Pseudophakic Pupillary Block due to the Capsular Bag Intraocular Lens Implant Located in the Sulcus: A Case Report.

Introduction: Pupillary block, a concerning complication of cataract surgery, is heightened when a single-piece acrylic (SPA) intraocular lens (IOL) is implanted in the ciliary sulcus. We report an unusual occurrence of relative pupillary block and chronic angle-closure glaucoma (ACG) identified in the late postoperative period due to unintentional SPA IOL implantation in the sulcus. Case Presentation: An 82-year-old woman presented with a history of chronic ACG 5 years after bilateral cataract extraction. Postoperatively, she experienced anterior chamber shallowing, elevated intraocular pressure (IOP), and two acute angle-closure attacks in the left eye, successfully managed with laser peripheral iridotomies (LPIs). Despite neodymium:YAG capsulotomy, elevated IOP persisted. Maximal medical therapy effectively controlled IOP; however, a shallow anterior chamber remained, prompting referral to our glaucoma service. Slit-lamp examination revealed a shallow peripheral anterior chamber, patent LPIs, and an Alcon SA60WF SPA IOL situated posteriorly with the optic against the pupil margin OS. Gonioscopy indicated a closed angle with peripheral anterior synechiae (PAS). Ultrasound biomicroscopy (UBM) confirmed haptics in the sulcus, with the lens optic and haptics anterior to the bag. These findings suggest relative pupillary block as the cause of her chronic ACG. The SPA IOL's bulky haptics in the sulcus likely induced iris bowing, leading to prolonged appositional angle-closure and chronic PAS formation. Conclusion: IOLs designed for the capsular bag should not be placed in the sulcus. Therefore, IOLs of varying dimensions should be taken to the operating room in the event of complicated cataract extraction. Finally, UBM proves valuable in identifying causes of pupillary block.

Patient Demand for Ophthalmologists in the United States: A Google Trends Analysis.

PURPOSE: To study geographic patterns in ophthalmologist supply and patient demand for services in the United States. METHODS: Google Trends data for the keywords "ophthalmology" and "ophthalmologist" between 2004 and 2019 were queried and normalized to determine relative search volumes (RSV) for each United States state. Ophthalmologist density was calculated by dividing the number of practicing ophthalmologists by the State Census Bureau population estimates. RSV values were divided by ophthalmologist density and normalized to calculate the relative demand index (RDI) for each state. The number of accredited ophthalmology programs per state was acquired through the Accreditation Council for Graduate Medical Education. RESULTS: Ophthalmologist concentration was highly heterogeneous across the country. The states with the highest concentration of ophthalmologist per 10,000 people were Washington, DC (1.42), Maryland (0.94), Massachusetts (0.87), and New York (0.86), while the lowest were Wyoming (0.19), Idaho (0.36), New Mexico (0.38), and Nevada (0.39). RSVs ranged from 36 (Alaska and North Dakota) to 100 (Michigan). The highest RDI was found in South Dakota (100), Delaware (84), Michigan (66), and Arizona (56). The lowest RDI was in Washington, DC (0), Hawaii (7), Oregon (8), and Montana (14). The highest number of ophthalmology residency programs were in New York (18), Texas (9), and California (9), whereas 12 states lacked residency programs altogether. CONCLUSIONS: In this study, we found a wide range in the geographic distribution of ophthalmologists and residency programs in the United States. States with the highest relative demand index may represent areas most at risk of unmet medical needs.

Examining the Influence of COVID-19 Infection and Pandemic Restrictions on the Risk of Corneal Transplant Rejection or Failure: A Multicenter Study.

