/kg (from 10 mg/kg) q8 hours. VA improved the next day and by discharge on hospital day #9, VA was 20/40 with an absence of macular fluid. The patient was not discharged on oral Acyclovir. At follow-up six days later, the VA was 20/70 with return of macular fluid. OCT confirmed serous macular detachment. He was referred to the retina service but was lost to follow-up. Discussion: The patient had a serous macular detachment which improved with aggressive IV Acyclovir treatment but subsequently recurred once treatment discontinued. In my literature search there have been few cases which correlate herpes zoster ophthalmicus with serous macular detachment and believe this to be one rare case



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A Case of Systemic Sclerosis / Lupus Overlap Syndrome Presenting with Bilateral Cotton Wool Spots

Caleb Liles, OMS-III – Medical Student, Ohio University Heritage College of Osteopathic Medicine

Chase Warner

Ronald Warwar


Purpose: Systemic sclerosis (SSc) is characterized by multi-system inflammation and fibrosis. Ophthalmologists must be aware of the uncommon ocular features of SSc to secure the diagnosis. Observations: Here we report the rare occurrence of bilateral cotton wool spots in an 86-year-old woman with SSc/lupus overlap syndrome presenting with a history of chronic obstructive pulmonary disease, gastroesophageal reflux disease, polymyalgia rheumatica, scalp tenderness, and right jaw pain on chewing. Fundoscopy showed diffuse bilateral cotton wool spots that prompted the diagnosis of SSc/lupus overlap syndrome. Conclusions: The confluence of patient symptoms was disguised as separate diseases, but the funduscopic finding of cotton wool spots in a patient without known risk factors prompted further investigation and the correct diagnosis. She was started on immunosuppressant therapy but died four months later. Importance: The differential diagnosis for bilateral cotton wool spots should include autoimmune processes such as SSc and systemic lupus erythematosus and may represent an early sign that can help direct early treatment. Keywords: Cotton wool spots; systemic lupus erythematosus; systemic sclerosis; overlap syndrome



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A novel ferrochelatase inhibitor decreases murine laser-induced choroidal neovascularization

Nathan Lambert-Cheatham, DO – 2019-2020 Research Fellow, Eugene and Marilyn Glick Eye Institute

Seung-Yong Yeo

Bomina Park

Sheik Pran Babu Sardar Pasha

Bit Lee

Sydney Waller

Sangil Kwon

Tim Corson


Pathologic neovascularization is a cause of vision deterioration and blindness in many common eye diseases such as age related macular degeneration and diabetic retinopathy. First line treatment in these cases usually involves vascular endothelial growth factor (VEGF) inhibitor injections. Anti-VEGF therapy has greatly improved patient outcomes. Still, there are many patient’s that are refractory to anti-VEGF treatment. This demonstrates the need for new therapeutic options to improve patient outcomes. In this poster you will see a preclinical model, known as the laser-induced choroidal neovascularization (L-CNV) model, used to evaluate a new antiangiogenic compound. By using an argon laser, this model creates pathologic neovascularization similar to that seen in patients. These lesions can then be evaluated using various modes of imaging (OCT, fundus photography, FA, IHC vascular staining). Here the compound being evaluated is a novel ferrochelatase inhibitor, SH-17023. It is demonstrated that SH-17023 administered by intravitreal injection reduces choroidal neovascularization in a murine L-CNV model.



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Aberrant Regeneration of Cranial Nerve Three Following Schwannoma Resection

