Paul Sidoti - Academia.edu (original) (raw)
Papers by Paul Sidoti
Ophthalmology, 2001
A 29-year-old female presented two months following blunt ocular injury to both eyes. Her best co... more A 29-year-old female presented two months following blunt ocular injury to both eyes. Her best corrected visual acuity (BCVA) was 3/60 OD and no perception of light in OS. Presenting intraocular pressure (IOP) was 55mmHg OU on two topical antiglaucoma medications OU. Anterior segment examination revealed bilateral anteriorly subluxated crystalline lenses with shallow anterior chamber. Gonioscopy revealed complete synechial angle closure OU. Right-eye 25G Pars Plana Vitrectomy and Pars Plana Lensectomy were combined with non-valved Glaucoma Drainage Device (GDD) implantation, pars plana tube insertion was done.IOP was well controlled at discharge. Two-month post surgery, unintended IOP spike of 40mmHg in OD on a combination antiglaucoma eye drop was noted. Tube lumen was found to be occluded with vitreous. Repeat pars plana vitrectomy was required to restore the tube functioning. Pars plana tube insertion of GDD should be done in eyes with complete vitrectomy including adequate shaving of the vitreous base.
European journal of ophthalmology, Jan 17, 2015
To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that ... more To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that resolved after resection of the primary tumor. Retrospective case review of the clinical record, ultrasonographic images, and histopathology. A 6-year-old Asian girl, with a dark iris tumor, pigment dispersion, and secondary glaucoma, was initially treated with topical antiglaucoma medication and observation. Rapid growth prompted biopsy, revealing melanocytoma. As the tumor continued to grow, excision of the primary tumor was performed. Surgery proved curative in that the pigment dispersion slowly reabsorbed and her glaucoma resolved. In this case, rapid growth did not indicate malignant transformation. Initial observation for growth and judiciously timed surgical intervention prevented progression, loss of vision, and potentially the loss of the eye.
Investigative Ophthalmology & Visual Science, 2011
Investigative Ophthalmology & Visual Science, 2011
Ophthalmic Surgery, Lasers and Imaging Retina, 1997
The authors investigated the role of ultrasound biomicroscopy after ocular trauma. Ultrasound bio... more The authors investigated the role of ultrasound biomicroscopy after ocular trauma. Ultrasound biomicroscopy was performed in six eyes of six patients at the New York Eye and Ear Infirmary after a variety of traumatic ocular injuries. Eyes with angle recession, iridodialysis, cyclodialysis, hyphema, an intraocular foreign body, scleral laceration, and subluxed crystalline lens were imaged without complication. Ultrasound biomicroscopy aided in the diagnosis when visualization was limited by media opacities or distorted anterior segment anatomy. Ultrasound biomicroscopy is a safe and effective adjunctive tool for the clinical assessment and management of ocular trauma, especially when visualization is limited and multiple traumatic injuries are involved.
Journal of Glaucoma, 2021
PRECIS Sub-Tenon's implantation of the Xen® Gel stent resulted in significant intraocular pre... more PRECIS Sub-Tenon's implantation of the Xen® Gel stent resulted in significant intraocular pressure lowering along with a low rate of postoperative bleb needling, and a favorable bleb morphology on anterior segment optical coherence tomography. PURPOSE To assess clinical outcomes and bleb morphology following sub-Tenon's implantation of the Xen® Gel Stent (Allergan Inc., Dublin, Ireland). METHODS The medical records of patients who underwent sub-Tenon's Xen® Gel Stent implantation with intraoperative mitomycin-C via an open conjunctival approach were reviewed. Postoperative intraocular pressure (IOP) and number of glaucoma medications at 1,3,6,9 and 12 months were assessed. Bleb morphology was analyzed at various timepoints using anterior segment optical coherence tomography (AS-OCT, Topcon DRI OCT version 1.1.1). RESULTS Twenty-six eyes were included in the study. Mean age was 69.4±8.0 years. Mean preoperative IOP was 28.1±7.8▒mm Hg on an average of 3.5±0.9 glaucoma medications. Mean IOP at postoperative month 12 (n=23 eyes) was 12.9±4.0▒mm Hg (P<0.01) on an average of 0.3±0.6 (P<0.01) glaucoma medications. Three eyes (12%) required postoperative needle revision. Bleb morphology in the early postoperative period (≤ 3▒mo) was characterized by multiple small subconjunctival microcysts on AS-OCT. At the intermediate (6-12▒mo) and long-term (>12▒mo) time points, reduction in microcysts with multiple internal parallel layers of aqueous flow and a uniform pattern were more frequently noted. All functional blebs were characterized by the presence of a posterior episcleral fluid lake. Failed blebs showed absence of aqueous humor around the distal end of the microshunt. CONCLUSION Following an open conjunctival approach, sub-Tenon's placement of the Xen® Gel Stent with significant IOP lowering was achieved. In eyes with good shunt function, bleb morphology by AS-OCT showed a posterior episcleral fluid lake similar to findings following trabeculectomy.
