Alana Lee Grajewski

All Publications

• Surgical Management of Childhood Glaucoma, Clinical Considerations and Techniques Freedman, S. edited by Grajewski, A., Bitrian, E., Papadopoulos, M. Springer Cham. 2018

  View details for DOI 10.1007/9783319540030

• 9th Consensus Meeting: Childhood Glaucoma WGA Consensus Series Grajewski, A., Papadopoulos, M., Griggs, J., Freedman, S. edited by Weinreb, R. Kugler Publications. 2013
• Giant Blebs Post Glaucoma Drainage Device Implantation in Pediatric Patients. Ophthalmology. Glaucoma Abou Khzam, R., Michele Macaron, M., Sharma, A., Grajewski, A., Bitrian, E. 2026

  Abstract

  Three pediatric patients with anterior extending blebs requiring revision surgery for cosmetic concerns are reported. We emphasize the impact of cosmesis on pediatric glaucoma patients' quality of life.

  View details for DOI 10.1016/j.ogla.2026.05.006

  View details for PubMedID 42155767

• Predictors of Long-Term Visual Acuity and Intraocular Pressure Outcomes in Childhood Glaucoma: A Multicenter Study By the Childhood Glaucoma Research Network JOURNAL OF GLAUCOMA Sheheitli, H., Brandt, J., Grajewski, A., Cooper, C., Edmunds, B., Kaushik, S., Bouhenni, R., Al-Haddad, C., Munshi, H., Jiang, Z., Marka, N., Reiser, B., Chang, T. 2025; 34 (11): 979-984

  Abstract

  This study identifies visual acuity and intraocular pressure at 3-year and 5-year follow-ups, along with other variables such as media opacity and nystagmus, as key predictors of long-term outcomes in childhood glaucoma, aiding better management and prognostication.This study aims to identify key predictive variables of visual acuity (VA) and intraocular pressure (IOP) outcomes in childhood glaucoma. By understanding these factors, the study seeks to improve prognostication and management strategies for pediatric patients.A retrospective analysis was conducted on pediatric glaucoma patients across multiple centers within the Childhood Glaucoma Research Network (CGRN). The study included patients with at least 5 years of follow-up. Variables such as sex, race, ethnicity, age of onset, laterality, and clinical measures including VA and IOP at various stages (initial visit, 3 y, 5 y, and final visits) were evaluated. Additional factors considered were anisometropia, media opacities, nystagmus, anterior segment dysgenesis (ASD), strabismus, and angle closure.The study included 396 eyes from 243 patients, with a mean age at presentation of 1.5 months. Several variables showed statistically and clinically significant correlations with final outcomes including IOP and VA at both 3-year and 5-year visits, as well as the presence of media opacities, unilateral glaucoma, nystagmus, and ASD. On the basis of multivariable prediction model analysis the 2 statistically significant predictors for visual acuity (n=31) were VA at 5-year visit and presence of angle closure. As for IOP outcomes (n=31), significant predictors included were IOP at 5-year visit and presence of nystagmus.This multicenter study highlights that VA and IOP measurements at 3 and 5 years postdiagnosis, along with the presence of specific ocular conditions such as media opacity and nystagmus, are crucial in predicting long-term outcomes in childhood glaucoma.

  View details for DOI 10.1097/IJG.0000000000002637

  View details for Web of Science ID 001607659100003

  View details for PubMedID 40982256

• Childhood Glaucoma OPHTHALMOLOGY GLAUCOMA Brandt, J. D., Blieden, L. S., Grajewski, A. L. 2025; 8 (5): S58-S63

  Abstract

  The glaucomas arising in children comprise a diverse group of developmental and secondary disorders. Until the mid-20th century, childhood glaucoma was a uniformly blinding disease. The development of surgical approaches like goniotomy ab interno (1940s) and trabeculotomy ab externo (1960s) provided the first effective treatments for this group of uncommon disorders. Since then, additional progress in the management of adult glaucoma has quickly found its way to childhood glaucoma-including the use of antimetabolites, modern glaucoma drainage devices, and techniques of circumferential ab interno and ab externo trabeculotomy using sutures or an illuminated microcatheter. Each of these techniques requires modifications to be safely used in infants and young children. The nomenclature and classification of the pediatric glaucomas were standardized in 2013 with the Childhood Glaucoma Research Network classification system which was a foundational step in developing registries and coordinated research in the field. Modern tools of molecular genetics have begun to elucidate the underlying molecular pathophysiology and inheritance of some forms of childhood glaucoma. Single-gene, Mendelian-inherited forms of childhood glaucoma may be ideal targets for clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing technologies to correct the disorder locally in the anterior chamber angle. All these advances greatly improved visual outcomes in childhood glaucoma. However, with the greatly improved visual prognosis in childhood glaucoma come unique considerations in how we care for these patients over a very long lifespan. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.ogla.2025.06.011

  View details for Web of Science ID 001601120800012

  View details for PubMedID 40767792

• Prescribing carbonic anhydrase inhibitors to patients with "sulfa" antibiotics allergy: do we dare? EYE Quintanilla, R., van Leeuwen, L., Sharma, A., Chang, T., Hodapp, E., Mcsoley, J., Grajewski, A., Bitrian, E. 2025; 39 (8): 1495-1500

  Abstract

  To evaluate if provider characteristics affect attitude toward carbonic anhydrase inhibitors (CAI) prescription for patients with history of sulfonamide antibiotic (SA) hypersensitivity.A survey querying providers' attitudes toward CAI prescription in hypothetical patients with prior SA hypersensitivity was distributed to four ophthalmology and optometry organizations. Logistic regression was used to assess the relationship between avoiding CAI and profession, specialty, organizational affiliation, and years in practice.Of 250 respondents, 27% and 52% would avoid topical and oral CAI, respectively, in patients with prior SA rash and/or urticaria. >90% would avoid oral CAI in patients with prior severe SA hypersensitivity. Respondents with >10 years in practice were more likely to avoid oral CAI in patients with prior SA rash and/or urticaria than those with ≤10 (OR 2.27, p = 0.002). Respondents affiliated with non-glaucoma organizations were more likely to avoid oral CAI in patients with prior SA rash and/or urticaria than those affiliated with glaucoma organizations (p = 0.03). Providers without glaucoma training were more likely to avoid topical CAI in patients with prior SA rash and/or urticaria (p = 0.004) and anaphylaxis (p = 0.01) than glaucoma-trained providers.Despite no supporting evidence, a significant number of respondents would avoid CAI in patients with prior SA hypersensitivity. Respondents without glaucoma training, no affiliation with a glaucoma organization, and >10 years in practice are more likely to avoid CAI in patients with type I SA hypersensitivity. Providers should be informed of the low cross-reactivity risk between CAI and SA so more patients may benefit from these drugs.

  View details for DOI 10.1038/s41433-025-03674-9

  View details for Web of Science ID 001422453300001

  View details for PubMedID 39955375

  View details for PubMedCentralID PMC12089305

• Genome sequencing reveals novel variants in a diverse population with congenital anterior segment anomalies SCIENTIFIC REPORTS Hussain, A., Villalba, M., Swols, D., Khzam, R., Johnson, B., Peart, L., D'Haiti, S., Grajewski, A. L., Tekin, M., Chang, T., Bademci, G. 2025; 15 (1): 518

  Abstract

  Congenital anterior segment anomalies are disorders that affect the development of the eye and cause severe visual impairment. The molecular basis of congenital anterior segment anomalies is not well known. In this study, genome sequencing was performed on 27 families from diverse ethnicities with congenital anterior segment anomalies and 11 variants were identified, most of which were novel and family specific. These variants included single nucleotide variants CPAMD8:c.4825 C > T, c.534 G > A, CRYBB1:c.683 C > A, NHS:c.1180 C > T, GJA3:c.176 C > T, CRYGC:c.470 G > A, COL2A1:c.2819 G > A, c.1693 C > T, EPHA2:c.2864 A > C, a splice donor variant in COL11A1:c.933 + 1del, and a copy number variant in FBN1. The observed inheritance patterns were predominantly dominant, with a few recessive cases and a single instance of X-linked inheritance. Genome sequencing identified variants in 40.74% of diverse cases, offering valuable insights for enhancing the diagnosis and management of this disorder.

  View details for DOI 10.1038/s41598-024-84205-6

  View details for Web of Science ID 001390088200049

  View details for PubMedID 39747279

  View details for PubMedCentralID PMC11695809

• Response to Letter to the Editor: Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study JOURNAL OF GLAUCOMA Mclaughlin, D. E., Savatovsky, E. J., O'Brien, R. C., Vanner, E. A., Munshi, H. K., Pham, A. H., Grajewski, A. L. 2025; 34 (1): e1-e2

  View details for DOI 10.1097/IJG.0000000000002502

  View details for Web of Science ID 001375605400010

  View details for PubMedID 39315925

• COMPARATIVE ANALYSIS OF PROMPTED AND UNPROMPTED CHATGPT RESPONSES TO FREQUENTLY ASKED QUESTIONS ABOUT PAEDIATRIC GLAUCOMA Goodman, D., Grajewski, A. L., Bitrian, E., Savatovsky, E. J., Chang, T., Pediat Glaucoma Study Grp SPRINGERNATURE. 2024: 149

  View details for Web of Science ID 001389189900078

• Response to Letter to the Editor: Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study JOURNAL OF GLAUCOMA McLaughlin, D. E., Savatovsky, E. J., O'Brien, R. C., Vanner, E. A., Munshi, H. K., Pham, A. H., Grajewski, A. L. 2024; 33 (8): e76-e77

  View details for DOI 10.1097/IJG.0000000000002432

  View details for Web of Science ID 001293514200014

  View details for PubMedID 38747726

• Esterman Visual Field Testing Using a Virtual Reality Headset in Glaucoma OPHTHALMOLOGY SCIENCE Sharma, M., Savatovsky, E., Huertas, L., O'Brien, R., Grajewski, A., Bitrian, E. 2024; 4 (5): 100534

  Abstract

  To test the use of a virtual reality visual field headset (VRVF) for implementation of the Esterman visual field (EVF) test as compared with standard automated perimetry (SAP) among people with glaucoma.Experimental design.Patients with mild to severe glaucoma ranging from 10 to 90 years who presented for follow-up at a glaucoma clinic in Miami, Florida were eligible.Participants performed the EVF test on both SAP and VRVF. Five glaucoma-trained ophthalmologists were then asked to rate all anonymized SAP and RVF tests as a "pass" or "failure" based on Florida state law.Point-by-point concordance between original VRVF EVF test results and SAP EVF test results was calculated using the Kappa statistic. Concordance between SAP and VRVF was secondarily assessed with a conditional logistic regression based on the pass-failure determinations by the glaucoma-trained ophthalmologists. Interrater agreement on test pass-failure determinations was also calculated. Finally, test results on SAP versus VRVF were compared based on Esterman efficiency score (EES), the number of correct points divided by the number of total points, and duration of testing.Twenty-two subjects were included in the study with ages ranging from 14 to 78 years old. Concordance between VRVF and SAP test using point-by-point analysis was poor (κ = 0.332, [95% confidence intervals {CI}: 0.157, 0.506]) and somewhat increased using pass-failure determinations from ophthalmologists (κ = 0.657, [95% CI: 0.549, 0.751]). Ophthalmologists were more likely to agree amongst themselves on pass-failure determinations for VRVF tests (κ = 0.890, [95% CI: 0.726, 0.964]) than for SAP (κ = 0.590, [95% CI: 0.372, 0.818]); however, VRVF demonstrated significantly lower EES than SAP (median EES difference: 4.5 points, P = 0.021).This pilot study is the first to assess the implementation of the EVF test using a virtual reality headset. Based on the weak overall agreement between VRVF and SAP, the current VRVF EVF test is not an acceptable determinant of driver's licensing. However, ophthalmologists were more likely to agree amongst themselves on VRVF test reports than on SAP reports. With further testing and improvement, virtual reality may eventually become a portable and convenient method for administering the EVF test.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.xops.2024.100534

  View details for Web of Science ID 001265205300001

  View details for PubMedID 39071919

  View details for PubMedCentralID PMC11283107

• Laser Focused: A Survey of Ophthalmology Trainee Use of Protective Eyewear During Laser Procedures Sharma, A., Savatovsky, E., Chang, T., Grajewski, A., Bitrian, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316202220

• Vision Screenings and Ophthalmology Referrals Among a Sample of Pediatricians in Florida CUREUS JOURNAL OF MEDICAL SCIENCE Sharma, M., Huertas, L., Savatovsky, E., Grajewski, A. 2024; 16 (5): e59473

  Abstract

  Introduction In Florida, mandated school vision screenings begin around the age of five. However, a joint statement in the ophthalmology community recommends that primary care providers, including pediatricians, screen for eye and vision symptoms and signs starting at birth. This suggests that pediatricians may be the first to catch signs of early vision loss and refer pediatric patients to an ophthalmologist. This study aims to understand the current vision screening practices of a sample of pediatricians in Florida and how comfort levels with vision screenings may impact ophthalmology referrals. Methods A survey with 36 questions was created by the authors of the study and sent to pediatricians through digital newsletters to the Florida Chapter of the American Academy of Pediatrics and pediatric departments at Florida universities. Descriptive statistics were gathered regarding the demographics of pediatricians surveyed, vision screening attitudes and practices, vision concerns and ophthalmology referrals from pediatric clinics, and the most common reasons for referral to an ophthalmologist. The Jonckheere-Terpstra nonparametric trend test was used to examine whether decreased comfort performing vision screening on a child was associated with lower rates of urgent referrals to an optometrist or ophthalmologist. Results Forty-six responses were collected. Seventy-eight percent of pediatricians reported performing early childhood vision screening (n=36). There was considerable variability in vision screening practices among the pediatricians studied, with only 66% beginning screenings from zero to two years of age (n=24). Fifty percent of respondents reported receiving no previous training on performing vision screening, and less than half of respondents reported feeling "somewhat comfortable" or "extremely comfortable" with performing the exam (n=22, 48%). The trend between decreased comfort performing pediatric vision screening and lower rates of urgent eye care referrals was approaching statistical significance (p=0.0705). The majority of urgent referrals were provided by respondents who were somewhat or extremely comfortable with screening (n=13, 65%). Conclusion From this sample of pediatricians in Florida, most respondents reported performing early childhood vision screening, but there was notable variability in the way screenings were performed among pediatricians. Moreover, many had never received training on performing the exam or did not feel comfortable performing them. Decreased comfort with vision screenings was almost significantly associated with decreased urgent referrals to an ophthalmologist. Future studies should examine whether increased training on vision screenings may help improve standardization of screening practices among pediatrics and comfort with vision screenings.

