Incidence of ocular surface squamous neoplasia in pterygium specimens.

OBJECTIVE: Pterygium and ocular surface squamous neoplasia (OSSN) have been recognized as likely related conditions and share similar risk factors such as ultraviolet radiation and chronic inflammation. The purpose of this study is to review the incidence of OSSN in pathology specimens sent as pterygium at a single tertiary centre between 2010 and 2022. METHODS: This is a retrospective chart review of patients operated on for pterygium between 2010 and 2022 at the University of Montreal Health Centre. Data collected include baseline demographics, results of pathology specimen, and clinical information for cases diagnosed as OSSN on pathology. RESULTS: A total of 1559 patients were operated on for a clinical diagnosis of pterygium between 2010 and 2022, of which 854 patients (55%) were male. A total of 1142 specimens had available pathology reports, and most of the specimens were consistent with pterygium on pathology (1105 of 1142; 97%). There was an unexpected finding of 3 cases of OSSN (3 of 1142; 0.3%). Other diagnosis besides pterygium were seen in 3% of specimens (34 of 1142), including nevus (n = 12), spheroidal degeneration (n = 3), pyogenic granuloma (n = 3), and lymphangiectasia (n = 2). The 3 cases of OSSN included an 81-year-old male of French-Canadian background, a 52-year-old male of South Asian background, and a 59-year-old female of French-Canadian background. The pathology was diagnosed as conjunctival intraepithelial neoplasia (CIN) grade 3, CIN grade 2, and CIN grade 2, respectively. CONCLUSION: The finding of OSSN in pterygium is rare in our population but can be clinically difficult to distinguish. It is important to send all pterygium specimens for pathology.

Fatal Oedipism: A Case Report and Literature Review.

PURPOSE: To describe a unique case of a fatal self-enucleation and review previously published cases. METHODS: The authors describe a unique case of a complete unilateral self-enucleation while under the influence of drugs, which resulted in severe intracranial hemorrhages, right internal carotid artery opacification, and death. A literature review was performed by searching articles published before January 2023 in the Pubmed/MEDLINE database using the keywords "auto-enucleation or self-enucleation." Cases of self-inflicted damage to the globe without severing any connections were excluded. RESULTS: A literature review identified a total of 54 articles and 75 patients who had self-enucleated at least one globe completely (84.0%). Their average age was 37 years and 50.7% were male. At the time of auto-enucleation, 64.0% of these patients had known psychiatric disorders, and 28.0% were found to be under the influence of illicit drugs or alcohol. Auto-enucleation resulted in intracranial complications in 26.7% of cases. There has been 1 prior case, which, like the authors' case, resulted in death due to intracranial complications. However, this occurred in a patient who partially enucleated one eye after a self-inflicted injury to the fellow eye. The current case is unique as these complications resulted from a complete unilateral auto-enucleation. CONCLUSIONS: The severity of this case's presentation and outcome highlights the importance of prompt neuroimaging and a thorough assessment. Prompt psychiatric assessment and treatment are also required.

The Matthew Effect: Prevalence of Doctor and Physician Parents among Ophthalmology Applicants.

Objective This article determines the prevalence of physician parents among ophthalmology residency applications. Design Retrospective, single-center cohort study. Subjects All applicants to the University of Kentucky Ophthalmology Residency between 2018 and 2023. Methods Residency applications were reviewed, with data collection including applicant gender, self-identified Under-Represented in Medicine (URiM) status, United States Medical Licensing Examination (USMLE) Step 1 score, USMLE Step 2 score, and whether the application identified a doctor or physician as a parent. Doctor was defined as a profession requiring a doctorate degree, and similarly, physician as a profession requiring a medical degree. Results A total of 2,057 applications were reviewed, representing 54% of all match participants during the study period. Fourteen percent (296) of applications indicated a parent was a doctor and 12% (253) a parent was a physician. There were no differences between gender, URiM, USMLE Step 1, and Step 2 scores between applicants indicating a doctor or physician as a parent and those that did not ( p all > 0.4 and Cohen's d all < 0.02). Of the type of doctors, 85% (253) were physicians, 6% (17) optometrists, 6% (17) Doctors of Philosophy, 3% (8) dentists, 1% (1) pharmacist, and 1% (1) veterinarian. Eighty-six percent (217) of applications with a physician parent provided the type of physician, with ophthalmologist the most common (93, 43%). Ninety-eight percent (249) of applications with a physician parent provided the gender of the parent, with father (168, 68%) more common than mother (42, 17%) or both parents (39, 16%). Conclusion Physician parents are substantially overrepresented in ophthalmology residency applicants. This raises concerns regarding diversity and inclusion efforts for recruitment in medicine.

