Publications by authors named "Preston H Blomquist"

40 Publications

Outcomes of resident-performed laser-assisted vs traditional phacoemulsification.

J Cataract Refract Surg 2020 09;46(9):1273-1277

From the Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Purpose: To compare the effectiveness of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPS) by resident surgeons.

Setting: Parkland Memorial Health and Hospital System, Dallas, Texas, USA.

Design: Prospective randomized study.

Methods: All surgeries to be performed by postgraduate year 3 and year 4 residents from October 2015 through June 2017 were eligible for inclusion. Patients were required to complete postoperative day 1, week 1, month 1, and month 3 visits. Specular microscopy was performed preoperatively and postoperatively. Surgeries were filmed, and each step was timed and compared. Surgeon and patient surveys were filled out postoperatively.

Results: Of the 135 eyes of 96 subjects enrolled in the study, 64 eyes received FLACS and 71 eyes received CPS. There was no significant difference in corrected distance visual acuity (CDVA), either preoperatively or at the postoperative day 1, week 1, month 1, or month 3 visits (P = .469, .539, .701, .777, and .777, respectively). Cumulated dissipated energy and irrigation fluid usage were not different between FLACS and CPS (P = .521 and .368, respectively), nor was there a difference in the reduction of endothelial cell counts postoperatively (P = .881). Wound creation (P = .014), cortical cleanup (P = .009), and IOL implantation (P = .031) were faster in the CPS group. Survey results indicated that the overall patient experience was similar for FLACS and CPS.

Conclusions: This first prospective randomized trial evaluating resident-performed FLACS shows that, in resident hands, FLACS provides similar results to CPS regarding visual acuity, endothelial cell loss, operative time, patient satisfaction, and surgical complication rate.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483782PMC
September 2020

Comparison of 1-field, 2-fields, and 3-fields fundus photography for detection and grading of diabetic retinopathy.

J Diabetes Complications 2019 12 12;33(12):107441. Epub 2019 Sep 12.

Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address:

Aim: To evaluate the sensitivity and specificity of 1-, 2-, and 3-fields, nonmydriatic (NM), 45° color photography compared with mydriatic ophthalmoscopy for detection of diabetic retinopathy (DR).

Methods: Masked, comparative case series was performed utilizing a group of 128 diabetic patients (256 eyes) with various stages of DR who underwent both 3-fields NM color photography and ophthalmologic examination. In a blinded manner, the same optometrist who read the original 3-fields images for a patient read the 1- and 2-fields photographs on separate dates later.

Results: The sensitivity and specificity of digital retinal photography compared with dilated ophthalmoscopy were, respectively: 88% and 76% for 1-field; 94% and 69% for 2-fields; and 100% and 79% for 3-fields. The proportion of agreement between fundus photography reading and exam DR diagnosis were 58% for 1-field, 58% for 2-fields, and 77% for 3-fields. Kappa and Cramer's V statistics for 1-, 2-, and 3-fields were 0.55 and 0.60, 0.52 and 0.57, and 0.72 and 0.74, respectively. Three-fields measurement of DR was most similar to the dilated ophthalmological exam overall and across all DR severity levels.

Conclusions: Compared to 1- and 2-fields fundus photography, 3-fields is superior for detecting vision-threatening DR. One- and 2-fields have reasonable sensitivity for DR screening.
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http://dx.doi.org/10.1016/j.jdiacomp.2019.107441DOI Listing
December 2019

Gender Differences in Case Volume Among Ophthalmology Residents.

JAMA Ophthalmol 2019 Sep;137(9):1015-1020

Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.

Importance: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear.

Objective: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency.

Design, Setting, Participants: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018.

Main Outcomes And Measures: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status.

Results: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P < .001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P < .001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P < .001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P = .81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P < .001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P < .001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P = .11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P = .008).

Conclusions And Relevance: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study.
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http://dx.doi.org/10.1001/jamaophthalmol.2019.2427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646997PMC
September 2019

Pupil-Involving Third Cranial Nerve Paresis at High Altitude.

