Chronic angle closure glaucoma with an atypical iris-pupillary membrane.

PURPOSE: To report the presentation and management of a 65-year-old female who presented with chronic angle closure glaucoma and an atypical iris membrane. CASE REPORT: A 65-year-old healthy female with no significant past medical history presented to the emergency room with a 2-day history of headache, blurry vision, and right ocular pain. She denied any such prior episodes, any prior ocular history including ocular trauma, or a family history of glaucoma. She was diagnosed with bilateral, severe chronic angle closure glaucoma with an atypical, pigmented iris-pupillary membrane in the right eye. Given the appearance of the membrane, ocular oncology consultation and anterior segment imaging were unremarkable. Surgical management included complex cataract extraction, limited pars plana anterior vitrectomy, iris membrane removal, and placement of a sulcus tube shunt. CONCLUSIONS: This complex case of chronic angle closure glaucoma with an atypical pupillary membrane highlights the importance of maintaining a broad differential and ruling out secondary pathologies such as iris melanoma. Additionally, it highlights the complexities of cataract extraction with a shallow anterior chamber.

Trends in Female Authorship in Cornea From 2007 to 2019.

PURPOSE: To identify female authorship trends in first author and last author positions in Cornea from 2007 to 2019. METHODS: First and last authors of all Clinical Science and Basic Investigation publications in Cornea over 13 years were sorted by sex. Identification of sex was based on the author's institutional profile or a Google-based name identifier in cases of equivocal names. The proportion of female board-certified ophthalmologists between 2007 and 2019 was collected from the American Board of Ophthalmology total roster of certified diplomats. RESULTS: First and last author sexes were collected from 2313 publications (1837 Clinical Science and 476 Basic Investigation). Between 2007 and 2019, the percentage of female first authors increased from 30.5% to 41.5%, although this change was not significant (P = 0.240). Female last author percentage increased significantly from 14.9% to 26.6% (P = 0.016). The percentage of female American Board of Ophthalmology-certified diplomats also increased significantly from 17.4% to 24.5% (P < 0.001). Similarly, when comparing 2007 and 2008 with 2018 and 2019, we noted a significant increase in the proportion of women in the last author (P < 0.001) but not in the first author (P = 0.208) position. We also identified a significantly higher proportion of female first authors than that of female board-certified ophthalmologists (P < 0.001). Finally, there was a strong association between first author sex and last author sex (P < 0.001) across manuscripts. CONCLUSIONS: The proportion of women in last author positions increased over 13 years among manuscripts in Cornea. Despite these advances in academic female representation within the cornea subspecialty, a gender gap in authorship persists.

Cutaneous B-Cell Lymphoblastic Lymphoma.

B-cell lymphoblastic lymphoma (B-LBL) is a malignant neoplasm of immature B cells that accounts for only 10% of all cases of lymphoblastic lymphoma. Most commonly, B-LBL presents as bony lesions, but in rare cases, the disease manifests cutaneously. We present a case of simultaneous cutaneous and systemic presentation of B-LBL in an otherwise healthy 28-year-old man in which the lymphoblastic infiltrate stained positive for CD79a, Tdt, CD10, and CD20. A diagnosis of cutaneous B-LBL was made, and systemic work-up revealed widespread involvement of the skin, bone, and lymph nodes. Review of all currently described cases of cutaneous B-LBL with or without systemic involvement revealed that the most frequently positive tumor markers were CD79a (92.3%), Tdt (90.6%), and CD10 (83.3%). Systemic involvement of B-LBL was found in nearly half of all cases with cutaneous presentation.

Steady-state pattern electroretinogram and short-duration transient visual evoked potentials in glaucomatous and healthy eyes.

IMPORTANCE: This study evaluates two rapid electrophysiological glaucoma diagnostic tests that may add a functional perspective to glaucoma diagnosis. BACKGROUND: This study aimed to determine the ability of two office-based electrophysiological diagnostic tests, steady-state pattern electroretinogram and short-duration transient visual evoked potentials, to discern between glaucomatous and healthy eyes. DESIGN: This is a cross-sectional study in a hospital setting. PARTICIPANTS: Forty-one patients with glaucoma and 41 healthy volunteers participated in the study. METHODS: Steady-state pattern electroretinogram and short-duration transient visual evoked potential testing was conducted in glaucomatous and healthy eyes. A 64-bar-size stimulus with both a low-contrast and high-contrast setting was used to compare steady-state pattern electroretinogram parameters in both groups. A low-contrast and high-contrast checkerboard stimulus was used to measure short-duration transient visual evoked potential parameters in both groups. MAIN OUTCOME MEASURES: Steady-state pattern electroretinogram parameters compared were MagnitudeD, MagnitudeD/Magnitude ratio, and the signal-to-noise ratio. Short-duration transient visual evoked potential parameters compared were amplitude and latency. RESULTS: MagnitudeD was significantly lower in glaucoma patients when using a low-contrast (P = 0.001) and high-contrast (P < 0.001) 64-bar-size steady-state pattern electroretinogram stimulus. MagnitudeD/Magnitude ratio and SNR were significantly lower in the glaucoma group when using a high-contrast 64-bar-size stimulus (P < 0.001 and P = 0.010, respectively). Short-duration transient visual evoked potential amplitude and latency were not significantly different between the two groups. CONCLUSIONS AND RELEVANCE: Steady-state pattern electroretinogram was effectively able to discern between glaucomatous and healthy eyes. Steady-state pattern electroretinogram may thus have a role as a clinically useful electrophysiological diagnostic tool.

Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service.

This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management.