Publications by authors named "Ryan B Rush"

43 Publications

Gas Tamponade for the Prevention of Postoperative Vitreous Hemorrhaging After Diabetic Vitrectomy: A Randomized Clinical Trial.

Am J Ophthalmol 2022 Jun 25;242:173-180. Epub 2022 Jun 25.

Panhandle Eye Group, Amarillo, TX, USA (R.B.R, S.W.R); Texas Tech University Health Science Center, Amarillo, TX, USA (R.B.R, S.W.R).

Purpose: To compare vitreous substitution with sulfur hexafluoride (SF6) gas to balanced salt solution (BSS) for the prevention of postoperative vitreous hemorrhage (VH) in proliferative diabetic retinopathy (PDR) patients undergoing pars plana vitrectomy (PPV) for the indication of non-clearing VH.

Methods: One hundred forty-four PDR subjects requiring PPV for the indication of non-clearing VH were enrolled into the trial. Subjects were prospectively randomized into 1 of 2 vitreous substitution groups: Group A subjects underwent 20% to 30% SF6 gas tamponade, whereas Group B subjects underwent vitreous substitution with BSS. The primary outcome was the incidence of postoperative VH during the 6-month trial period. Secondary outcomes were unplanned PPV for VH and best corrected visual acuity (BCVA) at 6-months follow-up.

Results: Ninety-six subjects underwent randomization and completed 6-months follow-up. Postoperative VH during the trial period occurred in 6 of 54 subjects in Group A (SF6) (11.1%) and 14 of 42 in Group B (BSS) (33.3%) (P = .008). Unplanned PPV during the trial period for postoperative VH occurred in 2 of 54 in Group A (3.7%) and 6 of 42 in Group B (14.2%) (P = .06). The mean BCVA was not significantly different at 6-months follow-up between groups (P = .58).

Conclusions: This trial indicates that vitreous substitution with SF6 gas lowers the incidence of postoperative VH compared with BSS in PDR subjects undergoing PPV for the indication of non-clearing VH at 6-months follow-up. Specialists may consider SF6 gas tamponade during PPV as a means of helping reduce postoperative VH in this patient population. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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http://dx.doi.org/10.1016/j.ajo.2022.06.015DOI Listing
June 2022

Patient Attitudes and Desirability Regarding Immediate Sequential Bilateral Cataract Surgery.

Clin Ophthalmol 2022 29;16:1375-1381. Epub 2022 Apr 29.

Texas Tech University Health Science Center, Amarillo, TX, 79106, USA.

Purpose: To analyze patient attitudes and desirability regarding routine immediate sequential bilateral cataract surgery (ISBCS).

Methods: This study was conducted as a prospective, consecutive survey-based case series from a single private practice institution serving a mostly rural population. A standardized phone survey assessing patient perspectives on ISBCS was administered to patients before and after routine delayed sequential bilateral cataract surgery (DSBCS) was performed. Subject responses were analyzed, including a subset analysis on patient responses under a variety of circumstances.

Results: There were 61 patients enrolled into the study and 47 completed the surveys before and after routine DSBCS (77.0% completion rate). Thirty-nine (83.0%) of respondents had a favorable outlook of ISBCS preoperatively, whereas 36 (76.6%) had a favorable outlook of ISBCS postoperatively (p>0.05). On the postoperative questionnaire, twenty-five (53.2%) of respondents were willing to accept additional surgical risk if necessary to receive ISBCS, and this finding was significant between the subgroup of patients with systemic health co-morbidities compared to those without systemic health co-morbidities (p=0.05).

Conclusion: Most patients had a favorable outlook of ISBCS before and after undergoing DSBCS. Patients with underlying systemic health co-morbidities were most likely to accept additional surgical risk if necessary to receive ISBCS. From a patient's perspective, ISBCS may be an acceptable option to routinely implement when cataract surgery is required for both eyes.
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http://dx.doi.org/10.2147/OPTH.S363327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9064052PMC
April 2022

VITRECTOMY FOR DIABETIC COMPLICATIONS: A Pooled Analysis of Randomized Controlled Trials Using Modern Techniques and Equipment.

Retina 2022 07;42(7):1292-1301

Retina Service, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina.

Purpose: To report updated clinical outcomes in subjects undergoing pars plana vitrectomy (PPV) using modern techniques and equipment for the treatment of proliferative diabetic retinopathy-related complications. Pooled analysis of five randomized clinical trials conducted at the same institution and included both study and control subjects from the trials.

Methods: There were 943 subjects who prospectively underwent small-gauge PPV with antivascular endothelial growth factor pretreatment for proliferative diabetic retinopathy-related complications and completed 6-month follow-up.

Results: The visual acuity of the study population improved from median 2.00 (interquartile range 1.3, 2.3) at baseline to median 1.00 (interquartile range 0.5, 1.3) at 6 months. One hundred and eighty-four patients (19.5%) achieved 20/50 or better acuity, and 652 patients (69.1%) achieved 20/200 or better acuity at 6 months. The vision improved or remained stable in 901 patients (95.5%), and 11 patients (1.2%) developed no light perception at 6 months. Intraoperative complications occurred in 343 cases (36.4%), and 199 cases (21.1%) experienced a postoperative complication. The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3% of all complications). Unplanned secondary PPV was necessary in 86 cases (9.1%).

Conclusion: This study reports updated clinical outcomes in patients undergoing PPV for proliferative diabetic retinopathy-related complications which compares favorably with the age before small-gauge PPV and antivascular endothelial growth factor pretreatment.
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http://dx.doi.org/10.1097/IAE.0000000000003471DOI Listing
July 2022

Complications Leading to Keratoplasty among Contact Lens Users and LASIK Patients: A 10-Year Cross-Sectional Analysis.

