Etiology and Characteristics of Patients Presenting with Eyelid Lacerations at a Level 1 Trauma Center.

Purpose: To investigate the etiology and demographic associations of patients presenting with eyelid lacerations to a US level 1 trauma center emergency department (ED). Patient and Methods: A retrospective chart review of all patients with eyelid lacerations presenting to the ED at a single level 1 trauma center was performed. Eyelid lacerations were categorized as simple eyelid lacerations, eyelid lacerations with eyelid margin involvement, and eyelid lacerations with nasolacrimal system involvement. Data on demographics and clinical characteristics were analyzed. Results: A total of 303 eyelid laceration cases were identified, 56% were simple eyelid lacerations, followed by 24% with nasolacrimal involvement and 20% involving the eyelid margin. Sixty percent of animal bites/scratches resulted in a nasolacrimal system involving laceration, most commonly affecting children. Falls were the most common etiology in children and patients over the age of 60. Black patients, patients presenting with concomitant ophthalmic injuries, and those with Medicaid insurance were more likely to have an assault etiology (p < 0.05 for all). Conclusion: Falls were the most common etiology for eyelid lacerations in children and the elderly, while assault was the most common in adults. Identifying the most common etiology by demographic factors can help raise awareness regarding targeted prevention strategies for high-risk populations.

Cost and Prescriber and Patient Characteristics of Cenegermin Use in the Medicare Population.

PURPOSE: To assess the cost and prescriber and patient characteristics associated with the early use of cenegermin (OXERVATE) after its approval among Medicare beneficiaries to better define resource use and areas for improvement in the treatment of neurotrophic keratopathy. DESIGN: Retrospective, cross-sectional study. METHODS: Medicare Part D claims data of all cenegermin prescriptions from January 1, 2019, to December 31, 2020, were identified using its National Drug Code. Patients younger than 65 years and those with missing demographic characteristics were excluded. Information on patient and prescriber demographic characteristics, quantity of cenegermin prescription, gross drug costs, and patient out-of-pocket costs were extracted from each claim. RESULTS: In 2019-2020, a total of 2410 Medicare beneficiaries aged 65 years or older were prescribed cenegermin. The mean (standard deviation [SD]) age of these patients was 77.3 (7.6) years. Most patients were female (63.6%), White (87.3%), and lived in urban areas (86.9%). The majority (72%) received a standard 8-week course. A total of 1025 clinicians prescribed cenegermin. Most were male (68.2%), in an urban setting (90.8%). The median (interquartile range [IQR]) duration of cenegermin therapy prescribed per patient by each clinician was 8 (7.5-8) weeks. Total gross drug cost of all cenegermin therapy over the study period was $287 million. Median (IQR) out-of-pocket patient cost was $5791 (180-7179). CONCLUSIONS: Despite the clinical benefits of cenegermin therapy, the associated significant cost warrants further analysis of its cost-effectiveness in patient care, especially in comparison with alternative novel management options.

Incidence, Characteristics, and Cost of Eyelid Lacerations in the United States from 2006 to 2014.

INTRODUCTION: To report the incidence, demographics, and cost of eyelid lacerations (ELs) in the USA. METHODS: The Nationwide Emergency Department Sample is the largest publicly available emergency department database in the US. We conducted a retrospective longitudinal analysis to identify all emergency department (ED) visits in the sample from 2006 to 2014 with a primary or secondary diagnosis of EL. Descriptive statistics were calculated for hospital characteristics, patient demographics, and inflation-adjusted patient ED and in-patient (IP) charges. RESULTS: The incidence of primary and total ELs from 2006 to 2014 decreased by 50 per million and 7.1 per million, respectively. In the same period, the total ED and average ED charge, corrected for inflation, increased by almost $37 million and $1600 per person, respectively. Motor vehicle accidents (MVAs) were the mechanism of injury (MOI) associated with the highest average ED and IP costs at $5391 and $42,677, respectively. However, object- (42.2%) and fall-related (28.8%) were the most reported MOI overall. Peak months of EL presentations were seen in May and July, and > 90% of primary ELs were classified as periocular. Most ELs occurred in men and children, representing 69% and 44% of all primary EL cases, respectively. CONCLUSION: The incidence of ELs declined from 2006 to 2014. ELs occurred most frequently in children and young adults. The high proportion of object and fall-related injuries in this population highlights an area to develop strategies to reduce the frequency of preventable eye injuries.

