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Micheletti JM, Weber N, McCauley MB, Doe EA, Coffee RE, Caplan MB. Punch and rescue technique for scleral fixation of dislocated single-piece intraocular lenses. J Cataract Refract Surg 2022; 48:247-250. [PMID: 34670946 DOI: 10.1097/j.jcrs.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
In-the-bag intraocular lens (IOL) dislocation is a well-known complication after cataract surgery. As the number of cataract surgeries performed annually continues to increase, so will the incidence of IOL dislocations requiring surgical correction. Described is a new technique for rescue and refixation of a single-piece acrylic IOL. In this method, a new instrument called the IOL punch is used to create a hole at the optic-haptic junction or along the border of the optic, which acts as an anchor point for centration and subsequent scleral fixation of a dislocated IOL. The IOL punch allows for precise intraocular manipulation of the IOL and is less invasive compared with popular scleral fixation methods. This innovative technique may decrease the risk for postoperative complications and allows patients to maintain or recover previous uncorrected visual acuity by circumventing the need for IOL explantation or exchange.
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Affiliation(s)
- J Morgan Micheletti
- From the Berkeley Eye Center, Houston, Texas (Micheletti, McCauley, Doe, Coffee, Caplon), Baylor College of Medicine, Houston, Texas (Weber)
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Brunin G, Khandelwal S, Coffee RE, Orengo-Nania S, Biggerstaff KS. Outcomes of anterior chamber intraocular lenses placed by surgeons in training. J Cataract Refract Surg 2016; 41:2102-6. [PMID: 26703285 DOI: 10.1016/j.jcrs.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/11/2015] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate risk factors and outcomes of unplanned, primary anterior chamber intraocular lenses (AC IOLs) placed by surgeons in training. SETTING Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. DESIGN Retrospective case series. METHODS Cataract surgeries performed primarily by a resident surgeon that resulted in an unplanned AC IOL were included. Cases that had concomitant retinal surgery were excluded. Preoperative data gathered included corrected distance visual acuity (CDVA), intraocular pressure (IOP), and ocular comorbid conditions. Operative times and complications requiring an AC IOL were assessed. Postoperative CDVA, IOP, corneal edema, persistent intraocular inflammation, macular edema, and need for additional surgery were analyzed for the first postoperative year. RESULTS Twenty-two eyes were included. The mean preoperative CDVA was 1.24 logMAR ± 0.92 SD and the mean preoperative IOP was 17.55 ± 3.88 mm Hg. The mean operative time was 103 ± 30 minutes. The most common operative complications necessitating an AC IOL were 7 (32%) capsule tears with vitreous prolapse requiring anterior vitrectomy and 7 (32%) capsule tears, zonular dehiscence, and vitreous prolapse requiring anterior vitrectomy. By the first postoperative year, the mean visual acuity was 0.40 ± 0.58 logMAR and the IOP was 15.05 ± 6.01 mm Hg. The most common complications 1 year postoperatively included persistent macular edema (23%) and need for additional surgery (18%). CONCLUSION This group of patients who received unplanned primary AC IOLs by surgeons in training had improved visual acuity and well-controlled IOP 1 year postoperatively. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Greg Brunin
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Sumitra Khandelwal
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert E Coffee
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Silvia Orengo-Nania
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Kristin S Biggerstaff
- From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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Walton OB, Garoon RB, Weng CY, Gross J, Young AK, Camero KA, Jin H, Carvounis PE, Coffee RE, Chu YI. Evaluation of Automated Teleretinal Screening Program for Diabetic Retinopathy. JAMA Ophthalmol 2016; 134:204-9. [DOI: 10.1001/jamaophthalmol.2015.5083] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- O. Bennett Walton
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Robert B. Garoon
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Christina Y. Weng
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Jacob Gross
- The University of Texas Medical School at Houston
| | - Alex K. Young
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Haoxing Jin
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Petros E. Carvounis
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Robert E. Coffee
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Yvonne I. Chu
- Harris Health System, Houston, Texas2Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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Abstract
Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, intraocular paraneoplastic syndrome characterized by multiple, elevated, pigmented uveal lesions, diffuse thickening of the uveal tract, and rapidly progressive cataracts. We report a 70-year-old Caucasian male with an inferotemporal conjunctival-scleral pigmented lesion of the right eye. Funduscopy and ultrasonography revealed multiple elevated pigmented choroidal lesions in both eyes. Genome-wide single nucleotide polymorphism (SNP) analysis of intraoperative transscleral fine-needle aspiration biopsies from both eyes revealed a whole gain on chromosome 5. BDUMP was diagnosed, and the patient underwent a thorough systemic investigation, which was negative for an underlying malignancy; however, by maintaining a high index of suspicion, multiple malignancies were uncovered and appropriately treated over the ensuing years. This report presents the clinical, cytologic, and cytogenetic features of BDUMP, and is the first to demonstrate a novel finding of a whole gain in chromosome 5 by SNP analysis of the choroidal lesions. Additionally, this is the first case to potentially associate BDUMP and both transitional cell carcinoma of the bladder as well as renal clear cell carcinoma.