Journal of glaucoma, 2018
To evaluate the efficacy and safety of a tube fenestration stented with a 10-0 polyglactin suture... more To evaluate the efficacy and safety of a tube fenestration stented with a 10-0 polyglactin suture for controlling early postoperative intraocular pressure (IOP) after Baerveldt glaucoma implant (BGI) surgery. The medical records of 110 patients (119 eyes) who underwent BGI surgery with a tube fenestration stented with a 10-0 polyglactin suture anterior to an occlusive tube ligature were retrospectively reviewed. Main outcome measures included IOP and number of glaucoma medications at postoperative day 1, week 1, and weeks 2 to 3 as well as complications occurring before ligature release. Mean±SD preoperative IOP was 30.9±9.3 mm Hg using an average of 3.8±1.1 glaucoma medications. A statistically significant reduction in IOP and glaucoma medications was observed at all timepoints during the first 3 postoperative weeks compared with baseline (P<0.001). Mean IOP on postoperative day 1, week 1, and weeks 2 to 3 was 18.4±12.2 mm Hg on no medication, 15.9±9.4 mm Hg on 1.0±1.3 medicatio...
Journal of glaucoma, Jan 26, 2017
Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and sev... more Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and severely elevated intraocular pressure. The pathophysiology of tube obstruction is related to central and anterior displacement of vitreous that is drawn into and condenses within the proximal lumen of the tube. This can occur from days to years following GDI surgery. Successful management of vitreous-tube obstruction generally requires manual removal of the condensed vitreous plug with end-grasping forceps. This technique achieves reversal of tube blockage and restoration of GDI function. Amputation of the incarcerated vitreous alone with vitrectomy or neodymium:yttrium-aluminum-garnet vitreolysis does not consistently restore GDI function and risks persistent intraluminal tube obstruction.
Journal of Glaucoma, 2016
To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) following fai... more To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) following failed trabeculectomy. The medical records of 27 patients (27 eyes) who underwent TCR with subconjunctival injection of MMC by a single surgeon between September 2001 and August 2013 were retrospectively reviewed. The same surgical protocol was followed for all patients. Revision was performed using a microvitreoretinal blade through a small conjunctival incision. Main outcome measures included visual acuity, intraocular pressure (IOP), and number of glaucoma medications. Failure was defined as an IOP&amp;lt;5 or &amp;gt;14 mm Hg, loss of light perception, or need for additional glaucoma surgery. Mean interval between trabeculectomy and TCR was 56.4±57.2 months. Mean preoperative IOP was 21.9±6.8 mm Hg using 4.0±1.2 glaucoma medications. Fifteen (55.6%) patients met success criteria. At most recent follow-up, mean IOP and number of glaucoma medications for successful patients were 9.7±3.8 mm Hg and 0.6±1.1, respectively. Kaplan-Meier analysis revealed 1-, 2-, and 3-year success rates of 62%, 58%, and 53%, respectively. Three additional patients achieved success after undergoing a second TCR, and 1 patient achieved success after a third TCR. Postoperative complications included transient choroidal effusion (n=8), shallow anterior chamber requiring reformation (n=5), 5-fluorouracil-related corneal epitheliopathy (n=10), and bleb leak (n=1). TCR with adjunctive MMC is a safe and effective procedure following failure of a trabeculectomy. More than 1 revision may be necessary to achieve long-term IOP reduction.
Current Opinion in Ophthalmology, 2016
Purpose of review This article describes important aspects of postoperative management after trab... more Purpose of review This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery. Recent findings Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/ plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course. Summary Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.
American Journal of Ophthalmology, 1996
Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peri... more Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peripheral iris. To differentiate them from other anterior segment tumors requires the ability to assess the distribution, tissue characteristics, and progression of such lesions, which we accomplished by using anterior segment echography. We reviewed the medical records of 49 consecutive patients referred to the Doheny Eye Institute for echographic evaluation of focal bulging of the peripheral iris. Echography of the anterior segment was performed on each patient by using an immersion technique. Clinical examination was also performed on 20 (41%) patients at the time of initial examination. We identified 52 iris pigment epithelial cysts in 52 eyes of the 49 patients studied. All lesions were single, localized to the posterior iris surface, and demonstrated a well-circumscribed, echolucent structure on B-scan echography. Average maximal sagittal thickness was 1.6 +/- 0.4 mm. Cysts were most frequently located in the inferotemporal quadrant (31%). Minimal increase in size or regression of lesions was noted in the nine patients (ten eyes) for whom follow-up echographic examinations were available. Primary iris pigment epithelial cysts possess characteristic features with regard to location, size, and internal structure, which can be accurately documented with echography. Clinically evident lesions tend to be between 1 and 4 mm in maximum sagittal thickness, conform to the contour of posterior chamber structures without distortion, produce anterior bulging of the peripheral iris, are preferentially located in the inferotemporal quadrant, and demonstrate limited potential for growth.
