Saba T. Alniemi

Experiences Of Vitreoretinal Surgery Fellows In The United States

Purpose: The purpose of this study was to evaluate the surgical volume, training, and experiences of 2-year vitreoretinal surgery fellows in the United States. Methods: An anonymous survey was sent to 82 US graduating vitreoretinal surgery fellows and contained items relating to their training, self-perceived competency, and future plans. Results: A total of 54 fellows (66%) responded. Fellows most commonly performed <20 scleral buckles (38.9%) and 301 to 400 vitrectomies (27.8%) as primary surgeon. Fifty-two fellows performed epiretinal membrane peeling (96.3%), and 51 performed internal limiting membrane peeling (94.4%). Self-reported competency for treating rarer diseases was 90.7% for posterior uveitis and 22.6% for ocular oncology. Most (54.7%) planned to be employed in private practice. Conclusion: The experiences of vitreoretinal surgery fellows in the United States varied considerably.

Rate of amblyopia in periocular infantile hemangiomas.

the 5-year event-free survival was 96%. Conservative management is acceptable when surgical resection appears to be curative. In the only fully documented prior case of conjunctival PFL to our knowledge, a 6-year-old boy with a small placoid epibulbar lesion underwent local excision without ancillary chemotherapy or radiotherapy. Three years later, he was disease free as verified by a repeated systemic workup. Despite lymphocytic tissue identified at the base of the excision, which may have been benign, and in the absence of any clinical evidence of residual or recurrent disease, we have elected to defer adjunctive local therapy and will be following up with the patient closely.

Comparison of automated and manual perimetry in patients with blepharoptosis.

Purpose: To compare Goldmann manual perimetry and Humphrey automated perimetry for sensitivity in detecting visual field loss, efficiency, and patient preference. Methods: This prospective study compared Goldmann manual perimetry and Humphrey automated perimetry testing techniques in 20 consecutive preoperative blepharoptosis patients with unilateral or bilateral blepharoptosis with a marginal reflex distance of ⩽+2.5 mm, no dermatochalasis overhanging the eyelid margin, and no superior visual field defects due to glaucoma, neurologic disease, or other causes. Main outcome measures included efficiency, patient preference, and sensitivity in detecting visual field loss. Institutional review board approval was obtained prior to the start of the study. Results: Goldmann perimetry had significantly shorter examination times (−&Dgr;6.4 minutes, 95% confidence interval: 4.5–8.3, p < 0.001) and was preferred by most patients (70%). There was no statistically significant difference between the 2 techniques in detecting superior visual field loss at 90° meridian. Conclusions: Goldmann manual perimetry for assessing visual field loss in blepharoptosis patients is more efficient than Humphrey automated perimetry and is preferred by patients. Both techniques are sensitive in detecting ptosis-related visual field loss.

Successfully managed endophthalmitis following strabismus surgery.

Endophthalmitis following strabismus surgery is rare and has been reported to occur in from 1:3,500 to 1:185,000 cases. Severe adverse sequelae, including phthisis bulbi and enucleation, occur often despite early and aggressive treatment. This report describes 3 patients with endophthalmitis following apparently uneventful strabismus surgery by three different surgeons. Infections were aggressively treated. Two patients received intravitreal steroids; all 3 returned to their preoperative baseline visual acuity.

Incidence and Clinical Characteristics of Periocular Infantile Hemangiomas

OBJECTIVE To report the incidence, demographics, and clinical findings among a population-based cohort of children with periocular infantile hemangiomas. METHODS The medical records of all patients (<19 years of age) diagnosed as having periocular infantile hemangiomas while residing in Olmsted County, Minnesota, from January 1, 1965, through December 31, 2004, were retrospectively reviewed. RESULTS Forty-three children were diagnosed as having periocular infantile hemangiomas during the 40-year period, yielding an incidence of 5.4 per 100,000 individuals younger than 19 years (95% CI, 3.8-7.1) or a birth prevalence of 1 in 1586 live births. Thirty children (70%) were female (P<.001). There was a history of maternal infertility in approximately 1 in 5 children and premature birth in 1 in 8 children. Twenty-six children (61%) had other abnormalities, including secondary hemangiomas in 9 (21%). Forty-one patients (95%) had unilateral disease, and 37 hemangiomas (86%) were located on the upper eyelid. CONCLUSIONS In this population-based study, periocular infantile hemangiomas occurred in 1 in 1586 live births and were most prevalent on the unilateral upper eyelid of white female patients. Prevalent associations included maternal infertility and premature birth. Other abnormalities, including secondary hemangiomas in 1 in 5 children, were common in this cohort.

Fibrotic encapsulation of a dexamethasone intravitreal implant following vitrectomy and silicone oil for rhegmatogenous retinal detachment.

Steroids are commonly used as adjunct therapy in the management of proliferative vitreoretinopathy. The authors report a case of proliferative vitreoretinopathy treated with an intravitreal dexamethasone implant following vitrectomy in a silicone oil-filled eye. Epiretinal fibrosis developed around the implant at 6 weeks postoperatively, resulting in a recurrent retinal detachment. This was repaired by vitrectomy, removal of the implant, and peeling of epiretinal proliferation.

Ultrasound Biomicroscopy in Pseudophakic Patients with Unexplained Recurrent Hyphema or Vitreous Hemorrhage

ABSTRACT Purpose: To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. Methods: Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. Results: There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. Conclusions: UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.