Jonathan Chou

Case 26: Tissue Loss in Open Globe Injuries: A Case of an Open Globe Requiring Corneal Patch Graft

An 83-year-old man with a history of a prior open globe injury of his left eye presents with a concern for a Zone I open globe injury of the same eye after a mechanical fall and subsequent direct strike of his eye on a metal railing in the bathroom. Although the patient understood the poor prognosis, he wanted to try and save his eye. Intraoperatively, the patient’s cornea was found to be too friable for direct closure due to the previous open globe and corneal scarring and a corneal patch graft was required to close the eye. Post-operatively, the patch remained in good position with the structural integrity of the globe intact. Corneal or scleral patch grafts may be needed in the event that there is inadequate healthy tissue for direct closure or in cases of tissue loss. There are several tissue options to use in these cases and it is helpful to be aware of these in case they are needed during the repair.

Case 47: Zone I/II Open Globe Repair with Post-Operative Elevated Intraocular Pressure

A 58-year-old man presented with a Zone I-II open globe injury of the left eye with associated lens dislocation from blunt trauma from a screwdriver. The patient underwent repair of his open globe injury followed by a subsequent pars plana lensectomy and vitrectomy for a posteriorly dislocated lens. His post-operative course was complicated by elevated intraocular pressure from mixed mechanism glaucoma. He was medically managed with a good response. It is important to monitor intraocular pressure (IOP) post-operatively after open globe repair since there are a number of different mechanisms that increase a patient’s risk of glaucoma after ocular trauma.

Resting nailfold capillary blood flow in primary open-angle glaucoma

Background/Aims An altered haemodynamic profile for various ocular posterior segment capillary beds has been documented in primary open-angle glaucoma (POAG). POAG may also involve abnormal non-ocular blood flow, and the nailfold capillaries, which are not affected by elevated intraocular pressure (IOP), are readily assessable. Methods We measured resting nailfold capillary blood flow in 67 POAG and 63 control subjects using video capillaroscopy. Masked readers tracked blood column voids between consecutive, registered image sequence frames, measured vessel diameter and calculated blood flow. We used multiple logistic regression to investigate the relation between nailfold capillary blood flow and POAG. In secondary analyses, we stratified cases by maximum IOP and concurrent topical beta-blocker use. Results Mean (±SD) blood flow in picolitres per second was 26.8±17.6 for POAG cases and 50.1±24.2 for controls (p<0.0001). After adjustment for demographic and clinical factors including blood pressure and pulse, every picolitre per second increase in resting nailfold blood flow was associated with a 6% (95% CI 0.92 to 0.96) reduced odds of POAG (p<0.0001). Similar relations between nailfold capillary blood flow and POAG were found for cases stratified by maximum known IOP and for cases stratified by concurrent topical beta-blocker use. Conclusion Reduced resting nailfold capillary blood flow is present in POAG independent of covariates such as blood pressure, pulse and IOP.

Quantitative Analysis of En Face Spectral-Domain Optical Coherence Tomography Imaging in Polypoidal Choroidal Vasculopathy

BACKGROUND AND OBJECTIVE Spectral-domain optical coherence tomography (SD-OCT) imaging can be used to visualize polypoidal choroidal vasculopathy (PCV) lesions in the en face plane. Here, the authors describe a novel lesion quantification technique and compare PCV lesion area measurements and morphology before and after anti-vascular endothelial growth factor (VEGF) treatment. PATIENTS AND METHODS Volumetric SD-OCT scans in eyes with PCV before and after induction anti-VEGF therapy were retrospectively analyzed. En face SD-OCT images were generated and a pixel intensity thresholding process was used to quantify total lesion area. RESULTS Thirteen eyes with PCV were analyzed. En face SD-OCT PCV lesion area quantification showed good intergrader reliability (intraclass correlation coefficient = 0.944). Total PCV lesion area was significantly reduced after anti-VEGF therapy (2.22 mm2 vs. 2.73 mm2; P = .02). The overall geographic pattern of the branching vascular network was typically preserved. CONCLUSION PCV lesion area analysis using en face SD-OCT is a reproducible tool that can quantify treatment related changes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:126-133.].