High Alt Med Biol 2018 Sep 30;19(3):286-287. Epub 2018 May 30.

Department of Ophthalmology, University of Texas Southwestern Medical Center , Dallas, Texas.

Blomquist, Preston H. Pupil-involving third cranial nerve paresis at high altitude. High Alt Med Biol. 19:286-287, 2018.-Although sixth cranial nerve palsies are a well-recognized entity at high altitude, other cranial nerve palsies due to altitude are much more uncommon. A case of a 55-year-old woman is presented who flew from Dallas, Texas (elevation 176 m) to Breckenridge, Colorado, where she hiked up to 3600 m above sea level. She developed a pupil-involving right third cranial nerve paresis that resolved over the next 3 months. In the absence of significant abnormalities on neuroimaging and serum laboratories, the etiology is presumed to be due to high altitude.
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http://dx.doi.org/10.1089/ham.2018.0033DOI Listing
September 2018

Supervised resident manual small-incision cataract surgery outcomes at large urban United States residency training program.

J Cataract Refract Surg 2018 01;44(1):34-38

From the Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:

Purpose: To examine the outcomes of resident-performed manual small-incision cataract surgery (SICS) in an urban academic setting.

Setting: Parkland Memorial Hospital, Dallas, Texas, USA.

Design: Retrospective case series.

Methods: Manual SICS was used only in selected cases for which phacoemulsification was expected to be difficult, namely for mature or brunescent cataracts, traumatic cataracts, and pseudoexfoliation syndrome or other causes of zonular weakness. All manual SICS cases performed by resident physicians as the primary surgeon over a 5-year period were reviewed. Postoperative visual acuity, intraoperative complications, and early postoperative complications were the main outcomes measured.

Results: For the 52 cases identified, the mean preoperative visual acuity was 2.165 logarithm of the minimum angle of resolution (logMAR) ± 0.141 (SD) (95% confidence interval) (slightly better than had motion acuity), improving to 0.278 ± 0.131 logMAR (Snellen 20/38) corrected visual acuity postoperatively. Of the 52 cases, the most frequent intraoperative complications were iris prolapse (5 cases [9.6%]) and zonular dialysis (4 cases [7.7%]), with vitreous loss occurring in 1 case (1.9%). The most frequent postoperative complications were cystoid macular edema (3 cases [5.8%]), retained ophthalmic viscosurgical device (2 cases [3.8%]), intraocular lens displacement (2 cases [3.8%]), and microhyphema (2 cases [3.8%]).

Conclusions: Although the more advanced wound construction in manual SICS might be challenging to surgeons unfamiliar with the technique, it was a safe and efficacious technique in the hands of learning residents. With several advantages over phacoemulsification, such as cost and ability to remove very dense nuclei, manual SICS will play a valuable role in modern cataract surgery.
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http://dx.doi.org/10.1016/j.jcrs.2017.09.032DOI Listing
January 2018

Use of Intravenous Vancomycin and Cefepime in Preventing Endophthalmitis After Open Globe Injury.

J Ocul Pharmacol Ther 2016 09 14;32(7):437-41. Epub 2016 Jul 14.

Department of Ophthalmology, The University of Texas Southwestern Medical Center , Dallas, Texas.

Purpose: The choice and route of antibiotic prophylaxis in the setting of open globe injury remains controversial. We investigated the utility of intravenous vancomycin and cefepime prophylaxis in preventing endopthalmitis after open globe injury.

Methods: The charts of 224 patients who presented to Parkland Memorial Hospital and Children's Medical Center in Dallas, Texas, between June 1, 2009 and June 30, 2013, with open globe injury and who were treated with prophylactic intravenous vancomycin and cefepime were retrospectively reviewed. Data collection included time from injury to presentation, mechanism of injury, details of ophthalmological examination, timing of open globe repair, and length of follow-up. All patients were treated with intravenous vancomycin and cefepime for 48 h after presentation.

