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Moderator
Sangeeta Abrol, MS, MPH, MBA
Panelists
Scott L. Geller, MD, ABO; Sung Min Kim, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Zachary Wiley, MD
Purpose
Retinal-scleral signaling likely plays a key role in controlling eye size. Mutations in IRBP, the most abundant protein of the extracellular matrix separating the retina from the RPE/choroid, is associated with inherited high myopia (Georgiou et al, 2025). To explore the mechanism behind this finding, we created an IRBP in a rodent model.
Methods
The IRBP gene was disrupted in albino Sprague Dawley rats using CRISPR-Cas9 genome editing. Animals were subsequently backcrossed to generate homozygous knockout lines. Retinal function was assessed by electroretinography (ERG). Ocular tissues were evaluated by histology, retinal morphometrics, and immunohistochemistry following multiple preservation protocols, including 10% formalin with paraffin embedding, freeze substitution, and glutaraldehyde/epon embedding for electron microscopy. Globe volume was determined by direct weighing of excised globes on an analytical scale, while overall ocular size was measured by laser micrometry. Corneal curvature was assessed by radial keratometry.
Results
ERG and histopathology demonstrate progressive photoreceptor degeneration with relative preservation of the inner nuclear layer. Immunohistochemistry confirmed absence of IRBP expression in knockouts. Electron microscopy revealed disrupted outer segments. Enucleated eyes from IRBP(−/−) rats weighed more than controls in both sexes, without changes in body weight. Laser micrometry showed increased globe size and axial length in knockouts, independent of body weight. Corneal keratometry revealed no significant curvature differences compared to wild type.
Conclusion
IRBP knockout increased globe size. Although the mechanism is not clear, given the importance of retinal signaling in maintaining emmetropia, we speculate that IRBP—strategically positioned at the retina–RPE/choroidal interface—may facilitate the transport of signaling molecules from the retina to drive scleral extracellular matrix remodeling.
Presenting Author
Sayuri Sekimitsu, MD
Co-Authors
Srujay Pandiri (BA), Celine Chaaya (MD), Ryan Meshkin (MD), Thomas Dohlman (MD), Nimesh Patel (MD)
Purpose
To describe the visual, anatomical, and vitreoretinal (VR) outcomes following Boston Keratoprosthesis (BKpro) type I and type II implantation.
Methods
A retrospective chart review was conducted of BKpro surgeries at Massachusetts Eye and Ear between May 2016 and November 2024.
Results
91 eyes from 89 patients (mean age: 67.9 ± 16.5 years) were analyzed. Type I BKpros (80.2%) were more common than type II (19.8%). Median duration of follow-up was 37.5 months (IQR: 16.9-67.7). VR complications were noted in 61.5% of eyes—64.3% in type I and 50.0% in type II. Complications include retroprosthetic membrane (8.28 events/100 years), epiretinal membrane (6.62/100 eye-years), endophthalmitis (5.24/100 eye-years), retinal detachment (4.42/100 eye-years), cystoid macular edema (4.42/100 eye-years), vitreous hemorrhage (3.59/100 eye-years) vitritis (2.48/100 eye-years) and choroidal hemorrhage (0.83/100 eye-years). Of those with VR complications, 82% had one occur in the first year.
Conclusion
Both type I and type II BKpros demonstrated improved visual acuity. However, vitreoretinal complication rates are high, particularly in the first year, suggesting a need for close multidisciplinary monitoring. Treatment of these sequalae remains challenging, often needing multiple procedures.
Presenting Author
Ayesha Musthafa, MBBS, MS
Co-Authors
Naren Shetty (MS, PhD), Padmamalini Mahendradas (MBBS, DO, DNB), Arka subhra Ghosh (PhD), Vrushali Deshpande (PhD)
Purpose
To evaluate whether metabolomic profiling of ocular fluids can identify distinct biomarkers that differentiate bacterial, viral, and fungal endophthalmitis, enabling accurate diagnosis and risk stratification.