Success of the Canadian Ophthalmological Society's first virtual meeting amid COVID-19 pandemic.

OBJECTIVE: To assess participant attendance and engagement for an in-person Canadian Ophthalmological Society (COS) annual meeting (2019) compared with a virtual COS annual meeting (2020). DESIGN: Retrospective case-control study of key event metrics of the 2019 and 2020 COS meetings as well as Twitter activity. METHODS: Key annual meeting metrics were collected retrospectively for 2020 virtual meeting and compared with the most recent in-person annual meeting cohort from 2019. Metrics collected included attendance by ophthalmology specialist, geographic distribution of attendees, postevent survey rate, and social media engagement (Twitter). RESULTS: Overall, there was a 7% (n = 60) increase in the number of registrants between 2019 and 2020. The largest change noted was the increase in registrants from British Columbia (n = 78). More ophthalmologists registered for the 2020 meeting than for 2019 meeting (627 versus 592). Of those who registered for the meeting, meeting participation (defined as checking in for the 2019 and logging in for the 2020 meetings) increased from 70% in 2019 to 79% in 2020. There was a 158% (n = 15 000) increase in tweet impressions in 2020 compared with 2019. CONCLUSION: The first COS virtual meeting attracted more participants and was available to a geographically wider audience. Indeed, more professionals from provinces that are geographically further from the traditional COS meeting locations were able to participate in the event. Meeting engagement on a social media platform increased in the virtual meeting in 2020 relative to the in-person meeting in 2019, and possible enablers for increased engagement should be sought and incorporated into future meetings.

Boston type I keratoprosthesis versus penetrating keratoplasty following a single failed corneal graft.

BACKGROUND/OBJECTIVES: To compare long-term outcomes of the Boston type 1 keratoprosthesis (KPro) with penetrating keratoplasty (PKP) in patients with a failed first PKP. SUBJECTS/METHODS: In this retrospective comparative case series, 48 eyes of 48 patients who underwent a second corneal replacement procedure after a first failed PKP at the Centre Hospitalier de l'Université de Montréal from 2008 to 2020 were included. Minimum follow-up duration was 5 years, and patients with keratoconus were excluded since such subjects are not candidates for KPro. Main outcome measures included best-corrected visual acuity (BCVA), postoperative complications, graft survival and subsequent interventions. RESULTS: Mean follow-up was 6.4 years for PKP and 9.6 years for KPro (p < 0.001). Preoperative BCVA was better in PKP patients (means 1.67 vs 2.13, p = 0.041). Visual outcomes were similar between groups. KPro patients developed 0.263 complication per patient-year (ppy) compared to 0.245 ppy or PKP. The most common complications for PKP were corneal complications (0.088 ppy) and glaucoma worsening (0.041 ppy). In KPro, glaucoma worsening (0.046 ppy), vitreoretinal complications (0.042 ppy) and retroprosthetic membrane (0.042 ppy) were the most frequent. Graft failure (69.6 vs 20.0%, p < 0.001) and reoperation rates (56.5 vs 12.0%, p = 0.001) were significantly higher for PKP. Failure mainly resulted from decompensation or rejection in PKP, while all five failures in KPro were caused by melt and/or extrusion. CONCLUSIONS: Both interventions showed similar visual outcomes. Complication profiles were different, with more posterior segment complications in the KPro group, and more corneal complications in the PKP group, often necessitating regraft.

Retroprosthetic Membrane Formation in Boston Keratoprosthesis Type 1: Incidence, Predisposing Factors, Complications, and Treatment.

