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Benjamin Abramowitz,1 Nisha Chadha,2 Amr Kouchouk,3 Rashed Alhabshan,4 David A Belyea,4 Tania Lamba4 1Glaucoma Department, Eye Consultants of Northern Virginia, Springfield, VA, USA; 2Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA; 3Cornea Department, Atlantis Eyecare, Torrance, CA, USA; 4Department of Ophthalmology, The George Washington University, Washington, DC, USA Aim: The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. Patients and methods: In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52weeks. Patients completed a survey 1week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3mmHg from baseline. Results: IOP was lowered to ≥3mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52weeks post treatment. There were more treatment failures in the micropulse group up to 52weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). Conclusion: Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure. Keywords: randomized controlled trial, selective laser trabeculoplasty, micropulse, glaucoma, intraocular pressure

Purpose: To report a case of macular fold formation following surgical repair of rhegmatogenous retinal detachment in a 57-year-old man treated with pars plana vitrectomy (PPV), subretinal fluid endodrainage, gas-fluid exchange and sulfur hexafluoride tamponade, and postoperative face-down positioning. We also discuss etiology and prevention of macular fold following retinal detachment surgery and review the literature regarding current trends in the management of this complication. Methods: Case report and literature review. Results: The macular fold has resolved spontaneously with eventual flattening of and restoration of vision to 20/20 at 12 months postoperatively. Conclusions: This case and other recently published reports suggest good outcomes with conservative management of outer retinal folds and partial thickness macular folds. Further research is needed to identify clinical and imaging features that could be used to build criteria to guide management of this complication.

It is well established and documented that fluoroquinolone use is associated with the development of tendinopathy. However, little is known about the possible effects of this class of antibiotics on the orbit. We present a case of lateral canthal tendon rupture that presented with an acute right lower eyelid ectropion in a young, renal compromised patient in the setting of recent fluoroquinolone use for pneumonia. Eye care clinicians need to be aware of the possible effects of fluoroquinolones on the eyelids.

Previous research has shown several limitations associated with the use of marijuana as a treatment for glaucoma. However, little is known regarding patients' perceptions toward using marijuana for glaucoma and their intentions to use this therapeutic alternative.To identify factors among patients with glaucoma that could lead to intentions to use marijuana for treatment.This cross-sectional survey study of 204 patients with glaucoma or suspected to have glaucoma was conducted at an academic-based glaucoma clinic in Washington, DC, between February 1 and July 31, 2013. Patients completed a self-administered survey assessing demographics, perceived severity of glaucoma, prior knowledge about marijuana use in glaucoma, past marijuana use, perceptions toward marijuana use (legality, systemic adverse effects, safety and effectiveness, and false beliefs), satisfaction with current glaucoma management, relevance of treatment costs, and intentions to use marijuana for glaucoma. Medical records were reviewed for disease severity. Data analysis was conducted from September 1, 2013, to September 30, 2015.The main outcome was patients' intentions to use marijuana for glaucoma. Multiple linear regression analysis was conducted to identify factors associated with patients' intentions to use marijuana for glaucoma.Of the 334 patients who were invited to participate in the study, 204 (61.1%) completed the survey. About half the participants were women (104 [51.0]%), and 82 (40.2%) were white. Regression analysis of 204 respondents indicated that perceptions of legality of marijuana use (β, 0.378; 95% CI, 0.205 to 0.444; P.001), false beliefs regarding marijuana (β, 0.323; 95% CI, 0.236 to 0.504; P.001), satisfaction with current glaucoma care (β, -0.222; 95% CI, -0.362 to -0.128; P.001), and relevance of marijuana and glaucoma treatment costs (β, 0.127; 95% CI, 0.008 to 0.210; P = .04) were significantly associated with intentions to use marijuana for glaucoma treatment after controlling for demographic variables, disease severity, and previous marijuana use.This study's findings suggest a need for more education on this topic for ophthalmologists to be able to protect patients with glaucoma against the increased acceptability among the public of using marijuana based on false perceptions of its therapeutic value in glaucoma therapy. Considering the strong influence of perceptions of the legality of marijuana use on intentions to use this substance as a treatment for glaucoma, patient education might be particularly relevant in states in which marijuana use for glaucoma is legal, as in the case of the current study's setting.

Cold Atmospheric Plasma (CAP) has been shown to influence tissue wound healing but little is known about the impact of CAP on healthy corneal tissues and their ability to respond to injuries. The objective of this study is to examine the effect of CAP on wound healing after corneal epithelial and basement membrane ablation in New Zealand white rabbits. The rabbits were assigned into three groups. Ten Rabbits from two groups underwent a 6 mm corneal ablation to the right eyes. After ablation, five rabbits in group (A) received 2 minutes of CAP whereas the other five rabbits (B) were not treated with CAP. A third group (C) included two rabbits and received CAP without ablation. Eyes monitored for corneal haze, epithelial healing, lens clarity and any signs of inflammation. At 24 hours, two rabbits from group A and two from group B were sacrificed to harvest the corneas. Twenty days, all remaining rabbits in groups A, B, and C were sacrificed and corneas were harvested. Corneas were fixed in formalin and stained with H&E or used for immunofluorescence microscopy to assess scar formation using antibodies against fibronectin and a-smooth muscle actin. At 24 hours, corneas from group A had average epithelial defect of 9.25 mm2 on day 1 whereas those from group B had average defect of 12.05 mm2, a difference of 2.8 mm2 (P=0.57). H & E stained corneal sections didn’t show abnormal responses to injury at 24 hours and 20 days. Epithelial thickness and stromal cell counts 20 days after injury showed no significant differences. Analysis of immunofluorescence microscopy images showed no differences between all groups. In conclusion, CAP application to cornea doesn’t appear to have obvious adverse effects. CAP does not interfere with rate of wound closure or induce increased inflammation. CAP did not have an effect on corneal wound healing or lead to scar formation.

David A Belyea, Rashed N Alhabshan, Sankaranarayana P Mahesh, Gregory S Gertner, Mirsad M Ibisevic,† Abdullah S Habib, Jacob A Dan Department of Ophthalmology, The George Washington University, Washington, DC, USA †Dr Mirsad Ibisevic passed away on January 4, 2013 Context: Although Heidelberg retinal tomography (HRT)-generated topographic images have been studied extensively for the detection of retinal nerve fiber layer (RNFL) defects, little is known about the role of HRT-generated surface reflectivity images in the detection of RNFL defects in either patients with glaucoma or glaucoma suspects. Aims: To evaluate the effectiveness of HRT version II (HRT II) optic nerve reflectivity images in uncovering RNFL defects in an outpatient population evaluated for glaucoma.Study design/materials and methods: In 102 consecutive eyes from 60 patients evaluated for glaucoma in an academic-based practice, HRT II optic nerve images were prospectively imaged and compared with clinical optic nerve exam techniques to see if HRT II was able to detect RNFL defects overlooked in clinical practice. Results: Nine eyes (8.8%) were found to have RNFL defects recognized by screening with HRT II. Of these nine eyes, eight (88.9%) were recognized to demonstrate RNFL defects by conventional examination techniques. One additional eye had an RNFL defect seen on physical exam that was not detected by HRT. Conclusion: In academic practice, HRT II may be helpful in complementing conventional exam techniques in the recognition and documentation of acquired RNFL loss. Keywords: HRT, RNFL defect, optic nerve, glaucoma, glaucoma suspect