Planning for cataract surgery and perioperative care in the very elderly requires the teamwork of the patient's primary care provider and the ophthalmologist.

Aims: To assess the concordance between conflicts of interest reported by physicians in three major scientific journals and industry-reported payments available through the Open Payments Program (OPP) database. Study Design: Comparative cross-sectional surveys. Place and Duration of Study: United States allopathic and osteopathic physicians with publications in American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology accepted after January 1, 2014 and published from May 2014 through October 2014. Methodology: We compared physicians’ self-reported conflicts of interest in their academic publications to industry-reported payments in the Centers for Medicare & Medicaid Services OPP Original Research Article Yee et al.; BJMMR, 10(5): 1-6, 2015; Article no.BJMMR.19640 2 database. Authors were categorized based on concordance between self-reported disclosures and payments listed in the database. Payments were designated as disclosed or undisclosed. Results: Of the 670 authors surveyed, 367 (54.8%) were in perfect concordance with the OPP database; 68 (10.1%) authors made disclosures beyond those in the database but had no undisclosed ties; 235 (35.1%) authors had one or more undisclosed payments. Disclosed and undisclosed payments totaled $1.46 million and $1.81 million, respectively. Conclusion: In three major ophthalmology journals, a significant discrepancy exists between conflicts of interest reported by physician authors and payments found in the OPP database. This lack of concordance raises concerns about incomplete physician disclosure, inaccurate reporting, inadequate vetting, and ambiguity over financial relevance, all of which undermine confidence in the disclosure process.

Wu, Annie M. BA; Wu, Connie M. BS; Margo, Curtis E. MD, MPH; Greenberg, Paul B. MD Author Information

Transverse (lateral) sinus thrombosis is a well-known complication of acute otitis media and mastoiditis in the pediatric and adult population. Thrombosis involving the transverse sinus can ultimately cause elevation of intracranial pressure (ICP) as a result of decreased cerebrospinal fluid absorption. If treatment to lower ICP is not undertaken, it can lead to ophthalmological complications including irreversible vision loss. The following case report describes an 11-year-old girl who was diagnosed with AOM by her pediatrician and subsequently presented to the emergency department complaining of nausea, vomiting, headache, and diplopia.

T he frequency of unintended vein or peripheral nerve biopsy with temporal artery biopsy has not been addressed specifically in the literature. The results of an inadvertent biopsy of a temporal vein or branch of the facial or auriculotemporal nerve are not inconsequential. Depending on the precise location in the temporal region and the type of peripheral nerve (motor or sensory), inadvertent peripheral nerve biopsy can result in considerable morbidity. It also requires that the procedure be repeated to obtain the correct tissue and, in some institutions, triggers a tissue committee review and clarification from the surgeon for the discrepancy between the intended and submitted tissue.

BACKGROUND:The cause of nonarteritic anterior ischaemic optic neuropathy (ION) is unknown, although assumed to be related to transient vascular insufficiency of the optic nerve head. Because the interaction of phosphodiesterase-5 (PDE-5) inhibitors with either an organic nitrate or alpha-blocker may theoretically increase the risk of ION, we conducted a screening study to determine if such a risk might exist.METHODS:Retrospective cohort study of male veterans with ION and possible ION. The national Veterans Health Administration (VHA) clinical database was cross-referenced (linked) with the VHA pharmacy database looking for specific drug combinations.RESULTS:Compared with no use, the relative risk (RR) of ION and possible ION for men prescribed both PDE-5 inhibitor and organic nitrate was 1.41 (95% CI 0.85, 2.33). Similarly, the RR of ION and possible ION with concurrent prescription of PDE-5 inhibitor and alpha-blocker was 1.21 (95% CI 1.01, 1.44). When risk was measured against use of a PDE-5 inhibitor alone, the RR was 1.29 (95% CI 0.78, 2.16) for PDE-5 inhibitor and organic nitrate and 1.12 (95% CI 0.92, 1.35) for PDE-5 inhibitor and alpha-blocker.CONCLUSIONS:We linked two large national databases to screen for a potentially important drug-drug-disease interaction. There was no increase in risk of ION and possible ION in men dispensed a PDE-5 inhibitor with either organic nitrates or an alpha-blocker compared with men dispensed PDE-5 inhibitor alone. An incidental observation that a substantial number of men were prescribed both an organic nitrate and a PDE-5 inhibitor within a single dispensing period raises concerns over non-ocular safety issues. The wisdom of co-dispensing medications that are contraindicated may deserve a broader audience.

