Incidence and clinical characteristics of pediatric eyelid retraction.

PURPOSE: To describe the incidence and clinical characteristics of upper and lower eyelid retraction in children. METHODS: The medical records of all pediatric patients (<19 years of age) diagnosed with upper and/or lower eyelid retraction from January 1, 1976, through December 31, 2010, were retrospectively reviewed. RESULTS: A total of 85 patients were diagnosed during the 35-year period, of whom 15 were residents of Olmsted County, Minnesota, yielding an annual age- and sex-adjusted annual incidence of 1.38 per 100,000 persons (95% CI, 0.70-2.05), or 1 in 72,463. Upper eyelid retraction was documented in 38 patients (45%; 24 unilateral and 14 bilateral); lower, in 25 (29%; 12 unilateral and 13 bilateral); and both upper and lower in 18 (21%; 3 unilateral and 15 bilateral). It was not recorded in 4 patients. The most common causes of eyelid retraction were thyroid eye disease (48 [56%]), primary congenital eyelid retraction (11 [13%]), and trauma (9 [11%]). Although there were no cases of visual impairment secondary to eyelid retraction, tearing, ocular surface irritation, and photophobia were noted in 38 patients (45%). Nineteen patients (22%) underwent surgical eyelid correction. CONCLUSIONS: Pediatric eyelid retraction is relatively rare, occurring in approximately 1 in 72,000. The leading causes of childhood eyelid retraction in this cohort were thyroid eye disease, primary congenital eyelid retraction, and trauma. No visual disturbances due to eyelid retraction were noted, and approximately 1 in 5 patients required corrective eyelid surgery.

Accuracy of Tonopen Versus iCare in Human Cadaveric Eyes With Edematous Corneas Over a Wide Range of Intraocular Pressures.

PURPOSE: The purpose of this study was to compare the accuracy of 2 portable tonometers, Tonopen and iCare, in extreme corneal edema, while also accounting for the location of pressure measurement over a wide range of intraocular pressure (IOP). METHODS: Utilizing an experimental laboratory investigation, IOP measurements were obtained with iCare and Tonopen against an internal digital manometer in 2 enucleated human cadaveric eyes with edematous corneas. Pachymetry was used to measure central corneal thickness in each eye. Each eye was then mounted on an upright-positioned mannequin, and a 30-G needle connected to a digital manometer was introduced into the anterior chamber at the limbus. Pressures were maintained at 0, 10, 20, 30, 40, and 50 mmHg using the digital manometer. Three measurements were taken with the tonometers at the central cornea, limbal cornea, and sclera, for a total of 9 measurements per device per eye at each manometric pressure reading. RESULTS: Comparing the mean absolute error of Tonopen versus iCare measurements at the central cornea for each manometric pressure reading, both devices underestimated the control at pressures >10 mmHg, with mean error increasing as IOP increased [mean absolute error (MAE) ranged from 1.67 to 13.33 with Tonopen and 3.67 to 21.00 with iCare]. Tonopen more accurately estimated pressure with an average MAE of 5.72 at the central cornea, compared with MAE of 10.83 at the central cornea for iCare (P<0.03). Comparing MAE between the devices at the limbus, there was no significant difference between the 2 (P=0.91), with average MAE for the Tonopen 5.47 and average MAE for the iCare 5.22. There was no significant difference between average MAE for Tonopen measurements at the central cornea versus the limbus (P=0.89), while the iCare was more accurate at the limbus with average MAE of 5.22 than the central cornea with average MAE of 10.83 (P<0.03). When measuring at the sclera, there was no statistically significant difference between average MAE for Tonopen (18.03) versus iCare (10.39) (P=0.24). DISCUSSION: Tonopen was more accurate than iCare when measuring at the central cornea, but consistently underestimated the control. MAE for both devices increased linearly with increasing true IOP. With limbus measurements in an edematous cornea, Tonopen and iCare performed similarly. The iCare performed better at the limbus than at the central cornea. Scleral measurements for both Tonopen and iCare were poor. In this experimental model, Tonopen performed superiorly to iCare with central cornea measurements in a grossly edematous cornea. Both devices underestimated true IOP.

Outflow Facility in Tube Shunt Fenestration.

