VISCOELASTIC ASSISTED DRAINAGE OF SUPRACHOROIDAL HEMORRHAGE ASSOCIATED WITH SETON DEVICE IN GLAUCOMA FILTERING SURGERY.

PURPOSE: The purpose of this article is to describe a novel surgical technique for the management of large suprachoroidal hemorrhages associated with the insertion of glaucoma seton devices. METHODS: In this interventional case series, the authors describe six eyes of six patients who had management of suprachoroidal hemorrhage with pars plana choroidal drainage along with simultaneous insertion of viscoelastic into the posterior segment. All patients had a median of 8-month postoperative follow-up. RESULTS: Five of the 6 patients had useful final vision ranging from 20/40 to 20/200. In all cases, the postoperative intraocular pressures did not increase beyond 28 mmHg and responded to aqueous humor suppressants. CONCLUSION: As suprachoroidal hemorrhage can be a devastating complication of glaucoma surgery, the authors report a relatively straightforward surgical technique that can restore ambulatory vision in a high proportion of patients.

COMPARISON OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY SCAN PATTERNS AND CLINICAL REVIEW STRATEGIES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To compare various spectral domain optical coherence tomography scan patterns and review strategies to identify an optimal imaging workflow for neovascular age-related macular degeneration. METHODS: A retrospective consecutive case series was performed in eyes after anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration with concurrent spectral domain optical coherence tomography imaging (Zeiss Cirrus), including horizontal/vertical five-line rasters, and macular cube analysis. For each scan pattern, a single report was independently reviewed in a masked fashion within the clinical image review software, whereas the cube was reviewed line-by-line in the reader software for the presence of fluid. RESULTS: One hundred and fifty-six reports and 39 cube scans of 39 patients were included. Among all spectral domain optical coherence tomography scans, 64% (25/39) had definitive fluid and 95% (37/39) had possible fluid. Sensitivities for definite fluid detection for horizontal, combined horizontal/vertical, and horizontal/vertical/map reviews were 68%, 76%, and 88%, respectively. When assessing for possible fluid, sensitivities for the detection for horizontal, combined horizontal/vertical, and horizontal/vertical/map reviews were 76%, 92%, and 97%, respectively. Line-by-line review of the cube scan had a sensitivity for definite and possible fluid detection of 96% and 86%, respectively. CONCLUSION: Optimizing both clinical accuracy and workflow are important factors in managing neovascular age-related macular degeneration. A zero-tolerance strategy with vertical/horizontal raster scans and thickness maps was comparable with line-by-line review of the cube to detect possible fluid.

Severe neutropenia presenting with Candida albicans eyelid abscess in a 1-year-old child.

A previously healthy 1-year-old boy presented with a right lower eyelid abscess. Oral and topical antibiotics were initiated, and the lesion was drained and explored. Despite medical and surgical treatment, the abscess failed to resolve completely and formed again 1 month later. A second incision and drainage procedure was performed, and Candida albicans grew in cultures. Additional workup revealed severe neutropenia with an absolute neutrophil count of 0.18 k/µl (1.19-7.21 k/µl). The abscess resolved after 2 weeks of oral fluconazole. C. albicans eyelid abscess may be the presenting sign of systemic immunodeficiency.

Dimensions and anatomic variations of the orbicularis oculi muscle in nonpreserved, fresh-frozen human cadavers.

PURPOSE: To determine average dimensions of the orbicularis oculi muscle (OOM) from the orbital rim and to investigate polymorphic variations through anatomical dissection of nonpreserved, fresh-frozen human cadavers. METHODS: The OOM was exposed using sharp and blunt dissection until its distal borders were identified. A metric ruler was used to measure the superior (S line), inferior (I line), and lateral (L line) dimensions of the OOM from the orbital rim. Data collection included age, gender, and race. Data were analyzed using 2-sample t tests, paired t tests, and mixed effect models. A p-value of ≤0.05 was considered statistically significant. RESULTS: A total of 40 hemifaces of 20 cadavers were dissected. All specimens were Caucasian. Ten specimens were men. Average age was 73.9 years (56-92 years). The overall S line was 1.4 cm (95% confidence interval [CI], 1.23-1.57), the I line was 1.2 cm (95% CI, 1.00-1.36), and the L line was 2.5 cm (95% CI, 2.27-2.68). Men had significantly larger average T, L, and S line values than women (p = 0.003, 0.005, 0.008, respectively). I lines did not differ significantly between genders (p = 0.28). CONCLUSIONS: In senescent Caucasians, the OOM extends approximately 1.4 cm superior, 1.2 cm inferior, and 2.5 cm lateral to the orbital rim. The muscle extends significantly further superiorly and laterally in Caucasian men than in women. Knowledge of the extent of the OOM should improve the understanding and the treatment of conditions affecting this region.

Retinopathy of Prematurity Versus Familial Exudative Vitreoretinopathy: Report on Clinical and Angiographic Findings.

BACKGROUND AND OBJECTIVE: Retinopathy of prematurity (ROP) and familial exudative vitreoretinopathy (FEVR) are classified as distinct diseases; however, emerging genetic research and fluoresce-in angiographic evidence suggest a margin of overlap between the two. PATIENTS AND METHODS This was an institutional review board-approved, retrospective case series. A literature review was performed, and medical records of all pediatric patients who underwent examination under anesthesia and laser for FEVR at the Bascom Palmer Eye Institute Pediatric Retina Service by one of the authors (AMB) from Jan. 1, 2006, to June 30, 2013, were analyzed retrospectively. RESULTS: Nine infants born prematurely had fluorescein angiograms and a clinical course most consistent with FEVR. Angiographic findings included irregular sprouts of vascularization at the vascular/ avascular junction, distinct pruning of vessels, pinpoint areas of hyperfluorescence, and segmental areas of vascular leakage. CONCLUSION: The authors propose a classification of ROPER (ROP vs. FEVR) to more accurately stratify these patients. Identification of this subset of patients will allow for sustained surveillance of infants with ROPER who demonstrate a continuing risk of disease activity.

Sector Retinitis Pigmentosa Associated With Novel Compound Heterozygous Mutations of CDH23.

Usher syndrome is an autosomal recessive condition characterized by retinitis pigmentosa (RP) and congenital hearing loss, with or without vestibular dysfunction. Allelic variants of CDH23 cause both Usher syndrome type 1D (USH1D) and a form of nonsyndromic hearing loss (DFNB12). The authors describe here a 34-year-old patient with congenital hearing loss and a new diagnosis of sector RP who was found to have two novel compound heterozygous mutations in CDH23, including one missense (c.8530C > A; p.Pro2844Thr) and one splice-site (c.5820 + 5G > A) mutation. This is the first report of sector RP associated with these types of mutations in CDH23.

The relationship between retinal microvascular abnormalities and coronary heart disease: a review.

Heart disease remains the leading cause of death in the United States despite decades of advancement in its diagnosis and treatment. Because of the limitations of traditional risk stratification for heart disease, evaluation of the retinal vasculature has been proposed as an easily and safely measured adjunct to commonly used screening methods. This article provides a comprehensive review of the literature concerning the relationships between retinal microvascular abnormalities and coronary heart disease. We outline details of the most recent large epidemiologic studies and discuss their potential implications for clinical practice. Finally, we propose a change to the current guidelines regarding the screening of "low-risk" women, a group that is often failed by traditional evaluation algorithms.