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Umfress AC, Glaser TS, Ploysangam P, Enyedi LB, Pineles S, Velez FG. Unilateral four muscle surgery for extra-large monocular exotropia. Arch Soc Esp Oftalmol (Engl Ed) 2023:S2173-5794(23)00071-3. [PMID: 37178786 DOI: 10.1016/j.oftale.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/10/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Recurrent exotropia is common following surgery for monocular large angle constant sensory exotropia. Surgery is usually limited to operations on the affected eye. Simultaneous oblique weakening surgery may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting forces. We report the results of simultaneous oblique muscle weakening procedures combined with ipsilateral horizontal rectus muscle surgery constant monocular exotropia greater than 35 prism diopters (PD). METHODS Retrospective case series of patients who underwent unilateral lateral rectus recession combined with medial rectus muscle resection and simultaneous weakening of both ipsilateral oblique muscles. Primary outcome measure was ocular alignment in primary position. RESULTS Twelve eyes of 12 patients were included. The mean preoperative exotropia improved from 57.9 ± 15.1 (range 35-80; median 60 PD) to 3.3 ± 5.5 (range 0-16; median 0 PD) postoperatively (p < 0.005). Two of 3 patients with a pre-existing vertical deviation had resolution of their vertical misalignment postoperatively. At the last postoperative follow up 92%% of the patients had an exodeviation of 10 PD or less (range 0-16 PD median 0 PD), and 7 (58%) measured near and distance orthotropia. Postoperative abduction measured -0.6 ± 1 (0 to -3) and adduction -0.4 ± 0.7 (0 to -2). CONCLUSION Weakening the ipsilateral oblique muscles may enhance the effect of the horizontal rectus muscles surgery by decreasing the abducting vectorial forces when operating for a large angle monocular exotropia. As an additional potential advantage, oblique muscle surgery may be used simultaneously to address associated vertical deviations.
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Affiliation(s)
- A C Umfress
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37209, United States
| | - T S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27705, United States
| | - P Ploysangam
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27705, United States
| | - L B Enyedi
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27705, United States
| | - S Pineles
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - F G Velez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27705, United States; Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA 90095, United States; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA 90033, United States.
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Tauscher RG, Haynie ML, Glaser TS, Freedman SF. "Coming up short" with an illuminated microcatheter for circumferential trabeculotomy externo in the buphthalmic infant eye: frequency and options. J AAPOS 2022; 26:340-342. [PMID: 36152757 DOI: 10.1016/j.jaapos.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
An illuminated microcatheter is frequently used to perform trabeculotomy ab externo in infants with primary congenital glaucoma (PCG). Enlarged corneas in these children can make it challenging to traverse 360o of Schlemm's canal (SC) before reaching the passable limit of the microcatheter. Using basic geometry, we predicted that the iTrack microcatheter would fail to cannulate SC completely in eyes with a horizontal corneal diameter (HCD) >14.8 mm. A retrospective chart review of patients with PCG undergoing angle surgery identified the frequency of corneas with HCD >14.8 mm and confirmed that this calculated cut-off predicts which eyes can-or cannot-be cannulated successfully (ie, 360o) by the iTrack microcatheter.
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Affiliation(s)
- Robert G Tauscher
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Matthew L Haynie
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tanya S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Department of Pediatrics, Duke University, Durham, North Carolina.