Ophthalmology, 1995
The authors present a retrospective study designed to assess the effectiveness of the Baerveldt g... more The authors present a retrospective study designed to assess the effectiveness of the Baerveldt glaucoma implant in controlling intraocular pressure (IOP) and maintaining visual function in eyes with neovascular glaucoma. The medical records of all 36 patients (36 eyes) who underwent Baerveldt glaucoma implantation for medically uncontrolled neovascular glaucoma between February 1991 and December 1992 were reviewed. Eighteen patients received Model 350 implants, 16 received Model 500 implants, and 2 received Model 200 implants. The 12- and 18-month life-table success rates (success defined as 6 mmHg < or = final IOP < or = 21 mmHg without additional glaucoma surgery or devastating complication) were 79% and 56%, respectively. Visual acuity remained stable or improved in 10 (31%) patients. Postoperative complications included flat anterior chamber, serous choroidal detachment, and obstruction of the proximal tube tip with fibrovascular tissue, each of which occurred in four (11%) patients. Eleven (31%) patients lost light perception. There were no significant differences between the groups receiving the Model 350 and Model 500 implants with respect to life-table success rates, percentage of postoperative IOP reduction, or complication rates. Patients in the Model 500 implant group required significantly fewer antiglaucoma medications post-operatively, but also demonstrated a significantly greater mean visual acuity reduction. Better preoperative visual acuity and increased patient age were positively correlated with a successful outcome. Baerveldt implantation is effective in controlling IOP elevation associated with neovascular glaucoma. Postoperative visual loss, despite adequate IOP control, is common. Young patient age and poorer preoperative visual acuity are significant predictors of surgical failure.
Ophthalmology, 1994
The treatment of glaucoma after scleral buckling surgery is often problematic. The authors invest... more The treatment of glaucoma after scleral buckling surgery is often problematic. The authors investigated a series of patients in whom a silicone tube was implanted to shunt aqueous from the anterior segment to the fibrous capsule surrounding a previously placed silicone episcleral encircling element. Methods: Thirteen patients were retrospectively reviewed. In each patient, a silicone tube was inserted through a small incision into the fibrous capsule overlying the scleral explant. In most patients, no attempt was made to secure the distal end of the tube to the silicone band. The proximal end of the tube was inserted into the eye via a needle track. Results: Successful control of intraocular pressure (lOP) (6 mmHg :s; final lOP :s; 21 mmHg with or without medication) was ultimately achieved in 11 (85%) of 13 patients (3 of the successful patients underwent one or more surgical revisions to relieve obstruction of the proximal and/or distal tube opening). Follow-up in these patients ranged from 8 to 49 months (mean ± standard deviation, 21.7 ± 14.1 months). The final postoperative visual acuities were within one line of the preoperative visual acuities or had improved in 11 (85%) patients. Complications included serous choroidal detachment (3 patients; 23%), conjunctival wound leak (2 patients; 15%), hyphema (1 patient; 8%), and tube obstruction by lens, iris, vitreous, or episcleral fibrous tissue (4 patients; 31 %). Conclusion: Aqueous tube shunt to a pre-existing episcleral encircling element is useful in treating complicated glaucomas after scleral buckling surgery. Fibrous obstruction of the external tube opening is a frequent complication in the early postoperative period, but it may be relieved by surgical revision.
Ophthalmology, 1994
Background: The authors report four cases of conjunctival epithelial invasion into the fibrous ca... more Background: The authors report four cases of conjunctival epithelial invasion into the fibrous capsule surrounding a Baerveldt glaucoma implant. All cases were associated with concurrent or recent prior scleral buckling surgery. Methods: Three patients had postoperative conjunctival wound leaks, one in the immediate postoperative period and the other two at 9 and 17 days postoperatively after release of the tube ligature. In the fourth patient, a fistulous tract developed over the implant after a first-stage insertion. Histopathologic confirmation of subconjunctival epithelialization was obtained in two of these patients. Results: Surgical revision was performed in all patients. Excision and debridement of all epithelium-lined subconjunctival tissues and extensive bipolar cautery were used in the three patients with wound leaks. Implant removal also was performed in one of these. Fistulectomy and bipolar cautery were used in the fourth patient. No recurrent wound leaks or other adverse sequelae were noted. Conclusions: Epithelial invasion of the subconjunctival space and inner bleb wall after implantation of glaucoma drainage devices can lead to breakdown of the conjunctival wound and persistent aqueous leak. Prior or concurrent scleral buckling surgery may predispose to this occurrence. Surgical revision involving epithelial debridement, cautery, and meticulous wound closure, with or without implant removal, has been used successfully in the management of this complication.
