Jennifer L. Jung

Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phacoemulsification in a Hispanic Population

ABSTRACT Purpose: To compare the efficacy of different surgical strategies for intraocular pressure (IOP) control in Hispanic glaucoma patients with and without visually significant cataracts. Design: Comparative retrospective consecutive case series. Methods: The charts of 153 consecutive patients with primary open angle glaucoma who underwent either trabeculectomy alone (n = 51), phacotrabeculectomy (n = 51), or phacoemulsification alone (n = 51) were reviewed to compare IOP control, the number of glaucoma medications required postoperatively, and the inci dence of surgical complications. Results: Preoperative IOP was 17.5 ± 5.2 mm Hg in the trabe-culectomy group, 15.4 ± 4.5 mm Hg in the phacotrabeculectomy group and 13.9 ± 2.9 mm Hg in the phacoemulsification group (p < 0.001 for all comparisons). Mean IOP reduction from baseline was 4.2 ± 6.9 (24.6%) for the trabeculectomy group, 2.9 ± 5.0 (20.8%) for the phacotrabeculectomy group, and 0.9 ± 3.4 (6.5%) for the phacoemulsification group (p = 0.009). The number of IOP-lowering medications required postoperatively decreased significantly in all three groups (p = 0.001). The rate of early and late postoperative complications was similar between the trabeculectomy and phacotrabeculectomy groups and less for the phacoemulsification group. Conclusion: Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glau coma. Both resulted in similar rates of success, IOP reduction, decrease in use of IOP-lowering medications and post operative complication rates. Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy. Phacoemulsification alone may be a reasonable option for patients with visually significant cataract and lower baseline IOP. How to cite this article: Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY. Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phaco-emulsification in a Hispanic Population. J Curr Glaucoma Pract 2014;8(2):67-74.

Validation of the CHOP model for detecting severe retinopathy of prematurity in a cohort of Colorado infants

Editor, A recently published large-scale study (Mimouni et al. 2016) identified hyperopia as the parameter that demonstrated the strongest association with retreatment after excimer laser refractive surgery. We do share this observation as we also note less accurate refractive predictability and, most frequently, final undercorrection after hyperopic corneal refractive surgery. To improve refractive predictability, preceding studies (Zaldivar et al. 2005; Spadea et al. 2006) suggested that preoperative cycloplegic or manifest refraction, or a combination of both (Zadok et al. 2003), could be used in the laser nomogram. Previously, we reported that a manifest-cycloplegic difference (MCD) in spherical equivalent (SE) of 1.00 dioptre (D) or more occurs in about 13% of hyperopic eyes. In these cases, a correction of the manifest SE only did not appear to be adequate (Frings et al. 2016a). In a recent multicentre study, we thus evaluated the efficacy, predictability and safety of LASIK retreatment based on manifest refraction in hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less who had LASIK retreatment based on manifest refraction. We analysed the refractive outcome of 113 hyperopic eyes according to standard graphs for reporting the efficacy, predictability and safety of refractive surgery. We found that efficacy (p < 0.001) and safety (p = 0.004) were statistically significant improved by the retreatment without being negatively influenced by preoperative manifest SE, manifest cylinder or keratometry, which we analysed. Still showing a trend towards undercorrection, retreatment resulted in 88 eyes (78.0%) that reached 0.50 D of the attempted correction. The optical zone diameter of the retreatment did not correlate with efficacy, predictability or safety. Treatment predictability, however, was statistically significant worse in eyes with a preoperative SE of more than 2.50 D (p = 0.005, tested with chisquare test). In our opinion, the main objective criterion for a retreatment is a difference between targeted and achieved manifest SE of 0.50 D or more after at least 6 months. We do not retreat eyes earlier after LASIK as keratometric and refractive changes are likely to occur up to 6 months (Frings et al. 2016b). The results of our study indicate that in hyperopic eyes with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less a LASIK retreatment is efficient, predictable and safe and therefore, finally meets preoperative patients’ expectations. To summarize, the improvement of hyperopic LASIK still is a matter of discussion, hyperopes should not be treated earlier than 6 months and the difference between cycloplegic and manifest refraction should be taken into account during treatment planning. Many hyperopic cases will likely need a retreatment, most of which result in high efficacy, predictability and safety after all. We would highly recommend clarifying this fact to hyperopic LASIK candidates before the treatment.

Ocular Manifestations of Dermatologic Diseases

The integumentary system consists of the skin and its specialized structures including hair, nails, sweat glands, mammary glands, and teeth. It is formed by all embryonic layers. There exists a wide range of multisystem disease that affects both skin and the eyes. Skin and eye findings may be the initial manifestation that can lead to a new diagnosis of a systemic disease. The extent of skin and eye involvement can be a driving factor for treatment. It is important for physicians to be knowledgeable in evaluating for these conditions as well as initiating appropriate treatment to prevent morbidity and long-term complications. This chapter will review the various dermatologic and multisystem disorders with ocular manifestations. It is divided into the five following sections: (1) Genetic Syndromes, (2) Immunologic disorders, (3) Skin and Hair disorders, (4) Infectious conditions, and (5) Other dermatologic disorders.

Rapid resolution of infantile lipemia retinalis following exchange transfusion

A 7-week-old female presented with irritability, emesis, fever, and feeding intolerance. She had severe hypertriglyceridemia (15078mg/dL), hypercholesterolemia (1807 mg/dL), elevated lipase (1533 U/L), and hepatomegaly. Retinal vasculature had a milky pink appearance, consistent with grade III lipemia retinalis (LR), (Fig. 1a-b) with grossly lipemic blood (Fig. 1c-d). Because of the presumed diagnosis of lipoprotein lipase (LPL) deficiency and clinical suspicion for pancreatitis, double exchange transfusion (ET) was undertaken and stabilized dyslipidemia. Repeat funduscopic photographs three days following ET (triglycerides 1284 mg/dL) revealed resolution of LR (Fig. 1e-f). LPL sequencing showed a homozygous pathogenic missense mutation (c.644G>A; p.G215E), confirming the diagnosis of LPL deficiency. LPL deficiency is a rare autosomal recessive disorder of chylomicron clearance associated with severe dyslipidemia and hypertriglyceridemia (Zahavi et al 2013; Brunzell 2014). LR occurs when plasma triglycerides exceed 2000 mg/dL. Grade III LR, the most severe form, is characterized by salmon-colored retina with milky retinal vasculature. LR has not been associated with changes in visual acuity, but recent data suggests electroretinographic changes can occur (Zahavi et al 2013; Cypel et al 2008; Lu et al 2005; Fu et al 2014). We employed ET based on clinical experience in similar conditions and another published case demonstrating its utility in infantile LPL deficiency (Pugni et al 2014). Salient features of this case are rapid improvement of pancreatitis and dyslipidemic parameters in conjunction with documented rapid resolution of LR following ET. The patient remains stable with triglycerides consistently <2000 mg/dL on total restriction of dietary long chain triglycerides.