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Juan Caceres,1,* Yibing Zhang,1,* Lawrence Boe,2 Yunshu Zhou,3 Cagri Besirli,3 Yannis M Paulus,3,4 Julie M Rosenthal3 1University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA; 2Penama Provincial Health, Godden Memorial Hospital, Ambae, Vanuatu; 3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; 4Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA*These authors contributed equally to this workCorrespondence: Julie M Rosenthal; Yannis M Paulus, University of Michigan, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Email julieros@med.umich.edu; ypaulus@med.umich.eduBackground and Objective: Proof-of-concept study to test the feasibility of using an all-in-one portable retinal camera for the screening of diabetic retinopathy in the Pacific Island of Vanuatu, which has a high rate of diabetes and its associated complications and a dearth of ophthalmologists.Study Design/Materials and methods: From February 10, 2020, through February 28, 2020, 49 patients with diabetes mellitus from three islands in Vanuatu were recruited to participate in the study. Demographics, basic health data and retinal photography were obtained. A non-mydriatic, handheld camera was used (Volk Pictor Plus).Results: Eleven participants (24%) had referral-warranted diabetic retinopathy. There was moderately high inter-rater reliability for our dependent variables: referral status (κ = 0.62, 95% CI 0.42– 0.83), retinopathy severity (κ = 0.76, 95% CI 0.55– 0.96), and clinically significant macular edema (κ = 0.50, 95% CI 0.25– 0.74).Conclusion: Our study confirms that portable handheld cameras can be used to obtain retinal images of sufficient quality for diabetic retinopathy screening even in resource limited environments like Vanuatu. Among this cohort, a relatively high (24%) prevalence of referral-warranted diabetic retinopathy was found in Vanuatu.Key

Avi Toiv, Asad F Durrani, Yunshu Zhou, Peter Y Zhao, David C Musch, Michael J Huvard, David N Zacks Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USACorrespondence: David N Zacks, Department of Ophthalmology and Visual Sciences, W K Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1 734-232-8404, Fax +1 734-232-8030, Email Davzacks@med.umich.eduPurpose: At the time of open globe injury (OGI), it may be difficult for clinicians to predict which eyes are at highest risk for requiring enucleation. We performed a 17-year retrospective cohort study to report outcomes and risk factors for enucleation following open globe injuryto better aid clinicians counseling patients at OGI diagnosis.Methods: A retrospective cohort study of all patients who presented to the University of Michigan with open globe injury (OGI) and were surgically managed between January 2000 and July 2017 was conducted. At least 30 days of follow-up was required. All eyes that ultimately underwent enucleation following OGI were identified and their clinical course analyzed. The main outcome measured was the rate of enucleation after OGI.Results: There were 587 eyes meeting inclusion criteria. The mean patient age was 40.75 ± 25.1 (range 1– 91). 441/585 (75.4%) patients were male. Average follow-up time was 1029.9 ± 1285.9 days. 116/587 eyes (19.8%) required enucleation after OGI, with 81.9% undergoing enucleation less than 30 days from injury. In enucleated eyes, the mean presenting logMAR vision was 2.91 ± 0.47 (Snellen equivalent between hand motion and light perception). The most common mechanism of injury requiring enucleation was globe rupture, 89/116 (76.7%), with 14/116 (12.1%) penetrating injuries and 13/116 (11.2%) perforating injuries. The mean age of patients that underwent enucleation was 45.6 ± 22.5 (range 3– 91).Conclusion: Open globe injuries are often visu