  View details for DOI 10.7759/cureus.59473

  View details for Web of Science ID 001230897000029

  View details for PubMedID 38826970

  View details for PubMedCentralID PMC11142456

• Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study JOURNAL OF GLAUCOMA McLaughlin, D. E., Savatovsky, E. J., O'Brien, R. C., Vanner, E. A., Munshi, H. K., Pham, A. H., Grajewski, A. L. 2024; 33 (1): 15-23

  Abstract

  Monitoring visual fields (VFs) through virtual reality devices proved to have good inter-test and test-retest reliability, as well as easy usability, when self-administered by individuals with and without VF defects in a remote setting.To assess the reliability of remote, self-administered VF monitoring using a virtual reality VF (VRVF) device in individuals without ocular disease and with stable VF defects.Individuals without ocular disease and with stable defects were recruited. All participants had a baseline standard automated perimetry (SAP) test. Participants tested remotely on a VRVF device for 4 weeks (examinations V 1 , V 2 , V 3 , and V 4 ), with the last 3 unassisted. The mean sensitivities of VRVF results were compared with each other and to SAP results for reliability.A total of 42 eyes from 21 participants were tested on the VRVF device. Participants tested consistently although external factors impacted outcomes. VRVF results were in reasonable agreement with the baseline SAP. Examinations performed by the cohort with stable defects evinced better agreement with SAP examinations (V2, P = 0.79; V3, P = 0.39; V4, P = 0.35) than those reported by the cohort without ocular disease (V2, P = 0.02; V3, P = 0.15; V4, P = 0.22), where the null hypothesis is that the instruments agree. Fixation losses were high and variable in VRVF examinations compared with those of SAP, particularly in certain test takers. Participants considered the device comfortable and easy to use.Self-administered, remote VF tests on a VRVF device showed satisfactory test-retest reliability, good inter-test agreement with SAP, and acceptability by its users. External factors may impact at-home testing and age and visual impairment may hinder fixation. Future studies to expand the sample size and understand inconsistencies in fixation losses are recommended.

  View details for DOI 10.1097/IJG.0000000000002290

  View details for Web of Science ID 001127031600004

  View details for PubMedID 37647317

  View details for PubMedCentralID PMC10713003

• A patient with concurrent Axenfeld-Rieger and Stickler syndromes verified by molecular genetics. American journal of ophthalmology case reports Fan, J., da Cruz, N. F., Fan, K. C., Negron, C. I., Amescua, G., Grajewski, A. L., Chang, T. C., Berrocal, A. M. 2023; 32: 101931

  Abstract

  Purpose: To report a case of Axenfeld-Rieger and Stickler Syndrome in a pediatric patient.Observations: A 3-month-old male was referred to the glaucoma clinic after he was noted to have elevated intraocular pressures in both eyes. His family history was notable for infantile glaucoma on his maternal side and retinal detachment on his paternal side. He was found to have anterior segment dysgenesis with iris strands, iridocorneal adhesions, and corectopia, as well as veil-like vitreous in both eyes. He required trabeculotomy, goniotomy, and multiple Baerveldt glaucoma implants in both eyes to achieve intraocular pressure control. Furthermore, the patient later developed macula-involving retinal detachments in both eyes, requiring pars plana vitrectomy with silicone oil tamponade. Genetic analysis confirmed heterozygous pathogenic variants in both the FOXC1 and COL2A1 genes, leading to the concurrent diagnoses of Axenfeld-Rieger and Stickler syndromes.Conclusions and importance: This is a rare case of a patient with concurrent Axenfeld-Rieger and Stickler syndromes. The severity of pathology in both the anterior and posterior segments required a collaborative multidisciplinary approach. In the diagnostic evaluation of congenital eye diseases, if there is strong family history of atypical findings for a given diagnosis, concurrent syndromes should be considered and ruled out. A comprehensive eye genetics panel may be a useful tool in these cases.

  View details for DOI 10.1016/j.ajoc.2023.101931

  View details for PubMedID 37822332

• The Burden of Pediatric Visual Impairment and Ocular Diagnoses in Barbados. International journal of environmental research and public health Da Silva, K., Dowell, M., Savatovsky, E. J., Grosvenor, D., Callender, D., Campbell, M. H., Hambleton, I., Vanner, E. A., Grajewski, A. L., Chang, T. C. 2023; 20 (16)

  Abstract

  Visual impairment (VI) negatively affects a child's quality of life. The prevalence of VI in the Caribbean is nearly three times higher than in the United States, but the causes remain uncertain. This study leverages Barbados' unique eye care system to survey the eye diseases and VI prevalence in Barbadian children. Medical records of all patients aged <19 years who received ophthalmic care in Barbados' two public eye care centers between January and December 2019 were reviewed, capturing the entirety of public pediatric eye care within the study period. Age at the first visit to the clinic and at the final visit in 2019, sex, best-corrected visual acuity (BCVA), past medical history, and clinical diagnoses were extracted and analyzed. VI was defined as a BCVA of 6/12 or worse in the better-seeing eye. There were 3278 patient records with a mean age at the first visit of 7.8 ± 3.9 years. There were 80 (2.4%) children with VI, 62.5% of which were attributed to amblyopia. A total of 94% of VI was preventable or treatable. The most common diagnoses were refractive error (87.5%), strabismus (27.5%), and allergic eye disease (20.0%). Amblyopia is the major cause of pediatric VI in Barbados and is largely avoidable.

  View details for DOI 10.3390/ijerph20166554

  View details for PubMedID 37623140

• Superior Visual Field Testing Using Virtual Reality With and Without Eye Tracking for Functional Upper Eyelid Surgery Evaluation: A Pilot Study Patel, A. J., Lee, W. W., Ziff, M., Munshi, H., Chang, T. C., Grajewski, A. L., Wester, S. T., Tse, D. T., Tse, B. C. LIPPINCOTT WILLIAMS & WILKINS. 2023: 381-385

  Abstract

  To assess the sensitivity and specificity of superior visual field tests administered in virtual reality (VR) with eye tracking (VR-ET) and without eye tracking (VR 0 ) for the fulfillment of insurance coverage criteria for functional upper eyelid surgery as compared with standard automated perimetry (SAP).This prospective cross-sectional study included 78 eyes from 41 patients with ptosis, brow ptosis, and dermatochalasis undergoing functional upper eyelid surgery evaluation. Participants underwent serial superior visual field tests using SAP and VR 0 or VR-ET in randomized order. Fulfillment of insurance coverage criteria for blepharoplasty was defined as a 30% increase in the grid seen from the untaped to the taped state. The main outcome measure was the sensitivity and specificity of VR 0 , VR-ET, and overall VR in meeting insurance coverage criteria as compared with SAP.VR had a sensitivity of 84.1% and specificity of 67.6%, with no significant difference between VR 0 and VR-ET. SAP agreed on insurance coverage criteria fulfillment with VR 0 in 28 (71.8%) eyes and with VR-ET in 32 (82.1%) eyes. Insurance coverage criteria fulfillment rates varied significantly by diagnosis on SAP ( p = 0.012) but not VR ( p = 0.059).VR may be an alternative to SAP for functional upper eyelid surgery evaluation. Future studies are needed to determine differences in patient satisfaction, testing and waiting time, and test-retest reliability between VR and SAP.

  View details for DOI 10.1097/IOP.0000000000002331

  View details for Web of Science ID 001024745300026

  View details for PubMedID 36852832

  View details for PubMedCentralID PMC10329975

• Esterman Virtual Reality Visual Fields in Patients with Glaucoma Sharma, M., Savatovsky, E. J., Grajewski, A., Bitrian, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758301057

• Professional Quality of Life and Associated Factors Among Pediatric Glaucoma Providers OPHTHALMOLOGY GLAUCOMA Patel, A. J., Munshi, H., Vanner, E. A., Bitrian, E., Hodapp, E. A., Chang, T. C., Grajewski, A. L. 2023; 6 (3): 316-321

  Abstract

  Even though physician burnout can negatively impact physical/mental health, ophthalmologists' quality of life (QOL) is understudied. Although managing high-risk diseases like pediatric glaucoma may lead to compassion satisfaction (CS), the responsibility of caring for very sick, demanding patients has been linked to higher burnout. Burnout and secondary traumatic stress (STS) constitute compassion fatigue, the negative effects resulting from helping those who experience stress. We assessed professional QOL, including CS, burnout, and STS, along with associated factors among pediatric glaucoma providers managing potentially blinding disease in children.Cross-sectional survey study.Pediatric glaucoma providers in the Childhood Glaucoma Research Network, American Glaucoma Society, and Indian Paediatric Glaucoma Society.Participants were sent an electronic survey of a validated instrument (Professional Quality of Life-Version 5) designed to measure burnout, STS, and CS, as well as questions related to demographics, lifestyle, training, and practice. Burnout, STS, and CS scores range from 10 to 50 and are classified into low (≤ 22), moderate (23-41), and high (≥ 42) subgroups.Burnout, STS, and CS.Seventy-six pediatric glaucoma providers completed the survey with resulting burnout (22.6 ± 6.3), STS (22.7 ± 6.1), and CS (42.3 ± 6.7) scores. Most respondents had low burnout (43, 56.6%), low STS (44, 57.9%) and high CS (48, 63.2%), though more than a third reported moderate burnout (33, 43.4%), STS (31, 40.8%), and CS (27, 35.6%). Older age and more years in practice correlated positively with CS, and age correlated negatively with STS (P < 0.05 for all). Frequent workday fatigue correlated positively with burnout and STS and negatively with CS, and frequent caffeine consumption correlated positively with burnout and negatively with CS (P < 0.05 for all). Members of a married or unmarried couple had significantly lower CS scores than single, divorced, or separated respondents (P = 0.022).Pediatric glaucoma providers derive a high level of professional satisfaction from their work, though many report moderate burnout and STS. To comprehensively address provider QOL, CS, and both components of compassion fatigue must be considered. Initial efforts may be focused on younger, early-career providers as this group had lower professional QOL scores than their older, late-career counterparts.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.ogla.2022.09.002

  View details for Web of Science ID 001002172200001

  View details for PubMedID 36126915

• The impact of childhood glaucoma on psychosocial functioning and quality of life: a review of the literature EYE McLaughlin, D., Semrov, A., Munshi, H. F., Patel, A., Rahi, J., Grajewski, A., Balkan CGRN Study Grp 2023; 37 (15): 3157-3173

  Abstract

  We present a novel comprehensive literature review of studies of the psychosocial functioning (PF) and quality of life (QoL) of patients with childhood glaucoma and their caregivers. Our findings demonstrate variable study quality and approach, as well as inconsistent results relating to the association of glaucoma-specific factors and sociodemographic variables with measured PF and QoL. Future studies should focus on the development of culturally cognizant and standardized assessment tools, execution of multi-center longitudinal studies with global representation, evaluation of PF and QoL among siblings and childhood glaucoma providers, and implementation of interventions to improve patient and caregiver PF and QoL.

