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This study sought to quantify the contributions of state-level factors including income inequality, state's legislature political control, and Medicaid expansion in new and established Latinx destination states on Latinx individuals' treated hypertension. Mixed-effects logistic regression analyses were conducted to analyze 2017 Behavioral Risk Factor Surveillance System data from 7524 Latinx adults nested within 39 states. Overall, 70% reported being pharmacologically treated for hypertension, and 66% resided in established destination states. Compared with Latinx people in established destination states, Latinx people in new destinations had lower odds of having treated hypertension (odds ratio [OR] = 0.72, 95% CI = 0.54-0.95). Within established Latinx destinations, the odds of treated hypertension were lower in states where legislatures expanded Medicaid than in states that did not expand Medicaid (OR = 0.84, 95% CI = 0.79-0.89). However, after controlling for the effects of individual-level factors, this association was no longer statistically significant. In new Latinx destination states, Medicaid expansion, legislatures' political control, and income inequality were not associated with treated hypertension. The study results highlight the importance of considering both individual- and state-level factors, as the interplay of such factors could hinder the successful implementation of cardiovascular risk reduction interventions. [ABSTRACT FROM AUTHOR]

Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes. Financial Disclosure Proprietary or commercial disclosures are listed after the references. [ABSTRACT FROM AUTHOR]

The surgical management of cataract in the small eye presents the ophthalmic surgeon with numerous challenges. An understanding of the anatomic classification in addition to a thorough preoperative assessment will help individualize each case and enable the surgeon to better prepare for the obstacles that might be encountered during surgery. Small eyes are especially challenging in terms of intraocular lens (IOL) calculations and possible current limitations of available IOL powers, which could necessitate alternative means of achieving emmetropia. Surgical strategies for minimizing complications and maximizing good outcomes can be developed from knowledge of the anatomic differences between various small-eye conditions and the pathologies that may be associated with each. A thorough understanding of the challenges inherent in these cases and the management of intraoperative and postoperative complications will ensure that surgeons approaching the correction of these eyes will achieve the best possible surgical results. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

The surgical management of ectopia lentis presents the ophthalmic surgeon with numerous challenges and options. From the clinical evaluation to the surgical approach, ectopia lentis patients require additional methodologies, techniques, and devices to ensure the best possible outcome. The continued refinement of surgical techniques and adjunctive prosthetic devices has led to incremental improvements in the ability to achieve successful in-the-bag placement and centration of intraocular lenses while reducing complications. A thorough understanding of the challenges inherent in ectopia lentis cases and the management of intraoperative complications will ensure that surgeons approaching the correction of these eyes will achieve the best possible surgical results. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Subluxated cataractous and clear lenses are commonly treated by limbal or pars plana lensectomy followed by primary or secondary intraocular lens (IOL) implantation. Adjunctive capsular prosthetic devices have facilitated lens removal and IOL centration in these challenging cases but have also added complexity and potential complications to the procedure. Although crystalline lens extraction may be required to clear the visual axis in mild to moderate lens subluxations, we propose insertion of a primary anterior chamber IOL without lens extraction in severe subluxations when the eye is optically aphakic or can be made functionally aphakic following neodymium:YAG laser zonulysis. Two cases demonstrating this approach are presented. [Copyright &y& Elsevier]

We present an unusual case of persistent interface fluid that would not resolve despite normal intraocular pressure and corneal endothelial replacement with Descemet-stripping endothelial keratoplasty. Dissection, elevation, and repositioning of the laser in situ keratomileusis flap were required to resolve the interface fluid. Circumferential corneal graft–host margin scar formation acting as a mechanical strut may have been the cause of the intractable interface fluid. [Copyright &y& Elsevier]

Purpose: To examine the profile of clear corneal cataract incisions in the living eye using optical coherence tomography (OCT). Setting: Private practice, Eugene, Oregon, USA. Methods: The Zeiss Visante OCT anterior segment imaging system was used to study the profile of clear corneal cataract incisions, all in senior citizens. The OCT images of the operative eye were taken on the first postoperative day approximately 24 hours after surgery. The OCT images of clear corneal incisions were compared with an OCT image of a control eye, incisions without stromal hydration, and previous drawings of clear corneal incisions. Results: In the images, the clear corneal incisions had an arcuate configuration rather than a straight line configuration, as previously indicated. This architecture appears to add greater stability as a result of a tongue-and-groove-like fit of the floor to the roof of the incision as well as an incision that is longer than the chord length that had previously been measured. Other findings include that stromal swelling, which facilitates sealing of these incisions by the endothelial pump, lasted for at least 24 hours. Conclusions: Results indicate an incision in the plane of the cornea with a chord length of at least 2.0 mm provides advantageous architecture for adequate self-sealing. Proper clear corneal incision construction resulted in an incision architecture that seemed to have increased stability and added safety, contributing to an absence of endophthalmitis for more than 10 years and 9000 cases in a single practice. [Copyright &y& Elsevier]

