Faculty Bibliography

BACKGROUND:Damaged or degenerated vertebral endplates are a significant cause of vertebrogenic chronic low back pain (CLBP). Modic changes are one objective MRI biomarker for these patients. Prior data from the treatment arm of a sham-controlled, RCT showed maintenance of clinical improvements at 2 years following ablation of the basivertebral nerve (BVN). This study reports 5-year clinical outcomes. METHODS:In total, 117 US patients were treated successfully with BVN ablation. Patient-reported outcomes of ODI, VAS, postablation treatments, and patient satisfaction were collected at a minimum of 5-years following BVN ablation. Primary outcome was mean change in ODI. Comparisons between the postablation and baseline values were made using an analysis of covariance with alpha 0.05. RESULTS:Of the 117 US treated patients 100 (85%) were available for review with a mean follow-up of 6.4 years (5.4-7.8 years). Mean ODI score improved from 42.81 to 16.86 at 5-year follow-up, a reduction of 25.95 points (p < 0.001). Mean reduction in VAS pain score was 4.38 points (baseline of 6.74, p < 0.001). In total, 66% of patients reported a > 50% reduction in pain, 47% reported a > 75% reduction in pain, and 34% of patients reported complete pain resolution. Composite responder rate using thresholds of ≥ 15-point ODI and ≥ 2-point VAS for function and pain at 5 years was 75%. CONCLUSION:CLBP patients treated with BVN ablation exhibit sustained clinical improvements in function and pain with high responder rates at a mean of 6.4 years following treatment. BVN ablation is a durable, minimally invasive treatment for vertebrogenic CLBP.

BACKGROUND:The case describes a rare entity. Most cases of IOL dislocation are associated with surgical trauma or preexisting zonulopathy. This patient presents IOL dislocation following routine exam, suggesting the need of careful evaluation of zonular integrity on pseudopahkic patients. METHODS:Patient is a 65 year old who presented with sudden loss of vision and pain following retinal examination using scleral depression. Patient was diagnosed with late intraocular lens dislocation, which was subsequently for proper repositioning of IOL. CONCLUSION/CONCLUSIONS:Pseduophakic eyes should be approached with caution when scleral indentation is attempted due to the possibility of zonular dehiscence and subsequent intraocular lens dislocation.

PURPOSE/OBJECTIVE:To evaluate the anatomic stability of an implanted Boston type I keratoprosthesis (KPro)-donor cornea interface and assess the presence or absence of a potential space (gap) between the KPro front plate and donor cornea using anterior segment optical coherence tomography (AS-OCT). The presence of a gap would raise concerns of a possible pathway for the exchange of extraocular fluid with the anterior chamber. METHODS:Fifteen eyes implanted with a Boston type I KPro were studied by the noncontact technique of AS-OCT (AC Cornea OCT prototype; OTI, Canada). All the KPro devices had been implanted at least 4 weeks before the study (mean: 7 months, range: 1-22 months). Eight eyes had aphakic Kpros, and the other 7 had pseudophakic implants. Anesthetized eyes were imaged before and during pressure application using sterile cotton-tip applicators. Pressure was applied for 10 seconds on the nasal or temporal side of the eye. Images were analyzed for any possible changes in the KPro-donor cornea interface during the application of pressure. RESULTS:Of 15 eyes, 10 had the threaded front plate model with a T-shaped silhouette and corrugated sides, whereas 5 had the threadless type with a T-shaped silhouette and smooth sides on cross-sectional optical coherence tomography. Of the 15 eyes, 2 revealed a gap between the front plate and the surface of the donor cornea. The rest revealed no gaps. With pressure, none of the eyes, including the 2 with gaps, demonstrated any change in the KPro-donor cornea interface during dynamic imaging (eg, gaping or evidence of fluid escape along the KPro-donor cornea borders). In all eyes, the position of the titanium locking ring was visible and verified to be in an adequate position. CONCLUSIONS:The implanted KPro-donor cornea interface seems to be stable dynamically using AS-OCT. A gap that has been documented with this imaging tool showed neither gaping nor escape of anterior chamber fluid during dynamic cross-sectional imaging. Further studies will be needed to assess the cause of these gaps and to determine if they are possibly related to the hydration status of the cornea, suture tension on the donor cornea, or other factors that remain to be determined.

PURPOSE: To report a case of polymicrobial keratitis resistant to topical and intraocular antibiotics with recurrence after penetrating keratoplasty. METHODS: Case report. RESULTS: We report a case of polymicrobial keratitis caused by Phialophora verrucosa, Candida tropicalis, and Propionibacterium acnes. Initial treatment included topical vancomycin, tobramycin, amphotericin B, voriconazole, and oral fluconazole, as well as subconjunctival amphotericin B. Penetrating keratoplasty was performed, and the infection seemed to have resolved until 4 weeks after keratoplasty. A second penetrating keratoplasty was performed, followed by 4 weekly intracameral injections of voriconazole. Two weeks after the fourth intracameral injection, the infection manifested as an active anterior-chamber reaction. The patient's eye was subsequently enucleated. Histopathologic evaluation showed penetration of the crystalline lens by fungus at the site of synechiae between the intact lens capsule and iris. CONCLUSIONS: To our knowledge, this is the first documented case of a polymicrobial keratitis caused by a bacterium, yeast, and a fungus. It is the first histopathologic demonstration of fungal penetration of intact lens capsule from infected iris