Ophthalmology, 1994
Background: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is ... more Background: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is installed through a single-quadrant conjunctival incision. The intermediate term results of a randomized study comparing the 350-and 500-mm 2 Baerveldt implants are reported. Methods: Seventy-three patients with medically uncontrollable, nonneovascular glaucomas associated with aphakia, pseudophakia, or failed filters were enrolled in a randomized, prospective study comparing 350-and 500-mm 2 Baerveldt implants. Sur gical success was defined as 6 mmHg ~ final intraocular pressure ~ 21 mmHg without glaucoma reoperation or devastating complication. Results: Of patients with 350-and 500-mm 2 implants, 93% and 88%, respectively, achieved surgical success (18-month life-table analysis, P = 0.93). The 500-mm 2 implants afforded intraocular pressure control with significantly fewer medications (0. 7 versus 1.3; P = 0.006). The postoperative visual acuities remained within one line of the pre operative visual acuities or improved in 62% and 66% of patients in the 350-and 500 mm2 groups, respectively (P = 0.93). Complication rates were statistically similar. The most frequent ones in the 350-and 500-mm 2 groups, respectively, were serous choroidal effusion (16% and 32%), strabismus (16% and 19%), anterior uveitis (14% and 11 %), and corneal or corneal graft edema (11% each). Conclusion: The intermediate-term results of the 350-and 500-mm 2 Baerveldt im plants were statistically comparable with respect to surgical and visual outcomes, as well as complications, although the larger implant was associated with a higher rate of some complications. However, the 500-mm 2 Baerveldt implant afforded intraocular pressure control with fewer medications than the 350-mm 2 implant. Ophthalmology 1994;
Journal of Glaucoma, 2015
Purpose: To determine the impact of 8 multicenter randomized clinical trials (RCTs) on glaucoma p... more Purpose: To determine the impact of 8 multicenter randomized clinical trials (RCTs) on glaucoma practice. Methods: An electronic survey was distributed to the members of the American Glaucoma Society (AGS). Each participant was asked 2 study-specific questions and 1 standard question common to all 8 RCTs assessing the study's impact on clinical practice.
Journal of Glaucoma, 1998
Journal of Glaucoma, 2013
To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral bucklin... more To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral buckling surgery for patients with glaucoma requiring a scleral buckle for retinal detachment repair. Retrospective, consecutive, noncomparative, and interventional case series of 30 eyes (30 patients) that underwent simultaneous scleral buckle and BGI surgery, using a staged (group 1, n=21 patients) or nonstaged (group 2, n=9 patients) approach to BGI implantation. Successful intraocular pressure (IOP) control was defined as 6 mm Hg≤IOP≤18 mm Hg. Although not statistically significant, mean best corrected visual acuity (LogMAR) improved from 2.0 before surgery to 1.7 after surgery (P=0.13) with a mean follow-up of 27.7 months. Of the 21 patients in group 1, only 13 (62%) required second-stage tube insertion at a mean of 7.0±8.0 months (range, 1 to 24 mo) postoperatively. For these eyes combined with group 2 eyes, mean IOP was reduced from 31.1±10.8 to 12.7±6.0 mm Hg (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and the mean number of glaucoma medications was reduced from 2.9±1.4 to 1.2±1.3 (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Life table rates of successful IOP control were 90% and 80% at 12 and 24 months, respectively. Combined scleral buckle and BGI is an effective technique for managing coexisting glaucoma and retinal detachment and provides the clinician with a useful surgical option while minimizing surgical risk.
Current Opinion in Ophthalmology, 1994
Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for... more Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for which the risk of failure of conventional filtering surgery is high. The basic design of these devices is similar; a silicone tube shunts aqueous humor from the anterior chamber to a fibrous capsule surrounding a synthetic plate or band positioned at the equatorial region of the globe. The capsule serves as a reservoir for aqueous drainage. Drainage implants have been used in the treatment of various refractory glaucomas, including those associated with aphakia and pseudophakia, prior unsuccessful filtering surgery, anterior segment neovascularization, trauma, youth, uveitis, epithelial downgrowth, iridocorneal endothelial syndrome, vitreoretinal disorders, and penetrating keratoplasty. Modifications in implant design and surgical technique have been developed to limit the occurrence of postoperative complications such as hypotony and its related sequelae, and strabismus.
