Avni P. Finn

Assessing Resident Cataract Surgery Outcomes Using Medicare Physician Quality Reporting System Measures

OBJECTIVESnTo assess resident cataract surgery outcomes at an academic teaching institution using 2 Physician Quality Reporting System (PQRS) cataract measures, which are intended to serve as a proxy for quality of surgical care.nnnDESIGNnA retrospective review comparing cataract surgery outcomes of resident and attending surgeries using 2 PQRS measures: (1) 20/40 or better best-corrected visual acuity following cataract surgery and (2) complications within 30 days following cataract surgery requiring additional surgical procedures.nnnSETTINGnAn academic ophthalmology center.nnnPARTICIPANTSnA total of 2487 surgeries performed at the Massachusetts Eye and Ear Infirmary from January 1, 2011 to December 31, 2012 were included in this study.nnnRESULTSnOf all 2487 cataract surgeries, 98.95% achieved a vision of at least 20/40 at or before 90 days, and only 0.64% required a return to the operating room for postoperative complications. Of resident surgeries, 98.9% (1370 of 1385) achieved 20/40 vision at or before 90 days follow-up. Of attending surgeries, 99.0% (1091 of 1102) achieved 20/40 vision at or before 90 days (p = 1.00). There were no statistically significant differences between resident and attending cases regarding postoperative complications needing a return to the operating room (i.e., 0.65%, or 9 of 1385 resident cases vs 0.64%, or 7 of 1102 attending cases; p = 1.00).nnnCONCLUSIONSnUsing PQRS Medicare cataract surgery criteria, this study establishes new benchmarks for cataract surgery outcomes at a teaching institution and supplemental measure for assessing resident surgical performance. Excellent cataract outcomes were achieved at an academic teaching institution, with results exceeding Medicare thresholds of 50%. There appears to be no significant difference in supervised trainee and attending cataract surgeon outcomes using 2 PQRS measures currently used by Medicare to determine physician reimbursement and quality of care.

Sheets Glide-Assisted Intraocular Placement of the Argus II Retinal Prosthesis

BACKGROUND AND OBJECTIVEnAs an increasing number of vitreoretinal surgeons are implanting retinal prosthesis devices, the need to share surgical techniques to ease implantation in challenging scenarios grows. The authors share a technique to aide in overcoming a challenge associated with uveal prolapse in a patient undergoing Argus II retinal prosthesis (Second Sight Medical Products, Sylmar, CA) implantation.nnnPATIENTS AND METHODSnA surgical technique is discussed and demonstrated using a video (Video available at www.healio.com/OSLIRetina).nnnRESULTSnA Sheets glide-assisted technique was used to successfully place the electrode array in the vitreous cavity.nnnCONCLUSIONnThe Sheets glide may be a useful tool in aiding the retinal surgeon to successfully and easily place the electrode array of the Argus II retinal prosthesis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:132-133.].

Case 42: Open Globe Rupture and Retinal Detachment with Retinal Incarceration from Baseball Injury

A 56-year-old man was struck in the right eye by a baseball and presented with a Zone III open globe rupture. B-scan ultrasonography after initial globe repair revealed vitreous hemorrhage, retinal detachment, and retinal incarceration and the patient subsequently underwent vitreoretinal surgery. This case highlights principles of posterior globe closure and retinal detachment repair, specifically retinal incarceration, in cases of open globe trauma.

The role of cystoid macular edema as a marker in the progression of non-paraneoplastic autoimmune retinopathy

