EPIRETINAL MEMBRANE WITH FOVEAL HERNIATION: Visual and Surgical Outcomes.

PURPOSE: Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. This study describes the visual symptoms and spectral domain optical coherence tomography findings associated with foveal herniation and evaluates the postoperative visual, anatomical, and surgical outcomes. METHODS: A multicenter retrospective review of patients diagnosed with epiretinal membrane identified 59 patients with preoperative foveal herniation on spectral domain optical coherence tomography. Data regarding visual symptoms, preoperative and postoperative best-corrected visual acuity (BCVA), central retinal thickness, macular volume, and size of foveal herniation were collected, and statistical analysis was performed. RESULTS: A total of 58 of the 59 patients with foveal herniation underwent surgical epiretinal membrane peeling, with foveal contour restored in 53.5% of patients after surgery. Average BCVA improved from 20/80 to 20/40 Snellen equivalent at most-recent postoperative visit (P < 0.0001). The average central retinal thickness decreased from 632 µm to 432 µm (P < 0.0001) and the average macular volume decreased from 11.3 mm3 to 9.5 mm3 (P < 0.0001) at 3 months postoperatively. Preoperatively, greater herniation height was associated with worse BCVA (P = 0.008), greater central retinal thickness (P = 0.01), retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone abnormality, and external limiting membrane abnormalities (P < 0.05). Postoperatively, there was a decrease in retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone, and external limiting membrane abnormality (P < 0.05) on spectral domain optical coherence tomography. CONCLUSION: Patients with larger foveal herniation height had greater preoperative central retinal thickness, worse preoperative and postoperative BCVA, and more intraretinal abnormalities on spectral domain optical coherence tomography. Surgical epiretinal membrane peeling in patients with foveal herniation resulted in a significant improvement in patients' BCVA and microstructural abnormalities.

Clinical outcomes and antibiotic susceptibilities of Staphylococcus aureus endophthalmitis.

PURPOSE: To compare the antibiotic susceptibilities and visual acuity (VA) outcomes in endophthalmitis caused by methicillin-resistant (MRSA) versus methicillin-sensitive S. aureus (MSSA). METHODS: The records of 34 cases of S. aureus endophthalmitis at The New York Eye and Ear Infirmary from Jan 1997 to June 2011 were reviewed. Antibiotic susceptibility profiles over time and VA at presentation and at 3, 6, and ≥12 months were recorded. S. aureus isolates were grouped based on oxacillin resistance. RESULTS: Of the 34 cases, 15 (44 %) were MRSA and 19 (56 %) MSSA. Median presenting VA was hand motions (logMAR 4.0) in both the MRSA and MSSA groups. There was no statistically significant difference in VA between the MRSA and MSSA groups at 3, 6, or ≥12 months. No MRSA isolates were resistant to vancomycin or gentamicin. While over 85 % of MRSA isolates tested for fourth-generation fluoroquinolones were resistant, just 10 % MSSA isolates tested were resistant. There was a trend suggesting an increase in the proportion of MRSA isolates compared to MSSA isolates over the course of the study period. CONCLUSIONS: There was no statistical difference in short- or long-term VA outcomes between the MRSA and MSSA groups at any time point. Resistance to fourth-generation fluoroquinolones was present in over 85 % of MRSA isolates, but just 10 % of MSSA isolates. An increasing proportion of MRSA amongst S. aureus isolates was noted over the course of the study period.

PERFLUOROCARBON LIQUIDS' ABILITY TO PROTECT THE MACULA FROM INTRAOCULAR DROPPING OF METALLIC FOREIGN BODIES: A Model Eye Study.

