Recurrent Bleeding, Survival, and Longitudinal Pulmonary Function following Bronchial Artery Embolization for Hemoptysis in a U.S. Adult Population.

PURPOSE: To report outcomes of bronchial artery embolization (BAE) for hemoptysis, including recurrent bleeding, survival, and longitudinal pulmonary function. MATERIALS AND METHODS: A prospective database identified 69 patients who underwent 97 BAE procedures (n = 1-7 per patient) at a tertiary academic medical center over a period of 11 years. Technical and clinical success were determined. Recurrent bleeding and survival were compared by etiology of lung disease. Rates of change in pulmonary function (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were measured and compared before and after index BAE by linear regression in 17 patients. RESULTS: The technical success rate of BAE was 90%. Clinical success rates at 24 hours and 30 days were 82% and 68%, respectively. Thirty percent of patients had recurrent bleeding that required bronchoscopy (7%) or additional embolization (23%). Median time to recurrent bleeding was 29 days among the 13 patients with sarcoidosis, compared with 293 days among patients without sarcoidosis (P = .0013). The hazard ratio for death in patients with sarcoidosis compared with those without sarcoidosis was 4 (95% confidence interval, 2.6-14.6). Analyzing all instances of pulmonary function tests, slopes of decline in FEV1 and FVC were significantly different (FEV1, P = .0048; FVC, P < .0001) before and after index BAE, with an improvement after BAE (FEV1, 0.8%/y; FVC, 1%/y) and a decrease before BAE (FEV1, -1.6%/y; FVC, -1.4%/y). CONCLUSIONS: BAE is an effective therapy for hemoptysis, but patients with sarcoidosis are at significant risk of recurrent bleeding and death compared with patients with other lung diseases. BAE does not accelerate deterioration in lung function.

Outcomes and Reasons for Late Presentation of Lens Induced Glaucoma: A Prospective Study.

PURPOSE: To determine the clinical outcomes and causes of late presentation in lens induced glaucoma (LIG). DESIGN: Prospective observational study. PARTICIPANTS: One hundred sixty-five patients with LIG who underwent cataract surgery. METHODS: Preoperative data collection included a questionnaire about reasons for late presentation, socioeconomic status, visual acuity, intraocular pressure (IOP), and the lens and angle status of the fellow eye. All patients underwent manual small-incision cataract surgery. Postoperative vision, IOP, the anterior segment, and the fundus were evaluated at days 1, 15, and 30. MAIN OUTCOME MEASURES: Reasons for late presentation, status of the fellow eyes, and surgical outcomes, including visual acuity and IOP at the 1-month postoperative visit. RESULTS: Mean age at presentation was 63.8 years, and the female-to-male ratio was 1.4:1. Of the entire cohort, 70.3% were phacolytic and 29.7% had phacomorphic glaucoma. The main causes for late presentation was nonfinancial (81.2%); of these, good vision in fellow eye and lack of escort to the hospital were the major reasons. Most fellow eyes were pseudophakic (72.1%). After surgery, 75.6% gained best-corrected visual acuity of 6/18 or more. Six percent experienced poor visual recovery (≤6/60) with optic atrophy as the major cause. Only 7.9% required further glaucoma management in the form of topical medications. Delayed presentation (>15 days) was associated with poor visual outcome. CONCLUSIONS: Nonfinancial causes, including good vision in the fellow eye and lack of escort, were the major determinants of late presentation. Most patients were pseudophakic in the fellow eye. After cataract extraction, only a few LIG patients required further glaucoma management.

Open-globe injury caused by barbed fish hook repaired using the back-out method: a report of two cases.

Fish hook open-globe injuries (OGIs) are challenging to repair surgically because of the backward-projecting barb near the hook's point that prevents withdrawal of the hook. The most commonly reported ophthalmic surgical technique for removal of barbed hooks is advance-and-cut, wherein the fish hook is pushed through an iatrogenic wound to the exterior of the globe, the barb is cut off, and the shank is backed out of the entry wound. We report 2 cases of zone I OGIs with retained fish hooks successfully repaired using the back-out technique. This strategy involves enlarging the entry wound to allow the entire hook and barb to be backed out, decreasing iatrogenic injuries and eliminating the need for wire cutters.

Use of Crossed Polarizers to Enhance Images of the Eyelids.

PURPOSE: To describe imaging of the external eye with Crossed Polarizers to enhance clinically important features in digital photographs of the eyelids. METHODS: External photographs with and without crossed polarizing filters were taken of patients with blepharitis and controls with no clinical eye pathology. RESULTS: Photographing eyelid skin through Crossed Polarizers decreased reflections on the skin surface and improved visualization of eyelid telangiectasias and blood vessels in patients with a broad range of skin pigmentation and ethnicities. CONCLUSIONS: The use of Crossed Polarizers in imaging the external eye reduces reflections and glare from the eyelid skin and margins, thereby allowing for a more detailed evaluation of underlying structures and analysis of images. These findings suggest that including Crossed Polarizers in clinical photography has informative applications for assessing eyelid disease.