Results: The primary outcome measure was rate of endophthalmitis, and the secondary outcome measure was identification of risk factors for developing endophthalmitis. Out of 224 patients who presented after open globe injury, 3 patients had signs of endophthalmitis on initial exam before starting antibiotics, and 2 patients developed endophthalmitis after initiation of vancomycin and cefepime (0.9%). Delayed time from injury to presentation was a risk factor for post-traumatic endophthalmitis (P = 0.0002). The association between presence of intraocular foreign body and post-traumatic endophthalmitis was approaching significance (P = 0.064).

Conclusions: When intravenous vancomycin and cefepime are used prophylactically after open globe injury, the rate of endophthalmitis is low.
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http://dx.doi.org/10.1089/jop.2016.0051DOI Listing
September 2016

Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease.

Ocul Surf 2016 04 13;14(2):168-88. Epub 2016 Feb 13.

Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA. Electronic address:

Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
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http://dx.doi.org/10.1016/j.jtos.2016.02.001DOI Listing
April 2016

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis--A Comprehensive Review and Guide to Therapy. I. Systemic Disease.

Ocul Surf 2016 Jan 5;14(1):2-19. Epub 2015 Nov 5.

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Electronic address:

The intent of this review is to comprehensively appraise the state of the art with regard to Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to the ocular surface complications and their management. SJS and TEN represent two ends of a spectrum of immune-mediated, dermatobullous disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. The widespread keratinocyte death seen in SJS/TEN is rapid and irreversible, and even with early and aggressive intervention, morbidity is severe and mortality not uncommon. We have divided this review into two parts. Part I summarizes the epidemiology and immunopathogenesis of SJS/TEN and discusses systemic therapy and its possible benefits. We hope this review will help the ophthalmologist better understand the mechanisms of disease in SJS/TEN and enhance their care of patients with this complex and often debilitating disease. Part II (April 2016 issue) will focus on ophthalmic manifestations.
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http://dx.doi.org/10.1016/j.jtos.2015.10.002DOI Listing
January 2016

Outcomes of manual extracapsular versus phacoemulsification cataract extraction by beginner resident surgeons.

J Cataract Refract Surg 2013 Nov 24;39(11):1698-701. Epub 2013 Aug 24.

From the Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Purpose: To evaluate the safety and efficacy of phacoemulsification cataract extraction and manual extracapsular cataract extraction (ECCE) performed by beginning resident surgeons.

Setting: Dallas Veterans Affairs Medical Center, Dallas, Texas, USA.

Design: Retrospective cohort study.

Methods: A review was performed of each resident's series of initial cataract surgery procedures as a late first-year or second-year resident. Data were collected for cases performed over almost a 6-year period during which initially the first primary surgeon cases were ECCE and later, the first primary surgeon cases were phacoemulsification. For each case, the following data were gathered: technique of cataract extraction, laterality, resident, vitreous loss or dropped nucleus, placement of posterior chamber intraocular lens (IOL), and need for reoperation within 90 days of surgery.

Results: Complications occurred in 6 (2.5%) of 244 cases in which phacoemulsification was performed by a beginner resident primary surgeon and in 7 (4.1%) of 172 cases in which ECCE was used (P=.40). Posterior chamber IOLs were placed in all but 2 phacoemulsification cases and 4 ECCE cases (P=.24). Moreover, 3 cases in the phacoemulsification group and 1 case in the ECCE group required a reoperation within 90 days (P=.65).

Conclusion: Phacoemulsification cataract extraction can be taught safely and effectively to residents with no cataract surgery experience as a primary surgeon.
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http://dx.doi.org/10.1016/j.jcrs.2013.05.037DOI Listing
November 2013

Ethical responsibility to disclose surgical errors.

J Cataract Refract Surg 2012 Dec;38(12):2209-10; author reply 2210

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http://dx.doi.org/10.1016/j.jcrs.2012.10.004DOI Listing
December 2012

A multicenter analysis of the ophthalmic knowledge assessment program and American Board of Ophthalmology written qualifying examination performance.

