Cataract Outcomes Following Scleral Buckle Surgery for Retinal Detachment.

Purpose: To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD). Patients and methods: A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted. Results: Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes. Conclusion: Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

The retina is the part of the eye that is responsible for converting incoming light into a signal that the brain can interpret. A retinal detachment is an emergent condition in which the retina is torn away from its normal position. Scleral buckling is one method of surgically reattaching the retina. Although quite successful, scleral buckling can cause changes to the shape of the eye, and also increases the risk of opacification of the natural lens of the eye, otherwise known as a cataract. The purpose of this study is to investigate the outcomes of cataract surgery in eyes with prior scleral buckle surgery. The results show that despite advancements in methods of measuring the shape of the eye, calculating the appropriately powered IOL to implant, and surgical technique, cataract surgery in eyes with prior scleral buckling may result in poorer outcomes compared to eyes with no history of scleral buckling.

Reversible Retinopathy Associated with Fibroblast Growth Factor Receptor Inhibitor.

We present a case of reversible, pseudovitelliform lesions while a patient was taking pembrolizumab (PDL-1 inhibitor) and erdafitinib (pan-fibroblast growth factor receptor inhibitor) outside of clinical trial protocols. A 61-year-old patient with 3 days of metamorphopsia was found to have pseudovitelliform lesions in both eyes 6 weeks after initiation of erdafitinib. After discontinuation of this drug, his visual complaints resolved and his lesions decreased on optical coherence tomography. To our knowledge, this is the first case depicting reversible macular lesions with use of this newly approved medication outside of clinical trial protocols.

Choroidal Thickness Correlates with Clinical and Imaging Metrics of Parkinson's Disease: A Pilot Study.

BACKGROUND: Parkinson's disease (PD) is marked clinically by motor symptoms and pathologically by Lewy bodies and dopamine neuron loss in the substantia nigra pars compacta (SNc). Higher iron accumulation, assessed by susceptibility MRI, also is observed as PD progresses. Recently, evidence has suggested that PD affects the retina. OBJECTIVE: To better understand retinal alterations in PD and their association to clinical and SNc iron-related imaging metrics. METHODS: Ten PD and 12 control participants (2 eyes each) from an ongoing PD imaging biomarker study underwent enhanced depth imaging optical coherence tomography evaluation. Choroidal (vascular) thickness and nerve layers were measured in 4 subregions [superior, temporal, inferior, and nasal] and at 3 foveal distances (1, 1.5, and 3 mm). These metrics were compared between PD and control groups. For significantly different metrics, their associations with clinical [levodopa equivalent daily dosage (LEDD), motor and visuospatial function] and SNc susceptibility MRI metrics [R2* and quantitative susceptibility mapping (QSM)] were explored. RESULTS: Compared to control participants, PD participants had a thicker choroid (p = 0.005), but no changes in nerve layers. Higher mean choroidal thickness was associated with lower LEDD (p < 0.01) and better visuospatial function (p < 0.05). Subregion analyses revealed higher choroidal thickness correlated with lower LEDD and better motor and visuospatial measures. Higher mean choroidal thickness also was associated with lower nigral iron MRI (p < 0.05). CONCLUSION: A small cohort of PD research participants displayed higher choroidal thickness that was related to better clinical performance and less nigral pathology. These intriguing findings warrant further investigation.

Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding.

PURPOSE: To investigate gender disparitie among pediatric ophthalmologists in academic rank, publication productivity, and National Institutes of Health (NIH) funding. METHODS: In this cross-sectional analysis of pediatric ophthalmologists at 113 US academic programs, data on gender, residency graduation year, and academic rank were obtained from institutional websites between January 2019 and March 2019. The Scopus database was used to calculate h-indices and m-quotients. The NIH Research Portfolio Online Reporting Tool was used to determine NIH funding. RESULTS: We identified 389 pediatric ophthalmologists: 194 women (49.9%) and 195 men (50.1%). A binomial logistic regression model, which included career length as an independent variable, showed proportions of women to men were similar across all academic ranks (assistant professor, 64.4% vs 46.2% [P = 0.738]; associate professor, 21.7% vs 19.0% [P = 0.357]; full professor, 13.9 vs 34.9% [P = 0.119]). Women had a lower median h-index (5.0 vs 8.0 [P = 0.008]) and a shorter median career duration (12.5 vs 25.0 years [P < 0.001]), but a similar median m-quotient (0.5 vs. 0.5; P = 0.525). Among pediatric ophthalmologists who received NIH funding (20 women vs. 27 men; P = 0.826), the overall median grant-funding total for women was $804K (interquartile range (IQR) 5.0M, mean $3.8M) compared to men, $2.2M (IQR, 4.0M; mean, $3.7M; P = 0.328). CONCLUSIONS: The shorter career duration for women likely contributes to the difference in overall h-indices between genders, as m-quotients were similar. The m-quotient should be used over the h-index when comparing academic productivity across genders when disparities in career length exist.