PURPOSE/OBJECTIVE:To describe the anterior ocular segment findings of eyes with implanted Boston type 1 keratoprostheses (KPro) in vivo by using anterior-segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). METHODS:A retrospective, comparative study was made of patients with implanted KPros who were examined with AS-OCT (AC Cornea OCT) and UBM (OTI Scan 35-50 MHz Ultrasound). RESULTS:One pseudophakic and 1 aphakic eye were included in the study. Cross-sectional AS-OCT adequately imaged the components of the KPro (front plate with stem, back plate, and titanium ring), the corneal graft, and host cornea. The angles could be seen as open, filled with debris, or closed. Coronal AS-OCT showed en face views of each KPro part. Retrokeratoprosthetic membranes were depicted to be thick opacities covering the rear optical surface of the stem. UBM, on the other hand, imaged the KPro front plate as a muffin-shaped space at the apical center, with the corneal graft appearing wispy and the host cornea grainy. The back plate, titanium ring, and angles could not be resolved. Glaucoma tubes and posterior-chamber intraocular lens (PCIOL) haptics were imaged below the iris plane. CONCLUSIONS:Cross-sectional AS-OCT adequately imaged the components of the assembled KPro in vivo, as well as its interaction with surrounding anterior-segment structures. It allowed visualization of the anterior chamber, iris, and angle, essential in the postoperative care of these patients. Coronal AS-OCT showed graphic en face images of the KPro device and suspected retrokeratoprosthetic membranes. UBM, on the other hand, adequately imaged glaucoma tube shunts and PCIOL haptics beneath the iris plane.

BACKGROUND AND OBJECTIVE/OBJECTIVE:To investigate the capability of the prototype AC Cornea OCT (Ophthalmic Technologies Inc., Toronto, Ontario, Canada) for imaging eyes with opaque corneas. PATIENTS AND METHODS/METHODS:More than 50 eyes of patients were included in the study. RESULTS:The density of opacification influenced the ability of OCT to reveal anterior segment details. Imaging was limited by shadows cast by abnormal pigmentation or vascularity within the cornea. However, the system's unique coronal perspective capability was helpful in revealing occult spatial relationships. CONCLUSIONS:The AC Cornea OCT is valuable for examining eyes with opaque corneas and provides cross-sectional and coronal views helpful in formulating specific management strategies.

We present a case of iatrogenic keratectasia in the left eye after laser in situ keratomileusis (LASIK) with 14 microm of stromal ablation. Preoperative evaluation did not show significant evidence of keratoconus or forme fruste keratoconus in either eye. Twenty months postoperatively, in addition to postoperative ectasia in the left eye, the right eye developed mild changes in manifest refraction and on corneal topography. A retrospective diagnosis of ectatic corneal disorder was made in a patient who had no obvious findings of corneal pathology prior to LASIK.

BACKGROUND AND OBJECTIVE: To investigate the effects of acute intraocular pressure (IOP) elevation on optic disc morphology. PATIENTS AND METHODS: Ophthalmodynamometry was used to increase the IOP of normal, healthy eyes. Confocal scanning laser ophthalmoscopy of the optic nerve head using the Heidelberg Retinal Tomograph II (Heidelberg GmbH, Heidelberg, Germany) and IOP measurements were obtained before, during, and after IOP elevation. RESULTS: Sixteen eyes of 16 normal volunteers (mean age, 32.8 +/- 11.9 years) were enrolled. Rim area, rim volume, cup area, cup volume, cup-to-disc ratio, mean cup depth, maximum cup depth, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area showed significant changes during IOP elevation (all P < .05, paired t test). All measured parameters returned to their original values after pressure resolution (all P > .2) except mean RNFL thickness (P = .03). CONCLUSION: Transient elevation of IOP results in measurable alterations in optic nerve head topography

BACKGROUND AND OBJECTIVE/OBJECTIVE:To determine whether ensured graft acceptance through the use of corneal autografts yields a better outcome than when standard homografts are used. PATIENTS AND METHODS/METHODS:Four patients who needed a corneal transplant in one eye and who had a blind fellow eye underwent a corneal autograft in the eye with corneal pathology. RESULTS:Three of the four patients had clear grafts on long-term follow-up, and no patient experienced immunologic graft rejection. However, two of the four patients had large amounts of astigmatism postoperatively. CONCLUSION/CONCLUSIONS:Autografts provided protection against immunologic graft rejection. However, because corneal autografts yielded unpredictable amounts of astigmatism, their outcomes are not necessarily better than those of homografts.

Recent evidence has demonstrated a marked anticollagenolytic effect for the tetracycline antibiotics. We have examined the efficacy of systemic tetracycline hydrochloride in a rabbit model of corneal ulceration. A standard alkali burn (1N sodium hydroxide for 40 s) was delivered to 62 eyes (31 rabbits). Animals were then divided into three groups: group 1 (controls) (ten rabbits [20 eyes]) received no treatment; group 2 (ten rabbits [20 eyes]) received 10 mg/kg/d of tetracycline hydrochloride, given intramuscularly; and group 3 (11 rabbits [22 eyes]) received 50 mg/kg/d. Ulceration occurred in 85% (17/20) of control eyes. The higher dosage of tetracycline was more effective in preventing ulceration than the lower dosage (9.1% vs 55%). Eyes with higher levels of tetracycline in ocular tissues were less likely to ulcerate.