The vitreous gel is a transparent, hypocellular tissue that effectively transmits light with negligible scatter or energy absorption. Although it is relatively resilient to age-related wear and tear, the vitreous is susceptible to injury from inflammatory cells and substances that breech the blood-retinal barrier. Over the course of a lifetime, the vitreous undergoes a variety of poorly understood, degenerative changes that lead to liquefaction—also referred to as syneresis. Vitreous syneresis is the most common predisposing factor for posterior vitreous detachment, which places a patient at risk for retinal detachment. While vision-threatening complications from deposits within the vitreous are uncommon (e.g., amyloid), the formation of vitreous membranes inflict considerable ocular morbidity. Vitreous membranes are a manifestation of a heterogeneous collection of disorders that share a final common pathway. Proliferative vitreoretinopathy (PVR) is the term applied to the uncontrolled growth of fibroglial membranes associated with rhegmatogenous retinal detachments. The most common reason for failed retinal reattachment surgery, PVR appears to exhibit an exaggerated reparative response to injury.

The association of lymphoma of the mucosa-associated lymphoid tissue type with localized amyloidosis in the small bowel was first reported in 1995.1Caulet S. Robert I. Bardaxoglou E. et al.Malignant lymphoma of mucosa associated lymphoid tissue: a new etiology of amyloidosis.Pathol Res Pract. 1995; 191: 1203-1207Crossref PubMed Scopus (27) Google Scholar Since that initial case report, low-grade B-cell lymphomas (most of which are marginal zone lymphomas, which include mucosa-associated lymphoid tissue–type lymphoma) and localized amyloidosis have been described in the lung, breast, and large bowel.2Wieker K. Rockern C. Koenigsmann M. et al.Pulmonary low-grade MALT-lymphoma associated with localized pulmonary amyloidosis: a case report.Amyloid. 2002; 9: 190-193Crossref PubMed Scopus (19) Google Scholar We describe a patient with a marginal zone lymphoma of the orbit with localized amyloidosis and osseous metaplasia. A 74-year-old woman was referred with a 6-month history of painless protrusion of her left eye. She complained of mild blurred vision in both eyes. Her general health was good, and she had no significant medical history. Visual acuities (VAs) were 20/60 and 20/40 in the right and left eyes, respectively. There was 4 mm of left proptosis. The remainder of the eye examination was normal, except for age-related cataracts. A computed tomography (CT) scan of the left orbit showed a 3.6×2.3-cm well-demarcated irregularly shaped mass situated predominantly within the intraconal space (Fig 1 [all figures available at http://aaojournal.org]). There were multiple discrete radio-dense deposits within the lesion (Hounsfield units consistent with bone) and moderate enhancement of the soft tissue component with contrast. The nonencapsulated lesion was removed piecemeal at surgery. Postoperatively, the patient did well, retaining 20/40 VA. On histological examination, the tumor consisted of a proliferation of small lymphocytes mixed with lymphoplasmacytic cells and plasma cells (Fig 2). The lymphocytes were positive for CD19, CD20, CD22, CD79a, and λ-light chain and negative for CD5 and CD10. A subset of cells with plasmacellular differentiation stained positive for CD138. Extracellular deposits of amorphous eosinophilic material formed sheets and thickened the walls of blood vessels. The material stained positive with Congo red and showed green birefringence when viewed under polarized light (Fig 3). Congo red positivity remained after pretreatment with potassium permanganate, indicating amyloid-light chains. Metaplastic bone was present within the amyloid deposits (Fig 4).Figure 3The extracellular material stains positive for amyloid with Congo red (original magnification, ×20).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Portions of mature bone with cellular marrow were associated with deposits of amorphous eosinophilic amyloid. Amyloid deposits surround the lamellar bone in the center of the photograph. The slight basophilic color imparted to the amyloid indicates early mineralization (stain, hematoxylin–eosin; original magnification, ×20).View Large Image Figure ViewerDownload Hi-res image Download (PPT) A postoperative evaluation guided by the diagnosis of extranodal marginal zone B-cell lymphoma revealed no evidence of systemic lymphoma or of amyloidosis elsewhere. A serum protein electrophoresis was normal and urine was negative for Bence Jones protein. Radiotherapy to the left orbit was recommended, but the patient declined further treatment. Evidence of dense calcification within the soft-tissue tumor of the orbit on a CT scan was a pivotal finding in this case. In radiological parlance, calcification is used to describe 3 different forms of soft-tissue mineralization: dystrophic calcification, metastatic calcification, and osseous metaplasia. Each condition is demonstrable on a CT scan when mineral salt deposits attain a threshold density and size (calcified tissue or bone typically measures >80–100 Hounsfield units). The vast number of entities that present with radiological calcification of soft tissue can be pruned substantially when anatomic location, size, and pattern of deposit are assessed in a clinical context. Soft-tissue osseous metaplasia is not nearly as common or ubiquitous as dystrophic or metastatic calcification. Perhaps the single most common predisposing condition that leads to osseous metaplasia is phthisis bulbi. We were unable to identify a case of osseous metaplasia occurring within a lymphoma. On a CT scan, orbital lymphomas typically have a homogenous electron density with distinct edges. Tumors usually conform to the shape of the globe or orbit. These same features also characterize an amyloid tumor of the orbit, with one exception: amyloidosis tends to calcify.3Motta A.O. Han J.S. Levine M. Benson J.E. Primary amyloid tumor of the lacrimal gland: CT findings.J Comput Assist Tomogr. 1983; 7: 1079-1080Crossref PubMed Scopus (14) Google Scholar A CT scan has documented the presence of dense calcification within amyloid tumors of the orbit (similar to the pattern in our case).3Motta A.O. Han J.S. Levine M. Benson J.E. Primary amyloid tumor of the lacrimal gland: CT findings.J Comput Assist Tomogr. 1983; 7: 1079-1080Crossref PubMed Scopus (14) Google Scholar In none of the reported cases, however, was there any histological correlation of the calcified tissue. Biopsies of calcified amyloidosis from a variety of tissues, including the lung, breast, female genital tract, and tarsus of the eyelid, have revealed osseous metaplasia.4Lynch L.A. Moriarty A.T. Localized primary amyloid tumor associated with osseous metaplasia presenting as bilateral breast masses: cytologic and radiologic features.Diagn Cytopathol. 1993; 9: 570-575Crossref PubMed Scopus (35) Google Scholar The association of lymphoma with systemic amyloidosis has been recognized for some time but is not nearly as common as the association between multiple myeloma and amyloidosis. There have been 2 patients with lymphoplasmacytic lymphoma of the orbit and serum paraproteinemia who developed systemic amyloidosis.5Brisbane J.U. Lessell S. Finkel H.E. Neiman R.S. Malignant lymphoma presenting in the orbit: a clinicopathologic study of a rare immunoglobulin-producing variant.Cancer. 1981; 47: 548-553Crossref PubMed Scopus (8) Google Scholar Neither patient had evidence of orbital amyloidosis. We are not aware of another reported case in which both amyloidosis and bone developed within an orbital lymphoma.