PURPOSE: The purpose of this study was to evaluate two aims. The first was whether patients with a history of keratoplasty who developed COVID-19 were at a higher risk of corneal graft rejection or failure. The second was examining whether patients who underwent a new keratoplasty during the first 2 years of the pandemic from 2020-2022 were at a higher risk of the same outcomes compared to those undergoing keratoplasty from 2017-2019 before the pandemic. METHODS: A multicenter research network, TriNetX, was used to query for keratoplasty patients with or without a COVID-19 between January 2020 and July 2022. Additionally, the database was also queried to identify new keratoplasties performed from January 2020-July 2022 and compare it to keratoplasties performed during a similar pre-pandemic interval between 2017-2019. 1:1 Propensity Score Matching was utilized to adjust for confounders. Graft complication of either a rejection or failure was assessed within 120 day follow-up using the Cox proportional hazard model and survival analysis. RESULTS: A total of 21,991 patients with any keratoplasty history were identified from January 2020-July 2022, of which 8.8% were diagnosed with COVID-19. Matching revealed two balanced cohorts of 1,927 patients where no significant difference in risk of corneal graft rejection or failure among groups ((aHR [95% CI] = 0.76 [0.43,1.34]; p = .244)). Comparing first-time keratoplasties performed in a pandemic period of January 2020-July 2022 to a corresponding pre-pandemic interval from 2017-2019 also similarly revealed no differences in graft rejection or failure in matched analysis (aHR = 0.937[0.75, 1.17], p = .339). CONCLUSIONS: This study found no significant increase in the risk of graft rejection or failure in patients with a prior keratoplasty history following COVID-19 diagnosis nor in any patients who had a new keratoplasty done during 2020-2022 when compared to a similar pre-pandemic interval.

Using infodemiology metrics to assess patient demand for oculoplastic surgeons in the United States: insights from Google Search Trends.

PURPOSE: The aim of this study was to compare state-by-state concentrations of oculoplastic surgeons against patient demand using Google Search Trends data, in order to identify potential areas of unmet need. METHODS: Google Trends data from 2004 to 2019 was collected to determine relative search volumes for the keyword "blepharoplasty" in each US state and the District of Columbia. Oculoplastic surgeon density was calculated by dividing the number of active American Society of Plastic and Reconstructive Surgeons members in 2019 by the State Census Bureau population estimates. Relative search volume values were divided by the local concentration of surgeons, and results were normalized between 0 and 100 to obtain a relative demand index for each state. RESULTS: Oculoplastic surgeon density varied widely across the country. The greatest concentrations of surgeons per 100,000 people were in D.C. (0.708) and Rhode Island (0.378), while the lowest were in Montana, New Mexico, North Dakota, South Dakota, and Wyoming (all 0). Relative search volumes were tightly distributed, ranging between 100 (Hawaii) and 45 (Vermont). The highest relative demand was found in low surgeon density states, such as Hawaii, Montana, New Mexico, North Dakota, South Dakota, and Wyoming. The lowest relative demand was found in DC (5), Rhode Island (12), and Utah (12). CONCLUSIONS: Our results revealed vast disparities in surgical concentrations across the US and highlighted a number of areas with a relative undersupply of oculoplastic surgeons. Further investigation is necessary to examine the underlying factors impacting the supply and distribution of oculoplastic surgeons.

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000-2020.

PURPOSE: The purpose of this study is to investigate US Medicare reimbursement trends for common glaucoma procedures from 2000 to 2020. MATERIALS AND METHODS: Current Procedural Terminology codes for Glaucoma procedures in the US centers for Medicare and Medicaid Services database were used to conduct this economic analysis. Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services were compiled for the selected procedures and compensation trends were investigated after adjusting for inflation in 2020 US dollars from the unadjusted data between 2000 and 2020. RESULTS: The average adjusted reimbursement for the analyzed procedures decreased by 20.5% [95% confidence interval (CI), -15.4% to -25.6%] over the 20-year period. On average, there was a 1.03% decrease in reimbursement rates per year (95% CI, -0.74% to -1.33%), with an adjusted compound annual growth rate of -1.35% (95% CI, -1.07% to -1.64%). The results show an overall declining rate in reimbursement for the glaucoma procedures analyzed in this study. CONCLUSIONS: The US Medicare reimbursement for glaucoma procedures in the United States showed a significant decline between 2000 and 2020. These findings may be relevant to understanding changing practice patterns for glaucoma care.

Top 100 Most Cited Papers in Laser-Assisted in situ Keratomileusis Surgery: A Bibliometric Analysis.

PURPOSE: To conduct a bibliometric analysis of the 100 most cited publications on LASIK using the Scientific Information (ISI) Web of Knowledge database. METHODS: This analysis used keyword-specific searches within the Web of Science database to isolate the 100 most frequently cited LASIK articles published between 1996 and 2019 (T100). Number of citations per article and per year were quantified from 1996 to 2019. Title, authors (as well as affiliated institutions and countries of origin), journal, year of publication, and citation frequency were variables analyzed. RESULTS: Of the T100 articles, each article was cited between 103 to 411 times with a mean of 167 citations. Between 0-11 articles in the T100 were published every year on average with a median of 5 publications per year. The highest concentration of T100 publications occurred between 2003 and 2008 at 51%. A decrease in the annual publication rate of influential articles was observed after 2010 at 23%; 39.1% of these articles compared LASIK to newer refractive surgical approaches. The highest number of T100 articles were from the Journal of Refractive Surgery. The University of California System produced the highest number of T100 articles. The author with the most articles in the T100 is Dan Z. Reinstein. Most T100 articles originated from the United States. CONCLUSION: The peak of influential LASIK research occurred between 2000-2010, likely due to topics such as postprocedural corneal ectasia and the femtosecond laser approach. While newer surgical techniques such as SMILE may have contributed to the decline in the annual rate of LASIK-related publication, the underlying cause for this decline is unclear.

