Glaucoma Screening in the Haitian Afro-Caribbean Population of South Florida

Objective: To evaluate the presence of clinical signs consistent with suspected glaucoma in Haitian Afro-Caribbean individuals residing in South Florida who do not receive regular eye examinations. Design: Retrospective, cross-sectional study. Methods: SETTING: Community health center in the Little Haiti district of Miami, Florida. PATIENT POPULATION: We reviewed medical records and screening forms from five health screenings between October 2011 to October 2013 of 939 Afro-Caribbean individuals older than 18 years, who were never diagnosed with glaucoma or had an eye examination within the last ten years. PROCEDURES: Measurements of distance visual acuity (VA), intraocular eye pressure (IOP), central corneal thickness (CCT), cup-to-disc ratio (CDR), frequency doubling technology (FDT) perimeter visual field (VF). Main Outcome Measures: Proportion of glaucoma suspects, based on IOP greater than or equal to 24 mm Hg or CDR greater than or equal to 0.7 in either eye, and determinants of CDR and IOP. Results: One hundred ninety-one (25.5%) of 750 patients were identified as glaucoma suspects. Glaucoma suspects were common in both the youngest and oldest age groups (70 years, 25.0%; 95% CI, 21.8–28.2) and higher in men than women less than 70 years; the reverse was true after 70 years. Among all patients, mean IOP was 19.2±4.5 mmHg, mean CDR was 0.37±0.17, and mean CCT was 532±37.1 µm. In multiple linear stepwise regression analysis, determinates of increased CDR included increasing age (P = 0.004), lack of insurance (P = 0.019), and higher IOP (P<0.001), while increasing CDR (P<0.001) and thicker CCT (P<0.001) were associated with higher IOP. Conclusions: This first glaucoma survey in a U.S. Haitian Afro-Caribbean population indicates glaucoma suspect status is high across all age groups, and suggests glaucoma monitoring in people less than 40 years of age is indicated in this population

Spontaneous Massive Splenic Infarction in the Setting of Renal Transplant and Septic Shock: A Case Report and Review of the Literature

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy. We report the case of a 50-year-old man with a history of renal transplant who presented with diffuse abdominal pain and rapidly developed septic shock. A computed tomographic study (CT scan) of the abdomen demonstrated MSI. The surgical team was consulted for splenectomy but conservative management was maintained and immune function preserved. The patient's clinical condition was resolved over a three-week period. This report demonstrates successful nonoperative management of a spontaneous MSI most likely secondary to hypoperfusion and a hypercoagulable state from both septic shock and renal transplant

Outcomes of Pars Plana Vitrectomy for Patients With Vitreomacular Traction

To evaluate clinical and optical coherence tomography (OCT) outcomes of pars plana vitrectomy (PPV) for patients with vitreomacular traction (VMT). Noncomparative, interventional, consecutive case series from 2007 to 2014. Of the 37 study eyes, patients were grouped according to the extent of VMT evident on OCT. Group 1 (18 eyes) had intraretinal cysts on OCT. Group 2 (19 eyes) had both intraretinal cysts and subretinal fluid. Visual acuity (VA) improved at least one line or more in 76% of eyes postoperatively. Postoperative VA was not significantly different across the two groups (P > .36). Postoperatively, a macular hole developed in 4 eyes (10%). After reoperation, three of four eyes achieved macular hole closure. Patients with VMT achieve visual and OCT improvements after PPV. Postoperative macular hole formation is uncommon but can be successfully repaired with further surgery

Frequency distribution curves for cup-to-disc ratio in non-cases and glaucoma suspects.

<p>Frequency distribution curves for cup-to-disc ratio in non-cases and glaucoma suspects.</p

Examination Findings in Glaucoma Suspect Cases (n = 191).

<p>SD = standard deviation; CCT = central corneal thickness; IOP = intraocular pressure; CDR = cup-to-disc ratio.</p>a<p>Abnormal visual field is 3 or more sector misses.</p><p>Examination Findings in Glaucoma Suspect Cases (n = 191).</p

Age and Sex-Specific Rates of Glaucoma Suspect (n = 191).

<p>GS = glaucoma suspect.</p><p>Age and Sex-Specific Rates of Glaucoma Suspect (n = 191).</p

Frequency distribution curves for central corneal thickness in non-cases and glaucoma suspects.

<p>Frequency distribution curves for central corneal thickness in non-cases and glaucoma suspects.</p

Multivariate linear regression models for cup-to-disc ratio and intraocular pressure outcomes (n = 750).

<p>CDR = cup-to-disc ratio; IOP = intraocular pressure; N.A. = not applicable; CCT = central corneal thickness.</p>a<p>Model Performance: <i>R</i>² 0.33 with 578 degrees of freedom. Model was adjusted for age, sex, insurance status, diabetes, hypertension, CCT, and IOP.</p>b<p>Model Performance: <i>R</i>² 0.34 with 578 degrees of freedom. Model was adjusted for age, sex, insurance status, diabetes, hypertension, CCT, and CDR.</p><p>Multivariate linear regression models for cup-to-disc ratio and intraocular pressure outcomes (n = 750).</p

Baseline Characteristics of Eligible Participants (n = 750).

<p>IOP = intraocular pressure; SD = standard deviation; CDR = cup-to-disc radio; CCT = central corneal thickness.</p>a<p>Family history of glaucoma or glaucoma suspect in a first- or second-degree relative.</p>b<p>Visual acuity in the better-seeing eye.</p>c<p>Abnormal visual field is 3 or more sector misses.</p><p>Baseline Characteristics of Eligible Participants (n = 750).</p