PURPOSE: To examine the utility of perfluoro-n-octane (PFO) in balanced salt solution (BSS) to shield the macula from the impact of dropped metallic intraocular foreign bodies (IOFBs) by modeling scenarios in which they may fall during surgical removal. METHODS: Model eyes were filled with various fluid mixtures (Group 1: 10% PFO/90% BSS; Group 2: 100% BSS; Group 3: 100% PFO; Group 4: 10% PFO/90% air; Group 5: 10% BSS/90% air). In Groups 1, 4, and 5, the 10% fluid volume covered the theoretical macula. For each fluid mixture, up to 30 IOFB drop scenarios were performed for each of the 5 sample IOFBs from 3 locations. Trajectories were recorded using a camera attached to a Zeiss operating microscope (Carl Zeiss, Jena, Germany). The percentages of IOFBs impacting the macula were calculated and Fisher exact test was used to assess differences. RESULTS: In Group 1, 93% (417/450) of the dropped IOFBs were deflected by the PFO-BSS interface compared with 0% (0/500) in Groups 2, 3, 4, and 5 (P < 0.01). With the exception of the heaviest IOFB (24.4 mg), which impacted the macula in 30% of tests when dropped from the superior posterior segment (P < 0.01), all other IOFBs (2.8-13.4 mg) were deflected by the PFO-BSS interface in 100% of Group 1 drops (P < 0.01). CONCLUSION: As demonstrated by these simulations, the PFO-BSS interface can deflect IOFBs dropped during surgery in a wide range of scenarios, especially when the IOFB is of lower mass.

RETINAL VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN NORMALS AND DIABETIC RETINOPATHY PATIENTS.

PURPOSE: To describe a new method of retinal vascular perfusion density mapping using optical coherence tomography angiography and to compare current staging of diabetic retinopathy based on clinical features with a new grading scale based on perifoveal perfusion densities. METHODS: A retrospective review was performed on subjects with diabetic retinopathy and age-matched controls imaged with a spectral domain optical coherence tomography system (Optovue XR Avanti, Fremont, CA). Split-spectrum amplitude-decorrelation angiography (SSADA) generated optical coherence tomography angiograms of the superficial retinal capillaries, deep retinal capillaries, and choriocapillaris. Skeletonized optical coherence tomography angiograms were used to create color-coded perfusion maps and capillary perfusion density values for each image. Capillary perfusion density values were compared with clinical staging, and groups were compared using analysis of variance and Kruskal-Wallis analyses. RESULTS: Twenty-one control and 56 diabetic retinopathy eyes were imaged. Diabetic eyes were grouped according to clinical stage. Capillary perfusion density values from each microvascular layer were compared across all groups. Capillary perfusion density values were significantly lower in nearly all layers of all study groups compared with controls. Trend analysis showed a significant decrease in capillary perfusion density values as retinopathy progresses for most layers. CONCLUSION: Quantitative retinal vascular perfusion density mapping agreed closely with grading based on clinical features and may offer an objective method for monitoring disease progression in diabetic retinopathy.

Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review.

PURPOSE: To identify the spectrum and susceptibility pattern of pathogens responsible for culture-positive endophthalmitis referred to a single institution and investigate possible trends in both pathogens and antibiotic sensitivities over the past 25 years. DESIGN: A retrospective, laboratory-based study of consecutive microbiological isolates. PARTICIPANTS: A total of 988 consecutive culture-positive endophthalmitis isolates from 911 eyes. METHODS: All culture-positive endophthalmitis isolates collected from 1987 to 2011 were identified. Susceptibility rates to a variety of antibiotics were calculated. Chi-square test for trend was used to detect changes in spectrum or susceptibility over time. MAIN OUTCOME MEASURES: Microbial spectrum and susceptibility pattern over time. RESULTS: A total of 988 isolates were identified from 911 eyes. The average patient age was 67 ± 18 years, and 55% of the patients were female. The most prevalent pathogens were coagulase-negative staphylococcus (39.4%), followed by Streptococcus viridans species (12.1%) and Staphylococcus aureus (11.1%). Gram-negative organisms and fungi accounted for 10.3% and 4.6% of all isolates, respectively. With the exception of 2 isolates, Enterococcus faecium and Nocardia exalbida, all the other 725 (99.7%) gram-positive bacteria tested were susceptible to vancomycin. Of the 94 gram-negative organisms tested against ceftazidime, 2 were of intermediate sensitivity and 6 were resistant. For 8 antibiotics, increasing microbial resistance over time was observed: cefazolin (P = 0.02), cefotetan (P = 0.006), cephalothin (P<0.0001), clindamycin (P = 0.04), erythromycin (P<0.0001), methicillin/oxacillin (P<0.0001), ampicillin (P = 0.01), and ceftriaxone (P = 0.006). For 3 antibiotics, increasing microbial susceptibility was observed: gentamicin (P<0.0001), tobramycin (P = 0.005), and imipenem (P<0.0001). CONCLUSIONS: Coagulase-negative staphylococcus remains the most frequently identified cause of endophthalmitis. Vancomycin and ceftazidime seem to be excellent empiric antibiotics for treating endophthalmitis. Although a statistically significant trend toward increasing microbial resistance against a variety of antibiotics, including cephalosporins and methicillin, was observed, a significant trend toward decreasing microbial resistance against aminoglycosides and imipenem also was detected.

