Faculty Bibliography

Cataract and glaucoma are the leading causes of blindness worldwide and commonly coexist in elderly patients. Endocyclophotocoagulation (ECP) is a minimally invasive approach for glaucoma management that is amenable to combination with cataract surgery. We review the literature on ECP and evaluate intraocular pressure reduction efficacy when combined with phacoemulsification. Several studies demonstrate that phacoemulsification and ECP (PECP) successfully reduces intraocular pressure (IOP) and decreases medication burden. PECP has a minimal side effect profile, and risks are limited to those usual post-phacoemulsification. Most importantly, PECP allows for all future procedures including trabeculectomy or tube implantation if necessary.

Purpose: To evaluate the epidemiology of open globe injuries and to identify factors correlated with differences in visual outcomes in patients presenting to Bellevue Hospital, a public Level 1 Trauma Center in New York City. Methods: A retrospective chart review of all patients with open globe injuries presenting to Bellevue Hospital between July 2008 and June 2015 was performed. Patient demographics, associated ocular injuries, visual acuity, and clinical courses were recorded. Results: Of 59 patients, 41 (69.5%) were males and 18 (30.5%) were females. The mean population was 44.7 years of age (range: 16 months to 85 years). 35 (59.3%) of the cases were reported as assault, with the rest a combination of accidental and un-identified trauma. Based on the Birmingham Eye Trauma Terminology System, there were 30 (50.9%) Zone I, 19 (32.2%) Zone II, and 10 (16.9%) Zone III injuries. Pre-operative visual acuity (VA) was worse than 20/400 in 57 (96.7%) patients, of which 25 (42.4%) patients presented with Light Perception (LP) vision and 18 (30.5%) patients presented with No Light Perception (NLP). Of the 51 patients that followed-up, 26 (50.9%) had no change in VA between initial presentation and their last clinic visit, 19 (37.3%) improved, and 6 (11.8%) worsened. Notably, five patients initially presenting with LP had deteriorated to NLP within an average of 4.5 months, all with Zone I injuries. Final visual outcomes are shown in Figure 1. The mean follow-up time was 426 days (range: 4 days to 7 years, SD: 566 days) and 8 patients (13.6%) were lost to follow-up within 1 month. 2 (3.39%) patients underwent a second operation for endophthalmitis and 7 (11.9%) patients eventually underwent enucleation of which 6 patients had associated orbital fracture injuries. Conclusions: Patients were predominantly male between the ages of 24-50. There was no single or group of prognostic factors that precluded visual recovery, even in the case of NLP upon presentation, highlighting the benefit of primary repair over enucleation. An orbital fracture was the most prognostic factor of enucleation, as globe injuries that involved orbital fractures were likely more severe. Highly variable follow up times combined with co-existing social factors were also associated with poorer outcomes, underscoring the importance of appropriate counseling to help patients manage their care and recovery