Marla Price

Pauline Chen, DO – Ophthalmology Resident, Beaumont Health- Taylor

Robert Beaulieu

Evan Black


A rare case of aberrant regeneration of a third nerve palsy in the absence of ischemic, aneurysmal, or traumatic etiology. Very rarely, a schwannoma can occur as a compressive lesion in the cavernous sinus with minimal clinical signs and symptoms of oculomotor nerve involvement. We describe a case of a 21-year-old female who presented with a complete pupil-involving third nerve palsy after resection of a cavernous sinus schwannoma secondary to Neurofibromatosis Type 2. Furthermore, patient later developed aberrant regeneration of the inferior division of the third nerve to the levator palpebrae superioris. She presented with signs of aberrant regeneration manifesting as Pseudo-Von Graefe’s sign. Pseudo-Von Graefe’s sign is paradoxical eyelid opening with attempted downgaze, the result of the nerve associated with the inferior rectus subnuclei being misdirected to the levator palpebrae. Preservation of third nerve function following tumor resection can be difficult as the distortion of the normal anatomy and intimate involvement of the nerve with tumor. Oculomotor nerve reconstruction can serve both functional and cosmetic purposes. Theoretical correction of this situation could be obtained with strabismus surgery to place the left eye in primary position, followed by a frontalis sling with an intact frontalis muscle and facial nerve function. This case highlights how oculoplastic reconstruction can be useful in cases of aberrant regeneration following surgical resection of schwannomas involving the oculomotor nerve.



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Acute Blindness of Pregnancy

Wesley Pace, DO – Resident, St. Johns Episcopal Hospital

David Kirsch


This poster presents a particular case in which a patient developed presumed posterior reversible encephalopathy syndrome (PRES) in addition to discussing the diagnosis' pertinent clinical findings, criteria, and treatment as well as outcomes of this particular encounter.



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An Unusual Presentation of Large B-cell Lymphoma

Joel Robinette – Medical Student, West Virginia School of Osteopathic Medicine

Chris White


Primary Non-Hodgkin's lymphoma of the lacrimal sac is extremely rare. Symptoms are usually atypical and nonspecific, which often leads to the original misdiagnosis of dacryocystitis. The most common presenting features are epiphora, swelling, and acute dacryocystitis. We present a case of a 67-year-old female with primary diffuse large B-cell lymphoma (DLBCL) of the lacrimal sac, which was originally diagnosed as dacryocystitis. This case report adds to the urgency that prompt and precise diagnosis and treatment is key.



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BAM - Beacon Aqueous Microshunt – A Novel Way to Treat Glaucoma: Case Report

Patrick Spencer

Garrett Rota

Craig Mitcham

Omar Saeed, MPH – Student, Ohio University Heritage College of Osteopathic medicine


The Beacon Aqueous Microshunt (BAM) is an investigational, ab externo, Minimally Invasive Glaucoma Surgery (MIGS) implant manufactured by MicroOptx (Maple Grove, MN). The implant is inserted superiorly at the limbus to direct outflow of aqueous humor (AH) from the anterior chamber to the tear film, with the intent of reducing intraocular pressure (IOP). The implant utilizes a polyethylene glycol (PEG) hydrogel channel to shunt AH. The diameter of the channel is engineered to specific calculations to provide controlled-outflow resistance of AH for optimal IOP reduction. The PEG hydrogel material is considered the gold standard for anti-biofouling polymers, preventing protein adsorption and bacterial attachment. The BAM is currently in pre-market clinical investigations in US and Europe. We treated the left eye of a 48-year-old male with refractory glaucoma. Medical history included POAG OU for 10 years and inactive pigmentary glaucoma OS on Pilocarpine OU, Vyzulta OU, Ripasudil OU, Combigan OU. Surgical history included Canaloplasty converted to Trabeculectomy OD; SLT OU X2; Laser PI OD; Micropulse CPC OU X3. Patient consented to the implant procedure, and the BAM was implanted at 12 o’clock position without complications. Flow through the channel was confirmed by Seidel’s test. Preop IOP (medicated) was lowered from 33 mmHg to 12mmHg without medications at both 3- and 6-months postop. Tear film, measured by Schirmer’s Tear Test, increased from 17 mm/5min at baseline to 35 mm/5 min and 26 mm/5 min at 3- and 6-months, respectively. No complications have occurred. Potential risks include device blockage, infection, possible foreign body sensation, and hypotony. Benefits of BAM include no bleb; ease of implantation and device removal (if needed); ease at assessing channel functionality by Seidel’s Test; and stand-alone procedure. of surgery for glaucoma. In our patient with refractory glaucoma, BAM safely provided significant IOP reduction, discontinuation of medication, and increased tear film.



