A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies.

BACKGROUND: The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. METHODS: Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild "green nucleus" with plus sign for yellow reflection of the posterior cortex), 3 (medium "yellow nucleus" with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being "red/brown nucleus" and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. RESULTS: Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman's rho = 0.8, p < 0.001). CONCLUSION: This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.

VALIDATION OF AN ALGORITHM FOR NONMETALLIC INTRAOCULAR FOREIGN BODIES' COMPOSITION IDENTIFICATION BASED ON COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING.

PURPOSE: To validate and evaluate the accuracy of an algorithm for the identification of nonmetallic intraocular foreign body composition based on computed tomography and magnetic resonance imaging. METHODS: An algorithm for the identification of 10 nonmetallic materials based on computed tomography and magnetic resonance imaging has been previously determined in an ex vivo porcine model. Materials were classified into 4 groups (plastic, glass, stone, and wood). The algorithm was tested by 40 ophthalmologists, which completed a questionnaire including 10 sets of computed tomography and magnetic resonance images of eyes with intraocular foreign bodies and were asked to use the algorithm to identify their compositions. Rates of exact material identification and group identification were measured. RESULTS: Exact material identification was achieved in 42.75% of the cases, and correct group identification in 65%. Using the algorithm, 6 of the materials were exactly identified by over 50% of the participants, and 7 were correctly classified according to their groups by over 75% of the materials. DISCUSSION: The algorithm was validated and was found to enable correct identification of nonmetallic intraocular foreign body composition in the majority of cases. This is the first study to report and validate a clinical tool allowing intraocular foreign body composition based on their appearance in computed tomography and magnetic resonance imaging, which was previously impossible.

Standard Trabeculectomy and Ex-PRESS Miniature Glaucoma Shunt: A Comparative Study and Literature Review.

PURPOSE: The aim of this study was to compare the efficacy and safety between standard trabeculectomy and the Ex-PRESS shunt implantation. METHODS: A retrospective review of the records of 100 eyes of 100 patients who underwent trabeculectomy or Ex-PRESS shunt implantation between July 2010 and June 2012 was conducted. Of these, 61 (61%) eyes underwent trabeculectomy and 39 (39%) eyes underwent Ex-PRESS shunt implantation. Demographic information, glaucoma type, surgical details, preoperative, and postoperative data including intraocular pressure (IOP), number of medications, reoperation, and occurrence of any complications were recorded. RESULTS: No differences in IOP reduction or number of postoperative IOP-lowering medications were demonstrated between the 2 procedures. Success rates were 86.9% for trabeculectomy and 84.6% for Ex-PRESS shunt. Rates of failure and hypotony were not significantly different between the groups. No parameter was correlated with success or failure of any procedure. CONCLUSIONS: Standard trabeculectomy and Ex-PRESS shunt have similar efficacy and safety profiles. As the Ex-PRESS shunt is considerably more expensive, its use may be unjustified, especially as a primary procedure.

Traumatic orbital floor fractures: repair with autogenous bone grafts in a tertiary trauma center.

PURPOSE: To evaluate the outcome of autologous bone grafts in the reconstruction of orbital floor fractures. A retrospective interventional case series was performed at a tertiary trauma center. MATERIALS AND METHODS: All patients with traumatic orbital floor fractures that had been reconstructed using calvarial or iliac autogenous bone grafts from August 2006 to January 2010 were included in the present study. The operations were performed by the same team of maxillofacial and oculoplastic surgeons. The patients were evaluated pre- and postoperatively for the presence of enophthalmus and diplopia. The surgical technique was tailored to best fit the patient's clinical characteristics, with attention to the cosmetic and functional outcomes and the preferred use of a sutureless transconjunctival technique, when applicable. The main outcome measures were residual enophthalmus, diplopia, and the complication rate. RESULTS: A total of 16 patients (11 males and 5 females), with an average age of 34.4 years, underwent orbital floor reconstruction using an autologous bone graft. Calvarial and iliac bone grafts were used in 11 and 5 patients, respectively. A transconjunctival approach was applied in 10 patients. All patients achieved good cosmetic and functional outcomes, with improvement in enophthalmus. Three patients had residual diplopia postoperatively that was probably due to traumatic muscular injury. No significant perioperative or long-term complications were noted during a mean follow-up of 12.5 months. CONCLUSION: Reconstruction of orbital floor fractures after trauma using autologous bone grafts is safe and associated with a low rate of complications. Combining the appropriate surgical approach with multidisciplinary teamwork results in excellent cosmetic and functional outcomes and allows for efficient and comprehensive postoperative management.

Gliomatosis cerebri presenting as idiopathic intracranial hypertension in a child.

We present a rare case of a diffuse anaplastic astrocytoma (gliomatosis configuration) in a child, which was misdiagnosed as pseudotumor cerebri following initially normal CT of the brain and elevated opening pressure on lumbar puncture with normal cerebrospinal composition.

Myotonic dystrophy--no evidence for preferential transmission of the mutated allele: a prenatal analysis.

Myotonic dystrophy is the commonest autosomal dominant type of muscular dystrophy in adults. It is one of the trinucleotide repeat expansion disorders, and its severity correlates with the number of CTG repeats in the myotonic dystrophy gene. It has been suggested that myotonic dystrophy exhibits the phenomenon of preferential transmission of the larger mutated alleles that has been described in other trinucleotide repeat disorders. Several authors have reported that the frequency of transmission of the mutated alleles is higher than 50%--a finding that, if true, does not comply with the Mendelian laws of segregation. However, these studies were based on data from the analysis of pedigrees with ascertainment bias. In our study, we determined the frequency of transmission of mutated alleles using data from prenatal molecular studies, which are not subject to ascertainment bias. This is the first study to examine the segregation of the mutated alleles in myotonic dystrophy in pregnancy. Eighty-three fetuses were examined, 30 of 62 mothers (48.38%) and 8 of 21 fathers (38.09%) transmitted the mutated allele, giving an overall transmission rate of 45.78%. We found no evidence of statistically significant deviation of the frequency of transmission of the mutated alleles from the 50% expected in autosomal dominant disorders. This study, unlike previous ones, excludes preferential transmission in myotonic dystrophy, a finding that may be attributable to the lack of correction for ascertainment bias in previous studies and to the use of prenatal data in this study.