Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls.

Ocular trauma may either be closed globe or open globe. Open globe injuries are full-thickness defects of the eyewall and are often differentiated by the mechanisms of injury from which they are caused: sharp or blunt trauma. They are ocular emergencies and can lead to substantial visual morbidity. Without timely intervention, damage is irreversible and leads to permanent vision loss. The goals of evaluation are to identify the mechanism of injury, characterize the extent of injury, and gather relevant history. If an open globe is suspected, ophthalmologic consultation should be requested. Once an open globe is diagnosed, preparations for surgery should be made immediately and steps should be taken to avoid further injury. Intraocular infection risk is relatively high, requiring immediate empiric systemic antibiotics. Emergent surgical exploration and primary closure is indicated whenever possible. After initial closure, secondary surgery and revision may be needed to improve vision outcomes, followed by extensive follow-up. In this review, best practices for evaluation and management are reviewed, with particular focus on the surgical approach and techniques.

Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course.

Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery. Setting James A. Haley Veterans' Hospital, Tampa, FL. Design Retrospective cohort study. Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010-2011) were compared with cases done by residents who completed the course (2011-2017). Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after). Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6-9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.

Intraluminal Stent Optimization for the Baerveldt Glaucoma Implant: An Experimental Study.

PRECIS: Our laboratory study determined the approximate suture diameter for use in intraluminal stenting of the Baerveldt glaucoma implant (BGI) to prevent postoperative hypotony. Commercial 3-0 monofilament nylon sutures which are commonly used may vary significantly outside of this diameter. PURPOSE: Postoperative hypotony is a complication of surgical treatment of glaucoma using the BGI. One method utilized to prevent early postoperative hypotony is intraluminal stenting of the implant with monofilament sutures. The present study attempted to determine optimal stent diameter in microns for 3-0 monofilament sutures to reduce outflow and thereby reduce the risk of postoperative hypotony using the BGI. MATERIALS AND METHODS: A laboratory bench model of the anterior chamber was utilized to measure the outflow rate of balanced salt solution through the BGI at pressures of 20 and 40 mm Hg while utilizing commercially available 3-0 monofilament nylon stents of various diameters. The BGI tube has an inner diameter of 300 µm. In addition, 3-0 nylon sutures were studied for variability by measuring the diameters at 10 equally spaced points along the length of each sample using a digital micrometer. RESULTS: Average experimental flow rates decreased with increasing intraluminal stent diameter and increased with increasing pressure. An intraluminal stent diameter of 250 µm yielded a flow rate of 40 µL/min at a nominal pressure of 20 mm Hg. Diameters of the tested 3-0 monofilament nylon sutures were all within the United States Pharmacopeia diameter range of 200 to 250 µm, but diameters varied significantly depending on the manufacturer. CONCLUSIONS: In our laboratory model, the optimal stent diameter to reduce aqueous flow to a level approaching the normal aqueous production is at least 250 µm. Secondarily, commercially available 3-0 monofilament nylon suture materials showed variable diameters within the United States Pharmacopeia diameter range.