United States

Background
The corneal dystrophies are a group of inherited disorders that are typically bilateral, symmetric, and slowly progressive, unaffected by environmental or systemic factors. Four types of corneal endothelial dystrophies, primarily affecting corneal endothelial cells, have been described. Here, we present a novel corneal endothelial dystrophy characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal opacity. Symptomatic individuals develop corneal edema, with successful restoration of vision achieved through endothelial keratoplasty (EK).

Methods
Thirty-five individuals from seven families, including 13 affected individuals exhibiting peripheral posterior corneal macular opacities, endothelial guttae and corneal edema, and 22 unaffected family members were included in this retrospective case series. Whole-exome sequencing was performed in three families and Sanger sequencing of CHST6 was performed in all individuals. Histological examination of Descemet membrane (DM) excised at the time of EK was performed for three probands. Serum keratan sulfate (KS) levels were measured in members of six families. Functional analysis of identified mutations was performed using CHST6 promoter containing CHST6 expression vector in human keratocytes (HK) and corneal endothelial cells (HCEnC).

Results
None of the affected individuals demonstrated a single corneal stromal deposit, either on slit lamp exam or on anterior segment OCT imaging, excluding the diagnosis of Macular Corneal Dystrophy. Five affected individuals from four families underwent EK, with resolution of the corneal edema. CHST6 sequencing revealed a non-coding promoter mutation (c.-690G&gt;C) in all families, either in homozygous state in five affected individuals from three families or in a compound heterozygous state with a coding mutation (p.R211Q, p.Y268C or p.P280L) in seven affected individuals from the other four families. In silico analysis predicted c.-690G&gt;C to be a regulatory variant, located at the RNA polymerase II binding site. Functional analysis demonstrated that c.-690G&gt;C leads to increased KS sulfation in HCEnC with no change of KS sulfation in HK, while coding mutations p.P280L and p.Y268C resulted in decreased KS sulfation in HK and no change of KS sulfation in HCEnC. DM staining revealed elevated levels of sulfated and non-sulfated KS in DM and endothelium in affected probands. Minimum changes in serum sulfated KS levels were observed in affected individuals.

Conclusion
A novel corneal endothelial dystrophy characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal opacities is associated with promoter mutation c.-690G&gt;C in CHST6 gene. We suggest the name Peripheral Macular Endothelial Dystrophy (PMED) to describe this dystrophy that can be and should be managed with EK.


AMA Research Challenge 2024 

Characterization of a Novel Corneal Dystrophy - Peripheral Macular Endothelial Dystrophy

Congratulations to all the researchers who have qualified for the AMA Research Challenge virtual poster symposium and semifinals!

Welcome to the **largest national, multi-specialty research event** featuring research from nearly 1,000 medical students, residents, fellows, and international medical graduates across six topic areas - basic science, clinical and translational research, clinical vignettes, health systems science, medical education, and public health and health policy.

#### Access the Event
Use the buttons below or navigation menu to access the event. 

[![](https://assets.underline.io/markdown_image/1/image/d4076f2146939317a29eb9f69c53ad41.png)](https://underline.io/events/506/sessions?searchGroup=all)
[![](https://assets.underline.io/markdown_image/1/image/6bcee0b523a4874c4292ca0415d88dde.png)](https://underline.io/events/506/posters?searchGroup=all)

#### Event Details
The 2025 AMA Research Challenge includes the following symposium halls:
* **Semifinals hall:** Features research from 54 medical students, residents and international medical graduates that received top scores during first round scoring. 
* **Poster symposium hall:** Features research from nearly 1,000 medical students, residents and international medical graduates categorized by topics and subtopics.

**Here’s how to participate:**
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with presenters** and provide feedback to help advance their research
* **New this year: Watch live poster presentations** by topic area and engage directly with researchers

At the conclusion of this event, the AMA announced the top five finalists who advanced to the AMA Research Challenge final round, presented their research to an elite panel of judges, and competed to win a $10,000 grand prize presented by Laurel Road.

