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Presents a case report of breast carcinoma metastatic to the uvea. Clinical characteristics of patients; Characteristics of individuals who have metastatic disease; Signs and symptoms of the disease.

Purpose: To identify safety and effectiveness outcomes of office-based cataract surgery. Each year, approximately 3.7 million cataract surgeries in the United States are performed in Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) locations. Medicare in July 2015 published a solicitation for expert opinion on reimbursing office-based cataract surgery., Design: Large-scale, retrospective, consecutive case series of cataract surgeries performed in Minor Procedure Rooms (MPRs) of a large US integrated healthcare center., Participants: More than 13 500 patients undergoing elective office-based cataract surgery., Methods: Phacoemulsification cataract surgery performed in MPRs of Kaiser Permanente Colorado from 2011 to 2014., Main Outcome Measures: Postoperative visual acuity and intraoperative and postoperative adverse events (AEs)., Results: Office-based cataract surgery was completed in 21 501 eyes (13 507 patients, age 72.6±9.6 years). Phacoemulsification was performed in 99.9% of cases, and manual extracapsular extraction was performed in 0.1% of cases. Systemic comorbidities included hypertension (53.5%), diabetes (22.3%), and chronic obstructive pulmonary disease (9.4%). Postoperative mean best-corrected visual acuity measured 0.14±0.26 logarithm of the minimum angle of resolution units. Intraoperative ocular AEs included 119 (0.55%) cases of capsular tear and 73 (0.34%) cases of vitreous loss. Postoperative AEs included iritis (n = 330, 1.53%), corneal edema (n = 110, 0.53%), and retinal tear or detachment (n = 30, 0.14%). No endophthalmitis was reported. Second surgeries were performed in 0.70% of treated eyes within 6 months. There were no life- or vision-threatening intraoperative or perioperative AEs., Conclusions: This is the largest US study to investigate the safety and effectiveness of office-based cataract surgery performed in MPRs. Office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of the study is to determine whether there is a higher incidence of complications in adult patients receiving corneas from pediatric donors compared to those receiving corneas from adult donors., Design: The design is a follow-up of two matched cohorts., Participants: The outcome of penetrating keratoplasty in 29 adult patients (age 20 years of age and older) receiving pediatric donor corneas (range, 0-5 years) was compared to that of 29 control patients matched for recipient age and diagnosis who received adult donor corneas (range, 40-70 years)., Intervention: Chart review was performed., Main Outcome Measures: Graft rejection, postoperative keratometry, postoperative refractive cylinder, postoperative intraocular pressure, and graft failure due to rejection were measured., Results: One or more allograft reactions occurred in 11 (37.9%) of 29 patients who received pediatric donor corneas compared to 2 (6.9%) of 29 patients who received adult donor corneas (P = 0.005, chi-square). There were a total of 20 rejection episodes in patients receiving pediatric donor corneas compared to a total of 5 rejection episodes in patients receiving adult donor corneas. The average postoperative keratometry was 46.1 diopters for the pediatric donor group and 44.0 diopters for the adult donor group (P = 0.03). There was no statistically significant difference in average refractive cylinder (P = 1.0), intraocular pressure (P = 0.26), or the incidence of graft failure due to rejection (P = 1.0) between the two groups. The average follow-up time for clear grafts was 58.3 months in the pediatric donor group and 59.9 months in the adult donor group., Conclusions: The incidence of allograft reactions and the postoperative corneal curvature is greater in adult eyes undergoing penetrating keratoplasty with young donor corneas compared to those undergoing penetrating keratoplasty with older donor corneas. There was no difference in the incidence of graft failure due to rejection between the two groups.

Contact lens fenestration can increase tear exchange. We describe a case in which a patient with 15 D of against-the-rule astigmatism was fit with a Softperm contact lens but was unable to wear it for more than 1 hour because of corneal edema. After fenestrating the Softperm lens with an argon laser the patient was able to wear her lens for 10 hours without signs of corneal decompensation.

Background: Computer-assisted videokeratography has emerged as a useful clinical and research tool. All of the currently available commercial units utilize a modified placido disk image and require a smooth reflective surface. The PAR Technology Corneal Topography System (PAR CTS) is a prototype of a new computer-assisted corneal imaging device. The system produces a true topographic map (elevation map) by analyzing a projected grid on the corneal surface, as opposed to a placido disk reflection, and utilizes the technique of raster photogrammetry to define elevation points on the corneal surface. Because the system defines elevation points, not curvature, mathematical modeling is easily accomplished. Current software displays include a true topographic map, a spherical subtraction map in both relative and absolute scales, and a meridian analysis that is adapted to display refractive photoablative surgery., Methods: We evaluated the accuracy of this device by analyzing three calibrated test spheres (55.76, 42.21, and 33.55 diopters). The test spheres were steel balls coated with a thin white silicone polyester coating that was necessary for grid projection. The test spheres were measured by a Taylor-Hobson contact profilometer possessing submicron accuracy. To determine the reproducibility of the system, three investigators measured three noncalibrated balls (20 mm, 18 mm, and 12 mm). The optical system was purposely decentered and refocused after each reading., Results: Utilizing the CTS custom optics, system accuracy at the 8-millimeter test area was 0.03 (SD 0.03), 0.00, (SD 0.02), and 0.07 (SD 0.01) D respectively. Smaller diameter test areas resulted in a predicted loss of accuracy. Maximum intraobserver variability was 0.09, 0.06, and 0.11 D respectively, and maximum interobserver variability measured 0.18, 0.12, and 0.16 D., Conclusions: These data demonstrate that the PAR CTS is both highly accurate and reproducible in determining topography of spheres that approximate the curvature of the human cornea.

We reviewed 75 consecutive cases of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in 69 patients with glaucoma. The mean preoperative intraocular pressure was 19.3 mm Hg on an average of 2.3 glaucoma medications. Visual acuity improved in 58 eyes (77%) at two months, with an average improvement of 3.3 and 3.6 lines at two and 12 months, respectively. Of the 75 eyes, 49 (65%) achieved a visual acuity of 20/40 or better; three patients (4%) had further deterioration in vision at the completion of follow-up because of progressive glaucoma or macular disease. Postoperatively, the average intraocular pressure was 3.8 and 3.0 mm Hg lower than the preoperative level at two and 12 months (P less than .001) on 0.63 and 0.79 glaucoma medications, respectively. However, 27 (36%) of the 75 eyes had a recorded intraocular pressure greater than 30 mm Hg and 30 (40%) had a pressure 7 mm Hg or more above their preoperative level during the first six months after surgery. Despite improved long-term control of intraocular pressure, detectable conjunctival filtering blebs were present in only 31 (41%) of 75 eyes at two months and in seven (12%) of 56 eyes at 12 months. Hyphema occurred in 34 (45%) of the cases.