J Ophthalmol 2021 13;2021:5563545. Epub 2021 Aug 13.

Panhandle Eye Group, 7400 Fleming Ave., Amarillo, TX 79106, USA.

Purpose: To determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States.

Methods: Population data was obtained from the United States Census Bureau and the Centers for Disease Control. A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a ten-year period. The main outcome was best-corrected visual acuity (BCVA) at 2 years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use versus LASIK.

Results: The study's geographic area had 46,545 CL users in one or both eyes during any given year and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and 3 post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval (OR 1.77 [0.53-5.87, 95% CI]; =0.35). BCVA at 2 years was 1.45 [1.0-1.90] logMAR (20/564 Snellen) in the CL using cohort and 0.07 [-1.19-1.33] logMAR (20/23 Snellen) in post-LASIK cohort following PK (=0.04).

Conclusions: Patients who underwent PK secondary to complications related to CL use had worse visual outcomes at 2 years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK.
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http://dx.doi.org/10.1155/2021/5563545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380166PMC
August 2021

OUTCOMES IN PATIENTS RESUMING INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOLLOWING TREATMENT DELAY DURING THE CORONAVIRUS-19 PANDEMIC.

Retina 2021 12;41(12):2456-2461

Panhandle Eye Group, Amarillo, Texas.

Purpose: To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti-vascular endothelial growth factor therapy.

Methods: A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti-vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic.

Results: Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti-vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both).

Conclusion: Treatment delay in subjects undergoing anti-vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.
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http://dx.doi.org/10.1097/IAE.0000000000003276DOI Listing
December 2021

Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Treatment-Naïve Diabetic Macular Edema: A Prospective, Uncontrolled Pilot Study.

Clin Ophthalmol 2021 21;15:2619-2624. Epub 2021 Jun 21.

Panhandle Eye Group, Amarillo, TX, 79106, USA.

Purpose: To report the outcomes in subjects undergoing pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for the management of treatment-naïve diabetic macular edema (DME).

Methods: Ten treatment-naïve subjects with non-proliferative diabetic retinopathy prospectively underwent PPV with ILM peeling for the treatment of DME at a single university-affiliated institution. The preoperative features, intraoperative details and postoperative outcomes were collected and analyzed.

Results: All 10 subjects underwent PPV with ILM peeling without significant intraoperative or postoperative complications at 6 months follow-up. Visual acuity improved from a baseline of 0.74 (95% CI: 0.48-1.0) logMAR (Snellen 20/110) to 0.46 (95% CI: 0.3-0.62) logMAR (Snellen 20/58) at 6 months follow-up (p=0.045). Optical coherence tomography central macular thickness reduced from a baseline of 456 (95% CI: 394.7-516.4) microns to 316.8 (95% CI: 275.9-357.7) microns at 6 months follow-up (p < 0.001).

Conclusion: This pilot study suggests that PPV with ILM peeling may be a viable treatment option for the management of treatment naïve DME in subjects with non-proliferative diabetic retinopathy. Development of a randomized controlled trial may be justified to validate the results of this study.

Clinicaltrialsgov Identifier #: NCT03660345.
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http://dx.doi.org/10.2147/OPTH.S320214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232852PMC
June 2021

Femtosecond-Assisted Laser in situ Keratomileusis with de novo Flap Creation Following Previous Microkeratome Laser in situ Keratomileusis.

Clin Ophthalmol 2021 30;15:1813-1818. Epub 2021 Apr 30.

Panhandle Eye Group, Amarillo, TX, 79106, USA.

Purpose: To report the outcomes of laser in situ keratomileusis (LASIK) in patients with previous microkeratome LASIK using a femtosecond laser platform to create a de novo flap.

Methods: The charts of 17 patients that underwent femtosecond-assisted LASIK with de novo flap creation for consecutive refractive error following previous microkeratome LASIK were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed.

Results: All 17 eyes underwent femtosecond-assisted LASIK with de novo flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 6 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed epithelial ingrowth during the postoperative period.

Conclusion: The femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK following previous microkeratome LASIK. Future investigations are required to further validate the findings in this study.
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http://dx.doi.org/10.2147/OPTH.S301450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096443PMC
April 2021

Optical Coherence Tomography-Guided Femtosecond LASIK in the Setting of Corneal Scarring.

Clin Ophthalmol 2021 20;15:1601-1606. Epub 2021 Apr 20.

Panhandle Eye Group, Amarillo, TX, 79106, USA.

Purpose: To report the outcomes of femtosecond-assisted laser in situ keratomileusis (LASIK) in patients with previous corneal scarring using optical coherence tomography (OCT) imaging to determine flap depths.

Methods: The charts of 11 eyes of 9 patients with previous off-visual axis corneal scarring that underwent femtosecond LASIK using OCT guidance for flap depth determination were retrospectively reviewed at a single private practice institution. The baseline characteristics, intraoperative findings and postoperative outcomes were analyzed.

Results: All 11 eyes underwent femtosecond laser flap creation and LASIK without any significant intraoperative complications. Uncorrected visual acuity improved postoperatively (p<0.0001) and remained stable at 3 months follow-up. None of the subjects lost any lines of best spectacle corrected visual acuity or developed any flap complications during the postoperative period.

Conclusion: The OCT-guided femtosecond laser technique described in this report can provide a safe and effective method to deliver LASIK in the setting of previous corneal scarring. Future investigations are required to further validate the findings in this study.
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http://dx.doi.org/10.2147/OPTH.S307191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068509PMC
April 2021

SILICONE OIL VERSUS PERFLUOROPROPANE GAS TAMPONADE DURING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT OR FIBROUS PROLIFERATION: A Randomized Clinical Trial.