**Addison Shenk, a fourth-year medical student from Edward Via Virginia College of Osteopathic Medicine, was the winner of the 2025 AMA Research Challenge and was awarded the grand prize of $10,000, presented by Laurel Road.**

#### A message from Dr. Bobby Mukkamala, AMA President
<div style="position: relative; width: 100%; padding-bottom: 56.25%; height: 0; overflow: hidden;">
  <iframe 
    src="https://underline.io/embed/136894-ama-video?t=0"
    title="AMA Welcome Video"
    allowfullscreen
    style="position: absolute; top: 0; left: 0; width: 100%; height: 100%; border: 0;">
  </iframe>
</div>


#### Recognized Institutions
In 2025, 1,400 abstracts were submitted across six topic areas representing 174 medical schools and more than 150 residency and health care institutions. [See if your institution is represented this year!](https://drive.google.com/file/d/1eFrTqCmCeobx9pr5drJK2hllvsIpFNOY/view?usp=drive_link)

#### Grand Prize Sponsor
AMA would like to thank Laurel Road, a brand of KeyBank, for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road and KeyBank are not involved in winner selection process. The winner will be announced during the AMA Research Challenge final round. Payment of the grand prize will be directly from Laurel Road/KeyBank. See the [AMA Research Challenge Official Rules for terms and conditions](https://www.ama-assn.org/system/files/research-challenge-official-rules.pdf).

[![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)](https://www.laurelroad.com/)

#### Code of Conduct
<html>
AMA has a code of conduct for its meetings – we ask all attendees to adhere to this code to participate in this year’s meeting. Please read and <a href="https://www.ama-assn.org/about/code-conduct" target="_blank">learn more here</a> about your conduct requirements.
<br><br>
	</html>
	

#### Semifinals Judges

You need to log in with the email address you registered with. Access credentials have been sent to your email. 

Please be sure to check your spam and other email folders if you do not see an email confirmation right away.

Need help? Contact us at <support@underline.io>.

Please log in to explore this event.

If you have used the AMA Research Challenge platform previously, please click the ‘Log-in’ button below. If you do not remember your password, please click “forgot password” and follow prompts to reset your password. After resetting your password, please refresh your webpage to access the platform. 

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals. 

**Please use [this link here](https://www.ama-assn.org/member-benefits/events/ama-research-challenge) to register for free. **

Registration Is Required

AMA Research Challenge 2025 

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background
The corneal dystrophies are a group of inherited disorders that are typically bilateral, symmetric, and slowly progressive, unaffected by environmental or systemic factors. Four types of corneal endothelial dystrophies, primarily affecting corneal endothelial cells, have been described. Here, we present a novel corneal endothelial dystrophy characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal opacity. Symptomatic individuals develop corneal edema, with successful restoration of vision achieved through endothelial keratoplasty (EK).

Methods
Thirty-five individuals from seven families, including 13 affected individuals exhibiting peripheral posterior corneal macular opacities, endothelial guttae and corneal edema, and 22 unaffected family members were included in this retrospective case series. Whole-exome sequencing was performed in three families and Sanger sequencing of CHST6 was performed in all individuals. Histological examination of Descemet membrane (DM) excised at the time of EK was performed for three probands. Serum keratan sulfate (KS) levels were measured in members of six families. Functional analysis of identified mutations was performed using CHST6 promoter containing CHST6 expression vector in human keratocytes (HK) and corneal endothelial cells (HCEnC).

Results
None of the affected individuals demonstrated a single corneal stromal deposit, either on slit lamp exam or on anterior segment OCT imaging, excluding the diagnosis of Macular Corneal Dystrophy. Five affected individuals from four families underwent EK, with resolution of the corneal edema. CHST6 sequencing revealed a non-coding promoter mutation (c.-690G>C) in all families, either in homozygous state in five affected individuals from three families or in a compound heterozygous state with a coding mutation (p.R211Q, p.Y268C or p.P280L) in seven affected individuals from the other four families. In silico analysis predicted c.-690G>C to be a regulatory variant, located at the RNA polymerase II binding site. Functional analysis demonstrated that c.-690G>C leads to increased KS sulfation in HCEnC with no change of KS sulfation in HK, while coding mutations p.P280L and p.Y268C resulted in decreased KS sulfation in HK and no change of KS sulfation in HCEnC. DM staining revealed elevated levels of sulfated and non-sulfated KS in DM and endothelium in affected probands. Minimum changes in serum sulfated KS levels were observed in affected individuals.

