Closure of a Chronic Traumatic Macular Hole Following Phacoemulsification Surgery.

PURPOSE: To report a case of chronic traumatic macular hole closure following an uncomplicated phacoemulsification surgery. METHODS: Retrospective chart review with optical coherence tomography imaging. RESULTS: 42-year-old woman with a 20-year history of a traumatic macular hole and cataract in the right eye underwent an uncomplicated phacoemulsification surgery. Following surgery, the patient was prescribed prednisolone acetate 1% four times per day, which was tapered off by postoperative month 1. By postoperative month 1, the full-thickness macular hole had closed. CONCLUSION: This unique case illustrates the closure of a full-thickness macular hole following cataract surgery. We hypothesize that closure of the macular hole was aided by the use of topical steroids in the postoperative period, allowing for resolution of the cystic intraretinal fluid and hole closure.

Familial co-segregation and the emerging role of long-read sequencing to re-classify variants of uncertain significance in inherited retinal diseases.

Phasing genetic variants is essential in determining those that are potentially disease-causing. In autosomal recessive inherited retinal diseases (IRDs), reclassification of variants of uncertain significance (VUS) can provide a genetic diagnosis in indeterminate compound heterozygote cases. We report four cases in which familial co-segregation demonstrated a VUS resided in trans to a known pathogenic variant, which in concert with other supporting criteria, led to the reclassification of the VUS to likely pathogenic, thereby providing a genetic diagnosis in each case. We also demonstrate in a simplex patient without access to family members for co-segregation analysis that targeted long-read sequencing can provide haplotagged variant calling. This can elucidate if variants reside in trans and provide phase of genetic variants from the proband alone without parental testing. This emerging method can alleviate the bottleneck of haplotype analysis in cases where genetic testing of family members is unfeasible to provide a complete genetic diagnosis.

VISION-RELATED MALPRACTICE INVOLVING PRISONERS: Analysis of the Westlaw Database.

PURPOSE: To characterize vision-related malpractice litigation involving prisoners. METHODS: Retrospective legal database review using the Westlaw database was performed to identify vision-related malpractice lawsuits involving prisoners in the United States from 1914 to 2020. Main outcomes and measurements were allegations of malpractice, verdicts, and settlements. RESULTS: Sixty-four vision-related malpractice lawsuits involving prisoners were identified. Mean defendant age was 49 years (range, 28-74 years). Fifty-seven percent of the defendants were ophthalmologists and 43% were optometrists. The cases were most commonly from the South and Midwest (n = 19 [30%] for each). Allegations of malpractice included inadequate medical care or treatment refusal (n = 21 [33%]), failure to treat fully leading to continued suffering (n = 18 [28%]), and delay in treatment or referral (n = 17 [27%]). Retina-related diagnoses were most common (n = 18 [28%]). Forty-six (72%) cases were closed, 14 (22%) were open, and four (6.3%) were partially closed. Only two (3.1%) cases were decided in favor of the plaintiff. The most common reason for an unsuccessful suit was lack of deliberate indifference by the eye care professional (n = 21 [46%]). CONCLUSION: The most common reasons for vision-related malpractice brought forth by prisoners were inadequate or incomplete eye care and treatment refusal. Retina was the most commonly involved subspecialty. However, the success rate of these suits was extremely low.

MACULAR HOLE CLOSURE WITH TOPICAL STEROIDS.

BACKGROUND AND OBJECTIVE: To report the outcomes of topical difluprednate 0.05% use in the closure of full-thickness macular holes. PATIENTS AND METHODS: Retrospective chart review of 4 patients with full-thickness macular holes who received difluprednate drops 4 times daily for a minimum of 12 weeks. Main outcome measures were macular hole status assessed with optical coherence tomography, visual acuity, intraocular pressure, and complications of treatment. RESULTS: All patients had macular hole closure within 12 weeks of difluprednate exposure. Mean time to macular hole closure was 5 weeks (range, 2-12 weeks). Visual acuity improved with macular hole closure. Average baseline visual acuity was 20/42. Average visual acuity after macular hole closure was 20/26 (P = 0.14). Two patients experienced increased intraocular pressure with topical steroid use. CONCLUSION: Exposure to difluprednate in this cohort of patients with full-thickness macular holes was associated with reduced macular edema, macular hole closure, and visual improvement.

Giant Intraoperative Corneal Bulla Managed with Bandage Lens Technique During Vitrectomy Surgery.

PURPOSE: To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively. METHODS: Retrospective case report with anterior segment optical coherence tomography (AS-OCT). RESULTS: A 77-year-old woman with history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy (PPV) and scleral fixated intraocular lens placement. During PPV, a large corneal bulla formed at the site of the main corneal incision, confirmed with AS-OCT. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery. CONCLUSION: This is the first report of corneal bullae formation during PPV that is confirmed by AS-OCT and successfully managed with a bandage contact lens intraoperatively.

ONE-YEAR OUTCOMES OF A NOVEL SURGICAL APPROACH FOR FIXATION OF A POSTERIOR CHAMBER INTRAOCULAR LENS USING GORE-TEX SUTURE.

PURPOSE: To report the 1-year outcomes of a novel surgical technique for the fixation of a CZ70BD intraocular lens with Gore-Tex suture using cow-hitch knots. METHODS: A retrospective chart review of 15 patients (13 men and 2 women) who underwent fixation of a posterior chamber intraocular lens with Gore-Tex suture was performed. Short- and long-term outcomes data were collected 1 month and 1 year after surgery, respectively. RESULTS: Fourteen of the 15 patients met inclusion criteria and were included in the analysis. Mean visual acuity improved significantly from Snellen 20/491 preoperatively to Snellen 20/59 at postoperative month 12 (P = 0.002). The most common short-term complications included increased intraocular pressure (n = 6) and cystoid macular edema (n = 4). The most common long-term complications included increased intraocular pressure (n = 2) and iris capture of the intraocular lens (n = 2). CONCLUSIONS: One-year outcome data suggest that this technique is a reasonable surgical option for secondary intraocular lens placement in patients who lack capsular support.

ONE-YEAR OUTCOMES OF A NOVEL SURGICAL TECHNIQUE FOR SUTURELESS INTRASCLERAL FIXATION OF A THREE-PIECE INTRAOCULAR LENS USING A 30-GAUGE NEEDLE.

PURPOSE: To present the 1-year results of a surgical technique for the sutureless intrascleral fixation of a 3-piece intraocular lens using a 30-gauge needle. METHODS: A retrospective chart review of a consecutive series of 9 eyes of 8 patients who underwent sutureless intrascleral fixation of posterior chamber intraocular lens using a 30-gauge needle was performed. Patients were required to have at least 1 year of follow-up to be included in the analysis. Short-term data were collected 1 month after surgery, and long-term data were collected 1 year after surgery. Data collected included visual acuity, lens stability, intraocular pressure, and the development of complications. RESULTS: Visual acuity improved from Snellen 20/309 preoperatively to Snellen 20/27 at postoperative Month 12 (P = 0.03). Short-term complications included increased intraocular pressure (n = 4) and corneal edema (n = 2). Long-term complications included exposed superior haptic (n = 1) and recurrent anterior chamber inflammation (n = 1). CONCLUSION: The novel surgical technique for sutureless intrascleral fixation of a 3-piece intraocular lens is well tolerated 1 year after surgery.