  View details for DOI 10.1038/s41433-023-02492-1

  View details for Web of Science ID 000954723200002

  View details for PubMedID 36949247

  View details for PubMedCentralID PMC10032631

• Leadership in Ophthalmology Professional Organizations: A Descriptive Analysis and Trends, 2002-2022 AMERICAN JOURNAL OF OPHTHALMOLOGY Lee, R. H., Vinod, K., Grajewski, A. L. 2023; 246: 155-162

  Abstract

  To describe characteristics and trends in appointed leaders of ophthalmology professional organizations between 2002 and 2022.Trend study.This study used a Web-based search and data collection. Data were collected on 232 individuals appointed to leadership positions of ophthalmology professional organizations. Main outcome measures were demographic and publication data.Of the 232 ophthalmology leaders appointed between 2002 and 2022, 22.8% were female. Most leaders had subspecialty training (92.9%), practiced in the South (32.6%, P = .001), and practiced at academic institutions (64.8%). Leaders were appointed 32.7 ± 7.3 years after graduation from medical school. Significant variation existed in the number of publications (98.3 ± 104.0) and research productivity scores (29.2 ± 19.5) at the time of appointment. The number of female leaders doubled in 2012-2021 as compared to 2002-2011 (2002-2011: 14.5% female vs 2012-2021: 29.6% female; P = .01). Female leaders were generally appointed earlier in their careers as compared to male leaders (P = .005, male vs female in 2002-2011; P = .02 male vs female in 2012-2021). There were no statistically significant differences in the number of publications or research productivity scores among female vs male leaders.Leaders of ophthalmology professional organizations are largely fellowship-trained subspecialists practicing at academic institutions. Although the number of female leaders of ophthalmology professional organizations has grown over time, most leaders are male. Female leaders tend to be earlier in their careers than male leaders; however, there is no statistically significant difference in research productivity scores among female vs male leaders.

  View details for DOI 10.1016/j.ajo.2022.10.006

  View details for Web of Science ID 000930558600006

  View details for PubMedID 36252674

• Diagnostic yield of next generation sequencing gene panel assays for early-onset glaucoma in an ethnically diverse population JOURNAL OF AAPOS Villalba, M., Grajewski, A. L., Tekin, M., Bademci, G., Chang, T. C. 2022; 26 (6): 302.e1-302.e6

  Abstract

  Early-onset glaucoma is a potentially sight-threatening condition with high heritability. Next generation sequencing is a cost-effective alternative to individual gene screening that could expedite its diagnosis. However, the diagnostic yield of multigene panel assays for early-onset glaucoma varies according to the tested population. The purpose of this study was to ascertain the diagnostic yield of next generation sequencing panels in our cohort and to identify population characteristics that increase such yield.We conducted a retrospective review of the medical records of consecutive patients from November 2016 to August 2021 who were evaluated at our clinics for early-onset glaucoma and had undergone next generation sequencing panels for molecular diagnosis.A total of 118 patients were included, in 22 of whom (19%) a causative variant was identified. Diagnostic yield varied by age of onset: of 60 patients with onset at <3 years of age, 19 (32%) had such variants identified. In contrast, of 58 patients with later-onset glaucoma, 3 (5%) had said variants identified (P = 0.0003). Other metrics that increased diagnostic yield were presence of additional ocular anomalies (P = 0.0092) and identifying ethnicity as White (compared with non-White, P = 0.0001).In childhood glaucoma, earlier age of onset is correlated with higher likelihood of pathogenic variant identification. The large proportion of unsolved cases indicates a robust opportunity for gene discovery and genetic therapy targets in early-onset glaucoma patients.

  View details for DOI 10.1016/j.jaapos.2022.08.529

  View details for Web of Science ID 001044830900007

  View details for PubMedID 36343799

  View details for PubMedCentralID PMC9772253

• Placement and Extension of Glaucoma Drainage Devices Using Polypropylene Suture in Pediatric Patients JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Patel, A. J., McLaughlin, D. E., Chang, T. C., Bitrian, E., Grajewski, A. L. 2022; 59 (5): E62-E65

  Abstract

  Glaucoma drainage device tube placement and extension in pediatric patients may be complicated by abnormal anterior segment anatomy and corneal opacities. The authors describe two techniques for placement and extension of non-valved glaucoma drainage device tubes using polypropylene suture as a guidewire and stabilizer, respectively. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e62-e65.].

  View details for DOI 10.3928/01913913-20220809-04

  View details for Web of Science ID 000923642900005

  View details for PubMedID 36149922

• Factors Associated With Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) Complications and Failure in Children AMERICAN JOURNAL OF OPHTHALMOLOGY Quan, A. V., Chen, J., Wang, Y., Vanner, E. A., Grajewski, A. L., Hodapp, E. A., Chang, T. 2022; 241: 168-178

  Abstract

  To identify the factors associated with the complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children.Retrospective case series.This study was conducted in an institutional setting in a pediatric population (aged <18 years) who had undergone GATT. Records were reviewed, and pre- and postoperative intraocular pressures (IOP), extent of angle treated, medications, complications, and failure were recorded. Failure was defined as IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision.A total of 74 eyes of 57 patients were included (mean age, 7.1 years). Over a median follow-up period of 28.5 months, 36 eyes (48.6%) failed. IOP spikes occurred in 25 eyes (33.8%) and were a significant risk factor for failure (hazard ratio [HR] = 2.17; P = .0207). Postoperative hyphema was a significant risk factor for IOP spike (HR = 4.13, P = .003) but not for failure (HR = 0.7, P = .2977). The risk of IOP spike was lowest in eyes treated with nonsteroidal anti-inflammatory drugs (NSAIDs; HR = 0.27, P = .0016). The risk of failure increased significantly in eyes that received topical corticosteroids (compared to NSAIDs; HR = 5.72, P = .0005), in eyes with <360○ incisions (HR = 4.69, P < .0001), and in younger children.GATT is a reasonably effective procedure in childhood glaucoma. Postoperatively, the use of topical NSAIDs (without corticosteroid) may decrease the risk of failure. Eyes with IOP spikes without hyphema are at the highest risk for failure.

  View details for DOI 10.1016/j.ajo.2022.04.023

  View details for Web of Science ID 000823213700005

  View details for PubMedID 35551908

• A Novel Technique for Anterior Segment Imaging Using B-scan Ultrasonography When Ultrasound Biomicroscopy Is Unavailable JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS McLaughlin, D. E., Patel, A. J., Chang, T. C., Bitrian, E., Grajewski, A. L. 2022; 59 (5): E58-E61

  Abstract

  Ultrasound biomicroscopy offers high-resolution images of anterior segment anatomy, essential for determining surgical intervention in special circumstances, yet is sometimes unavailable. The authors describe a novel technique to obtain gross anterior segment visualization using a commonly available instrument, B-scan ultrasonography, and compare it to ultrasound biomicroscopy imaging from two pediatric cases. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e58-e61.].

  View details for DOI 10.3928/01913913-20220809-02

  View details for Web of Science ID 000923642900004

  View details for PubMedID 36149921

• Glaucoma Cascade Screening in a High Risk Afro-Caribbean Haitian Population: A Pilot Study JOURNAL OF GLAUCOMA Chang, T. C., Celestin, L., Hodapp, E. A., Grajewski, A. L., Junk, A., Rothman, A. L., Duerr, E. R. H., Swaminathan, S. S., Gedde, S. J., Young, T. L., Wiggs, J., Olivier, M. M. G., Quintanilla, R., Arrieta, E., Savatovsky, E. J., Vanner, E. A., Parrish, R. K. 2022; 31 (7): 584-589

  Abstract

  Glaucoma cascade screening in first-degree relatives (FDRs) of young Haitian glaucoma patients had high yield for diagnosing manifest and suspected glaucoma in 30.8% of those screened despite modest participation.To evaluate the outcomes of glaucoma cascade screening in FDRs (parents, siblings, and offspring) of Haitian juvenile open-angle glaucoma (JOAG) patients.Consecutive index patients (Haitians with JOAG) were identified, and the number/type of FDRs residing in South Florida were recorded. These FDRs were invited for free glaucoma screening, which included a comprehensive ophthalmic exam, gonioscopy, automated visual field testing and optical coherence tomographic analysis of the retinal nerve fiber layers. FDR characteristics and clinical findings from screening are reported.A total of 77 FDRs were invited, 26 (33.8%) agreed to undergo screening (18 females, 9 males), which revealed 2 (7.7%) with manifest glaucoma (mean age 77.5 y; one of whom was previously unaware of his glaucoma diagnosis), 6 (23.1%) with suspected glaucoma (mean age 29.8±18.3 y), and 18 (69.2%) without manifest or suspected glaucoma (mean age 37.2±21.8 y). Siblings of index patients were least likely to participate in cascade glaucoma screening when compared with index patients' parents or offspring. FDR eyes with manifest glaucoma had significantly worse best-corrected visual acuities, higher intraocular pressures, thinner central corneal thicknesses, and thinner circumferential papillary retinal nerve fiber layer thicknesses than those without glaucoma.Glaucoma cascade screening of Haitian JOAG patients' FDRs revealed that 30.8% had suspected or manifest glaucoma. Future efforts centered on provider-initiated recruitment and improving public glaucoma awareness and education may increase screening participation.

  View details for DOI 10.1097/IJG.0000000000001996

  View details for Web of Science ID 000923521200015

  View details for PubMedID 35131981

  View details for PubMedCentralID PMC9232278

• Visual Field Testing in a Telehealth Setting: Remote Perimetry Using a Head-Mounted Device in Normal Eyes McLaughlin, D., Munshi, H., Savatovsky, E., Vanner, E., Chang, T., Grajewski, A. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401303249

• Comparison of Virtual Reality Device vs. Standard Automated Perimetry in the Assessment of Superior Visual Field Prior to Functional Upper Eyelid Surgery Patel, A. J., Lee, W. W., Munshi, H., Chang, T., Grajewski, A. L., Tse, D. T., Tse, B. C. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401301269

• Referral Patterns for Pediatric Eye Care within the Public Sector of Barbados Dowell, M., Da Silva, K., Munshi, H., Callender, D., Campbell, M., Hambleton, I., Savatovsky, E., Grajewski, A. L., Grosvenor, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437003125

• Patterns of Pediatric Visual Impairment in the Public Sector of Barbados Da Silva, K., Dowell, M., Savatovsky, E., Callender, D., Campbell, M., Hambleton, I., Munshi, H., Grajewski, A. L., Grosvenor, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437003126

• Preliminary Retrospective Validation of a Novel Virtual Reality Visual Field Standard Testing Algorithm, as Compared to Standard Automated Perimetry Munshi, H., Da Silva, K., Savatovsky, E., Bitrian, E., Grajewski, A. L., Chang, T. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401303258

• The Effect of Changing Fellowship Interview Format on Candidate Ranking Variabilities: The COVID-19 Experience JOURNAL OF OPHTHALMOLOGY Chang, T., Hodapp, E. A., Parrish, R. K., Grajewski, A. L., Gedde, S. J., Lee, R. K., Wellik, S. R., Junk, A. K., Vazquez, L., Swaminathan, S. S., Bitrian, E., Rothman, A. L., Vanner, E. A. 2022; 2022: 7402079

  Abstract

  This study investigated the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on preliminary fellowship candidate ranking variabilities.Cross-sectional observational study.In 2018 and 2019, the glaucoma fellowship interviews were conducted in-person in a one-to-one format, whereas in 2020, interviews were virtual and in a multiple (interviewers)-to-one (candidate) format. We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of WSR versus NWSR on ranking variabilities. We also compared ranking categories ("accept," "alternate," and "pass") agreements between 2018, 2019, and 2020 to assess the effect of virtual versus in-person interviews on ranking variabilities.NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability between 2018/2019 (in-person interviews) and 2020 (virtual interviews) showed no differences between in-person and virtual interviews (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020; p < 0.05 for all years). The overall least attractive candidate has the lowest variability; the most attractive candidate has the second lowest variability.Grouping interviewers WSR during the interview decreased ranking variabilities compared to NWSR, while a change from in-person to virtual interview format did not increase the ranking variabilities. This suggests that the decreased nonverbal interactions in virtual interviews do not decrease interviewers' perceptions as applied to preliminary rankings.

