Analysis of resident-performed manual small incision cataract surgery (MSICS): an efficacious approach to mature cataracts.

To examine and improve outcomes of resident-performed manual small incision cataract surgery (MSICS) cases via analysis of visual recovery, intraoperative adverse events, and early postoperative course. Particular focus was directed toward mature cataracts extracted by MSICS. A retrospective review was performed to identify MSICS cases performed by resident surgeons unfamiliar with the technique (initial ten cases) in an academic setting. Preoperative history, intraoperative adverse events, and postoperative course were reviewed. Of 30 cases identified, mean preoperative acuity was 1.8 ± 0.9 logMAR units (Snellen equivalent = 20/1262) improving to 0.20 ± 0.35 logMAR units (20/31) at final follow-up (p < 0.0001). Mean follow-up was 22.1 ± 19.0 days. The most frequent intraoperative adverse events were wound leak requiring intraoperative suturing (33 %), vitreous loss (6.7 %), and capsulorhexis radialization (6.7 %). Transient cornea edema was the most frequent (56.7 %) early postoperative minor complication. Two major complications occurred that required wound revision in one eye and iridoplasty in one eye. Of the 30 eyes undergoing surgery, 19 were noted to have mature cataracts. In this subset, mean acuity was 2.25 ± 0.64 logMAR units (20/3557) improving to 0.28 ± 0.42 logMAR (20/38) at final follow-up (p < 0.0001). Complications were similar in nature and frequency to the entire population in this subgroup. Supervised resident MSICS cataract surgery can result in excellent anatomic and visual outcomes. Appropriate wound construction is a frequently encountered difficulty, so particular attention should be directed to this step by both trainers and trainees.

Increased Rates of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) Graft Failure and Dislocation in Glaucomatous Eyes with Aqueous Shunts.

PURPOSE: To investigate the rates of Descemet's stripping automated endothelial keratoplasty (DSAEK) graft dislocation and failure in glaucomatous eyes, including eyes with history of trabeculectomy and/or aqueous shunts. METHODS: A retrospective, case-control study on a total of 424 consecutive eyes undergoing DSAEK at an academic setting compared 96 glaucomatous eyes to a control group of 328 eyes. Pre- and post DSAEK procedure data was aggregated for up to 2 years (mean follow-up, 6.5±6.9 months) including rates of graft dislocation and failure. RESULTS: Out of 96 glaucomatous eyes, 20 had undergone trabeculectomy, 27 had received one or more aqueous shunts, 12 had undergone both procedures and 37 were on medical therapy. Complete DSAEK graft dislocation and failure occurred in 2.7% and 3% of non-glaucomatous patients, respectively. Eyes with history of aqueous shunt surgery experienced graft dislocation and failure rates of 26.0% (OR=4.6, 95% CI 1.5-13.7, p=0.0067) and 26.0% (OR=10.3, 95% CI 3.8-27.1, p<0.0001), respectively. In contrast, glaucomatous eyes only on medical therapy (p=0.13) or with history of trabeculectomy (p>0.40) had no significant increase in graft dislocation or failure rates. CONCLUSION: Eyes with medically controlled glaucoma or prior trabeculectomy demonstrated comparable rates of graft dislocation and failure as compared to controls. Aqueous shunt surgery was associated with increased rates of graft dislocation and failure after DSAEK.

Spatial correlation between hyperpigmentary changes on color fundus photography and hyperreflective foci on SDOCT in intermediate AMD.

PURPOSE: Macular hyperpigmentation is associated with progression from intermediate to advanced age-related macular degeneration (AMD). The purpose of this study was to accurately correlate hyperpigmentary changes with spectral domain optical coherence tomography (SDOCT) hyperreflective foci in eyes with non-advanced AMD. METHODS: A prospective cross-sectional analysis of 314 eyes (314 subjects) with intermediate AMD was performed in the multicenter Age-Related Eye Disease Study 2 (AREDS2) Ancillary SDOCT Study to correlate hyperpigmentary changes on color fundus photographs (CFP) with abnormal morphology on SDOCT. Spatial coregistration was performed with an automated algorithm in two nonoverlapping subsets of 20 study eyes, which permitted double-masked CFP and SDOCT grading by certified investigators. RESULTS: Macular CFP hyperpigmentation was significantly associated with SDOCT intraretinal hyperreflective foci in the 314 study eyes (P < 0.001). In a substudy of 40 eyes, automated intermodality spatial coregistration was successfully achieved in all 136 (100%) retinal regions selected for CFP and SDOCT grading. In one subset of 20 study eyes, 28 of 39 (71.8%) retinal CFP regions with hyperpigmentation were correlated with focal hyperreflectivity on SDOCT, versus seven of 39 (17.9%) control regions (P < 0.001). In another subset of 20 eyes, 21 of 29 (72.4%) SDOCT regions with hyperreflective foci were correlated with hyperpigmentary changes on CFP, versus two of 29 (6.9%) control regions (P < 0.001). CONCLUSIONS: A novel algorithm achieves automated intermodality spatial coregistration for masked grading of regions selected on CFP and SDOCT. In intermediate AMD, macular hyperpigmentation has high spatial correlation to SDOCT hyperreflective foci and often represents the same anatomical lesion. (ClinicalTrials.gov number, NCT00734487.).