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Affiliation(s)
- Ehsan Rahimy
- J ules Stein Eye Institute , UCLA, Los Angeles, California , USA and
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Meleth AD, Pinninti U, Coffee RE, Carvounis PE. Acute severe visual loss and a brainstem mass. Lancet 2012; 380:1790. [PMID: 23158253 DOI: 10.1016/s0140-6736(12)61335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annal D Meleth
- Department of Opthalmology, Baylor College of Medicine, Houston TX 77055, USA.
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Prasad PS, Oliver SC, Coffee RE, Hubschman JP, Schwartz SD. Ultra Wide-Field Angiographic Characteristics of Branch Retinal and Hemicentral Retinal Vein Occlusion. Ophthalmology 2010; 117:780-4. [DOI: 10.1016/j.ophtha.2009.09.019] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 09/03/2009] [Accepted: 09/11/2009] [Indexed: 11/30/2022] Open
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Coffee RE, Westfall AC, Davis GH, Mieler WF, Holz ER. Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol 2007; 144:409-413. [PMID: 17583667 DOI: 10.1016/j.ajo.2007.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/24/2007] [Accepted: 05/01/2007] [Indexed: 12/21/2022]
Abstract
PURPOSE To establish the necessity for an early follow-up examination after an initial funduscopic examination with negative results for patients with acute, symptomatic posterior vitreous detachment (PVD). DESIGN Retrospective case-control study and meta-analysis. METHODS Records were reviewed of patients seeking treatment over a 4.5-year period who were diagnosed with an acute, symptomatic PVD. A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathologic features after acute, symptomatic PVD. RESULTS The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall rate of retinal break in the meta-analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed-onset retinal breaks, 24 (82.8%) had at least one of the following: vitreous hemorrhage at initial examination, hemorrhage in the peripheral retina at initial examination, or new symptoms. CONCLUSIONS If the results of an initial examination of a patient with an acute, symptomatic PVD are negative for retinal tears, the necessity of early follow-up may be best determined by the presence of pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage. Most patients with symptomatic PVD may not need an early follow-up examination.
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Affiliation(s)
- Robert E Coffee
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Chong EM, Coffee RE, Chintagumpala M, Hurwitz RL, Hurwitz MY, Chévez-Barrios P. Extensively necrotic retinoblastoma is associated with high-risk prognostic factors. Arch Pathol Lab Med 2006; 130:1669-72. [PMID: 17076529 DOI: 10.5858/2006-130-1669-enriaw] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Retinoblastoma is the most common malignant intraocular tumor in children. It has been shown that adjuvant therapy following enucleation in patients with high-risk histopathologic features significantly decreases the mortality. We describe the association of extensive necrosis of tumor and intraocular structures with 2 of the major risk factors: optic nerve invasion and choroidal invasion. This may alert the pathologist who makes the observation of extensive necrosis to carefully search for histologic features associated with adverse outcome. OBJECTIVE To determine whether extensively necrotic retinoblastoma is associated with high-risk histologic prognostic factors for metastatic disease and patient survival. DESIGN Retrospective case series. Forty-three eyes of 43 patients with retinoblastoma who underwent enucleation between 1990 and 2001 were evaluated. Medical records, histopathology specimens, pathology reports, and clinical photographs were reviewed. Tumors were designated as exhibiting extensive necrosis if more than 95% of tumor cells and intraocular tissues were necrotic. The main outcome measure was the association of extensive tumor necrosis with 3 high-risk histopathologic features: extraocular extension, optic nerve invasion, or choroidal invasion. Metastatic disease, patient survival, and associations with pathologic findings were also analyzed. RESULTS Optic nerve head invasion (P < .001), post-lamina-cribrosal invasion (P < .001), and choroidal invasion by tumor (P = .004) were observed more frequently in eyes with extensive necrosis compared with eyes without extensive necrosis. Two of the 11 patients with extensively necrotic intraocular retinoblastoma died from metastatic disease (P = .06). None of the 32 patients without extensive necrosis developed metastatic disease or died. CONCLUSIONS Extensive ocular tissue and tumor necrosis is associated with histologic high-risk prognostic factors for tumor metastasis and mortality.
