Yoseph Glovinsky

Long-term follow up of accidental parafoveal laser burns.

The findings after 12 years of follow-up evaluation of 2 patients who sustained accidental parafoveal and juxtafoveal Nd:YAG laser injuries are reported. In both cases, the fovea was not destroyed by the initial insult and early scar formation. Both cases demonstrated, after more than a decade, minimal visual deficit without significant late complications. In spite of early decrease in visual performance, the long-term prognosis for Q-switched Nd:YAG laser retinal lesions in which the fovea was not directly involved in the injury or its repair mechanisms is relatively benign.

A feasibility study of an Internet-based telemedicine system for consultation in an ophthalmic emergency room.

We examined the feasibility of a low-bandwidth, Internet-based tele-ophthalmology system for consultation in an ophthalmic emergency room. Forty-nine patients (98 eyes) with complicated cases were seen during night shifts in the ophthalmic emergency room. Ocular images were taken using a slit-lamp connected to a video camera, processed and transmitted to a senior physician by email. A telephone was used for real-time audio communication. Each case was re-examined by the same senior physician the following day. The time needed to capture and to process the images was 5 min (SD 2). Each case was given a feasibility score (0-100%), which was defined as the contribution made by the transmitted images in presenting clinical details which could not have been described verbally. High feasibility scores (mean scores ranging from 85 to 90) were found for the following images: ocular surface, anterior chamber, anterior chamber angle, pupils, lens, optic nerve and macula. In contrast, images of vitreous and peripheral retina received low feasibility scores (mean score 65). There was 100% agreement between the diagnosis made during consultation and the on-site examination made by the senior ophthalmologist later on. Ninety-eight percent of the patients stated that they would prefer being examined under the telemedicine system on their next emergency room visit, rather than the traditional resident on-site examination.

Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs

BACKGROUND AND OBJECTIVE The effects of cataract extraction on intraocular pressure (IOP) were studied in glaucoma patients who had previously undergone trabeculectomy. PATIENTS AND METHODS The files of 22 patients with 25 glaucomatous eyes with functioning filtering blebs who underwent cataract extraction were retrospectively reviewed. All patients had undergone pretrabeculectomy examination and had at least 18 months of follow-up after cataract surgery. Visual acuity, IOP, status of the filtering bleb, and the number of medications applied were recorded. RESULTS The mean increase in IOP was 3.63 mm Hg, 3.84 mm Hg, 5.4 mm Hg, and 2.8 mm Hg at 3, 6, 12, and 18 months after cataract extraction, respectively. This elevation was statistically significant 3 months postoperatively (P < .001) and remained relatively constant thereafter. The postoperative IOP was still significantly lower than the pretrabeculectomy IOP (P < .001). CONCLUSIONS Cataract extraction through corneal incisions in patients with functioning filtering blebs is followed by an increase in IOP. Cataract surgery in these patients does not neutralize the pressure-lowering effect achieved by the trabeculectomy, but it tends to elevate the post-trabeculectomy baseline pressure.

Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments

Purpose. To identify factors that determined the outcome of eyes that underwent pars plana vitrectomy for retained lens fragments after phacoemulsification. Methods. A retrospective review of the records of 63 eyes that underwent vitrectomy for retained lens fragments after phacoemulsification. Fragments were defined as nuclear if they contained any nucleus component or non-nuclear if they contained only cortex and epinucleus. Nuclear fragments were further divided into large (at least 1/3 the size of the nucleus) or small. Results. A total of 67% of eyes had retained nuclear fragments and 33% had non-nuclear fragments. Of the eyes with nuclear fragments, 64% had large fragments and 36% had small fragments. Statistical analysis revealed that the lens fragment type was the major determinant of the final visual acuity (VA). Only 38.8% (14/36) of the eyes with nuclear fragments achieved final VA of 20/40 or better, compared with 77.7% (14/18) of eyes with non-nuclear fragments (p=0.007). All other parameters, including size of the nuclear fragment, were not correlated with final VA. The major complications encountered in this series were retinal detachment (12.6%), Pseudophakic bullous keratopathy (6.3%), cystoid macular edema (15.8%), and glaucoma (15.8%). Conclusions. The major finding of our study is that posterior dislocation of nuclear lens fragments is associated with worse visual outcome than that of non-nuclear fragments. This may be related to a more complicated course of the cataract surgery, direct mechanical damage to the retina, a stronger inflammatory response, or a more traumatic vitrectomy procedure.