  View details for DOI 10.1155/2022/7402079

  View details for Web of Science ID 000806184000001

  View details for PubMedID 35462616

  View details for PubMedCentralID PMC9020973

• The effect of photographic light brightness on cup to disc ratio grading BMC OPHTHALMOLOGY McSoley, M. J., Rosenfeld, E., Grajewski, A., Chang, T. 2021; 21 (1): 431

  Abstract

  Digital optic disc photographs are integral to remote telehealth ophthalmology, yet no quality control standards exist for the brightness setting of the images. This study evaluated the relationship between brightness setting and cup/disc ratio (c/d) grading among glaucoma specialists.Optic disc photographs obtained during routine examinations under anesthesia were collected to construct an image library. For each optic disc, photographs were obtained at 3 light intensity settings: dark, medium, and bright. From the image library, photograph triads (dark, medium and bright) of 50 eyes (50 patients) were used to construct the study set. Nine glaucoma specialists evaluated the c/d of the study set photographs in randomized order. The relationships between the brightness levels and the c/d grading as well as graders' years in practice and variability were evaluated.The c/d were graded as significantly larger in bright photographs when compared to photographs taken at the medium light intensity (0.53 vs 0.48, P < 0.001) as well as those taken at the dark setting (0.47, P < 0.001). In addition, no relationship was found between ophthalmologists' years in practice and the variability of their c/d grading (P = 0.76).Image brightness affects c/d grading of nonstereoscopic disc photographs. The brighter intensity is associated with larger c/d grading. Photograph brightness may be an important factor to consider when evaluating digital disc photographs.

  View details for DOI 10.1186/s12886-021-02209-6

  View details for Web of Science ID 000729771800001

  View details for PubMedID 34903194

  View details for PubMedCentralID PMC8667014

• Evaluation of a computer-based facial dysmorphology analysis algorithm (Face2Gene) using standardized textbook photos EYE Javitt, M. J., Vanner, E. A., Grajewski, A. L., Chang, T. C. 2022; 36 (4): 859-861

  Abstract

  Genetic syndromes often have ocular involvement. Ophthalmologists may have difficulty identifying dysmorphic features in genetic syndrome evaluations. We investigated the sensitivity and specificity of Face2Gene (F2G), a digital image analysis software trained on integrating dysmorphic features, by analysing patient photos from genetics textbooks.We analysed all clear facial photos contained within the textbooks Smith's Recognizable Patterns of Human Malformation and Genetic Diseases of the Eye using F2G under standard lighting conditions. Variables captured include colour versus grey scale photo, the gender of the patient (if known), age of the patient (if known), disease categories, diagnosis as listed in the textbook, and whether the disease has ophthalmic involvement (as described in the textbook entries). Any photos rejected by F2G were excluded. We analysed the data for accuracy, sensitivity, and specificity based on disease categories as outlined in Smith's Recognizable Patterns of Malformation.We analysed 353 photos found within two textbooks. The exact book diagnosis was identified by F2G in 150 (42.5%) entries, and was included in the top three differential diagnoses in 191 (54.1%) entries. F2G is highly sensitive for craniosynostosis syndromes (point estimate [PE] 80.0%, 95% confidence interval [CI] 56.3-94.3%, P = 0.0118) and syndromes with facial defects as a major feature (PE 77.8%, 95% CI 52.4-93.6%, P = 0.0309). F2G was highly specific (PE > 83percentage with P < 0.001) for all disease categories.F2G is a useful tool for paediatric ophthalmologists to help build a differential diagnosis when evaluating children with dysmorphic facial features.

  View details for DOI 10.1038/s41433-021-01563-5

  View details for Web of Science ID 000645882300001

  View details for PubMedID 33931761

  View details for PubMedCentralID PMC8086228

• Virtual Versus In-Person Surgical Fellowship Interviews and Ranking Variability: the COVID-19 Experience. Research square Chang, T. C., Hodapp, E. A., Parrish, R. K., Grajewski, A. L., Gedde, S. J., Lee, R. K., Wellik, S. R., Junk, A. K., Vazquez, L., Swaminathan, S. S., Bitrian, E., Rothman, A. L., Vanner, E. A. 2021

  Abstract

  Objective: To investigate the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on candidate ranking variabilities.Method: In 2018/2019, the glaucoma fellowship interviews were conducted in-person and one-to-one, whereas in 2020, interviews were virtual and multiple (interviewers)-to-one (candidate). We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of this change on ranking variabilities. We also compared ranking categories ("accept," "alternate," and "pass") agreements between in-person and virtual interviews to assess the effect of this change on ranking variabilities.Results: NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability of in-person interviews and later virtual interviews showed no differences (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020; p < 0.05 for all years). The overall least attractive candidate has the lowest variability; the most attractive candidate has the second lowest variability.Conclusion: Grouping interviewers decreased ranking variabilities, while a change from in-person to virtual interview format did not increase the ranking variabilities.

  View details for DOI 10.21203/rs.3.rs-415697/v1

  View details for PubMedID 34013249

• Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population Medert, C. M., Cavuoto, K. M., Vanner, E. A., Grajewski, A. L., Chang, T. C. ELSEVIER. 2021: 63-70

  Abstract

  Report factors associated with failure and complication in a cohort of children who have undergone glaucoma drainage device (GDD) implantation.Retrospective case series.Consecutive pediatric GDD eyes that met criteria between May 1997 and July 2019.Entries were included for analysis if age <18 years at the time of GDD implantation. Failure was defined as an intraocular pressure (IOP) greater than 21 mmHg or IOP reduction <20% or IOP <5 mmHg at 2 consecutive follow-up visits >3 months after implantation, reoperation for glaucoma, or loss of light perception vision. Complications were defined as postoperative events due to the GDD that required additional examination under anesthesia or additional surgery.Survival analyses of surgical failures and complications.Over a mean follow-up period of 5.4 years, 58 (38%) of 150 first-time GDD implants failed. Glaucoma associated with acquired conditions had decreased risk for failure when compared with glaucoma secondary to nonacquired systemic diseases (hazard ratio [HR], 12; P = 0.0063), nonacquired ocular anomalies (HR, 12; P = 0.0054), and primary congenital glaucoma (HR, 5.4; P = 0.041). There was an increased risk of failure for first-time tubes in younger patients with a 23% reduction of failure with each 3-year increase in age (HR, 0.77; P = 0.034). A total of 38 (25.3%) of the first-time GDD implantations had a complication. Higher preoperative IOP (5 mmHg increase; HR, 1.2; P = 0.038) and younger age (<3 years; HR, 2.1; P = 0.024; < 2 years, HR, 1.9; P = 0.046) increased the risk of complication. There were 22 second-time GDD implants in the study, of which 11 failed (50%), and increased risk for failure was associated with younger age at the time of implantation (<1 year; HR, 27; P = 0.0053) and concurrent glaucoma-related procedures with or without non-glaucoma anterior segment surgery at the time of implantation (HR, 13; P = 0.0085).Although GDD implantation in children is relatively safe and effective, these data should be interpreted in the context of children's relative longevity. These findings offer an outcome metric to which future novel glaucoma procedures in children can be compared.

  View details for DOI 10.1016/j.ogla.2020.07.006

  View details for Web of Science ID 000662210000018

  View details for PubMedID 32707177

  View details for PubMedCentralID PMC7854772

• A Novel Surgical Approach in the Management of Peters Anomaly With Glaucoma JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Sheheitli, H., Groth, S. L., Chang, T., Hodapp, E. A., Grajewski, A. L. 2020; 57 (6): E25-E29

  Abstract

  Treatment options for Peters anomaly vary depending on the degree of corneal and lenticular involvement. The authors report a novel surgical approach for patients with type I Peters anomaly and glaucoma. It involves ab externo circumferential trabeculotomy, simultaneous lysis of iridocorneal adhesions at the time of trabecular cleavage, and optical iridectomy. [J Pediatr Ophthalmol Strabismus. 2020;57:e25-e29.].

  View details for DOI 10.3928/01913913-20200204-01

  View details for Web of Science ID 001016294700007

  View details for PubMedID 32176806

• Juvenile angle closure management: The role of lens extraction and goniosynechialysis. American journal of ophthalmology case reports Lee, J. Y., Berrocal, A. M., Grajewski, A. L., Chang, T. C. 2020; 19: 100808

  Abstract

  PURPOSE: Angle closure (AC) is a rare condition in young people. In adults with AC, lens extraction and goniosynechialysis (LE-GSL) are effective in restoring angle anatomy and function. However, the efficacy of LE-GSL is poorly understood in the juvenile population. In this study, we report the efficacy and safety of LE-GSL in a series of young patients with AC.METHODS: We reviewed the medical records of consecutive patients with AC. Eyes were included if aged <40 years at the time of diagnosis, had angle closure, at least one month of postoperative follow-up, and had undergone LE-GSL between January 1, 2015 and June 30, 2019. Eyes were excluded if they had undergone prior incisional glaucoma surgery. AC was defined as elevated untreated intraocular pressure (IOP)>24mmHg and (1) less than 180° of visible trabecular meshwork, or (2) any peripheral anterior synechiae noted on gonioscopy, or (3) iridocorneal apposition prior to dilation>180° identified on anterior segment imaging.RESULTS: A total of 11 eyes (7 patients) were included. The mean ages of diagnosis and LE-GSL were 19.0 and 21.2 years, respectively. Of the 11 eyes, 8 had a history of laser retinal ablation for the treatment of retinopathy of prematurity (ROP, 72.7%). Intraoperatively, 7 eyes received intraocular lens (63.3%), 6 had concurrent vitrectomy (54.5%), and 4 had concurrent endocyclophotocoagulation (36.4%). Following LE-GSL, visual acuity (VA) improved from a mean preoperative LogMAR of 0.88 (20/150 Snellen equivalence) to a mean LogMAR of 0.68 (20/100 Snellen equivalence, P=0.029). IOP significantly decreased from 18.2mmHg (Tmax 38.4±12.2mmHg) preoperatively to a mean of 11.3mmHg postoperatively (P=0.009). The number of glaucoma medications was significantly reduced from a mean of 2.4 preoperatively to no medications at final follow-up (mean duration of 13.7 months, P<0.001). There were no significant intra- or postoperative complications in any eyes.CONCLUSIONS AND IMPORTANCE: In our cohort, LE-GSL significantly lowered IOP, improved visual outcomes, and decreased medication burden in young patients with AC, many of which had infantile retinal ablation for ROP. LE-GSL may be considered an effective intervention in young patients with AC.

  View details for DOI 10.1016/j.ajoc.2020.100808

  View details for PubMedID 32642598

• Microcornea and Thickened Lens in Angle Closure following Nonsurgical Treatment of Retinopathy of Prematurity JOURNAL OF OPHTHALMOLOGY Chang, T. C., Tran, K. D., Cernichiaro-Espinosa, L. A., Leung, E. H., Grajewski, A. L., Hodapp, E. A., Abou Shousha, M. F., Berrocal, A. M. 2020; 2020: 7510903

  Abstract

  To characterize the clinical features in young patients with angle closure and to determine the characteristics associated with acquired anterior segment abnormality following retinopathy of prematurity (ROP) treatment.We performed two retrospective case-control series. In the first series, we identified consecutive young angle closure patients without prior surgeries, with and without a history of ROP treatment; in the second series we identified consecutive patients who underwent ROP treatment, without and without anterior segment changes.In the first series, 25 eyes of 14 consecutive angle closure patients were included: 19 eyes (11 patients, 78.6%) had a history of treated ROP, while 6 eyes (3 patients) belonged to full-term patients. The treated ROP eyes had significantly shallower anterior chambers (1.77 ± 0.17 mm vs 2.72 ± 0.18 mm, P < 0.0001) and thicker lenses (5.20 ± 0.54 mm vs 3.98 ± 0.20 mm, P = 0.0002) compared to the full-term controls. In the second series, 79 eyes of 40 patients were included, with median gestational age of 24.6 weeks. Acquired iridocorneal adhesion was noted in the eight eyes (10.1%) at a mean age of 4.7 years and was associated with prior zone 1 and plus disease (P = 0.0013), a history of initial intravitreal bevacizumab treatment (IVB, P = 0.0477) and a history of requiring additional IVB after initial treatment (P = 0.0337).Many young angle closure patients may have a history of treated ROP and may present with the triad of increased lens thickness, microcornea, and angle closure.

