Outer Retinal Tubulation in Geographic Atrophy.

BACKGROUND AND OBJECTIVE: Outer retinal tubulation (ORT) is observed on optical coherence tomography images from patients with geographic atrophy (GA), but its clinical implications are unclear. The objective of this study was to investigate the prevalence of ORT and its association with GA lesion growth rates. MATERIALS AND METHODS: This post hoc longitudinal analysis assessed 62 eyes randomized to sham treatment in the phase 2 FILLY trial. ORT prevalence was estimated at baseline, month 12, and month 18 and change in GA lesion growth from baseline to month 18 was calculated. RESULTS: ORT prevalence rates were 24%, 43%, and 43% at baseline, month 12, and month 18, respectively. Slower mean GA lesion growth was observed in eyes with ORT present at baseline in the overall population as well as the subfoveal and nonsubfoveal GA subgroups. CONCLUSION: ORT presence may indicate a slower-growing GA lesion phenotype, independent of foveal involvement. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

FACE COVERING ADHERENCE IN AN OUTPATIENT OPHTHALMOLOGY CLINIC DURING COVID-19.

Purpose: The purpose of this report is to examine the proper use of face coverings by patients entering one of several outpatient ophthalmology clinics during the coronavirus disease 19 (COVID-19) global pandemic.Methods: Proper face-covering use was documented for all patients entering thirteen different outpatient ophthalmology clinics in Western Pennsylvania in July 2020. Gender and age of all patients were collected. Patients who were not wearing or improperly wearing a face covering were provided one with instructions on proper use.Results: Over 5 days, 43 of 2286 patients (2%) that entered one of the participating clinics were observed not or incorrectly wearing face coverings. The average age of patients who were not correctly wearing a face covering was significantly higher. There was no association between gender and face-covering use.Conclusion: As case counts continue to rise, effective use of face coverings in healthcare settings remains essential. The high percentage of adherence presented in this report is reassuring. However, the elderly, a high-risk population, may require additional, targeted educational measures to increase face-covering adherence.

Choroidal Effusion Mimicking Uveal Melanoma: A Novel Presentation of Idiopathic Systemic Capillary Leak Syndrome.

BACKGROUND: Idiopathic systemic capillary leak syndrome (ISCLS, also known as Clarkson's disease) is a rare medical condition characterized by episodes of capillary endothelial cell dysfunction with leakage of fluid into the interstitial space resulting in severe hypotension, hemoconcentration, hypoalbuminemia, and generalized edema. Each episode can result in multiorgan failure due to systemic hypoperfusion. CASE PRESENTATION: We report a case of uveal effusion, mimicking uveal melanoma, associated with ISCLS following viral infection. A 74-year-old white male was evaluated in our ocular tumor clinic for a large intraocular mass in the right eye concerning for choroidal melanoma. We completed a review of the literature and list clinical recommendations for these cases. ISCLS, although rare, was a significant diagnostic consideration in this patient. Due to the high mortality rate of this condition, accurate diagnosis and prompt treatment was critical. We hypothesize that the mechanism of choroidal effusion development was due to reduced oncotic pressure from rapid decrease in serum albumin. Increased permeability of choroidal capillaries may be an additional mechanism leading to uveal effusion. CONCLUSION: With treatment, the patient had complete resolution of his choroidal effusion with no recurrence of his ISCLS. Further research should be considered on the role of viral infections in the pathogenesis of ISCLS.

Use of Kaolin-impregnated Gauze for Improvement of Intraoperative Hemostasis and Postoperative Wound Healing in Blepharoplasty.

PURPOSE: Kaolin is a mineral shown to be effective in controlling hemorrhage when combined with standard gauze and applied to wounds. This study investigates the application of kaolin to control intraoperative bleeding and promote wound healing in eyelid surgery. METHODS: This prospective, randomized, double-blind study recruited patients who underwent eyelid surgery. Following skin incision, kaolin-impregnated gauzewas placed in one eyelid wound bed and cotton gauze in the other, then removed. Distinct, individual areas of bleeding were recorded. Standardized photographs were obtained postoperatively on Day 1, 4, and 7. Photographs were graded for edema and ecchymosis by four blinded observers. Patients also completed a survey inquiring which side had more bruising, swelling, and pain at each return visit. RESULTS: A total of 46 patients completed the study. The number of intraoperative bleeding sites for kaolin versus plain gauze was not significantly different (p=0.96). Photographic grading by blinded observers did not identify any statistically significant differences in postoperative edema at any time point between lids. There was a statistically significant difference for ecchymosis at postoperative Day 4 (p=0.009) and Day 7 (p=0.016). Patient surveys did not show any difference in perceived edema, ecchymosis, or pain between lids. CONCLUSION: Intraoperative hemostasis was not affected by the use of kaolin-impregnated gauze. The effectiveness of kaolin in wound healing showed improved ecchymosis at Days 4 and 7 when assessed by blinded observers. Patients did not notice any improvement in postoperative edema, ecchymosis, or pain.

Risk of ocular blood splatter during oculofacial plastic surgery.

PURPOSE: To assess intraoperative blood splatter to the ocular surface and adnexa during oculofacial surgery. METHODS: Four surgeons and multiple assistants at three separate locations wore a total of 331 protective eye shields during 131 surgeries. Postoperatively, a luminol blood detection system was used to identify blood splatter on the shields. In the event of positive blood splatter, the total number of blood spots was counted. Controls were used to verify the blood detection protocol. A postoperative questionnaire was given to all surgeons and assistants after each case, and they were asked whether intraoperative blood splatter was noticed. RESULTS: Blood was detected on 61% of eye shields and in a total of 80% of surgical cases. However, only 2% of blood splatters were recognized intraoperatively by the surgical participants. There was no significant difference in the splatter rate between surgeons (64%), assistants (60%), and surgical technicians (58%) (p = 0.69). Shields worn during full-thickness eyelid procedures, direct brow lifting, orbitotomy with bony window, and orbital fracture repairs were more likely to be splattered (p = 0.03), and there was a significant difference between splatter rates among different surgeons (range, 29-90%; p = 0.0004), suggesting that blood splatter rate may be both procedure dependent and surgeon dependent. CONCLUSIONS: Mucocutaneous and transconjunctival transmission of human immunodeficiency virus and viral hepatitis has been documented. These results suggest that oculofacial plastic surgeons should consider eye protection for patients with known blood-borne diseases and in cases where blood splatter is expected. This precautionary practice is supported by the high incidence (98%) of undetected, intraoperative blood splatter.