Weather Patterns and the Frequency of Ophthalmology Consultations in the Emergency Setting.

PURPOSE: To determine if weather patterns are associated with the frequency of ophthalmology consultations in the Emergency Room (ER) and trauma settings. METHODS: Hospital-based ophthalmology consultations between January 1, 2015 and December 31, 2020 at the University of Maryland Medical Center (UMMC) were included in the BALCITE (BALtimore Consultation, Inpatient, and Trauma of the Eye) database. Encounters were filtered to the general ER, the R. Crowley Adams Shock Trauma Center, and consultations within 24 h of admission where a delay was attributed to bed assignment. Weather data from the National Climatic Data Center (NCDC) for Baltimore, Maryland, was matched to the day of the initial encounter. RESULTS: A total of 3,877 patients were included. Overall, there was a significant association between increasing daily average temperature (R2 = .152, p = 0.0003) and daily maximum temperature (R2 = .243, p < 0.001) with incidence of ophthalmology consultations. There was no significant decrease in consultations with increasing precipitation (R2 = -.007, p = 0.7477). For trauma-related consultations, there was not a significant association between consultation incidence and average daily temperature (R2 = .011, p = 0.2013), maximum daily temperature (R2 = -0.012, p = 0.6529), or precipitation levels (R2 = .075, p = 0.24). The months with the highest consultation volume were September, August, and July, and the lowest numbers in April, March, and February. CONCLUSIONS: Emergency ophthalmology consultations increased with increasing daily temperature. Trauma-specific consultations did not show a significant association with weather patterns. This information may prove useful to ER providers and ophthalmologists in order to help predict frequency of consultations and better deploy personnel and resources.

Chlamydia psittaci -Induced Reactive Infectious Mucocutaneous Eruption With Ocular Involvement.

INTRODUCTION: This report highlights a postinfectious mucocutaneous inflammatory response involving the ocular surface and adnexa after Chlamydophila psittaci exposure. CASE DESCRIPTION: A 35-year-old man presented after a prodrome of upper respiratory symptoms with rash and mucocutaneous blistering involving the ocular and oral mucosa, causing pseudomembranous conjunctivitis and corneal epithelial defects. Extensive inflammatory and infectious workup suggested recent C. psittaci infection. The patient was treated with doxycycline and supportive therapy, whereas the ocular surface was treated with lubrication and prophylactic antibiotics. In follow-up, he has retained excellent visual acuity but required scleral contact lenses to control ocular surface symptoms because of fibrotic changes of the marginal conjunctiva. DISCUSSION: Such blistering inflammation has most commonly been described after pediatric respiratory infections because of Mycoplasma pneumoniae with additional instances related to Chlamydia pneumoniae , Epstein-Barr virus, influenza B, and other stimuli . To the best of our knowledge, this is the first reported case of C. psittaci- induced reactive infectious mucocutaneous eruption (RIME). RIME is a rare parainfectious inflammatory condition with sequelae frequently involving the periocular mucosa. Although systemic and nonocular adverse outcomes in this condition tend to be self-limited, the impact on the ocular surface may be severe, and the consequences to vision may be ongoing, especially if not treated aggressively at the outset.

Phthiriasis palpebrarum effectively treated with tea tree oil.

Phthiriasis palpebrarum, also known as crab lice, is a rare eyelash infestation by Pthirus pubis that is often misdiagnosed as common blepharitis, and thus mistreated. Treatment of Phthiriasis palpebrarum is widely variable. Tea tree oil is an essential oil with broad-spectrum anti-microbial therapeutic effects. Notably, however, the role of this agent in Phthiriasis palpebrarum management is unclear. The current article reports a case of phthiriasis palpebrarum effectively treated with tea tree oil.

Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial.

PURPOSE: To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). METHODS: This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts. RESULTS: In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months. CONCLUSION: Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.

The detection of keratoconus using novel metrics derived by anterior segment optical coherence tomography.

PURPOSE: To determine through a feasibility study whether anterior and posterior corneal arc length and cross-sectional area measured using anterior segment ocular coherence tomography (AS-OCT) can distinguish between healthy and keratoconic corneas. METHODS: Patients diagnosed with keratoconus along with healthy controls underwent AS-OCT. ImageJ was used to determine the central 6 mm anterior and posterior corneal arc lengths and cross-sectional areas. Each length and area was then divided into 1-mm segment and relative differences compared. RESULTS: Twenty-five eyes from 15 patients with keratoconus, along with 25 eyes from 14 healthy controls were enrolled. There was a statistically significant difference in anterior and posterior corneal arc lengths as well as corneal cross-sectional area (p = 0.006, p = 0.005, p = 0.01, respectively). When selecting for the less advanced keratoconus eye, it was noted that posterior corneal arc length was longer in the paracentral temporal segment (1003 vs. 1010 µm, p = 0.04) and that greater change in corneal cross-sectional areas occurred between adjacent segments in less advanced keratoconus eyes. CONCLUSION: AS-OCT is capable of reliably measuring corneal arc lengths in patients with keratoconus and healthy patients. Both anterior and posterior corneal arc lengths along with central cross-sectional areas are statistically different between healthy and keratoconus eyes.

