High-speed Beveled Tip Versus Standard Tip Vitrectomy Probe: A Prospective Randomized Clinical Trial.

Purpose: To compare the efficiency of the advanced ultravit beveled vitrector probe (10,000 cuts per minute) to the current standard ultravit highspeed (7500 cuts per minute) vitrector probe. Methods: A prospective, randomized controlled trial was conducted on patients undergoing routine vitrectomy surgery for epiretinal membrane, full-thickness macular hole, and vitreous opacities. Patients were randomly assigned to undergo PPV with the ultravit highspeed probe (Probe 1) or the advanced ultravit beveled probe (Probe 2). The main outcome measure was time to completion of core vitrectomy and vitreous base shave. Results: Forty patients were enrolled in this study, 20 in each cohort. The average time to completion of core vitrectomy was 10.4 +/- 1.8 min in the Probe 1 cohort compared to 9.7 +/- 2 min in the Probe 2 cohort (P = 0.21). The average time to completion of vitreous base shave was 9.6 +/- 2.7 min in the Probe 1 cohort compared to 9.4 +/- 1.8 min in the Probe 2 cohort (P = 0.39). Conclusion: In the current study, the advanced ultravit beveled probe was noninferior to the ultravit highspeed vitrectomy probe when looking at the time to completion of core vitrectomy and vitreous base shave. The increased cut rate did not affect the efficiency of vitreous removal.

Ganglion Cell Layer Thickness Variance Using SPECTRALIS Optical Coherence Tomography.

BACKGROUND: To determine the normal variance of the mean macular ganglion cell layer (GCL) volume among subjects without significant ocular pathology using SPECTRALIS optical coherence tomography (OCT). METHODS: Fifty subjects underwent a baseline scan using SPECTRALIS OCT followed by 2 more studies with (reg-ON) and without (reg-OFF) eye registration all taken at the same session. The mean GCL volume was measured using built-in SPECTRALIS software. Eyes with macular pathology were excluded. The reproducibility of the measurements of the GCL volume was evaluated with Bland-Altman plots and limits of agreement, intraclass correlation coefficient (ICC), and the coefficient of repeatability (CR). RESULTS: A total of 98 eyes met criteria for the analysis. The mean GCL volume difference was 0.0002 ± 0.029 and -0.0005 ± 0.035 mm 3 for scans 1 versus 2 (baseline vs reg-ON) and 3 (baseline vs reg-OFF), respectively. The ICCs were 0.985 and 0.977 for the baseline vs reg-ON and reg-OFF groups. The CR for baseline vs reg-ON was 0.056 while CR for baseline vs reg-OFF was 0.069. Ninety percent of eyes fell within 0.04 mm 3 of test-retest reliability. CONCLUSIONS: Our model found a predictable threshold of 0.07 mm 3 or less for SPECTRALIS OCT mean GCL volume variance, which did not significantly change with eye registration in eyes without macular pathology. Clinicians may also consider a threshold of 0.04 mm 3 when determining stable vs progressive changes in mean GCL volume using this device.

Cancer-Associated Retinopathy due to Clear Cell Renal Carcinoma.

An 84-year-old female presented with bilateral scotomas and progressive nyctalopia over 1 year. Best-corrected visual acuity was 20/50 in both eyes with reduced color vision. Goldmann visual field showed bilateral cecocentral scotomas and generalized constriction of the visual fields. This led to an electroretinogram showing an electronegative pattern consistent with autoimmune retinopathies. Infectious workup was negative. Anti-retinal antibodies were positive, leading to a presumed diagnosis of cancer-associated retinopathy (CAR). Imaging showed a previously unknown left renal lower pole mass, and she underwent a radical nephrectomy. Biopsy showed nuclear grade-3 clear cell renal carcinoma staged T1. The patient was treated with oral prednisone with no ocular improvement. We report on a rare case of clear cell renal carcinoma causing CAR. CAR is an important paraneoplastic syndrome to diagnose since the majority of ocular cases precede other manifestations of malignancy. Therefore, a timely diagnosis of CAR can be lifesaving or at least life-extending.

Bilateral Ocular Ischemic Syndrome in the Setting of Chronic Angle Closure Glaucoma.

We report novel case of a 57-year-old woman who developed bilateral ocular ischemic syndrome in the setting of chronic angle closure glaucoma without associated angle neovascularization. Detailed is a course in which markedly prolonged, elevated intraocular pressure led to significantly reduced arterial perfusion at the level of the central retinal artery, leading to the clinical picture of ocular ischemic syndrome.

Inpatient Adherence to Topical Glaucoma Medications before and after an Educational Intervention.