Yilin Feng,1 Jemin Park,1 Yunshu Zhou,1 Stephen T Armenti,1 David C Musch,1,2 Shahzad I Mian1 1Department of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, Ann Arbor, MI, USA; 2Department of Epidemiology, University of Michigan, Ann Arbor, MI, USACorrespondence: Shahzad I MianProfessor of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI, 48105, USATel +1 734-763-5904Email smian@med.umich.eduPurpose: Studies have identified a wide range of ocular signs and symptoms in coronavirus disease 2019 (COVID-19) patients; however, these studies were often conducted outside of the United States. We aim to investigate the ocular manifestations of hospitalized COVID-19 patients at a tertiary care medical center in the United States.Patients and Methods: A retrospective, cross-sectional study was conducted on individuals aged 18 and over who were hospitalized for COVID-19 between March 10, 2020 and April 13, 2020. The electronic health record was reviewed for all patients, and a follow-up phone survey was conducted on patients who were discharged home. Data on patient history, physical exam, laboratory results, and hospital disposition were collected and analyzed.Results: A total of 400 patients were included. The mean patient age was 61.7 years (SD 15.5) and 233 (58.3%) were males. Ocular signs and symptoms were noted in 38 (9.5%) patients. The most common ocular abnormality was conjunctival injection, followed by vision changes and ocular irritation. Among the 38 patients, 30 (79.0%) developed ocular involvement prior to day 30 of onset of their COVID symptoms. Univariate analysis showed that age, gender, ocular history, fever, mechanical ventilation, and increasing inflammatory markers were not significantly associated with the presence or development of ocular symptoms.Conclusion: In this study, 9.5% of hospitalized COVID-19 patients exhibited ocular signs and symptoms. Factors associate

Katie X Li,1 Nicholas Carducci,1 Omar Moinuddin,1 Yunshu Zhou,1 David C Musch,1,2 David N Zacks,1 Cagri G Besirli,1 Thomas J Wubben1 1Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; 2Department of Epidemiology, University of Michigan, Ann Arbor, MI, USACorrespondence: Thomas J WubbenDepartment of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USATel +1 734 936 8072Email twubben@med.umich.eduPurpose: To investigate the clinical features and surgical outcomes of rhegmatogenous retinal detachment (RRD) associated with giant retinal tears (GRTs) at a tertiary referral center.Patients and Methods: A retrospective, non-consecutive interventional case series of GRT-associated RRDs that underwent primary surgical repair at the University of Michigan W.K. Kellogg Eye Center between January 1, 2011 and July 1, 2020. Clinical characteristics and preoperative, perioperative, and postoperative data were collected.Results: Forty-eight eyes of 47 patients with GRT-associated RRDs met inclusion criteria, including those that were children (under 12 years, N=4, 8.3%), associated with a history of trauma (N=20, 41.7%) or with grade C proliferative vitreoretinopathy (PVR-C) (N=7, 14.6%) at baseline. Median age was 46 years (interquartile range (IQR): 29 years, range: 4 to 72 years), median follow-up was 28 months (IQR: 43 months, range: 3– 124 months), and 83.3% (N=40) of subjects were male. Primary surgical repair for GRT-associated RRDs included pars plana vitrectomy (PPV) (N=40, 83.3%), scleral buckle (SB) (N=1, 2.1%), or combined PPV/SB (N=7, 14.6%). Surgical approach commonly involved the use of perfluorocarbon liquid (N=43, 90%) and gas tamponade (N=39, 81%). Single surgery anatomic success (SSAS) was 75% (95% CI: 60%, 85%) at 3 months and 65% (95 CI: 47%, 78%) at 2 years. Final anatomic success was achieved in all 48 eyes (100%). Median visual acuity improved fr

Asad F Durrani,1 Peter Y Zhao,1 Yunshu Zhou,1 Michael Huvard,2 Lyna Azzouz,3 Jason M Keil,3 Stephen T Armenti,1 Vaidehi S Dedania,4 David C Musch,1,5 David N Zacks1 1Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; 2Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA; 3University of Michigan Medical School, Ann Arbor, MI, USA; 4Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USACorrespondence: David N ZacksDepartment of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USATel +1 734-232-8404Email Davzacks@med.umich.eduBackground/Aims: To determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI).Methods: A retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis.Results: In this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9– 10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1– 11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5– 19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1– 0.7, p