Azin Abazari

The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma

Endoscopic Cyclophotocoagulation (ECP) is a glaucoma surgery designed to reduce the intraocular pressure (IOP) by partially ablating the ciliary processes to decrease aqueous humour production and secretion. The aim of this paper is to review the literature regarding the background, indications and results of the surgery. Although there are case reports of visually devastating complications, including persistent hypotony and phthisis, the use of ECP is often reported in eyes with advanced diseases. When compared with both trabeculectomy and aqueous shunt implantation, the visual outcomes were better with ECP while the IOP outcomes were very similar. The evidence supports ECP as a very effective surgical option in recalcitrant glaucoma while some evidence supports its safety for use as a primary procedure.

Improved refractive outcomes of postgraduate year 4 cataract surgery after implementing a stepwise biometry lecture series reinforced by self-assessment at a teaching program

Purpose To determine whether a structured biometry course improves refractive outcomes of resident phacoemulsification. Setting Northeast Veterans Administration Hospital, Northport, New York, USA. Design Retrospective case study. Methods Phacoemulsification surgeries performed by residents before and after a biometry curriculum were reviewed. The inclusion criterion was phacoemulsification performed by residents. Patients with fewer than 3 months of follow‐up were excluded. The main outcome measure—the mean absolute difference between the target and final refraction—was compared using a linear mixed model. Results Phacoemulsification surgeries performed by 4 residents before (n = 223) and by 4 residents after (n = 242) a biometry curriculum was implemented were reviewed. All measured preoperative factors were similar in both groups, including age, visual acuity, axial length, steep and flat keratometry values, astigmatism, anterior chamber depth, and lens thickness. Before the biometry course was instituted, 10% of patients had a mean absolute difference of less than 0.25 diopter (D); the percentage was 35% afterward. The mean absolute difference was less than 0.50 D in 40% before the curriculum was initiated and 70% after. The mean absolute difference was less than 1.00 D in 75% before the curriculum was initiated versus 94% after (all P < .05). The corrected distance visual acuities were similar in both groups, with 83% and 80%, respectively, having an acuity of at least 20/25 (P > .05). Conclusion Residents’ refractive predictions significantly improved after a formal biometry curriculum, showing that improvements in resident surgical outcomes are possible with structured curriculums reinforcing outcome measures. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Early-onset methicillin-resistant Staphylococcus aureus keratitis and late-onset infectious keratitis in astigmatic keratotomy incision following femtosecond laser–assisted cataract surgery

UNLABELLED A 79-year-old woman had uneventful femtosecond laser-assisted cataract surgery including paired laser astigmatic keratotomies (AKs) in the right eye. Three weeks postoperatively, a corneal infiltrate developed in the superotemporal AK incision. Cultures grew methicillin-resistant Staphylococcus aureus. The infection was treated with topical fortified vancomycin and tobramycin; full resolution required several months of therapy. Five months after cataract surgery, the patient presented with a second stromal infiltrate, also in the superotemporal AK incision. Despite negative cultures, the infiltrate resolved quickly on a short course of broad-spectrum fortified antibiotics. At 6 months, the corrected distance visual acuity was 20/30. This case demonstrates that infectious keratitis can occur following uneventful femtosecond laser-assisted AK performed concurrently with cataract surgery. We reviewed the literature on infectious keratitis following refractive keratotomy and femtosecond laser-assisted procedures. Several recommendations to prevent these infections are proposed. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

iStent surgery as an option for mild to moderate glaucoma

Surgery with the iStent (Glaukos Corporation, Laguna Hills, CA, USA), a trabecular bypass stent, has been added as an option for the treatment of mild to moderate glaucoma. It is a 1 mm titanium stent used to directly shunt aqueous from the anterior chamber into Schlemm’s canal. The published literature indicates that it can be used in open-angle glaucomas to achieve an IOP in the mid-teens. No vision threatening complications related to the device have been reported.

A review of teaching methods and outcomes of resident phacoemulsification

Cataract surgery with phacoemulsification is a challenging procedure for surgeons in training to learn to perform safely, efficiently, and effectively. We review the auxiliary learning tools outside the operating room that residency programs have incorporated into their curriculum to improve surgical skills, including wet laboratory and surgical simulators. We then discuss different methods of teaching cataract surgery in the operating room. Our goal is to define a learning curve for cataract surgery. We demonstrate that complication rates decline significantly after a resident performs an average of 70 cases. We summarize the reported incidence and risk factors for complications in resident-performed cataract surgery to help identify cases that require a higher level of skill to improve visual outcomes. We suggest that future studies include details on preoperative comorbidities, risk stratification, resident skill level, and frequency of takeover by attending.

Outcomes analysis of trabecular meshwork bypass devices

ABSTRACT Introduction: Recent innovations in glaucoma surgery have led to new alternatives for glaucoma patients requiring surgery. We investigate the intraocular pressure (IOP) outcomes following the placement of trabecular bypass devices. Areas covered: The aim of this paper is to analyze the current literature on trabecular bypass devices. The first and second generation iStents (Glaukos Corporation, Laguna Hills, CA, USA) act as a snorkel to increase delivery of aqueous through the trabecular meshwork and into Schlemm’s canal. The Hydrus (Ivantis Inc., Irvine, CA) is a larger device that in addition to acting as a snorkel, maintains Schlemm’s canal patency over several clock hours. The literature reviewed was found by searching Pubmed for iStent, micro-bypass, Schlemm’s canal scaffold, and individual references were followed. Expert commentary: Safer alternatives in Minimally Invasive Glaucoma Surgery (MIGS) procedures continue to be developed, and have a more favorable safety profile compared to traditional penetrating surgeries. However, the IOP reduction associated with these procedures is not as reliably low. There is significant heterogeneity in reported results, particularly with first generation stents. Early data with multiple stent insertion suggests that it is possible to achieve target IOPs in the mid-teens or below in a significant number of patients while still on medication.

Trabeculectomy for Traumatic Hyphema in Sickle Cell Trait

Abstract A case report of a traumatic hyphema in a patient with sickle cell trait is presented. A review of the published literature in PubMed was performed and medical management strategies and surgical treatment indications for traumatic hyphema are discussed. We support the case for temporary trabeculectomy in patients with traumatic hyphema and sickle cell disease.

A 31-year-old man with bilateral blurry vision and floaters.

We report a case of bilateral multifocal retinochoroiditis and bilateral optic disc edema in a patient with cat-scratch disease from Bartonella henselae. The patient initially had negative serologic testing. Repeat testing showed a markedly increased IgG and IgM convalescent titer and the development of a branch retinal artery and vein occlusion. In patients for whom there is a high clinical suspicion of cat-scratch disease, a convalescent titer should be obtained 2-3 weeks following a negative initial result.

Diabetic Eye Disease

Diabetes mellitus is a universal disease that has been associated with a significant increase in incidence among all regions of the world and in all races, ages, and sexes over the last several decades. If the same explosion of the disease continues, it is estimated that there will be over 350 million diabetics worldwide in 2030. Over 30 % of diabetic patients have some form of diabetic eye disease, mostly diabetic retinopathy (DR). Diabetic retinopathy is the leading cause of preventable blindness among individuals of working age, and a major cause of vision loss in the elderly population. Visual loss develops secondary to complications of DR such as diabetic macular edema and ischemia, vitreous hemorrhage, and retinal detachment. Glaucoma, another common cause of blindness, also occurs more often in diabetics and carries a worse prognosis compared to nondiabetics.