Dexamethasone implant migration in an eye with congenital glaucoma: A case report and review of the literature.

INTRODUCTION: The dexamethasone (DEX) implant is an FDA approved treatment for diabetic macular edema, non-infectious posterior uveitis, and macular edema secondary to branch or central retinal vein occlusions. We describe a case of anterior chamber (AC) migration of a DEX implant in a patient with a history of congenital glaucoma and perform a review of the literature on this particular complication, summarizing the common risk factors, subsequent complications, and management options. CASE DESCRIPTION: A 46-year-old female with a history of congenital glaucoma, status post cataract extraction with insertion of intraocular lens, pars plana vitrectomy, and Baerveldt tube implant in the left eye was referred for post-operative cystoid macular edema (CME). The patient underwent insertion of a DEX implant, resulting in improvement in her CME. After the fourth implant was injected, the patient noticed a white line in her eye while looking in the mirror after doing jumping jacks. Slit lamp examination confirmed migration of the implant into the AC. Ultimately, the patient was taken to the operating room, where her implant was removed via bimanual vitrectomy through an anterior approach. CONCLUSION: This case report and literature review explores the ophthalmic structural changes specific to congenital glaucoma which may have predisposed this eye to anterior migration of the DEX implant. The purpose of this review is to detail the anatomic changes that may increase the risk of anterior chamber implant migration in patients with congenital glaucoma so that physicians may be aware of these risks when selecting patients for this implant.

Corneal Changes After Belantamab Mafodotin in Multiple Myeloma Patients.

OBJECTIVES: To describe progressive corneal microcyst-like epithelial changes (MECs) that developed in patients treated with the investigational drug belantamab mafodotin (belamaf) for refractory multiple myeloma (MM). METHODS: This is a single center case series of patients with MM receiving the investigational drug belamaf. RESULTS: All 12 patients included in this analysis who were treated with belamaf developed MECs that initially appeared in the peripheral cornea and progressed centrally with time. Cessation of therapy resulted in regression of the MECs first in the periphery then centrally. Microcyst-like epithelial changes recurred in all patients on retreatment. With prolonged therapy, eight patients developed corneal staining patterns suggestive of limbal stem cell dysfunction (LSCD). CONCLUSION: We describe MECs and LSCD associated with systemic administration of belamaf. Further study is needed to determine the etiology and composition of the MECs and the mechanism of limbal stem cell involvement.

Comparison of Preoperative Parameter Measurements Using an Optical Biometer, Automated Keratometer, and a Placido-Based Topographer Module.

OBJECTIVES: To assess the agreement of corneal power, corneal astigmatism, axis location, and astigmatic vector component measurements using a Lenstar LS900, a T-cone add-on, and an ARK 1S autorefractor, furthermore, to assess instrument agreement in a subset of astigmatic eyes. METHODS: Retrospective analysis of keratometric readings from 3 instruments for 66 eyes undergoing cataract surgery at the Maryland Veterans Affairs Medical Center from November 2014 to 2015. Agreement in corneal power, mean corneal power, axis location, and astigmatic vector components (J0, J45) between devices was evaluated. Comparability was assessed using intraclass correlation, analysis of variance (ANOVA) one-way analysis, Bland-Altman analysis, and power vector analysis. Intraclass correlation was then assessed for a subset of 42 eyes with corneal astigmatism greater than or equal to 1 D. RESULTS: The intraclass correlation between instruments was 0.941 for corneal power, 0.788 for corneal astigmatism, 0.932 for J0, and 0.809 for J45. The ANOVA one-way repeated P values comparing Kf, Ks, Km, corneal astigmatism, axis location, J0, and J45 were all greater than 0.05. Power vector analysis showed nearly all values between instruments to be within ±0.5 D. Finally, the intraclass correlation between instruments in eyes with ≥1 D of corneal astigmatism as measured by the T-cone was 0.946 for corneal power, 0.837 for corneal astigmatism, 0.948 for J0, and 0.950 for J45. CONCLUSIONS: The high level of agreement between all devices indicates the instruments may be used interchangeably. Our data suggest that this may also be true for the subset of eyes with greater than or equal to 1 D in astigmatism, highlighting the toric intraocular lens population.

Reducing Cancellations and Optimizing Surgical Scheduling of Ophthalmology Cases at a Veterans Affairs Medical Center.

Preventable causes of ophthalmology surgical case cancellations were identified, and interventions were implemented to improve operating room utilization at our Veterans Affairs (VA) Medical Center. A retrospective review of 269 patients with cancellations from 2013 to 2015 was performed. Interventions implemented from September 2014 to March 2015 were evaluated followed by in-depth chart reviews to identify demographics and wait-time intervals. Interventions included scheduling surgeries electronically, by specialty, and with predetermined attending coverage. In addition, the preoperative templates and technology to obtain preoperative measurements were updated. Cancellation rates dropped significantly from 35% to 7% (p = .014). Preventable causes of cancellations decreased from 28% to 5% (p = .005). Operating room utilization increased significantly with 264 more scheduled cases in 2015 than in 2013 (485 vs. 749, p < .001), and surgery wait time trended downward. These findings may support the use of similar interventions at other VA medical centers or similar hospitals with the goal of improving quality of care through decreased cancellations and cost.

