Comparison of Ocular Biometric Parameters Between Hispanic and Non-Hispanic Ethnicities in White Adults Undergoing Cataract Surgery.

OBJECTIVES: To compare ocular biometric parameters between Hispanic and non-Hispanic White adult patients undergoing cataract surgery. METHODS: We included 433 adult patients undergoing surgery for senile cataract. Only patients with race and ethnicities of Hispanic and non-Hispanic White were included. The following parameters measured by the IOLMaster 700 were compared between Hispanic and non-Hispanic patients: mean keratometry, corneal astigmatism, anterior chamber depth (ACD), lens thickness, vitreous length, axial length, white-to-white diameter, and emmetropic intraocular lens power. RESULTS: There were 219 Hispanic patients and 214 non-Hispanic patients with a mean age of 70.1±7.7 years (range, 50-88 years), and 66.7% were women. Although sex distribution was similar between the two groups, Hispanic patients had a lower age compared with non-Hispanic patients (69.3±8.3 vs. 70.9±6.9 years, P=0.02). In biometric values, ACD was significantly lower in Hispanic patients (3.07±0.40 mm) than in non-Hispanic patients (3.16±0.37 mm, P=0.01). Such statistically significant difference persisted after adjustment for age and sex (P=0.01). No other significant differences were found in other ocular parameters measured. CONCLUSIONS: Anterior chamber depth is significantly shorter in Hispanic patients compared with non-Hispanic patients. Such ethnic difference should be considered when performing cataract and corneal surgeries because this ethnic difference may be associated with a higher risk of corneal endothelial injury.

Occurrence of Occult Neoplasia in Pterygium Specimens Among Hispanic and Non-Hispanic Patients.

PURPOSE: To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia in pterygium specimens. METHODS: This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of ocular surface squamous neoplasia were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult ocular surface squamous neoplasia in pterygium specimens. RESULTS: There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 70.8% and non-Hispanic in 29.2%. Among all specimens, 18 (3.6%) were positive for occult ocular surface squamous neoplasia. The prevalence of occult ocular surface squamous neoplasia in pterygium specimens was higher in Hispanics compared to non-Hispanics (4.8% vs. 0.7%, respectively, p = .025). The prevalence of occult ocular surface squamous neoplasia in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (p = .57). There were also no statistically significant differences between those with or without occult ocular surface squamous neoplasia regarding age or sex. CONCLUSIONS: A significant but low rate of occult ocular surface squamous neoplasia was found in pterygium specimens. The percentage of those with ocular surface squamous neoplasia in pterygium specimens was significantly greater in Hispanics compared to non-Hispanics. As treatment and prognosis of pterygium and ocular surface squamous neoplasia differ, histopathologic evaluation of all pterygium specimens is warranted.

Superior limbic keratoconjunctivitis: a comprehensive review.

Superior limbic keratoconjunctivitis (SLK) is characterized by chronic inflammation of the superior limbus and superior bulbar and tarsal conjunctivae. Patients also often have fine punctate staining of the limbus and adjacent area, superior limbic proliferation seen as thickening of the limbal epithelium and surrounding conjunctiva, and occasionally filaments at the superior limbus and upper cornea. SLK frequently presents with ocular irritation, foreign body sensation, and photophobia. SLK can be associated with other ocular and non-ocular conditions, such as thyroid disease. Although the pathogenesis of SLK is still unknown, it is thought to be related to mechanical injury, tear film instability, or an autoimmune/inflammatory etiology. Many patients with SLK can be asymptomatic or have symptoms that resolve or remit spontaneously. For symptomatic SLK, patients are managed medically with treatments such as lubricants, topical anti-inflammatory or immunomodulatory medications, punctal occlusion, and bandage contact lenses. Patients with symptoms refractory to medical management may need surgical interventions. We detail the current literature on the epidemiology, clinical manifestations, associated conditions, histopathology, pathogenesis, and treatment of SLK.

A review of filamentary keratitis.

Filamentary keratitis (FK) is characterized by the presence of filaments on the corneal surface that are often associated with symptoms of foreign body sensation, irritation, and eye pain. FK is associated with a variety of ocular and systemic conditions, most notably dry eye disease. These filaments are composed primarily of epithelium, mucus, and cellular debris; however, their pathogenesis remains an area of debate. Aggravating factors for FK include desiccation, inflammatory mediators, as well as eyelid mechanical forces. Management consists of addressing associated conditions, especially dry eye disease, and providing medical and procedural treatments to alleviate symptoms and restore the ocular surface. Mainstay treatments include filament removal, increased lubrication with artificial tears and punctal occlusion, hypertonic saline, antiinflammatory and mucolytic medications, and autologous serum eye drops, as well as bandage contact lenses. A stepwise approach is required to manage patients with acute or chronic FK. Prolonged therapy is often necessary to prevent recurrence of this bothersome condition.

Patterns and Predictors of Successful Treatment Discontinuation in Retinal Vein Occlusions With Macular Edema in the Real World.