Scleral fixation of intraocular lenses (IOLs) and adjunctive capsular devices can be performed under the protection of a scleral flap. A modification of this technique uses a scleral pocket initiated through a peripheral clear corneal incision. Full-thickness passage of a double-armed suture through the scleral pocket and conjunctiva, with subsequent retrieval of the suture ends through the external incision for tying, facilitates scleral fixation. This modification offers several advantages over traditional methods: It eliminates the need for conjunctival dissection and scleral cauterization; a scleral pocket affords a greater surface area for suture placement through an ab externo or ab interno approach; retrieval of the sutures through the external corneal incision and subsequent tying allows the suture knot to pass under the protective roof of the scleral pocket, negating the need for suture knot rotation; and the architecture of the scleral pocket eliminates the need for sutured wound closure. Suture retrieval and scleral fixation through a corneoscleral pocket offers a refined method for fixation of IOLs and other intraocular adjunctive devices. [Copyright &y& Elsevier]

Scleral fixation of intraocular lenses (IOLs) can be performed under the protection of a scleral flap. A variation of this technique uses a scleral tunnel for suture fixation to the eye. Passage of a double-armed suture through the roof of the scleral tunnel with subsequent retrieval of the suture ends through the external incision for tying facilitates scleral fixation. This modification offers several advantages: A scleral tunnel is easier to construct than a triangular flap and does not require suture closure. It affords a greater surface area for suture placement through an ab externo or ab interno approach. Tying each suture allows the suture knot to pass under the roof of the tunnel, eliminating the need for suture knot rotation. Suture retrieval and scleral fixation through a scleral tunnel incision offers a simplified and elegant method for fixation of IOLs and other intraocular adjunctive devices. [Copyright &y& Elsevier]

The article discusses refractive lens exchange. Multifocal and accommodative intraocular lens implantation is included in the options for corrections of refractive error and presbyopia by means of refractive lens exchange (RLE). The fast recovery and astigmatically neutral incisions currently used for modern cataract surgery have allowed corneal refractive surgery to be used with greater predictability for RLE.

Phacoemulsification with mechanical pupil dilation was performed on a functionally monocular glaucoma patient with pseudoexfoliation syndrome. The postoperative course was complicated by persistent intraocular hemorrhaging from the pupil margin in multiple locations that ceased temporarily with a marked elevation in intraocular pressure (IOP). Normalization of IOP with medication or paracentesis resulted in recurrent bleeding and a subsequent increase in IOP elevation. Surgical intervention using bipolar diathermy was required to control the bleeding and the elevated IOP. A bimanual approach allowed the corrective procedure to be performed in a simple and efficacious manner. [Copyright &y& Elsevier]

A 72-year-old man had exchange of a foldable silicone multifocal intraocular lens (IOL) by transection, removal, and monofocal IOL replacement. One month after the exchange, irreversible corneal edema developed and penetrating keratoplasty was performed. At the time of the corneal transplant, a small silicone fragment was discovered in and removed from the anterior chamber. Histologic evaluation of the patient''s cornea demonstrated an absence of corneal endothelium, suggesting the fragment was the etiology of the corneal decompensation. [Copyright &y& Elsevier]

Bimanual microincision phacoemulsification entails the removal of the crystalline lens through 2 1.2 mm incisions. Infusion is provided through a separate irrigating handpiece, and phacoemulsification and aspiration are performed through a sleeveless phacoemulsification needle. We describe a technique for refractive lens exchange using bimanual microincision phacoemulsification. Capsulorhexis formation, cortical cleaving hydrodissection, lens extraction in the iris plane, and residual cortex removal are performed through the microincisions. This technique offers improved surgeon control throughout the procedure and added safety by maintaining continuous pressurization of the eye while removing the lens far from the posterior capsule. [Copyright &y& Elsevier]