Methods
A prospective case-control study was conducted. Tear and aqueous humor samples from patients with confirmed bacterial, viral, or fungal endophthalmitis were analyzed using UPLC-MS coupled with multivariate statistical analysis. Patients were stratified by etiology and severity. Differential metabolite expression was compared across groups, and signature pathways were identified for each infectious category.
Results
Distinct metabolic signatures were observed among etiologies. Bacterial endophthalmitis was associated with elevated methyl linolenate, palmitoleamide, and myristoleoyl carnitine. Viral cases demonstrated altered cholesterol and triglyceride-related metabolites. Fungal infections showed sterol and ergosterol pathway dysregulation. These metabolomic differences achieved statistically significant separation between groups (p<0.05).
Conclusion
Ocular metabolomics enables differentiation of bacterial, viral, and fungal endophthalmitis. Biomarker signatures may support rapid, non-invasive diagnosis and guide targeted therapy, improving clinical outcomes and personalized management.
Presenting Author
Brian T Cheng, MD
Co-Authors
Qiang Zhang (PhD), Jordan Deaner (MD), Binod Acharya (PhD), Allen Ho (FACS, MD), Julia Haller (MD), Leslie Hyman (PhD), Douglas Wisner (MD)
Purpose
Yttrium Aluminum Garnet capsulotomy (YAG) is the standard of care for treatment of post-capsular opacification. Retrospective studies have reported variable rates of rhegmatogenous retinal detachment (RRD) and tears (RT) after YAG. This study aimed to characterize the incidence, timing, and risk factors of RRD and RT (RRD/RT) after YAG capsulotomy.
Methods
Data were analyzed from 713,841 adults (1,072,977 eyes) 40+ years old with YAG in the 2014-2023 American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Patients with previous RRD, RT, or retinal procedure were excluded. The primary study outcome was time to RRD/RT after YAG capsulotomy, identified by CPT and ICD-9/ICD-10 codes. Multivariable proportional hazards regression models were constructed to examine risk factors for RRD/RT. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were reported. Posterior vitreous detachment (PVD) was stratified into 3 groups: no PVD before or after YAG, new PVD only after YAG, and PVD documented prior to YAG.
Results
One-year incidence of RRD/RT, RRD, and RT after YAG were 0.49%, 0.29%, and 0.22%, respectively. Median times to RRD and RT were 132 (interquartile range: 57-233) days and 135 (56-235) days. Risk of RRD/RT was positively associated with younger age (HR [95% CI], 40-50y: 4.41 [3.82-5.08], 51-60y: 4.23 [3.90-4.59], 61-70y: 2.38 [2.22-2.55]), male gender (2.56 [2.42-2.71]), high myopia (1.31 [1.22-1.42]), lattice degeneration (14.0 [13.0-15.1]), new PVD following YAG (13.2 [12.3-14.2]), and PVD prior to YAG (2.38 [2.21-2.55]). Asian (0.59 [0.46-0.74]) and Black race (0.62 [0.52-0.75]) and longer time from cataract surgery to YAG (0.99 [0.99-0.99]) were inversely associated with RRD/RT.
Conclusion
The incidence of RRD/RT following YAG capsulotomy is low. Patients with younger age, male gender, high myopia, lattice degeneration, new PVD following YAG or prior diagnosis of PVD before YAG, and shorter time between cataract surgery and YAG had a greater risk of RRD/RT after YAG. These data may guide risk stratification and patient counseling.
Presenting Author
Vinita Yadav, MS, MBBS
Co-Authors
Naren Shetty (MS, PhD), Abhijit Roy (PhD), Chaitra Jayadev (PhD, MS)
Purpose
To enhance patient care in ophthalmic OPD by integrating AI-based classification of retinal disease using ultra-wide field Optos imaging.
