Advances in the management of intraocular foreign bodies.

Intraocular foreign bodies (IOFBs) remain a severe complication of ocular trauma commonly encountered worldwide. This literature review aimed to discuss current practice patterns, areas of controversy, and advances in the management of IOFBs. Injuries involving IOFBs carry significant ocular morbidity and management can be extremely challenging. A systematic approach to preoperative evaluation and IOFB surgical management is detailed in this article and should be applied in each case. The location and composition of an IOFB have important implications on surgical approach and timing, especially in cases of toxic metals and vegetable matter. The advantages, disadvantages, and previous literature regarding immediate versus delayed foreign body removal are presented. Surgical approaches are described, with an emphasis on posterior chamber IOFB management and removal via pars plana vitrectomy. Final visual acuity is variable, but approaches have been used to prognosticate outcomes including the Ocular Trauma Score. By synthesizing current IOFB literature, the goal is to provide practitioners with guidance that will maximize the chances of surgical success and patient outcomes.

Characterization of ophthalmology virtual visits during the COVID-19 pandemic.

OBJECTIVES: To characterize the use of virtual visits, as well as compare the characteristics to in-person visits during the pandemic period. METHODS: This retrospective study included patients who had virtual and in-person ophthalmology visits from March 19, 2020, to July 31, 2020, in a large multispecialty ophthalmic center. Exclusion criteria included patients aged less than 18 years old; canceled, incomplete, mislabelled, and duplicated visits. 2943 virtual and 56,174 in-person visits were identified. A random sample of 3000 in-person visits was created. Each visit was analyzed as an individual data point. RESULTS: 2,266 virtual visits (2,049 patients, 64.3% female, mean [SD] age 64.3 [16.6] years old) and 2590 in-person visits (2509 patients, 59.5% female, 65.9 [15.8] years old) were included. Most virtual visits were classified as comprehensive ophthalmology (34.6%), optometry-related (19.5%), and oculoplastics (13.0%). For in-person visits, the most common specialties were optometry (29.8%), comprehensive ophthalmology (23.9%), and retina and uveitis (17.3%). The most common diagnoses in the virtual group were from the eyelids, lacrimal system, and orbits group (26.9%), while in the in-person groups were choroid and retina conditions (19.3%). CONCLUSIONS: Numerous ocular conditions were evaluated and managed through virtual visits, and external complaints and oculoplastic consults appear to be well-suited to the virtual format. Further studies focusing on visual outcomes and patient experience will be beneficial.

Determining the Location of the Fovea Centralis Via En-Face SLO and Cross-Sectional OCT Imaging in Patients Without Retinal Pathology.

Purpose: The purpose was to establish the position of the fovea centralis to the optic nerve via en-face, near-infrared spectral domain optical coherence tomography (NIR-OCT) in healthy patients. This may shed light on physiological variability and be used for studying subtle cases of foveal ectopia in macular pathology and after retinal detachment. Methods: SD-OCT data of 890 healthy eyes were retrospectively analyzed. Exclusion criteria included axial myopia causing tilting of the optic disc, peripapillary atrophy >1/3 the width of the disc, macular images excluding greater than half of the optic disc, and patients unable to maintain vertical head positioning. Two independent reviewers measured the horizontal and vertical distance from the fovea to the optic disc center and optic disc diameter via cross-sectional and en-face scanning laser ophthalmoloscopy OCT imaging. Results: 890 eyes were included in the study. The right and left eyes differed in the horizontal distance from the fovea to the disc center (4359 vs. 4248 µm, P < 0.001) and vertical distance from the fovea to the disc center (464 µm vs. 647, P < 0.001). This corresponded to a smaller angle between the right and left eyes (6.07° vs. 8.67°, P < 0.001). Older age was associated with a larger horizontal (P = 0.008) and vertical distance (0.025). These differences persisted after correcting for axial length in the 487 patients with axial-length data. Conclusions: This study compares the position of the fovea centralis among individuals without macular pathology on a micron level basis. The significant variability between right and left eyes indicates that contralateral eye evaluation cannot be reliably used. Rather, true foveal ectopia requires assessments of preoperative and postoperative NIR-OCT scans. This finding is relevant to retinal detachment cases and evaluation of subtle foveal ectopia. Translational Relevance: This finding is relevant to retinal detachment cases and evaluation of subtle foveal ectopia.

Impact and Characterization of Delayed Pan-Retinal Photocoagulation in Proliferative Diabetic Retinopathy.

