To protect from erosion of the tube in glaucoma drainage device (GDD), the tube is covered by a biologic tissue which is roofed by the conjunctiva. Sclera, pericardium, dura mater and cornea are available as a patch graft. Drawbacks of some of these materials may include high cost and poor appearance. The purpose of this study is to report the long-term outcomes of partial thickness corneal grafts to cover the tube and prevent its exposure, in GDD surgeries. This was a retrospective review of all patients who underwent Ahmed glaucoma valve implantation and had a minimum follow-up of 12 months. The tube was covered by a 300-micron partial thickness corneal graft taken either from a previous Descemet stripping endothelial keratoplasty procedure or cut from a whole corneal graft button unsuitable for keratoplasty. Forty-four patients (45 eyes, mean follow-up of 27.6 ± 11.4 months) were enrolled. The partial thickness corneal grafts maintained clarity throughout follow-up with satisfactory cosmetic results. Mild conjunctival retraction occurred in 4 eyes (8.9 %) between 1 and 12 months after the surgery. Corneal graft melting occurred in 3 (6.7 %) eyes. Tube exposure and additional surgery to re-patch or suture the conjunctiva over the tube was needed in 1 (2.2 %) eye. None of the patients had graft infection or immunologic rejection. Partial thickness corneal grafts have favorable long-term outcome as a patch for GDD tubes with low rates of tube exposure and other complications.

Purpose: To evaluate retinal and optical coherence tomography findings and establish their prevalence in preeclamptic women. Methods: Twenty-seven preeclamptic women who underwent clinical examinations with both slit-lamp biomicroscopy and optical coherence tomography were prospectively studied. Results: Three of the 4 women (14.8%) identified by clinical examinations as having retinal findings related to preeclampsia had visual disturbances. Optical coherence tomography revealed retinal pathology in 2 women (7.4%) consisting of retinal edema, subretinal fluid, photoreceptors irregularities, and lesions at the retinal pigment epithelium level (Elschnig spots). The mean retinal nerve fiber layer thickness was significantly higher in women with pathologic funduscopic findings (P = 0.009) than in women with normal eye examinations. All women with ocular findings had severe preeclampsia and higher systolic blood pressure than women without ocular findings (P = 0.03). Conclusion: The prevalence of retinal involvement is high in severe preeclampsia and low in asymptomatic preeclampsia. Preeclamptic women diagnosed as having ocular involvement should be evaluated and monitored by optical coherence tomography, provided that their systemic condition allows it. Findings of retinal nerve fiber layer thickening in these women may indicate occult central nervous system involvement.

Background: The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. Methods: Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild “green nucleus” with plus sign for yellow reflection of the posterior cortex), 3 (medium “yellow nucleus” with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being “red/brown nucleus” and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. Results: Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman′s rho = 0.8, p < 0.001). Conclusion: This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.