Fall 2017 Newsletter

Follow our latest updates in our Fall 2017 Newsletter

Fall 2017 Newsletter
7th Residency Announcement

Exciting Residency Announcement!

ACGME approves seventh resident complement; first increase in over 30 years!

Grand Rounds

Grand Rounds and Case Studies

Check out our weekly presentations

OTEP

OTEP

Ophthalmic Technician Education Program

LARGEST STUDY ON CHINESE AMERICANS PUBLISHED

LARGEST STUDY ON CHINESE
AMERICANS PUBLISHED

USC Ophthalmology Researchers Find More
Effective Treatments For Blinding Eye Diseases

EDUCATION

Case Study: Be Careful of the Cute Ones

Shan Bedrood
Presenter: Meghan Shan, MD, PhD Discussant: Sahar Bedrood, MD, PhD
 

History

  • 44-year-old woman presents with mild blunt trauma to her eye
  • Three days prior to presentation, patient was hit in the eye by her baby with a toy
  • Night prior to presentation, she developed pain and blurry vision OS
  • PMH: currently eight months pregnant
  • POH: high myopia s/p phakic IOL OU years ago; retinal hole OS s/p laser retinopexy
  • No past surgical history, family history or medications
  • Denies alcohol and smoking

Exam Findings

  • BCVA: 20/25 OD, HM OS (was unremarkable at ENT visit 05/2017)
  • Pupils: round and reactive OD, irregular and fixed OS
  • IOP: 17 OD, 49 OS
  • EOMI
  • Anterior exam: remarkable for left edematous eyelid, 1+ injection and edematous cornea. Within normal limits OD
Figure 1: Anterior slit lamp photos show displaced phakic intraocular lens.
Figure 1: Anterior slit lamp photos show displaced phakic intraocular lens.

Diagnosis

  • Displaced Phakic Intraocular Lens

Phakic Intraocular Lenses

  • Two types of phakic IOLs are FDA approved in the US
    • Posterior chamber IOL
    • Iris-fixated anterior chamber IOL
  • Typically used for patients with severe degrees of refractive error
    • Older than 21 years of age
    • Stable refraction (<0.5D change over one year)
    • Irido-corneal angle > 30 degrees
    • Central endothelial count >2000
    • Mesopic pupil <5-6mm
  • Contraindications
    • Active anterior segment disease (AC < 3-3.2mm; narrow angles, any angle abnormality)
    • Glaucoma / IOP >21mmHg
    • Anomalous irises / pupils
    • Pre-existing macular pathology
    • Retinal disease
    • Recurrent or chronic uveitis
    • Cataracts
    • Systemic diseases a/w poor healing (e.g. DM, connective tissue disease, autoimmune disease etc)
  • Outcomes at three years, as reported by Huang et al for the American Academy of Ophthalmology

Cute Ones Table

  • Complications
    • Endothelial cell damage and decompensation
    • Chronic inflammation
    • Angle scarring
    • Pigment dispersion (PCIOLs)
    • Iris atrophy
    • Pupillary block: ppx LPI 90 degrees apart
    • Cataracts
    • Endophthalmitis

Case Management

  • Was unable to obtain HMO approval for in-clinic LPI in a timely manner
  • Underwent same-day phakic IOL repositioning with surgical iridectomy OS
Figure 2: Phakic IOL repositioning with surgical iridectomy OS.
Figure 2: Phakic IOL repositioning with surgical iridectomy OS.
  • Post-op week 1:
    • BCVA 20/70 OS; IOP 15 OS
    • Lens haptics found covering surgical iridectomy
  • Considered LPI but iris was spastic and dilated post-op
  • Post-op month 1, IOP elevated to 38
  • Patient underwent phakic IOL extraction and given state of pregnancy, will defer further IOL placements to a later date

References

  • Alio, Jorge et al. Follow-up Study of More than 15 years of an Angle-Supported Phakic Intraocular Lens Model (ZB5M) for High Myopia. Outcomes and Complications. JAMA Ophthalmology 131 (12), 2013.
  • Allan, Barsam. Excimer Laser Refractive Surgery versus Phakic Intraocular Lenses for the Correction of Moderate to High Myopia (Review)”. Cochrane Database Syst Rev. Jan 18; 1:CD007679, 2012.
  • Huang, D et al. Phakic Intraocular Lens Implantation for the Correction of Myopia. A report by the American Academy of Ophthalmology. Ophthalmology Nov; 116 (11): 2244-58, 2009.
  • http://www.eyewiki.aao.org/Phakic_Intraocular_Lenses

Contact

Section Editors

  • Vivek Patel, MD, Associate Professor of Clinical Ophthalmology, Program Director, vivek.patel@med.usc.edu
  • Jesse Berry, MD, Assistant Professor of Clinical Ophthalmology, Associate Program Director, jesse.berry@med.usc.edu
  •  

    Produced by: Monica Chavez, John Daniel, and Dr. Vivek Patel
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