Thomas Patrianakos

Comparison of cumulative dissipated energy between the Infiniti and Centurion phacoemulsification systems

Purpose To compare cumulative dissipated energy between two phacoemulsification machines. Setting An ambulatory surgical center, Honolulu, Hawaii, USA. Design Retrospective chart review. Methods A total of 2,077 consecutive cases of cataract extraction by phacoemulsification performed by five surgeons from November 2012 to November 2014 were included in the study; 1,021 consecutive cases were performed using the Infiniti Vision System, followed by 1,056 consecutive cases performed using the Centurion Vision System. Results The Centurion phacoemulsification system required less energy to remove a cataractous lens with an adjusted average energy reduction of 38% (5.09 percent-seconds) (P<0.001) across all surgeons in comparison to the Infiniti phacoemulsification system. The reduction in cumulative dissipated energy was statistically significant for each surgeon, with a range of 29%–45% (2.25–12.54 percent-seconds) (P=0.005–<0.001). Cumulative dissipated energy for both the Infiniti and Centurion systems varied directly with patient age, increasing an average of 2.38 percent-seconds/10 years. Conclusion The Centurion phacoemulsification system required less energy to remove a cataractous lens in comparison to the Infiniti phacoemulsification system.

Nailfold Capillary Abnormalities in Primary Open-Angle Glaucoma: A Multisite Study.

PURPOSE There is considerable evidence for systemic vascular dysfunction in primary open-angle glaucoma (POAG). We performed nailfold capillary video microscopy to observe directly the nature of nonocular microvasculature abnormalities in POAG. METHODS We enrolled 199 POAG patients and 124 control subjects from four sites. We used JH-1004 capillaroscopes to perform nailfold capillary video microscopy on the fourth and fifth digits of each subjects nondominant hand. Videos were evaluated for hemorrhages, dilated capillary loops > 50 μm, and avascular zones > 100 μm by graders masked to case status. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) for POAG were obtained by means of logistic regression analyses that were applied to data from all cases and controls. Corresponding estimates of moderate or severe POAG versus mild POAG (based on the Hodapp-Anderson-Parrish scale) were obtained among cases only. RESULTS After controlling for demographic factors, family history of glaucoma, systemic diseases, and use of anticoagulation and antiplatelet therapy, for each 100 nailfold capillaries assessed, all types of microvascular abnormalities were significantly associated with POAG. Specifically, the presence of any dilated capillaries (OR = 2.9; 95% CI, 1.6-5.6), avascular zones (OR = 4.4; 95% CI, 1.7-11.3) and hemorrhages (OR = 12.2; 95% CI, 5.9-25.1) were associated with POAG. Among cases, the frequency of microvascular abnormalities was not associated with glaucoma severity (P ≥ 0.43). CONCLUSIONS These data provided support for nonocular capillary bed abnormalities in POAG. Comparable vascular abnormalities in the optic nerve may render it susceptible to glaucomatous damage.

Anatomic and physiologic rationale to be applied in accessing the suprachoroidal space for management of glaucoma.

&NA; This review examines the anatomic and physiologic rationale for accessing the suprachoroidal space in the management of glaucoma. The potential benefits and limitations of past and present attempts to tap into the intraocular pressure–lowering effects of the suprachoroidal space are highlighted. Financial Disclosure The author has no financial or proprietary interest in any material or method mentioned.

Management of anterior segment trauma

Ophthalmologic emergencies have the potential to lead to severe morbidity and loss of vision. The ability to recognize and efficiently relay pertinent findings to an ophthalmologist is critical to preventing life-changing damage to the eye. Basic understanding of ocular anatomy, physiology, and pathology will facilitate a successful discussion between an ophthalmologist and the referring physician. As with other specialties, a detailed HPI should be attained that includes basic information such as onset, duration, intensity, and medication use. A useful review of systems includes questions regarding flashing lights, floaters, vision loss, and pain. Additionally, performing an ocular examination that checks visual acuity, intraocular pressure, and pupils will be advantageous to you, the ophthalmologist, and the patient. Anterior segment trauma involves injury to the part of the eye that is visible to the naked eye. Briefly, with the patients lids open, one should be able to see the conjunctiva, sclera, cornea, iris, and pupil. Identification of these structures is critical and expected of physicians at any level. The variety of anterior segment trauma one may encounter is vast, thus, this article will focus on the presentation, diagnosis, and treatment of chemical burns, corneal abrasions, hyphemas, and traumatic iritis.

Primary Cutaneous Coccidioidomycosis of the Eyelid: A Case Report.

A 33-year-old man presented with an ulcerated nodule on his left eyelid and eyebrow that was unresponsive to broad-spectrum antibiotics. Incisional biopsies were performed, and cultures were positive for Coccidioides immitis. An extensive work-up revealed no systemic involve ment of disseminated coccidioidomycosis. The patient was treated with oral itraconazole for 6 months with resolution of the lesion. Few cases of primary cutaneous coccidioidomycosis have been reported. The authors describe a primary cutaneous coccidioidomycosis lesion of the eyelid without disseminated disease.

Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia

Purpose To compare the intraoperative pain, anxiety, undesired movement, and cooperation between patients receiving oral diazepam or intravenous (IV) midazolam for conscious sedation during cataract surgery under topical anesthesia. Setting Ambulatory surgical center, Honolulu, Hawaii, USA. Design Prospective randomized controlled trial. Methods Patients having first‐time cataract extraction with topical anesthesia were randomized to receive sedation with oral diazepam 30 minutes before surgery or IV midazolam immediately preceding surgery. The outcomes of intraoperative pain, anxiety, undesired movement, and poor cooperation were observed by the surgeon and recorded during surgery. Results One hundred fifty‐six cataract surgeries were included, 83 in the IV midazolam group and 73 in the oral diazepam group. Twenty‐four patients (29%) in the IV group and 7 patients (10%) in the oral group showed undesired movement (P < .02). Seven patients (8%) in the IV group and 2 patients (3%) in the oral group showed poor cooperation (P > .05). Fifteen patients (18%) in the IV group and 9 patients (12%) in the oral group had anxiety (P > .05). Three patients (4%) in the IV group and 3 patients (4%) in the oral group experienced pain (P > .05). Conclusions Fewer patients receiving oral diazepam 30 minutes before cataract surgery than patients receiving IV midazolam immediately preceding surgery showed undesired movement during surgery. There was no statistically significant difference in the number of patients showing poor cooperation or experiencing pain or anxiety between the 2 groups. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.