Retina 2021 Jul;41(7):1407-1415

Instituto de la Visión-Hospital La Carlota, Nuevo León, México.

Purpose: To compare vitreous substitution with silicone oil to perfluoropropane gas in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy (PPV) for the treatment of tractional retinal detachment or extensive fibrous proliferation.

Design: Randomized clinical trial.

Methods: Three hundred and two proliferative diabetic retinopathy subjects with tractional retinal detachment or extensive fibrous proliferation requiring PPV were enrolled into the trial. Subjects were prospectively randomized into one of two vitreous substitution groups during PPV: Group A subjects underwent 1,000 centistoke silicone oil tamponade, whereas Group B subjects underwent 14% to 16% silicone oil to perfluoropropane gas tamponade. The principal outcome was the best-corrected visual acuity at 6-month follow-up. Secondary outcomes were postoperative complications and unplanned PPV during the 6-month trial interval.

Results: Two hundred and fifty-eight subjects were randomized to receive a vitreous substitute and completed 6-month follow-up. Group B had better best-corrected visual acuity, more subjects ending up with 0.4 logarithm of the minimum angle of resolution (20/50) or better visual acuity, and more subjects ending up with 1 logarithm of the minimum angle of resolution (20/200) or better visual acuity at 6 months compared with Group A (P < 0.001, P = 0.02, P < 0.001, respectively). There were no significant differences in baseline characteristics, intraoperative or postoperative complications, or incidence of unplanned PPV between groups.

Conclusion: This trial demonstrated that vitreous substitution with silicone oil to perfluoropropane gas resulted in better visual acuity at 6 months compared with silicone oil tamponade in proliferative diabetic retinopathy patients undergoing PPV for tractional retinal detachment or extensive fibrous proliferation. Surgeons should consider silicone oil to perfluoropropane gas tamponade as the first-line vitreous substitute in this patient population.
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http://dx.doi.org/10.1097/IAE.0000000000003052DOI Listing
July 2021

INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE: A Randomized Clinical Trial.

Retina 2021 May;41(5):1118-1126

Instituto de la Visión- Hospital La Carlota, Zambrano, Montemorelos, Nuevo León, México.

Purpose: To evaluate the benefits of internal limiting membrane peeling in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the treatment of vitreous hemorrhage.

Methods: Two hundred and fifty-eight proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage were enrolled into the trial. Patients were randomized into one of two cohorts: Group A patients underwent internal limiting membrane peeling, whereas Group B patients did not undergo internal limiting membrane peeling. The main outcome was best-corrected visual acuity at 6 months. Secondary outcomes were optical coherence tomography central macular thickness at 6 months, incidence of diabetic macular edema treatment during the postoperative trial period, and incidence of epiretinal membrane at 6 months.

Results: Two hundred and seven patients were randomized and completed 6 months follow-up. Group A had better best-corrected visual acuity at 6 months than Group B (P < 0.01). Group A had a lower incidence of diabetic macular edema treatment during the postoperative trial period and a lower incidence of epiretinal membrane at 6 months than Group B (P = 0.02 and P < 0.001, respectively). There was a trend toward lower central macular thickness on optical coherence tomography in Group A than Group B (P = 0.09). There were no significant differences in baseline details or complications intraoperatively or postoperatively between cohorts.

Conclusion: This trial demonstrated better vision, fewer postoperative diabetic macular edema treatments, and a lower incidence of epiretinal membrane at 6 months when internal limiting membrane peeling was performed. Internal limiting membrane peeling may be considered a vital maneuver to perform in proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for vitreous hemorrhage.
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http://dx.doi.org/10.1097/IAE.0000000000002976DOI Listing
May 2021

Anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy for scarring of the central cornea following pterygium excision.

Int J Ophthalmol 2020 18;13(3):503-508. Epub 2020 Mar 18.

Panhandle Eye Group, Amarillo, TX 79106, USA.

Aim: To report the outcomes of patients undergoing anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy (ASOCT T-PTK) for central corneal scarring after pterygium excision.

Methods: The charts of 11 eyes of 10 patients that underwent ASOCT T-PTK following excision of visual axis-involving pterygia were retrospectively reviewed from a single private practice institution. The visual outcomes and corneal topographic findings were evaluated 4±1mo after pterygium excision and 6±2mo after transepithelial phototherapeutic keratectomy (T-PTK).

Results: All 11 eyes tolerated both the pterygium excision and T-PTK procedure well without any significant intraoperative or postoperative complications. Uncorrected distance visual acuity (UDVA) and manifest refraction corrected distance visual acuity (CDVA) improved after pterygium excision (=0.03 and =0.05, respectively). The UDVA and CDVA improved further after T-PTK (=0.004 and =0.002, respectively). The topographic surface asymmetry index, topographic surface regularity index, and topographic projected visual acuity significantly improved after T-PTK (=0.0092, =0.0022, and =0.0002, respectively). None of the subjects lost any lines of CDVA, developed recurrence of pterygia or required keratoplasty during the postoperative period.

Conclusion: ASOCT T-PTK can provide excellent visual and anatomic outcomes in patients with central corneal scarring after excision of visual axis-involving pterygia.
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http://dx.doi.org/10.18240/ijo.2020.03.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154194PMC
March 2020

Bevacizumab before Diabetic Vitrectomy: A Clinical Trial Assessing 3 Dosing Amounts.

Ophthalmol Retina 2018 10 3;2(10):1010-1020. Epub 2018 Oct 3.

Instituto de la Vision-Hospital La Carlota, Nuevo Leon, México; Panhandle Eye Group, Amarillo, Texas; Texas Tech University Health Science Center, Amarillo, Texas; Southwest Retina Specialists, Amarillo, Texas. Electronic address:

Purpose: To evaluate the optimal dosing of preoperative intravitreal bevacizumab (IVB) in patients undergoing pars plana vitrectomy (PPV) for manifestations of proliferative diabetic retinopathy (PDR).