Methods
A process improvement approach was implemented to streamline OPD workflows, particularly by replacing dilatation with Optos imaging in selected cases. Two pilot studies measured turnaround time (TAT) before and after workflow changes. In parallel, a deep learning software using ResNet152, Densenet121, EfficientNetB0, and MobileNetV3 architectures was developed for automated classification of fundus images as normal or abnormal. Both ROI(Region Of Interest)-aware and direct classification pipelines were evaluated. Software prototypes included patient modules for image analysis and reporting.
Results
Workflow changes reduced median TAT from 4h 19m to under 2h for most patients, with Optos imaging significantly decreasing wait times, though single-machine load increased during peak periods. The deep learning models achieved up to 97% accuracy in classifying retinal images. Integration of the AI software into OPD processes facilitated efficient, accurate screening, improved patient flow, and optimized staff resource allocation.
Conclusion
Workflow revision combined with AI-based imaging enables rapid, accurate retinal screening, shortens patient waiting time, enhances patient experience, improves OPD productivity and optimizes resource use, offering a blueprint for technology-driven patient-centric ophthalmic care.
Presenting Author
Hana Rehman, MBBS, FCPS
Co-Authors
Aires Lobo (FRCOphth, FRCSEd)
Purpose
To evaluate whether combined phacoemulsification and intravitreal corticosteroid implant improves visual, anatomical, and OCT biomarker outcomes in eyes with cataract and macular edema. Patients were selected over 6 months and followed for 2 months postoperatively. Both treatment-na�ve and anti-VEGF pretreated eyes were included.
Methods
This retrospective, non-randomized, unmasked case series included 17 eyes with visually significant cataract and macular edema due to diabetic retinopathy or retinal vein occlusion. Patients were enrolled over 6 months and followed for 2 months postoperatively. Two groups were analyzed: treatment-na�ve and those with prior anti-VEGF therapy. Exclusion criteria included glaucoma or other ocular comorbidities. All eyes underwent phacoemulsification with intraocular lens implantation and intravitreal dexamethasone implant. Outcomes included best-corrected visual acuity, central macular thickness, and OCT biomarkers (intraretinal fluid, subretinal fluid, hyperreflective foci) using Topcon OCT.
Results
Seventeen eyes (12 DMO, 4 BRVO, 2 CRVO) underwent combined surgery. In treatment-intensive eyes (n=10), VA improved from 47.7±26.2 to 58.6±24.4 letters (p=0.03), and CMT reduced from 376.8±84.1 to 336.2±97.7 µm (p=0.04). In treatment-na�ve eyes (n=5), VA improved from 68±6.0 to 74±6.8 letters (p=0.05), and CMT from 369.8±32.0 to 338.6±20.3 µm (p=0.04). IRF decreased in both groups; other OCT biomarkers (HRF, DRIL, EZI) showed partial improvement. IOP remained stable or decreased. No adverse events were noted.
Conclusion
Combined phacoemulsification and intravitreal dexamethasone implant resulted in significant visual and anatomical improvements in both treatment-na�ve and anti-VEGF pretreated eyes with macular edema. Partial resolution of OCT biomarkers was observed, with no safety concerns during short-term follow-up.
Presenting Author
Mehmet O Kiristioglu, MD
Co-Authors
Ahmet Ozmen (MD), Mehmet Baykara (MD), Ahmet Akcan (MD), Meral Yildiz (MD), Esin Sogutlu Sari (MD)
Purpose
To investigate retinal microvascular and peripapillary retinal nerve fiber layer (RNFL) alterations in children after bilateral congenital cataract extraction with secondary intraocular lens (IOL) implantation, using optical coherence tomography angiography (OCTA) with OCTAVA-based vascular morphology analysis.
Methods
This retrospective, cross-sectional study involved children who underwent bilateral congenital cataract extraction before 1 year with secondary IOL implantation; age-matched healthy peers served as controls. OCTA (DRI OCT Triton, Topcon) 6�6 mm scans quantified vessel area and length density, total vessel length, mean diameter, branchpoint density, tortuosity, and fractal dimension. FAZ was measured with an ImageJ macro. Subfoveal choroidal thickness and vascularity index were obtained by EDI-OCT, RNFL thickness by spectral-domain OCT. Bennett-Littmann scaling corrected magnification. GEE adjusted for age, axial length, and refraction.