Conclusion
A novel corneal endothelial dystrophy characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal opacities is associated with promoter mutation c.-690G>C in CHST6 gene. We suggest the name Peripheral Macular Endothelial Dystrophy (PMED) to describe this dystrophy that can be and should be managed with EK.


poster

Welcome to the **largest national, multi-specialty research** event featuring research from more than 750 medical students, residents, fellows, and international medical graduates.

Use the buttons below or navigation menu to access the event.
<br><br><br>

[![](https://assets.underline.io/markdown_image/1/image/20e1e77aa954efeac7a15d84c85eb383.jpg)](https://underline.io/events/468/sessions?searchGroup=all)
<br>
[![](https://assets.underline.io/markdown_image/1/image/068522d81aca0b68a369787c7dfccd1b.jpg)](https://underline.io/events/468/posters?searchGroup=all)
<br>
[![](https://assets.underline.io/markdown_image/1/image/d3971ece79d5e5575b178bdc2c8bbfae.jpg)](https://underline.io/events/468/help-desk)
<br><br>

#### Event Details

The 2024 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. **Log in at any time throughout the event to:**

* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges, and compete to win a $10,000 grand prize presented by Laurel Road.<br><br>

### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in winner selection process. The winner will be announced on February 20, 2025 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

[![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)](https://www.laurelroad.com/)

<br><br>

You need to log in with the email address you registered with. Access credentials have been sent to your email. 

Please be sure to check your spam and other email folders if you do not see an email confirmation right away.

**There is no registration fee for this event! **

If you have used the AMA Research Challenge platform previously, please click the ‘Log-in’ button below. If you do not remember your password, please click “forgot password” and follow prompts to reset your password. After resetting your password, please refresh your webpage to access the platform.

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals. 

**Please use this link [here](https://www.ama-assn.org/member-benefits/events/ama-research-challenge) to register for free.**

Background 
Endophthalmitis is a serious ophthalmic inflammatory pathology that can result in blindness. Intravitreal (IVT) injections, commonly used treatment vectors for various retinal diseases, have been associated with the risk of developing endophthalmitis. This study aims to compare the incidence of endophthalmitis following IVT dexamethasone (Ozurdex) and anti-VEGF injections administered by several vitreoretinal specialists in outpatient settings. 

Methods 
We retrospectively reviewed IVT dexamethasone and anti-VEGF injections conducted by a network of vitreoretinal specialists in outpatient settings between January 2019 and January 2024. Data was collected on the incidence of endophthalmitis within two weeks following ocular injections. The total sample size included 330,572 cases: 318,618 anti-VEGF injections and 11,954 IVT dexamethasone injections. Statistical analysis was performed to compare the observed and expected frequencies of endophthalmitis for each treatment group, and the significance was determined using a p-value threshold. 

Results 
The incidence of endophthalmitis following Ozurdex injection was found to be higher compared to anti-VEGF injections. Specifically, 15 cases of endophthalmitis were reported out of 11,954 IVT dexamethasone injections, resulting in an incidence rate of 0.109%. In contrast, 106 cases of endophthalmitis were reported out of 318,618 anti-VEGF injections, yielding an incidence rate of 0.033%. The observed frequency of endophthalmitis for IVT dexamethasone was significantly higher than the expected frequency (0.125% vs. 0.037%), whereas the observed frequency for anti-VEGF injections was lower than the expected frequency (0.033% vs. 0.037%). The difference was statistically significant, P < .0001, indicating that IVT dexamethasone is more likely than anti-VEGF to cause endophthalmitis. 

Conclusion 
The findings of this study suggest that patients receiving IVT dexamethasone injections are at a higher risk of developing endophthalmitis compared to those receiving anti-VEGF injections. This significant difference in incidence rates highlights the need for clinicians to carefully consider the risks and benefits when choosing between these treatment options. Further research is warranted to explore the underlying factors contributing to the increased risk associated with IVT dexamethasone and to develop strategies for minimizing this risk.