  View details for DOI 10.1155/2020/7510903

  View details for Web of Science ID 000536261600001

  View details for PubMedID 32454993

  View details for PubMedCentralID PMC7225864

• Risk Factors for Complications and Failure after Gonioscopy-Assisted Transluminal Trabeculotomy in a Young Cohort OPHTHALMOLOGY GLAUCOMA Chen, J., Wang, Y., Quan, A., Grajewski, A., Hodapp, E., Vanner, E. A., Chang, T. 2020; 3 (3): 190-195

  Abstract

  To determine the risk factors for failures and complications of gonioscopy-assisted transluminal trabeculotomy (GATT) in a young cohort.Retrospective case series.Eyes that underwent GATT at Bascom Palmer Eye Institute.Preoperative and postoperative intraocular pressure (IOP), extent of angle treated, postoperative IOP spike, postoperative drop regimen, and postoperative failure were recorded. Failure was defined as (1) IOP of more than 21 mmHg or less than 5 mmHg after postoperative month 3, (2) absence of at least 20% reduction from the preoperative IOP baseline after postoperative month 3, or (3) performance of additional IOP-lowering surgery before postoperative month 3. Intraocular pressure spike complication was defined as an increase in IOP in the operated eye at any postoperative visit to higher than preoperative IOP within the first 3 months. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to assess the time to events (failure and IOP spike).Risk of failure associated with any of the preoperative, intraoperative, or postoperative variables.A total of 102 eyes of 88 patients were included. The median follow-up time was 7.4 months, with an interquartile range of 3.3 to 13.1 months (standard deviation, 8.7 months). Patients who used corticosteroids after surgery were more likely to experience IOP spikes than those using nonsteroidal anti-inflammatory drugs (NSAIDs) alone (hazard ratio, 3.34; P = 0.042), and patients who underwent noncircumferential trabeculotomy were 2.56 times more likely to experience treatment failure (P = 0.002) compared with those who underwent circumferential surgery.Eyes that received postoperative corticosteroids were more likely to experience an IOP spike complication than those that received postoperative NSAIDs alone, which may suggest corticosteroid-mediated outflow obstruction distal to the trabecular meshwork. Achieving a circumferential trabeculotomy and using only NSAIDs may be more likely to result in surgical success when compared with noncircumferential trabeculotomy or using postoperative corticosteroids.

  View details for DOI 10.1016/j.ogla.2020.02.002

  View details for Web of Science ID 000661196400006

  View details for PubMedID 32672614

• Spectrum of Genetic Variants Associated with Anterior Segment Dysgenesis in South Florida GENES Thanikachalam, S., Hodapp, E., Chang, T. C., Swols, D., Cengiz, F. B., Guo, S., Zafeer, M. F., Seyhan, S., Bademci, G., Scott, W. K., Grajewski, A., Tekin, M. 2020; 11 (4)

  Abstract

  Anterior segment dysgenesis (ASD) comprises a wide spectrum of developmental conditions affecting the cornea, iris, and lens, which may be associated with abnormalities of other organs. To identify disease-causing variants, we performed exome sequencing in 24 South Florida families with ASD. We identified 12 likely causative variants in 10 families (42%), including single nucleotide or small insertion-deletion variants in B3GLCT, BMP4, CYP1B1, FOXC1, FOXE3, GJA1, PXDN, and TP63, and a large copy number variant involving PAX6. Four variants were novel. Each variant was detected only in one family. Likely causative variants were detected in 1 out of 7 black and 9 out of 17 white families. In conclusion, exome sequencing for ASD allows us to identify a wide spectrum of rare DNA variants in South Florida. Further studies will explore missing variants, especially in the black communities.

  View details for DOI 10.3390/genes11040350

  View details for Web of Science ID 000537224600077

  View details for PubMedID 32224865

  View details for PubMedCentralID PMC7230952

• Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost JAMA OPHTHALMOLOGY Javitt, M. J., Grossman, A., Grajewski, A., Javitt, J. C. 2020; 138 (4): 382-386

  Abstract

  Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions.To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation.A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019.The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year.Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year.Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.

  View details for DOI 10.1001/jamaophthalmol.2020.0048

  View details for Web of Science ID 000526606900010

  View details for PubMedID 32105297

  View details for PubMedCentralID PMC7047872

• Case Series of Brittle Cornea Syndrome CASE REPORTS IN OPHTHALMOLOGICAL MEDICINE Eleiwa, T., Raheem, M., Patel, N. A., Berrocal, A. M., Grajewski, A., Abou Shousha, M. 2020; 2020: 4381273

  Abstract

  This case series demonstrate diagnostic features, treatment options, and challenges for Brittle Cornea Syndrome. Observations. Three cases presented with bluish sclera and extremely thin cornea. Genetic workup was performed and confirmed the diagnosis of Brittle Cornea Syndrome, a rare autosomal recessive disorder characterized by corneal thinning and blue sclera. Case 1 was a 4-year-old boy who developed cataract and glaucoma after undergoing right tectonic penetrating keratoplasty (PK) secondary to a spontaneous corneal rupture. Glaucoma was controlled medically. Later, the kid underwent right transcorneal lensectomy and vitrectomy with synechiolysis. After 6 weeks, he sustained graft dehiscence that was repaired using onlay patch graft. Case 2 was a 7-year-old boy who underwent PK in the right eye, then a pericardial patch graft in the left eye following spontaneous corneal rupture. Glaucoma in both eyes was controlled medically. Case 3 was the 2-year-old sister of the 2nd case. She had a pachymetry of 238 μm OD and 254 μm OD and 254 .Long-term follow-up of children diagnosed with Brittle Cornea Syndrome is paramount to minimize the morbidity of corneal rupture and late-onset extraocular conditions.

  View details for DOI 10.1155/2020/4381273

  View details for Web of Science ID 000522987700001

  View details for PubMedID 32257481

  View details for PubMedCentralID PMC7109549

• International Study of Childhood Glaucoma OPHTHALMOLOGY GLAUCOMA Papadopoulos, M., Vanner, E. A., Grajewski, A. L., Int Study Childhood Glaucoma Child 2020; 3 (2): 145-157

  Abstract

  To ascertain the types of childhood glaucoma managed at major international centers, current clinical practice, and intraocular pressure (IOP) control and visual acuity (VA) outcomes.Prospective, multicenter, consecutive case series.All children with newly diagnosed glaucoma in at least 1 eye who fulfilled the Childhood Glaucoma Research Network (CGRN) definition of childhood glaucoma were recruited over a 1-year period with the aim of 18 months follow up.Demographic, clinical, management data (including complications), and outcomes (IOP and VA) were entered in a secure online database. All cases included in the outcome analysis had a minimum of 6 months follow-up.The management of childhood glaucoma, IOP control, and VA outcomes.A total of 441 children (691 eyes) with newly diagnosed glaucoma were enrolled from 17 international centers. Approximately 60% of patients came from 2 centers in India; however, 47.5% of Indian patients had no or less than 6 months of follow-up outcome data from diagnosis. Primary congenital glaucoma (PCG) was the most common diagnosis (45.4%, n = 314 eyes). There was a statistically significant association between diagnosis and ethnicity/race (P < 0.001), with PCG more frequent in nonwhite patients, glaucoma associated with acquired conditions more frequent in South Asian patients, and glaucoma after cataract surgery more frequent in white patients. The initial surgical procedure of choice for eyes with PCG significantly differed by country. Angle surgery alone was first line in centers in the United States, United Kingdom, Germany, Saudi Arabia, Singapore, and Israel (Group 1), whereas combined trabeculotomy-trabeculectomy was the first-line procedure for PCG in centers in India and Ghana (Group 2). There was no significant difference in IOP control nor VA between the 2 groups.The most common diagnoses in this international study of children with newly diagnosed glaucoma in order of frequency were PCG, glaucoma after congenital idiopathic cataract surgery, and glaucoma associated with trauma. Indian children had a disproportionately high loss to follow-up rate. Despite international differences in the surgical approach to PCG, there was no statistically significant difference in IOP or VA outcomes. We hope the results of this study will inform key areas of future international, collaborative clinical research in childhood glaucoma.

  View details for DOI 10.1016/j.ogla.2019.12.007

  View details for Web of Science ID 000661195600009

  View details for PubMedID 32672598

• Neuro-ophthalmic Disease in Pediatric Glaucoma Practice JOURNAL OF GLAUCOMA Tirpack, A. R., Vanner, E. A., Sheheitli, H., Mendoza, C. E., Grajewski, A., Chang, T. C. 2020; 29 (2): 117-123

  Abstract

  Pediatric glaucoma referral to neuro-ophthalmology has a high yield for diagnosing neurological disease and neuroimaging in this cohort often uncovers intracranial abnormalities.Multiple studies have examined the utility of neuro-ophthalmology referrals in an adult glaucoma patient population. No similar studies in the pediatric glaucoma population have been completed. An analysis of pediatric referral patterns and clinical characteristics can serve to guide future physician referrals and improve patient outcomes.A retrospective review of medical records was conducted to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology services at Bascom Palmer Eye Institute from January 2013 to August 2018. Records were reviewed for clinical examination findings, demographics, ophthalmic imaging, neuroimaging, and ultimate diagnosis.A total of 59 patients, average age 10 years old, were included for analysis. The majority of patients were referred from pediatric glaucoma to neuro-ophthalmology (n=52, 88.1%). The most common reasons for referral included suspected nonglaucomatous optic neuropathy (n=14), optic disc swelling (n=7), color vision deficiency (n=6), and nonglaucomatous visual field defect (n=4). Referral to neuro-ophthalmology resulted in neuro-imaging in 22 patients (22/52, 42.3%), with 7 patients (7/52, 13.7%) having pathology on the scan. Ultimately, 38 patients (73.1%) referred to neuro-ophthalmology had an ultimate diagnosis unrelated to glaucoma. Color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer <70 µm in at least 1 eye were associated with a diagnosis unrelated to glaucoma. Of the 7 patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure lowering therapy.Patients referred from pediatric glaucoma to neuro-ophthalmology often have nonglaucomatous disease requiring subspecialty evaluation and neuroimaging. Neuroimaging in this cohort is high yield for uncovering intracranial pathology.

  View details for DOI 10.1097/IJG.0000000000001416

  View details for Web of Science ID 000510769100009

  View details for PubMedID 31821182

• Trabeculotomy Ab Interno With the Trab360 Device for Childhood Glaucomas AMERICAN JOURNAL OF OPHTHALMOLOGY Areaux, R. G., Grajewski, A. L., Balasubramaniam, S., Brandt, J. D., Jun, A., Edmunds, B., Shyne, M. T., Bitrian, E. 2020; 209: 178-186

  Abstract

  To report outcomes and complications of trabeculotomy ab interno using the Trab360 device (Trab360; Sight Sciences, Menlo Park, California, USA) in eyes with childhood glaucomas.Multicenter retrospective interventional case series.Eyes with childhood glaucomas that underwent Trab360 with at least 3 months follow-up were evaluated. Postoperative intraocular pressure (IOP) less than or equal to 24 mm Hg with or without medications and no additional surgery defined success.Forty-six eyes of 41 patients were included. Median age at surgery was 12 months (range 1-325 months, mean 71 months); 54% prior to 20 months. A total of 48% were right eyes; 48% were male. Mean treatment was 290°. Median follow-up was 14.5 months (range 6-34 months, mean 16.2 months). Median preoperative IOP was 30 mm Hg (range 18-49 mm Hg, mean 30.9 mm Hg); median postoperative IOP was 18 mm Hg (range 5-40 mm Hg, mean 20.3 mm Hg]. Median number of preoperative glaucoma medications was 2.5 (range 0-5, mean 2.6); median number postoperatively was 1 (range 0-4, mean 1.6). Success was achieved in 67.4% (95% CI: 51.9%-80.0%) of eyes. Among 40 eyes for which Trab360 was the first glaucoma surgery, success rate was 70% (95% CI 53.3%-82.9%). Success was achieved in 81% (95% CI 57.4%-93.7%) of primary congenital glaucoma (PCG) eyes. Among 18 PCG eyes for which Trab360 was the first glaucoma surgery, success rate was 83.3% (95% CI 57.7%-95.6%). Two eyes (4.3%) suffered cyclodialysis. There were no other significant complications.Trab360 success resembles literature on other angle surgeries for childhood glaucomas. Good surgical technique and caution in high-risk angles is imperative to avoid cyclodialysis. Our study is limited by the imperfections inherent in any retrospective analysis. Single-incision ab interno trabeculotomy with the Trab360 device is effective and safe for treating childhood glaucomas, especially PCG.

  View details for DOI 10.1016/j.ajo.2019.10.014

  View details for Web of Science ID 000507428600021

  View details for PubMedID 31647927

• American Glaucoma Society Position Statement on Cannabinoid Use in Pediatric Glaucoma Patients OPHTHALMOLOGY GLAUCOMA Grossman, A. L., Javitt, M. J., Moster, S. J., Grajewski, A. L., Amer Glaucoma Soc 2019; 2 (6): 365-366

  View details for DOI 10.1016/j.ogla.2019.07.007

  View details for Web of Science ID 000660582700001

  View details for PubMedID 32672568

• Pigment dispersion syndrome and response to laser peripheral iridotomies in a child with Marfan syndrome JOURNAL OF AAPOS Areaux, R. G., Grajewski, A. L. 2019; 23 (5): 300-302

  Abstract

  Pigment dispersion syndrome (PDS) and pigmentary glaucoma have rarely been reported in Marfan syndrome and have never been reported in a child with Marfan syndrome. We report the clinical and ultrasound biomicroscopic findings of PDS in a 14-year-old girl with Marfan syndrome and its favorable response to bilateral laser peripheral iridotomy.