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Glaser TS, Meekins LC, Freedman SF. Outcomes and lessons learned from two decades' experience with glaucoma drainage device implantation for refractory Sturge Weber-associated childhood glaucoma. J AAPOS 2021; 25:332.e1-332.e6. [PMID: 34655770 DOI: 10.1016/j.jaapos.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate glaucoma drainage device (GDD) implantation for refractory pediatric glaucoma associated with Sturge-Weber syndrome (SWS). METHODS The medical records of consecutive children with SWS-associated glaucoma at a single center who were treated by a single surgeon using GDDs over 20 years were reviewed retrospectively. The main outcome measure was GDD treatment success, defined as absence of any of the following indications of treatment failure: (1) intraocular pressure (IOP) of >21 mm Hg on two consecutive visits despite maximal medical therapy, (2) additional IOP-lowering surgery, and (3) sight-threatening complications. RESULTS A total of 22 eyes of 22 children were included. The median age at glaucoma diagnosis was 0.73 years (range, 0.06-13.2), and the median age at GDD surgery was 4.8 years (range, 0.6-13.3). Most eyes (14 [68%]) had prior glaucoma surgery. Mean follow-up was 2.8 ± 1.5 years. Success (95% confidence interval) by Kaplan-Meier analysis for GDD surgery at 1, 3, and 5 years was 91% (68-98), 75% (50-89), and 52% (24-73), respectively. Failure occurred in 8 eyes (36%). Complications were common, occurring in 50% of eyes, with 23% of eyes having more than one complication. Severe vision-threatening complications (n = 3) included one case each of possible infection requiring GDD removal, persistent hypotony, and cilioretinal artery occlusion. CONCLUSIONS GDDs are an effective treatment for SWS-associated glaucoma but have a high rate of complications. We report several severe complications that prompted surgical modifications for increased safety when implanting GDDs in eyes with SWS-associated glaucoma.
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Affiliation(s)
- Tanya S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
| | - Landon C Meekins
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
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Umfress AC, Glaser TS, Ploysangam P, Freedman SF. Rebound tonometry by iCare 200 (IC200): comparison with Tono-Pen in the operating room and Goldmann applanation in the clinic. J AAPOS 2021; 25:329.e1-329.e6. [PMID: 34737080 DOI: 10.1016/j.jaapos.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tonometry guides decision making in children with known or suspected glaucoma. The iCare IC200 is a recently FDA-approved rebound tonometer that can measure intraocular pressure (IOP) in both supine and upright patients. The purpose of this study was to evaluate this new tonometer against more commonly used standard instruments: Tono-Pen in the operating room (OR arm) and Goldmann applanation in the clinic (clinic arm). METHODS The OR arm included sequential children undergoing general anesthesia. The clinic arm included cooperative children seen in clinic. IOP was measured twice (right eye then left eye, repeat) with IC200 and either Tono-Pen (OR arm) or Goldmann (clinic arm). RESULTS A total of 99 children were included: 75 for the OR arm and 24 for the clinic arm. There was a strong correlation between the IOP measured by IC200 and each device (R2 = 0.81 for Tono-Pen; R2 = 0.78 for Goldmann). In the OR arm, the overall mean IOP difference (ΔIOP [Tono-Pen - IC200]) was -1.6 mm Hg. For eyes with corneal edema (n = 12), ΔIOP ranged from -8 to 15 mm Hg. At IOP >20 mm Hg, mean ΔIOP was -3.7 mm Hg. In the clinic arm, the mean ΔIOP (ΔIOP [Goldmann - IC200]) was -1.2 mm Hg. CONCLUSIONS In eyes of children under general anesthesia with IOP <20 mm Hg without corneal edema, IC200 and Tono-Pen correlated well. In cooperative clinic patients, Goldmann and IC200 correlated well over the range of IOP studied.
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Affiliation(s)
- Allison C Umfress
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tanya S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Pimpiroon Ploysangam
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Chandramouli SA, Glaser TS, Umunakwe O, Gupta D, Margeta MA, Challa P, Kuo AN, Freedman SF. Glaucoma Drainage Devices Calculator App: A Modern Clinical Decision Tool. Ophthalmol Glaucoma 2021; 4:550-551. [PMID: 33484931 DOI: 10.1016/j.ogla.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tanya S Glaser
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Obinna Umunakwe
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Divakar Gupta
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Milica A Margeta
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Pratap Challa
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Anthony N Kuo
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.