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Characterization of Pachychoroid Spectrum Disorders with Swept Source Optical Coherence Tomography Angiography

Joud Chamchikh

Moises Enghelberg, DO – Medical and Vitreoretinal Surgery Fellow, Loma Linda University, Department of Ophthalmology

KV Chalam


Objective: To describe the imaging characteristics in patient with pachycdhoroidal disorders with high resolution swept source optical coherence tomograpraphy angiography and be able to compare the results with the established standard of care and diagnosis such as indocyanine green angiography (ICGA). Methods: This is a prospective, observational study analyzing the data from patients examined by the retina service at Loma Linda University Eye Institute with an ophthalmological history consistent with pachychoroidal disease. Four patients were identified to have ophthalmoscopic findings consistent with IPCV and spectrum disorders. Imaging was obtained using the PlexLite Elite Swept Source Optical Coherence Tomography Angiography. Montage images were obtained taking advantage of the device unique capabilities. 12mmx12mm images were captured. The caliper tool was used to measure the caliber of the choroidal vessels within the imaged area. Results: Among the 4 patients, the mean (standard deviation) patient age was 57.75 (SD +/- 18.17) years. 3 men and 1 female were selected. Clear images of the polypoidal structures were obtained in 3 cases. The mean size of the pigment epithelial detachment (PED) in patients was 832.22 (+/- 582.42) μm. The mean size of the choroidal vessels (CV) in the aforementioned patient group was 481.33 (184.69) μm. In patients presenting with neurosensory detachments (ND), the mean widest base diameter of the detached area was 3988 (+/- 2471.77) μm. The mean size of the CV beneath the area of ND was 389.25 (51.9) μm. The mean value of the CV in the non involved fellow eye was 298.3 (SD +/- 51.87) μm. Using the flow map function PEDs presented profound flow void. All patients presented with disruption of the choriocapillaris. Conclusions: In patients with pachychoroidal disease and specifically IPCV presenting with PED there is an increase in caliber of the external choroidal vessels. Patients presenting with PEDs consistently presented with changes in the perfusion flow map surrounding the PED. Polyps were easily identified beneath the PED area obviating the need for ICG. Regardless of the presentation of the disease in the IPCV and pachychoroid spectrum, there was disruption of the choriocapillaris.



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Effect of Oral Re-esterified Omega-3s on Dry Eyes

Eric Donnenfeld

David Kirsch

Alice Epitropoulos

Zubin Shah, DO, MPH – Physician Resident, St. John's Episcopal Hospital

Edward Holland


Purpose: To assess the effect of oral re-esterified omega-3 fatty acids on tear osmolarity, matrix metalloproteinase-9 (MMP-9), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), fluorescein corneal staining, Schirmer score, meibomian gland dysfunction (MGD) stage and omega-3 index in subjects with dry eyes and confirmed MGD. Methods: This was a multicenter, prospective, interventional, placebo-controlled, double-masked study. Subjects were randomized to receive 4 softgels containing a total of 1680 mg of eicosapentaenoic acid/560 mg of docosahexaenoic acid or a control of 3136 mg of linoleic acid, daily for 12 weeks. Subjects were measured at baseline, week 6, and week 12 for tear osmolarity, TBUT, OSDI, fluorescein corneal staining, and Schirmer test with anesthesia. MMP-9 testing and omega-3 index were done at baseline and at 12 weeks. Results: One hundred five subjects completed the study. They were randomized to omega-3 (n = 54) and control group (n = 51). Statistically significant reduction in tear osmolarity was observed in the omega-3 group versus control group at week 6 (−16.8 ± 2.6 vs. −9.0 ± 2.7 mOsm/L, P = 0.042) and week 12 (−19.4 ± 2.7 vs. −8.3 ± 2.8 mOsm/L, P = 0.004). At 12 weeks, a statistically significant increase in omega-3 index levels (P < 0.001) and TBUT (3.5 ± 0.5 s vs. 1.2 ± 0.5 s, P = 0.002) was also observed. Omega-3 group experienced a significant reduction in MMP-9 positivity versus control group (67.9% vs. 35.0%, P = 0.024) and OSDI scores decreased significantly in omega-3 (−17.0 ± 2.6) versus control group (−5.0 ± 2.7, P = 0.002). Conclusions: Oral consumption of re-esterified omega-3 fatty acids is associated with statistically significant improvement in tear osmolarity, omega-3 index levels, TBUT, MMP-9, and OSDI symptom scores.