Eventual Endothelial Failure After Initial Corneal Clearing After a Detached Endothelial Graft in Fuchs Dystrophy.

PURPOSE: To report a case of eventual corneal endothelial cell failure after spontaneous resolution of corneal edema after failed Descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective case report. RESULTS: A 56-year-old man with Fuchs endothelial corneal dystrophy underwent cataract and DMEK surgery in the left eye. The transplanted DMEK graft detached in the early postoperative period and formed a peripheral scroll. Despite graft detachment, corneal edema resolved with endothelial cell repopulation of the central cornea. The patient's uncorrected visual acuity 5 months after surgery was 20/25. However, by 7 months after this spontaneous improvement, the patient started to complain of worsening vision. At 2.5 years, recurrent corneal edema became clinically apparent, and no endothelial cells were visible by specular microscopy in the central cornea. CONCLUSIONS: This case suggests that spontaneous healing of a large central Descemet membrane defect significantly diminishes the peripheral endothelial cell reserves and can lead to imminent bullous keratopathy. If there is any potential of corneal endothelial cells to regenerate after surgical removal of central Descemet membrane in Fuchs dystrophy, it is likely very limited.

Correlation of corneal thickness and volume with intraoperative phacoemulsification parameters using Scheimpflug imaging and optical coherence tomography.

PURPOSE: To evaluate post-phacoemulsification corneal edema using central corneal thickness (CCT) and central corneal volume (CCV) derived from Scheimpflug imaging, optical coherence tomography (OCT), and ultrasound (US) pachymetry and to correlate CCV with phacoemulsification parameters. SETTING: Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts, USA. DESIGN: Prospective case study. METHODS: Scheimpflug imaging (Pentacam HR), OCT (Cirrus HD-OCT), and US pachymetry (Pachmate) were used to measure the CCT, CCV, and phacoemulsification parameters after uneventful phacoemulsification over a 1-month follow-up. RESULTS: In the 16 eyes assessed, the Scheimpflug CCT was less than the US CCT preoperatively (P=.01) and 1 week postoperatively (P=.02). The OCT CCT was less than the US CCT at 1 week and 1 month (both P<.01). At 3.0 mm, the CCV was increased at 1 day and 1 week (both P<.01) but returned to preoperative levels by 1 month (P=.09). However, the 7.0 mm CCV remained elevated at 1 month (P<.01). There were strong correlations between the change in the 7.0 mm CCV and the estimated fluid used (r = 0.76) and phacoemulsification time (r = 0.61). CONCLUSIONS: Scheimpflug imaging and OCT underestimated the CCT in normal eyes compared with US pachymetry, with a trend toward thicker measurements in acutely edematous corneas. Although the CCV returned to preoperative values at 1 month, the peripheral cornea remained edematous, possibly because of a correlation with the estimated amount of fluid used and phacoemulsification time.

Effect of variation in derived corneal wavefront aberrations by calculation methods on intraocular lens selection.

PURPOSE: To compare topographically derived corneal wavefront aberrations between the NIDEK Magellan corneal topographer with built-in software (NIDEK Co Ltd) and VOL-CT software (Sarver and Associates) and determine their effects on intraocular lens (IOL) choice based on spherical aberration profiles. METHODS: Data were collected prospectively for 28 eyes without existing corneal disease prior to undergoing cataract surgery. Corneal higher order aberrations were calculated using Zernike polynomial expansions from topographic data and compared between the builtin NIDEK software and VOL-CT software. RESULTS: Using two-tailed paired t tests, statistically significant (P<.05) differences were found between the two calculations at 4 mm for 4th order aberrations (NIDEK: 0.2005 µm, VOL-CT: 0.1202 µm) and 6th order aberrations (NIDEK: 0.0985 µm, VOL-CT: 0.0546 µm). Statistically significant differences were noted between the two calculations at 6 mm for 5th order aberrations (NIDEK: 0.2757 µm, VOL-CT: 0.1618 µm) and 6th order aberrations (NIDEK: 0.2641 µm, VOL-CT: 0.0920 µm). No statistically significant differences existed for 3rd order, spherical aberration, and total higher order aberrations. However, using spherical aberration-based IOL selection criteria, the ultimate IOL selection would have differed in 13 eyes if calculated using the NIDEK versus VOL-CT software. CONCLUSIONS: Statistically significant differences were present in wavefront aberration calculations using the NIDEK versus VOL-CT software for 4- and 6-mm pupil sizes. These differences in spherical aberration could influence wavefront-optimized IOL selection for cataract surgery.