Long-term follow-up after laser vision correction in physicians: quality of life and patient satisfaction.

PURPOSE: To evaluate the satisfaction and quality of life after laser vision correction (LVC) exclusively in a physician population. SETTING: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. DESIGN: Cohort study. METHODS: A 12-question survey targeted toward physicians and the unique qualities of their experience with refractive surgery was sent to physicians who had refractive surgery at the Cole Eye Institute between 2000 and 2012. In conjunction, the visual outcomes and clinical information of physicians who received the survey were reviewed. RESULTS: Two hundred twenty-six physicians (439 eyes) met the inclusion criteria for our study. One hundred thirty-two physicians (58%) responded to the survey and reported an overall satisfaction rate of 95.3%. Respondents included surgeons (28.0%), physicians who perform procedures but not surgery (43.2%), and physicians who do not perform procedures or surgery (28.8%). Of the physicians, 84.8% reported an improvement in the quality of vision compared with the corrected preoperative vision, 39.0% reported that their ability to perform procedures accurately had improved and 1.6% said they believed their ability to perform procedures was less. Ninety-six percent reported they would have the procedure again. Visual outcomes showed high levels of surgical predictability, efficacy, and safety. CONCLUSION: Despite high visual demands, physicians having LVC had a high percentage of good visual outcomes, satisfaction, and quality-of-life improvements.

Surgical outcomes of DSAEK in patients with prior Ahmed glaucoma drainage device placement.

PURPOSE: To study the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with previous Ahmed glaucoma valve (AGV) implantation. METHODS: Retrospective chart review of all patients who underwent DSAEK by a single surgeon in the setting of prior AGV implantation between December 2009 and September 2011 with at least 12 months follow-up. Preoperative and postoperative endothelial cell counts, visual acuity, intraocular pressure, and glaucoma medications were recorded. RESULTS: Eighteen eyes of 13 patients were included. The average endothelial cell count (cells/mm2) was 3087.7 (SD 390.8) preoperatively, 1974.3 (SD 646.0) at 6 months, 1831.7 (SD 851.2) at 12 months, and 1821.3 (SD 762.2) at 24 months. The average IOP (mm Hg) was 13.7 (SD 4.3) preoperatively, 15.1 (SD 5.0) at 6 months, 15.5 (SD 6.6) at 12 months, and 15.1 (SD 4.8) at 24 months. Average visual acuity (VA) preoperatively was 20/100 (logMAR 0.73, SD 0.27) and average best VA postoperatively was 20/60 (logMAR 0.5, SD 0.27). Nine of the 18 eyes (50%) had failed DSAEK grafts at 9.3 (SD 6.0) months. Six of these eyes had peripheral anterior synechiae (PAS) preoperatively, 3 had a history of uveitis, and 4 failures had multiple AGVs. Intraocular pressure control (<21 mm Hg) was maintained without additional medications in 11 eyes (61%) and with additional medication in 4 eyes (22%). Intraocular pressure control was not maintained in 3 eyes (17%). CONCLUSIONS: Though challenging, DSAEK surgery can be successful in the setting of previous AGV implantation, with success rates comparable to those of penetrating keratoplasty in the same population. Higher failure rate of DSAEK with prior AGV appears to be associated with the presence of chronic angle closure glaucoma with 360-degree PAS with shallow chambers, the presence of multiple AGVs, and presence of uveitis.

PI3K/Akt pathway mutations in retinoblastoma.

PURPOSE: Many malignancies are known to be associated with abnormal activation of the PI3K-AKT pathway. Recently, a somatic mutation in the AKT1 gene (E17K) was identified in a small proportion of human tumors. This mutation activated AKT1 by means of abnormal membrane recruitment and stimulated downstream signaling. This study was designed to analyze AKT1 mutations in retinoblastoma and gain insights into the role PI3K-AKT pathway plays in the development of this tumor. METHODS: Twenty-four samples of retinoblastoma from children were analyzed for mutations in the AKT1, PTEN and K-RAS genes, using a chip-based matrix-assisted laser desorption-time-of-flight (MALDI-TOF) mass spectrometer. Mutations in the PIK3CA gene were analyzed in 16 retinoblastoma samples using direct sequencing. RESULTS: These results show that the mutation E17K/AKT1 was not detected in the 24 samples of retinoblastoma analyzed. K-RAS mutations were identified in two samples. There were no mutations in any of the other genes analyzed by a mass array system. On direct sequencing of 16 samples for the PIK3CA gene, one sample showed gain of function mutation in exon 9. In another sample, a genetic polymorphism of unknown significance (rs17849079) was detected in exon 20. CONCLUSIONS: Although the PI3K-AKT pathway is known to be dysregulated in retinoblastoma, the low frequency of oncogenic mutations in the AKT1, PIK3CA, and PTEN genes, suggests a different activating mechanism.