American Journal of Ophthalmology, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Ophthalmology, 2001
A 29-year-old female presented two months following blunt ocular injury to both eyes. Her best co... more A 29-year-old female presented two months following blunt ocular injury to both eyes. Her best corrected visual acuity (BCVA) was 3/60 OD and no perception of light in OS. Presenting intraocular pressure (IOP) was 55mmHg OU on two topical antiglaucoma medications OU. Anterior segment examination revealed bilateral anteriorly subluxated crystalline lenses with shallow anterior chamber. Gonioscopy revealed complete synechial angle closure OU. Right-eye 25G Pars Plana Vitrectomy and Pars Plana Lensectomy were combined with non-valved Glaucoma Drainage Device (GDD) implantation, pars plana tube insertion was done.IOP was well controlled at discharge. Two-month post surgery, unintended IOP spike of 40mmHg in OD on a combination antiglaucoma eye drop was noted. Tube lumen was found to be occluded with vitreous. Repeat pars plana vitrectomy was required to restore the tube functioning. Pars plana tube insertion of GDD should be done in eyes with complete vitrectomy including adequate shaving of the vitreous base.
European journal of ophthalmology, Jan 17, 2015
To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that ... more To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that resolved after resection of the primary tumor. Retrospective case review of the clinical record, ultrasonographic images, and histopathology. A 6-year-old Asian girl, with a dark iris tumor, pigment dispersion, and secondary glaucoma, was initially treated with topical antiglaucoma medication and observation. Rapid growth prompted biopsy, revealing melanocytoma. As the tumor continued to grow, excision of the primary tumor was performed. Surgery proved curative in that the pigment dispersion slowly reabsorbed and her glaucoma resolved. In this case, rapid growth did not indicate malignant transformation. Initial observation for growth and judiciously timed surgical intervention prevented progression, loss of vision, and potentially the loss of the eye.
Investigative Ophthalmology & Visual Science, 2011
Investigative Ophthalmology & Visual Science, 2011
Ophthalmic Surgery, Lasers and Imaging Retina, 1997
The authors investigated the role of ultrasound biomicroscopy after ocular trauma. Ultrasound bio... more The authors investigated the role of ultrasound biomicroscopy after ocular trauma. Ultrasound biomicroscopy was performed in six eyes of six patients at the New York Eye and Ear Infirmary after a variety of traumatic ocular injuries. Eyes with angle recession, iridodialysis, cyclodialysis, hyphema, an intraocular foreign body, scleral laceration, and subluxed crystalline lens were imaged without complication. Ultrasound biomicroscopy aided in the diagnosis when visualization was limited by media opacities or distorted anterior segment anatomy. Ultrasound biomicroscopy is a safe and effective adjunctive tool for the clinical assessment and management of ocular trauma, especially when visualization is limited and multiple traumatic injuries are involved.
Journal of Glaucoma, 2021
PRECIS Sub-Tenon's implantation of the Xen® Gel stent resulted in significant intraocular pre... more PRECIS Sub-Tenon's implantation of the Xen® Gel stent resulted in significant intraocular pressure lowering along with a low rate of postoperative bleb needling, and a favorable bleb morphology on anterior segment optical coherence tomography. PURPOSE To assess clinical outcomes and bleb morphology following sub-Tenon's implantation of the Xen® Gel Stent (Allergan Inc., Dublin, Ireland). METHODS The medical records of patients who underwent sub-Tenon's Xen® Gel Stent implantation with intraoperative mitomycin-C via an open conjunctival approach were reviewed. Postoperative intraocular pressure (IOP) and number of glaucoma medications at 1,3,6,9 and 12 months were assessed. Bleb morphology was analyzed at various timepoints using anterior segment optical coherence tomography (AS-OCT, Topcon DRI OCT version 1.1.1). RESULTS Twenty-six eyes were included in the study. Mean age was 69.4±8.0 years. Mean preoperative IOP was 28.1±7.8▒mm Hg on an average of 3.5±0.9 glaucoma medications. Mean IOP at postoperative month 12 (n=23 eyes) was 12.9±4.0▒mm Hg (P<0.01) on an average of 0.3±0.6 (P<0.01) glaucoma medications. Three eyes (12%) required postoperative needle revision. Bleb morphology in the early postoperative period (≤ 3▒mo) was characterized by multiple small subconjunctival microcysts on AS-OCT. At the intermediate (6-12▒mo) and long-term (>12▒mo) time points, reduction in microcysts with multiple internal parallel layers of aqueous flow and a uniform pattern were more frequently noted. All functional blebs were characterized by the presence of a posterior episcleral fluid lake. Failed blebs showed absence of aqueous humor around the distal end of the microshunt. CONCLUSION Following an open conjunctival approach, sub-Tenon's placement of the Xen® Gel Stent with significant IOP lowering was achieved. In eyes with good shunt function, bleb morphology by AS-OCT showed a posterior episcleral fluid lake similar to findings following trabeculectomy.
