Enucleations, Eviscerations, and Exenterations at a Supratertiary-care Hospital in Puerto Rico: A Retrospective Study.

OBJECTIVE: To provide a descriptive analysis of the indications and the intraoperative and postoperative complications of eye enucleations and eviscerations, and orbital exenterations performed at the only academic institution in Puerto Rico providing supratertiary care. METHODS: A retrospective medical record review of patients who underwent enucleations, eviscerations, and exenterations from January 2015 through June 2020 was conducted. The data were analyzed to generate a descriptive profile of the demographic characteristics of the patients, their clinical indications and surgical complications, and a histopathological diagnosis per type of eye-removal procedure. RESULTS: A total of 118 eyes were removed via enucleation, evisceration, or exenteration over the 66-month study period. The average patient age was 64 (±17.5) years and 63.8% of the patients were male. The most frequently performed eye-removal procedure was enucleation (73.7%), followed by evisceration (18.6%) and exenteration (7.6%). The main clinical indications for enucleations and eviscerations were infectious processes, namely panophthalmitis, endophthalmitis, and/or perforated corneal ulcers, that failed medical management. In our sample, squamous cell carcinoma was the most common diagnosis (both clinically and histopathologically) leading to exenteration. Postoperative complications in our patient cohort were minimal. CONCLUSION: At our institution, enucleations predominate over eviscerations. Retrospective reviews published in recent years indicate that the rate of eviscerations at our institution is comparatively low. The results of this study, the first of its kind at our institution, may encourage a re-evaluation of the indications for evisceration versus enucleation in our patient population.

Characteristics Upon Presentation of Patients with Type 2 Macular Telangiectasia in Puerto Rico.

OBJECTIVE: To describe the systemic disease associations and clinical features upon initial presentation of a cohort of patients with type 2 macular telangiectasia who live in Puerto Rico. METHODS: A retrospective review of patients with macular telangiectasia was performed in 4 private retina practices in Puerto Rico. The demographic and clinical characteristics were recorded. RESULTS: Twenty-one patients who were diagnosed with macular telangiectasia were included in the analysis. The median age of presentation was 62 years; 86% were female, and all patients were Hispanics. The median visual acuity at presentation was 20/50. A prior medical diagnosis of type II diabetes mellitus was found in 15 (71.4%) patients, essential hypertension in 12 (57.1%), and dyslipidemia in 9 (42.9%). All patients had bilateral disease. The most common ocular findings were the presence of right-angle vessels in 32 (76.2%) eyes and angiographic hyperfluorescence temporal to the fovea, found in 22 (52.4%) of the affected eyes. One eye had evidence of choroidal neovascularization. CONCLUSION: Our cohort showed a higher prevalence of type 2 diabetes in patients with type 2 macular telangiectasia than in other cohorts. It also supports the findings of other studies showing that macular telangiectasia patients are more likely to have type 2 diabetes and hyperlipidemia. However, the increased prevalence of diabetes and hyperlipidemia may be due to selection bias, and further studies are needed to assess the significance of these findings.

Characteristics, Upon Presentation, of a Cohort of Patients with Vogt-Koyanagi-Harada Disease in Puerto Rico.

OBJECTIVE: To describe the clinical features, upon initial presentation, of a cohort of patients with Vogt-Koyanagi-Harada (VKH) disease who live in Puerto Rico. METHODS: A retrospective medical record review of patients with VKH was performed. The demographic and clinical characteristics were analyzed. RESULTS: Twenty-two patients who met the diagnostic criteria for VKH were identified and included in the analysis. The median age at presentation was 41 years; 68.2% were female, and all patients were Hispanics. Bilateral disease was present in 90.9% of patients, and 59.1% of patients were categorized as having probable VKH. A headache was reported in 54.5% of patients and was the most common complaint at the time of presentation; the second most common complaint was tinnitus, which was present in 22.7% of patients. Vitiligo, alopecia, and meningismus were each preset in 9.1% of patients while hearing loss and aseptic meningitis were each reported in 4.5% of patients. Seventy-seven percent of patients had either topical or systemic corticosteroid use prior to the initial encounter. CONCLUSION: Our study suggests that in Puerto Rico, patients with Vogt-Koyanagi-Harada disease may have a distinctive prevalence of characteristics at the presentation when compared to other ethnic groups, including other Hispanic cohorts.

Acute idiopathic blind spot enlargement syndrome following influenza vaccination.

PURPOSE: To report a case of acute idiopathic blind spot enlargement syndrome (AIBSES) following influenza vaccination. OBSERVATIONS: A 57-year old woman presented with a one-month history of photopsia, temporal visual field disturbance on the right eye, 11 days following the administration of the influenza virus vaccine. Visual acuity was 20/30, and color vision remained normal. Examination revealed mild venular dilation at the edge of the right optic disk and was otherwise unremarkable. Visual field testing revealed enlargement of the right physiological blind spot. Medical workup, including brain CT scan, brain MRI, RPR, Treponema pallidum antibodies, Chest X-Ray, ANA, and PPD testing, was found within normal limits. Ancillary testing was compatible with an assessment of AIBSES secondary to influenza virus vaccination. CONCLUSIONS AND IMPORTANCE: Although direct causation may not be absolutely established by a single report, our case suggests that the influenza virus vaccine may serve as an immunological trigger for some cases of AIBSES. Thoughtful vaccination history is of the utmost importance when evaluating patients with AIBSES, as it may help elucidate the underlying precipitating factor. To our knowledge, this is the first reported case of AIBSES following influenza virus vaccination.

Calcium upregulated survivin expression and associated osteogenesis of normal human osteoblasts.

Survivin is an antiapoptotic protein expressed in all phases of the normal cell cycle but is at its highest level during the G2/M interphase. This protein has been recently identified in normal human osteoblasts and has raised questions about the regulation of its expression. This study intends to verify if survivin expression could be manipulated by external factors such as calcium ions. Normal human alveolar bone explants recovered from six healthy donors were cultured to 2nd passage. Cells were cultured with essential medium as a control and with medium containing supplemental calcium ions at a concentration of 30 parts per million as a study group. Vitamin D(3) was added to all culture groups at the 5th and 18th days to promote differentiation. Differentiation markers were confirmed by performing mineralization, alkaline phosphatase (ALP), and osteocalcin assays at 7 and 21 days. Cell attachment was measured at 16 h and used as a reference for cell proliferation at 7 days and 21 days. Survivin levels were measured at 16 h, 7 and 21 days. Compared with the control group, the study group presented a significant increase of survivin expression at 16 h (p < 0.01), at 7 days (p < 0.01), and at 21 days (p < 0.05), a significant increase of cell proliferation, ALP activity and mineralization at 7 days (p < 0.05) and 21 days (p < 0.05), and a significant increase in osteocalcin expression only at 21 days (p < 0.01). This study demonstrated that survivin expression could be significantly upregulated by calcium-enhanced normal human osteoblast cultures, which might correlate to subsequent upregulation of cell proliferation and differentiation.