Against the backdrop of the diverse minority-majority state of Hawaii, this study seeks to better characterize associations between idiopathic intracranial hypertension (IIH) with sociodemographic variables and medical comorbidities. A retrospective case-control study was conducted by utilizing 54 IIH patients and 216 age-, sex-, and race-matched controls, 216 unmatched controls, and 63 age-, sex-, and race-matched migraine patients. Relative to controls, IIH were 25 years younger (p < 0.0001) and 10.18 kg/m² heavier (p < 0.0001), as well as exhibited greater odds of the following variables (p < 0.05): female (odds ratio [OR]: 8.87), the lowest income quartile (OR: 2.33), Native Hawaiian or other Pacific Islander (NHPI; OR: 2.23), Native American or Alaskan Native (OR: 16.50), obesity class 2 (35.0-39.9 kg/m²; OR: 4.10), obesity class 3 (>40 kg/m²; OR: 6.10), recent weight gain (OR: 11.66), current smoker (OR: 2.48), hypertensive (OR: 3.08), and peripheral vascular disease (OR: 16.42). Odds of IIH were reduced (p < 0.05) for patients who were Asian (OR: 0.27) or students (OR: 0.30;). Unique from Whites, NHPI IIH patients exhibited greater odds (p < 0.05) for being from lower socioeconomic status and currently smoking, as well as potential association with seizures (p = 0.08). Compared to migraines, IIH headaches were at increased odds of occurring (p < 0.05) occipitally, for greater than 15 days per month, aggravated by postural changes, and comorbid with dizziness and tinnitus. These results not only better characterize IIH, but also highlight socioeconomic and racial disparities in diagnosis.

Purpose: Conjunctival melanoma is a rare neoplasm with high rates of recurrence and metastasis. Traditional management includes surgical excision and cryotherapy, followed by adjuvant therapy as needed. Immune checkpoint inhibitors, including nivolumab, are a targeted treatment option with improved survival rates. However, various immune-related adverse effects have been reported with these drugs. While systemic granulomatous inflammation is a documented systemic side effect, it has rarely been reported in the conjunctiva and ocular adnexa. Observation: A patient with a history of recurrent metastatic conjunctival melanoma presented with both a left sub-conjunctival and upper eyelid lesion after the commencement of treatment with nivolumab. The lesions were excised with a clinical suspicion for metastasis and consisted of noncaseating granulomatous inflammation with no evidence of malignancy on histopathologic examination. Infectious and primary autoimmune etiologies were ruled out. Conclusion and importance This is a biopsy-proven case of periocular immune checkpoint inhibitor-associated granulomatous inflammation.

Purpose: To report a case of corneoscleral juvenile xanthogranuloma (JXG) with progressive anterior segment involvement refractory to topical steroids. Observations: A 4-month-old male was referred for a new-onset subconjunctival lesion in the right eye. He was found to have a thickened, yellow corneoscleral lesion and hyphema, presumed to be ocular JXG. He was started on topical steroids as empiric treatment, with initial improvement for the first 3 months. Despite remaining on topical steroids, the lesion persisted and was biopsied at age 8 months. Conjunctival, scleral, and aqueous biopsies ruled out uveitic and malignant etiologies and were consistent with JXG with CD68-positive histiocytes, CD3-positive T cells, and CD20-positive B cells. Over the next few months, axial length increased out of proportion to normal growth, and intraocular pressure was elevated despite multiple pressure-lowering drops. At age 11 months, the patient acutely developed a flat anterior chamber with complete keratolenticular and iridocorneal adhesions secondary to a pupillary membrane. The patient improved after undergoing placement of an Ahmed drainage implant, synechiolysis, pars plana lensectomy and vitrectomy, subconjunctival and intravitreal injection of bevacizumab, and intravitreal methotrexate. Conclusions and importance This is a rare presentation of ocular JXG presenting with diffuse infiltration of the sclera, cornea, and iris. Given the involvement of multiple ocular structures, progression despite initial response to topical steroids, and increased intraocular pressure, aggressive management was required. Lesions should be closely monitored for progression and may benefit from surgical intervention and treatment with intraocular bevacizumab and/or methotrexate if topical steroids are insufficient.

Background/Purpose: To compare the microbiologic and histopathologic features of Acanthamoeba isolates recovered from patients with Acanthamoeba keratitis (AK) who underwent a therapeutic penetrating keratoplasty (TPK), optical penetrating keratoplasty (OPK), or deep anterior lamellar keratoplasty (DALK) after Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT). Methods: Surgical specimens were stained with hematoxylin, eosin, and Periodic Acid-Schiff stains as per institutional protocol at the University of Miami, Bascom Palmer Eye Institute. Analysis of Acanthamoeba cyst depth, number of cysts, and average corneal thickness was established by light microscopy. Results: Seventeen patients with AK underwent surgical intervention and RB-PDAT. Eight patients underwent a TPK and nine patients underwent an OPK/DALK. In the TPK group, average cyst depth was 42.0 ± 52.5 μm from Descemet’s layer and mean corneal button thickness was 661.7 ± 106.5 μm. Comparatively, in the OPK/DALK group, average cyst depth from Descemet’s layer was 261.7 ± 222.7 μm with a mean corneal button thickness of 474.2 ± 126.6 μm. Conclusions: Acanthamoeba cysts were found to penetrate deeper within the cornea amongst patients that underwent an emergent TPK compared to patients that underwent an elective OPK/DALK. This may suggest an association between Acanthamoeba cyst depth and infection severity and provides valuable clinical insights towards understanding factors such as infection recurrence and resistance to treatment.