BACKGROUND AND OBJECTIVE: To identify factors associated with successful treatment discontinuation in eyes with retinal vein occlusions (RVOs) and macular edema (ME) in real-world settings. PATIENTS AND METHODS: Retrospective study of 214 eyes with RVO and ME with 24-month follow-up at five academic centers. Regression analyses identified factors associated with (1) successful treatment discontinuation for at least 6 months without fluid recurrence and (2) best-corrected visual acuity (BCVA) at 24 months. RESULTS: Forty percent of eyes with branch RVO and 35% with central RVO (CRVO) / hemi-retinal RVO (HRVO) successfully discontinued therapy without fluid recurrence, with median time to discontinuation of 6 and 7 months, respectively. Lower 6-month central subfield thickness was associated with greater likelihood of treatment discontinuation within 24 months for eyes with CRVO/HRVO (P = .001), whereas better 6-month BCVA was associated with better 24-month BCVA for all RVO subtypes (P < .001). CONCLUSION: Early anatomic response at 6 months is associated with greater likelihood of stopping treatments. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:84-92.].

Etiology and Risk Factors for Infectious Keratitis in South Texas.

PURPOSE: To determine the causative organisms and associated risk factors for infectious keratitis in South Texas. METHODS: This retrospective study was performed at a tertiary teaching hospital system in South Texas. Medical records of all patients who presented with infectious keratitis from 2012 to 2018 were reviewed. Only patients with culture-proven bacterial, fungal, and Acanthamoeba keratitis were included. RESULTS: In total, 182 eyes of 181 patients had culture-proven bacterial, fungal, or Acanthamoeba keratitis. The age of patients ranged from 3 to 93 years, with a mean of 48.3 ± 20.8 years. The most common etiologic agent was bacteria, with 173 bacterial cultures (95.1%) recovered, followed by 13 fungal cultures (7.1%), and 3 Acanthamoeba cultures (1.6%). Of the 218 bacterial isolates, coagulase-negative Staphylococcus was the most common (25.7%), followed by Pseudomonas aeruginosa (23.4%), Staphylococcus aureus (11.0%), and Moraxella (7.8%). Fusarium was the most common fungal isolate (46.2%). The most common risk factors for infectious keratitis included contact lens wear (32.4%), underlying corneal disease (17.6%), trauma (14.3%), and ocular surface disease (13.7%). CONCLUSIONS: Bacteria are the most common cause of infectious keratitis in this patient population, with coagulase-negative Staphylococcus and Pseudomonas as the most common isolates. The prevalence of culture-positive fungal keratitis is significantly lower than that of bacterial keratitis. Contact lens wear is the most common risk factor associated with infectious keratitis in South Texas.

Design and Validation of a Cervical Laminectomy Simulator using 3D Printing and Hydrogel Phantoms.

BACKGROUND: The development of technical skills for a cervical laminectomy are traditionally acquired through intraoperative learning and cadaveric courses. These methods provide little objective assessment, involve financial and biohazard considerations, and may not incorporate desired pathology. OBJECTIVE: To develop an inexpensive cervical spine laminectomy simulator capable of measuring operative performance and to assess its face, content, and construct validity. METHODS: A virtual model was generated and 3D printed into negative molds. A multilayered surgical phantom was fabricating by filling molds with hydrogels, plaster, and fiberglass. A pressure transducer measured simulated spinal cord manipulation. Participants completed full-procedural laminectomy simulations. Post-simulation surveys assessed face and content validity. Construct validity was assessed by comparing expert and novice procedural metrics. RESULTS: Twelve surgeons participated. The simulator received median face and content validity ratings of 4/5. Differences between experts and novices were found in mean intrathecal pressure wave count (84 vs 153, P = .023), amplitude (4 vs 12% > 2SD above expert mean, P < .001), area under curve (4 vs 12% > 2SD above expert mean, P < .001), procedure time (35 vs 69 min P = .003), and complication rates (none vs 3 incorrect levels decompressed and 1 dural tear, P = .06). Insignificant differences were found in mean pressure wave slope and blood loss. CONCLUSION: This inexpensive cervical laminectomy simulator received favorable face and content validity ratings, and distinguished novice from expert participants. Further studies are needed to determine this simulator's role in the training and assessment of novice surgeons.

Estimating ground water recharge using flow models of perched karstic aquifers.

The fraction of rain that is annually recharged to ground water is a function of the transient quantities of precipitation (wet vs. dry years) as well as other meteorological and geologic factors, and thus it is very difficult to estimate. In this study, we have used long records (20 to 30 years) of precipitation and spring discharge to reconstruct the transient character of yearly recharge. These data sets were used to calibrate numerical ground water flow models on the less than 3 km(2) scale for four separate perched karstic aquifers in the Judean and Samarian Mountains of Israel. The stratification and karstic character of the local carbonate rock aquifers cause ground water to flow through discrete dissolution channels and to discharge at isolated springs. An innovative, dual-porosity approach was used where a finite-difference solution simulates flow in the rock matrix, while the karstic channels are simulated using computationally simple drains. Perched conditions are also simulated innovatively using MODFLOW by treating the bottom unsaturated layer as if it is saturated, but by assuming zero pressure head throughout the "unsaturated" layer. Best fitting between measured and computed spring hydrograph data has allowed us to develop a set of empirical functions relating measured precipitation to recharge to the aquifer. The generic methodology presented gives insight into the suspected changes in aquifer recharge rates between particularly wet or dry years.