PURPOSE: To assess the inpatient adherence rate and factors associated with adherence to topical glaucoma medications (TGMs) at a single academic institution throughout hospitalization before and after an educational intervention. DESIGN: Nonrandomized, comparative, retrospective study. PARTICIPANTS: Inpatients 18 years of age and older admitted to a single academic hospital from January 2014 through June 2019 with a diagnosis of glaucoma who also received TGMs. METHODS: The medication administration record during admission was examined closely to determine if the TGMs were reconciled and administered correctly before and after an educational intervention with inpatient providers. A simple intervention reached various health care providers through an educational e-mail, communication in a weekly newsletter, and a morning report presentation. Adherence was defined as administration of more than 75% of recommended doses during the inpatient stay. Other collected variables included length of stay and primary diagnosis on admission. MAIN OUTCOME MEASURES: Adherence rate to inpatient administration of TGMs. RESULTS: One hundred eighty-four patients (n = 142 before intervention; n = 42 after intervention) were included. The preintervention group had a total of 275 TGMs, of which 207 (75.3%) were administered in accordance with the adherence definition of this study. After the intervention phase, 49 of 56 (87.5%) TGMs were administered with appropriate adherence (P = 0.047). Adherence was associated significantly with a known outpatient medication regimen (P = 0.006) and correct admission reconciliation (P < 0.001). CONCLUSIONS: When glaucoma patients requiring topical treatment are admitted, approximately one quarter of patients seem to not receive their medications appropriately. In this study, a simple educational intervention was able to improve adherence. To prevent daily fluctuations in intraocular pressure for vulnerable glaucoma patients, inpatient adherence to appropriate medication administration should be stressed continuously. While in the care of health care providers, inpatients should be afforded at least the opportunity to maintain adequate adherence, just as is carried out for other medications related to other chronic medical conditions.

Bilateral Ocular Necrotizing Fasciitis in an Immunosuppressed Patient on Prescription Eye Drops.

Preseptal cellulitis is an infection of ocular tissue that is often unilateral and caused by extension of sinonasal disease. In rare instances it can lead to life-threatening necrotizing fasciitis. We present here a unique case of bilateral preseptal cellulitis incited by local conjunctivitis caused by prescription eye drops. The patient was immunosuppressed, which allowed her local inflammation to progress to severe infection and, ultimately, to necrotizing fasciitis. This necessitated serial debridement by ophthalmology and otolaryngology teams and a prolonged course of intravenous antibiotics monitored by an infectious disease team. Despite these interventions, the patient's vision did not return to baseline and she had persistent cosmetic and functional deformity. This case is unique due to the inciting incident of new prescription eye drops, the patient's immunosuppressed state leading to severity of infection, and the severe bilateral disease burden.

Quantifying membrane protein oligomerization with fluorescence cross-correlation spectroscopy.

Fluorescence cross-correlation spectroscopy (FCCS) is an advanced fluorescence technique that can quantify protein-protein interactions in vivo. Due to the dynamic, heterogeneous nature of the membrane, special considerations must be made to interpret FCCS data accurately. In this study, we describe a method to quantify the oligomerization of membrane proteins tagged with two commonly used fluorescent probes, mCherry (mCH) and enhanced green (eGFP) fluorescent proteins. A mathematical model is described that relates the relative cross-correlation value (fc) to the degree of oligomerization. This treatment accounts for mismatch in the confocal volumes, combinatoric effects of using two fluorescent probes, and the presence of non-fluorescent probes. Using this model, we calculate a ladder of fc values which can be used to determine the oligomer state of membrane proteins from live-cell experimental data. Additionally, a probabilistic mathematical simulation is described to resolve the affinity of different dimeric and oligomeric protein controls.

Childhood Vision Screening in Western South Dakota: Examining Barriers to Post-Vision Screening Follow-up Referral.

BACKGROUND: Poor follow-up after post-screening referral is a challenge faced by vision screening organizations. This study examines barriers to follow-up eye care in children who were referred for a comprehensive eye exam following a vision screening event in western South Dakota. METHODS: Children referred for a comprehensive eye exam following a screening event by Northern Plains Eye Foundation Western South Dakota Lions Children's Vision Screening Initiative (CVSI) from September 2014 to February 2015 were identified for a telephone survey. Parents/guardians of these children were contacted and asked a series of questions aimed at assessing the barriers to obtaining eye care. RESULTS: Of the 282 children identified, parents/guardians of 63 were successfully surveyed (22.3 percent), 38 had attended an appointment (60.3 percent), and 19 (30.2 percent) brought the CVSI referral form when they attended the appointment. When parents/guardians of the 25 children who had not attended an appointment were surveyed, 12 (19 percent) were not aware the screening results indicated a full eye exam was recommended, 10 (15.9 percent) identified barriers to scheduling an appointment, and three (4.8 percent) had an appointment scheduled in the future or forgot a scheduled appointment. CONCLUSION: The majority of surveyed parents/guardians reported their children having seen an eye care provider. Appropriate documentation has been limited due to reliance on parents/guardians to give referral forms to eye care providers and subsequent dependence on providers to forward completed referral forms to CVSI. Improved documentation is needed to assess the accuracy of the screening, support screening prevalence data, and evaluate the impact of CVSI.

Vaginal cuff dehiscence: a randomized trial comparing robotic vaginal cuff closure methods.

The purpose of this study is to compare the rate of vaginal cuff dehiscence between two different methods of closure in patients undergoing robotic-assisted total laparoscopic hysterectomy and explore variables related to postoperative breakdown. This was a prospective, randomized controlled study with two arms. The control group (Arm 1) underwent single-layer continuous closure while the study group (Arm 2) had three additional imbricating figure-of-X sutures placed in addition to the standard protocol. Of the 263 patients who completed the study, 4 patients (1.49 %) experienced dehiscence of the vaginal cuff. Three of the four patients with dehiscence received the standard single vaginal cuff closure (Arm 1) and the one remaining case of dehiscence underwent the protocol with additional sutures (Arm 2). All patients who experienced dehiscence were current smokers. Our study suggests that there may be benefit in adding additional sutures to the standard single-layer vaginal cuff closure procedure. Physicians should evaluate smoking status before deciding on a vaginal cuff closure method.