R. Rishi Gupta

Surgical Repair of a Persistent Full-Thickness Macular Fold With Base-to-Base Photoreceptor Apposition Secondary to Hypotony From Trabeculectomy Surgery and Postoperative Laser Suturelysis

Purpose: To report the successful repair of a persistent full-thickness retinal fold secondary to hypotony from trabeculectomy surgery. Results: Laser suturelysis was performed on a patient to relieve an elevated intraocular pressure posttrabeculectomy surgery. This resulted in chronic hypotony, a full-thickness retinal fold, and a decline in visual acuity to “count fingers.” The patient underwent a pars plana vitrectomy with internal limiting membrane peeling, subretinal injection of balanced saline solution, fluid-air exchange, injection of F-Decalin, peripheral retinotomy, endolaser photocoagulation, and vitreous substitution with 15% C3F8 gas. Anatomic improvement was documented via multimodal imaging. Six months postoperatively best-corrected visual acuity (BCVA) returned to 20/30. Conclusions: We describe a surgical approach to full-thickness retinal folds and review the management options previously reported in the setting of hypotony. We provide support for the active management of appositional full-thickness retinal folds involving the fovea and demonstrate that surgical correction can significantly improve BCVA even after 4 months of hypotony.

Macular buckle without vitrectomy for myopic macular schisis—a Canadian case series

OBJECTIVE To determine the effectiveness of a macular buckle procedure without vitrectomy for the treatment of symptomatic myopic macular schisis. DESIGN Retrospective case series. PARTICIPANTS AND METHODS All patients who underwent surgery with placement of an NPB macular buckle (AJL Ophthalmic, Miñano, Álava, Spain) without vitrectomy for symptomatic myopic macular schisis were included. Visual acuity and anatomical outcomes based on optical coherence tomography (OCT) were reviewed. RESULTS Eight consecutive eyes from 7 patients were included. Six of the 7 patients were female and the mean age was 59 ± 6 years (range, 49-66 years). The mean follow-up duration was 11 ± 7 months (range, 3-23 months). Mean preoperative axial length was 29.54 ± 1.28 mm (range, 27.88-31.96 mm). Mean preoperative best-corrected visual acuity (BCVA) was 0.71 ± 0.29 logMAR (Snellen equivalent 20/103); mean postoperative BCVA was 0.46 ± 0.44 (Snellen equivalent 20/58; p = 0.19) and 87.5% of patients maintained or improved vision. Pre- and postoperative OCT images are included and discussed within. Preoperative ellipsoid zone status and postoperative central macular buckle indentation appear to be important in visual outcomes. Two patients required a buckle repositioning for persistent schisis. One patient developed a macular hole postoperatively that resolved with subsequent vitrectomy. There were no other complications. CONCLUSIONS The macular buckle is an effective and promising therapeutic option for myopic macular schisis.

Spectral domain optical coherence tomography interpretation

Lonial, S., Petrucci, M.T., Orlowski, R.Z., Zamagni, E., Morgan, G., Dimopoulos, M.A., Durie, B.G., Anderson, K.C., Sonneveld, P., San Miguel, J., Cavo, M., Rajkumar, S.V. & Moreau, P. (2015) Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. Journal of Clinical Oncology, 33, 2863–2869. Palumbo, A., Chanan-Khan, A., Weisel, K., Nooka, A.K., Masszi, T., Beksac, M., Spicka, I., Hungria, V., Munder, M., Mateos, M.V., Mark, T.M., Qi, M., Schecter, J., Amin, H., Qin, X., Deraedt, W., Ahmadi, T., Spencer, A. & Sonneveld, P. (2016) Daratumumab, bortezomib, and dexamethasone for multiple myeloma. New England Journal of Medicine, 375, 754–766. Plesner, T., Arkenau, H.T., Gimsing, P., Krejcik, J., Lemech, C., Minnema, M.C., Lassen, U., Laubach, J.P., Palumbo, A., Lisby, S., Basse, L., Wang, J., Sasser, A.K., Guckert, M.E., de Boer, C., Khokhar, N.Z., Yeh, H., Clemens, P.L., Ahmadi, T., Lokhorst, H.M. & Richardson, P.G. (2016) Phase 1/2 study of daratumumab, lenalidomide, and dexamethasone for relapsed multiple myeloma. Blood, 128, 1821– 1828. Walker, I., Coady, A., Neat, M., Ladon, D., Benjamin, R., El-Najjar, I., Kazmi, M., Schey, S. & Streetly, M. (2016) Is the revised international staging system for myeloma valid in a real world population? British Journal of Haematology, 180, 451.