Incidence and Characteristics of Orbital Hemorrhages in the United States from 2006 to 2018.

Purpose: To determine the incidence, characteristics, and costs associated with orbital hemorrhages presenting to US EDs. Patients and Methods: This was a retrospective, longitudinal study of the Nationwide Emergency Department Sample, 2006 to 2018. Medical records from patients presenting to participating hospital-owned EDs and diagnosed with primary or secondary orbital hemorrhage were examined to determine incidence, demographics, clinical characteristics, mechanism, disposition and related risk factors, and costs. Results: From 2006 to 2018, an estimated 20,762 US ED visits included an orbital hemorrhage diagnosis. Most primary diagnosis patients were elderly (35%) and male (51%), and incidence increased from 1.1 (95% CI: 0.8-1.4) to 3.1 per million (95% CI: 2.5-3.7, p < 0.0001). Fall was the most common mechanism (21.6%), particularly among the elderly (39.9%). Fall-related diagnoses increased from 0.03 (95% CI: -0.01-0.07) to 1.0 per million (95% CI: 0.7-1.3, p < 0.0001), while overall falls increased by only 7%. Assault-related orbital hemorrhage increased from 0.1 (95% CI: 0.0-0.2) to 0.6 per million (95% CI: 0.4-0.7, p < 0.0001), while overall assaults decreased by 22%. Annual total ED costs increased from $463,220 (95% CI: 233,993-692,446) to $6,117,320 (95% CI: 4,665,403-7,569,237, p < 0.001). Inpatient admission was uncommon (9.0%), but related costs totaled $18.9 million (95% CI: 13.3-24.5). Odds of admission were lower in fall- and objects-related injuries and higher with certain concurrent injuries. Conclusion: Orbital hemorrhages are becoming more frequent and costly. A disproportionately large increase in fall- and assault-related diagnoses highlights the need for targeted injury prevention strategies to reduce cost and morbidity.

Orbital inflammation in the setting of a nylon foil implant.

A 61-year-old man underwent left medial wall and floor fracture repair with a Suprafoil® implant. He had postoperative orbital congestion and lower eyelid swelling that persisted for over seven weeks. Examination demonstrated hyperglobus with supraduction, infraduction, and adduction deficits. Imaging revealed a 3.7 × 3.6 × 2.6 cm isodensity along the implant, thought to be hematoma. The patient elected to pursue exploration and possible drainage. Intraoperatively, there was no hematoma; rather, we found a fibroinflammatory rind along the periorbita surrounding the implant. This was biopsied, and the implant was removed, as the fractures had sufficiently healed. Pathology showed dense fibroconnective tissue with associated inflammation. The patient completed a steroid taper with improvement in all symptoms and resolution of diplopia. To our knowledge, this is the first reported case of such a prominent orbital inflammatory reaction to nylon foil, a departure from the delayed hematic cysts typically associated with these implants.

Freeze-thaw decellularization of the trabecular meshwork in an ex vivo eye perfusion model.

OBJECTIVE: The trabecular meshwork (TM) is the primary substrate of outflow resistance in glaucomatous eyes. Repopulating diseased TM with fresh, functional TM cells might be a viable therapeutic approach. Decellularized TM scaffolds have previously been produced by ablating cells with suicide gene therapy or saponin, which risks incomplete cell removal or dissolution of the extracellular matrix, respectively. We hypothesized that improved trabecular meshwork cell ablation would result from freeze-thaw cycles compared to chemical treatment. MATERIALS AND METHODS: We obtained 24 porcine eyes from a local abattoir, dissected and mounted them in an anterior segment perfusion within two hours of sacrifice. Intraocular pressure (IOP) was recorded continuously by a pressure transducer system. After 72 h of IOP stabilization, eight eyes were assigned to freeze-thaw (F) ablation (-80 °C × 2), to 0.02% saponin (S) treatment, or the control group (C), respectively. The TM was transduced with an eGFP expressing feline immunodeficiency viral (FIV) vector and tracked via fluorescent microscopy to confirm ablation. Following treatment, the eyes were perfused with standard tissue culture media for 180 h. TM histology was assessed by hematoxylin and eosin staining. TM viability was evaluated by a calcein AM/propidium iodide (PI) assay. The TM extracellular matrix was stained with Picro Sirius Red. We measured IOP and modeled it with a linear mixed effects model using a B-spline function of time with five degrees of freedom. RESULTS: F and S experienced a similar IOP reduction of 30% from baseline (P = 0.64). IOP reduction of about 30% occurred in F within 24 h and in S within 48 h. Live visualization of eGFP demonstrated that F conferred a complete ablation of all TM cells and only a partial ablation in S. Histological analysis and Picro Sirius staining confirmed that no TM cells survived in F while the extracellular matrix remained. The viability assay showed very low PI and no calcein staining in F in contrast to many PI-labeled, dead TM cells and calcein-labeled viable TM cells in S. CONCLUSION: We developed a rapid TM ablation method that uses cyclic freezing that is free of biological or chemical agents and able to produce a decellularized TM scaffold with preserved TM extracellular matrix in an organotypic perfusion culture.

