Faculty Bibliography

Apocrine hidrocystomas are benign cystic tumors derived from apocrine sweat glands; they are most commonly located in the skin of the head and neck regions. Ophthalmic occurrences characteristically appear at the lash line and canthi of the eyelid, although rare instances have been described in the conjunctiva, caruncle, and orbit. The authors describe an exceptional instance of a mobile epibulbar subconjunctival apocrine hidrocystoma in a 57-year-old woman without a history of previous ocular injury or surgery. Histopathology of the excised specimen displayed an empty cyst lined by a double layer of cuboidal epithelium with the inner layer exhibiting periodic acid-Schiff-positive apical decapitation secretion. Confirmatory immunohistochemistry included reactivity with cytokeratin-7, smooth muscle actin, D2-40, and CDGFP-15.

Conjunctival papillomas are common tumors that exhibit an exophytic growth pattern, comprised of multiple filiform fronds of squamous epithelium that contain fibrovascular cores. The inverted (endophytic) variety of papilloma, often termed "Schneiderian," rarely occurs on the conjunctiva, with only 15 cases reported to date. Endophytic and exophytic papillomas are well described arising in the sinonasal Schneiderian epithelium where a low rate of malignant transformation may occur in the endophytic type; malignant transformation in exophytic sinonasal papillomas is exceedingly rare. The authors describe 2 cases of exophytic conjunctival papillomas with the morphology of a sinonasal or Schneiderian-type papilloma. Both were pink, sessile acquired growths in women in the sixth decade of life involving the inferior conjunctival fornix or nasal limbus. Nonkeratinizing squamous epithelium along with numerous goblet cells, intraepithelial mucinous cysts, and microabscesses were present. Immunohistochemistry showed reactivity for cytokeratin 7 and wild-type staining for p16 and p53, paralleling the findings in common conjunctival papillomas; both were also driven by low-risk human papillomavirus.

Purpose : To evaluate the efficacy and safety of combined cataract extraction (CE) and either excisional goniotomy performed with Kahook Dual Blade (K

OBJECTIVE:Familial Dysautonomia (FD) disease, lacks a useful biomarker for clinical monitoring. In this longitudinal study we characterized the structural changes in the macula, peripapillary and the optic nerve head (ONH) regions in subjects with FD. METHODS:Data was consecutively collected from subjects attending the FD clinic between 2012 and 2019. All subjects were imaged with spectral-domain Optical Coherence Tomography (OCT). Global and sectoral measurements of mean retinal nerve fiber layer (RNFL) and macular ganglion cell and inner plexiform layer (GCIPL) thickness, and ONH parameters of rim area, average cup-to-disc (C:D) ratio, and cup volume were used for the analysis. The best fit models (linear, quadratic and broken stick linear model) were used to describe the longitudinal change in each of the parameters. RESULTS:91 subjects (149 eyes) with FD of ages 5-56 years were included in the analysis. The rate of change for average RNFL and average GCIPL thicknesses were significant before reaching a plateau at the age of 26.2 for RNFL and 24.8 for GCIPL (- 0.861 µm/year (95% CI - 1.026, - 0.693) and - 0.553 µm/year (95% CI - 0.645, - 0.461), respectively). Significant linear rate of progression was noted for all ONH parameters, except for a subset of subjects (24%), with no cupping that did not show progression in any of the ONH parameters. CONCLUSIONS:The rapidly declining RNFL and GCIPL can explain the progressive visual impairment previously reported in these subjects. Among all structural parameters, ONH parameters might be most suitable for longitudinal follow-up, in eyes with a measurable cup.

PURPOSE/OBJECTIVE:We aim to describe ocular infection epidemiology for a public tertiary care hospital in New York City (NYC). METHODS:We retrospectively reviewed 558 patients with ocular isolates from conjunctival, corneal, and intraocular culture from 2009 to 2017 for microbial growth and antimicrobial sensitivities. RESULTS:= .006). CONCLUSIONS:The microbial epidemiology of ocular infection of a public NYC hospital was distinct from other geographic locations, underscoring the importance of examining local profiles to more precisely inform empiric therapy.