PURPOSE: The purpose of this study was to evaluate the incidence, rate of formation, and risk factors of retroprosthetic membrane (RPM) after Boston type 1 keratoprosthesis (BKPro) as well as identify secondary complications linked to its formation and describe its treatment. METHODS: This was a retrospective cohort study. One hundred thirty-three eyes of 115 patients who underwent BKPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1-year follow-up. Charts were reviewed, and data were collected, including incidence of RPM formation, preoperative and intraoperative risk factors, postoperative complications, and treatment modalities. RESULTS: The mean follow-up was 5.5 years, and 39% (n = 52) of eyes developed RPM. No etiologies were found to be significantly associated with RPM development. Simultaneous lensectomy and simultaneous intraocular lens extraction were respectively positively and negatively correlated with RPM development [odds ratio (OR): 0.3590, 95% CI: 0.1629-0.7570, P = 0.0097; OR = 2.646, 95% CI: 1.273-5.585, P = 0.0086, respectively]. As for postoperative complications, the strongest correlation was between RPM and retinal detachment (OR = 6.16, 95% CI: 2.14-16.14; P = 0.0004). RPM development was also positively associated with the development of hypotony and corneal melt. Nd:YAG membranectomy was the most common treatment, performed in 83% of eyes with RPM (n = 24), with 58% resolution. CONCLUSIONS: More than one third of patients who undergo BKPro will develop RPM, requiring close monitoring for retinal detachment. Simultaneous intraocular lens extraction seems protective, whereas simultaneous lens extraction increases the rate of RPM formation significantly. Nd:YAG membranectomy can be used as an initial noninvasive approach.

Pediatric Glaucoma in a University Hospital.

AIMS AND OBJECTIVES: This study aimed at describing the characteristics and outcomes of pediatric glaucoma patients in a university hospital in Lebanon and comparing them between primary congenital glaucoma (PCG) and secondary glaucoma. MATERIALS AND METHODS: Sixty-four eyes of 40 pediatric glaucoma patients with a follow-up of 1 year or more were reviewed. Parameters were studied for both PCG and secondary glaucoma groups. Three major outcomes were considered: intraocular pressure (IOP) control, final best-corrected visual acuity (BCVA), and the proportion of failed angle surgeries. RESULTS: Sixty-four eyes were included divided into 29 PCG and 35 secondary glaucoma eyes, followed up for a mean of 6.6 ± 4.7 years. Eyes with PCG presented earlier, with a higher initial IOP and underwent earlier surgery than their secondary glaucoma counterparts. Although 85.9% of all eyes achieved good IOP control, 44.4% of them had a BCVA ≥20/50 with PCG having a better visual prognosis. Secondary glaucoma eyes needed more medications at the end of their follow-up. In this group, it was shown that a later age at first surgery, unilateral disease, and multiple surgeries were associated with a BCVA < 20/50. CONCLUSION: Patients with PCG presented earlier and with a higher IOP than secondary glaucoma; they were also operated on earlier. Both groups demonstrated good IOP control at the end of the follow-up period with PCG eyes having a superior visual outcome. Secondary glaucoma eyes required a higher number of medications at their final visit. In this population, multiple surgeries, unilateral disease, and a delayed first surgery conferred a poorer visual prognosis. CLINICAL SIGNIFICANCE: Data regarding the characteristics of pediatric glaucoma, especially in the Middle East, are scarce. Our study sheds the light on the presentation of different types of pediatric glaucoma and their outcomes namely IOP control and visual acuity. HOW TO CITE THIS ARTICLE: Dakroub M, Khair D, Noureddine B, et al. Pediatric Glaucoma in a University Hospital. J Curr Glaucoma Pract 2021;15(1):8-13.

Vitreoretinal Complications in Boston Keratoprosthesis Type 1.

PURPOSE: To evaluate the incidence of vitreoretinal complications, treatment modalities, and the visual outcomes in a large cohort of eyes that underwent Boston Keratoprosthesis (KPro) implantation. DESIGN: Retrospective, interventional case series. METHODS: 132 eyes of 114 patients who underwent KPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1 year follow-up. Charts were reviewed and data was collected, including demographics, initial corneal indication for surgery, posterior segment complications, preoperative and postoperative visual acuity. RESULTS: Mean follow-up was 68.2 months and 61.4% of eyes developed postoperative vitreoretinal complications (VRC). The most common VRC was RPM formation (38.6%, n=51) followed by RD (15.2%, n=20), CME (12.1%, n=16), ERM (9.8%, n=13), endophthalmitis (9.1%, n=12), sterile vitritis (7.6%, n=10), vitreous hemorrhage (6.8%, n=9), choroidal detachment (3.0%, n=4) and central retinal vein occlusion (0.7%, n=1). BCVA improved in the no VRC group from 1.74 ± 0.33 logMAR to 1.33±0.83 logMAR and in the VRC group from 1.74±0.36 logMAR to 1.52±0.83 logMAR, without any statistically significant intergroup differences (p=0.231). RD was the only significant complication associated with poorer visual outcomes (p=0.001). CONCLUSION: Potentially blinding secondary complications occur in the majority of patients and frequent monitoring is necessary, specifically in the early and intermediate postoperative periods. This study evidenced significant improvements in visual outcomes of KPro eyes, including those that developed postoperative vitreoretinal complications.