The Evolving Surgical Paradigm of Scleral Allograft Bio-Tissue Use in Ophthalmic Surgery: Techniques and Clinical Indications for Ab-Externo and Ab-Interno Scleral Reinforcement.

To review the latest surgical advances and evolving clinical use of scleral bio-tissue for reinforcement in the eye and review the published literature on novel surgical applications of scleral allograft bio-tissue. Conventional surgical procedures for scleral reinforcement using homologous scleral allograft have been traditionally ab-externo interventions comprising of anterior or posterior reinforcement of the sclera for clinical indications such as trauma, scleromalacia, glaucoma drainage device coverage, scleral perforation, buckle repair as well as posterior reinforcement for pathologic myopia and staphyloma. There have been a few novel ab-interno uses of scleral bio-tissue for reinforcement in both retina and glaucoma. Over the last decade, there has been an increase in peer-reviewed publications on scleral reinforcement, reflecting more interest in its clinical applications. With favorable biological and biomechanical properties, scleral allograft may be an ideal substrate for an array of new applications and surgical uses.

Remote vision testing of central retinal acuity and comparison with clinic-based Snellen acuity testing in patients followed for retinal conditions.

Introduction: The unmet need for remote monitoring of visual function with home-based, patient-centric technologies became increasingly palpable during the COVID-19 pandemic. Many patients with chronic eye conditions lack access to office-based examinations. Here, we evaluate the efficacy of the Accustat® test, a virtual application for measuring near visual acuity on any portable electronic device via telehealth. Materials and methods: Thirty-three adult subjects from the telehealth remote monitoring service of a retina practice performed the Accustat® acuity testing at home. All patients underwent in-office general eye examination with additional fundoscopic examination and optical coherence tomography retina imaging. Best corrected visual acuity assessment using a Snellen chart was compared with remote visual acuity assessment with the Accustat® test. Visual acuity was analyzed and compared between the best-corrected near visual acuity potential achieved on the Accustat® and in-office distance best-corrected Snellen visual acuity. Results: The mean logarithm of the minimum angle of resolution (logMAR) visual acuities of all eyes tested using the Accustat test was 0.19 ± 024 and for the office Snellen test 0.21 ± 0.21. A linear regression model with 95% confidence intervals reveals that there is a strong linear relationship between Accustat logMAR and office Snellen logMAR. Bland-Altman analysis demonstrated 95.2% significant agreement between Accustat and Office Snellen's best corrected visual acuity. Intraclass correlation coefficient (ICC = 0.94) demonstrated a strong positive correlation between at home versus office visual acuity. Conclusion: There was a high correlation between the visual acuity measured with the Accustat near vision digital self-test and the office Snellen acuity test, suggesting the potential utility of scalable remote monitoring of central retinal function via telehealth.

Remote patient monitoring of central retinal function with MACUSTAT®: A multi-modal macular function scan.

Introduction: There is significant unmet need for patient-centric remote monitoring of visual function for chronic retinal diseases, as demonstrated by the COVID-19 pandemic. The Macustat® central retinal function scan is a novel cloud-based digital health application for remote monitoring. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations. Materials and methods: Patients with underlying macular pathology underwent office-based retinal and visual acuity examinations and OCT macula imaging followed by remote tele-monitoring assessment with the Macustat. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation. Results: The foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan. Conclusion: The Macustat demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.

Taut internal limiting membrane causing diffuse diabetic macular edema after vitrectomy: clinicopathological correlation.

