ULTRASOUND BIOMICROSCOPY AND ECHOGENIC EXTERNAL MARKER ASSISTED INTRAOCULAR FOREIGN BODY REMOVAL.

PURPOSE: We report a novel method of intraoperative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy and an insulated needle. METHODS: A retrospective case report of a 56-year-old man who presented with a right eye IOFB. RESULTS: On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage, but no other signs of a penetrating laceration. Orbital CT revealed an IOFB, and the initial vitrectomy failed to retrieve the IOFB. Then, during the subsequent vitrectomy, using an ultrasound compatible needle and an ultrasound biomicrosopy, we were able to precisely locate and remove the small anterior IOFB. CONCLUSION: Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

Bilateral Cystoid Macular Edema Following Bimatoprost Implants.

PURPOSE: To report the development of bilateral cystoid macular edema (CME) following bimatoprost implant (Durysta) injections in both eyes to treat primary open angle glaucoma (POAG). METHODS: Case Report. RESULTS: A 93-year-old woman with a history of POAG received bimatoprost implant (Durysta) injections in both eyes four weeks apart. The patient subsequently developed progressively decreased visual acuity in both eyes due to bilateral CME, which improved with topical corticosteroid therapy. CONCLUSIONS: Bimatoprost implant (Durysta) can cause CME in susceptible individuals. Patients who received the implant should be assessed for the presence of CME following any decline in visual acuity, particularly in high-risk patients.

Accuracy of Remote Diagnosis of Acute Posterior Segment Pathology by Residents and Attendings Captured with a Smartphone and Standard 20/28D Lens.

Background and Objective: To assess the use of a smartphone-based fundus camera in diagnosing acute posterior segment disease in the emergency room (ER) of an academic center, where standard fundus cameras are currently unavailable. Study Design/Patients and Methods: Images were obtained on 10 eyes with various types of posterior segment pathology. These were analyzed retrospectively by 35 reviewers (21 residents and 14 attending physicians). Accuracy of diagnosis was compared to in-office fundus photography. Results: The average probability of correct diagnosis was over 78%. There was no difference between resident and attending reviewers, except for one of the vitreous hemorrhage cases where residents performed better (p=0.039). Conclusion: Smartphone-based cameras are effective in screening for ocular diseases in the ER of academic centers, where residents and fellows are often the first providers to see various types of vision and life-threatening pathology.

Combined epiretinal and internal limiting membrane retracting door flaps for large macular holes associated with epiretinal membranes.

PURPOSE: To assess the closure rate of large full-thickness macular holes (FTMH) associated with epiretinal membrane (ERM) with a combined epiretinal and internal limiting membrane retracting door flap. METHODS: Retrospective chart review of patients treated at a single tertiary retina practice between January 2017 and November 2019. Individuals with FTMH larger than 400 µm and co-diagnosis of ERM who underwent surgical repair with an ERM flap were included. Patients underwent pars plana vitrectomy with peeling of ERM that was positioned as a retracting door flap to cover the FTMH. Primary outcome was closure rate at 6 months following surgery. Final surgical success rate and visual acuity were secondary outcomes. RESULTS: Among 7 eyes of 7 patients, 6 eyes achieved primary surgical success and final surgical success rate was achieved in all 7 eyes with a large FTMH repaired with ERM flap. The mean minimum linear diameter of the FTMH was 681 µm ± 295. All patients had follow-up greater than 6 months, with a mean duration of 17 months (range 14-23 months). Visual acuity improved from a mean of 0.9 ± 0.3 logMar (20/160) before surgery to 0.3 ± 0.5 logMar (Snellen 20/40), postoperatively. CONCLUSION: Large FTMH with concurrent ERM that are managed with an ERM flap have high single-surgery success rate.

Patients' Preference Regarding Laser Photocoagulation or Cryoretinopexy for the Treatment of Retinal Pathology.