Design: Randomized clinical trial.

Participants: Two hundred six patients with severe manifestations of PDR underwent PPV at a single university-based hospital.

Methods: Patients were randomized into 1 of 3 treatment groups: group A received 0.625 mg IVB (0.025 ml) 1 to 10 days before PPV, group B received 1.25 mg IVB (0.05 ml) 1 to 10 days before PPV, and group C received 2.5 mg IVB (0.1 ml) 1 to 10 days before PPV.

Main Outcome Measures: The primary outcome was best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures were rates of perioperative tractional retinal detachment (TRD) development, intraoperative and postoperative complications, and incidence of unplanned PPV at 6 months.

Results: One hundred sixty-seven patients underwent PPV and completed 6 months of follow-up. There were no significant differences between treatment groups regarding baseline characteristics, final BCVA, intraoperative complications, postoperative complications, or unplanned PPV rates. There were no patients in group A (0.0%), 3 patients in group B (7.0%), and 5 patients in group C (8.5%) who demonstrated perioperative TRD after IVB administration, but before PPV (P = 0.0283). This difference was significant between groups A and B (P = 0.0494) and between groups A and C (P = 0.0080).

Conclusions: This randomized clinical trial demonstrated that patients receiving the 0.625-mg dose of IVB before PPV for the treatment of PDR-related manifestations showed similar visual acuity, but a lower incidence of perioperative TRD development compared with patients receiving the 1.25-mg and 2.5-mg doses. Clinicians should consider adopting the lowest effective dose, 0.625 mg, into clinical practice. The current study is limited by the lack of a control group receiving no IVB before PPV.
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http://dx.doi.org/10.1016/j.oret.2018.04.014DOI Listing
October 2018

Ziv-aflibercept versus bevacizumab administration prior to diabetic vitrectomy: a randomised and controlled trial.

Br J Ophthalmol 2019 12 31;103(12):1740-1746. Epub 2019 Jan 31.

Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México

Purpose: To compare the effectiveness of intravitreal ziv-aflibercept (IVZ) to intravitreal bevacizumab (IVB) administered preoperatively to patients undergoing pars plana vitrectomy (PPV) for severe manifestations of proliferative diabetic retinopathy (PDR).

Design: Randomised clinical trial (RCT).

Methods: Two hundred and six patients with PDR-related complications requiring PPV were randomised into one of two treatment groups: Group A received IVZ (1.25 mg/0.05 mL) 1-10 days before PPV, while Group B received IVB (1.25 mg/0.05 mL) 1-10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months follow-up. Secondary outcome measures were perioperative tractional retinal detachment (TRD) rates, surgical times, intraoperative and postoperative complications and incidence of unplanned PPV during the 6 month study interval.

Results: One hundred and seventy three subjects underwent PPV and completed the 6-month follow-up interval. Group A subjects had better BCVA at 6 months (p=0.0035), shorter surgical times (p=0.0013) and were less likely to have a recurrence of vitreous haemorrhaging in the postoperative period (p=0.0101) when compared with subjects in Group B. There were no significant differences among the treatment groups with regards to baseline characteristics, perioperative TRD development, intraoperative complications and incidence of unplanned PPV during the 6 month study interval.

Conclusions: This RCT demonstrated better final visual outcomes, shorter operating times and less vitreous haemorrhage recurrences in the postoperative period when subjects received IVZ compared to IVB prior to PPV for the treatment of PDR-related complications.
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http://dx.doi.org/10.1136/bjophthalmol-2018-313313DOI Listing
December 2019

Optical Coherence Tomography-Guided Transepithelial Phototherapeutic Keratectomy for Central Corneal Opacity in the Pediatric Population.

J Ophthalmol 2018 24;2018:3923617. Epub 2018 Dec 24.

Panhandle Eye Group, 7400 Fleming Ave., Amarillo, TX 79106, USA.

Purpose: To report the outcomes of optical coherence tomography- (OCT-) guided transepithelial phototherapeutic keratectomy (PTK) for central corneal opacity in the pediatric population.

Methods: The charts of 10 eyes of 8 children aged 9 to 17 with central corneal opacity from various pathologies who underwent a standardized OCT-guided transepithelial PTK technique at a single private practice institution were retrospectively reviewed. The corneal topographic findings, OCT measurements, and visual results with refractive outcomes were analyzed 6 months after the PTK treatment.

Results: All 10 eyes tolerated the procedure well without any significant intraoperative or postoperative complications. Uncorrected and best spectacle-corrected visual acuity (BSCVA) significantly improved postoperatively ( < 0.0001 and =0.0045, respectively). The absolute value of spherical equivalent on cycloplegic refraction significantly improved postoperatively as well (=0.0014), but there were no significant changes in topographic measurements. Seven out of the 10 eyes had complete resolution of the central corneal opacity on OCT imaging. None of the subjects lost any lines of BSCVA and developed recurrence of the corneal opacity from the primary disease condition or required keratoplasty during the follow-up period.

Conclusions: OCT-guided transepithelial PTK can provide excellent visual outcomes in pediatric patients with central corneal opacities.
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http://dx.doi.org/10.1155/2018/3923617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323485PMC
December 2018

Reply.

Am J Ophthalmol 2018 03;187:169

Amarillo, Texas and Montemorelos, Nuevo Leon, Mexico.

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http://dx.doi.org/10.1016/j.ajo.2017.12.008DOI Listing
March 2018

Preoperative Bevacizumab Administration in Proliferative Diabetic Retinopathy Patients Undergoing Vitrectomy: A Randomized and Controlled Trial Comparing Interval Variation.