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Gonococcal Conjunctivitis

Marla Price

Anju Aggarwal

Matthew Fullmer, DO – Resident PGY2, Beaumont Hospital


Conjunctivitis caused by the organism neisseria gonorrhoeae is considered rare outside of neonatal populations. We will present a case report of a 23 year old male contact lens user presenting with gonococcal conjunctivitis this case will be discussed along with course and treatment of the disease. Gonococcal conjunctivitis usually presents with severe eyelid edema, conjunctival injection/chemosis, and hyperacute purulent discharge. It can also develop more severe complications such as: uveitis, keratitis, and corneal ulceration/perforation. The incubation period for exposure to ocular symptoms varies from 3 to 19 days. In this case our patient visited the Emergency Department with bilateral eye redness and purulent discharge for the last 3 days and was diagnosed with bacterial conjunctivitis. He was sent home on moxifloxacin three times daily with instructions to follow up with ophthalmology. The Patient was next seen 2 weeks later in the ED for increased symptoms and this time also admitted to urethral discharge. He was seen by ophthalmology in the ED and prevalent testing included conjunctival scrapings/discharge sent for culture/gram stain/sensitivities and Gonococcal/chlamydial DNA probe. Azithromycin IM injection, Ceftriaxone IV, and Moxifloxacin topical eye drops were all started on the Patient and he was admitted to the hospital. The Patient had a successful treatment for culture positive Gonococcal conjunctivitis, and after 3 days of IV antibiotics was discharged on oral/topical treatment. Many cases of acute bacterial conjunctivitis are self-limited and will clear within 10 days without treatment. However, there are cases caused by more virulent organisms, which if not treated may cause severe damage, including neisseria gonorrhoeae. Bacterial conjunctivitis if severe, recalcitrant, or recurrent, should be cultured and treated accordingly. Antibiotics should be started empirically and then adjusted according to culture sensitivity testing. Follow up daily until significant improvement is seen, and then every 2-3 days until resolved.



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Monocular HIV patient with Progressive Outer Retinal Necrosis

David Kirsch

Brittany DeNaro, DO – Brittany DeNaro, St John's Episcopal Hospital


Necrotizing herpetic retinopathy is a sight-threating disease that affects immunocompetent and immunocompromised patients alike. Acute retinal necrosis (ARN) and progressive outer retina necrosis (PORN) are two forms of destructive, rapidly progressing necrotizing herpetic retinopathy that represent reactivation of a latent VZV or HSV infection.1 These two forms of retinopathy differ in patient population affected and inflammatory response. PORN is the second most frequent opportunistic retinal infection in patients suffering from AIDS.3. This diagnosis must be recognized immediately and treated promptly in order to preserve visual function. Due to the aggressive nature of the disease, these forms are best treated with IV antivirals and intravitreal injections. Fundus photos should be taken at diagnosis and throughout the treatment course to properly assess and evaluate clinical improvement.