Comparative Incidence of Endophthalmitis After Intravitreal Dexamethasone Versus Anti-VEGF Injections: A Retrospective Study

Background: Patients undergoing corneal transplantation are at a higher risk of graft failure with concurrent glaucoma. Despite advances in corneal transplant techniques requiring less steroid use, the risk of vision loss from glaucoma persists. Rho Kinase Inhibitors (RKIs) are a newer class of glaucoma drops that reduce intraocular pressure (IOP); however, their corneal effects are lesser known. Some reports suggest a role in corneal endothelial cell survival, while others report a reversible, reticular edema in cornea transplant patients started on RKIs. These contradictory effects make it difficult to assess the exact scenario in which RKIs help or harm the cornea. Specialists must balance the risk of vision loss from glaucoma with the potential toxicity of glaucoma therapies. The literature mostly consists of case series. This retrospective analysis aims to understand how this recently emerged glaucoma medication impacts corneal grafts.
Methods: A retrospective chart review was conducted on adult patients with corneal transplants treated with topical RKIs (netarsudil 0.02%) between 2018 and 2022 at a tertiary care center. Inclusion criteria consisted of glaucoma diagnosis, any type of corneal transplant, and at least one follow-up visit post-RKI initiation. Data collected included patient demographics, ocular history, RKI use, and outcomes related to graft clarity and glaucoma management.
Results: Thirty patients (mean age 64.2 years) were included. The mean number of previous ocular surgeries was 3.6, and the mean logMAR vision was 0.51. The average number of grafts prior to RKI was 1.83. At baseline, 86.67% of patients were on topical carbonic anhydrase inhibitors, and the mean IOP was 26.6 mmHg. Post-RKI, 66.66% of grafts remained clear, while 33.33% developed corneal edema. Univariate analysis identified the number of previous grafts as a significant predictor of graft failure (p=0.05). Other variables, including RKI duration, glaucoma tube shunts, and CAI use, were not significantly associated with graft failure. Furthermore, 46.7% of patients required additional glaucoma surgeries, and 20% required repeat transplants.
Conclusions: Duration of RKI use did not significantly affect graft survival, though a correlation with the number of prior grafts was noted. The confounding variables and absence of a control group limit the ability to draw isolated conclusions. RKI's elusive effects on the cornea warrant further study as specialists balance mitigating glaucoma and preserving graft clarity. Further studies with larger sample sizes and control groups are necessary to better understand the role of RKIs in patients with corneal transplants and glaucoma.

Effects of Rho Kinase Inhibitors on Corneal Transplant Survival


Background
Ophthalmic image quality is impacted by ocular pathology, decreasing accuracy of artificial intelligence (AI) algorithms classifying these images. This study uses AI to improve image quality on color fundus photos (CFPs) to determine if this will restore an AI algorithm’s accuracy in identifying diabetic retinopathy (DR) despite simulated cataracts (SCs).
Methods
A convolutional neural network (CNN) was trained to classify CFPs as either DR or non-DR. Cataracts were simulated by applying Gaussian blur, and the CNN was used to classify these images. A Very Deep Super-Resolution (VDSR) AI was used to enhance the images with simulated cataracts. The CNN then classified these images.
Results
The CNN was able to classify the dataset without any SC with an accuracy of 93%. This accuracy decreased to 78% with SC, but improved back to 85% after images were enhanced using the VDSR.
Conclusion
This study shows that despite AI accuracy decreasing with noise from SC, it can be improved partially using AI-based image enhancement.


Image Resolution Enhancement for Improving an Artificial Intelligence Algorithm’s Accuracy in Detecting Diabetic Retinopathy through Simulated Cataract

Background:
Stent-based MIGS (sb-MIGS) is a revolutionary technology that allows patients to receive sight-saving procedures in a safer and less invasive way. The utilization of sb-MIGS nationally has yet to be explored. Epic Cosmos is a dataset made up of 260-million patients who receive care at a healthcare institution that uses Epic as their electronic health record system. While Sb-MIGS has become popular over the last 10 years, there has been limited published data focused on demographic variations, making our study the first to investigate this topic. 