Ophthalmology 2012 Oct 28;119(10):1949-53. Epub 2012 Jul 28.

Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA.

Objective: To compare the performance on the American Board of Ophthalmology Written Qualifying Examination (WQE) with the performance on step 1 of the United States Medical Licensing Examination (USMLE) and the Ophthalmic Knowledge Assessment Program (OKAP) examination for residents in multiple residency programs.

Design: Comparative case series.

Participants: Fifteen residency programs with 339 total residents participated in this study. The data were extracted from the 5-year American Board of Ophthalmology report to each participating program in 2009 and included residency graduating classes from 2003 through 2007. Residents were included if data were available for the USMLE, OKAP examination in ophthalmology years 1 through 3, and the WQE score. Residents were excluded if one or more of the test scores were not available.

Methods: Two-sample t tests, logistic regression analysis, and receiver operating characteristic (ROC) curves were used to examine the association of the various tests (USMLE, OKAP examination year 1, OKAP examination year 2, OKAP examination year 3, and maximum OKAP examination score) as a predictor for a passing or failing grade on the WQE.

Main Outcome Measures: The primary outcome measure of this study was first time pass rate for the WQE.

Results: Using ROC analysis, the OKAP examination taken at the third year of ophthalmology residency best predicted performance on the WQE. For the OKAP examination taken during the third year of residency, the probability of passing the WQE was at least 80% for a score of 35 or higher and at least 95% for a score of 72 or higher.

Conclusions: The OKAP examination, especially in the third year of residency, can be useful to residents to predict the likelihood of success on the high-stakes WQE examination.
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http://dx.doi.org/10.1016/j.ophtha.2012.06.010DOI Listing
October 2012

Resident experience with toric and multifocal intraocular lenses in a public county hospital system.

J Cataract Refract Surg 2012 May 15;38(5):793-8. Epub 2012 Mar 15.

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.

Purpose: To study the outcomes of toric and multifocal intraocular lens (IOL) implantation performed by resident surgeons.

Setting: Parkland Health and Hospital System, Dallas, Texas, USA.

Design: Case series.

Methods: Patients seen between July 2008 and May 2011 and meeting inclusion criteria (including >1.0 diopter [D] of astigmatism in toric group and <0.75 D astigmatism in multifocal group) were offered implantation of the study IOLs. Major outcomes were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) and, for the multifocal IOL, near visual acuity. Residents were surveyed about their knowledge regarding these IOLs.

Results: Seventy-nine eyes of 60 patients received an Alcon Acrysof toric IOL. Eighteen eyes of 10 patients received an Alcon Acrysof Restor IOL. In the toric group, 57% of eyes achieved a postoperative UDVA of 20/25 or better and 90% achieved 20/40 or better. The CDVA was 20/25 or better in 92% of eyes. The mean refractive cylinder was 1.69 D preoperatively and 0.38 D postoperatively. In the multifocal group, 78% of patients achieved a UDVA of 20/25 or better and 94% achieved 20/40 or better. All patients had a CDVA of 20/25 or better. Near vision was Jaeger 3 or better in 94%. The survey showed that residents have a strong comfort level with preoperative and surgical techniques for premium IOLs after their experience in the residency setting.

Conclusion: Residents in public county hospitals can be taught to use premium IOLs with good success rates, comparable to those in other published studies.

Financial Disclosure: Dr. McCulley is a consultant to Alcon Laboratories, Inc., and Dr. Aggarwal is on the speaker's bureau for Alcon Laboratories, Inc. No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2011.11.043DOI Listing
May 2012

Risk factors for vitreous complications in resident-performed phacoemulsification surgery.

J Cataract Refract Surg 2012 Feb 21;38(2):208-14. Epub 2011 Nov 21.

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.

Purpose: To identify risk factors for intraoperative vitreous complications in resident-performed phacoemulsification surgery.

Setting: Two urban public county hospitals.

Design: Case series.