Transient myopic shift due to ciliary body detachment as the sole ocular manifestation of hypertensive emergency – A case report

Purpose Hypertensive emergency usually presents to ophthalmologists in the form of hypertensive retinopathy. We present a case of hypertensive emergency that presented as bilateral transient myopic shift due to ciliary body detachment in the absence of any retinal pathology. The purpose of this paper is to showcase another ocular manifestation of hypertensive emergency. Observations A 35 year-old female with a blood pressure of 192/114 mmHg presented to the emergency department with headache and acute onset blurry vision. Computed Tomography (CT) of the head, and lumbar puncture were within normal limits. Visual acuity was counting fingers in the right eye and 6/90 in the left eye, both of which improved to 6/9 with −5.00 diopters spherical correction in the right eye, and −4.75 diopters correction in the left eye. Intraocular pressures were normal. Anterior chambers were shallow, and there were no retinal changes on dilated fundus examination. Enhanced-depth optical coherence tomography (EDI-OCT) showed bilateral increased choroidal thickness and ultrasound biomicroscopy (UBM) showed 360° ciliary body detachment with angle closure. With improved blood pressure control, her ciliary body detachment resolved and her refractive error returned to baseline. Conclusions & Importance: Hypertensive emergency may present with choroidal thickening with anterior ciliary body rotation and detachment. A review of medications is important, as this presentation has also been reported as a rare side effect of sulphonamide drugs. In the absence of retinopathy, UBM and EDI-OCT imaging should be considered in the acutely hypertensive patient presenting with myopic shift.

VEGF-A is increased in exogenous endophthalmitis

OBJECTIVE Exogenous endophthalmitis is an ophthalmologic emergency defined by panocular inflammation. Vascular endothelial growth factor A (VEGF-A) contributes to inflammation by promoting chemotaxis of monocytes and granulocytes and by increasing vascular permeability. The purpose of this article is to determine if VEGF-A is elevated in the vitreous samples obtained from individuals with exogenous endophthalmitis. METHODS Vitreous samples from individuals with exogenous endophthalmitis (n = 18) were analyzed via Luminex assay and enzyme-linked immunosorbent assay for the cytokines VEGF-A, tumor necrosis factor (TNF), interleukin 6 (IL-6), IL-8 (chemokine [CXCL]-8), IL-1β, IL-10, IL-12p70, IL-33, interferon (IFN)-γ, IFN-α, IFN-β, chemokine ligand (CCL)-3, IL-2, IL-5, IL-15, CXCL-10, CCL-2, IL-1Ra, CCL-5, IL-17, and CCL-11. Vitreous samples obtained at the time of macular hole surgery served as controls (n = 8). RESULTS Concentrations of VEGF-A were significantly elevated in vitreous samples from individuals with exogenous endophthalmitis compared with macular hole (p < 0.001). VEGF-A was significantly upregulated in individuals with exogenous endophthalmitis after cataract surgery (p = 0.001), vitrectomy (p = 0.024), and intravitreal injection (p = 0.012). VEGF-A concentrations were similar in both culture-positive and culture-negative populations (p > 0.05). In a linear regression model, levels of VEGF-A correlated significantly with the chemokine CXCL-8 (p = 0.028). CONCLUSIONS We demonstrate that VEGF-A is potently upregulated in exogenous endophthalmitis. This observation provides a foundation for future studies of targeted VEGF-A blockade in the management of endophthalmitis.

