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Background/purpose: To describe a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that was mistaken for nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome., Methods: We present the case of a 58-year-old white man with metastatic renal clear cell carcinoma for which he was palliatively treated with IV nivolumab immunotherapy. The patient developed subacute onset of blurry vision and gray spots in the visual fields of both eyes, macular subretinal fluid, thickening of the retinal pigment epithelium, and swollen optic nerve heads. Differential diagnosis included nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome, and the patient was initially treated with steroids, which gave no improvement. Investigation showed the development of dark-gray patches in the peripheral retina of both eyes and cataract, which prompted reevaluation of the diagnosis, deeming BDUMP most likely. The patient was successfully treated with plasmapheresis., Results: The initial presentation of the case was incorrectly diagnosed as nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome. On repeat studies of the patients' symptoms and imaging, we concluded we had missed signs of BDUMP., Conclusion: The diagnosis BDUMP was missed in the first evaluation. We present this case to discuss the similarities and differences between this disease and nivolumab-induced Vogt-Koyanagi-Harada disease-like syndrome. More importantly, we want to highlight that reevaluation of the diagnosis on worsening of a disease was key in this unusual case., Competing Interests: None of the authors have any proprietary interest. There are no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Introduction: The pathological mechanisms of abnormal collagen type IV predisposing to macular hole formation in Alport syndrome are hypothesized to be related to defective Bruch's membrane leading to ruptured intraretinal cysts. However, abnormal collagen type IV may also predispose to macular hole formation due to vitreous cortex abnormalities., Methods: An observational case series of Optical Coherence Tomography (OCT) findings in three patients., Results: In two patients diagnosed with Alport syndrome and in one patient with a possibly pathogenic genetic variant in COL4A3 we observed a remarkable posterior vitreous cortex with a vitreoschisis-like appearance on OCT. Two of these patients developed a rhegmatogenous retinal detachment, of which one was caused by a giant retinal tear, and one patient developed a macular hole. During surgery, a firmly adherent vitreous cortex was observed centrally in the left eye and in the midperiphery in the right eye in one patient with a macular hole and giant retinal tear, respectively., Conclusion: These new vitreous cortex findings in patients with Alport syndrome are possibly related to pathogenic genetic variants affecting type IV collagen. Abnormal type IV collagen may cause pathological vitreoretinal traction, potentially leading to an increased risk of macular holes and rhegmatogenous retinal detachments., Competing Interests: Conflict of interest: No conflicting relationship exists for any author., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Purpose: To demonstrate unique behavior of subretinal perfluorocarbon liquid (PFCL) following macular reattachment surgery., Methods: An observational case report. Changes in visual functioning and consecutive optical coherence tomograms are described., Results: Following macular reattachment surgery with the aid of PFCL, a small residual PFCL bubble, measuring 175 μ m in diameter, is noted beneath the fovea on optical coherence tomogram. During nine months of follow-up, the bubble is shown to elongate and migrate toward the vitreous space. Once the bubble reaches the inner retinal surface, it gradually becomes smaller and disappears completely. We observed anatomical restoration of the retinal layers, and maintenance of fair visual acuity (20/32 feet) without scotoma., Conclusion: This report shows the potential of PFCL to migrate through the retina toward the vitreous. Rather than opt for a second surgery to remove small PFCL bubbles, observation may be clinically appropriate in selected cases.

Purpose: To describe the pathological features, treatment, and resolution of pembrolizumab-associated retinal detachment., Methods: A case report with a brief review of the literature and details of patient presentation, physical examination, systemic workup, fluorescein angiography, and indocyanine angiography., Results: A 25-year-old white woman was diagnosed with unresectable metastatic melanoma of the skin with a BRAF V600E mutation. The patient was treated with pembrolizumab injections every 3 weeks, upon which quick remission was seen of the metastases. After five injections, visual acuity of the patient deteriorated to 20/32 in the right eye. Ocular examination revealed bilateral panuveitis, papillitis, and serous retinal detachments. Treatment consisted of an oral prednisone taper schedule, topical prednisolone drops, and cessation of the pembrolizumab therapy, after which complete resolution of the subretinal fluid was seen., Conclusion: Pembrolizumab therapy may cause the development of panuveitis, papillitis, and serous retinal detachment, symptoms which are able to be controlled with lengthy steroid therapy.

Purpose: To describe a patient with acute central serous chorioretinopathy after use of γ-hydroxybutyric acid (GHB), also known as "liquid ecstasy.", Methods: Observational case report of a patient who developed central serous chorioretinopathy a day after use of GHB at a party., Results: A young adult male patient presented at the department complaining of non-improving acute onset of vision loss in the left eye after use of GHB at a party 3 weeks before. Fundus examination, optical coherence tomography, and fluorescein angiography revealed a dome-shaped retinal elevation centered to the macula of the left eye, suggesting the diagnosis of central serous chorioretinopathy. Spontaneous subretinal fluid resolution with improvement of vision was observed a month later., Conclusion: γ-hydroxybutyric acid has been reported to induce an acute increase in cortisol secretion after its administration. In addition, a case of Cushing syndrome after chronic abuse of GHB has been described. The acutely increased cortisol levels, induced by GHB, might have been the cause of central serous chorioretinopathy in the patient.