AIMS: To describe 2 cases of diffuse diabetic macular edema (DME) after diabetic vitrectomy caused by a taut internal limiting membrane (ILM), with clinicopathological correlation. METHODS: Interventional case series with immunohistochemical analysis. RESULTS: Two patients were referred for unresponsive diffuse DME after pars plana vitrectomy with removal of the posterior hyaloid. Clinically, a taut ILM was noted over the fovea, and its removal resulted in rapid and long-term resolution of the edema, confirmed by optical coherence tomography with visual acuity improvement. Histopathology with immunostaining revealed a segment of ILM with an inner monolayer of cytokeratin-positive (retinal pigment epithelial cells) and/or glial fibrillary acidic protein-positive cells with smooth muscle actin immunoreactivity. CONCLUSIONS: A taut ILM can cause diffuse DME after vitrectomy, and its removal can restore the normal foveal contour and improve visual acuity. Tangential tractional forces from contractile cells propagated across the fovea via the ILM appear to be the etiology.

Recurrent hemolacria: a sign of scleral buckle infection.

PURPOSE: The purpose of this study was to report recurrent hemolacria, or "bloody tears," as a sign of scleral buckle (SB) infection. METHODS: This is an interventional case series of three eyes of three patients with hemolacria after SB placement. RESULTS: Two men and one woman were treated for recurrent hemolacria after SB placement for a rhegmatogenous retinal detachment. Two patients had an encircling silicone sponge placed, one 6 years and the other 3 years before presentation. The third patient had a segmental solid silicone element placed 3 months before presentation. Two of the patients reported between 6 to 10 episodes of hemolacria occurring for "years" before referral and diagnosis. In all three patients, hemolacria originated from an occult conjunctival fistula overlying or adjacent to an exposed SB. Microbiological cultures grew Staphylococcus aureus in two eyes and polymicrobial growth in the other. Hemolacria resolved with explantation of the SB in two patients and with long-term continuous topical antibiotics in the other patient. CONCLUSION: Hemolacria can be a sign of a SB infection and should raise a high level of suspicion for the presence of an occult conjunctival fistula with exposure of the underlying scleral buckling element when frank exposure is not seen.

Macular hole formation, progression, and surgical repair: case series of serial optical coherence tomography and time lapse morphing video study.

BACKGROUND: To use a new medium to dynamically visualize serial optical coherence tomography (OCT) scans in order to illustrate and elucidate the pathogenesis of idiopathic macular hole formation, progression, and surgical closure. CASE PRESENTATIONS: Two patients at the onset of symptoms with early stage macular holes and one patient following repair were followed with serial OCTs. Images centered at the fovea and at the same orientation were digitally exported and morphed into an Audiovisual Interleaving (avi) movie format. Morphing videos from serial OCTs allowed the OCTs to be viewed dynamically. The videos supported anterior-posterior vitreofoveal traction as the initial event in macular hole formation. Progression of the macular hole occurred with increased cystic thickening of the fovea without evidence of further vitreofoveal traction. During cyst formation, the macular hole enlarged as the edges of the hole became elevated from the retinal pigment epithelium (RPE) with an increase in subretinal fluid. Surgical repair of a macular hole revealed initial closure of the macular hole with subsequent reabsorption of the sub-retinal fluid and restoration of the foveal contour. CONCLUSIONS: Morphing videos from serial OCTs are a useful tool and helped illustrate and support anterior-posterior vitreofoveal traction with subsequent retinal hydration as the pathogenesis of idiopathic macular holes.

Comparative study of intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) in the treatment of neovascular age-related macular degeneration.