  View details for DOI 10.1016/j.jaapos.2019.06.005

  View details for Web of Science ID 000499763000025

  View details for PubMedID 31513900

• Glaucomatous optic disc changes despite normal baseline intraocular pressure in a child. American journal of ophthalmology case reports Hoffman, B. B., Rosenfeld, E., Grajewski, A. L., Chang, T. C. 2019; 13: 104-109

  Abstract

  PURPOSE: We describe a case of normal tension glaucoma in the setting of sickle cell disease in a 9-year-old patient with a five-year follow up.OBSERVATIONS: A 9-year-old male patient with a history of sickle cell disease presented initially at the age of 4 years for evaluation of a brief episode of nonspecific eye pain that had spontaneously resolved prior to the clinic visit. Over the course of several years, the patient was noted to have progressive optic disc cupping bilaterally, retinal nerve fiber layer thinning bilaterally, and has developed a corresponding inferior arcuate defect on automated visual field testing in the right eye, all without elevated intraocular pressures (IOP). After neuro-ophthalmic pathologies were ruled out, the patient was diagnosed with glaucoma associated with sickle cell disease and normal baseline IOP, and brimonidine therapy was initiated.CONCLUSIONS AND IMPORTANCE: To our knowledge, this is the first reported case of normal-tension glaucoma in a pediatric patient. Normal-tension glaucoma may be a consideration in the evaluation of pediatric glaucoma suspects, but remains a diagnosis of exclusion.

  View details for DOI 10.1016/j.ajoc.2018.12.012

  View details for PubMedID 30619974

• Re: Nudleman et al.: Glaucoma after lens-sparing vitrectomy for advanced retinopathy of prematurity OPHTHALMOLOGY Chang, T. C., Hodapp, E. A., Grajewski, A. L., Vanner, E. A., Berrocal, A. M., Freedman, S. F. 2019; 126 (1): E4

  View details for DOI 10.1016/j.ophtha.2018.07.020

  View details for Web of Science ID 000453531300001

  View details for PubMedID 30577920

• Early Predictors of Long-term Outcomes in Childhood Glaucoma JOURNAL OF GLAUCOMA Chang, T. C., Cavuoto, K. M., Grajewski, A. L., Hodapp, E. A., Vanner, E. A. 2018; 27 (12): 1094-1098

  Abstract

  A data-based staging system for childhood glaucoma is likely to improve the prediction of visual acuity and intraocular pressure (IOP) control outcomes. We investigated early clinical factors associated with poor long-term visual, and IOP control outcomes in early-onset glaucoma as the initial steps to constructing a severity staging system.Statistical modeling of retrospective case series data.Glaucoma patients younger than 3 years of age who presented to Bascom Palmer Eye Institute between 1990 and 2010 with at least 5 years of follow up.Statistical modeling of retrospective case series data from first, second, third, 3-year, 5-year, and final visits.Association of early clinical characteristics to final IOP-control outcomes and visual acuities.A total of 26 eyes of 15 children were included. Nine of 15 (60%) of patients were male. Mean age at initial presentation: 9.98±10.55 months. Mean duration between initial and final visits: 11.13±3.55 years. By the third visit (mean 6.69 mo after presentation), presence of nystagmus, anterior segment dysgenesis (ASD) or having failed angle surgery increased the final LogMAR visual acuity by 0.76 (P=0.0516), 0.64 (P=0.0618), and 0.58 (P=0.0159), respectively. At year 3, failed amblyopia therapy, failed angle surgery, nystagmus, media opacity (MO), or ASD increased the final LogMAR by 1.30, 1.34, 1.21, 0.85, 0.64, respectively (all P<0.02). Failed angle surgery or MO increased the chance of uncontrolled IOP at the final visit (proportional odds ratio of 6.77 and 12.88, respectively).In this pilot study of a modest size cohort, the presence of nystagmus, ASD or failed angle surgery early in the course of infantile-onset glaucoma management predicted poor final visual outcome, whereas failed angle surgery and presence of MO predicted poor final IOP control. These predictors of poor outcomes will serve as the initial steps in constructing a severity staging system.

  View details for DOI 10.1097/IJG.0000000000001031

  View details for Web of Science ID 000453564300015

  View details for PubMedID 30059407

• New classification system for pediatric glaucoma: implications for clinical care and a research registry CURRENT OPINION IN OPHTHALMOLOGY Thau, A., Lloyd, M., Freedman, S., Beck, A., Grajewski, A., Levin, A. V. 2018; 29 (5): 385-394

  Abstract

  The Childhood Glaucoma Research Network (CGRN) has created a new classification system for childhood glaucoma that has become the first International Consensus Classification. The purpose of this review is to present this classification system and share its use to date.The diagnoses of the classification system include glaucoma and glaucoma suspect. The primary glaucomas include: primary congenital glaucoma and juvenile open-angle glaucoma. The secondary glaucomas include: glaucoma following cataract surgery, glaucoma associated with nonacquired systemic disease or syndrome, glaucoma associated with nonacquired ocular anomalies, and glaucoma associated with acquired conditions. This system reached consensus agreement at the Ninth World Glaucoma Association Consensus, which has been adopted by the American Board of Ophthalmology, and has been implemented in outcomes research, incidence studies, and review articles. The new Robison D. Harley, MD CGRN International Pediatric Glaucoma Registry uses this classification system as a shared language, allowing international clinicians and researchers to collaborate and make large-scale investigations of this otherwise rare disease possible.The diagnoses in this system are assigned by following a logical and systematically approachable path. The ability to easily adopt and implement the system lends itself to international research.

  View details for DOI 10.1097/ICU.0000000000000516

  View details for Web of Science ID 000442246800003

  View details for PubMedID 30096087

• Comprehensive Genetic Testing Identifies Rare Pathogenic Variants for Anterior Segment Dysgenesis Morel, D., Thanikachalam, S., Hodapp, E., Chang, T., Cengiz, F., Bademci, G., Scott, W., Grajewski, A., Tekin, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932807177

• Intraocular Pressure in Children Under General Anesthesia: Sevoflurane versus Nitrous Oxide Bitrian, E., Tutiven, J., Chang, T., Grajewski, A. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394210601297

• Paradoxical thinning of the retinal nerve fiber layer after reversal of cupping: A case report of primary infantile glaucoma INDIAN JOURNAL OF OPHTHALMOLOGY Chang, T., Grajewski, A. L. 2016; 64 (9): 690-U123

  Abstract

  The circumpapillary retinal nerve fiber layer (RNFL) thickness was assessed by spectral domain optical coherent tomography (SD-OCT) before and after surgical reduction of intraocular pressure in an eye with primary infantile glaucoma. In this case, a postoperative reduction of cupping and a subsequent increase in neuroretinal rim area is associated with a paradoxical thinning of the RNFL. This is the first-known characterization of cupping reversal using SD-OCT.

  View details for DOI 10.4103/0301-4738.97092

  View details for Web of Science ID 000389310100020

  View details for PubMedID 27853025

  View details for PubMedCentralID PMC5151167

• Single clear corneal incision for glaucoma drainage device shortening in pediatric glaucoma JOURNAL OF AAPOS Radke, P. M., Bitrian, E., Grajewski, A. L. 2016; 20 (3): 274-276

  Abstract

  Glaucoma drainage devices are commonly used for management of glaucoma in adults and children. With time, the position of the tube can change and cause damage such as corneal scarring, iris or lens contact, and uveitis. Most of these problems can be improved with tube shortening and/or excision of adherent iris or fibrous tissue. We describe a surgical technique that uses a single clear corneal incision to externalize and trim the shunt in pediatric patients. The technique has a short surgical. We review the indications and outcomes for this procedure in 13 eyes of 12 children who required shunt revision.

  View details for DOI 10.1016/j.jaapos.2016.02.007

  View details for Web of Science ID 000378186200022

  View details for PubMedID 27156496

• A retrospective survey of childhood glaucoma prevalence according to Childhood Glaucoma Research Network classification INDIAN JOURNAL OF OPHTHALMOLOGY Hoguet, A., Grajewski, A., Hodapp, E., Chang, T. 2016; 64 (2): 118-123

  Abstract

  To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification.Retrospectively, the medical records of 205 consecutive childhood glaucoma and glaucoma suspect patients at an urban tertiary care center were reviewed. The initial diagnosis and new diagnosis according to CGRN classification were recorded.All patients fit one of the seven categories of the new classification. Seventy-one percent of diagnoses were changed upon reclassification. Twenty-three percent of patients had primary glaucoma (juvenile open-angle glaucoma and primary congenital glaucoma [PCG]); 36% had secondary glaucoma (glaucoma associated with nonacquired ocular anomalies; glaucoma associated with nonacquired systemic disease or syndrome; glaucoma associated with acquired condition; and glaucoma following cataract surgery); and 39% were glaucoma suspect. Of the patients diagnosed with glaucoma, PCG was the most common diagnosis, seen in 32% of patients.The CGRN classification provides a useful method of classifying childhood glaucoma.

  View details for DOI 10.4103/0301-4738.179716

  View details for Web of Science ID 000374163800004

  View details for PubMedID 27050345

  View details for PubMedCentralID PMC4850805

• Surgical Outcomes of Congenital Glaucoma in Peters' Anomaly Bitrian, E., Grajewski, A. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882206304

• Hypotony maculopathy after trabeculectomy: outcomes of bleb revision and choroidal drainage Zhou, C., Bitrian, E., Wright, M. M., Grajewski, A. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882206305

• PERIPHERAL RETINAL VASCULOPATHY IN CHILDHOOD GLAUCOMA RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Kim, H. Y., Hodapp, E., Grajewski, A. L., Sarraf, D., John, V. J., Hess, D. J., Berrocal, A. M. 2015; 35 (5): 1028-1035

  Abstract

  To report wide-field fluorescein angiography findings in the peripheral retina of eyes with childhood glaucoma.Fluorescein angiograms were examined retrospectively in 12 patients with childhood glaucoma who underwent wide-field fluorescein angiography after surgical or medical treatment of glaucoma. This series included 12 eyes of 6 patients with primary congenital glaucoma, 5 eyes of 3 patients with glaucoma associated with congenital cataract surgery, 4 eyes of 2 patients with glaucoma associated with a systemic condition, and 1 eye of 1 patient with phakomatosis pigmentovascularis Type II. RetCam fundus photography images and digital fluorescein angiography were performed under general anesthesia.The most common finding observed in our series was peripheral retinal nonperfusion, which affected 20 eyes (91%). Other notable features seen were circumferential branching of the retinal vessels parallel to the ora serrata (77%), venous shunts (50%), and abnormal capillary branching patterns, including capillary dilatation (41%) and tortuous capillary tangles (18%). Leakage at the junction of vascular and avascular retina was not commonly seen (13.6%). None of the eyes had evidence of retinal neovascularization or fibrovascular proliferation.Retinal vascular abnormalities and peripheral nonperfusion are novel findings in childhood glaucoma. Further studies are needed to understand the significance and possible long-term consequences of these findings.

  View details for DOI 10.1097/IAE.0000000000000415

  View details for Web of Science ID 000353408900025

  View details for PubMedID 25545481

• Reliability of Automated Visual Fields in Children Dar, S., Bitrian, E., Tokarev, J., Grajewski, A., Anderson, J. S., Bothun, E. D., Summers, C. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433205501074

• Genetic influence of optic disc structure: The Minnesota Twins Reared Apart Study (MISTRA) Bitrian, E., Armbrust, K., Wright, M. M., Grajewski, A., Caprioli, J., van Kuijk, E. J., Segal, N., Bouchard, T. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433205501028

• Expanded Phenotype of Axenfeld Spectrum: Congenital Hypothyroidism and Glaucoma Bitrian, E., McPherson, E., Grajewski, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013

  View details for Web of Science ID 000436232904416

• Axenfeld-Rieger syndrome: new perspectives BRITISH JOURNAL OF OPHTHALMOLOGY Chang, T. C., Summers, C., Schimmenti, L. A., Grajewski, A. L. 2012; 96 (3): 318-322

  Abstract

  Axenfeld-Rieger syndrome is a genetic disease affecting multiple organ systems. In the eye, this condition manifests with varying degrees of anterior segment dysgenesis and carries a high risk of glaucoma. Other associated systemic issues include cardiovascular outflow tract malformations, craniofacial abnormalities and pituitary abnormalities, which can result in severe endocrinological sequelae. Recent advances in molecular genetics have identified two major genes, PITX2 and FOXC1, demonstrating a wide spectrum of mutations, which aids in the molecular diagnosis of the disease, although evidence exists to implicate other loci in this condition. The management of individuals affected by Axenfeld-Rieger syndrome requires a multidisciplinary approach and would include dedicated surveillance and management of glaucoma, sensorineural hearing loss, and cardiac, endocrinological, craniofacial and orthopaedic abnormalities.