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Glaser TS, Mulvihill MS, Freedman SF. Endoscopic cyclophotocoagulation (ECP) for childhood glaucoma: a large single-center cohort experience. J AAPOS 2019; 23:84.e1-84.e7. [PMID: 30890461 DOI: 10.1016/j.jaapos.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the factors associated with successful outcomes in the management of childhood glaucoma treated with endoscopic cyclophotocoagulation (ECP) as both primary and adjunctive surgery. METHODS The medical records of consecutive children with glaucoma treated by a single surgeon at a single center over a 17-year period using ECP procedures were reviewed retrospectively. Treatment failure was defined as (1) intraocular pressure (IOP) >24 mm Hg at two consecutive examinations despite maximal medical treatment, (2) any additional glaucoma surgery, (3) sight-threatening complications, or (4) progression to no light perception visual acuity. Success was defined as the absence of treatment failure. RESULTS A total of 107 ECP procedures on 80 eyes of 70 children were included. Glaucoma diagnoses included: following-cataract-surgery (60%), anterior segment dysgenesis (13%), primary congenital (9%), and other (19%). Most eyes (67 [84%]) had prior glaucoma surgery, and 73 (91%) were aphakic or pseudophakic at first ECP. Median follow-up was 2.2 years (IQR, 1.1-3.5) after initial ECP; mean number of ECP treatments per eye was 1.3 (range, 1-3). Success for a single ECP treatment at 1, 3, and 5 years (Kaplan-Meier analysis) was 64% (95% CI, 54-76), 36% (26-50), and 16% (7-37), respectively. Cumulative success (≥1 ECP) at 5 years was 34% (23-50). In multivariable analysis, of many risk factors considered, only a preoperative IOP of <32 mm Hg was significantly associated with treatment success. CONCLUSIONS ECP represents a modestly effective long-term therapy for childhood glaucoma and may be most successful in patients with preoperative IOP of <32 mm Hg.
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Affiliation(s)
- Tanya S Glaser
- Duke University Department of Ophthalmology, Durham, North Carolina
| | | | - Sharon F Freedman
- Duke University Department of Ophthalmology, Durham, North Carolina.
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Glaser TS, Doss LE, Shih G, Nigam D, Sperduto RD, Ferris FL, Agrón E, Clemons TE, Chew EY. The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37. Ophthalmology 2015; 122:1471-9. [PMID: 25972257 DOI: 10.1016/j.ophtha.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate whether dietary intake of luteiin/zeaxanthin and B vitamins is associated with cataract prevalence and incidence. DESIGN Clinic-based, baseline cross-sectional and prospective cohort study designs. PARTICIPANTS Three thousand one hundred fifteen patients (6129 eyes) enrolled in the Age-Related Eye Disease Study 55 to 80 years of age followed up for mean of 9.6 years. METHODS Participants completed baseline food frequency questionnaires. Baseline and annual lens photographs were graded centrally. Multivariate models controlling for previously identified risk factors for cataracts tested for the association of cataracts with reported dietary intake, using the lowest quintile as reference. MAIN OUTCOME MEASURES Cataract surgery, cataract status (type and severity) at baseline, and development of cataracts. RESULTS At baseline, increased dietary riboflavin and B12 were associated inversely with nuclear and cortical lens opacities. In comparisons of persons with and without cataract, persons with the highest riboflavin intake versus those with the lowest intake had the following associations: mild nuclear cataract: odds ratio (OR), 0.78; 95% confidence interval (CI), 0.63-0.97; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.90; and mild cortical cataract: OR, 0.80; 95% CI, 0.65-0.99. For B12, the results were: mild nuclear cataract: OR, 0.78; 95% CI, 0.63-0.96; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.88; and mild cortical cataract: OR, 0.77; 95% CI, 0.63-0.95. Highest dietary B6 intake was associated with a decreased risk of moderate nuclear lens opacity developing compared with the lowest quintile (OR, 0.67; 95% CI, 0.45-0.99). Highest dietary intake levels of niacin and B12 were associated with a decreased risk of development of mild nuclear or mild cortical cataracts in participants not taking Centrum (Pfizer, New York, NY) multivitamins. For participants taking multivitamins during the study, the highest intake of dietary folate was associated with an increased risk of mild posterior subcapsular lens opacity development. No statistically significant associations were found between lutein plus zeaxanthin intake and presence at baseline or development of nuclear or cortical lens opacity outcomes. CONCLUSIONS These findings are consistent with earlier studies suggesting that dietary intake of B vitamins may affect the occurrence of age-related lens opacities. Further investigations are warranted.