AIMS: To compare the safety and efficacy of 2 anti-vascular-endothelial-growth-factor agents - bevacizumab (Avastin) versus ranibizumab (Lucentis) - in the treatment of patients with neovascular age-related macular degeneration (AMD). METHODS: Retrospective analysis of patients who received intravitreal injections of bevacizumab or ranibizumab for neovascular AMD. Primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessed by Spectral Domain scanning laser ophthalmoscope-optical coherence tomography (SD-OCT). A secondary outcome measure was the report of any adverse events in the 2 groups. RESULTS: The number of injections in the bevacizumab group was 184 (average of 4.7 per eye) compared to 187 in the ranibizumab group (average of 5.5 per eye). The mean logMAR equivalent of BCVA at 1 month after the injection improved by 0.18 in the bevacizumab group (p = 0.009) and by 0.13 in the ranibizumab group (p = 0.004). The average SD-OCT CFT decreased from 325 + or - 72 to 300 + or - 69 microm in the bevacizumab group (p = 0.016) and from 307 + or - 57 to 289 + or - 56 microm in the ranibizumab group (p = 0.017). In the bevacizumab group, there was 1 event of lower extremity pain (0.54%) and 1 event of increased arterial blood pressure (0.54%). In the ranibizumab group, there were 2 events of transiently increased intraocular pressure (1.1%) and 1 event (0.53%) of intraocular inflammation following injection. CONCLUSIONS: Bevacizumab and ranibizumab treatments resulted in similar gains in visual acuity and reduction in macular thickness, documented each month following injection. Intravitreal bevacizumab appears to be as safe and effective as intravitreal ranibizumab in the treatment of exudative AMD.

Cytomegalovirus retinitis after treatment with topical difluprednate in an aphakic eye of an immunocompetent patient.

PURPOSE: To report a case of an immunocompetent 64-year-old man who developed cytomegalovirus (CMV) retinitis after using topical difluprednate. OBSERVATIONS: A 64-year-old man with type 2 diabetes developed hemorrhagic retinitis while using topical difluprednate after penetrating keratoplasty. Polymerase chain reaction of the vitreous was positive for CMV DNA. Complete blood count was within normal limits and 4th generation human immunodeficiency virus assay was negative. The retinitis resolved with oral valgancyclovir and intravitreal foscarnet injections. CONCLUSION AND IMPORTANCE: CMV retinitis may occur after topical difluprednate in an immunocompetent patient.

Pain Control after Intravitreal Injection Using Topical Nepafenac 0.3% or Pressure Patching: A Randomized, Placebo-Controlled Trial.

PURPOSE: Pain after an intravitreal injection (IVI) can last up to 7 days and negatively impacts the patient's experience, potentially reducing treatment compliance. We prospectively evaluated topical nepafenac 0.3% suspension and patching for the reduction of pain after IVI. DESIGN: Randomized controlled trial. PARTICIPANTS: Sixty patients receiving an IVI of bevacizumab, aflibercept, or triamcinolone acetonide in 1 eye. METHODS: Participants were randomized equally to receive either a single drop of nepafenac 0.3%, a pressure patch for 2 hours, or a single drop of preservative-free artificial tears (control group). A single-blinded placebo-controlled design was used to mask the topical treatment used. Pain was assessed using the Numeric Pain Rating Scale that ranged from 0 to 10 (horizontal pain scale). Because pain scores were not normally distributed, statistical analysis was performed using a nonparametric randomization-based analysis of covariance. MAIN OUTCOME MEASURE: Pain scores. RESULTS: Fifty-six and 53 patients of the 60 patients enrolled completed the 6- and 24-hour follow-ups, respectively. Numeric Pain Rating Scale scores at 6 and 24 hours after IVI were lower in the nepafenac group (0.8±0.3 and 0.1±0.1, respectively; n = 18) and the patching group (1.3±0.4 and 0.4±0.2, respectively; n = 19) compared with the control group (2.5±0.6 and 0.9±0.4, respectively; n = 19). After controlling for age, gender, number of prior injections, and physician administering the injection, patients in the nepafenac group reported significantly lower pain scores than those in the control group at 6 hours (1.3±0.6 less; P = 0.047) and 24 hours (0.7±0.3 less; P = 0.047). Although the patching group reported lower pain scores than the control group, this was not statistically significant (6 hours, P = 0.24; 24 hours, P = 0.29). CONCLUSIONS: Nepafenac 0.3% was effective as a single drop in reducing pain at 6 and 24 hours after IVI compared with placebo. Limited patching was associated with lower pain scores than placebo, but the difference was not statistically significant. Additional studies are needed to determine the most effective method to maximize the patient's experience after an IVI without sacrificing outcomes.

SILDENAFIL CITRATE INDUCED RETINAL TOXICITY-ELECTRORETINOGRAM, OPTICAL COHERENCE TOMOGRAPHY, AND ADAPTIVE OPTICS FINDINGS.

