Intraocular Pressure, Aqueous Humor Dynamics, And Fibrosis Using A Novel Glaucoma Drainage Pathway

The purpose of this study was to compare fibrosis, aqueous humor dynamics, and intraocular pressure (IOP) of two suprachoroidal shunts that are part of a new class of glaucoma drainage devices. After in vitro testing, 20 rabbits were implanted with either a gold shunt (GS, GMSplus+, Solx) or polypropylene shunt (PS, Aquashunt, OPKO). Ten eyes received mitomycin C (MMC) and triamcinolone. Peak and trough IOP were monitored with a pneumatonometer and tono-pen through 15 weeks. Aqueous humor dynamics were evaluated fluorophotometrically and tonographically. Fibrosis was quantified using ImageJ. In vitro growth was similar. In vivo, both shunts were devoid of foreign body reaction but exhibited fibrosis, and GS showed vascularization. There was no significant difference in aqueous or uveoscleral flow. Preoperative morning IOP was 23.7 ± 2 mm Hg and evening IOP was 26.5 ± 2 mm Hg (p=0.000). Morning IOP was decreased through 15 weeks and evening IOP through 8 weeks in all groups. The morning IOP decrease was most profound at 15 weeks in PS (41%) compared to GS (18%). Antifibrotics initially enhanced but eventually diminished shunt performance. At 15 weeks, thickness of scleral fibrosis was greater in GS (246 ± 47 μ) and PS (188 ± 47 μ, p=0.285) compared with GS+MMC (109 ± 26 μ, p=0.023 to GS) and PS+MMC (48 ± 30 μ, p=0.028 to PS). In a rabbit model, suprachoroidal polypropylene and gold shunts allow access to a new drainage pathway with different IOP profiles that can be modified with antifibrotics

The Residency Application Abyss: Insights and Advice

Most medical students apply for residency training upon completion of medical school. The choice of specialty is one of a student’s first major career decisions, and the application process often results in considerable anxiety, as it is competitive, unpredictable, and requires a significant investment of time and money. This article, which addresses several important facets of the residency application using both experiential and evidence-based data, is organized chronologically into sections that describe a logical approach to applying for residency: choice of a specialty, the personal statement, the interview day, and developing a rank list. A list of relevant websites is also included. This paper is a resource that provides timely and tangible guidance to medical students applying for residency training

Age-related distance esotropia--fusional amplitudes and clinical course.

BackgroundAge-related distance esotropia (ARDET) is a form of acquired strabismus that affects elderly patients and manifests as an esotropia greater with distance fixation. Limited information exists regarding fusional amplitudes and deficient divergence in this disorder.MethodsIn this retrospective study, patient characteristics, ocular alignment and motility, and clinical course of patients with ARDET were recorded. Fusional amplitudes were analyzed to assess whether deficient divergence was present in patients with ARDET.ResultsTwenty patients with ARDET were identified. Median age was 77.5 years (range, 59 to 89 years) and median best-corrected visual acuity was 20/25. Median esotropia angle with distance fixation was 5.5Δ (range, 2 to 18Δ); median angle with near fixation was esotropia 2.5Δ (range, exotropia 3Δ to esotropia 13Δ). Fusional divergence amplitudes were decreased in all but two patients. The median amplitude with distance fixation was 4.5Δ for break (range, 1 to 11Δ) and 2Δ for recovery (range, 0 to 9Δ). In 5 patients, the fusional divergence amplitude was as large or larger than the esotropia angle. Most patients remained stable throughout a mean follow-up of 18 months (range, 3 to 37 months). Nineteen patients were managed with prisms. Strabismus surgery was performed in one patient.ConclusionsFusional divergence amplitude was deficient in most but not all patients with ARDET. In this study, most patients with ARDET remained stable and free of diplopia with prism treatment