Bilateral retinal artery occlusions as the first manifestation of extramedullary central nervous system involvement in relapsed acute myeloid leukaemia.

Retinal artery and vein occlusion are rare devastating complications of central nervous system (CNS) leukaemic infiltrates of the retina and its vasculature. Only a handful of reports exist wherein CNS relapse presents with retinal vascular occlusions. This is usually accompanied by optic nerve swelling and subretinal infiltrates. We present a case of bilateral retinal artery occlusion as a first manifestation of CNS relapse in a patient with acute myeloid leukaemia without optic disc oedema and retinal infiltrates.

Barriers, Attitudes and Clinical Approach of Lebanese Physicians Towards HPV Vaccination; A Cross- Sectional Study.

OBJECTIVES: HPV infection is associated with the development of cervical and oropharyngeal cancer. HPV vaccination prevents cervical cancer, but is still not part of Lebanon's routine vaccination schedule. As such, understanding physicians' practice towards HPV vaccination is essential. MATERIAL AND METHODS: We conducted a cross-sectional study in Greater Beirut, Lebanon to assess the barriers, attitudes and clinical approach of Lebanese physicians towards HPV vaccination. We also aimed to analyze the factors associated with physicians' barriers to HPV vaccination. RESULTS: In total, 228 physicians completed the survey. Our results show that physicians and parents consider the cost of HPV vaccination to be a main barrier (58.9% and 80.7% respectively). Also, parents tend to have concerns about vaccine safety (78.1%), efficacy (68.6%), and lack education concerning HPV infection (81.8%). Furthermore, female physicians tend to have fewer barriers when compared to male physicians (aOR = 0.39; p-value = 0.007). Additionally, physicians who completed residency programs in the USA also showed fewer barriers when compared to physicians who completed Lebanese residency programs (aOR = 0.24; p-value = 0.040). Finally, physicians with higher knowledge score have fewer barriers when compared to those with lower knowledge scores (aOR = 0.42; p-value = 0.018). CONCLUSIONS: Physician gender, residency program and level of knowledge play a role in HPV vaccine barriers and recommendation in Lebanon. Future improvements in cost and awareness about HPV might improve vaccination rates. Creating uniform practices towards HPV vaccine is warranted to improve patient care.

Factors associated with Human Papilloma Virus (HPV) vaccine recommendation by physicians in Lebanon, a cross-sectional study.

Persistent Human Papilloma Virus (HPV) infection is associated with the development of cervical cancer, a leading cause of female death worldwide. In Lebanon, cervical cancer is the 6th most common cancer amongst girls and women aged 14-44 years. Cervical cancer is preventable through HPV vaccination; however, Lebanon does not include HPV vaccination in its national routine vaccination schedule. Hence, physician recommendation is key for patient vaccine uptake. We conducted a cross-sectional study in Beirut, Lebanon to assess factors affecting physician recommendation regarding HPV vaccination. Physicians practicing in Obstetrics and Gynecology (OBGYN), Pediatrics, Family Medicine and Infectious Diseases were included in the study. In total, 228 physicians completed the survey (28.79% response rate). The survey consisted of a set of demographic and HPV knowledge questions along with clinical vignettes. The vignettes presented theoretical patients who differed in gender, age, sexual activity, social background and whether the patient presented with his mother or not. The results show that physicians tend to recommend the vaccine more commonly for vignettes presenting female patients, with an Adjusted Odds Ratio (AOR) of 6.8. Also, physicians were more likely to recommend the vaccine for vignettes with patients coming from a non-conservative background (AOR = 2.1), vignettes where patients claim to be sexually active (AOR = 2.7) and vignettes where patients presented with their mother (AOR = 1.4). Physicians tend to recommend the vaccine less in vignettes with married patients (AOR = 0.5). Physicians with higher knowledge scores recommended the vaccine more often (AOR = 3.4). Overall, OBGYN physicians recommended the vaccine less than pediatricians (AOR = 0.5). These results show that Lebanese physicians' recommendations rely on factors external to international guidelines. The results also highlight the importance of knowledge in adequate patient consultation. Thus, improved physician awareness towards international guidelines and physician education regarding HPV vaccination is essential in order to improve patient care in Lebanon.