  View details for DOI 10.1136/bjophthalmol-2011-300801

  View details for Web of Science ID 000300604900003

  View details for PubMedID 22199394

• Fluorescein angiography findings in a case of Rubinstein-Taybi syndrome CLINICAL OPHTHALMOLOGY Jacobs, D. J., Sein, J., Berrocal, A. M., Grajewski, A. L., Hodapp, E. 2012; 6: 1369-1371

  Abstract

  The purpose of this report is to describe the fluorescein angiography findings in a case of Rubinstein-Taybi syndrome. Fundus photography and fluorescein angiography were performed on a 6-year-old male with Rubinstein-Taybi syndrome due to CREB binding protein gene mutation. Fundus photography showed glaucomatous cupping and diffusely attenuated retinal vasculature. Choroidal vasculature was prominent due to diffuse retinal atrophy with scattered focal retinal pigment epithelial changes. Fluorescein angiography showed retinal vascular attenuation, prolonged arteriovenous transit time with delayed venous filling, late small vessel leakage, and 360 degrees of peripheral avascularity. Peripheral retinal avascularity and retinal vascular inflammation evidenced by late small vessel leakage can be demonstrated by fluorescein angiography in the retinal dystrophy of Rubinstein-Taybi syndrome.

  View details for DOI 10.2147/OPTH.S31023

  View details for Web of Science ID 000215903500207

  View details for PubMedID 22942640

  View details for PubMedCentralID PMC3429291

• Peripheral retinal vascular abnormalities in primary infantile glaucoma. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Shane, T. S., Berrocal, A. M., Hodapp, E. A., Grajewski, A. L., Hess, D. J. 2011; 42 Online: e144-6

  Abstract

  Two patients with primary infantile glaucoma were imaged with fluorescein angiography during an examination under anesthesia. Both patients were found to have abnormal peripheral retinal vasculature and non-perfusion. These findings may represent a previously unrecognized retinal vascular component of primary infantile glaucoma.

  View details for DOI 10.3928/15428877-20111215-01

  View details for PubMedID 22185639

• Bilateral Acute Angle-Closure Associated With Systemic Lymphoma: A Report of 2 Cases JOURNAL OF GLAUCOMA Cristol, S. M., Baumblatt, J., Icasiano, E., Grajewski, A. L., Olivier, M. M. G., Parrish, R. K. 2011; 20 (2): 115-117

  Abstract

  Bilateral acute angle-closure is a rare occurrence. When the central anterior chambers are shallow, it is often associated with systemic disease. We present 2 patients with atypical bilateral acute angle-closure as the presentation of systemic lymphoma. In these patients, angle closure may be caused by a uveal effusion or swelling of the ciliary body. If an atypical bilateral acute angle-closure attack cannot be attributed to a drug reaction or a bilateral iatrogenic cause, the patient should be evaluated for an associated systemic disease. In some patients, the acute angle-closure cannot be fully resolved until the underlying disease is treated. This report discusses the spectrum of presentations and the various diseases that have been associated with bilateral acute angle-closure.

  View details for DOI 10.1097/IJG.0b013e3181d787d1

  View details for Web of Science ID 000286923600008

  View details for PubMedID 20436365

• Reproducibility and agreement in evaluating retinal nerve fibre layer thickness between Stratus and Spectralis OCT EYE Arthur, S. N., Smith, S. D., Wright, M. M., Grajewski, A. L., Wang, Q., Terry, J. M., Lee, M. S. 2011; 25 (2): 192-200

  Abstract

  To evaluate intra-device reproducibility of retinal nerve fibre layer (RNFL) measurements obtained using Stratus and Spectralis optical coherence tomography, and to analyze inter-device correlation and agreement for these measurements.Prospective observational study.A total of 30 normal individuals participated in the study. One eye of each participant was scanned three times during one session by the same operator using Spectralis and Stratus. Intra-class correlation coefficients (ICCs), correlation coefficients (R), and Bland-Altman plots (BAPs) were used to assess reproducibility, correlation, and agreement between the two devices, respectively.A significant difference in mean RNFL thickness was seen between Stratus and Spectralis (106.2 ± 6.9 μm vs 100.0 ± 7.3 μm, P = 0.0001). ICCs of RNFL thickness measurements ranged from 0.69 (clock hour 2; 95% confidence interval (95% CI): 0.54, 0.85) to 0.91 (inferior quadrant; 95% CI: 0.86, 0.96) for Stratus and were higher for Spectralis, ranging from 0.87 (temporal-superior sector; 95% CI: 0.79, 0.94) to 0.96 (global and nasal-inferior sector; 95% CI: 0.94, 0.99). Rs of RNFL thickness measurements between the two instruments ranged from 0.61 (temporal quadrant) to 0.87 (superior quadrant). BAPs demonstrated a systematic difference in RNFL values between the two devices, with Spectralis producing thinner RNFL values than Stratus.Spectralis demonstrated higher ICCs and thinner RNFL measurements than Stratus. Although the inter-device correlation was good, differences in RNFL measurements obtained by the two devices indicate that these measurements would not be interchangeable in clinical evaluations.

  View details for DOI 10.1038/eye.2010.178

  View details for Web of Science ID 000287187300010

  View details for PubMedID 21109776

  View details for PubMedCentralID PMC3169228

• Uveitis-Glaucoma-Hyphema Syndrome and Corneal Decompensation in Association With Cosmetic Iris Implants AMERICAN JOURNAL OF OPHTHALMOLOGY Arthur, S. N., Wright, M. M., Kramarevsky, N., Kaufman, S. C., Grajewski, A. L. 2009; 148 (5): 790-793

  Abstract

  To report a case and management of uveitis-glaucoma-hyphema (UGH) syndrome and corneal decompensation associated with cosmetic iris implants.Interventional case report.Department of Ophthalmology, University of Minnesota School of Medicine.A 29-year-old man presented with bilateral redness, severe pain, photophobia, and reduction in visual acuity. Examination revealed intraocular pressure (IOP) of 38 mm Hg and 40 mm Hg right and left eye respectively, bilateral conjunctival injection 3+, epithelial corneal edema, microhyphema, cells 3+ to 4+ and flare 2+, bilateral cosmetic iris implants, and surgical peripheral iridectomies. The patient was diagnosed with UGH syndrome and corneal decompensation associated with cosmetic iris implants.Immediate medical management of inflammation and elevated IOP, anterior segment imaging, specular microscopy, Humphrey 24-2 visual field (VF) testing; following failed conservative management, combined trabeculectomy and removal of the iris implants.Anterior chamber inflammation and microhyphema, IOP, and corneal edema.Anterior segment imaging demonstrated bilateral implant-iris apposition and implant-angle structures apposition. Specular microscopy demonstrated a significant reduction of the number of endothelial cells. VF test demonstrated a right superior arcuate scotoma and a normal left VF. Following surgical treatment IOP normalized and inflammation and microhyphema subsided. However, mild corneal edema persisted.Cosmetic iris implantation may lead to UGH syndrome and corneal decompensation. Therefore, its use should be reserved for patients with significant medical indications, and avoided in patients with intact natural iridies, until more short-term and long-term safety data are available.

  View details for DOI 10.1016/j.ajo.2009.06.008

  View details for Web of Science ID 000271669300022

  View details for PubMedID 19660735

• Natural history of normal-tension glaucoma OPHTHALMOLOGY Alward, W. L., Feldman, F., Trope, G., Cashwell, L. F., Wilensky, J., Geijssen, H. C., Greeve, E., Quigley, H., Jampel, H., Skuta, G., Lichter, P. R., Blondeau, P., Anderson, D. R., Grajewski, A., Hodapp, E., Balazsi, G., Amyot, M., Desjardins, D. C., Levene, R. Z., Minckler, D., Heuer, D., Drance, S. M., Mikelberg, F., Douglas, G., Johnstone, M., Hetherington, J., Hoskins, H. D., Pollack, I. P., Abrams, D., Mills, R., Kasner, O. P., Schwartz, A., Liebmann, J., Ritch, R., Cohen, J., Tuulonen, A., Airaksinen, P. J., Schulzer, M., Anderson, D. R., Drance, S. M., Clarkson, J., Litinsky, S., Hardy, R., Schiffman, J., Rose, A., Neaton, J., Drance, S. M., Schulzer, M., Anderson, D. R., Steele, T., Collaborative Normal-Tension Glauc 2001; 108 (2): 247-253

  Abstract

  A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP.Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. RANDOMIZATION AND SUBJECT SELECTION: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage.Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned.Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the "survival" time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time.The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between -0.2 and -2 db per year.Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.

  View details for Web of Science ID 000166701800021

  View details for PubMedID 11158794

• Surgical revision of glaucoma shunt implants Tsai, J. C., Grajewski, A. L., Parrish, R. K. SLACK INC. 1999: 41-46

  Abstract

  To determine the efficacy of surgical revision of glaucoma shunt implants in patients with advanced glaucoma.The records of 13 patients who underwent revision of their shunt implants were retrospectively reviewed.Surgical success was achieved in: 3 of 3 patients (100%) with drainage tube malposition or extrusion; 1 of 6 patients (17%) with occlusion of the intracameral portion of the drainage tube; and 1 of 4 patients (25%) with elevated intraocular pressure secondary to fibrous capsule formation over the implant.Surgical revision of glaucoma shunt implants is a useful procedure in patients who develop tube malposition or extrusion. Surgical revision is much less effective in patients with tube occlusion or fibrous capsule formation. Failure of the shunts due to recurrent fibrosis is commonly observed.

  View details for Web of Science ID 000078048100008

  View details for PubMedID 9923492

• Measurement of intraocular pressure after epikeratophakia BRITISH JOURNAL OF OPHTHALMOLOGY Wright, M. M., Grajewski, A. L. 1997; 81 (6): 448-451

  Abstract

  To assess the accuracy of three commonly used tonometers in eyes after epikeratophakia.Five eye bank eyes with sutured epikeratophakia buttons were connected to a manometer and a pressure transducer. Intraocular pressure was adjusted in 5 mm Hg increments from 0 to 50 mm Hg. The intraocular pressure was measured at each increment using a Goldmann tonometer, a pneumatonometer, and a Tono-pen.The difference between the manometer (actual pressure) and the Goldmann tonometer ranged from -19 to +9 mm Hg (mean (SD) overestimation 2.6 (5.8) mm Hg). The pneumatonometer error ranged from -27.5 to +5.5 mm Hg (mean (SD) overestimation 4.7 (6.1) mm Hg), and for the Tono-pen the range was -18 to +11 mm Hg (mean (SD) overestimation 0.05 (7.9) mm Hg). The correlation coefficients for the three tonometers were 0.94, 0.92, and 0.87 for the Goldmann tonometer, pneumatonometer, and Tono-pen respectively.The Goldmann tonometer had the best correlation with the manometer in eye bank eyes with epikeratophakia (correlation coefficient 0.94), but none of the tonometers was accurate over the entire range of pressures tested. Detection of glaucoma in eyes with epikeratophakia cannot rely on tonometry alone, but requires examination of the optic nerve and visual field.

  View details for DOI 10.1136/bjo.81.6.448

  View details for Web of Science ID A1997XF69900013

  View details for PubMedID 9274407

  View details for PubMedCentralID PMC1722219

• Treatment of hypotony maculopathy after trabeculectomy OPHTHALMIC SURGERY AND LASERS Cohen, S. M., Flynn, H. W., Palmberg, P. F., Gass, J. D., Grajewski, A. L., Parrish, R. K. 1995; 26 (5): 435-441

  Abstract

  To determine if resuturing of the scleral flap to increase IOP in the post-trabeculectomy eye is an effective treatment of hypotony maculopathy.The medical records of nine consecutive patients who developed visual acuity loss after trabeculectomy related to hypotony maculopathy were reviewed to determine factors that contribute to successful restoration of visual acuity. The average age of the patients was 50 years and average refractive error was -4.25 diopters (D). Mean Snellen visual acuity dropped from 20/25 to 20/200 after the onset of hypotony.Six of nine eyes recovered visual acuity to within one line of initial level after treatment of the hypotony. Four of these six eyes underwent resuturing of the scleral flap to reverse the excess filtration within 6 months of the onset of hypotony maculopathy. Five of these six patients had final vision of 20/30 or better. The mean phakic preoperative refractive error in these six eyes was -2.25 D, compared with a mean refractive error of -8.50 D in the three eyes with persistent visual loss (P = 0.002). After reversal of the hypotony, the average peak intraocular pressure in the six eyes with visual recovery was 33 mm Hg, compared with an average peak IOP of 7 mm Hg in the three eyes with persistent visual loss. (P = 0.015)Although reversal of the hypotony maculopathy in six eyes was associated with a few weeks of higher than normal IOP, the final IOP was acceptably low. Five of six filtering blebs remained functional with a mean follow-up of 3 years. The final average IOP in the six eyes that were successfully treated was 12.7 mm Hg. In this series of patients, visual acuity was restored to eyes with hypotony maculopathy by increasing the IOP to higher than normal levels.