Method:
The proportion of patients with a diagnosis of mild or moderate primary open-angle glaucoma (mm-POAG), ICD-10 code H40.11X, was compared to the proportion of patients who underwent sb-MIGS, CPT code 0191T denoting iStent or Hydrus implantation, between 1/2014 - 12/2023.

Results:
19149 patients received sb-MIGS out of 361830 mm-POAG patients. Most mm-POAG patients resided in urban areas (90.3% urban vs 6.5% rural; p<0.01). Most sb-MIGS were performed in urban areas (86.4% vs 9.7%; p<0.01). These splits are somewhat different from the urban/rural population split (80/20) per the 2020 US census. A higher proportion of rural patients underwent sb-MIGS relative to mm-POAG rates (~5/100 rural patients vs ~3/100 urban patients; p<0.01), which coincided with an odds ratio of 26.0. Rural non-Hispanic whites (NHW) (90.9% sb-MIGS vs 90% mm-POAG; p=0.34) and minorities, composed of Black-Americans, American-Indian and Hispanic patients, (9.1% vs 9.2%; p=0.88) received sb-MIGS at rates similar to mm-POAG diagnoses rates. Urban NHWs received sb-MIGS at rates significantly higher than mm-POAG diagnosis rates (73.8% vs 63.4%; p<0.01). Urban minorities received sb-MIGS at considerably lower rates versus mm-POAG diagnosis rates (10.9% vs 37.6%; p<0.01). The Epic customer profile limits this study.

Conclusions:
Our findings suggest that mm-POAG diagnoses and sb-MIGS rates are significantly higher in urban areas, where racial and ethnic barriers to sb-MIGS appear to be exacerbated. While geographic barriers may limit rural communities from getting access to eye care, ethnic and racial barriers may not be as limiting.

Insights from a Nationwide Electronic Health Record Cohort on Disparities in Microinvasive Glaucoma Surgery Utilization

Background
Amidst the growing concern over methamphetamine's ophthalmic sequelae, our study focuses on methamphetamine associated keratitis-induced corneal perforation, a significant but underreported complication of methamphetamine use. Three primary mechanisms have been suspected as the link between methamphetamine use and corneal ulcer formation. Firstly, methamphetamine promotes vasoconstriction which in turn leads to corneal stromal neovascularization. Additionally, methamphetamine can cause neurotrophic keratitis which elevates patients’ pain threshold, potentially delaying care. Methamphetamine users also experience hyper-fixation on foreign body sensations which may result in or worsen epithelial defects due to continued physical irritation of the eye. This retrospective chart review aims to illuminate the correlation between methamphetamine use and the development of corneal ulcer perforation treated with therapeutic penetrating keratoplasty (PKP).
Methods
We evaluated 8 patients with a documented history of methamphetamine use who developed corneal ulcers which perforated and subsequently underwent PKP at Loma Linda University Health. The study assessed post-operative outcomes, including best-corrected visual acuity (BCVA), complications, graft survival, and follow-up duration. Furthermore, concomitant drug use and associated microbial infections were also examined.
Results
Our findings underscore the critical impact of methamphetamine use on ocular health, specifically highlighting risk of keratitis leading to corneal perforations. Post-operative outcomes reveal no significant BCVA improvement (p = 0.8323) and poor graft survival rates with an average graft survival time of less than one year. Additionally, the majority of patients had a challenging clinical course with 71.4% of patients demonstrating inconsistent follow-up and 66.7% of patients with at least 6-months of follow-up data experiencing graft failure within one year of their PKP. More than 50% of patients presented with a significant post-operative complication, including corneal edema, epithelial defects, and corneal neovascularization.
Conclusion
Methamphetamine-induced keratitis presents unique clinical challenges, including a risk for corneal perforation and subsequent need for a therapeutic PKP. Our study highlights the importance of recognizing methamphetamine use as a significant risk factor for severe ocular complications and advocating for early detection and multidisciplinary management to optimize outcomes. The findings call for increased awareness and research into targeted interventions that can reduce the adverse ophthalmic effects of methamphetamine abuse.