BACKGROUND/PURPOSE: To report a case of persistent retinal toxicity associated with a high dose of sildenafil citrate intake. METHODS: Single retrospective case report. RESULTS: A 31-year-old white man with no medical history presented with complaints of bilateral multicolored photopsias and erythropsia (red-tinted vision), shortly after taking sildenafil citrate-purchased through the internet. Patient was found to have cone photoreceptor damage, demonstrated using electroretinogram, optical coherence tomography, and adaptive optics imaging. The patient's symptoms and the photoreceptor structural changes persisted for several months. CONCLUSION: Sildenafil citrate is a widely used erectile dysfunction medication that is typically associated with transient visual symptoms in normal dosage. At high dosage, sildenafil citrate can lead to persistent retinal toxicity in certain individuals.

Vitreous Occlusion of a Glaucoma Drainage Implant-Surgical Management.

Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and severely elevated intraocular pressure. The pathophysiology of tube obstruction is related to central and anterior displacement of vitreous that is drawn into and condenses within the proximal lumen of the tube. This can occur from days to years following GDI surgery. Successful management of vitreous-tube obstruction generally requires manual removal of the condensed vitreous plug with end-grasping forceps. This technique achieves reversal of tube blockage and restoration of GDI function. Amputation of the incarcerated vitreous alone with vitrectomy or neodymium:yttrium-aluminum-garnet vitreolysis does not consistently restore GDI function and risks persistent intraluminal tube obstruction.

Long-term Outcomes and Complications of Pars Plana Baerveldt Implantation in Children.

PURPOSE OF THE STUDY: The purpose of the study was to report long-term outcomes and complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in children. MATERIALS AND METHODS: The medical records of consecutive aphakic and pseudophakic children (<16 y of age) who underwent BGI surgery with pars plana tube insertion between 1990 and 2013 were retrospectively reviewed. Main outcome measures were intraocular pressure and number of glaucoma medications. Postoperative complications were recorded. Failure was defined as an intraocular pressure <5 or ≥21 mm Hg (with or without glaucoma medications), loss of light perception, or need for additional glaucoma surgery. RESULTS: Thirty-seven children were identified with a mean age of 6.0±4.7 years (range, 4 mo to 14.5 y). Mean follow-up after pars plana BGI surgery was 6.5±3.4 years (range, 9 mo to 12.8 y) for patients who met success criteria. Mean intraocular pressure and mean number of glaucoma medications at most recent follow-up for patients with successful intraocular pressure control were 13.8±4.1 and 2.3±1.9 mm Hg, respectively. The Kaplan-Meier survival analysis revealed 1-, 3-, 5-, and 7-year success rates of 94.5%, 74.6%, 65.0%, and 45.8%, respectively. Complications included tube exposure in 1 patient (2.7%), tube obstruction in 8 patients (21.6%), and retinal detachment in 9 patients (24.3%). Seventeen patients (45.9%) failed due to inadequate intraocular pressure control, of whom 9 (24.3%) required additional glaucoma surgery. CONCLUSIONS: Although pars plana BGI surgery is a reasonable option for managing refractory glaucoma in aphakic and pseudophakic children, surgeons must be aware of the potential need for additional glaucoma surgery and/or posterior segment complications with extended follow-up.

Corneal abrasion following anaesthesia for non-ocular surgical procedures: A case-controlled study.

The aim of this study was to identify risk factors associated with perioperative corneal abrasion at a single hospital in Mineola, New York (United States). A chart review was conducted of patients with perioperative corneal abrasion following non-ocular surgery and age-matched controls between June 2011 and November 2013. An age-stratified logistic regression model evaluated the association between corneal abrasion and potentially predisposing variables. The adjusted odds of a corneal abrasion occurring were 4.6 times greater for patients having surgery for ≥ 3 hours (p=0.001) and 3.6 times greater for patients with pre-existing ocular disease (p=0.02). Gender, diabetes status, surgical procedure or position were not found to be associated with the occurrence of a corneal abrasion. Corneal abrasions were associated with longer procedures and history of pre-existing ocular disease. No significant association between body positioning or surgical site and perioperative corneal abrasion was found. The study concludes that a longer duration of surgical procedure and pre-existing ocular disease are risk factors for perioperative corneal abrasion.