PURPOSE:To produce an internationally valid tool to assess skill in performing trabeculectomy surgery.
METHODS:A panel of 5 experts developed a tool for assessing trabeculectomy surgery by using a ...modified Dreyfus scale of skill acquisition and providing descriptors for each level of skill for each category. The tool was then reviewed by a panel of 10 international content experts for their constructive comments, which were incorporated into the final rubric tool.
RESULTS:A final rubric, incorporating the suggestions of the international panel, published here as the ICO-OSCARTrabeculectomy.
CONCLUSIONS:The tool ICO-OSCARTrabeculectomy has content and face validity. It can be used internationally to assess trabeculectomy surgery skill. Predictive and construct validity, and reliability are yet to be determined.
Purpose. To describe a patient with two episodes of deep venous thrombosis and factor V Leiden mutation who presented with central retinal vein occlusion (CRVO) despite prophylactic use of warfarin ...sodium (Coumadin). Methods. A case report of a 44-year-old woman with a history of recurrent deep venous thrombosis and Factor V Leiden mutation was placed on lifelong prophylactic therapy with warfarin. The patient presented with CRVO in the left eye despite therapeutic levels of warfarin. Results. Extensive systemic evaluation disclosed high titers for antinuclear antibody (ANA). Conclusion. Systemic anticoagulation with warfarin may not preclude further thrombotic episodes. In younger patients presenting with retinal vein occlusion and pre-existing multiple thrombophilic risk factors, a multidisciplinary approach is recommended to explore other therapeutic options to avoid further thromboembolic complications.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
ABSTRACT
Purpose: The purpose of this study was to compare the accuracy and reproducibility of central corneal thickness measured by hand-held and desk-mounted ultrasound pachymeter in glaucoma ...patients under treatment. Methods: Prospective study of 65 glaucoma patients. Central corneal thickness was measured by two ultrasound pachymeters: the hand-held, portable PachPen (Accutome, Lynwood, WA), and the desk-mounted PacScan 300 (Sonomed, Lake Success, NY). Results: The mean ± SD central corneal thickness was 526.5 ± 44.8 µm and 530.0 ± 44.7 µm for the hand-held and desk-mounted pachymeters, respectively (p = 0.15). Linear regression analysis revealed a slope of 0.97 with Pearson correlation coefficient of 0.96. Bland-Altman analysis showed a mean difference of measurements by both pachymeters of 3.22 µm with two standard deviations = 9.51. Both instruments showed high intraobserver correlation: 0.972 for the hand-held pachymeter and 0.993 for the desk-mounted pachymeter. Conclusion: Central corneal thickness measurements were comparable with the use of hand-held and desk-mounted ultrasound units in glaucoma patients with good intraobserver reproducibility.
Abstract
Purpose: To review recent literature regarding ocular hypertension following intravitreal antivascular endothelial growth factors (anti-VEGF). Method: An electronic literature search was ...performed using MEDLINE, OVID, and PubMed. Key search terms were elevated IOP, anti-VEGF, sustained IOP elevation in anti-VEGF, chronic intraocular pressure elevation in anti-VEGF, high IOP with anti-VEGF, acute elevation in intraocular pressure with anti-VEGF, glaucoma and anti-VEGF. Result: Transient elevation of intraocular pressure after intravitreal anti-VEGF injection is due to temporary increase in volume, and the acute spike generally does not affect a healthy eye. Caution should be taken in a glaucomatous eye, and pretreatment with an IOP-lowering medication is recommended. Persistent elevation of intraocular pressure is more common than previously thought and may be correlated to several factors including increased number of intravitreal injections. Conclusion: Persistent ocular hypertension may be associated with intravitreal anti-VEGF injections. Physicians should be aware of this condition and monitor their patients for persistent ocular hypertension, especially in eyes with preexisting glaucoma. Prompt diagnosis and treatment can prevent potential loss of vision.
Older patients who stop driving have decreased quality of life and high rates of depression and are 5 times more likely to enter a long-term care facility. Ophthalmic intervention Salim said she ...believes that ophthalmologists should do a better job with this patient population by focusing more on function rather than just on the objective clinical measures. Patient and public safety should be emphasized, Salim advised, adding that patients can be referred to social workers to discuss alternative transportation options.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To assess whether the transient intraocular pressure rise, frequent intraocular pressure fluctuations, or antivascular endothelial growth factor (VEGF) effects of repeated intravitreal injection of ...anti-VEGF agents can lead to changes in the optic nerve vertical cup-to-disk ratio (C/D).
Patients with a known history of glaucoma and those receiving triamcinolone acetonide were excluded from the study. Fundus photographs were cropped to optic disk images only, which were then randomized and independently graded by two glaucoma specialists. In patients who received treatments in only one eye, the fellow eye was used as a control.
Twenty-three eyes of 21 patients met inclusion criteria. The mean change in C/D was -0.012 (95% confidence interval CI, -0.053 to 0.029) for the treated group and -0.006 (95% CI, -0.106 to 0.095) for the control group, with no statistically significant difference (P = 0.90). The mean change in C/D for eyes receiving < or =5 injections (n = 9) was 0.003 (95% CI, -0.089 to 0.095) in the treated group and 0.054 (95% CI, -0.033 to 0.142) in the control group, with no statistically significant difference (P = 0.33). In eyes receiving >5 injections (n = 14), the mean change in C/D was -0.021 (95% CI, -0.095 to 0.052) in the treated group and -0.057 (95% CI, -0.231 to 0.116) in the control group, with no statistically significant difference (P = 0.70).
There was no statistically significant change in the vertical C/D of optic nerves in patients receiving multiple intravitreal injections of anti-VEGF agents, regardless of whether they received fewer or more than five total injections. This suggests that the short-term intraocular pressure rise and frequent intraocular pressure fluctuation, as well as the anti-VEGF properties of these drugs, do not adversely change the optic nerve C/D. Additional prospective studies are warranted to confirm these conclusions.
Iridocorneal endothelial syndrome in a child Salim, Sarwat; Shields, M Bruce; Walton, David
Journal of pediatric ophthalmology and strabismus,
09/2006, Volume:
43, Issue:
5
Journal Article
Peer reviewed
The iridocorneal endothelial syndrome is an important and unusual cause of acquired glaucoma in adults. We report its occurrence in a child who presented with glaucoma. The patient required glaucoma ...surgery, and a goniotomy and trabeculectomy were performed. The patient's clinical findings and the results of surgeries are described.
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