Reading Speed as an Objective Measure of Improvement Following Vitrectomy for Symptomatic Vitreous Opacities.

BACKGROUND AND OBJECTIVE: There is currently no objective measure of the visual deficits experienced by patients with symptomatic vitreous opacities (SVOs) that would also correlate with the functional improvement they report following vitrectomy. This study aims to determine whether reading speed can be used as a reliable outcome measure to assess objectively the impact of both SVOs and vitrectomy on patients' visual performance. PATIENTS AND METHODS: Twenty adult patients seeking surgery for SVO were included. Measures of visual function were obtained before and after vitrectomy using the Early Treatment Diabetic Retinopathy Study acuity chart, the National Eye Institute Visual Function Questionnaire, and the MNREAD acuity chart. RESULTS: In patients with nonopacified lenses (n = 10), maximum reading speed increased significantly from 138 to 159 words per minute after complete removal of SVOs by vitrectomy (95% confidence interval, 14-29; P < .001). CONCLUSIONS: Reading speed is impaired with SVOs and improves following vitrectomy in phakic and pseudophakic eyes with clear lenses. Reading speed is a valid objective measure to assess the positive effect of vitrectomy for SVOs on near-distance daily life activities. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:456-466.].

Infusion Misdirection in Microincisional Vitrectomy Surgery.

PURPOSE: To review the incidence and possible mechanisms of 2 problems caused by infusion misdirection during microincisional vitrectomy in 1 physician's practice and to find an estimate of the broader occurrence among other physicians. DESIGN: Observational series of 1 surgeon's cases over 2 periods. A survey also was sent to other retinal specialists. PARTICIPANTS: Patients undergoing microincisional vitrectomy. METHODS: The physician tracked the occurrence of intraoperative hypotony and unintentional anterior chamber air infusion in his practice. A survey was sent to 2000 members of the American Society of Retina Specialists and the Retina Society. MAIN OUTCOME MEASURES: Primary outcome measure was the incidence of hypotony during microincisional vitrectomy, defined as softening of the globe to the point of corneal or scleral infolding, or both, that resolved with repositioning of the infusion cannula. The secondary outcome measure was incidence of unplanned air flow into the anterior chamber. Survey questions included frequency of observed infusion interruption and incidence of inadvertent anterior chamber air infusion. RESULTS: In the earlier series, of 232 vitrectomies, 37 (16%) showed signs of episodic hypotony after infusion blockage. Seven cases (3%) showed inadvertent air flow into the anterior chamber. One hundred fifty-two physicians responded to the survey. Fifty-seven percent reported infusion blockage and hypotony in 1% to 5% of cases. Fifty-nine percent reported air flow into the anterior chamber in some cases. In the later series, 12 instances of infusion blockage were noted in 118 cases. Awareness of the issue and additional attention to the infusion line taping did not prevent the problem from occurring. In the survey, most respondents reported observing both infusion interruption and inadvertent anterior chamber air infusion on occasion. CONCLUSIONS: Infusion misdirection resulting in hypotony or air flow into the anterior chamber seems to be infrequent, but it remains a risk. Awareness of the problem reduces the incidence, but does not eliminate it. The potential inadvertently to touch the retina, choroid, or lens increases when these events occur. Infusion misdirection can be avoided by maintaining the correct position of the cannula, which may be facilitated by an external support to the tubing.

Central serous chorioretinopathy treatment with spironolactone: a challenge-rechallenge case.

PURPOSE: To present a case of central serous chorioretinopathy (CSC) treatment with spironolactone in a challenge-rechallenge pattern. METHODS: At presentation, fundus photography, fluorescein angiography, spectral domain optical coherence tomography, and enhanced depth imaging ocular coherence tomography were performed in both eyes. The patient was prescribed 25 mg spironolactone daily along with serum potassium monitoring. At follow-ups, spectral domain optical coherence tomography and enhanced depth imaging ocular coherence tomography were performed. RESULTS: A 37-year-old white male accountant presenting with CSC. Spironolactone treatment resolved the CSC. After the patient discontinued treatment, it returned. After returning to daily treatment, the CSC again resolved. CONCLUSION: Spironolactone was an effective treatment of CSC in this case. Other groups have reported similar findings with eplerenone, a similar drug.

Increased cancer risks in myotonic dystrophy.

OBJECTIVE: To estimate cancer risks for patients with myotonic dystrophy, given that increased risks for neoplasms in association with myotonic dystrophy type 1 and type 2 have been suggested in several studies but the risks of cancers have not been quantified. PATIENTS AND METHODS: A cohort of 307 patients with myotonic dystrophy identified from medical records of Mayo Clinic in Rochester, MN, from January 1, l993, through May 28, 2010, was retrospectively analyzed. We estimated standardized incidence ratios (SIRs) of specific cancers for patients with myotonic dystrophy compared with age- and sex-specific cancer incidences of the general population. Age-dependent cumulative risks were calculated using the Kaplan-Meier method. RESULTS: A total of 53 cancers were observed at a median age at diagnosis of 55 years. Patients with myotonic dystrophy had an increased risk of thyroid cancer (SIR, 5.54; 95% confidence interval [CI], 1.80-12.93; P=.001) and choroidal melanoma (SIR, 27.54; 95% CI, 3.34-99.49; P<.001). They may also have an increased risk of testicular cancer (SIR, 5.09; 95% CI, 0.62-18.38; P=.06) and prostate cancer (SIR, 2.21; 95% CI, 0.95-4.35; P=.05). The estimated cumulative risks at age 50 years were 1.72% (95% CI, 0.64%-4.55%) for thyroid cancer and 1.00% (95% CI, 0.25%-3.92%) for choroidal melanoma. There was no statistical evidence of an increased risk of brain, breast, colorectal, lung, renal, bladder, endometrial, or ovarian cancer; lymphoma; leukemia; or multiple myeloma. CONCLUSION: Patients with myotonic dystrophy may have an increased risk of thyroid cancer and choroidal melanoma and, possibly, testicular and prostate cancers.