PURPOSE: The American Academy of Ophthalmology recommends that patients diagnosed with proliferative diabetic retinopathy (PDR) be considered for pan-retinal photocoagulation (PRP) treatment within 1 month of diagnosis. This study aimed to investigate the effect delayed treatment had on visual outcomes and to characterize the medical and socioeconomic factors that contributed to delayed treatment of PDR. DESIGN: Retrospective clinical study. METHODS: This study examined 259 patients diagnosed with PDR and treated with PRP from 2015 to the present. Visual acuity (VA) outcomes through 24 months were compared among patients treated the day of diagnosis, and at 1-14 days, 14-31 days, and >31 days post-treatment. The relationships between time to treatment (days between PDR diagnosis and PRP) and medical comorbidities (coronary artery disease and/or myocardial infarction, heart failure, chronic kidney disease, dialysis, stroke, inpatient admission), laboratory values (hemoglobin A1c, blood urea nitrogen, serum creatinine), and socioeconomic factors (health insurance, median household income of ZIP code, and distance from ZIP code to treatment site) were examined. RESULTS: Mean time to treatment for all patients was 27.8 ± 41.4 days. VA was significantly decreased in patients who received PRP after 31 days compared with those treated on the day of diagnosis at 12 (P < .001) and 24 (P = .03) months post-treatment. Inpatient admission between diagnosis and treatment was significantly associated with an increase in time to treatment (86.5 ± 50.2 days; P < .001). CONCLUSIONS: In patients with diagnosed PDR, a delay in PRP treatment beyond 31 days was associated with worse visual outcomes than those treated earlier. Hospital admissions significantly delayed PRP delivery.

CONSEQUENCES OF LAPSES IN TREATMENT WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN ROUTINE CLINICAL PRACTICE.

PURPOSE: Evaluating outcomes in patients receiving intravitreal antivascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration whom experience a lapse in treatment. METHODS: A retrospective chart review evaluating 3,304 patients ≥18 years who experienced treatment lapses ≥3 months compared with control counterparts. Demographic information, macular thickness as measured by central subfield thickness, and visual acuity were collected at baseline, the first postlapse appointment, and at 3, 6, and 12 months after the lapse for the study group. RESULTS: Lapse (n = 241) and control patients (n = 241) had similar baseline visual acuity and central subfield thickness (Early Treatment Diabetic Retinopathy Study: 58.9 ± 20.2 [20/63] vs. 59.2 ± 20.1 [20/63]; central subfield thickness: 252.4 ± 63.2 µm vs. 259.8 ± 66.2 µm, P = 0.21). Analysis revealed that lapse patients experienced a significant increase in central subfield thickness after lapse when compared with controls (279.4 ± 86.9 µm vs. 253.7 ± 65.9 µm, P < 0.01), which normalized on resumption of treatment (259.1 ± 79 µm vs. 246.8 ± 57.6 µm, P = 0.06). Study patients also experienced loss in the visual acuity after lapse when compared with controls (52.9 ± 23.6 Early Treatment Diabetic Retinopathy Study [20/100] vs. 59.9 ± 20.8 [20/63] Early Treatment Diabetic Retinopathy Study, P < 0.01) that did not recover through 12 months of follow-up. CONCLUSION: Patients with neovascular age-related macular degeneration who have lapses in care are at risk for poorer outcomes. Although macular thickness normalizes on resumption of treatment, their decline in the visual acuity does not recover.

Comparison of Widefield Imaging Between Confocal Laser Scanning Ophthalmoscopy and Broad Line Fundus Imaging in Routine Clinical Practice.

BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the difference between widefield confocal scanning laser imaging (WSLO) and widefield broad line fundus (WBLF) imaging in their ability to view the peripheral retina in routine clinical practice. PATIENTS AND METHODS: A retrospective chart review identified patients within routine clinical practice who were imaged with a WSLO image and a single and montaged WBLF image. The primary outcome was the number of ultra-widefield quadrants captured utilizing the UWF consensus definitions. Secondary outcomes included the area within each of quadrant and the differences in clinical grading between modalities. RESULTS: More vortex ampullae were identified with the WSLO than either single image or montage WBLF image. The WSLO captured 116 of the possible 260 vortex ampullae (45%) in comparison to the WBLF single image (8 of 260; 3%) and WBLF montage (96 of 260; 37%). Only five eyes from WSLO and no images from the WBLF single image met the ultra-widefield consensus definition in routine clinical practice. The average area per individual quadrant acquired by WSLO image was greater than the single or montage WBLF image (781.67 mm2, 433.82 mm2, and 686.03 mm2, respectively; P < .001). Clinical grading of images found a substantial inter-rater agreement with both technologies (86% on WSLO; 88% on WBLF). CONCLUSIONS: Both systems had a low rate of meeting UWF consensus definitions in routine clinical practice. A single WSLO image acquired a greater area than WBLF image in both single-image and montage formats. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:89-94.].