Association Between Sex Composition and Publication Productivity of Journal Editorial and Professional Society Board Members in Ophthalmology.

Importance: Because women remain underrepresented in leadership positions in medicine, including ophthalmology, knowledge of sex composition of ophthalmic journal editorial and professional society boards seems warranted. Objectives: To investigate the sex composition of ophthalmic journal editorial and professional society boards and compare the publication productivity and number of citations of male vs female board members. Design, Setting, and Participants: In this cross-sectional study, the SCImago Journal Rank indicator was used to identify the 20 highest-ranked ophthalmology journals. Faculty members from each ophthalmic subspecialty were surveyed within a US academic ophthalmology department to identify 15 influential ophthalmology societies. The 2018 board members of each journal and society were identified from the journals' and societies' official websites, and the sex of each individual was recorded. Information regarding journals and societies was collected from October 1 to December 31, 2018. The Scopus database was accessed in January 2019 and then used to find each member's h-index and m-quotient. Main Outcomes and Measures: The h-index, defined as the highest number of an author's publications that received at least h number of citations, was calculated for each board member. The m-quotient, which accounts for varying lengths of academic careers, was calculated by dividing the h-index by the number of years since first publication. Results: Of the 1077 members of ophthalmic journal editorial and society leadership boards, 797 (74.0%) were men and 280 (26.0%) were women. Among the 24 editors in chief of the 20 journals investigated, 23 (95.8%) were male. Thirteen of the 15 professional society presidents (86.7%) were men. Male board members had significantly higher median h-indexes (male vs female journals: 34 [interquartile range {IQR}, 23-47] vs 28 [IQR, 19-40], P < .001; male vs female societies: 27 [IQR, 15-41] vs 17 [IQR, 8-32], P = .006), median publication numbers (male vs female journal board members: 157 [IQR, 88-254] vs 109 [IQR, 66-188], P < .001; male vs female society board members: 109 [IQR, 57-190] vs 58 [IQR, 28-139, P = .001), and median citations (male vs female journal board members: 4027 [IQR, 1897-8005] vs 2871 [IQR, 1344-5852], P < .001; male vs female society board members: 2228 [IQR, 1005-5069] vs 1090 [IQR, 410-2527], P = .003). However, the median m-quotients for male and female board members were comparable (male vs female journal board members: 1.2 [IQR, 0.8-1.6] vs 1.1 [IQR, 0.8-1.5], P = .54; male vs female society board members: 1.0 [IQR, 0.7-1.4] vs 0.9 [IQR, 0.6-1.3], P = .32). Conclusions and Relevance: The findings suggest that the sex composition on journal editorial and professional society boards in ophthalmology is consistent with the sex composition of ophthalmologists in the US, as reported by the Association of American Colleges, but that editor in chief and society president positions are male dominated despite the apparent equality in academic productivity.

Ocular nail gun injuries: epidemiology and visual outcomes.