A Porcine Anterior Segment Perfusion and Transduction Model With Direct Visualization of the Trabecular Meshwork.

PURPOSE: To establish a consistent and affordable, high quality porcine anterior segment perfusion and transduction model that allows direct visualization of the trabecular meshwork. METHODS: Porcine anterior segments were cultured within 2 hours of death by removing lens and uvea and securing in a specially designed petri dish with a thin bottom to allow direct visualization of the trabecular meshwork with minimal distortion. Twenty-two control eyes (CO) with a constant flow rate were compared to eight gravity perfused eyes (COgr, 15 mm Hg). We established gene delivery to the TM using eGFP expressing feline immunodeficiency virus (FIV) vector GINSIN at 108 transducing units (TU) per eye (GINSIN_8, n = 8) and 107 TU (GINSIN_7, n = 8). Expression was assessed for 14 days before histology was obtained. RESULTS: Pig eyes were a reliable source for consistent and high quality anterior segment cultures with a low failure rate of 12%. Control eyes had an intraocular pressure (IOP) of 15.8 ± 1.9 mm Hg at fixed pump perfusion with 3 µL/min compared to gravity perfused COgr with imputed 3.7 ± 1.6 µL/min. Vector GINSIN_8 eyes experienced a transient posttransduction IOP increase of 44% that resolved at 48 hours; this was not observed in GINSIN_7 eyes. Expression was higher in GINSIN_8 than in GINSIN_7 eyes. Trabecular meshwork architecture was well preserved. CONCLUSIONS: Compared with previously used human donor eyes, this inexpensive porcine anterior segment perfusion model is of sufficient, repeatable high quality to develop strategies of TM bioengineering. Trabecular meshwork could be observed directly. Despite significant anatomic differences, effects of transduction replicate the main aspects of previously explored human, feline and rodent models.

Poly (glycerol sebacate) elastomer supports osteogenic phenotype for bone engineering applications.

For bone engineering, the optimal scaffolding material and composition has yet to be elucidated. In this study, we investigated poly (glycerol sebacate) (PGS), an elastomer known primarily for its soft tissue regeneration ability, as a suitable substrate to support osteo-precursor cell attachment and function. We synthesized PGS in the form of sheets where MC3T3-E1 cells were seeded in three different densities of 25,000, 50,000 and 100,000 cells mm(-3) and we investigated the cells/scaffold constructs for their cellular proliferation, matrix deposition, maturation, mineralization and their mechanical compression strength at 24 h and two and four weeks. MC3T3-E1 cells proliferated, synthesized a collagenous matrix and expressed osteogenic markers Runx2, bone sialoprotein and osteocalcin according to their initial seeding density on PGS. We conclude that PGS can support the osteoblastic phenotype in vitro and is a promising osteoconductive substrate for bone regeneration research and for future clinical translation.

Poly(glycerol sebacate) elastomer: a novel material for mechanically loaded bone regeneration.

The selection criteria for potential bone engineering scaffolds are based chiefly on their relative mechanical comparability to mature bone. In this study, we challenge this notion by obtaining full regeneration of a rabbit ulna critical size defect by employing the elastomeric polymer, poly(glycerol sebacate) (PGS). We tested the regeneration facilitated by PGS alone, PGS in combination with hydroxyapatite particles, or PGS seeded with bone marrow stromal cells. We investigated the quantity and quality of the regenerated bone histologically, by microcomputed tomography and by four-point bending flexural mechanical testing at 8 weeks postimplantation. We conclude that the relatively lower stiffness of this biocompatible elastomer allows a load-transducing milieu in which osteogenesis, matrix deposition, and eventual bone maturation can take place. This study's results suggest that PGS elastomer is an auspicious osteoconductive material for the regeneration of bony defects. These results call for an innovative reassessment of the current art of selection for novel bone scaffold materials.