Journal of glaucoma, 2018
To evaluate the efficacy and safety of a tube fenestration stented with a 10-0 polyglactin suture... more To evaluate the efficacy and safety of a tube fenestration stented with a 10-0 polyglactin suture for controlling early postoperative intraocular pressure (IOP) after Baerveldt glaucoma implant (BGI) surgery. The medical records of 110 patients (119 eyes) who underwent BGI surgery with a tube fenestration stented with a 10-0 polyglactin suture anterior to an occlusive tube ligature were retrospectively reviewed. Main outcome measures included IOP and number of glaucoma medications at postoperative day 1, week 1, and weeks 2 to 3 as well as complications occurring before ligature release. Mean±SD preoperative IOP was 30.9±9.3 mm Hg using an average of 3.8±1.1 glaucoma medications. A statistically significant reduction in IOP and glaucoma medications was observed at all timepoints during the first 3 postoperative weeks compared with baseline (P<0.001). Mean IOP on postoperative day 1, week 1, and weeks 2 to 3 was 18.4±12.2 mm Hg on no medication, 15.9±9.4 mm Hg on 1.0±1.3 medicatio...
Journal of glaucoma, Jan 26, 2017
Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and sev... more Vitreous occlusion of a glaucoma drainage implant (GDI) can lead to failure of the device and severely elevated intraocular pressure. The pathophysiology of tube obstruction is related to central and anterior displacement of vitreous that is drawn into and condenses within the proximal lumen of the tube. This can occur from days to years following GDI surgery. Successful management of vitreous-tube obstruction generally requires manual removal of the condensed vitreous plug with end-grasping forceps. This technique achieves reversal of tube blockage and restoration of GDI function. Amputation of the incarcerated vitreous alone with vitrectomy or neodymium:yttrium-aluminum-garnet vitreolysis does not consistently restore GDI function and risks persistent intraluminal tube obstruction.
Journal of Glaucoma, 2016
To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) following fai... more To evaluate the efficacy of transconjunctival revision (TCR) with mitomycin-C (MMC) following failed trabeculectomy. The medical records of 27 patients (27 eyes) who underwent TCR with subconjunctival injection of MMC by a single surgeon between September 2001 and August 2013 were retrospectively reviewed. The same surgical protocol was followed for all patients. Revision was performed using a microvitreoretinal blade through a small conjunctival incision. Main outcome measures included visual acuity, intraocular pressure (IOP), and number of glaucoma medications. Failure was defined as an IOP&amp;lt;5 or &amp;gt;14 mm Hg, loss of light perception, or need for additional glaucoma surgery. Mean interval between trabeculectomy and TCR was 56.4±57.2 months. Mean preoperative IOP was 21.9±6.8 mm Hg using 4.0±1.2 glaucoma medications. Fifteen (55.6%) patients met success criteria. At most recent follow-up, mean IOP and number of glaucoma medications for successful patients were 9.7±3.8 mm Hg and 0.6±1.1, respectively. Kaplan-Meier analysis revealed 1-, 2-, and 3-year success rates of 62%, 58%, and 53%, respectively. Three additional patients achieved success after undergoing a second TCR, and 1 patient achieved success after a third TCR. Postoperative complications included transient choroidal effusion (n=8), shallow anterior chamber requiring reformation (n=5), 5-fluorouracil-related corneal epitheliopathy (n=10), and bleb leak (n=1). TCR with adjunctive MMC is a safe and effective procedure following failure of a trabeculectomy. More than 1 revision may be necessary to achieve long-term IOP reduction.
Current Opinion in Ophthalmology, 2016
Purpose of review This article describes important aspects of postoperative management after trab... more Purpose of review This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery. Recent findings Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/ plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course. Summary Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.
American Journal of Ophthalmology, 1996
Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peri... more Primary cysts of the iris pigment epithelium frequently appear to be focal elevations of the peripheral iris. To differentiate them from other anterior segment tumors requires the ability to assess the distribution, tissue characteristics, and progression of such lesions, which we accomplished by using anterior segment echography. We reviewed the medical records of 49 consecutive patients referred to the Doheny Eye Institute for echographic evaluation of focal bulging of the peripheral iris. Echography of the anterior segment was performed on each patient by using an immersion technique. Clinical examination was also performed on 20 (41%) patients at the time of initial examination. We identified 52 iris pigment epithelial cysts in 52 eyes of the 49 patients studied. All lesions were single, localized to the posterior iris surface, and demonstrated a well-circumscribed, echolucent structure on B-scan echography. Average maximal sagittal thickness was 1.6 +/- 0.4 mm. Cysts were most frequently located in the inferotemporal quadrant (31%). Minimal increase in size or regression of lesions was noted in the nine patients (ten eyes) for whom follow-up echographic examinations were available. Primary iris pigment epithelial cysts possess characteristic features with regard to location, size, and internal structure, which can be accurately documented with echography. Clinically evident lesions tend to be between 1 and 4 mm in maximum sagittal thickness, conform to the contour of posterior chamber structures without distortion, produce anterior bulging of the peripheral iris, are preferentially located in the inferotemporal quadrant, and demonstrate limited potential for growth.