Purpose : Digital eye strain, which can lead to persistent screen- associated dry eye and ocular symptoms, has been well studied in the adult population. However, despite increased use of digital devices in children, there is a paucity of studies characterizing the relationship of dry eye syndrome to screen use in children. Thus, we sought to determine the prevalence of dry eye in the pediatric population of New York City hospitals to evaluate whether screen time was a risk factor for ocular symptoms. Methods : We performed a cross-sectional study where we distributed questionnaires to parents of children aged 4 to 17 presenting to pediatric clinics at Bellevue Hospital Center and New York University Langone Medical Center. In a single-page survey modified from the Ocular Surface Disease Index, parents were asked whether their child experienced any of 8 dry eye symptoms, whether their child uses a smartphone or tablet, their child's daily screen time, and the age and sex of their child. Logistic and linear regression analyses were performed to determine the relationship between symptoms experienced and children's age, sex, smartphone or tablet use and daily hours of screen time. Results : From 210 complete survey responses, we were able to assess a pediatric population aged 10.4 +/- 3.7 that was 56.2% male. The average number of dry eye symptoms reported was 2.5 (SD: 2.4) and hours of daily screen time was found to be a statistically significant predictor of number of symptoms, when controlling for age, sex, and use of a smartphone or tablet (p=0.0036). Furthermore, screen time was observed to be associated with increased odds ratios of experiencing several individual symptoms including tearing (OR 1.56, 95% CI 1.10- 2.26, p=0.016), red eyes (OR 1.58, 95% CI 1.10-2.32, p=0.015), eye rubbing (1.55, 95% CI: 1.14-2.11, p=0.005), and headache (OR 1.49, 95% CI 1.09-2.05, p= 0.014). By contrast, no statistically significant difference was observed with age, sex, or smartphone or tablet use for these symptoms. Conclusions : Screen time may represent a significant risk factor for dry eye syndrome in children. Symptoms of tearing, eye redness, eye rubbing and headache may indicate screen time-associated dry eye within the pediatric population. Further clinical studies are needed to determine if reported dry eye symptoms reflect the true burden of treatable ocular surface disease in this population

Purpose : To characterize corneal and conjunctival microbial profiles of patients from Bellevue Hospital, a large New York public hospital. Methods : All eye cultures from 2009 to 2015 at Bellevue Hospital were retrospectively reviewed. All cultures, antibiotic sensitivities, and clinical courses were analyzed. Results : Of the 451 eye cultures reviewed, 155 (34%) were positive. Of the positive cultures, 46 (30%) were corneal scrapings and 29 (19%) were conjunctival. Of the 46 positive corneal ulcer cultures, the most common isolates were P. aeruginosa (39%), S. marscescens (17%), and S. viridans (11%). Of P. aeruginosa cultures, 44% were resistant to cefuroxime while the rest were pansensitive. All S. marscescens cultures were resistant to cefazolin and cefuroxime. All S. viridans cultures were resistant to erythromycin. Among the 29 positive conjunctiva cultures, the most common isolates were coagulase negative staphylococci (34%), S. viridans group (17%), S. aureus MRSA (17%), and S. aureus MSSA (14%). Three of the MRSA cultures were also resistant to sulfamethoxazole/trimethoprim and two were resistant to erythromycin and tetracycline. Conclusions : Corneal ulcer cultures most frequently grew bacteria, with P. aeruginosa being the most common organism. This is consistent with current literature showing that P. aeruginosa is a common isolate often due to contact lens wear. Given the resistance patterns of corneal ulcers, fluoroquinolones continue to be an effective choice of treatment. While most conjunctival cultures grew bacteria consistent with normal skin flora, many grew S. aureus with over half comprising of MRSA

Purpose: Intrastromal ring segments are known to reduce the magnitude of irregular astigmatism, but whether they allow freedom from use of medical contact lenses is less clear. We performed a retrospective chart review of patients with corneal ectasia to determine whether post-surgical contact lens modality was affected. Methods: 58 eyes of 42 patients age 23 to 81 years (n=32 males and 24 females) with a diagnosis of keratoconus or LASIK induced corneal ectasia who were implanted with intrastromal ring segments in at least one eye over a 10 year period were included. Refraction, visual acuity, keratometry, apical thickness and elevation were measured with the Pentacam (Oculus) before and 6 months after surgery. The primary endpoint was type of contact lens fit at 6 months after surgery. Descriptive statistics were used for data analysis. Results: 52 eyes carried a diagnosis of keratoconus and 6 eyes had LASIK induced ectasia. 90% of subjects in this review had Stage 4 disease. Patients using hybrid lenses: 12.5% were fit with custom soft lens, 18.75% were fit with a commodity soft lens, 18.75% stayed in a hybrid, 12.5% were fit with a scleral lens, 18.75% were without lenses. Patients using corneal rigid gas permeable lenses: 6.25% were fit with a custom soft lens, 18.75% were fit with commodity soft lenses, 18.75% went into a hybrid, 0% were fit in a scleral, 37.53% stayed in a rigid gas permeable lens, and 18.75% wore no lens. Patients who did not use lenses before the procedure (due to intolerance (72%) or inability to achieve a successful fit (28%): 25% were fit with rigid lenses post-operatively, 30% were fit in a scleral lens and 44% continued not to wear a lens. Conclusions: This review of patients with advanced corneal ectasia demonstrated that the majority of our patients enjoyed improvements in refractive and topographical parameters, but most still required the use of custom contact lenses. In our cohort, 11% of treated eyes were free of contact lenses, but 57% required the use of medical, custom contact lenses post-operatively. We recommend that future studies on intrastromal ring segments include use of medical contact lenses as an outcome measure. Patients with advanced corneal ectasias should be properly counseled regarding the likelihood of needing custom contact lenses after placement of intrastromal ring segments