Emory Eye Center

To investigate the accuracy of slit lamp measurement of toric Intraocular lens (IOL) axis compared with photography and software measurement of the same IOL. The medical charts of 102 eyes of 86 patients who underwent cataract surgery with toric IOL implantation in Ein-Tal eye center, Israel, were retrospectively reviewed. Preoperative data includes demographics, biometry, and calculated IOL. Post-operative data includes visual acuity, refraction, and the IOL axis as measured at the slit lamp and using the Goniotrans eye photograph software. The difference between the two measurements was calculated. The mean absolute difference between the slit lamp and the photography measurement was 2.13 ± 1.9o (range 0.0-9.0o). In the against the rule (ATR) cases (n = 50) 48% were counterclockwise (CCW), 32% were clockwise (CW) and in 20% there was no difference, the average absolute deviation was 0.4 ± 1.8o CCW, range 0.5-7.0o. In the with the rule (WTR) cases (n = 40), 52% were CCW, 23% were CW and in 25% there was no difference, the average absolute deviation was 1.0 ± 2.0o CCW, range 0.5-9.0o. In the oblique cases (n = 12) 58% were CW, 25% were CCW and in 17% there was no difference, the average absolute deviation was 0.37 ± 1.9 o CW, range 0.5-5.5o. Average discrepancy between the slit lamp and photography measurement was small, but in an individual case it was found to be as high as 9.0o. It can be significant when rotation of toric IOL is needed. When photography is not available slit lamp measurements should be used as is.

The current standard of care for retinopathy of prematurity (ROP) screening eye examinations, binocular indirect ophthalmoscopy (BIO), is associated with discomfort and stress in infants. In this study, we compared pain scores and vital signs during examination with BIO and non-contact laser speckle contrast imaging (LSCI). Preterm neonates underwent retinal exam with BIO and LSCI during ROP screening. Infant stress was scored using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and collected with vital signs, before, during, and after eye examination. Seventy-one infants with gestational ages 22–32 weeks and birthweights 400–1900 g underwent 196 BIO examinations and 101 LSCI examinations. N-PASS scores during BIO were significantly higher than LSCI (8.8 vs. 3.7, p < 0.0001). Maximum heart rate was significantly higher during BIO compared to LSCI (182 ± 19 beats per minute vs. 175 ± 20 beats per minute, p = 0.008). Minimum oxygen saturation was significantly lower during BIO compared to LSCI (83 ± 12% vs. 86 ± 10%, p = 0.035). After BIO, vital sign instability remained for 30 s, whereas vital signs returned to baseline after LSCI. We found lower pain scores and more stable vital signs during LSCI compared to BIO.

In 2024, the American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee became aware of reports of coring of vial stoppers in relation to preparation of intravitreal injections. A literature review was performed to further understand and characterize this occurrence within the context of retina practice and the broader medical community. Relevant articles were identified through a systematic search of PubMed using predefined criteria. Coring can be observed when a needle punctures the rubber stopper of a medication vial, pushing a small piece or pieces of the stopper material into the container and introducing extrinsic particles into the drug product. Factors associated with coring include larger gauge needles, perpendicular needle entry, multiple-use vials, and thicker rubber stoppers. Rubber stopper thickness and composition also influence the likelihood of coring. To prevent patient safety issues from coring, filter needles are commonly used to draw up medications from vials because they are effective in mitigating particulate matter from entering syringes. No documented cases of clinical complications related to coring in ophthalmology have been identified. Coring represents an unreported phenomenon in the preparation of intraocular medications. Although there have been no safety implications in retina practice related to coring and intravitreal drug vials, these reports underscore the importance of careful medication preparation, inspection of vials, the use of appropriate needles, and adherence to best clinical practices.

Glaucoma is a common optic neuropathy characterized by degeneration of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP), that is, ocular hypertension, is the primary modifiable risk factor for glaucoma and the primary characteristic of most preclinical glaucoma models. Extensive genotype and phenotype diversity at relatively low cost and high accessibility makes laboratory mice an excellent preclinical model for glaucoma. The microbead occlusion model was introduced in 2010 as an inducible model of ocular hypertension in mice and is now one of the most extensively utilized models of rodent glaucoma. Subsequent modifications of the microbead model increased the magnitude and duration of IOP elevation, primarily through modification of injection materials. Despite its popularity, accessibility of the model is hindered by procedural consistency between users. Here we outline an updated and comprehensive protocol for execution of the microbead model that is focused on improving surgical and outcome measure consistency and on enabling single experimenter execution.

Background MYCN-amplified RB1 wild-type (MYCNARB1+/+) retinoblastoma is a rare but clinically important subtype of retinoblastoma due to its aggressive character and relative resistance to typical therapeutic approaches. Because biopsy is not indicated in retinoblastoma, specific MRI features might be valuable to identify children with this genetic subtype. Purpose To define the MRI phenotype of MYCNARB1+/+ retinoblastoma and evaluate the ability of qualitative MRI features to help identify this specific genetic subtype. Materials and Methods In this retrospective, multicenter, case-control study, MRI scans in children with MYCNARB1+/+ retinoblastoma and age-matched children with RB1-/- subtype retinoblastoma were included (case-control ratio, 1:4; scans acquired from June 2001 to February 2021; scans collected from May 2018 to October 2021). Patients with histopathologically confirmed unilateral retinoblastoma, genetic testing (RB1/MYCN status), and MRI scans were included. Associations between radiologist-scored imaging features and diagnosis were assessed with the Fisher exact test or Fisher-Freeman-Halton test, and Bonferroni-corrected P values were calculated. Results A total of 110 patients from 10 retinoblastoma referral centers were included: 22 children with MYCNARB1+/+ retinoblastoma and 88 control children with RB1-/- retinoblastoma. Children in the MYCNARB1+/+ group had a median age of 7.0 months (IQR, 5.0-9.0 months) (13 boys), while children in the RB1-/- group had a median age of 9.0 months (IQR, 4.6-13.4 months) (46 boys). MYCNARB1+/+ retinoblastomas were typically peripherally located (in 10 of 17 children; specificity, 97%; P < .001) and exhibited plaque or pleomorphic shape (in 20 of 22 children; specificity, 51%; P = .011) with irregular margins (in 16 of 22 children; specificity, 70%; P = .008) and extensive retina folding with vitreous enclosure (specificity, 94%; P < .001). MYCNARB1+/+ retinoblastomas showed peritumoral hemorrhage (in 17 of 21 children; specificity, 88%; P < .001), subretinal hemorrhage with a fluid-fluid level (in eight of 22 children; specificity, 95%; P = .005), and strong anterior chamber enhancement (in 13 of 21 children; specificity, 80%; P = .008). Conclusion MYCNARB1+/+ retinoblastomas show distinct MRI features that could enable early identification of these tumors. This may improve patient selection for tailored treatment in the future. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Rollins in this issue.

ABSTRACT Purpose To compare visual outcomes, ocular complications and therapies for patients with scleritis-associated intraocular inflammation (SAI) and patients with isolated scleritis (IS). Results A total of 52 patients (36 with SAI and 16 with IS) were reviewed. Mean age (standard deviation) at presentation was 48.4 years old (± 15.4) in the SAI group and 53 years old (± 17.1) in the IS group (p = .37). Visual acuity was worse at presentation and last visit for patients with SAI compared to IS (p = .04). Patients in the SAI group developed greater posterior segment complications than in the IS group (p = .002). Conclusions Scleritis with intraocular inflammation was associated with a higher rate of visual morbidity compared to isolated scleritis. More aggressive management strategies may be needed for patients who present with scleritis associated with inflammation.