The 100 Most Mentioned Glaucoma Articles Online With Highest Altmetric Attention Scores.

PRCIS: Characteristics of the most mentioned glaucoma articles on the internet were analyzed, allowing a better understanding of the dissemination of glaucoma research to the general public. PURPOSE: The aim was to determine the 100 most mentioned articles on the internet in the field of glaucoma and analyze their characteristics. MATERIALS AND METHODS: We identified the top 100 glaucoma articles with the highest Altmetric Attention Score (AAS), an automatically calculated metric for monitoring social media. Each article was evaluated for several characteristics including year of publication, title, journal name, journal impact factor (IF), article topic, article type, affiliation, and online mentions (news, blog, policy, Twitter, Facebook, etc.). Correlation analysis was conducted for AAS with these characteristics. RESULTS: The selected 100 articles came from 44 journals with more than half (56%) published in ophthalmology-specific journals. There was no significant correlation between IF and number of articles in a specific journal or AAS (P>0.1), but the number of articles in the top 100 was higher for ophthalmology journals with a higher IF (P<0.05). Original study was the most common study type (87%), of which clinical observation study was the most common subgroup (40%). Epidemiology/risk factor and basic science were the most common article topics (each 24%), followed by medical treatment (13%). Article topics regarding medical treatment had a significantly greater AAS than other topics (P<0.05). Of the top 5 articles, more than half (60%) were related to "Lifestyle choice" topics. CONCLUSIONS: There was no association between journal IF and AAS, consistent with previous studies. 90% of journals that had articles in the top 100 had a Twitter page. "Lifestyle choice" activities and other modifiable risk factors attracted significant online attention regarding glaucoma studies, with two of the top three most mentioned articles related to dietary intake. The present study thus provides a better understanding of online engagement with glaucoma research and the dissemination of this research to the general public.

Public Interest in Refractive Diseases and Treatments During the COVID-19 Pandemic: A Google Trends Analysis.

Purpose To assess national internet search trends/public interest in refractive diseases and treatments during the first year of the COVID-19 pandemic. Methods A Google Trends search for refractive terms was performed during the first year of the COVID-19 pandemic. Refractive terms were divided into disease and treatment terms. Relative search volume (RSV) indices were assessed in the United States from the initial lockdown period (March 1 - June 28), summer reopening period (July 5 - November 1), and winter case surge/vaccine rollout period (November 8 - February 28). A t-test of two independent samples assuming unequal variances was utilized in comparing the pandemic year to pooled data of overlapping weeks between 2016-2019.  Results The majority of disease and treatment terms showed a significant decrease in RSV during the initial lockdown period (p<0.05). There was a significant increase in RSV for cataract, astigmatism, cataract surgery, and photorefractive keratotomy (PRK) (p<0.05), accompanied by a significant decrease in RSV for contact lens during the summer reopening period. There was a significant increase in RSV for cataract, astigmatism, glasses, and PRK, accompanied by a significant decrease in RSV for hyperopia, keratoconus, contact lens, and LASIK during the winter case surge/vaccine rollout period.  Conclusion There was a significant decrease in the public interest in refractive diseases and treatments during the lockdown period, accompanied by an increase in interest later in the year. Decreased public interest can lead to delays in care, poorer health literacy, and potentially worse outcomes. Strategies to enhance public interest and care during the pandemic may prove to be beneficial.

Effect of eyedrops and applanation tonometry on optical biometry.

