Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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The selective advantage of gynomonoecy, the sexual system wherein plants produce a mixture of female and bisexual flowers, is poorly understood. One hypothesis for the evolution of this system is that the absence of androecia from female flowers reduces herbivore damage to the gynoecia of these flowers. Here, we examined patterns of herbivore damage in 53 collections representing 25 species of asters and goldenrods from Massachusetts, USA. In these taxa flowers are crowded into compact capitula, with bisexual flowers occupying the centre and female flowers situated on the periphery. Damage to gynoecia of bisexual flowers was significantly greater than damage to gynoecia of female flowers overall, and in about half of the individual populations. We also compared damage to central and peripheral flowers in the heads of 16 collections of other Asteraceae that produce only bisexual flowers to see whether the location of flowers rather than their sex might determine the patterns of herbivory. In only one of these 16 collections did we find a significant difference in herbivory between flower positions. We conclude that herbivore damage is influenced by flower type in asters and goldenrods, a pattern consistent with a role for herbivory in the evolution and maintenance of gynomonoecy.

Hydroxychloroquine (HCQ), an antimalarial drug in use since 1955, is still used with great success in the treatment of systemic lupus erythematosis and other rheumatological diseases. HCQ is generally well tolerated and its side effect profile confers many advantages over many other immunosuppressive agents. However, HCQ is known to induce retinopathy. Unfortunately, HCQ-induced retinopathy can present insidiously with subtle color vision changes and paracentral scotoma, which makes early detection difficult. Moreover, cessation of HCQ does not typically result in resolution of the visual loss, and vision loss may actually continue to progress even after HCQ is stopped. Therefore, identifying those patients most at risk for development of retinopathy is of the utmost importance, and adequate screening of patients taking HCQ is recommended. A brief case presentation of a patient who has developed retinal toxicity from hydroxychloroquine is provided along with a discussion regarding the characteristic retinopathy and review of current screening recommendations.

Eyes treated with DP after vitreoretinal surgery were at increased risk for developing clinically significant increases in IOP compared with those receiving PA.

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To analyze the surgical and visual outcomes in patients who underwent early versus delayed vitrectomy for dense nondiabetic, nonvascular vitreous hemorrhage from undetermined cause. Methods: A retrospective, consecutive series evaluating all patients with a preoperative diagnosis of nondiabetic vitreous hemorrhage treated surgically at The Retina Institute over the past 5 years. Vitreous hemorrhage had to be described as dense, with first-order vessels not visualized on funduscopic examination. Exclusion criteria included a diagnosis of diabetes mellitus, retinal vascular disease, any prior intraocular surgery other than cataract extraction, or any previously diagnosed ocular conditions. A total of 275 patients and 286 eyes were evaluated, with 52 patients and 52 eyes meeting inclusion criteria. Surgical treatment was with standard pars plana vitrectomy. Results: Of the 52 eyes that met inclusion criteria, 32 (61.5%) were found to have at least 1 retinal break. Sixteen eyes (30.1%) had a rhegmatogenous retinal detachment. Mean time from diagnosis of the vitreous hemorrhage to surgical intervention was 15 days (range, 0-78 days). Early vitrectomy was defined as surgical intervention within 10 days of diagnosis, while late vitrectomy was defined as surgical intervention following 10 days. Of eyes that were found to have a retinal detachment, 75% were phakic and 25% were pseudophakic. Final postoperative visual acuity in the early surgery cohort was 20/66, while in the late surgery cohort was 20/89, which did not achieve statistical significance (P ¼ .67). Conclusion: A significant percentage of patients with retinal detachment were phakic at the time of vitreous hemorrhage (75%) as compared to pseudophakic. Data from the largest series to date indicate that in phakic patients with dense hemorrhage, the risk of retinal detachment is high and should prompt consideration for more urgent surgical intervention.

No abstract