Results
18 patients (36 eyes; median age 8) and 17 controls (34 eyes; median age 9) were analyzed. BCVA was lower in pseudophakic eyes (0.6) vs controls (1.0, p<0.05). Study eyes were more myopic (SE ?2.6 D) than controls (+1.0 D, p<0.05). OCTA showed greater MD (OD 116 vs 107 µm, p=0.049; OS 112 vs 110 µm, p=0.044), higher MT (OD 1.16 vs 1.15, p=0.036; OS 1.14 vs 1.19, p=0.047), and reduced BD (OD 1.03 vs 1.29, p=0.018; OS 1.03 vs 1.11, p=0.036). VAD, VLD, TVL, FD were similar (p>0.05). FAZ was smaller but nonsignificant. RNFL was thicker in temporal (OD p=0.029; OS p=0.021), superonasal (OD p=0.026), and inferotemporal (OS p=0.044) sectors, with no global difference. CT and CVI did not differ
Conclusion
OCTA with OCTAVA revealed larger vessel caliber, greater tortuosity, reduced branching, and sectoral RNFL thickening in children post bilateral congenital cataract surgery with secondary IOL. These exploratory findings suggest persistent microstructural changes despite surgery and visual rehab, needing confirmation in larger studies.
Presenting Author
Pooja P Patel, BA, MS, MPH
Co-Authors
Hueyjong Shih (MD), Ryan Meshkin (MD), Celine Chaaya (MD), Nasir Stovall (BSc), Samantha Hoffman (PhD), Richmond Woodward (MD), John Miller (MD), Nimesh Patel (MD)
Purpose
To evaluate the incidence, timing, and management of postoperative intraocular lens (IOL) tilt following secondary IOL insertion using the Yamane flanged intrascleral haptic fixation (FISHF) technique in a consecutive single-center series.
Methods
A retrospective consecutive case series was conducted of all patients undergoing secondary IOL implantation with the Yamane FISHF technique at a single institution over a 4-year period. Patient demographics, surgical approach, and postoperative outcomes were collected.
Results
Among 186 consecutive cases, 21 eyes (11%) developed postoperative IOL tilt. Techniques for haptic externalization included 30-gauge needles (57%), 27-gauge needles (14%), and 27-gauge pars plana vitrectomy ports (29%). The median interval between IOL implantation to detection of tilt was 10 days (range: 1-1086 days, IQR: 75 days). Lens exchange was pursued to address the tilt in 9 (43%) eyes. Of the remaining cases, 8 (38%) were repositioned, 3 (14%) were observed, and 1 (5%) underwent lens removal and was left aphakic. The mean best corrected visual acuity before and after any procedure to correct lens tilt was 1.10 logMAR and 0.55 logMAR respectively (p = 0.03).
Conclusion
There is a significant rate of spontaneous lens tilt following insertion using the Yamane FISHF technique. This occurs early, often within the first 2 weeks. Lens tilt was observed in various haptic externalization techniques and the majority required surgical intervention with IOL exchange, repositioning or removal.
Presenting Author
Hsi An Yang, MD, PhD
Co-Authors
Wun-Long Jheng (MD, MS)
Purpose
Diabetic retinopathy (DR) is a major yet preventable cause of vision loss. While ICDR grading standardizes severity, it remains too abstract for patients to grasp retinal changes. Herein, we present DRNovosight, an explainable generative AI that simulates post-treatment fundus images to visualize lesion regression and aid clinical care.
Methods
We analyzed 71,000 fundus images graded 0-4 on the ICDR scale from EyePACS and APTOS 2019, partitioned into 70% training, 10% validation, and 20% testing. Histogram matching and color normalization reduced inter-dataset variability. Lesion masks for microaneurysms, hemorrhages, and exudates within macular arcades were generated using a U-Net trained on IDRiD. A LoRA-fine-tuned Stable Diffusion 1.5 synthesized images with reduced severity through negative prompts for hemorrhage absence and macular clarity. A ResNet-DR classifier assigned ICDR grades to simulated images. Grad-CAM and SHAP heatmaps were used to assess overlap between edits and lesion masks, ensuring anatomical fidelity.
