Central Serous Chorioretinopathy in African Americans at Wilmer Eye Institute.

OBJECTIVE: To evaluate the frequency of central serous chorioretinopathy (CSC) in African Americans/blacks within an academic center in a predominantly African American city, as the current belief is that CSC is rare in this population. METHODS: A retrospective review of all patients' charts diagnosed with CSC at Wilmer Eye Institute/Johns Hopkins University from August 2009-August 2015 was conducted via an electronic health record search (EPIC). The charts were categorized by self-reported race and gender. The diagnosis was confirmed by multiple physician consensus through chart and imaging review. Fluorescein angiograms were classified as single versus multiple point leakage. OCTs were evaluated for subfoveal thickness, location of fluid, presence or absence of pigment epithelial detachment. Color photos were categorized as to the extent of retinal pigment epithelial changes. RESULTS: Of the 590 charts identified via EPIC as CSC patients, 407 were confirmed as CSC through chart and imaging review. 45 patients (11.1%) were African Americans and 298 patients (73.2%) were Caucasians. Of all patients seen during the study period, 0.09% of African Americans at Wilmer had CSC and 0.18% of Caucasians had CSC. While three fold more Caucasians were seen during the study period as compared to African Americans, this study's prevalence rate in African Americans/blacks at Wilmer Eye Institute was half of that in Caucasian/whites. CONCLUSIONS: CSC has been reported as exceedingly rare in African Americans, but our study suggests that CSC may be underestimated in this population. A large nationally representative population based study is needed to determine true racial prevalence to ensure that the diagnosis of CSC is not overlooked in African Americans.

Preferred practice pattern in central serous chorioretinopathy.

PURPOSE: Central serous chorioretinopathy (CSC) management lacks well-defined guidelines given the variable natural history of this disease and the lack of prospective trials. We conducted an online preferred physician practice survey to track international trends and variations in the management of CSC data. METHODS: We designed and distributed an online 27-item questionnaire with secure confidential access to retina specialists with a publication record in CSC. Physicians with at least one publication as first or corresponding author in any national or international peer reviewed journal in the English language on CSC within the last 2 years on PubMed were included. Participants were masked to the responses from other participants. RESULTS: The response rate was 82.3% (107 out of 130). 79.1% physicians preferred to observe cases of acute CSC. For chronic cases, 66.7% offered photodynamic therapy (PDT) as first line treatment. The most commonly used PDT protocol was full dose and half-fluence (60.6%). For chronic cases with intraretinal cystic changes, 43.1% opted for observation. Enhanced depth imaging, optical tomography was a common diagnostic tool for 59.8%, while indocyanine green angiography was only used by 37.8%. One regional difference was a preference for focal laser in Asia for initial treatment. CONCLUSIONS: While there are some common practice patterns for of CSC, there are still variations in regional and individual practice patterns indicating the need to establish more definitive practice guidelines. This survey data could be useful to plan a prospective study to address many unanswered questions.

Double insurance transfacetal screws for lumbar spinal stabilization.

AIM: The authors report experience with 14 cases where two screws or "double insurance" screws were used for transfacetal fixation of each joint for stabilization of the lumbar spinal segment. The anatomical subtleties of the technique of insertion of screws are elaborated. MATERIALS AND METHODS: During the period March 2011 to June 2014, 14 patients having lumbar spinal segmental instability related to lumbar canal stenosis were treated by insertion of two screws into each articular assembly by transfacetal technique. After a wide surgical exposure, the articular cartilage was denuded and bone chips were impacted into the joint cavity. For screw insertion in an appropriate angulation, the spinous process was sectioned at its base. The screws (2.8 mm in diameter and 18 mm in length) were inserted into the substance of the medial or inferior articular facet of the rostral vertebra via the lateral limit of the lamina approximately 6-8 mm away from the edge of the articular cavity. The screws were inserted 3 mm below the superior edge and 5 mm above the inferior edge of the medial (inferior) facets and directed laterally and traversed through the articular cavity into the lateral (superior) articular facet of the caudal vertebra toward and into the region of junction of base of transverse process and of the pedicle. During the period of follow-up all treated spinal levels showed firm bone fusion. There was no complication related to insertion of the screws. There was no incidence of screw misplacement, displacementor implant rejection. CONCLUSIONS: Screw insertion into the firm and largely cortical bones of facets of lumbar spine can provide robust fixation and firm stabilization of the spinal segment. The large size of the facets provides an opportunity to insert two screws at each spinal segment. The firm and cortical bone material and absence on any neural or vascular structure in the course of the screw traverse provides strength and safety to the process.

Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison.

OBJECTIVE: The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of 'Goel facet spacer' in the treatment of degenerative spinal canal stenosis. MATERIALS AND METHODS: Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. RESULTS: The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. CONCLUSIONS: Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.