The Success Rate of Glaucoma Drainage Device Revision.

PRCIS: We report the survival of surgical revision to glaucoma drainage devices for several indications in a large cohort of patients, with an overall success rate of 45% at 36 months. PURPOSE: To evaluate the outcomes of surgical revision for complications of glaucoma drainage devices. METHODS: Three hundred thirty-five eyes of 318 patients who underwent tube revision or removal at University of California Los Angeles (UCLA) Jules Stein Eye Institute between 1997 and 2019 were included. The pre-defined primary outcome measure was surgical success of the initial revision, defined as resolution of the condition with no additional revisions required, no functionally significant change in vision, and no instances of intraocular pressure > 21 mmHg at 2 consecutive visits postoperatively. Kaplan-Meier survival analysis was applied to evaluate survival at 36 months based on these criteria. The Wilcoxon paired test was used to compare mean preoperative and postoperative intraocular pressure, medication usage, and visual acuity. RESULTS: Overall, survival of revised tubes at 36 months was 45%. The 4 most common indications for revision were exposure of the implant (42% of all revisions), occlusion (14%), corneal failure or threat of failure (12%), and hypotony (11%). Survival at 36 months for each of these indications was 44%, 45%, 52%, and 37%, respectively. CONCLUSIONS: These results suggest that eyes with glaucomatous damage with long-term glaucoma drainage device complications can still have a reasonably successful outcome when a revision is performed. However, with substantial rates of vision loss and a frequent need for additional revisions to manage complications, managing patient expectations for success and making them aware of the likelihood of additional surgeries or failure is important.

The Phenylephrine Test Revisited.

PURPOSE: To characterize the phenylephrine test in ptotic patients to help clinicians perform the test more efficiently. METHODS: Adults with involutional ptosis (n = 24, 30 eyes) were assessed with digital photographs for response to topical 2.5% phenylephrine drop instillation. Patient characteristics (age, gender, iris color, dermatochalasis, brow ptosis, and baseline marginal reflex distance-1 [MRD-1] height) were recorded. From the photographs, change in (MRD-1), presence of conjunctival blanching, pupillary dilation, and Hering effect were recorded at specified time intervals, 1 minute to 1 hour after drop placement. Correlations between patient characteristics and measured outcomes were evaluated using analysis of variance, Pearson coefficient, or chi-square tests. RESULTS: The authors found that 73% of eyes had eyelid elevation with phenylephrine. Of these, 50% reached maximal eyelid elevation by 5 minutes, and 86% by 10 minutes after drop placement, but 14% did not reach maximal MRD-1 until 30 minutes. There is a negative correlation between the maximum MRD-1 and the baseline MRD-1 eyelid height (r = -0.5330, p < 0.01). There is no significant relationship between time to pupillary dilation with either time to max eyelid elevation or max eyelid elevation. No patient characteristic studied affected the likelihood of eyelid response to phenylephrine or presence of Hering effect. CONCLUSIONS: Although most ptotic eyelids demonstrate a response to 2.5% phenylephrine within 10 minutes, there is a subset of patients that respond much later. More ptotic eyelids had greater eyelid elevation with phenylephrine. Pupillary dilation and conjunctival blanching are neither predictive of nor temporally associated with eyelid height elevation. The authors did not identify any patient factors (e.g., dermatochalasis, brow ptosis) that can predict the likelihood of response to phenylephrine.

Diabetic Retinopathy: Focus on Minority Populations.

Diabetic retinopathy is a major cause of blindness in the United States. With rise of the epidemic of obesity and diabetes in the USA and around the globe, serious and common diabetic complications are evolving as a major public health problem, particularly among minority populations. These populations are disproportionately affected by diabetes and 2-3 times more likely to develop visually significant complications. In this highly illustrated review article, we discuss the diabetic epidemic, highlighting the biology and the pathophysiologic mechanisms of this disorder on the anatomy of the eye. We also discuss the risk factors and the implications for minority populations. For the health care providers, we provide cutting edge information and imminently relevant information to help evaluate, manage, and know when to refer their patients to a specialist in ophthalmology to quell the tide of the epidemic.

Hydrogen sulfide-releasing aspirin suppresses NF-κB signaling in estrogen receptor negative breast cancer cells in vitro and in vivo.

Hormone-dependent estrogen receptor positive (ER+) breast cancers generally respond well to anti-estrogen therapy. Unfortunately, hormone-independent estrogen receptor negative (ER-) breast cancers are aggressive, respond poorly to current treatments and have a poor prognosis. New approaches and targets are needed for the prevention and treatment of ER- breast cancer. The NF-κB signaling pathway is strongly implicated in ER- tumor genesis, constituting a possible target for treatment. Hydrogen sulfide-releasing aspirin (HS-ASA), a novel and safer derivative of aspirin, has shown promise as an anti-cancer agent. We examined the growth inhibitory effect of HS-ASA via alterations in cell proliferation, cell cycle phase transitions, and apoptosis, using MDA-MB-231 cells as a model of triple negative breast cancer. Tumor xenografts in mice, representing human ER- breast cancer, were evaluated for reduction in tumor size, followed by immunohistochemical analysis for proliferation, apoptosis and expression of NF-κB. HS-ASA suppressed the growth of MDA-MB-231 cells by induction of G(0)/G(1) arrest and apoptosis, down-regulation of NF-κB, reduction of thioredoxin reductase activity, and increased levels reactive oxygen species. Tumor xenografts in mice, were significantly reduced in volume and mass by HS-ASA treatment. The decrease in tumor mass was associated with inhibition of cell proliferation, induction of apoptosis and decrease in NF-κB levels in vivo. HS-ASA has anti-cancer potential against ER- breast cancer and merits further study.