PURPOSE: To determine whether eyedrops (phenylephrine, tropicamide, and fluorescein-proparacaine) and Goldmann applanation tonometry (GAT) have an effect on optical biometry measurements for preoperative cataract surgery workup. SETTING: George Washington University, Washington, DC. DESIGN: Nonrandomized controlled trial. METHODS: Participants older than 18 years with no contraindications to eyedrops or tonometry were recruited. Optical biometry measurements were obtained on a single eye using the Lenstar LS900. One drop each of phenylephrine, tropicamide, and fluorescein-proparacaine was applied to the same eye, and measurements were repeated. GAT was performed, and measurements were repeated. For controls, the contralateral eye was also measured at each interval. RESULTS: There was no statistically significant difference in mean predicted postoperative refraction (PPOR) keratometry (K) 1, K2, or axis postdrops and post-GAT 62 eyes (n = 62). After drops were applied, mean central corneal thickness increased from 540 to 542 µm (P = .0002), mean anterior chamber depth (ACD) increased from 3.68 to 3.70 mm (P < .0001), and lens thickness (LT) decreased from 3.66 to 3.65 (P = .001). After GAT, ACD increased to 3.76 mm (P < .0001), and LT increased to 3.60 mm (P < .0001). There was no statistically significant difference in PPOR or other parameters for the control eyes (n = 5). CONCLUSIONS: GAT and phenylephrine, tropicamide, and fluorescein-proparacaine drops did not affect the primary outcome of PPOR. This suggests that cataract surgery candidates do not need to return for a separate preoperative visit for optical biometry.

Predictive and construct validity of virtual reality cataract surgery simulators.

This review was conducted to assess the current literature on virtual reality (VR) simulation in cataract surgery training. Studies evaluating the construct and predictive validity of VR simulators, such as the EyeSi simulator, were compiled and compared. Two databases, PubMed and Scopus, were systematically searched, and 20 articles were determined to meet the study inclusion criteria (full-length articles written in English). Of these, 11 studies examined construct validity, and 9 studies examined predictive validity. Although the construct validity of some VR simulators is yet to be established by multiple studies, many of the modules within the EyeSi simulator have been repeatedly validated. Furthermore, several studies have shown that VR simulator training improves overall cataract surgery performance. This review demonstrated the ability of cataract surgery VR simulators to differentiate surgical experience levels and improve operating room performance, which supports the use of VR simulators in ophthalmology residency training.

Trends in Authorship of Original Scientific Articles in Journal of Glaucoma: An Analysis of 25 Years Since the Initiation of the Journal.

PRéCIS:: Publications in glaucoma have seen an increase in the number of authors and disclosures per article, authors with dual degrees, and international authors, but contributions of women to articles published remains low. PURPOSE: Authorship trends have been studied across many medical specialties and in ophthalmology as a whole, but not specifically in glaucoma. The authors explored the authorship trends of original scientific articles in the Journal of Glaucoma. MATERIALS AND METHODS: The authors recorded the number of authors and disclosures per article, degree type of first and last authors, geographical origin of the corresponding author, and sex of first and last authors of original content from the Journal of Glaucoma published in 1992, 1997, 2002, 2007, 2012, and 2017. RESULTS: A total of 642 articles were analyzed. From 1992 to 2017, annual published articles increased from 38 to 242 (P=0.02), the mean number of authors per article increased from 3.2 to 5.2 (P<0.01), the mean number of disclosures per article increased from 0.3 to 1.0 (P=0.04), the proportion of first and last authors with dual degrees (medical plus advanced degrees) also increased (both P<0.03), whereas the proportion with a sole medical degree decreased (both P<0.05). There was a proportional decrease in articles from North America (P=0.03), and proportional increase from the "Far East" (P=0.04) and "Other" regions (P=0.04). No significant changes in proportions of female first and last authors were found (both P>0.28). CONCLUSIONS: Consistent with authorship trends across various other medical specialties, glaucoma has seen an increase in the number of authors and disclosures per article, authors with dual degrees, and authors from the "Far East" and "Other" regions. However, contributions of women to articles published in Journal of Glaucoma remain low.

Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma.

AIM: The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. PATIENTS AND METHODS: In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1 hour and 1, 1-6, 6-12, 6-24, 24-36, and 36-52 weeks. Patients completed a survey 1 week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3 mmHg from baseline. RESULTS: IOP was lowered to ≥3 mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24-52 weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24-52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52 weeks post treatment. There were more treatment failures in the micropulse group up to 52 weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). CONCLUSION: Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure.

Herpetic Stromal Keratitis following Selective Laser Trabeculoplasty.