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Affiliation(s)
- Tanya S Glaser
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Lauren E Doss
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Grace Shih
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Divya Nigam
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Glaser TS, Rauen KA, Jeng LJB, de Alba Campomanes AG. Lipodermoid in a patient with Emanuel syndrome. J AAPOS 2013; 17:211-3. [PMID: 23528375 DOI: 10.1016/j.jaapos.2012.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Abstract
We report an 8-month-old boy with Emanuel syndrome who also had the clinical features of Goldenhar syndrome. At birth, he was observed to have bilateral microtia with multiple auricular pits, retrognathia, and a unilateral lipodermoid. Further testing revealed cardiac defects. The finding of a lipodermoid in Emanuel syndrome demonstrates phenotypic overlap between Goldenhar and Emanuel syndromes and suggests a role for genetic analysis in all patients with clinical features that include ear anomalies and lipodermoids. Correct identification of patients with Emanuel syndrome is important for determining whether there is risk of long-term neurodevelopmental disability, and genetic testing can determine parental carrier status to aid in family planning.
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Affiliation(s)
- Tanya S Glaser
- Department of Ophthalmology, University of California-San Francisco, San Francisco, California, USA
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See CW, Srinivasan M, Saravanan S, Oldenburg CE, Esterberg EJ, Ray KJ, Glaser TS, Tu EY, Zegans ME, McLeod SD, Acharya NR, Lietman TM. Prior elicitation and Bayesian analysis of the Steroids for Corneal Ulcers Trial. Ophthalmic Epidemiol 2013; 19:407-13. [PMID: 23171211 DOI: 10.3109/09286586.2012.735332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To elicit expert opinion on the use of adjunctive corticosteroid therapy in bacterial corneal ulcers. To perform a Bayesian analysis of the Steroids for Corneal Ulcers Trial (SCUT), using expert opinion as a prior probability. METHODS The SCUT was a placebo-controlled trial assessing visual outcomes in patients receiving topical corticosteroids or placebo as adjunctive therapy for bacterial keratitis. Questionnaires were conducted at scientific meetings in India and North America to gauge expert consensus on the perceived benefit of corticosteroids as adjunct treatment. Bayesian analysis, using the questionnaire data as a prior probability and the primary outcome of SCUT as a likelihood, was performed. For comparison, an additional Bayesian analysis was performed using the results of the SCUT pilot study as a prior distribution. RESULTS Indian respondents believed there to be a 1.21 Snellen line improvement, and North American respondents believed there to be a 1.24 line improvement with corticosteroid therapy. The SCUT primary outcome found a non-significant 0.09 Snellen line benefit with corticosteroid treatment. The results of the Bayesian analysis estimated a slightly greater benefit than did the SCUT primary analysis (0.19 lines verses 0.09 lines). CONCLUSION Indian and North American experts had similar expectations on the effectiveness of corticosteroids in bacterial corneal ulcers; that corticosteroids would markedly improve visual outcomes. Bayesian analysis produced results very similar to those produced by the SCUT primary analysis. The similarity in result is likely due to the large sample size of SCUT and helps validate the results of SCUT.
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Affiliation(s)
- Craig W See
- FI Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA
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