BACKGROUND: Nail-gun accidents have become a common reason for penetrating ocular injuries in patients presenting to the emergency room with globe trauma. To date, there are only five patients (one case report and one small case series) in the medical literature of penetrating ocular injury due to nail-guns. The aim of this study is to describe the epidemiology and visual outcomes of patients presenting to a tertiary medical center with ocular injuries resulting from nail-gun injuries. METHODS: This is an institutional review board-approved retrospective chart review of 24 patients presenting to the Medical University of South Carolina after sustaining eye injuries secondary to the use of nail-guns. The records of 178 patients with penetrating eye injuries treated between July 1996 and June 2006 were reviewed. Twenty-four patients (14%) had open globe injuries related to nail-guns. Demographic data, ocular examination findings, and visual outcomes were recorded. RESULTS: Of the 24 cases identified, 17 were work-related; this represented approximately 71% of patients. All were men with an average age of 29.4 years. Fifty-eight percent of the patients were non-English speaking. There was no record of any patient wearing safety glasses at the time of injury. The visual acuity at presentation ranged from 20/20 to hand motion or worse. Half (50%) of these patients had a presenting visual acuity of hand motion or worse. At last examination, 38% (nine patients) had visual acuity of 20/40 or better, 34% (eight patients) had visual acuity of counting fingers to hand motion, 13% (three patients) 20/60, 4% (one patient) 20/200, and three were lost to follow-up. The correlation coefficient between visual acuity at presentation and most recent was significant at 0.679 (p = 0.001). CONCLUSIONS: The majority of nail-gun injuries presented in this series were work-related. These injuries could be prevented with adherence to established safety measures including proper training and education of nail-gun operators, the use of sequential-trip triggers, and required safety glasses. Visual acuity outcomes of these 24 patients are better than what might be expected due to the nature of the injury.

Macular thickness assessment in healthy eyes based on ethnicity using Stratus OCT optical coherence tomography.

PURPOSE: To assess the variation in macular thickness measurements in healthy Caucasian and African American men and women through Stratus OCT optical coherence tomography (OCT-3). METHODS: One hundred sixty-six eyes of 83 healthy patients underwent complete ophthalmologic examination in this prospective study. Exclusion criteria included a diagnosis of diabetes mellitus, hypertension, intraocular pressure (IOP) greater than 21 mm Hg, history of eye surgery or trauma, or evidence of eye disease. For analysis purposes, the authors excluded those participants in whom OCT signal strength was <7 in each eye. A fast macular thickness protocol consisting of a 6-mm radial scan centered on the fovea was used for the analysis, and the data were analyzed using the t-test for independence and linear regression. Both eyes of each patient were analyzed using the OCT-3, and analysis showed a statistically significant correlation between right and left eyes. Therefore, only one eye from each patient was randomly selected for final correlation and analysis. RESULTS: Mean foveal thickness (MFT) for Caucasians was 32 microm greater than for African Americans (217 vs. 185 microm, respectively; P < 0.001). The MFT was significantly thicker in males than in females (220 vs. 197 microm, respectively; P < 0.001). CONCLUSIONS: The fovea is significantly less thick in African Americans and females than in Caucasians and males. Racial and sexual differences should be considered when interpreting an OCT scan.

Tonic pupil and sarcoidosis.

PURPOSE: To present a case of tonic pupil associated with enhancement in the region of the ciliary ganglion on magnetic resonance imaging in a patient with sarcoidosis. DESIGN: Observational case report. METHODS: A 52-year-old woman with sarcoidosis had a right pupil exhibiting sectoral palsy to light and light-near dissociation. RESULTS: Topical administration of 0.1% pilocarpine demonstrated supersensitivity of the right pupillary sphincter muscle. Magnetic resonance imaging (MRI) with contrast revealed enhancement in the region of the right ciliary ganglion. CONCLUSIONS: Tonic pupil may be a manifestation of sarcoidosis, and in such cases, MRI may show enhancement at the level of the ciliary ganglion. Sarcoidosis should be included in the differential diagnosis of tonic pupil.

Endothelial decompensation after laser in situ keratomileusis.

We report the results of laser in situ keratomileusis (LASIK) in a 58-year-old woman with a history of corneal guttata in the right eye and mild Fuchs' dystrophy in the left eye. Preoperative pachymetry was 586 microm and 656 microm, respectively. The surgical treatment was +1.50 diopters (D) in the right eye and +3.25 D in the left eye. Surgery was performed using a VISX S2 Star laser and a Hansatome microkeratome with a 9.5 mm ring. Postoperatively, edema in the right eye resolved and pachymetry returned to 585 microm, but the left cornea decompensated despite maximum medical therapy and had a final pachymetry of 779 microm. The patient was referred to our cornea service for penetrating keratoplasty, which was performed 14 months after the LASIK treatment.