  View details for Web of Science ID A1995TT12800011

  View details for PubMedID 8963858

• 5-FLUOROURACIL FILTERING SURGERY AND NEOVASCULAR GLAUCOMA - LONG-TERM FOLLOW-UP OF THE ORIGINAL PILOT-STUDY TSAI, J. C., FEUER, W. J., PARRISH, R. K., GRAJEWSKI, A. L. LIPPINCOTT-RAVEN PUBL. 1995: 887-892

  Abstract

  The long-term efficacy and safety of filtering surgery with 5-fluorouracil (5-FU) in eyes with neovascular glaucoma are unknown.Kaplan-Meier survival curve analysis of surgical outcome was performed on all 34 patients (34 eyes) enrolled from May 1982 through April 1986 in the original pilot study of filtering surgery with 5-FU.Success rates at the 1-, 2-, 3-, 4-, and 5-year intervals were 71%, 67%, 61%, 41%, and 28%, respectively. The median filter survival time was 38.7 months (95% confidence interval: 32-45 months). Twelve (35%) of 34 patients lost light perception vision, and phthisis bulbi developed in 8 (24%) of 34 patients. Age of 50 years or younger (P < 0.0001) and type 1 diabetes (P = 0.0004) were significant risk factors for surgical failure. The 1-year success rate for patients no older than 50 years of age was 23% compared with a 95% success rate in patients older than 50 years of age. After adjustment for age, type 1 diabetes was a borderline risk factor (P = 0.06).There is a high risk of long-term failure of filtering surgery with 5-FU in neovascular glaucoma. Patients 50 years of age or younger have an extremely poor prognosis. Patients older than 50 years of age have initial short-term success with an accelerated failure rate after 3 years.

  View details for DOI 10.1016/S0161-6420(95)30938-4

  View details for Web of Science ID A1995RC16600013

  View details for PubMedID 7777295

• ONE-YEAR FOLLOW-UP RESULTS OF COMBINED MITOMYCIN-C TRABECULECTOMY AND EXTRACAPSULAR CATARACT-EXTRACTION OPHTHALMOLOGY JOOS, K. M., BUECHE, M. J., PALMBERG, P. F., FEUER, W. J., GRAJEWSKI, A. L. 1995; 102 (1): 76-83

  Abstract

  When patients with glaucoma require cataract surgery, combined procedures offer important advantages over cataract surgery alone. Because mitomycin C has improved the success rate of a trabeculectomy in patients at high risk for filtration failure, the authors investigated whether it also would increase the survival rate of functioning filters in combined procedures.Patients with both cataract and glaucoma underwent combined mitomycin C trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation. Mitomycin C (0.5 mg/ml) was applied topically to the trabeculectomy site for 5 minutes before the cataract extraction. Intraocular pressure (IOP), visual acuity, and astigmatism were measured preoperatively and postoperatively. One-year results are available for 74 patients.At 1 year, 54 (73%) of 74 patients had IOPs of 15 mmHg or less without glaucoma medications. Visual acuity was 20/40 or better in 44 (60%) of 74 patients. Ten (15%) patients had a shift of more than 2 diopters of astigmatism against the rule compared with preoperative values. No notable corneal epithelial toxicity was present. Postoperative symptomatic hypotony with the wound construction occurred in 3 (4%) of 74 patients, with 1 patient requiring surgical revision. Other potential complications of mitomycin C include endothelial toxicity (1 patient had decreased vision due to endothelial folds) and wound stability (1 patient had wound rupture after direct ocular trauma).The 1-year survival rate of a functioning trabeculectomy using mitomycin C in combined glaucoma and cataract surgery is encouraging. The longer-term benefits and possible adverse effects of mitomycin C in combined procedures are unknown and continue to be investigated.

  View details for Web of Science ID A1995QB55800018

  View details for PubMedID 7831046

• VITRECTOMY FOR PARS-PLANA PLACEMENT OF A GLAUCOMA SETON OPHTHALMIC SURGERY AND LASERS SMIDDY, W. E., RUBSAMEN, P. E., GRAJEWSKI, A. 1994; 25 (8): 532-535

  Abstract

  Trabeculectomy, even with supplemental antifibrosis agents, has a low success rate in controlling intraocular pressure (IOP) in certain cases; ones involving severe anterior-chamber-angle disease are particularly challenging. Ten patients with advanced, non-neovascular glaucoma underwent vitrectomy and pars plana placement of seton implants. The tube was placed through the pars plana sclerotomy in each case because severe anterior chamber angle narrowing, aphakia, or penetrating keratoplasty prevented standard placement. Previous trabeculectomy had failed to control IOP in 9 of the 10 patients. In each, the preoperative IOP was 25 mm Hg or more despite maximal medical therapy. In nine of the patients, the postoperative IOP was 19 mm Hg or less, without pressure-lowering agents. The seton appeared to be functional in all of the cases. Vision remained stable or improved in seven cases, but deteriorated in three due to graft failure, progressive traction retinal detachment, or rhegmatogenous retinal detachment (one case each). Pars plana placement of tubes for glaucoma seton implants should be considered as an alternative to anterior chamber placement in certain cases of refractory glaucoma in which the anterior chamber anatomy has been severely disrupted.

  View details for Web of Science ID A1994PD41500010

  View details for PubMedID 7970536

• CARDIAC VALVULAR DISEASE AND AXENFELD-RIEGER SYNDROME AMERICAN JOURNAL OF OPHTHALMOLOGY TSAI, J. C., GRAJEWSKI, A. L. 1994; 118 (2): 255-256

  View details for DOI 10.1016/S0002-9394(14)72910-1

  View details for Web of Science ID A1994PA91000018

  View details for PubMedID 8053476

• COMBINED PENETRATING KERATOPLASTY AND SETON SURGERY KARP, C., ALFONSO, E., LUETKEMEYER, J., GRAJEWSKI, A. LIPPINCOTT-RAVEN PUBL. 1994: 1874

  View details for Web of Science ID A1994MZ58502859

• IMMUNE-RELATED DISEASE AND NORMAL-TENSION GLAUCOMA - A CASE-CONTROL STUDY ARCHIVES OF OPHTHALMOLOGY CARTWRIGHT, M. J., GRAJEWSKI, A. L., FRIEDBERG, M. L., ANDERSON, D. R., RICHARDS, D. W. 1992; 110 (4): 500-502

  Abstract

  We reviewed the charts of 67 patients with the diagnosis of normal-tension glaucoma listed in the Bascom Palmer Eye Institute computer database. These patients were matched with respect to age, race, and sex with an equal number of patients having ocular hypertension. All medical diagnoses in the charts for both groups were tabulated and classified as either immune-related or non-immune-related. Twenty (30%) patients with normal-tension glaucoma had one or more immune-related disease(s) compared with five (8%) patients in the comparison group (P = .00134, McNemar statistic with continuity correction).

  View details for DOI 10.1001/archopht.1992.01080160078035

  View details for Web of Science ID A1992HN27900026

  View details for PubMedID 1562256

• MEASUREMENT OF INTRAOCULAR-PRESSURE WITH A FLAT ANTERIOR-CHAMBER OPHTHALMOLOGY WRIGHT, M. M., GRAJEWSKI, A. L. 1991; 98 (12): 1854-1857

  Abstract

  When a flat chamber develops in an eye after filtration surgery, management depends on whether the cause is excessive filtration or aqueous misdirection (ciliary block or malignant glaucoma). This diagnosis is often based on the intraocular pressure: low pressure in excessive filtration, high pressure in aqueous misdirection. To determine the accuracy of tonometry when the lens is in contact with the cornea, flat anterior chambers were created in 5 eyes obtained from an eye bank. The pressure in the vitreous cavity was raised and lowered with an infusion line and monitored with a pressure transducer. The intraocular pressure was estimated with a Goldmann applanation tonometer, a Pneumatonometer, and a Tono-pen. The readings poorly represented the actual pressure in the vitreous cavity. The error was 0 to 51 mmHg (mean, 12.8 mmHg) with the Goldmann tonometer, 0 to 33 mmHg (mean, 9.0 mmHg) with the Pneumatonometer, and 1 to 28 mmHg (mean, 13.5 mmHg) with the Tono-pen. Therefore, in the face of a flat anterior chamber, pressure measurements made on the cornea cannot be relied on to distinguish excessive filtration from aqueous misdirection.

  View details for Web of Science ID A1991GV09100025

  View details for PubMedID 1775320

• BETA-ADRENERGIC RESPONSIVENESS OF CHOROIDAL VASCULATURE OPHTHALMOLOGY GRAJEWSKI, A. L., FERRARIDILEO, G., FEUER, W. J., ANDERSON, D. R. 1991; 98 (6): 989-995

  Abstract

  Using in vitro binding methods and autoradiographs, the authors showed that choroidal vessels specifically bind iodine 125 cyanopindolol, a nonselective blocker of beta-adrenergic receptors, in albino rabbits. In humans, the presence of beta-adrenergic receptors in choroidal vessels was confirmed by showing an increased choroidal vascular tone after systemic administration of timolol maleate, a nonselective beta-adrenergic blocker. Topically administered timolol maleate lowered the intraocular pressure but did not reach the choroidal receptors in sufficient quantity to produce a measurable effect on vascular tone.

  View details for Web of Science ID A1991FQ28700034

  View details for PubMedID 1678154

• ND-YAG CYCLOPHOTOCOAGULATION - OUTCOME OF TREATMENT FOR UNCONTROLLED GLAUCOMA OPHTHALMIC SURGERY AND LASERS WRIGHT, M. M., GRAJEWSKI, A. L., FEUER, W. J. 1991; 22 (5): 279-283

  Abstract

  We reviewed the records of 35 patients (35 eyes) treated with Nd:YAG cyclophotocoagulation for uncontrolled glaucoma and followed for 6 to 36 months or until treatment was declared a failure (loss of light perception, or intraocular pressure (IOP) greater than 21 mm Hg). The mean pretreatment intraocular pressure was 37.9 mm Hg (range, 20 to 61 mm Hg). The total energy in the initial treatment session ranged from 50.4 to 372.4 J (191.7 +/- 66.3 J). After the treatment, the mean IOP was 21.2 mm Hg (range, 0 to 53 mm Hg). The Kaplan Meier survival analysis demonstrated that failures occurred throughout the follow-up period and that the majority of patients required further intervention or lost all vision if followed long enough. Visual outcome was not correlated with energy used. Eleven eyes (31%) lost two or more lines of acuity or lost all light perception. These findings suggest that Nd:YAG cyclophotocoagulation may control IOP but cannot always save vision.

  View details for Web of Science ID A1991FM17500008

  View details for PubMedID 1852382

• TRABECULECTOMY AND THREATENED FIXATION IN ADVANCED GLAUCOMA PARRISH, R., KEOLEIAN, G., MULANEY, J., GRAJEWSKI, A. LIPPINCOTT-RAVEN PUBL. 1991: 1107

  View details for Web of Science ID A1991FC76202152

• ACCURATE APPLANATION TONOMETRY WITHOUT FLUORESCEIN MARTINEZMESA, F., LEWIS, M. L., ANDERSON, D. R., GRAJEWSKI, A., FEUER, W. J. LIPPINCOTT-RAVEN PUBL. 1991: 808

  View details for Web of Science ID A1991FC76200699

• MEASUREMENT OF INTRAOCULAR-PRESSURE WITH FLAT ANTERIOR-CHAMBER WRIGHT, M. M., GRAJEWSKI, A. L. LIPPINCOTT-RAVEN PUBL. 1991: 808

  View details for Web of Science ID A1991FC76200698

• 5-FLUOROURACIL AFTER TRABECULECTOMY AND THE IRIDOCORNEAL ENDOTHELIAL SYNDROME OPHTHALMOLOGY WRIGHT, M. M., GRAJEWSKI, A. L., CRISTOL, S. M., PARRISH, R. K. 1991; 98 (3): 314-316

  Abstract

  Nine patients (nine eyes) with iridocorneal endothelial (ICE) syndrome underwent trabeculectomy and received postoperative subconjunctival injections of 5-fluorouracil (5-FU) to enhance bleb formation (total 5-FU dose, 30-105 mg; mean, 53.8 mg). Eight eyes had undergone prior unsuccessful trabeculectomy. Four eyes had intraocular pressure (IOP) less than or equal to 21 mmHg on zero to two glaucoma medications after 6 to 54 months of follow-up (mean, 25.3 months). Five eyes required repeat surgery within 2 to 13 months and were considered failures. All five eyes that failed received a Molteno drainage implant. Progressive endothelial proliferation may explain late onset bleb failure and the relative ineffectiveness of 5-FU in this condition.

  View details for Web of Science ID A1991FA65400013

  View details for PubMedID 2023751