PURPOSE:To describe the ocular involvement in xanthoma disseminatum. DESIGN:Case report and literature review. METHODS:Histopathologic study of excised conjunctival tumor and clinical follow-up. RESULTS:A 29-year-old woman with normal serum lipoproteins developed widespread xanthomas of the skin, throat, and episclera. There were no signs of recurrence 12 months after removal of the conjunctival xanthomas. CONCLUSIONS:Xanthoma disseminatum is a rare condition for which there is no medical treatment. The distinction between the normolipemic xanthomatoses awaits a better understanding of their pathogenesis. Surgical removal of episcleral xanthomas can be successful, but long-term follow-up of such patients has been limited.

OBJECTIVE:To study the demographic features and patterns of hospital admission in Florida for nontraumatic disorders of the eye and ocular adnexa.METHODS:The public data set from the Florida Agency for Health Care Administration for 2001 was used to identify persons hospitalized for 24 hours or longer for nontraumatic disorders of the eye and ocular adnexa by using International Classification of Diseases, Ninth Revision, Clinical Modification codes.RESULTS:In 2001, there were 2137 hospital admissions for nontraumatic disorders of the eye and ocular adnexa, most of which were for infections or neuro-ophthalmologic disorders. The median length of stay was 3.0 days (mean +/- SD, 3.4 +/- 3.8 days). On average, 1 patient was admitted per month to 180 Florida hospitals. Eighty-three patients (3.9% of eye admissions) were hospitalized for 10 days or longer and accounted for 18.1% of total hospital-patient days. Prolonged hospital stay was positively associated with hospital transfer (P <.001) and facial cellulitis (P =.04). A trend for positive association with Medicaid coverage was also observed (P =.07).CONCLUSIONS:Nontraumatic eye care composes a small proportion of all inpatient care (< 0.1%) in Florida. Few of these patients require prolonged hospitalization but use a large proportion of inpatient care on the basis of the percentage of gross charges. An opportunity exists to improve hospital efficiency and improve eye care by targeting the patients at highest risk for prolonged hospital stay.