Am J Ophthalmol 2017 Nov 30;183:1-10. Epub 2017 Aug 30.

Instituto de la Vision - Hospital La Carlota, Nuevo Leon, Mexico; Panhandle Eye Group, Amarillo, Texas; Texas Tech University Health Science Center, Amarillo, Texas; Southwest Retina Specialists, Amarillo, Texas. Electronic address:

Purpose: To assess the optimal interval of preoperative intravitreal bevacizumab (IVB) administration in diabetic subjects undergoing pars plana vitrectomy (PPV) for severe manifestations of active proliferative diabetic retinopathy (PDR).

Design: Randomized clinical trial.

Methods: One hundred and fifty-six patients with PDR-related complications requiring PPV were prospectively randomized into 1 of 2 treatment groups: Group A received IVB (2.5 mg/0.1 mL) 1-3 days before PPV, while Group B received IVB (2.5 mg/0.1 mL) 5-10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months follow-up. Secondary outcome measures were intraoperative surgery time, intraoperative complications, postoperative complications, and incidence of unplanned PPV at 6 months follow-up.

Results: One hundred and twenty-five subjects underwent PPV and completed the 6-month follow-up interval. Group B patients had better final BCVA (P = .033) and were less likely to have a postoperative complication (P = .018) when compared to Group A patients. The mean difference in final BCVA between groups was 0.22 logMAR (95% confidence interval: 0.02-0.43, P = .017). Group A was 3.90 (95% confidence interval: 1.08-17.31, P = .046) times more likely to have a loss of 1 or more logMAR lines of final BCVA when compared to Group B. There were no significant differences among the treatment groups with regard to baseline features, intraoperative surgery time, intraoperative complications, and incidence of unplanned PPV during the study interval.

Conclusions: This randomized clinical trial demonstrated better postoperative outcomes at 6 months when subjects received preoperative IVB 5-10 days before PPV compared to 1-3 days for the treatment of PDR-related complications.
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http://dx.doi.org/10.1016/j.ajo.2017.08.013DOI Listing
November 2017

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States.

J Ophthalmol 2016 13;2016:6284595. Epub 2016 Dec 13.

Panhandle Eye Group, 7400 Fleming Ave., Amarillo, TX 79106, USA; Texas Tech University Health Sciences Center, 1400 S. Coulter, Amarillo, TX 79106, USA; Southwest Retina Specialists, 7411 Wallace Blvd., Amarillo, TX 79106, USA.

. To compare the long-term outcomes of infectious versus sterile perforated corneal ulcers after therapeutic penetrating keratoplasty in the United States. . The charts of 45 consecutive eyes that underwent primary therapeutic penetrating keratoplasty for a perforated corneal ulcer at a single center were retrospectively reviewed. The perforated ulcers were classified as infectious or sterile and the underlying demographics, clinical features, and 36-month outcomes were compared among the two groups. Mean follow-up among subjects was 38.6 (±6.9) months. Patients presenting with sterile perforated ulcers were more likely to have a peripheral perforation location ( = 0.0333) and recurrence of the underlying disease condition ( = 0.0321), require adjunctive surgical measures in the immediate postoperative period ( < 0.0001), have reperforation after keratoplasty ( = 0.0079), have worse best corrected visual acuity ( = 0.0130), develop no light perception vision ( = 0.0053), and require enucleation/evisceration ( = 0.0252) when compared to the infectious perforated ulcer group. . Sterile perforated corneal ulcers have a worse prognosis and may be more frequent than those caused by infectious disease in the United States compared to the developing world.
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http://dx.doi.org/10.1155/2016/6284595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187482PMC
December 2016

Epithelium-off versus transepithelial corneal collagen crosslinking for progressive corneal ectasia: a randomised and controlled trial.

Br J Ophthalmol 2017 04 7;101(4):503-508. Epub 2016 Jul 7.

Panhandle Eye Group, Amarillo, Texas, USA.

Aim: To compare the outcomes of corneal collagen crosslinking (CXL) for the treatment of progressive corneal ectasia using a standard epithelium-off technique versus a transepithelial technique with enhanced riboflavin solution.

Methods: One hundred and forty-four eyes with progressive corneal ectasia were prospectively randomised into a transepithelial CXL study arm or an epithelium-off CXL control arm. Follow-up examinations were set at 3, 6, 12 and 24 months. The primary outcome measure was change in the maximum simulated keratometry value (K) after 24 months of follow-up. The secondary outcome measure was change in the best spectacle-corrected visual acuity (BSCVA) after 24 months follow-up.

Results: One hundred and thirty-one eyes completed the 24-month follow-up interval. Change in K was -1.52±0.66 dioptres (D) for the control group versus -0.54±0.58 D for the study group at 24 months of follow-up (p=0.0320). Change in BSCVA was -0.18±0.09 logMAR for the control group versus -0.14±0.08 logMAR for the study group at 24 months of follow-up (p=0.4978). Two eyes in the control group had minor postoperative complications that did not affect the final visual acuity, and one eye in the control group underwent keratoplasty during the study interval.

Conclusions: At 24 months of follow-up, subjects in the epithelium-off CXL group demonstrated a greater improvement in K compared with subjects in the transepithelial CXL group, but no statistically significant difference in BSCVA was found between groups.

Trial Registration Number: NCT01708538; pre-results.
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http://dx.doi.org/10.1136/bjophthalmol-2016-308914DOI Listing
April 2017

Corneal Epithelial Thickness Measured by Manual Electronic Caliper Spectral Domain Optical Coherence Tomography: Distributions and Demographic Correlations in Preoperative Refractive Surgery Patients.

Asia Pac J Ophthalmol (Phila) 2016 Mar-Apr;5(2):147-50

From the *Panhandle Eye Group; †Texas Tech University Health Sciences Center; ‡West Texas A&M University; and §Southwest Retina Specialists, Amarillo, TX.