Purpose: High-risk peripheral retinal pathology can be prophylactically treated with both laser photocoagulation (laser) and cryoretinopexy (cryopexy). We sought to identify a possible preference by patients toward one modality and any underlying association. Methods: A single-center survey was conducted of patients with peripheral retinal pathology who received both laser and cryopexy at Associated Retinal Consultants (Royal Oak, Michigan). The main outcome measure was the preferred treatment modality. Results: Patients reported more pain after cryopexy (46%) than laser (11%). Most patients felt it was easier to recover from laser (52%) than cryopexy (13%). Overall, patients preferred laser (60%) to cryopexy (25%), with a minority (15%) having no preference. There was a negative relationship between a patient's likelihood of preferring cryopexy and the number of applications (P = .009). Conclusions: Most patients preferred laser (60%) to cryopexy. If cryopexy is performed, minimizing the number of freezes may improve the patient's experience and recovery.

SUSPECTED INTRAUTERINE INJURY CAUSING ABUSIVE OCULAR TRAUMA.

PURPOSE: The purpose of this report is to describe a patient who has fluorescein angiographic evidence and retinal changes suspicious for intrauterine abusive ocular trauma. METHODS: A case report of a premature ward of the state with no prenatal care and a presentation suspicious for intrauterine abusive ocular trauma. We performed serial ophthalmologic examinations, reviewed available prenatal history with the infant's social worker, and all relevant hospital notes, laboratory results, and imaging results. RESULTS: After initial empiric treatment for possible viral retinitis in the setting of a positive urine cytomegalovirus, repeat examinations demonstrated fluorescein angiographic evidence and clinical findings suspicious for abusive ocular trauma including neovascularization and no evidence of retinitis; therefore, the child was treated with laser photocoagulation. CONCLUSION: At-risk newborns will benefit from an examination of the retinal periphery and wide field fluorescein angiography. Intrauterine abusive ocular trauma should be included in the differential of retinal hemorrhage and avascular retinal periphery. It is imperative for clinicians to recognize this presentation to prevent progression of associated visual morbidity.

A Case Series Demonstrating a Novel Technique for Reversal of Trabeculectomy Using Lamellar Sclerectomy and Corneal Graft.

AIM AND OBJECTIVE: We describe two cases demonstrating a new technique to permanently reverse a problematic trabeculectomy. BACKGROUND: Trabeculectomy-related complications are typically treated in a manner that preserves the initial surgical outcome; however, in certain cases a complete reversal of the trabeculectomy is preferable to revision. TECHNIQUE: Our technique involves seating a lamellar corneal graft into a partial thickness sclerectomy. CONCLUSION: This method achieves permanent closure of large ostomies or areas of scleromalacia. CLINICAL SIGNIFICANCE: This technique can be used on very anterior ostomies while still providing an excellent seal, patient comfort, and cosmesis without inducing astigmatism. HOW TO CITE THIS ARTICLE: Bakhsh SR, Rooney D, Goldman BA, et al. A Case Series Demonstrating a Novel Technique for Reversal of Trabeculectomy Using Lamellar Sclerectomy and Corneal Graft. J Curr Glaucoma Pract 2020;14(2):61-63.

Staphylococcus aureus alpha-hemolysin impairs corneal epithelial wound healing and promotes intracellular bacterial invasion.

Colonization by Staphylococcus aureus (S. aureus) has been implicated in many infectious and wound healing disorders. This study was performed to characterize the pathogenic role of S. aureus alpha-hemolysin (alpha-toxin) in corneal epithelial wound healing and infectious keratitis in the setting of a corneal wound. The effect of wild-type and isogenic Hla mutant (α-hemolysin gene deleted) S. aureus bacteria and conditioned media on corneal epithelial wound healing was tested in vitro using a scratch assay and in vivo using a murine epithelial debridement model. The invasiveness of wild-type and Hla mutant S. aureus was evaluated in vitro in human corneal epithelial cells and in vivo in a murine model of infectious keratitis following total epithelial debridement. S. aureus and its conditioned media significantly delayed epithelial wound closure both in vitro (P < 0.05) and in vivo (P < 0.05). The effect of S. aureus on wound healing was significantly diminished with the Hla mutant strain (P < 0.05). Likewise, compared to the wild-type strain, the Hla mutant strain demonstrated significantly reduced ability to invade corneal epithelial cells in vitro (P < 0.05) and infect murine corneas following total epithelial debridement in vivo (P < 0.05). In conclusion, S. aureus alpha-hemolysin plays a major role in the pathologic modulation of corneal epithelial wound healing and the intracellular invasion of the bacteria. Limiting colonization by S. aureus and/or blocking alpha-hemolysin may provide a therapeutic approach for corneal wound healing and infectious disorders.