AIM: Determination of the effect of varying fenestration technique, and simulated patch graft on outflow facility for Baerveldt tube. MATERIALS AND METHODS: Silicone tubing similar to Baerveldt implant (AMO, Santa Ana, CA) with different fenestrations techniques was connected to a digital manometer in a closed system with a fluid-filled syringe on a stand to adjust pressure. The venting slits included: (A) 4 piercings with 7-0 TG140-8 needle; (B) a 2-mm slit with a 15° blade; (C) 4 piercings with a 15° blade; (D) 9-0 Nylon on CS140-6 needle with suture stenting the fenestration. RESULTS: For pressures of 10, 20, 30, 40 mm Hg in groups A to D, the average outflow facility (mL/min/mm Hg) were group A: 0.11, 0.20, 0.28, 0.40; group B: 0.30, 0.69, 0.98, 0.93; group C: 0.73, 0.80, 0.81, 0.88; group D: 0.58, 0.65, 0.80, 0.87. For external compression with 10 gram weights at pressures of 10, 20, 30, 40 mm Hg, outflow were group A: 0.0, 0.18, 0.20, 0.53; group B: 0.75, 0.70, 0.97, 1.21. Group C: 0.18, 0.03, 0.57, 0.04. Group D: 0.73, 0.90, 1.13, 0.91. CONCLUSION: Effectivity of venting slits in maintaining adequate IOP in the early postoperative period for non-valved glaucoma implant is variable, multifactorial and largely intraocular pressure (IOP) dependent. CLINICAL SIGNIFICANCE: This study explores methods of producing fenestration and the effects on outflow at different pressures in an attempt to determine which fenestration technique has more reproducible results that can be made applicable in clinical practice. This is also the first study to evaluate the effect of external pressures similar to scleral patch graft on the tube fenestrations. HOW TO CITE THIS ARTICLE: Olayanju J, Borras T, Qaqish B, Fleischman D. Outflow Facility in Tube Shunt Fenestration. J Curr Glaucoma Pract 2018;12(3):113-118.

Trabeculectomy-related complications in Olmsted County, Minnesota, 1985 through 2010.

IMPORTANCE: Trabeculectomy is the surgical standard of care for patients with medically refractory glaucoma. The use of antimetabolite agents, such as mitomycin, has increased the rate of complications after trabeculectomy. OBJECTIVE: To determine the rate of trabeculectomy-related complications during a 25-year study. DESIGN, SETTING, AND PARTICIPANTS: For this retrospective, population-based study, we enrolled the residents of Olmsted County, Minnesota, who underwent a trabeculectomy from January 1, 1985, through December 31, 2010, at the Mayo Clinic and Olmsted Community Hospital. Data were collected from August 2012 to September 2013 followed by data analysis through January 2014. EXPOSURES: After reviewing the patient records, we determined the occurrence of complications, including bleb leak, hypotony, hyphema, choroidal effusion, choroidal hemorrhage, blebitis, and endophthalmitis, as they relate to the mitomycin concentration administered during the operation. We reviewed relevant publications in Ovid, MEDLINE, and PubMed to identify studies representative of the reported trabeculectomy complication rate. MAIN OUTCOMES AND MEASURES: Cumulative probabilities of short- and long-term complications, determined using the Kaplan-Meier method, and the relation to mitomycin concentration applied during trabeculectomy. RESULTS: In 334 patients, 460 eyes underwent trabeculectomy (mean [SD; range] follow-up, 7.7 [5.7; 0-27.7] years). Among them, 159 eyes had complications, with early complications (<3 months) in 100 eyes and late complications (≥3 months) in 59 eyes during the follow-up. Ten eyes had an early and a late complication. The 20-year cumulative chances of early, late, or any complication were 19.7% (95% CI, 16.2%-23.6%), 26.0% (95% CI, 15.0%-36.0%), and 45.0% (95% CI, 38.0%-52.0%), respectively. The cumulative probabilities of vision-threatening complications during 20 years were 2.0% (95% CI, 0%-4.0%) for blebitis and 5.0% (95% CI, 1.0%-9.0%) for endophthalmitis. Association between the rate of trabeculectomy complications and mitomycin dose used was P = .77. In total, 98 cases (21.3%) underwent further surgical procedures related directly to the complication. CONCLUSIONS AND RELEVANCE: The rate of trabeculectomy-related complications does not appear to be associated with mitomycin use during a mean follow-up of 7.7 years. The rate of vision-threatening complications appears to be comparable to those of previous studies of shorter duration.