: PurposeTo analyze the incidence and clinical outcomes of patients developing diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) treated with topical and oral corticosteroids.: SettingOregon Eye Institute, Eugene, Oregon, USA.: MethodsA retrospective analysis of the last consecutive 1000 LASIK cases was performed. Eyes developing stage 3 DLK or at risk for progressing to stage 3 were treated with a combination of high-dose prednisolone acetate 1% and oral prednisone and evaluated for corneal scarring, loss of best spectacle-corrected visual acuity (BSCVA), and deviation from the intended refractive outcome.: ResultsDiffuse lamellar keratitis developed in 40 eyes (4%). It progressed to stage 3 in 7 eyes (17%). Oral and topical steroids were used in 22 eyes (55%). The mean variation from the desired refractive outcome was 0.14 diopter ± 0.53 (SD). There were no instances of corneal scarring or permanent loss of BSCVA. No eye had interface irrigation.: ConclusionTreatment of severe DLK with high-dose topical and oral corticosteroids produced excellent results without flap lifting and interface irrigation. [Copyright &y& Elsevier]

: PurposeTo compare the performance of sonic phacoemulsification with that of ultrasonic phacoemulsification in regard to 1-day postoperative visual acuity, corneal edema, and procedure efficiency.: SettingOregon Eye Institute, Eugene, Oregon, USA.: MethodsThis prospective nonrandomized study comprised 86 eyes with mild to moderate nuclear sclerotic cataract. Forty-three eyes had sonic and 43 ultrasonic phacoemulsification using the Staar Sonic Wave phacoemulsification system. The mean age was 76 years in the ultrasonic group and 71 years in the sonic group. The mean nuclear sclerosis was 2.0+ in the sonic group and 1.9+ in the ultrasonic group. Patient age, lens density, postoperative corneal edema, 1-day postoperative uncorrected visual acuity (UCVA), and the percentage of eyes with a visual acuity of 20/40 or better were determined. In addition, the mean ultrasonic and sonic times, mean percentage phaco power, and mean effective phaco time (EPT) were calculated in each group.: ResultsBoth groups had a 5% incidence of trace corneal edema. The mean UCVA was 20/41 in the ultrasonic group and 20/42 in the sonic group. Seventy-nine percent of eyes in the ultrasonic group and 74% in the sonic group had a UCVA of 20/40. The mean percentage phaco power was 7.2% and 7.6% in the ultrasonic group and sonic group, respectively. The mean EPT was low in both groups, 4.0 and 2.9 seconds, respectively.: ConclusionSonic technology yielded outcomes similar to those of ultrasonic phacoemulsification with respect to postoperative visual acuity and corneal edema in patients with average density nuclear sclerotic cataract. [Copyright &y& Elsevier]

Background. Although dizziness is a common symptom in both primary care and referral practices, the relative frequency of various causes has not been well delineated. Methods. A MEDLINE search identified 12 articles containing original data on the etiology of dizziness in consecutive patients. Study sites included primary care offices (n = 2), emergency room (n = 4), and referral clinics (n = 6). Each study's strength of design was graded using nine quality criteria. Results. Dizziness was attributed to a peripheral vestibulopathy in 44% of patients, a central vestibulopathy in 11%, psychiatric causes in 16%, other conditions in 26%, and an unknown cause in 13%. Certain serious causes were relatively uncommon, including cerebrovascular disease (6%), cardiac arrhythmia (1.5%), and brain tumor (<1%). Conclusions. Dizziness is due to vestibular or psychiatric causes in more than 70% of cases. Since serious treatable causes appear uncommon, diagnostic testing can probably be reserved for a small subset of patients. [ABSTRACT FROM AUTHOR]

Compares health department-initiated partner notification at anonymous and confidential HIV test sites in Colorado. Number of index cases assigned for partner notification interview; Comparison of provider-referral partner notification; HIV transmission behavior.

A 64-year-old phakic patient had a trabeculectomy complicated by complete shallowing of the anterior chamber 10 days postoperatively. Despite repair of a conjunctival wound dehiscence and reformation of the anterior chamber with sodium hyaluronate 3.0%−chondroitin sulfate 4.0% (Viscoat®), he had a flat anterior chamber again the following day with 360 degrees of pupillary synechias and lens-to-cornea touch. Sodium hyaluronate 2.3% (Healon®5) instilled through a paracentesis at the slitlamp lysed the synechias, stabilized the anterior chamber, facilitated filtration, and prevented complications from hypotony. The unique properties of Healon5 allowed for a conservative and less invasive approach in the management of this particular complication. [Copyright &y& Elsevier]