Purpose: The aim of this study was to report the distributions and demographic correlations of corneal epithelial thickness measured by manual electronic caliper spectral domain optical coherence tomography in preoperative refractive surgery patients.

Design: This was a retrospective review.

Methods: The charts of 218 consecutive patients (413 eyes) who presented for refractive surgery evaluation from April 2013 through September 2013 were retrospectively reviewed.

Results: The mean corneal epithelial thickness was 51.0 μm with a range of 43 to 61 μm. Corneal epithelial thickness was significantly correlated with sex (P < 0.0001), corneal keratometry (P = 0.01), and underlying corneal thickness excluding the epithelium (P = 0.0268). No significant associations were identified in which corneal epithelial thickness correlated with either age (P = 0.0760) or existing refractive status of the eye (P = 0.5135).

Conclusions: Corneal epithelial thickness measured by manual electronic caliper optical coherence tomography in preoperative refractive surgery patients is comparable with the findings for the general population using other measurement techniques, the awareness of which may be useful in the preoperative assessment of these patients.
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http://dx.doi.org/10.1097/APO.0000000000000166DOI Listing
November 2016

One-Year Outcomes of Femtosecond Laser-Assisted LASIK Following Previous Radial Keratotomy.

J Refract Surg 2016 Jan;32(1):15-9

Purpose: To report the 1-year outcomes of LASIK in patients with previous radial keratotomy using a novel femtosecond laser platform.

Methods: The charts of 27 eyes of 18 patients who underwent femtosecond laser-assisted LASIK with the WaveLight FS200 laser (Alcon Laboratories, Inc., Fort Worth, TX) for consecutive hyperopia following previous radial keratotomy were retrospectively reviewed at a single private practice location. The preoperative characteristics, intraoperative details, and postoperative results were evaluated.

Results: All 27 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively to 0.13 ± 0.13 logMAR at 12 months of follow-up (P < .0001). Postoperative spherical equivalent averaged 0.11 ± 0.53 diopters. None of the patients lost any lines of corrected distance visual acuity during the postoperative period.

Conclusions: The femtosecond laser technique described by this study resulted in a safe and effective way to deliver LASIK following previous radial keratotomy. Future investigations are needed to further validate the outcomes of this study.
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http://dx.doi.org/10.3928/1081597X-20151207-07DOI Listing
January 2016

Ranibizumab Versus Bevacizumab for Neovascular Age-Related Macular Degeneration With an Incomplete Posterior Vitreous Detachment.

Asia Pac J Ophthalmol (Phila) 2016 May;5(3):171-5

From the *Southwest Retina Specialists; †Panhandle Eye Group; and ‡Texas Tech University Health Science Center, Amarillo, TX.

Purpose: The aim of this study was to compare the effects of ranibizumab to those of bevacizumab during the treatment of neovascular age-related macular degeneration (AMD) with an incomplete posterior vitreous detachment.

Design: A retrospective chart review.

Methods: A retrospective chart review was performed on treatment-naive neovascular AMD subjects with an incomplete posterior vitreous detachment treated with either ranibizumab or bevacizumab over a 12-month period.

Results: One hundred thirty subjects were analyzed. There were 49 subjects determined to have vitreous attachment to the fovea. Subjects with vitreous attachment to the fovea required a significantly greater number of injections during the study interval compared with those without (10.2 ± 0.75 vs 7.8 ± 0.62) (P < 0.0001). In subjects with vitreous attachment to the fovea, the ranibizumab cohort had a greater improvement in visual acuity (0.18 ± 0.1 vs 0.04 ± 0.11 logMAR) (P = 0.0176) and a greater reduction in macular thickness (93.4 ± 32.2 μm vs 30.3 ± 28.3 μm) (P = 0.0064) compared with the bevacizumab cohort.

Conclusions: Neovascular AMD patients with vitreous attachment to the fovea may have better visual and anatomic outcomes when treated with ranibizumab compared with bevacizumab.
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http://dx.doi.org/10.1097/APO.0000000000000157DOI Listing
May 2016

The Safety and Efficacy of Routine Administration of Intracameral Vancomycin during Cataract Surgery.

J Ophthalmol 2015 4;2015:813697. Epub 2015 Nov 4.

Panhandle Eye Group, 7400 Fleming Avenue, Amarillo, TX 79106, USA ; Texas Tech University Health Sciences Center, 1400 S. Coulter, Amarillo, TX 79106, USA ; Southwest Retina Specialists, 7411 Wallace Boulevard, Amarillo, TX 79106, USA.

Purpose. To evaluate the safety and efficacy of intracameral vancomycin during cataract surgery using a standardized dosage and delivery technique. Methods. The charts of 20,719 consecutive eyes that underwent phacoemulsification with intraocular lens implantation in a single ambulatory surgery center were retrospectively reviewed over a 5-year period. Results. The first 11,333 consecutive cases did not receive intracameral vancomycin, whereas the next 9,386 consecutive cases all received intracameral vancomycin. There were no significant differences in the baseline characteristics between the cohort of subjects who received intracameral vancomycin and the cohort of subjects that did not. There were a total of 11 subjects (0.97 cases per 1,000) that developed postoperative endophthalmitis in the group that did not receive intracameral vancomycin, whereas there were no cases of postoperative endophthalmitis in the group that received intracameral vancomycin (p = 0.0015). The overall rate of intraoperative and postoperative complications and the final postoperative visual acuities were similar among cohorts. There were no cases of toxic anterior segment syndrome occurring in either group during the study period. Conclusions. Routine administration of intracameral vancomycin during cataract surgery significantly decreased the incidence of postoperative endophthalmitis and was not associated with an increased incidence of postoperative adverse events.
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http://dx.doi.org/10.1155/2015/813697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649092PMC
November 2015

Femtosecond Laser Flap Creation for Laser In Situ Keratomileusis in the Setting of Previous Radial Keratotomy.