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Ocular Manifestation of Neuroendocrine Carcinoma- Iris Metastasis

Shayma Jawad, DO – Ophthalmology Resident, Beaumont Health

Anju Aggarwal

Marla Price

Himanshu Aggarwal


Introduction: Ocular metastasis from systemic carcinomas most commonly occurs in the choroid while iris metastasis is rare. Breast and lung are the most common primary sites. Background: We report a case of a patient with iris metastasis as the initial manifestation of a systemic cancer: neuroendocrine carcinoma of the lung. Case Presentation: A 52 year-old African-American gentleman with past medical history of HTN, 53 pack-year smoking history, and Asthma presented with left eye pain, blurred vision, and episodes of vision loss. His vision on initial examination was 20/25 in the left eye. Slit lamp examination demonstrated multiple fan-shaped atypical iris masses and significant inflammation in the anterior chamber. His IOP was normal at first visit. He admitted to unintentional weight loss in the past 6 months and coughing for the past year. A CT chest demonstrated invasion of the mediastinum and to major blood vessels. After extensive work-up by oncology and histopathological examination of his lung biopsy, he was diagnosed with a poorly differentiated neuroendocrine carcinoma of the lung with extensive metastasis into the brain, adrenal glands, and spine. He was treated with one cycle of carboplatin/VP-16 chemotherapy. At ocular examination three months later, he subsequently developed elevated intraocular pressure and a choroidal effusion. His systemic condition deteriorated rapidly thereafter and lead to his death in the16th week after initial presentation. Conclusion: Iris involvement is a rare site for metastasis. In the literature, common ocular complications can occur including uveitis, spontaneous hyphemas, neovascularization, secondary angle closure, and refractory glaucoma. A red eye with acute iritis and atypical iris lesions should be considered a possible initial manifestation of an underlying malignancy. We recommend a comprehensive evaluation by an oncologist for systemic malignancies. Prognosis is poor with most patients surviving less than twelve months.



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Outcomes of Quarterly Anti-VEGF Dosing for nAMD Management in Real-World Clinical Practice

Charles Wykoff

Tien Wong

Alexander Rusakevich – OMSI, Touro University - California / College of Osteopathic Medicine

Brenda Zhou


Purpose: Quarterly dosing with intravitreal anti-vascular endothelial growth factor (VEGF) injections (QD) is a common approach to managing eyes with neovascular age related macular degeneration (nAMD). Prospective treat-and-extend trials report that 22-40% of patients achieve an interval of >10 weeks between retreatments. The current study retrospectively evaluated outcomes of QD for nAMD. Methods: Records of 6,809 nAMD patients receiving injections from 2005 through 2017 within a large, urban retina practice were reviewed to identify those who received ≥5 consecutive injections intentionally at intervals of 11 to 15 weeks, defined as QD. Documented reason(s) for transition to and from QD were collected along with visual acuity (VA) in Snellen fractions at date of nAMD diagnosis, initiation and termination of QD, and final visit. VA was converted to approximate Early Treatment Diabetic Retinopathy Study (ETDRS) letter equivalent, and changes in VA were analyzed using Student’s T-tests and ANOVA. Results: 150 eyes from 134 patients received a mean 9.8 injections (range 5-29) over a mean of 29 months (range 12-98) during QD. Mean VA increased from nAMD diagnosis to initiation of QD (51 to 55 letters), then decreased to final visit or termination of QD (55 to 51 letters), with no significant change in VA from diagnosis to final visit or termination of QD (p=0.03). 91 (61%) eyes were maintained on QD through the final visit, while 59 (39%) stopped receiving QD and were either treated more frequently (35 eyes, 59%) most commonly due to increased exudative disease activity, or intentionally stopped receiving treatment (24 eyes, 41%) most commonly due to apparent disease inactivity. Of the 24 eyes observed following QD for a mean of 30 months of follow-up, 9 (38%) eyes had recurrent exudative activity after a mean of 23 months (range 6-58) and were re-initiated on anti-VEGF treatment following a mean 8-letter loss relative to VA at the time of QD termination (p=0.03). Conclusions: In the current, real-world analysis of QD for 150 eyes with nAMD, 39% of patients stopped receiving QD, most (59%) transitioned to more frequent dosing due to increased exudative disease activity. While 24 stopped QD due to disease inactivity, 38% of these re-initiated anti-VEGF dosing due to eventual recurrent disease activity. Patients managed with quarterly anti-VEGF intravitreal treatments require consistent long-term clinical care.