This is a case report describing two cases of disciform corneal edema following uncomplicated selective laser trabeculoplasty (SLT) thought to be secondary to herpes simplex virus (HSV) given the presence of a dendrite, decreased corneal sensation, corneal thinning, and response to therapy with oral and topical antivirals. Corneal edema after SLT treatment has been reported before, but the etiology has been unclear. Our cases highlight HSV as a likely etiology, which may help with prevention and better management of such cases in the future.

Marijuana Use Among Patients With Glaucoma in a City With Legalized Medical Marijuana Use.

IMPORTANCE: Previous research has shown several limitations associated with the use of marijuana as a treatment for glaucoma. However, little is known regarding patients' perceptions toward using marijuana for glaucoma and their intentions to use this therapeutic alternative. OBJECTIVE: To identify factors among patients with glaucoma that could lead to intentions to use marijuana for treatment. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study of 204 patients with glaucoma or suspected to have glaucoma was conducted at an academic-based glaucoma clinic in Washington, DC, between February 1 and July 31, 2013. Patients completed a self-administered survey assessing demographics, perceived severity of glaucoma, prior knowledge about marijuana use in glaucoma, past marijuana use, perceptions toward marijuana use (legality, systemic adverse effects, safety and effectiveness, and false beliefs), satisfaction with current glaucoma management, relevance of treatment costs, and intentions to use marijuana for glaucoma. Medical records were reviewed for disease severity. Data analysis was conducted from September 1, 2013, to September 30, 2015. MAIN OUTCOMES AND MEASURES: The main outcome was patients' intentions to use marijuana for glaucoma. Multiple linear regression analysis was conducted to identify factors associated with patients' intentions to use marijuana for glaucoma. RESULTS: Of the 334 patients who were invited to participate in the study, 204 (61.1%) completed the survey. About half the participants were women (104 [51.0]%), and 82 (40.2%) were white. Regression analysis of 204 respondents indicated that perceptions of legality of marijuana use (ß, 0.378; 95% CI, 0.205 to 0.444; P < .001), false beliefs regarding marijuana (ß, 0.323; 95% CI, 0.236 to 0.504; P < .001), satisfaction with current glaucoma care (ß, -0.222; 95% CI, -0.362 to -0.128; P < .001), and relevance of marijuana and glaucoma treatment costs (ß, 0.127; 95% CI, 0.008 to 0.210; P = .04) were significantly associated with intentions to use marijuana for glaucoma treatment after controlling for demographic variables, disease severity, and previous marijuana use. CONCLUSIONS AND RELEVANCE: This study's findings suggest a need for more education on this topic for ophthalmologists to be able to protect patients with glaucoma against the increased acceptability among the public of using marijuana based on false perceptions of its therapeutic value in glaucoma therapy. Considering the strong influence of perceptions of the legality of marijuana use on intentions to use this substance as a treatment for glaucoma, patient education might be particularly relevant in states in which marijuana use for glaucoma is legal, as in the case of the current study's setting.

Utility of Heidelberg retinal tomography as a screening tool for analyzing retinal nerve fiber layer defects.

CONTEXT: Although Heidelberg retinal tomography (HRT)-generated topographic images have been studied extensively for the detection of retinal nerve fiber layer (RNFL) defects, little is known about the role of HRT-generated surface reflectivity images in the detection of RNFL defects in either patients with glaucoma or glaucoma suspects. AIMS: To evaluate the effectiveness of HRT version II (HRT II) optic nerve reflectivity images in uncovering RNFL defects in an outpatient population evaluated for glaucoma. STUDY DESIGN/MATERIALS AND METHODS: In 102 consecutive eyes from 60 patients evaluated for glaucoma in an academic-based practice, HRT II optic nerve images were prospectively imaged and compared with clinical optic nerve exam techniques to see if HRT II was able to detect RNFL defects overlooked in clinical practice. RESULTS: Nine eyes (8.8%) were found to have RNFL defects recognized by screening with HRT II. Of these nine eyes, eight (88.9%) were recognized to demonstrate RNFL defects by conventional examination techniques. One additional eye had an RNFL defect seen on physical exam that was not detected by HRT. CONCLUSION: In academic practice, HRT II may be helpful in complementing conventional exam techniques in the recognition and documentation of acquired RNFL loss.

Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration.

This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma have not been discussed. Our report highlights the importance of recognizing the often multifactorial etiology of angle closure glaucoma to help guide clinical management.

Indirect cyclopexy for treatment of a chronic traumatic cyclodialysis cleft with hypotony.