Diagnosis of posttraumatic stress disorder after surgery for primary rhegmatogenous retinal detachment.

Purposes: To investigate the prevalence of posttraumatic stress disorder (PTSD) in patients who underwent surgery for primary rhegmatogenous retinal detachment and to explore variables associated with the disorder. Methods: Subjects eligible for the study were patients aged 18 years or older, who underwent surgery for primary rhegmatogenous retinal detachment at the Goldschleger Eye Institute, from January 1, 2004, to December 31, 2009, and were followed for at least 1 month. Study patients were screened for the existence of PTSD symptoms via a telephone survey, and positively identified patients were asked to undergo a structured psychiatric interview. Posttraumatic stress disorder was assessed by the Clinician Administered PTSD Scale, and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was used as a measure of vision-related quality of life. Objective clinical measures were obtained from the patients medical records. Clinical variables were compared between PTSD-diagnosed patients, patients who were screened for PTSD but were found to be PTSD negative in the interview (false-positive group), and patients who were found negative for PTSD in the screening survey. Results: Of the 547 eligible patients, 366 were enrolled in the study. Nine patients (2.5%) met the criteria for PTSD diagnosis. Posttraumatic stress disorder patients reported significantly more traumatic events in their past (P = 0.015), and for these patients, NEI-VFQ-25 composite score was significantly lower (P < 0.001). Clinical measures were not found as independent risk factors for PTSD prediction. Conclusion: Posttraumatic stress disorder may develop in the aftermath of primary rhegmatogenous retinal detachment. Previous traumatic events and NEI-VFQ-25 scores were found as independent risk factors for PTSD prediction.

The relationship between patient age and astigmatism magnitude after congenital cataract surgery.

Purpose To evaluate the magnitude of refractive astigmatism after congenital cataract surgery and to define its correlation with patient age. Methods The authors retrospectively reviewed the charts of all pediatric patients who underwent congenital cataract extraction with intraocular lens (IOL) implantation through a 3.0-mm clear corneal incision from 1998 to 2003, and had no suture removal for 5 months afterward. Thirty-four children were included, aged 2 months to 15 years. Refractive astigmatism was assessed manually 1 week, 3 months, and 5 months after surgery by an experienced optometrist. The paired t test was used to compare the magnitude of postoperative astigmatism at different postoperative periods. Spearman correlation was used to determine the correlation between patient age and the postoperative refractive astigmatism. Results Mean refractive astigmatism in all patients was 1.8±1.5 diopters (D) at 1 week post-operatively. It significantly decreased to 1.0±0.7 D at 3 months postoperatively (p=0.001), and to 0.8±0.7 D at 5 months postoperatively (p=0.03). The change in astigmatism was significantly greater during the first 3 postoperative months than during the following 2 months (p=0.04). Patient age was significantly correlated with 1 week postoperative astigmatism (Spearman coefficient, r = −0.46; p=0.006) and with 3 months postoperative astigmatism (Spearman coefficient, r =–0.37; p=0.03). Conclusions Congenital cataract surgery using a small, clear corneal incision for IOL implantation caused high early postoperative astigmatism, which spontaneously regressed thereafter. Younger patients had higher early postoperative astigmatism.

Trabeculectomy with brief exposure to mitomycin C.

Background:  To evaluate the safety and efficacy of primary trabeculectomy with brief exposure (15 s) to mitomycin C (MMC) (0.4 mg/mL).

Surgical consequences in coexisting cataract and glaucoma.

&NA; Of the three classical approaches to surgery for coexisting cataract and glaucoma, last years publications dealt with the surgical consequences of combined cataract and glaucoma operations only. When used in combined cataract and glaucoma surgery, a small‐incision extracapsular cataract extraction (ECCE) with phacoemulsification (PHACO) was found to be only slightly superior to the standard manual ECCE in terms of postoperative intraocular pressure (IOP) control. Injections of 5‐fluorouracil postoperatively did not improve IOP control in PHACO‐ECCE‐trabeculectomy or manual ECCE‐trabeculectomy. A preliminary uncontrolled report suggests, however, that intraoperative mitomycin C application in PHACO‐ECCE‐trabeculectomy may result in excellent postoperative IOP control without antiglaucomatous medications, and with no significant mitomycin C‐related complications. Controlled studies on mitomycin C application in small‐incision cataract and glaucoma surgery are needed to assess its long‐term effect on IOP and astigmatism.