Ophthalmology, 1995
The authors present a retrospective study designed to assess the effectiveness of the Baerveldt g... more The authors present a retrospective study designed to assess the effectiveness of the Baerveldt glaucoma implant in controlling intraocular pressure (IOP) and maintaining visual function in eyes with neovascular glaucoma. The medical records of all 36 patients (36 eyes) who underwent Baerveldt glaucoma implantation for medically uncontrolled neovascular glaucoma between February 1991 and December 1992 were reviewed. Eighteen patients received Model 350 implants, 16 received Model 500 implants, and 2 received Model 200 implants. The 12- and 18-month life-table success rates (success defined as 6 mmHg < or = final IOP < or = 21 mmHg without additional glaucoma surgery or devastating complication) were 79% and 56%, respectively. Visual acuity remained stable or improved in 10 (31%) patients. Postoperative complications included flat anterior chamber, serous choroidal detachment, and obstruction of the proximal tube tip with fibrovascular tissue, each of which occurred in four (11%) patients. Eleven (31%) patients lost light perception. There were no significant differences between the groups receiving the Model 350 and Model 500 implants with respect to life-table success rates, percentage of postoperative IOP reduction, or complication rates. Patients in the Model 500 implant group required significantly fewer antiglaucoma medications post-operatively, but also demonstrated a significantly greater mean visual acuity reduction. Better preoperative visual acuity and increased patient age were positively correlated with a successful outcome. Baerveldt implantation is effective in controlling IOP elevation associated with neovascular glaucoma. Postoperative visual loss, despite adequate IOP control, is common. Young patient age and poorer preoperative visual acuity are significant predictors of surgical failure.
Ophthalmology, 1994
The treatment of glaucoma after scleral buckling surgery is often problematic. The authors invest... more The treatment of glaucoma after scleral buckling surgery is often problematic. The authors investigated a series of patients in whom a silicone tube was implanted to shunt aqueous from the anterior segment to the fibrous capsule surrounding a previously placed silicone episcleral encircling element. Methods: Thirteen patients were retrospectively reviewed. In each patient, a silicone tube was inserted through a small incision into the fibrous capsule overlying the scleral explant. In most patients, no attempt was made to secure the distal end of the tube to the silicone band. The proximal end of the tube was inserted into the eye via a needle track. Results: Successful control of intraocular pressure (lOP) (6 mmHg :s; final lOP :s; 21 mmHg with or without medication) was ultimately achieved in 11 (85%) of 13 patients (3 of the successful patients underwent one or more surgical revisions to relieve obstruction of the proximal and/or distal tube opening). Follow-up in these patients ranged from 8 to 49 months (mean ± standard deviation, 21.7 ± 14.1 months). The final postoperative visual acuities were within one line of the preoperative visual acuities or had improved in 11 (85%) patients. Complications included serous choroidal detachment (3 patients; 23%), conjunctival wound leak (2 patients; 15%), hyphema (1 patient; 8%), and tube obstruction by lens, iris, vitreous, or episcleral fibrous tissue (4 patients; 31 %). Conclusion: Aqueous tube shunt to a pre-existing episcleral encircling element is useful in treating complicated glaucomas after scleral buckling surgery. Fibrous obstruction of the external tube opening is a frequent complication in the early postoperative period, but it may be relieved by surgical revision.
Ophthalmology, 1994
Background: The authors report four cases of conjunctival epithelial invasion into the fibrous ca... more Background: The authors report four cases of conjunctival epithelial invasion into the fibrous capsule surrounding a Baerveldt glaucoma implant. All cases were associated with concurrent or recent prior scleral buckling surgery. Methods: Three patients had postoperative conjunctival wound leaks, one in the immediate postoperative period and the other two at 9 and 17 days postoperatively after release of the tube ligature. In the fourth patient, a fistulous tract developed over the implant after a first-stage insertion. Histopathologic confirmation of subconjunctival epithelialization was obtained in two of these patients. Results: Surgical revision was performed in all patients. Excision and debridement of all epithelium-lined subconjunctival tissues and extensive bipolar cautery were used in the three patients with wound leaks. Implant removal also was performed in one of these. Fistulectomy and bipolar cautery were used in the fourth patient. No recurrent wound leaks or other adverse sequelae were noted. Conclusions: Epithelial invasion of the subconjunctival space and inner bleb wall after implantation of glaucoma drainage devices can lead to breakdown of the conjunctival wound and persistent aqueous leak. Prior or concurrent scleral buckling surgery may predispose to this occurrence. Surgical revision involving epithelial debridement, cautery, and meticulous wound closure, with or without implant removal, has been used successfully in the management of this complication.
