Felfeli and Mireskandari provide details on a 14-year-old boy with autism spectrum disorder who was referred to a pediatric eye clinic for a "blue haze" in both eyes. He had a history of self-injury, ...which included hitting his head and vigorous eye rubbing that had led to bilateral lichenification of the eyelids. On examination, the patient had cataracts bilaterally, with a retinal tear and a chronic retinal detachment in the right eye and an acute shallow retinal detachment in the left eye. In an effort to preserve vision, an urgent surgical repair of the retinal detachment and cataract extraction with intraocular lens implantation for the left eye were performed, which healed successfully with the aid of a safety helmet incorporating eye protection postoperatively.
In the current study, we evaluated the virucidal efficacy and contact times for commonly used ophthalmic concentrations of PVI and CHX against SARS-CoV-2 using Vero E6 cells as indicator cell lines ...for residual viable virus based on previously established methodologies (online supplemental appendix).4–6 PVI (5% weight per volume, w/v) and CHX (0.05% and 0.1% w/v) were tested at full strength. Viable residual SARS-CoV-2 was quantified by the Reed-Muench median tissue culture infectious dose (TCID50) procedure in Vero E6 cells.7 Additional efficacy testing using 1:4 and 1:16 dilutions in phosphate buffered saline were performed in order to mimic clinical settings where dilution of the formulations occurs as a result of mixing with patients’ ocular secretions. First manuscript draft: TF.
To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors.
A retrospective review of all ...consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400 μm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together.
Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47 μm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days.
The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.
Abstract Objective The aim of the study was to investigate whether individuals who develop retinal vein occlusion (RVO) or sudden-onset activity in otherwise quiescent diabetic retinopathy (DR) and ...those who have normal blood pressure (BP) or controlled hypertension according to their family physician show evidence of occult hypertension on 24-hour BP monitoring. Methods Patients with a new-onset RVO or DR that led to vitreous hemorrhage after a period of quiescence were identified. Informed consent was obtained, and patients were enrolled in the study if they met all of the inclusion criteria. Hypertension cut-offs were established in accordance with the Canadian Hypertension Education Program and the American Heart Association recommendations. All patients underwent a baseline BP measurement and 24-hour ambulatory BP monitoring. Results A total of 20 patients were enrolled in the study. Eleven (55%) were female (mean age 67.5 years). Seven patients (35%) had diabetes. Seventeen had retinal vein occlusions (85%), and 3 had sudden-onset activity in otherwise quiescent diabetic retinopathy (15%). Ten patients (50%) had no previous history of hypertension, and 10 (50%) had controlled hypertension on medications. Two patients (10%) failed to wear their BP cuff for the 24-hour duration and were excluded from the analysis. The average baseline systolic BP and diastolic BP were 133 and 78 mm Hg, respectively. Twelve patients (67%) tested positive for hypertension on their 24-hour recording, and 5 (42%) of these patients had no history of hypertension. One of 12 patients (8%) had a positive nighttime average only but a normal daytime average. Nine of the 12 patients (75%) who had a positive recording had a subsequent change made to their medications. Conclusions Uncontrolled hypertension is a known risk factor for the development of RVO and for vitreous hemorrhage in otherwise quiescent DR. Many of these patients may have occult hypertension that has not been detected by the currently usual standard. Twenty-four-hour ambulatory BP monitoring is a useful and potentially lifesaving clinical test, which can detect uncontrolled hypertension, especially nocturnal hypertension, in this cohort of patients. The results of this test have important treatment implications that can help prevent or minimize further systemic complications.
This study simulated respiratory droplet spread during an ophthalmologic slitlamp examination to help establish risk of infectious disease contagion in this setting.
To create a model of the abatement profiles of the three most commonly employed endophthalmitis prophylaxis intracameral (IC) antibiotics—cefuroxime, vancomycin, and moxifloxacin—to enable comparison ...of their durations of efficacy against common endophthalmitis pathogens.
Humber River Hospital and The Eye Foundation of Canada, Toronto, Ontario, the University of Toronto, Ontario, and McGill University, Montreal, Quebec, Canada.
Literature review, as well as review of our clinical experience with 4797 consecutive cases with IC vancomycin, followed by 9185 consecutive cases with IC moxifloxacin.
A detailed review of the prophylactic antibiotic literature was performed. Exponential decay models of the selected IC antibiotics were updated from previous work by the study authors with decay constants adjusted to agree with the available published objective data.
The graphs generated by the study data demonstrate the relative duration of IC bactericidal activity of moxifloxacin, cefuroxime, and vancomycin. They suggest that at present, IC moxifloxacin, when administered in appropriate doses, is the most effective agent in preventing postoperative endophthalmitis. Unlike vancomycin and cefuroxime, bacterial resistance to moxifloxacin is dose-dependent, and it is overcome in the vast majority of cases with doses that can safely be achieved intracamerally. The graphs can serve as a useful tool to assess the expected efficacy of each antibiotic in reference to local pathogen resistances.
The model shows IC moxifloxacin, cefuroxime, and vancomycin durations of bactericidal efficacy post-cataract surgery, which correlate well with the published objective data.
Purpose
To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury.
Methods
A retrospective case series of ...pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014.
Results
A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8–16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury.
Conclusion
Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.
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