Multiple parallel-line endotheliitis: case report and literature review of an emerging entity

repair. Pressure on the wound produced a small amount of discharge, which later grew methicillin-sensitive Staphylococcus aureus in culture. The wound was irrigated with bacitracin solution. The silicone sling ends were tucked into a preperiosteal pocket, without any trimming. Direct closure in 2 layers was performed with additional wound support provided by adhesive strips fixed with tincture of benzoin. Ophthalmic antibiotic ointment was applied after shedding of the adhesive strips. There was subsequent dehiscence over a couple weeks. The silicone sling was removed 6 months after insertion without difficulty. Exploration of the wound revealed pyogenic granuloma, which was excised. The wound was left to heal by secondary intention and closed by the first postoperative visit at 2 weeks. After the explant, the lid height and contour were unchanged after 1 year. Silicone is a safe and effective material for the frontalis sling procedure. It is inert and easy to work with and has become a popular choice. Adjustability and elasticity are among the touted advantages. Removal is usually simple and, as demonstrated in our case, the fibrous connections between the eyelid and frontalis can be sufficient to maintain lid height and contour after explant. Complications are uncommon and limited to only the periocular area, because a remote harvest site is not required as in the traditional tensor fascia lata frontalis sling procedure popularized at our institution by Jack Crawford. Extrusion of the silicone sling is an established infrequent complication. In the case described here, the unusual feature is that exposure did not occur at a surgical wound. The precise mechanism in our case cannot be established with certainty, but presumably the silicone tips prevented wound healing with secondary pyogenic granuloma formation and S. aureus colonization/infection. It is possible that the tissue overlying the silicone ends was more susceptible to laceration with trauma as a result of local inflammation or infection as a result of the foreign material. Despite mechanistic uncertainty, the case demonstrates an unusual event after frontalis silicone sling ptosis repair.

Trends in subspecialty training by Canadian ophthalmology graduates

OBJECTIVE To evaluate the trends in subspecialty fellowship training by Canadian ophthalmology graduates over the last 25 years. DESIGN Cross-sectional study. PARTICIPANTS Canadian-funded, Royal College-certified graduates from 1990 to 2014 who completed a full residency in an English-language Canadian ophthalmology postgraduate training program. METHODS Data were obtained by contacting all 11 English-language ophthalmology residency programs across Canada for demographic and fellowship information regarding their graduates. Society web sites were then used to corroborate and complement the data set, including those of the Canadian Ophthalmology Society, American Academy of Ophthalmology, and Provincial Colleges of Physicians and Surgeons. Data were organized by demographic variables, and analysis was performed using SPSS v22.0. RESULTS Of the 528 graduates from 1990 to 2014, 63.5% pursued fellowship training. Males and females were equally likely to undertake fellowship training. The proportion of graduates obtaining fellowship training did not change significantly during this 25-year period. The most popular subspecialty choices were vitreoretinal surgery (24.5%), glaucoma (16.7%), and anterior segment (16.7%). Significantly more males than females pursued vitreoretinal surgery and oculoplastics fellowships (p = 0.001, χ(2) test), whereas females were more likely to train in a paediatric ophthalmology and strabismus fellowship (p = 0.001, χ(2) test). CONCLUSIONS The majority of ophthalmology graduates from English-language residency programs pursue subspecialty fellowship training. An understanding of trends in fellowship training may be helpful for both workforce planning and career decision making.

Eye love you

However, this era also allow you to get the book from many sources. The off line book store may be a common place to visit to get the book. But now, you can also find it in the on-line library. This site is one of the on-line library in which you can find your chosen one to read. Now, the presented eye love you is a book that you can find here. This book tends to be the book that will give you new inspirations.

A Ghostly OCT.

1. Sproule DM, Kaufmann P. Mitochondrial encephalopathy, lactic acidosis, and strokelike episodes: basic concepts, clinical phenotype, and therapeutic management of MELAS syndrome. Ann N Y Acad Sci. 2008;1142:133-58. 2. Daruich A, Matet A, Borruat FX. Macular dystrophy associated with the mitochondrial DNA A3243G mutation: pericentral pigment deposits or atrophy? Report of two cases and review of the literature. BMC Ophthalmol. 2014;14:77.