Results
On a 7,200-image hold-out set, our model markedly outperformed a GAN baseline (FID 32.1 ± 1.3 vs 79.0; SSIM 0.77 ± 0.02 vs 0.61; PSNR 22.9 ± 0.5 vs 18.3; all p < 0.001). Notably, 70% of simulated images were reclassified at least one ICDR grade lower, and 35% by two grades, suggesting diminished macular edema risk. Grad-CAM overlap with lesion masks increased from 57% to 84% (p < 0.001), validating anatomically precise edits. Grading consistency AUC rose from 0.86 to 0.89, demonstrating that simulated images maintained clinically reliable severity trends without bias.
Conclusion
DRNovosight enables realistic and explainable simulation of DR regression with validated grading consistency, supporting patient counseling, resident training, and surgical planning through standardized visual endpoints. Future work includes OCT integration and modeling DR evolution under varying glycemic control.
Presenting Author
Fatma F Shakarchi, MD, MSc
Co-Authors
Ahmed Shakarchi (MD, MPH), Muhammad Chauhan (MD, MS), Ahmed Sallam (MD, PhD, FRCOphth)
Purpose
To evaluate the frequency and types of additional intraocular surgeries within two years following primary globe repair and assess the association of uveal prolapse and patients' demographics with this surgical burden.
Methods
We conducted a retrospective cohort study for patients with open globe injury with primary globe exploration and repair between 2015 and 2022 using the TriNetX US Collaborative Network. We evaluated the rates of major subsequent ophthalmic surgeries, both on the same day (primary repair) and within two years, stratified by uveal prolapse at injury.
Results
Of 4,880 patients, the average age was 42.8 ± 22.7 years with a male-to-female ratio of 3:1. Upon presentation, 281 (5.8%) patients required additional primary surgery. Within 2 years, 1,424 (32.3%) had additional surgeries, including 505 (10.4%) enucleation/evisceration, 601 (12.8%) pars plana vitrectomy, 604 (12.7%) cataract surgery, 305 (6.7%) glaucoma surgery, and 91 (1.9%) penetrating keratoplasty. The odds ratios in patients with uveal prolapse compared to patients without were 1.17 (0.97-1.41), 1.70 (1.49-2.06), 1.01 (0.85-1.19), 1.30 (1.03-1.64), and 1.85 (1.21-2.82), respectively. Patients aged ?70 years had lower odds of receiving subsequent surgery (OR: 0.69; 95% CI: 0.55-0.88).
Conclusion
One in three patients required further surgical intervention within two years of primary globe repair, highlighting the considerable long-term burden of open globe injury. These findings have important implications for patient counseling, surgical planning, and healthcare resource allocation following ocular trauma.
Presenting Author
Ahmed Sallam, MD, PhD, FRCOphth
Co-Authors
Fatma Shakarchi (MD, MSc), Ahmed Shakarchi (MD, MPH), Mohmed Soliman (MD, PhD)
Purpose
To determine the risk factors for subsequent intraocular lens (IOL) surgery among eyes undergoing either combined or sequential phaco-vitrectomy.
Methods
We performed a retrospective cohort study with adult patients undergoing phacoemulsification at eight United Kingdom clinical centers between July 2003 and March 2015. We excluded patients undergoing surgery for a dropped nucleus fragment, glaucoma, or iris problems. We categorized the eyes into three groups: with previous vitrectomy, undergoing combined phaco-vitrectomy, and with both previous vitrectomy and current combined phaco-vitrectomy. We calculated adjusted relative risks (aRR) using the Poisson model.