Methods: Phacoemulsification cataract surgeries performed by residents between January 4, 2005, and January 8, 2008, were retrospectively reviewed. Clinical characteristics of patients with and without intraoperative vitreous complications were compared and independent factors associated with vitreous complications identified using univariate and multivariate analysis.

Results: Of 2434 cases meeting inclusion criteria, there were 92 vitreous complications (3.8%). On univariate analysis, significant preoperative risk factors for vitreous complications included older age (P=.020), poor preoperative corrected distance visual acuity (CDVA) (P=.007), left eye (P=.043), history of trauma (P=.045), prior pars plana vitrectomy (P=.034), dementia (P=.020), phacodonesis (P=.014), zonule dehiscence (P<.0001), posterior polar cataract (P=.037), white/mature cataract (P=.005), dense nuclear sclerotic cataract (P=.0006), and poor red reflex (P=.002). Factors that remained significant on multivariate analysis were older age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05), poor preoperative CDVA (OR, 1.52; 95% CI, 1.14-2.03), left eye (OR, 1.63; 95% CI, 1.05-2.51), prior pars plana vitrectomy (OR, 1.88; 95% CI, 1.01-3.51), dementia (OR, 3.65; 95% CI, 1.20-11.17), and zonule dehiscence (OR, 8.55; 95% CI, 3.92-18.63).

Conclusion: Elements of the preoperative history and examination can identify patients at higher risk for intraoperative complications during resident-performed phacoemulsification surgery.
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http://dx.doi.org/10.1016/j.jcrs.2011.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277662PMC
February 2012

Penetrating globe injury during infraorbital nerve block.

Arch Otolaryngol Head Neck Surg 2011 Apr 17;137(4):396-7. Epub 2011 Jan 17.

Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9057, USA.

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http://dx.doi.org/10.1001/archoto.2010.239DOI Listing
April 2011

Ocular complications of systemic medications.

Am J Med Sci 2011 Jul;342(1):62-9

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390-9057, USA.

Systemic medications can have adverse effects on the eyes that range from dry eye syndrome, keratitis and cataract to blinding complications of toxic retinopathy and optic neuropathy. This review focuses on major drugs with common ocular side effects and highlights more recently recognized associations with systemic medications. Recommendations for ocular monitoring are given for medications with frequent and/or severe adverse ocular effects.
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http://dx.doi.org/10.1097/MAJ.0b013e3181f06b21DOI Listing
July 2011

Validation of Najjar-Awwad cataract surgery risk score for resident phacoemulsification surgery.

J Cataract Refract Surg 2010 Oct;36(10):1753-7

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.

Purpose: To validate the Najjar-Awwad cataract surgery risk score for residents, which has been proposed to predict surgical complexity and risk.

Setting: Two urban public county hospitals.

Design: Case series.

Methods: Phacoemulsification cataract surgeries performed by residents between January 2005 and April 2008 were retrospectively reviewed. The cataract risk score was calculated retrospectively. Intraoperative complications included posterior and anterior capsular tears, vitreous prolapse, dropped nucleus, and conversion to manual extracapsular cataract extraction.

Results: Of the cases performed by 33 residents, 1833 met the inclusion criteria. There were 120 complications (6.5%); the rate of complications involving vitreous prolapse or loss (including dropped nucleus) was 3.2%. Significant risk factors in the risk score associated with intraoperative complications were dense nuclear sclerosis (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32-3.26; P = .004) and poor red reflex (OR, 2.10; 95% CI, 1.45-3.06; P = .00007). Cataract risk scores ranged from 3 to 16. The score was less than 5 in 85 cases (4.6%) and less than 7 in 885 cases (48.3%). The OR for complications increased significantly when the risk score was higher than 6 (OR, 2.11; 95% CI, 1.42-3.14; P = .0002).