Asia Pac J Ophthalmol (Phila) 2015 Sep-Oct;4(5):283-5

From the *Panhandle Eye Group, †Texas Tech University Health Sciences Center, and ‡Southwest Retina Specialists, Amarillo, TX.

Purpose: The aim of the study was to report the outcomes of laser in situ keratomileusis (LASIK) in subjects with previous radial keratotomy (RK) using a novel femtosecond laser setting on a proprietary femtosecond laser platform.

Design: This was a retrospective, consecutive chart review of patients at a single private practice institution.

Methods: The medical records of 16 eyes of 8 subjects who underwent femtosecond-assisted LASIK for consecutive hyperopia after RK were retrospectively reviewed. The preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed.

Results: All 16 eyes had successful femtosecond laser flap creation without significant intraoperative or postoperative complications. Uncorrected visual acuity significantly improved postoperatively (P = 0.0142) and remained stable through the final follow-up interval at 9 to 12 months postoperatively. None of the subjects lost any lines of best spectacle-corrected visual acuity in the postoperative period.

Conclusions: The novel femtosecond laser technique described in this study can provide a safe and effective method for patients undergoing LASIK after previous RK. Future investigations are required to further validate the findings reported in this study.
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http://dx.doi.org/10.1097/APO.0000000000000131DOI Listing
July 2016

Predictability of Recurrent Exudation and Subretinal Hemorrhaging in Neovascular Age-Related Macular Degeneration With Indocyanine Green Angiography.

Ophthalmic Surg Lasers Imaging Retina 2015 Jul-Aug;46(7):718-23

Background And Objective: To report the predictability of recurrent exudation and subretinal hemorrhaging after treatment extension in neovascular age-related macular degeneration (AMD) through assessment of interval changes in choroidal neovascularization (CNV) size on indocyanine green (ICG) angiography.

Patients And Methods: The charts of patients with neovascular AMD who underwent bevacizumab therapy using a treat-and-extend protocol were retrospectively reviewed over a 12-month period.

Results: An increase of 33% or more in CNV surface area on ICG angiography from 4 to 6 weeks, 6 to 8 weeks, and 8 to 10 weeks was observed in patients whose treatment interval could not be extended from 6 to 8 weeks, 8 to 10 weeks, and 10 to 12 weeks, respectively, and this was significant compared to patients whose treatment interval was successfully extended during those respective intervals (P < .0001, P = .0002, P = .0004, respectively).

Conclusion: CNV size change on ICG angiography can predict which patients are likely to experience recurrent exudation and/or subretinal hemorrhaging after treatment extension using treat-and-extend bevacizumab.
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http://dx.doi.org/10.3928/23258160-20150730-05DOI Listing
April 2016

BILATERAL LAMELLAR MACULAR HOLE SURGERY IN RETINITIS PIGMENTOSA.

Retin Cases Brief Rep 2016 ;10(1):83-5

*Southwest Retina Specialists, Amarillo, Texas; †Panhandle Eye Group, Amarillo, Texas; and ‡Texas Tech University Health Science Center, Amarillo, Texas.

Purpose: To report the visual and anatomical outcomes after surgical repair of bilateral lamellar macular holes in a patient with retinitis pigmentosa.

Methods: A 66-year-old woman with a 39-year history of retinitis pigmentosa presented with decreased visual acuity in both eyes. On examination, she was diagnosed with lamellar macular holes in both eyes. She underwent pars plana vitrectomy with internal limiting membrane peeling and short-term gas tamponade in both eyes.

Results: The macular holes were successfully closed in both eyes. The patient's best-corrected Snellen visual acuity improved from 20/60⁻² to 20/30⁻¹ in the right eye and from 20/70⁻¹ to 20/40⁻¹ in the left eye at 6 months of postoperative follow-up.

Conclusion: Bilateral lamellar macular holes are rare occurrences in patients with retinitis pigmentosa; improved visual and anatomical outcomes can result after surgical intervention.
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http://dx.doi.org/10.1097/ICB.0000000000000166DOI Listing
September 2016

Predictability of Recalcitrance in Neovascular Age-Related Macular Degeneration With Indocyanine Green Angiography.

Asia Pac J Ophthalmol (Phila) 2015 Jul-Aug;4(4):187-90

From the *Southwest Retina Specialists; †Panhandle Eye Group; and ‡Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX.

Purpose: This study aimed to evaluate the utility of indocyanine green (ICG) angiography in predicting recalcitrance in neovascular age-related macular degeneration (nAMD).

Design: A retrospective case series.

Methods: The charts of treatment-naive subjects with nAMD undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy during a 6-month period were retrospectively reviewed. The study group consisted of subjects with persistent retinal edema on optical coherence tomography (OCT) despite 6 consecutive monthly anti-VEGF injections. The control group was age-matched to the study group and consisted of subjects who demonstrated complete resolution of retinal edema on OCT after 3 or fewer monthly anti-VEGF injections.

Results: There were 42 study cases and 42 controls included in the analysis. The baseline visual acuity, central macular thickness on OCT, and choroidal neovascularization (CNV) surface area on ICG angiography were statistically similar between the study and control groups. The CNV surface area on ICG angiography 2 months after starting consecutive monthly anti-VEGF injections increased from a baseline of 1.78 ± 0.86 to 2.66 ± 0.92 mm2 in the study group (P = 0.008) and decreased from a baseline of 1.94 ± 0.97 to 1.12 ± 0.05 mm2 in the control group (P = 0.04); this change in CNV size on ICG angiography from baseline to 2-month follow-up was statistically significant between the study and control groups (P < 0.0001).

