Anna Venkatraman

Outcomes of inferonasal Baerveldt glaucoma drainage implant surgery

Purpose:To determine the outcomes of inferonasal Baerveldt glaucoma implant (BGI) surgery. Patients and Methods:A retrospective, non-comparative case series of 182 eyes of 182 patients who underwent inferonasal placement of a Baerveldt glaucoma implant. The main outcome measures included intraocular pressure, number of glaucoma medications, best corrected visual acuity, and complications. Results:Patients were followed for an average (± SD) of 19 ± 15 months. Median Snellen visual acuity was unchanged at last follow-up. Intraocular pressure was reduced from a mean (± SD) of 28.6 ± 11.5 mm Hg preoperatively to 13.4 ± 5.7 mm Hg at most recent follow-up (P < 0.001). The number of antiglaucoma medications was reduced from a mean (± SD) of 2.7 ± 1.3 preoperatively to 1.1 ± 1.1 at most recent follow-up. Nineteen eyes met our criteria for failure, yielding a cumulative percent survival of 92% at 12 months, 88% at 24 months, and 77% at 44 months. The most common complications were hyphema (14 eyes, 8%), choroidal effusion (12 eyes, 7%), and corneal decompensation (19 eyes, 10%). Endophthalmitis and diplopia occurred rarely (1 eye, <1%; 3 eyes, 2%, respectively). Conclusions:Inferonasal Baerveldt glaucoma implant placement appears to be a safe and effective surgical option that may be helpful in certain clinical situations.

Endophthalmitis Caused by Staphylococcus epidermidis: In Vitro Antibiotic Susceptibilities and Clinical Outcomes

BACKGROUND AND OBJECTIVE To compare the effectiveness of augmented superior oblique Z-tenotomy (SOZT) with fixed standard SOZT in canceling preoperative superior oblique overaction associated with A pattern anisotropia or V pattern in Browns syndrome. PATIENTS AND METHODS Sixteen consecutive patients with superior oblique overaction or Browns syndrome were treated by removal of a triangular piece of the superior oblique tendon near its insertion (augmented SOZT). Outcome was compared with 20 consecutive historical controls after standard SOZT. RESULTS The decrease in superior oblique overaction in the right and left eyes and fundus intorsion and the collapse of A pattern anisotropia were more significant for patients with superior oblique overaction (P = .003, P = .007, P = .05, P = .0015, respectively) and patients with Browns syndrome (P = .025, P = .03, and P = .05, respectively). No study patient with superior oblique overaction and A pattern anisotropia required reoperation compared with 5 of 14 controls (37.5%); rates for patients with Browns syndrome were 0 for the study group and 3 of 6 (50%) for the control group. CONCLUSIONS Augmented SOZT is superior to standard SOZT for correcting superior oblique overaction, intorsion, A or V pattern, and stereopsis. It is not associated with complications or reoperation. The size of the Z-tenotomy can be modified according to the intraoperative assessment to achieve symmetric results.

Regional Anesthesia With Monitored Anesthesia Care for Surgical Repair of Selected Open Globe Injuries

BACKGROUND AND OBJECTIVE To investigate clinical features and visual acuity outcomes associated with the use of regional anesthesia with monitored anesthesia care (RA/MAC) versus general anesthesia for open globe injuries in adult reparable eyes. PATIENTS AND METHODS Retrospective, consecutive case series including all adults with open globe injuries repaired at Bascom Palmer Eye Institute between 2000 and 2003. RESULTS The study included 238 eyes of 238 patients with a median age of 41 years. RA/MAC was employed in 141 (59%) eyes and general anesthesia in 97 (41%) eyes. Patients who had RA/MAC were significantly (P< .001) more likely to have anterior wound location (64% corneal/limbal vs 50%), shorter wound length (6.5 vs 12 mm), and formed anterior chamber (82% vs 56%), and were significantly less likely to have an afferent pupillary defect (12% vs 43%). The improvement from presenting visual acuity to each postoperative follow-up interval was similar for the two groups. CONCLUSIONS RA/MAC is a reasonable alternative to general anesthesia for selected patients with open globe injuries.