Conclusions: Although the Najjar-Awwad cataract surgery risk score can be used to predict intraoperative complications at the time of cataract surgery, the complication rate did not significantly increase until the score reached 7. There were few cases with scores lower than 5 in these county hospital populations. Beginning surgeons should be given cases with a risk score of less than 7.
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http://dx.doi.org/10.1016/j.jcrs.2010.04.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595548PMC
October 2010

Ophthalmic Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis and Relation to SCORTEN.

Am J Ophthalmol 2010 Oct 8;150(4):505-510.e1. Epub 2010 Jul 8.

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX75390-9057, USA.

Purpose: To evaluate the severity of ocular involvement of patients with Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap, and to investigate the relationship of the SCORTEN (a severity-of-illness score for SJS and TEN based on a minimal set of well-defined variables calculated within 24 hours of admission) with eye disease in this patient population.

Design: Retrospective observational case series.

Methods: Charts of all patients admitted to the Parkland Memorial Hospital Burn Center with a preliminary diagnosis of SJS, SJS/TEN overlap, or TEN between 1998 and 2008 were reviewed. Patients were included for study if they met clinical criteria, had positive diagnostic skin biopsy, and had dermatologic and ophthalmologic consultations. Eighty-two patients with a diagnosis of SJS, SJS/TEN overlap, or TEN met inclusion criteria. Ocular manifestations were classified as mild, moderate, or severe. Admission data were used to calculate the SCORTEN. Main outcome measure was the severity of ocular involvement with respect to diagnosis and SCORTEN.

Results: Overall, 84% of patients had ocular involvement (71% SJS, 90% TEN, 100% SJS/TEN overlap). There was no difference in the severity of acute ocular complications among groups. While the SCORTEN value did correlate well with mortality rate (correlation coefficient 0.97, P = .005), there was no correlation between the SCORTEN value and severity of eye involvement in the acute setting. There was also no association of any individual diagnosis of SJS/overlap/TEN with the severity of eye involvement, although eye findings are more common in TEN (P = .03).

Conclusions: Ocular damage in the acute setting was more frequent in patients with epidermal detachment >10% of the total body surface area. The SCORTEN value did not correlate with the severity of eye involvement in the acute setting.
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http://dx.doi.org/10.1016/j.ajo.2010.04.026DOI Listing
October 2010

Left-handed residents.

J Cataract Refract Surg 2010 Jan;36(1):186; author reply 186

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http://dx.doi.org/10.1016/j.jcrs.2009.07.031DOI Listing
January 2010

Vitreoretinal training during residency.

Ophthalmology 2009 Dec;116(12):2486-2486.e1

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http://dx.doi.org/10.1016/j.ophtha.2009.08.019DOI Listing
December 2009

Fusarium keratitis associated with ReNu with MoistureLoc sample kits.

Eye Contact Lens 2008 Nov;34(6):337-9

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9057, USA

Objective: To describe a patient who developed contact-lens associated Fusarium sp. keratitis associated with use of sample kits of ReNu with MoistureLoc purchased after worldwide recall of the product from the market.

Methods: The patient's history, clinical presentation, and laboratory workup were reviewed.

Results: In April 2008, a 64-year-old woman with a 45-year history of contact lens wear presented with a large central corneal infiltrate after receiving empiric antibiotic treatment before referral. Corneal and contact lens cultures revealed Fusarium sp. The patient had been using sample kits of ReNu with MoistureLoc purchased from a dollar store to clean her lenses.

Conclusions: Although a worldwide recall of ReNu with MoistureLoc occurred in May 2006, the product may still be obtained in discount stores through sale of professional sample kits. Patients with contact lens-associated keratitis should be questioned regarding specifics of their contact lens hygienic regimen.
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http://dx.doi.org/10.1097/ICL.0b013e31818c25bfDOI Listing
November 2008

Computed tomography in the diagnosis of occult open-globe injuries.

Ophthalmology 2007 Aug;114(8):1448-52

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.

Purpose: To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury.

Design: Retrospective chart review.

Participants: Forty-eight eyes (of 46 patients), 34 of which were found to have an occult open-globe injury on surgical exploration.