Ophthalmology, 1994
Background: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is ... more Background: The Baerveldt glaucoma implant is a large equatorial aqueous shunting device that is installed through a single-quadrant conjunctival incision. The intermediate term results of a randomized study comparing the 350-and 500-mm 2 Baerveldt implants are reported. Methods: Seventy-three patients with medically uncontrollable, nonneovascular glaucomas associated with aphakia, pseudophakia, or failed filters were enrolled in a randomized, prospective study comparing 350-and 500-mm 2 Baerveldt implants. Sur gical success was defined as 6 mmHg ~ final intraocular pressure ~ 21 mmHg without glaucoma reoperation or devastating complication. Results: Of patients with 350-and 500-mm 2 implants, 93% and 88%, respectively, achieved surgical success (18-month life-table analysis, P = 0.93). The 500-mm 2 implants afforded intraocular pressure control with significantly fewer medications (0. 7 versus 1.3; P = 0.006). The postoperative visual acuities remained within one line of the pre operative visual acuities or improved in 62% and 66% of patients in the 350-and 500 mm2 groups, respectively (P = 0.93). Complication rates were statistically similar. The most frequent ones in the 350-and 500-mm 2 groups, respectively, were serous choroidal effusion (16% and 32%), strabismus (16% and 19%), anterior uveitis (14% and 11 %), and corneal or corneal graft edema (11% each). Conclusion: The intermediate-term results of the 350-and 500-mm 2 Baerveldt im plants were statistically comparable with respect to surgical and visual outcomes, as well as complications, although the larger implant was associated with a higher rate of some complications. However, the 500-mm 2 Baerveldt implant afforded intraocular pressure control with fewer medications than the 350-mm 2 implant. Ophthalmology 1994;
Journal of Glaucoma, 2015
Purpose: To determine the impact of 8 multicenter randomized clinical trials (RCTs) on glaucoma p... more Purpose: To determine the impact of 8 multicenter randomized clinical trials (RCTs) on glaucoma practice. Methods: An electronic survey was distributed to the members of the American Glaucoma Society (AGS). Each participant was asked 2 study-specific questions and 1 standard question common to all 8 RCTs assessing the study's impact on clinical practice.
Journal of Glaucoma, 1998
Journal of Glaucoma, 2013
To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral bucklin... more To report on the usefulness of combined Baerveldt glaucoma implantation (BGI) and scleral buckling surgery for patients with glaucoma requiring a scleral buckle for retinal detachment repair. Retrospective, consecutive, noncomparative, and interventional case series of 30 eyes (30 patients) that underwent simultaneous scleral buckle and BGI surgery, using a staged (group 1, n=21 patients) or nonstaged (group 2, n=9 patients) approach to BGI implantation. Successful intraocular pressure (IOP) control was defined as 6 mm Hg≤IOP≤18 mm Hg. Although not statistically significant, mean best corrected visual acuity (LogMAR) improved from 2.0 before surgery to 1.7 after surgery (P=0.13) with a mean follow-up of 27.7 months. Of the 21 patients in group 1, only 13 (62%) required second-stage tube insertion at a mean of 7.0±8.0 months (range, 1 to 24 mo) postoperatively. For these eyes combined with group 2 eyes, mean IOP was reduced from 31.1±10.8 to 12.7±6.0 mm Hg (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and the mean number of glaucoma medications was reduced from 2.9±1.4 to 1.2±1.3 (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Life table rates of successful IOP control were 90% and 80% at 12 and 24 months, respectively. Combined scleral buckle and BGI is an effective technique for managing coexisting glaucoma and retinal detachment and provides the clinician with a useful surgical option while minimizing surgical risk.
Current Opinion in Ophthalmology, 1994
Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for... more Glaucoma drainage implants provide a useful option in the management of complicated glaucomas for which the risk of failure of conventional filtering surgery is high. The basic design of these devices is similar; a silicone tube shunts aqueous humor from the anterior chamber to a fibrous capsule surrounding a synthetic plate or band positioned at the equatorial region of the globe. The capsule serves as a reservoir for aqueous drainage. Drainage implants have been used in the treatment of various refractory glaucomas, including those associated with aphakia and pseudophakia, prior unsuccessful filtering surgery, anterior segment neovascularization, trauma, youth, uveitis, epithelial downgrowth, iridocorneal endothelial syndrome, vitreoretinal disorders, and penetrating keratoplasty. Modifications in implant design and surgical technique have been developed to limit the occurrence of postoperative complications such as hypotony and its related sequelae, and strabismus.
American Journal of Ophthalmology, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.