Results
Of 5,215 eyes, 2,124 had previous vitrectomy, 2,512 had combined phaco-vitrectomy, and 579 eyes had previous vitrectomy with a current combined phaco-vitrectomy. The risk of subsequent IOL surgery was 0.6% (reference group) in eyes with previous vitrectomy, 1.6% (aRR 2.6, CI: 1.4-5.1) in eyes with current combined phaco-vitrectomy, and 3.3% (aRR 3.8, CI: 1.7-8.3) with previous plus current combined phaco-vitrectomy. Other significant risk factors were age (aRR 0.98 per year), pseudoexfoliation (aRR 6.76, CI: 2-28), zonular dialysis (aRR 10.6, CI: 4.8-24), scleral buckle in the current surgery (aRR 8.05, CI: 4-14), and the use of silicone oil (aRR 3.6, CI: 1.6-8.4) compared to no tamponade.
Conclusion
Combined phaco-vitrectomy is associated with a higher risk of IOL complications than sequential surgery. This information is useful for planning surgery in patients requiring both cataract and retinal surgeries.
Presenting Author
Salem Abu Al-Burak, BSc
Co-Authors
Fahad Butt (BSc), Andrew Mihalache (None), Ryan Huang (MD, MSc), Marko Popovic (MD), Faisal Ahmed (FRCOphth)
Purpose
To examine the association between diabetic retinopathy (DR) and mental health outcomes, including anxiety and depression, in a nationally representative sample of U.S. adults.
Methods
A retrospective, cross-sectional analysis was conducted using 2023 National Health Interview Survey (NHIS) data from adults aged ?18 years. Participants self-reported DR diagnosis and mental health outcomes. Primary outcomes included anxiety and depression diagnoses, symptom severity (GAD-2, PHQ-2), screening thresholds (GAD-2 >2, PHQ-2 >2), individual symptom reports, and mental health service use. Secondary analyses assessed associations with vision loss due to DR. Multivariable logistic regression was performed using RStudio v12.0, adjusting for sociodemographic confounders.
Results
Of 29,468 adults (mean age: 53.3 ± 18.6 years), 370 (1.26%) reported a DR diagnosis. DR was associated with higher odds of anxiety (OR=2.18, 95% CI: 1.62-2.92, p<0.001) and depression (OR=2.42, 95% CI: 1.81-3.23, p<0.001), greater symptom severity (GAD-2 OR=2.59, PHQ-2 OR=2.68, p<0.001), and meeting screening thresholds (GAD-2 >2 OR=1.98; PHQ-2 >2 OR=1.92, p<0.001). DR was also associated with nervousness (OR=2.19, 95% CI=[1.51-3.18], p<0.001), inability to stop worrying (OR=2.62, 95% CI=[1.84-3.72], p<0.001), feeling down (OR=2.52, 95% CI=[1.76-3.60], p<0.001), loss of interest (OR=2.87, 95% CI=[2.11-3.90], p<0.001), and utilization of therapy (OR=2.02, 95% CI=[1.37-2.97], p<0.001).
Conclusion
DR was independently associated with worse mental health outcomes. Integrating mental health screening and support within DR care may improve patient outcomes. A multidisciplinary approach involving ophthalmology and mental health providers may be warranted.
Presenting Author
Qais A Dihan, MD
Co-Authors
Reem ElSheikh (MD), Jamal Azhari (MD), Muhammad Chauhan (MD, MS), Paul Phillips (MD), Abdelrahman Elhusseiny (MD)
Purpose
To evaluate the association between vitamin D deficiency (VDD) and the development of sickle cell retinopathy (SCR) in patients with Hemoglobin SS sickle cell disease (SCD).
Methods
We conducted a retrospective US-based population study. Following 1:1 propensity score matching, we compared a patient cohort with SCD + VDD (7,446 pts) to a cohort with SCD + no VDD (7,446 pts). We assessed their risk for developing SCR at 1, 2, and 5 years.