Methods: A retrospective chart review of all eyes of patients 18 years or older undergoing surgical exploration to rule out occult open-globe injury after CT examination at Parkland Memorial Hospital between October, 1998, and September, 2003, was conducted. Patients with obvious corneal or corneoscleral lacerations or with uveal prolapse were excluded. The CT films were obtained and independently reviewed by 3 masked observers (2 neuroradiologists and 1 ophthalmologist).

Main Outcome Measures: Presence of occult open-globe injury with respect to radiographic globe and orbital findings.

Results: The sensitivity of CT for determining occult open-globe injury varied from 56% to 68% between the observers, specificity ranged from 79% to 100%, positive predictive value ranged from 86% to 100%, and negative predictive value ranged from 42% to 50%. Open-globe injuries averaged more CT findings per patient compared with intact globes (P = 0.047). Statistically significant CT findings for occult open-globe injury included any change in globe contour (P = 0.001), obvious volume loss (P = 0.003), an absent or dislocated lens (P = 0.048), vitreous hemorrhage (P = 0.003), and retinal detachment (P = 0.044). Additionally, moderate to severe change in globe contour, obvious volume loss, total vitreous hemorrhage, and absence of lens were seen only in eyes with occult rupture.

Conclusions: Although CT scanning may provide valuable information in patients in whom an occult open-globe injury is suspected, its sensitivity and specificity are inadequate to be relied on fully, and such patients generally should be taken to the operating room for formal surgical evaluation. Significant changes in globe contour or obvious volume loss are strong predictors of globe rupture, and any vitreous hemorrhage should be a concern for occult injury.
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http://dx.doi.org/10.1016/j.ophtha.2006.10.051DOI Listing
August 2007

Progressive outer retinal necrosis complicated by combined central retinal vein and central retinal artery occlusions.

Retin Cases Brief Rep 2007 ;1(3):138-40

From the Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas.

Purpose: To describe an uncommon presentation and course of progressive outer retinal necrosis.

Methods: A 36-year-old man presented with unilateral optic disk edema with enhancement of the optic nerve sheath shown by magnetic resonance imaging. Intravenous methylprednisolone treatment was initiated.

Results: Two days later, he developed multiple discrete areas of outer retinal opacification with areas of confluence in the periphery of the retina. Results of laboratory testing for antibody to human immunodeficiency virus were positive. Therapy for progressive outer retinal necrosis was initiated, and the patient developed combined central retinal vein and central retinal artery occlusions 3 days later.

Conclusions: Although usually characterized by a lack of vascular inflammation, progressive outer retinal necrosis may lead to vascular occlusions.
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http://dx.doi.org/10.1097/01.ICB.0000279642.61206.64DOI Listing
November 2014

Association between ocular injuries and internal orbital fractures.

J Oral Maxillofac Surg 2007 Apr;65(4):713-20

University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.

Purpose: The physical mechanism of orbital blowout fractures has been debated for years by surgeons. Three main theories have been promulgated, including the hydraulic theory, the contact of globe-to-orbital wall theory, and the bone buckling theory. One might anticipate a strong association of blowout fractures and traumatically induced ocular injuries with the hydraulic and globe-to-wall theories because in both, the force is delivered directly to the ocular globe. This study was performed to assess the association between orbital blowout fractures and ocular injuries.

Patients And Methods: Records of patients with orbital blowout fractures were collected from a single hospital. Those with complete records that included a thorough ophthalmologic examination were collected, and information about the nature of the injury to the bone and the ocular globe was tabulated.

Results: A total of 225 patients ranging in age from 13 to 98 years (mean, 34.9 yr) who had sustained 240 blowout fractures (15 were bilateral) met the inclusion criteria. In all, 53 fractures (22%) involved ocular injuries that were thought to be directly associated with ocular trauma. The most common positive ocular finding was commotio retinae, which was present in 21 of 60 globes with significant traumatic ocular findings. This was followed in frequency by traumatic mydriasis (19 globes) and traumatic iritis (15 globes). Most ocular injuries were minor.

