Meet Julia Shulman, MD
Cryptococcal chorioretinitis with immune reconstitution inflammatory syndrome
Immune Reconstitution Inflammatory Syndrome (IRIS) is an inflammatory syndrome in the context of immune restoration directed at a specific infectious antigen despite resolution of infection, often associated with opportunistic infections. IRIS has been reported in 30% to 35% of HIV patients who have cryptococcosis in whom antiretroviral therapy was initiated. We would like to report a case of IRIS localized to the eye secondary to cryptococcal infection.
Whole-body 18FDG PET-CT imaging of systemic sarcoidosis: ophthalmic oncology and uveitis
PURPOSE: To describe whole-body 18-fluorodeoxyglucose (FDG) positron emission tomography/computed radiographic tomography (PET-CT) imaging of ophthalmic patients with systemic sarcoidosis.
RESULTS: In all cases, PET-CT revealed focal systemic lesions with increased uptake (SUV range 1.7-5.9 kg/mL). Cases 1 and 2 had a previous diagnosis of sarcoidosis (without ocular involvement), while cases 3 and 4 were diagnosed during their work-up. PET-CT revealed the presence and distribution of systemic sarcoid granulomas.
Failed descemet-stripping automated endothelial keratoplasty grafts: a clinicopathologic analysis
PURPOSE: To describe the clinicopathologic findings in failed Descemet-stripping automated endothelial keratoplasty (DSAEK) grafts.
RESULTS: DSAEK failure was strongly associated with postoperative lenticle dislocation. Graft failure was primary in 19 DSAEKs and secondary to rejection, eccentric trephination with epithelial inggrid-xth, or bacterial infection in the remaining 3. All failed grafts demonstrated endothelial hypocellularity and stromal edema. Additional findings included stromal inflammation (68%), interface fibrosis (50%), retrocorneal membrane (36%), unplanned retention of Descemet membrane (14%), immunoreactivity for HSV-1 (14%), paucicellular stroma (14%), and uneven trephination with epithelial inggrid-xth (5%).
Refractory Lupus Choroidopathy
ABSTRACT: We report a case of bilateral lupus Choroidopathy and central nervous system (CNS) vasculitis in a 43-year-old female with systemic lupus erythematous. The patient improved systemically on high dose steroids and mycophenolate. Choroiditis flared and escalation of therapy with Rituximab achieved CNS disease control. Choroiditis refractory to systemic therapy improved with micropulse laser therapy. Sequential indocyanine green angiography and enhanced depth imaging of optic coherence tomography allowed monitoring the response to therapy.
KEYWORDS: Lupus Choroidopathy; Choroiditis; uveitis; systemic lupus erythematous; Indocyanine green angiography; Spectral domain optical coherence tomography
authors: Ana M. Suelves, David Fernandez and Julia P. Shulman
published: October 20, 2015
Practice Patterns in Ophthalmic Examinations for Retinopathy of Prematurity in the United States
PURPOSE: To assess the types of dilating drops used, their perceived safety and the need to monitor preterm infants with retinopathy of prematurity during eye examinations.
RESULTS: Of 86 responders (29 retina specialists, 33 pediatric ophthalmologists, 24 neonatologists), most used cyclopentolate/phenylephrine (cyclomydrilTM) combination drops. 29% of neonatologists reported serious side effects from dilating drops compared to 8% of ophthalmologists. 50% of neonatologists compared to 6% of ophthalmologists expressed the need to monitor some infants’ vital signs during dilated eye examinations.
authors: Ana Suelves, Julia Shulman, Majida Gaffar, Ajey Jain and M. Elizabeth Hartnett
published: October 05, 2015
Scanning laser polarimetry reveals status of RNFL integrity in eyes with optic nerve head swelling by OCT
PURPOSE: Optical coherence tomography (OCT) shows retinal nerve fiber layer (RNFL) thickening in optic nerve head (ONH) swelling, but does not provide information on acute axonal disruption. It was hypothesized that scanning laser polarimetry (SLP) compared with OCT might reveal the status of axon integrity and visual prognosis in acute RNFL swelling.
RESULTS: At presentation, average RNFL by OCT was similar for eyes with papilledema and NAION (P = 0.97), and reduced for optic neuritis. Average RNFL by SLP was slightly increased for papilledema and optic neuritis, and reduced for NAION (P = 0.02) eyes. The RNFL by SLP was reduced in at least one quadrant in 1 eye with papilledema, 1 eye with optic neuritis, and in 13 eyes with NAION. In NAION eyes, quadrants with reduced SLP had corresponding visual field loss that did not recover. By one month, eyes with NAION showed RNFL thinning by OCT (7/17 eyes) and by SLP (14/16 eyes) in contrast to optic neuritis (by OCT, 0/12, P = 0.006; and by SLP, 1/12, P = 0.0004).
Optical coherence tomography/scanning laser ophthalmoscopy imaging of optic nerve head drusen
BACKGROUND AND OBJECTIVE: To evaluate optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) imaging for optic nerve head drusen (ONHD).
RESULTS: OCT/SLO imaging of ONHD demonstrated lucencies (100%), variable amounts of displacement, and thickening of the overlying nerve fiber layer, as well as disorganization of the adjacent retinal pigment epithelium (44%). Optic nerve head topography was measured (using horizontal and vertical electronic calipers). Mean disc diameter was 1.81 mm (range: 1.49 to 2.12 mm). All ONHD demonstrated anterior displacement of the base of the optic nerve cup (shallowing) compared to controls. The cup base was a mean +0.32 mm anterior to the retinal pigment epithelium for ONHD versus -0.23 mm for normal controls.
authors: Patel NN, Shulman Julia, Chin KJ, Finger PT
Source: SLACK Incorporated