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Reticular corneal edema in eyes treated with Netarsudil: A Case Series

Arsham Sheybani

David Godfrey

Khaled Moumneh, MS – OMS-III, Touro College of Osteopathic Medicine - Harlem

Davinder Grover

Ronald Fellman


This is a descriptive case series of three patients with uncontrolled intraocular pressure that developed reticular corneal changes after initiating Netarsudil (0.02%). In all cases, upon observing reticular corneal edema, netarsudil (0.02%) was stopped followed by disappearance of corneal honeycombing. With the increasing use of this novel glaucoma medication, potentially more rare side effects will be observed. Reticular corneal edema or corneal honeycombing is an ocular exam finding that can rarely occur after initiating netarsudil (0.02%) regardless of prior corneal edema status. In our experience, the reticular changes resolve upon cessation of netarsudil.



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You can't always trust the bloodwork

Cole Richardson, DO – Ophthalmology Resident, Beaumont Hospital, Taylor

Jennifer Aye

Himanshu Aggarwal


Acute retinal necrosis, ARN, is a rare inflammatory condition hallmarked by uveitis, retinal periarteritis, followed by diffuse necrotizing retinitis and possible retinal detachment. The herpes-virus family is typically the cause of acute retinal necrosis. The incidence of the disease is .5-.63 cases per one million. ARN is a devastating ocular disease with half of patient’s visual acuity at 6 months 20/200 or worse. The patient presented to the emergency department with decreased vision, ocular pain, photophobia and mild tearing. The patient had an initial visual acuity of 20/30, intraocular pressure of 29, 3+ injection, 4+ cell, inferior keratitic precipitates, disc edema, mild vitritis, and patchy white dots inferiorly and temporally. The patient had multiple infectious and inflammatory markers drawn including HSV, CMV, HIV, and VZV and had a MRI brain and orbit. The patient was started on IV acyclovir 10 mg/kg daily, prednisone eye drops and cyclogyl. The patient was followed daily while inpatient with no positive lab markers except for VZV IgG. Once discharged, the patient was noted to have diffuse retinal whitening and was diagnosed with positive VZV aqueous PCR tap from the anterior chamber. The patient later went on to develop a retinal detachment with the need to surgery. Due to the limited number of cases, there is poor evidence of standard of care, which is currently based on case reports. Most patients will be started on IV antivirals, and some patients need additional medications including intravitreal injections. Our patient experienced similar symptoms as described in other case reports, however, more clinical information is needed to justify current standard of care. 70% of untreated patients will go on to develop bilateral ARN. Early ophthalmic intervention is needed for aqueous PCR for proper treatment, including IV or PO antivirals with or without intravitreal injections, to reduce ocular morbidity.



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Acute Calcific Longus Colli Tendonitis: A Unique Source of Dysphagia

Kevin Blume, DO – Otolaryngology and Facial Plastic Surgery PGY4, McLaren Health Care Macomb

Michael Sherbin

David Demello


Our case of Acute Calcific Longus Colli Tendonitis (ACLCT) provides an example of a rare condition that could easily be misdiagnosed as a retropharyngeal abscess. The goal of our poster demonstration is to raise awareness of this pathology in order to prevent unnecessary surgical intervention and potential morbidity. These patients can present similarly to patients with a retropharyngeal abscess: neck pain, limited range of neck motion, odynophagia, dysphagia, fever, and leukocystosis. Therefore, the diagnosis of ACLCT must be made with a CT of the neck with contrast. The calcium deposits are often localized in the superior oblique fibers of the longus colli muscle from C1-C2. MRI of the neck with contrast can aid in the diagnosis to demonstrate an effusion without rim enhancement with a T2 weighted image. After making the diagnosis of ACLCT, conservative treatment in the form of a short course of corticosteroids and oral NSAIDs can commence. Our patient’s symptoms resolved within a matter of days and avoided unnecessary surgery.