Conclusions: Change in CNV surface area on ICG angiography can predict which subjects with nAMD are likely to have persistent retinal edema on OCT after 6 or more consecutive monthly anti-VEGF injections.
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http://dx.doi.org/10.1097/APO.0000000000000111DOI Listing
April 2016

Evaluation of Idiopathic Choroidal Neovascularization with Indocyanine Green Angiography in Patients Undergoing Bevacizumab Therapy.

J Ophthalmol 2015 31;2015:642624. Epub 2015 May 31.

Panhandle Eye Group, 7400 Fleming Avenue, Amarillo, TX 79106, USA ; Texas Tech University Health Science Center, 1400 S. Coulter, Amarillo, TX 79106, USA.

Purpose. To examine the clinical implications of change in choroidal neovascularization (CNV) size on indocyanine green (ICG) angiography in subjects with idiopathic CNV undergoing bevacizumab therapy. Methods. The charts of subjects with an idiopathic CNV treated by a modified PRN regimen with intravitreal bevacizumab over a 12-month period were retrospectively reviewed. Results. There were 34 subjects included in the analysis. Baseline CNV sizes of less than 1.0 mm(2) on ICG angiography correlated with complete CNV resolution (P = 0.0404), fewer injections delivered (P = 0.0002), and better Snellen visual acuity (P = 0.0098) at 12 months. Subjects that experienced a 33% or more reduction in CNV size on ICG angiography at 2 months had complete CNV resolution (P = 0.0047) and fewer injections (P < 0.0001) at 12 months compared to subjects that did not experience a 33% or more reduction in CNV size on ICG angiography at 2 months. Conclusions. Smaller baseline CNV size on ICG angiography resulted in better visual acuity and fewer injections at 12 months, and a reduction of 33% or more in CNV size after 2 months may predict a better clinical course in subjects with idiopathic CNV undergoing bevacizumab therapy.
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http://dx.doi.org/10.1155/2015/642624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465762PMC
June 2015

Incidence and Outcomes of Anterior Chamber Gas Bubble during Femtosecond Flap Creation for Laser-Assisted In Situ Keratomileusis.

J Ophthalmol 2015 20;2015:542127. Epub 2015 Apr 20.

Panhandle Eye Group, 7400 Fleming Avenue, Amarillo, TX 79106, USA ; Texas Tech University Health Sciences Center, 1400 S. Coulter, Amarillo, TX 79106, USA ; Southwest Retina Specialists, 7411 Wallace Boulevard, Amarillo, TX 79106, USA.

Purpose. To report the incidence and outcomes of anterior chamber gas bubble formation during femtosecond laser flap creation for laser-assisted in situ keratomileusis (LASIK). Methods. The charts of 2,886 consecutive eyes that underwent femtosecond LASIK from May 2011 through August 2014 were retrospectively reviewed. The incidence, preoperative characteristics, intraoperative details, and postoperative outcomes were analyzed in subjects developing anterior chamber gas bubble formation during the procedure. Results. A total of 4 cases (0.14%) developed anterior chamber gas bubble formation during femtosecond laser flap creation. In all four cases, the excimer laser was unable to successfully track the pupil immediately following the anterior chamber bubble formation, temporarily postponing the completion of the procedure. There was an ethnicity predilection of anterior chamber gas formation toward Asians (p = 0.0055). An uncorrected visual acuity of 20/20 was ultimately achieved in all four cases without further complications. Conclusions. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK is an uncommon event that typically results in a delay in treatment completion; nevertheless, it does influence final positive visual outcome.
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http://dx.doi.org/10.1155/2015/542127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411458PMC
May 2015

Prospective analysis of outcomes and economic factors of same-day bilateral cataract surgery in the United States.

J Cataract Refract Surg 2015 Apr 6;41(4):732-9. Epub 2015 Mar 6.

From the Panhandle Eye Group (S.W. Rush, Gerald, Smith, J.A. Rush, R.B. Rush), Texas Tech University Health Sciences Center (S.W. Rush, J.A. Rush, R.B. Rush), and Southwest Retina Specialists (R.B. Rush), Amarillo, Texas, USA. Electronic address:

Purpose: To evaluate the visual and economic benefits of same-day bilateral cataract surgery versus separate-day bilateral cataract surgery in the United States.

Setting: Private practice, Amarillo, Texas, USA.

Design: Prospective controlled nonrandomized clinical trial.

Methods: A cohort of patients having same-day bilateral cataract surgery was age-matched with a cohort of control patients who had standard separate-day bilateral cataract surgery. The primary outcome was a comparison of the direct cost for the patient, physician, ambulatory surgery center (ASC), and third-party payer.

Results: The same-day cohort (42 patients, 84 eyes) had similar baseline characteristics and postoperative outcomes as the control cohort (42 patients, 84 eyes). The same-day cohort had less total distance traveled for care (P = .0039 and P < .0001 for in-town and out-of-town residents, respectively), less total time spent traveling for care (P = .0008 and P < .0001 for in-town and out-of-town residents, respectively), less total number of visits required for care (P < .0001), and less total time for vision recovery (P < .0001) than the control cohort. The physician and ASC reimbursements were lower in the same-day cohort (P = .0028 and P = .0016, respectively), whereas the total physician time spent caring for the patient in surgery was not different between the 2 groups (P = .7310). The total ASC expenses were higher in the same-day cohort (P < .0001). The total third-party payer cost was significantly less in the same-day cohort (P < .0001).

Conclusion: Visual and economic benefits for the patient can be achieved with same-day bilateral cataract surgery in the U.S. at the present time.

Financial Disclosure: 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.2014.07.034DOI Listing
April 2015
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