INCIDENCE AND RISK FACTORS FOR HYPOTONY AFTER 25-GAUGE PARS PLANA VITRECTOMY WITH NONEXPANSILE ENDOTAMPONADE.

PURPOSE: The purpose of this study was to assess the incidence and risk factors for early postoperative hypotony after 25-gauge pars plana vitrectomy with nonexpansile endotamponade. METHODS: A retrospective study of consecutive patients who underwent 25-G pars plana vitrectomy. Hypotony was defined as an intraocular pressure of 5 mmHg or less after surgery and ocular hypertension as an intraocular pressure greater than 21 mmHg. RESULTS: Overall, 307 eyes of 307 patients with a mean age of 61.7 ± 14.3 of which 56.7% were males were included. Hypotony was identified in 5.2% of cases (n = 16) at Day 1 and 0.7% (n = 2) at Week 1 with no hypotony-related complications. The hypotony group had a higher number of previous vitreoretinal surgeries (1.5 ± 1.1 vs. 0.4 ± 0.7, P < 0.001) and a higher prevalence of preoperative ocular hypertension (22.2% vs. 4.8%, P = 0.02), pseudophakia (77.8% vs. 48.4%, P = 0.01), silicone oil removal (61.1% vs. 8.3%, P < 0.001), and external diathermy performed (55.6% vs. 20.1%, P = 0.001). In stepwise multivariate analysis, significant parameters were silicone oil removal (R = 16.34%, odds ratio 13.45, P < 0.001), pseudophakia (R = 5.69%, odds ratio 3.65, P = 0.03), and younger age (R = 2.68%, odds ratio 0.96, P = 0.04). CONCLUSION: Silicone oil removal is a significant risk factor for early postoperative hypotony after 25-G pars plana vitrectomy.

Publication outcome of abstracts submitted to the American Academy of Ophthalmology meeting.

OBJECTIVE: Abstracts submitted to meetings are subject to less rigorous peer review than full-text manuscripts. This study aimed to explore the publication outcome of abstracts presented at the American Academy of Ophthalmology (AAO) annual meeting. METHODS: Abstracts presented at the 2008 AAO meeting were analyzed. Each presented abstract was sought via PubMed to identify if it had been published as a full-text manuscript. The publication outcome, journal impact factor (IF), and time to publication were recorded. RESULTS: A total of 690 abstracts were reviewed, of which 39.1% were subsequently published. They were published in journals with a median IF of 2.9 (range 0-7.2) and a median publication time of 426 days (range 0-2,133 days). A quarter were published in the journal Ophthalmology, with a shorter time to publication (median 282 vs. 534 days, p=0.003). Oral presentations were more likely to be published than poster presentations (57.8% vs. 35.9%, p<0.001) and in journals with higher IFs (3.2 vs. 2.8, p=0.02). Abstracts describing rare diseases had higher publication rates (49.4% vs. 38.0%, p=0.04) and were published in higher IF journals (3.7 vs. 2.9, p=0.03), within a shorter period of time (358 vs. 428 days, p=0.03). In multivariate analysis, affiliation with an institute located in the United States (p=0.002), abstracts describing rare diseases (p=0.03), and funded studies (p=0.03) were associated with publication in higher IF journals. CONCLUSIONS: Almost 40% of abstracts were published. Factors that correlated with publication in journals with higher IF were a focus on rare diseases, affiliation with a US institute, and funding.

Preoperative Anxiety Levels and Pain during Cataract Surgery.

Purpose: To evaluate the correlation between pain during cataract surgery and preoperative anxiety.Methods: This prospective observational masked study included 103 eyes of 103 consecutive patients who underwent routine clear corneal incision phacoemulsification surgery at the Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel. Patients were interviewed prior to surgery and 5 min following surgery by two separate independent interviewers. Anxiety level was measured by the Visual Analog Scale for Anxiety (VASA) and pain by the Visual Analog Scale (VAS). The main outcome measure was the maximum amount of pain endured during the procedure using VAS.Results: The mean participant age was 68.9 ± 8.9 years, and 46.6% were male. Severe anxiety (VASA ≥ 7) and pain (VAS ≥ 7) were documented in 18.5 and 17.5% of patients, respectively. There was a statistically significant positive correlation between VAS and VASA (r = 0.62, p < .001) as well as between VAS and duration of surgery (r = 0.20, p = .04). There was no association between VAS and all other investigated parameters in the univariate analysis. In backward regression analysis, VASA was the only parameter that was significantly associated with VAS (R2 = 36.61%, p < .001). Patients with severe anxiety were >10 times more likely to experience severe pain, and a VASA > 4 predicted severe pain with a sensitivity of 88.9% and a specificity of 69.4%.Conclusions: One-fifth of patients experienced severe anxiety and pain. Preoperative anxiety levels were the only significant predictor of pain. Reducing preoperative anxiety in cataract patients is warranted.

Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy.

PURPOSE: The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection. METHODS: This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0-10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0-10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe. RESULTS: Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores (r = 0.43, p=0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (p=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (p=0.006). The ROC curve analysis revealed an area under the curve of 0.89 (p < 0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain. CONCLUSIONS: Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).

Anterior Corneal Folds Correlate With Low Intraocular Pressure and May Serve as a Marker for Ocular Hypotony.

PURPOSE: Subtle folds can be seen in the anterior cornea in eyes with hypotony using fluorescein and blue light. We aim to assess their extent and grade with respect to the level of intraocular pressure (IOP). PATIENTS AND METHODS: Patients who presented to the department of ophthalmology at Rambam Health Care Campus with IOP<10 mm Hg during the period between July 2016 and June 2017. Corneal folds were evaluated after instilling an anesthetic drop and fluorescein staining. Outcome measures included: IOP, presence of anterior corneal folds, and the percentage of corneal surface containing folds. RESULTS: Overall, 100 eyes of 100 patients were included. The mean age±SD was 63.6±16.7 years (range, 19 to 96 y); 56% (n=56) were of male sex. Mean IOP was 5.3±2.7 mm Hg (range, 0 to 9 mm Hg). Subjects with and without anterior corneal folds were of similar age (P=0.25) and sex (P=0.69). Those with anterior corneal folds had a significantly lower IOP than the control group (4.0±2.4 vs. 7.4±1.7; P<0.001). Eyes with IOP of 0 to 2, 3 to 4, 5 to 6, 7 to 9 mm Hg demonstrated anterior corneal folds in 95%, 91%, 67%, and 18.4%, respectively. At an IOP≤5 mm Hg cut-off, the sensitivity and specificity of corneal folds as a predictor of hypotony was 89.8% and 70.6%, respectively. A significant inverse correlation between the relative area of the cornea covered by folds and the IOP was found (r=-0.7; P<0.001). CONCLUSIONS: Folds observed in the anterior corneal surface appear to be a robust sign of severe hypotony.