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Collision Tumor in the Pituitary: Concurrent Pituitary Adenoma and Craniopharyngioma

Bryan Figueroa

Devin Mistry

Connor Kerndt, BS – Resident Physician, Michigan State College of Osteopathic Medicine

Trevor Nessel

Zaid Shareef, BS – Medical Student, Michigan State University College of Osteopathic Medicine


Introduction: Collision tumors are two independent, histological distinct tumors occupying the same anatomical space. To date, only fifteen cases of pituitary adenoma-craniopharyngioma collision tumors have been identified, thus presentations are poorly-defined. We present a case of pituitary adenoma-craniopharyngioma(PAC) collision tumor presenting with hemianopsia. Case Presentation: A 60-year-old with a past history of a non-secretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. The patient was subsequently lost to follow-up without surveillance. An MRI was ordered for concern of recurrence, given his previous history and worsening neurologic complaints. MRI revealed a 3.0cm suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical team elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma. Discussion: PAC collision tumors are remarkably rare tumors, especially the adamantinomatous(AD) subtype in an adult patient. Diagnosis of collision tumor depends on histologic findings as imaging frequently cannot delineate. The current paradigm presumes the AD-subtype inflicts children as an embryonic remnant of Rathke’s pouch while the papillary subtype arises in adults from metaplasia. This case deviates from this conjecture as previous MRI and tumor resection shows no evidence of craniopharyngioma.



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Lymphoepithelial Carcinoma of the Parotid Gland with Facial Nerve Paralysis

Eric Sugihara

Aileen Kerns, BS, DO – ENT/Head & Neck Surgery Resident, Detroit Medical Center

Noah Stern

Sambasiva Bathula


Lymphoepithelial carcinoma is a rare salivary gland tumor and is typically associated with Epstein-Barr Virus. We present a rare case of a 50-year-old African-American woman with a rapidly growing parotid mass with facial nerve paralysis and ipsilateral neck metastatic disease. She was surgically managed with radical parotidectomy, facial nerve sacrifice, and ipsilateral selective neck dissection. Pathology revealed sheets of epithelioid cells with nuclear enlargement, pleomorphism, and marked infiltration of lymphoid cells in the stroma, consistent with a lymphoepithelial carcinoma. She underwent adjuvant concurrent chemoradiotherapy. Incidentally, she also had Papillary carcinoma which was removed with a right hemithyroidectomy at the time of her parotid surgery. She demonstrated no evidence of disease out to 12 months follow up. To our knowledge, this is the first case of lymphoepithelial carcinoma reported in an African-American patient. The patient had atypical features with Epstein-Barr Virus negative pathology and facial nerve paralysis.



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Mammary Analogue Secretory Carcinoma of the Submandibular Gland: A Case Report

Zachary Kranz – Medical Student, Michigan State University College of Osteopathic Medicine

Shant Korkigian

Christine Lepoudre

Jake Sims


Background: Secretory Carcinoma (SC), originally named mammary analogue secretory carcinoma (MASC), of salivary glands was first described by Skalova et al. and was found to be histologically identical to its counterpart in the breast. Both secretory carcinoma (SC) of the breast and SC of salivary glands have been shown to have the genetic alteration of t(12;15) (p13;q25) which leads to an ETV6-NTRK3 fusion protein and subsequent chimeric tyrosine kinase activation. This tumor is typically low-grade with potential for high grade transformation. We report a case with a high-grade MASC of the submandibular gland and a review of literature. Case Report: A 67-year-old male presented with a chronic right sided neck mass and salivary gland pain. Computed Tomography findings were consistent with enlarged right submandibular gland with surrounding lymphadenopathy. Excision of right submandibular gland with right selective level I neck dissection was performed secondary to intra-operative findings. Pathology results post-surgery revealed extension into surrounding skeletal muscle, perineural invasion, focal positive DOG1 expression, and positive for mucin, mammaglobin, and S100. Patient was recommended to undergo adjuvant radiotherapy post-op. Conclusion: Multiple immunochemical studies are used to confirm MASC and rule out other low-grade malignant salivary gland neoplasms. High-grade transformations and submandibular cases of MASC are uncommon. More research needs to be done to look at optimal treatment of high-grade transformation of submandibular MASC.



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