Conclusions: The low incidence of significant ocular injury may indicate that direct contact of the globe with the traumatic force is not common. This finding gives credence to the buckling theory of blowout fracture, which seems more likely in most cases.
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http://dx.doi.org/10.1016/j.joms.2006.09.006DOI Listing
April 2007

Ocular and facial injuries associated with the use of immersion heaters in an inmate population.

Am J Ophthalmol 2006 Jun;141(6):1147-8

UT Southwestern, Department of Ophthalmology, Dallas, TX 75390, USA.

Purpose: To report ocular and facial injuries caused by the use of electric immersion heaters in an inmate population.

Design: Prospective observational case series.

Methods: Data were recorded over a six-month period on age, gender, mechanism of injury, examination, and treatment of Dallas County inmates who experienced ophthalmic injuries from immersion heaters and were referred to a tertiary-care center.

Results: Eight male inmates were treated for thermal ocular injuries, which occurred within jail cells as a result of cooking explosions from electric immersion heaters, known by inmates as "stingers." All patients had thermal eyelid burns, either first- or second-degree facial burns, and corneal abrasions with corneal edema. Corneal metallic foreign bodies were removed in one patient, and three patients underwent debridement for corneal sloughing.

Conclusions: Immersion heater-related accidents may cause thermal injuries within the inmate population. Physicians evaluating incarcerated patients with ocular trauma should be aware of immersion heaters as a common cause.
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http://dx.doi.org/10.1016/j.ajo.2006.01.034DOI Listing
June 2006

Decrease in complications during cataract surgery with the use of a silicone-tipped irrigation/aspiration instrument.

J Cataract Refract Surg 2005 Jun;31(6):1194-7

Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75300-9057, USA.

Purpose: To compare rates of vitreous loss during cataract surgery when a silicone-tipped irrigation/aspiration (I/A) instrument is used for cortex removal as opposed to a metal tip.

Setting: Parkland Memorial Hospital, Dallas, Texas, USA.

Methods: A retrospective chart review of all patients who had cataract extraction by phacoemulsification by third-year ophthalmology residents between September 2000 and February 2004 was conducted. A silicone-tipped I/A instrument was used to remove cortex for all surgeries beginning in September 2002, whereas a metal I/A tip was used previously.

Results: Of the 1072 cases performed with a metal I/A tip, there were 13 cases of vitreous loss during cortex removal (rate 1.2%) and 26% of all vitreous loss during that time occurred during cortex removal. Of the 805 cases performed with a silicone I/A tip, there was a single case (0.1%) of vitreous loss during cortex removal (P=.004); only 4% of all vitreous loss during that time occurred during cortex removal (P=.011).

Conclusion: The overall incidence of vitreous loss during cortex removal and the ratio of vitreous loss during cortex removal to all cases of vitreous loss were significantly decreased using the silicone-tipped I/A instrument.
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http://dx.doi.org/10.1016/j.jcrs.2004.11.049DOI Listing
June 2005

spectrum of ocular trauma at an urban county hospital.

Tex Med 2004 Dec;100(12):60-3

Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9057, USA.

A prospective study of all patients with ocular trauma seen by an ophthalmologist at Parkland Memorial Hospital's emergency department or ophthalmology clinic in Dallas between December 1, 2001, and April 30, 2002, was performed. One hundred fifty-seven patients with 181 injured eyes were included. Eighty-three percent of patients were male, and 64% were younger than 40 years. Assault was the most common setting for injury (31%), followed by work (27%) and home (17%). Blunt trauma was the usual method of assault injury. Alcohol was involved more often in assault than accidental injuries (P < .001). Most work injuries involved young Latino men, usually performing construction work. Permanent severe visual loss in one eye occurred in 14% of patients, usually as a result of open globe injury. Focusing prevention strategies at employers and blue-collar workers, especially young Latino men in high-risk occupations, may decrease ocular trauma in the Dallas area.
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December 2004
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