Results
The VDD cohort had an increased risk of developing SCR at each progressive time point studied compared to no VDD counterparts. This included at 1 (aHR: 2.69; 95% CI: 1.7 - 4.3), 2 (aHR: 4.715; 3.0 - 7.5), and 5 years (aHR: 4.5; 3.2 - 6.2). At 5 years, the absolute risk of developing SCR with VDD was 2.93% compared to 0.55% in no VDD cohort - a greater than fivefold absolute risk increase.
Conclusion
We found VDD to be associated with an increased risk of developing SCR in patients with SCD. These findings are suggestive that vitamin D monitoring and supplementation may be a valuable consideration in the comprehensive ophthalmological management of SCD.�Future prospective studies are warranted to confirm the efficacy of supplementation.
Presenting Author
Kevin Yang Wu, MD
Co-Authors
Anna Zhang (MD), Ananda Kalevar (MD)
Purpose
To summarize clinical characteristics, management, and outcomes of Vogt-Koyanagi-Harada (VKH)-like uveitis associated with immune checkpoint inhibitor (ICI) therapy and to identify patterns of comorbidity, drug exposure, and treatment response across published cases.
Methods
A systematic review (PROSPERO CRD42024558269) was conducted per PRISMA guidelines. MEDLINE, Embase, CENTRAL, and Web of Science were searched for English-language reports of VKH-like uveitis following ICI therapy up to June 2024. Observational studies, case series, and case reports were included. Data on demographics, cancer type, ICI regimen, ocular features, management, and outcomes were extracted. Risk of bias was assessed using a modified Murad tool.
Results
Forty-two articles describing 52 patients were included. Mean age was 60 years; 61.5% were female and 69.2% had melanoma. Most cases involved PD-1 inhibitors (63.5%) or combination PD-1/CTLA-4 therapy (19.2%). VKH-like uveitis developed after a mean of 22 weeks of treatment; 73.1% showed bilateral involvement. Systemic or intravitreal corticosteroids were used in 90.4%, and 59.6% required ICI discontinuation. Visual remission or resolution occurred in 82.7% of patients.
Conclusion
VKH-like uveitis is an uncommon but vision-threatening immune-related adverse event, most often linked to PD-1 inhibitors in melanoma. Prompt recognition and multidisciplinary management are crucial to preserve vision and guide continuation of cancer immunotherapy.
Presenting Author
Javokhir Ibatov, MD
Co-Authors
Jamshid Mamatov (MD), Mokhiryam Alieva (MD), Kamoliddinbekzod Yusupov (MS)
Purpose
To report a case of juvenile-onset Stargardt disease misdiagnosed as amblyopia, emphasizing the diagnostic value of optical coherence tomography (OCT) in revealing characteristic macular and photoreceptor changes that clarified the cause of longstanding low vision in a young patient.
Methods
An 18-year-old male with lifelong bilateral low vision underwent comprehensive ophthalmic assessment, including refraction, slit-lamp, and dilated fundus examinations, followed by spectral-domain OCT (Zeiss Cirrus). OCT parameters such as foveal contour, ellipsoid zone integrity, and retinal pigment epithelium (RPE) thickness were analyzed. Structural findings were correlated with visual acuity and clinical appearance to confirm juvenile-onset Stargardt disease after exclusion of refractive and amblyopic causes.
Results
The patient's best-corrected visual acuity was 0.05 in both eyes with no refractive improvement. Fundus exam revealed central RPE atrophy and a "beaten bronze" macular reflex. OCT showed marked foveal thinning, complete ellipsoid zone loss, and RPE attenuation consistent with Stargardt disease. Inner retinal GCL+IPL thinning was noted, while RNFL thickness remained normal, confirming isolated macular pathology. Supportive management with lutein/zeaxanthin, omega-3, and low-vision rehabilitation was initiated.
Conclusion
OCT provides structural evidence for early diagnosis of Stargardt disease in young patients with unexplained low vision. Detecting photoreceptor and RPE loss helps distinguish macular dystrophy from amblyopia, enabling genetic counseling, vision rehabilitation, and access to emerging gene or pharmacologic trials.