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Affiliation(s)
- Eva-Marie Chong
- Department of Ophthalmology, Baylor College of Medicine, Houston, Tex, USA
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Albini TA, Benz MS, Coffee RE, Westfall AC, Lakhanpal RR, McPherson AR, Holz ER. Optical Coherence Tomography of Idiopathic Juxtafoveolar Telangiectasia. Ophthalmic Surg Lasers Imaging Retina 2006. [DOI: 10.3928/1542-8877-20060301-07] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Albini TA, Benz MS, Coffee RE, Westfall AC, Lakhanpal RR, McPherson AR, Holz ER. Optical coherence tomography of idiopathic juxtafoveolar telangiectasia. Ophthalmic Surg Lasers Imaging 2006; 37:120-8. [PMID: 16583633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND OBJECTIVE To document optical coherence tomography (OCT) findings in a series of eyes with group 2A idiopathic juxtafoveal telangiectasia. PATIENTS AND METHODS This study is a retrospective review of patient charts, OCT, fundus photography, and fluorescein angiography involving 23 eyes (12 patients). Mean retinal thickness in 9 macular areas was calculated and compared to previously published measurements from normal eyes. RESULTS OCT in 8 of 13 stage 3 eyes revealed foveal cysts without evidence of cystoid macular edema on fluorescein angiography or biomicroscopy, and 1 lamellar hole. In stage 3 eyes, mild retinal thickening was found in 7 of 9 macular areas (P < .05). CONCLUSIONS OCT commonly reveals foveal cysts in stage 3 idiopathic juxtafoveal telangiectasia. Consistent findings of associated mild macular thickening and lack of late petaloid hyperfluorescence on fluorescein angiography suggest that these cysts differ in pathophysiology from cystoid macular
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Affiliation(s)
- Thomas A Albini
- Section of Vitreoretinal Diseases and Surgery, Baylor College of Medicine, Department of Ophthalmology, Houston, Texas 77030, USA
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Coffee RE, Nicholas JS, Egan BM, Rumboldt Z, D'Agostino S, Patel SJ. Arterial compression of the retro-olivary sulcus of the medulla in essential hypertension: a multivariate analysis. J Hypertens 2005; 23:2027-31. [PMID: 16208145 DOI: 10.1097/01.hjh.0000187256.02072.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) has been postulated to cause neurogenically mediated essential hypertension (EHTN). We aimed to establish whether the association between AC of specifically the retro-olivary sulcus (ROS) of the VLM and EHTN was significant, while controlling for other risks associated with EHTN. DESIGN Case-control study. METHODS Posterior fossa magnetic resonance imaging scans of 131 subjects, including 58 subjects with EHTN and 73 normotensives, were reviewed to determine the presence of AC in the ROS. The history of other risk factors for EHTN was obtained by reviewing medical records. RESULTS Multivariate logistic regression analysis of these data shows a significant association between AC in the ROS (right and/or left) and EHTN [odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.30, 7.06]. This analysis was done controlling for other known EHTN risk factors such as age, race, sex, diabetes, and obesity. A secondary analysis also controlling for these variables shows that AC of both the right and left ROS are independently associated with EHTN (right AC: OR = 5.04, 95% CI = 1.33, 19.17; left AC: OR = 3.39, 95% CI = 1.20, 9.60). CONCLUSIONS In this retrospective study of subjects with EHTN and normotensive controls that had undergone magnetic resonance imaging of the posterior fossa, AC of the ROS on either side of the medulla is a significant independent risk factor in EHTN. Further studies are required to determine whether this is true for the general population of patients with neurogenically mediated EHTN.
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Affiliation(s)
- Robert E Coffee
- College of Medicine, Medical University of South Carolina, Charleston, 29425, USA
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