Nisha Chadha

Indirect cyclopexy for treatment of a chronic traumatic cyclodialysis cleft with hypotony

Cyclodialysis cleft is a rare clinical finding and therefore, reports on surgical repair techniques in the literature are limited. Additionally, hypotony can make repair technically challenging. We share a novel, simple surgical approach to management of a case of chronic traumatic cyclodialysis cleft with a successful outcome.

Irreversible Blindness Following Periocular Autologous Platelet-rich Plasma Skin Rejuvenation Treatment

A 49-year-old woman developed acute visual loss in the right eye following bilateral cosmetic platelet-rich plasma injections to rhytids in the glabellar region. External exam showed skin necrosis in the region over the right rhytids and restricted right ocular motility. Dilated fundus exam was significant for ophthalmic artery occlusion. Imaging revealed right eye extraocular muscle ischemia and optic nerve infarction, along with right frontal, parietal, and occipital lobe infarction. Work-up for thromboembolic and vascular etiologies were negative. To our knowledge, this is the first case reported of extensive ischemia following autologous platelet-rich plasma therapy.

Risk factors for visual impairment associated with corneal diseases in southern China

Purpose To identify the most common etiologies of corneal disease and the risk factors associated with worse visual outcomes in Changsha, Hunan, located in southern China. Methods This observational, cross-sectional study evaluated 100 consecutive patients seen at the cornea clinic of The Second Xiangya Hospital of Central South University. Ocular history, demographic information, and ocular use of traditional Chinese medicine were recorded and analyzed. Causes of infectious keratitis were diagnosed clinically. Fungal and acanthamoeba keratitis were confirmed by confocal microscopy. Visual impairment was categorized based on visual acuity according to World Health Organization recommendations. A binary logistic regression model was used to calculate odds ratio (OR). Results One hundred consecutive patients were evaluated. Sixty patients (60%) had noninfectious corneal diseases, most commonly dry eye syndrome (26.7%, n=16), followed by corneal abrasion (18.3%, n=11). Forty-five patients had infectious keratitis, five of whom had both infectious and noninfectious etiologies. Of the patients with infectious keratitis, viral keratitis was the most frequent cause (57.8%, n=26), followed by fungal (20%, n=9) and bacterial (20%, n=9). Older age (OR =5.08, P=0.048), male sex (OR =3.37, P=0.035), and rural residence (OR =3.11, P=0.017) had increased odds of having worse visual impairment. Rural residence was also associated with infectious keratitis (P=0.005), particularly bacterial and fungal keratitis (P=0.046), and a history of ocular trauma (P=0.003). Occupation was not a significant risk factor in this population. Fourteen patients reported use of traditional Chinese medicine, with no association with visual outcomes found. Conclusion Older age, male sex, and rural residence were associated with worse visual impairment. Prevalence and outcome of corneal diseases may be improved with an increased awareness in these populations.

Trends in ophthalmology resident surgical experience from 2009 to 2015.

Background Resident procedure minimums have been established in surgical training programs to ensure adequate training experience. However, achievement of these minimums may fluctuate. Review of resident experience is essential for maintaining successful training curricula. Objective To evaluate trends in ophthalmology resident surgical experience from 2009 to 2015. Methods This was a database study reviewing Accreditation Council for Graduate Medical Education ophthalmology resident surgical case logs. Case logs from 2,797 US ophthalmology residents were reviewed for trends in average surgical cases performed by residents as primary surgeon in the area of cataract, cornea, retina, glaucoma, pediatrics, plastics, and trauma from 2009 to 2015. Results Significant trends in resident surgical experience were demonstrated in the areas of cataract, retina, and glaucoma, while experience in cornea, pediatrics, plastics, and trauma remained stable. These trends included an increase in average cases of phacoemulsification cataract surgery from 143.8 to 173.6, vitreous tap/inject procedures from 31.3 to 93.1, and glaucoma shunt surgery from 4.5 to 6.7, with a decline in average cases of nonphacoemulsification cataract surgery from 3.8 to 2.2, retinal photocoagulation from 59.6 to 45.5, and filtering surgery from 6 to 4.5. Conclusion Trends in ophthalmology surgical experience in cataract, retina, and glaucoma paralleled new surgical or therapeutic developments as well as practice pattern shifts in these fields. Educators should be cognizant of the impact of such trends on resident experience and determine if curricular adjustments should be made to maintain comprehensive education of physicians-in-training.

Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration

This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma have not been discussed. Our report highlights the importance of recognizing the often multifactorial etiology of angle closure glaucoma to help guide clinical management.

Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma.

Aim The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. Patients and methods In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1 hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52 weeks. Patients completed a survey 1 week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3 mmHg from baseline. Results IOP was lowered to ≥3 mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52 weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52 weeks post treatment. There were more treatment failures in the micropulse group up to 52 weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). Conclusion Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure.

A case of recurrent hypotony and choroidal effusion in a patient with previous filtration surgery

Purpose To report a case of recurrent hypotony and choroidal effusion following trabeculectomy. Observations: A 70 year old male with advanced pseudoexfoliation glaucoma in both eyes underwent trabeculectomy in the left eye. Initially intraocular pressure (IOP) was controlled without topical therapy, but dorzolamide-timolol and brimonidine were added when IOP elevated above target. Aqueous suppressant glaucoma medications were thought to cause three episodes of hypotony resolving with discontinuation of these medications. Conclusions and Importance: Although hypotony and choroidal detachment associated with the use of aqueous suppressants is rare, it should be considered in patients with hypotony of unclear etiology following a glaucoma filtering procedure. Aqueous suppressants should be discontinued and it is recommended that the glaucoma drop regimen be switched to non-aqueous suppressants in patients with these findings.

Trabectome (Trabeculectomy Ab Interno)

Trabectome is a microinvasive surgical procedure which can offer intraocular pressure reduction in eyes with ocular hypertension or glaucoma. It is an angle-based surgery which increases aqueous humor outflow through removal of the outer trabecular meshwork, a site of major resistance to outflow. While similar to goniotomy and trabeculotomy, trabectome is distinct in its use of electroablation of the trabecular meshwork tissue. It is a conjunctival sparing glaucoma procedure with a better safety profile and faster recovery compared to traditional glaucoma surgeries.

Effect of supine body position on central corneal thickness

To evaluate the effect of supine body position on central corneal thickness (CCT) in open‐angle glaucoma patients and in healthy subjects.