Michel J. Belliveau

The consequences of waiting for cataract surgery: a systematic review

Background: Cataract surgery is the most common operative procedure performed in Canada, and how patients are affected by wait times for this surgery has important clinical, public health and health policy considerations. We conducted a systematic review to understand the relation between wait time for cataract surgery and patient outcomes and the variables that modify this relation. Methods: We performed an electronic search of 11 databases and the proceedings of 4 conferences. The search was restricted to studies published after the transition to phacoemulsification (1990). We assessed the quality of the included studies using the Jadad Scale for randomized controlled trials and the Newcastle–Ottawa Scale for cohort and case–control studies. The data were found to be inappropriate for meta-analysis, thus we performed a qualitative synthesis. Results: We found a total of 27 studies that met our inclusion criteria. When these studies were reviewed, a dichotomy was observed for the wait time–outcome relation: outcomes associated with wait times of ≤ 6 weeks were better than outcomes associated with wait times of ≥ 6 months. Patients who waited more than 6 months to receive cataract surgery experienced more vision loss, a reduced quality of life and had an increased rate of falls compared with patients who had wait times of less than 6 weeks. The outcomes associated with wait times between 6 weeks and 6 months remain unclear. Interpretation: Patients who wait more than 6 months for cataract surgery may experience negative outcomes during the wait period, including vision loss, a reduced quality of life and an increased rate of falls.

Anatomical and visual outcomes of macular hole surgery with short-duration 3-day face-down positioning.

Purpose: The role of face-down posturing after macular hole (MH) surgery remains unclear and controversial. We evaluated the anatomical and visual outcomes of MH repair using a short duration (3 days) of prone positioning. Methods: Prospective series of 50 consecutive eyes in 50 patients with Stage 2 or Stage 3 idiopathic MHs. All eyes underwent vitrectomy MH surgery with internal limiting membrane peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, MH closure rates, complications, and postoperative visual acuity were investigated. Results: Anatomical closure of MHs was achieved in 49 (98%) of 50 eyes by 1 surgery. Postoperative logarithm of the minimum angle of resolution visual acuity decreased (i.e., improved) by 0.271 (95% confidence interval, 0.101–0.441 [P = 0.0024]). One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure fluctuations. Conclusion: Vitrectomy with internal limiting membrane peeling and gas tamponade with SF6 followed by short-duration 3-day face-down positioning is a successful surgical intervention for Stage 2 and Stage 3 idiopathic MHs. This method possessed minimal complications and offered significant improvement in visual acuity.

10-Year Framingham risk in patients with retinal vein occlusion: a systematic review and meta-analysis

OBJECTIVE Cardiovascular risk factors predispose individuals to retinal vein occlusions (RVOs). Yet, the future risk for development of cardiovascular disease in persons with RVOs is uncertain. We performed a literature review and meta-analysis of studies to determine the 10-year Framingham risk for individuals with RVO. METHODS A literature search was performed in MEDLINE and EMBASE. Studies were eligible if they included subjects with RVO and presented data on age, sex, smoking status, systolic blood pressure, total cholesterol, and high-density lipoprotein. The 10-year Framingham risk was calculated. Sensitivity analysis was performed and hypothesis testing was carried out using the upper tail z test with α = 0.05 to compare the estimated Framingham risk in RVO patients with the risk in the general Canadian population. Subgroup meta-analysis was carried out by Cochrane Collaboration Review Manager 4.5 software (Cochrane IMS, Copenhagen, Denmark). RESULTS A final list of 6 articles was included. The estimated 10-year Framingham risk score in subjects with RVO was 10.1% (95% CI 9.9-10.2). Sensitivity analysis found Framingham risk score to be greatest in male smokers. The Framingham risk in subjects with RVO was significantly greater than the general Canadian population. In a subgroup analysis, the 10-year risk was significantly greater in subjects with RVO compared with control subjects. CONCLUSIONS Patients with RVO have an increased 10-year risk for cardiovascular disease. This risk is greatest for male smokers (high risk). These patients may benefit from therapy aimed at controlling their risk factors. All individuals with an increased Framingham risk should be warned about vision loss as a potential complication of systemic atherosclerotic disease.

Peripapillary choroidal neovascular membrane in a teenage boy: presenting feature of idiopathic intracranial hypertension and resolution with intravitreal bevacizumab.

Peripapillary choroidal neovascular membrane (ppCNVM) is an infrequent finding in patients with idiopathic intracranial hypertension (IIH). In the pediatric subgroup there is only a single previously reported case. We describe the use of intravitreal bevacizumab for ppCNVM in a teenage boy with IIH.

Melkersson-Rosenthal syndrome presenting with isolated bilateral eyelid swelling: a clinicopathologic correlation

Melkersson-Rosenthal syndrome (MRS) is a rare condition characterized by the triad of orofacial edema, facial nerve palsy, and furrowing of the tongue. The full triad is present in only 25% of patients. Isolated eyelid swelling is a very rare, and possibly under-diagnosed, presentation. A 60-year-old man was referred for assessment of chronic eyelid swelling of approximately 7 years’ duration. His general health was good and he had no known systemic medical conditions. His ethnic origin was Indian. Formal allergy testing had previously been performed by another physician as part of a work-up for his eyelid swelling. Examination revealed bilateral, nonerythematous, nonpitting, upper eyelid swelling, greater on the left side (Fig. 1) than on the right. The remainder of his ophthalmic examination was unremarkable. Investigations (including complete blood count, erythrocyte sedimentation rate, c-reactive protein, creatinine, urinalysis, angiotensin converting enzyme level, antineutrophil cytoplasmic antibodies, extractable nuclear antigens antibodies, double-stranded DNA antibodies,

Idiopathic intracranial hypertension

More than 93% of people with idiopathic intracranial hypertension (previously called pseudotumour cerebri and benign intracranial hypertension) are obese. The annual incidence of the disease is highest among young obese women, at an estimated 20 per 100 000.[1][1] The median age at onset is 34 years

Acute orbital inflammatory syndrome following H1N1 immunization

Conventional surveillance for an unknown primary cancer in ocular metastasis involves computed tomography imaging of the thorax and abdomen. Because testicular GCTs are the most common malignancy in men between 20 and 39 years of age, this case illustrates the significance of including a testicular examination or investigating the possibility of extragonadal GCTs when searching for a primary malignancy as the source of uveal metastasis presenting in young adult males.

Giant cell arteritis

Permanent, severe loss of vision is a feared complication; however, it is not the sole possible devastating outcome of giant cell arteritis. Myocardial infarction, ischemic stroke and limb gangrene may also occur. Thoracic aortic aneurysms are seen over 17 times more often in patients with giant

INTRAVITREAL INJECTIONS INDUCING DE QUERVAIN TENOSYNOVITIS: INJECTORʼS WRIST

PURPOSE To describe a case of de Quervain tenosynovitis triggered by the repetitive performance of intravitreal injections. METHODS Case report of a 32-year-old ophthalmologist. RESULTS The ophthalmologist experienced de Quervain tenosynovitis while performing 425 intravitreal injections a month. These were predominantly performed in condensed sessions (injection clinics). Symptoms resolved with nonsurgical management. CONCLUSION The repetitive performance of intravitreal injections may be an unrecognized occupational hazard for ophthalmologists.

Neglected conditions Oculopharyngeal muscular dystrophy

Oculopharyngeal muscular dystrophy (OPMD, OMIM 164300) fits the description of a neglected condition as described in the CMAJ editorial by Kelsall.[1][1] This condition has escaped attention in many medical school and resident teaching curricula despite having an unusually high prevalence in those