PurposeTo determine the relationship between cystoid macular edema (CME) and disease severity and progression in non-paraneoplastic autoimmune retinopathy (npAIR).MethodsA retrospective study was conducted on patients seen between 2008 and 2016 with npAIR as defined by electroretinogram (ERG) dysfunction, visual field changes, presence of antiretinal antibodies, a negative malignancy workup, and no other apparent cause for visual dysfunction. Optical coherence tomography (OCT) scans were reviewed for each patient. A minimum follow-up of 1xa0year was necessary for study inclusion. The presence or absence of CME and the length of the preserved EZ on the centermost line scan of the SD-OCT images was recorded at each visit. The main outcome measure assessed was the rate of EZ loss (EZ finalu2009−u2009EZ initialxa0/xa0days follow-up) over time, a marker for disease progression.ResultsThirty-two eyes (16 patients) were included with an average follow-up of 42xa0months. Twenty-one eyes (66%) had CME on initial presentation and final follow-up (group 1), eight eyes (25%) did not have CME on presentation or final follow-up (group 2), and three eyes (9%) did not have CME on presentation but developed CME during follow-up (group 3). Group 1 eyes had a lower maximal a-wave amplitude (59.0 vs. 220.9xa0mV, pu2009=u20090.012) and lower maximal b-wave amplitude (88.1 vs 256.9xa0mV, pu2009=u20090.017) on baseline ERG compared to Group 2 eyes. The rate of EZ loss over time was significantly greater for group 1 with CME compared to group 2 without CME both at 12xa0months (−u20091.26xa0μm/day vs. −u20090.26xa0μm/day, pu2009=u20090.022) and at final follow-up (−u20091.03xa0μm/day vs. −u20090.08xa0μm/day, pu2009=u20090.012).ConclusionsCME was associated with decreased ERG amplitudes and greater velocity of EZ loss, suggesting that CME is a useful biomarker of more severe and more progressive disease in npAIR.

Chapter 11 – Treatment of Diabetic Retinopathy in Pregnancy

Management of diabetic retinopathy during pregnancy requires special consideration. It is well known that both diabetic retinopathy severity and macular edema can progress during pregnancy. Fluorescein angiography and intravitreal anti–vascular endothelial growth factor injection are typically avoided in pregnancy; however, specific exceptions do exist. This chapter reviews guidelines for evaluation and the treatment options for diabetic retinopathy and macular edema during pregnancy. The potential adverse effects and complications to consider in pregnancy are outlined.

Argus II retinal prosthesis system: a review of patient selection criteria, surgical considerations, and post-operative outcomes

Retinitis pigmentosa (RP) is a group of heterogeneous inherited retinal degenerative disorders characterized by progressive rod and cone dysfunction and ensuing photoreceptor loss. Many patients suffer from legal blindness by their 40s or 50s. Artificial vision is considered once patients have lost all vision to the point of bare light perception or no light perception. The Argus II retinal prosthesis system is one such artificial vision device approved for patients with RP. This review focuses on the factors important for patient selection. Careful pre-operative screening, counseling, and management of patient expectations are critical for the successful implantation and visual rehabilitation of patients with the Argus II device.

Venous Loop Reveals an Occult Retinoblastoma Tumor

A 14-day-old girl presented with bilateral hereditary retinoblastoma. At 3 months, a slight bend in the superotemporal arcade was observed to have developed into a venous loop. With concern for an occult lesion along the arcade, handheld optical coherence tomography (hhOCT) confirmed a small tumor and helped to guide prompt laser treatment while sparing the venous arcade. A venous loop is a previously unrecognized clinical finding that preceded the clinical detection and hhOCT confirmation of the tumor. The authors hypothesize that the venous loop was induced by pro-angiogenic factors secreted by the tumor. Portable hhOCT is a valuable adjunct imaging modality in the diagnosis and management of small retinoblastoma tumors. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:768-770.].

Characteristics and Outcomes of Simultaneous Bilateral Rhegmatogenous Retinal Detachments.

BACKGROUND AND OBJECTIVEnTo better understand the clinical course and outcomes of simultaneous bilateral retinal detachments managed by modern vitreoretinal surgical techniques.nnnPATIENTS AND METHODSnA retrospective review of 21 patients (42 eyes) presenting between April 2000 and June 2015 with simultaneous bilateral rhegmatogenous retinal detachments.nnnRESULTSnMean visual acuity (VA) improved from 20/100 at presentation to 20/40 at last follow-up (P = .01). The mean final VA for patients undergoing scleral buckle (SB) alone was 20/30 (log MAR 0.17), pars plana vitrectomy (PPV) alone was 20/40 (logMAR 0.33), and combined PPV/SB was 20/80 (logMAR 0.59) (P = .019). Primary reattachment rate in this series was 98%.nnnCONCLUSIONnIn contrast to prior studies, which investigated the management of simultaneous bilateral retinal detachments primarily by SB alone, multiple treatment modalities were utilized in this study, including vitrectomy alone, and overall success of retinal detachment repair was high regardless of treatment modality chosen. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:840-845.].