Cyclodialysis cleft is a rare clinical finding and therefore, reports on surgical repair techniques in the literature are limited. Additionally, hypotony can make repair technically challenging. We share a novel, simple surgical approach to management of a case of chronic traumatic cyclodialysis cleft with a successful outcome.

Telerobotic contact transscleral cyclophotocoagulation of the ciliary body with the diode laser.

To assess the feasibility of using the Robotic Slave Micromanipulator Unit (RSMU) to remotely photocoagulate the ciliary body for the treatment of glaucoma with the diode laser. In fresh unoperated enucleated human eyes, the ciliary body was destroyed either with a standard contact transscleral cyclophotocoagulation 'by hand' diode laser technique, or remotely using the RSMU. The treated sections were fixed in formalin, paraffin-embedded, and stained with hematoxylin and eosin. Histological evaluation was performed by a masked observer using a standardized grading system based on the amount of damage to the ciliary body to evaluate effectiveness of treatment. Both methods of contact transscleral cyclophotocoagulation showed therapeutic tissue disruption of the ciliary processes and both the non-pigmented and pigmented ciliary epithelium. Histology examination of remote robotic contact transscleral cyclophotocoagulation and "by hand" technique produced similar degrees of ciliary body tissue disruption. Remote diode laser contact transscleral cyclophotocoagulation of the ciliary body in fresh enucleated human eyes is possible with the RSMU. Therapeutic tissue disruption of the ciliary body was achieved. Additional study is necessary to determine the safety and efficacy of robotically-delivered cyclophotocoagulation in live eyes.

Peripheral laser iridoplasty opens angle in plateau iris by thinning the cross-sectional tissues.

Plateau iris syndrome has been described as persistent angle narrowing or occlusion with intraocular pressure elevation after peripheral iridotomy due to the abnormal plateau iris configuration. Argon laser peripheral iridoplasty (ALPI) is an effective adjunct procedure to treat plateau iris syndrome. Classic theory suggests that the laser causes the contraction of the far peripheral iris stroma, "pulls" the iris away from the angle, and relieves the iris-angle apposition. We report a case of plateau iris syndrome that was successfully treated with ALPI. Spectral domain optical coherence tomography confirmed the angle was open at areas with laser treatment but remained appositionally closed at untreated areas. Further analysis suggested significant cross-sectional thinning of the iris at laser-treated areas in comparison with untreated areas. The findings indicate that APLI opens the angle, not only by contracting the iris stroma, but also by thinning the iris tissue at the crowded angle. This is consistent with the ALPI technique to aim at the iris as far peripheral as possible. This case also suggests that spectral domain optical coherence tomography is a useful adjunct imaging tool to gonioscopy in assessing the angle condition.

Influence of surgery simulator training on ophthalmology resident phacoemulsification performance.

PURPOSE: To determine whether the use of an eye-surgery simulator during ophthalmology residency training improves cataract surgery performance. SETTING: Department of Ophthalmology, Medical Faculty Associates, George Washington University, Washington, DC, USA. DESIGN: Comparative case series. METHODS: Residents were divided into a simulator group and a nonsimulator group based on the inclusion or absence of the eye-surgery simulator in residency training. Consecutive resident cataract surgeries with the same attending surgeon were retrospectively reviewed. The phaco time and percentage power and intraoperative complications in each case were recorded. The adjusted phaco time in each case was calculated. RESULTS: The study reviewed 592 surgeries. The mean values for phaco time, percentage phaco power, adjusted phaco time, complication rates, and complication grade were 1.88 minutes (range 0.11 to 7.20 minutes), 25.32% (range 2.2% to 50.0%), 47.58 minutes (range 0.24 to 280.80 minutes), 0.04, and 2.33, respectively, in the simulator group (n = 17) and 2.41 minutes (range 0.04 to 8.33 minutes), 28.19% (range 8.0% to 70.0%), 71.85 minutes (range 0.32 to 583.10 minutes), 0.06, and 2.47, respectively, in the nonsimulator group (n = 25). The Student t tests showed a statistically significant between-group difference in mean phaco time (P<.002), adjusted phaco time (P<.0001), and percentage phaco power (P<.0001). Regression analysis showed a significantly steeper slope of improvement in mean phaco time and power in the nonsimulator group than in the simulator group (P<.0001). CONCLUSIONS: Residents who trained using the simulator had shorter phaco times, lower percentage powers, fewer intraoperative complications, and a shorter learning curve. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.