Iris and orbital myeloid sarcoma in a pediatric patient.

We report the case of a 35-month-old previously healthy girl who presented with a history of several months of both an enlarging orbital mass and a contralateral iris mass as her initial signs of acute myeloid leukemia.

Elevated IOP following a bladder filling protocol: A case report.

Purpose: We describe a patient with elevated intraocular pressure (IOP) secondary to an oral water bolus and examine the utility of the water-drinking test. Observations: A 66-year-old male with a history of hypertension presented with headache, bilateral retro-orbital ache, and blurry vision. Symptoms began shortly after his radiation treatment for prostate cancer, for which he consumed a water bolus to fill his bladder 30 minutes prior to treatment initiation. On exam, he had bilateral elevated IOP that responded to topical IOP-lowering medications. Gonioscopy demonstrated open angles and fundus exam showed non-glaucomatous optic nerves with pronounced retinal venous tortuosity. The water-drinking test showed a peak intraocular pressure of 20 mmHg in the right eye (5 mmHg increase from baseline) and 23 mmHg in the left eye (8 mmHg increase from baseline), suggesting impairment of the outflow system in the left compared to the right eye. He was started on topical IOP-lowering therapy and followed in our clinic as a glaucoma suspect. Conclusions: Consumption of a water bolus can be associated with IOP elevation and may be a risk factor in patients with otherwise normal IOPs at risk for glaucoma. The water-drinking test was historically used as provocative testing for open-angle glaucoma and may have an updated role in evaluating at-risk patients without ocular hypertension.

Systemic follicular lymphoma in a patient with a history of thyroid eye disease: a case report.

The most common cause of both unilateral and bilateral proptosis in adults is thyroid eye disease (TED), and the diagnosis in typical cases is made without imaging. However, many other orbital diseases, including inflammatory, infectious, and neoplastic processes, can mimic the symptoms of thyroid eye disease, highlighting the importance of imaging and biopsy in challenging cases. There are limited reports in the literature of orbital lymphoma being diagnosed in patients with a history of thyroid eye disease. Here, we present the case of a patient with long-standing TED who developed new asymmetric proptosis and was subsequently diagnosed with systemic follicular lymphoma.

Computer-based video training is effective in teaching basic surgical skills to novices without faculty involvement using a self-directed, sequential and incremental program.

INTRODUCTION: Computer-based video training (CBVT) of surgical skills overcomes limitations of 1:1 instruction. We hypothesized that a self-directed CBVT program could teach novices by dividing basic surgical skills into sequential, easily-mastered steps. METHODS: We developed a 12 video program teaching basic knot tying and suturing skills introduced in discrete, incremental steps. Students were evaluated pre- and post-course with a self-assessment, a written exam and a skill assessment. RESULTS: Students (n = 221) who completed the course demonstrated significant improvement. Their average pre-course product quality score and assessment of technique using standard Global Rating Scale (GRS) were <0.4 for 6 measured skills (scale 0-5) and increased post-course to ≥3.25 except for the skill tying on tension whose GRS = 2.51. Average speed increased for all skills. Students' self-ratings (scale 1-5) increased from an average of 1.4 ± 0.7 pre-elective to 3.9 ± 0.9 post-elective across all skills (P < 0.01). CONCLUSION: Self-directed, incremental and sequential video training is effective teaching basic surgical skills and may be a model to teach other skills or to play a larger role in remote learning.

Long-term Clinical Outcomes of Pars Plana Versus Anterior Chamber Placement of Glaucoma Implant Tubes.

PURPOSE: To compare long-term surgical outcomes and complications of pars plana (PP) tube implantation with conventional anterior chamber (AC) tube implantation. MATERIALS AND METHODS: Records of patients undergoing glaucoma tube implant surgery at a single institution between 2007 and 2015 were retrospectively reviewed. Eyes were matched for glaucoma diagnosis and patient age. Demographics, baseline characteristics, and treatment outcomes were recorded. Surgical success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg, no subsequent glaucoma surgeries performed, and at least light perception vision. RESULTS: Fifty-seven eyes that underwent Ahmed or Baerveldt glaucoma drainage device surgery with PP tube placement were compared with 57 eyes with AC tube placement. Mean follow-up was 43.5 months in the PP group and 35.3 months in the AC group (P=0.02). Forty-nine (86.0%) PP eyes and 46 (80.7%) AC eyes achieved surgical success (P=0.45). At last follow-up, mean IOP decreased from 29.0 to 15.1 mm Hg in the PP group (P<0.01) and from 32.7 to 15.6 mm Hg in the AC group (P<0.01). Mean number of medications decreased from 2.9 to 1.1 in the PP group (P<0.01) and from 2.8 to 1.3 in the AC group (P<0.01). Mean IOP and number of medications were similar between PP and AC groups at baseline, last follow-up, and all interim time points (P>0.05 for all). There were 16 complications in the PP group and 14 in the AC group (P=0.67). CONCLUSIONS: Long-term results of glaucoma tube implant surgery with PP versus AC implantation shows effective IOP control with similar rates of surgical success.

OUTCOMES OF PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION TREATED WITH ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR THREE OR MORE YEARS: A Review of Current Outcomes.

PURPOSE: To summarize the findings of long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy (≥36 months) in patients with exudative age-related macular degeneration. METHODS: Studies reporting long-term outcomes (≥36 months) of anti-VEGF therapy (n = 11) were identified and analyzed for changes in visual acuity (VA), optical coherence tomography, and safety findings. RESULTS: Six prospective extension studies of Phase 3 clinical trials and five retrospective evaluation studies were identified. The largest improvements in VA with anti-VEGF treatment were found in Years 1 to 2 after treatment initiation. In five studies, VA ultimately declined below patients' pretreatment initial baseline; in three studies, VA ultimately returned to patients' baseline; in three studies, VA decreased but ultimately remained improved over patients' baseline. There was a trend demonstrating that a higher frequency of intravitreous injections showed a better maintenance in VA. Rates of adverse events were similar to previous registration studies of anti-VEGF drugs. CONCLUSION: The body of evidence to date regarding long-term anti-VEGF treatment indicates a variable course at greater than 36 months follow-up and seems to be dependent on the treatment protocol. Consistent dosing with fluid-free interval is suggested to maintain VA gains in patients with exudative age-related macular degeneration. There is no evidence suggesting that there are additional adverse events from long-term anti-VEGF use.

Measuring outcomes in cataract surgery.

PURPOSE OF REVIEW: The article presents a review of recently published studies reporting postcataract surgery outcomes and the use of electronic systems to track them. RECENT FINDINGS: Current publications report several parameters to measure cataract outcomes such as visual acuity, patient-reported visual function, contrast sensitivity, reading speed, residual refractive errors and complications (intraoperative and postoperative). SUMMARY: Cataracts currently afflict an estimated 94 million people worldwide, and surgical removal is the only effective therapy known. Tracking outcomes through registry databases has been shown to be a powerful tool for improving patient outcomes, understanding and adopting best clinical practices, reducing costs and increasing value delivered. Large datasets present in electronic registry systems are valuable resources for evaluating the quality of care by allowing researchers and healthcare providers to analyze, understand and adjust to 'real-world' best practices and adverse events.