Methamphetamine Associated Corneal Ulcer Perforation: Poor Post-Operative Outcomes with Penetrating Keratoplasty

Optimizing Ophthalmology Education via ChatBot-Generated Materials: Readability Analysis of AI-generated Patient Education Materials and North American Neuro-Ophthalmology Society (NANOS) Patient Brochures

Background:
It is crucial that patients are offered concise patient education materials (PEMs) to facilitate an enhanced understanding of diagnoses and treatment options. As the average American reads at an 8th grade reading level, the AMA suggests that PEMs be written at a 6th grade level. Despite significant efforts made by NANOS to provide easily accessible webpages for different diagnoses, treatments, and surgeries, the readability of such materials exceeds these recommended guidelines. AI chatbots such as Chat-GPT and Google’s Bard can generate sophisticated responses to free-text input and modifying responses to user feedback. When prompted appropriately, such technology offers promising application to fill the need for more comprehensible ophthalmological PEMs. As such, the aim of this study is to compare the readability of North American Neuro-Ophthalmology Society (NANOS) patient brochures to that of PEMs generated by the AI-chat bots ChatGPT 3.5 and Google Bard.

Methods:
PEMs on 13 common neuro-ophthalmology topics were generated by ChatGPT 3.5 and Google Bard, with and without a 6th grade reading level prompt. The PEMs were analyzed using seven readability metrics: Flesch Reading Ease score, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman–Liau Index, SMOG Index Score, Automated Readability Index, and Linsear Write Readability Score. Each AI-generated PEM was compared with the equivalent NANOS PEM. 

Results:
When comparing ChatGPT generated PEMs to NANOS brochures, unprompted ChatGPT PEMs consistently had lower readability scores (Flesch-Reading Ease Score NANOS 49.5 ± 3.3; ChatGPT 43.8 ± 8.8, p = 0.04) and higher grade level-equivalent readability scores (SMOG index NANOS 9.7 ± 0.5; ChatGPT 10.4 ± 1.0, p = 0.04), indicating that this material may be the most difficult to comprehend in its unprompted form. On the other hand, Bard generated PEMs that corresponded to a lower grade level compared to NANOS brochures (Linsear-Write Formula NANOS 12.1 ± 1.5; Bard 10.6 ± 2.2), though this difference was non-significant. However, when prompted to produce PEMs at a 6th grade reading level, both ChatGPT and Bard possessed far superior readability scores across all readability metrics compared to NANOS texts. The grade-level equivalent averaged around 8 for both ChatGPT and Google Bard, whereas NANOS brochures corresponded to an 11th grade level.

Conclusion:
This study offers compelling evidence that, when prompted appropriately, AI chat bots can generate comprehensible PEMs for patients on a variety of neuro-ophthalmology topics. Use of this technology in a clinical setting may offer patients with succinct and readable information on complex topics and can guide patient-oriented decision making. Furthermore, use of AI chat bots in this manner may be clinically beneficial in satellite centers where there is a scarcity of neuro-ophthalmologists by assisting triage of patients for neuro-ophthalmology referrals.

Optimizing Ophthalmology Patient Education via ChatBot-Generated Materials: Readability Analysis of AI-generated Patient Education Materials and the North American Neuro-Ophthalmology Society Patient Brochures

Purpose: The role of face-down posturing following rhegmatogenous retinal detachment (RRD) repair remains a consistent management component; however, there is no direct evidence to allow firm conclusions as to what role face-down positioning plays following RRD repair with modern micro-incisional vitrectomy surgery (MIVS) platforms. We evaluated the anatomic and visual outcomes of primary vitrectomy for RRD repair, employing no amount of post-operative prone positioning (POPP) to clarify the role of face-down posturing for RRD re-attachment.

Methods: Retrospective consecutive interventional case series of 116 eyes in 116 patients undergoing primary vitrectomy for RRD repair. Surgical outcomes, single surgery anatomic success (SSAS), and post-operative best-corrected visual acuity (BCVA) were investigated. The primary objective is to study the anatomic and visual outcomes of vitrectomy RRD re-attachment employing no POPP.

Results: SSAS was achieved in 112 (96.5%) of 116 eyes; SSAS was 100% in phakic patients (n=56) and 93% in pseudophakic patients (n=60), with both groups experiencing a mean improvement in BCVA. 

Conclusions: Primary vitrectomy with no POPP is a successful surgical intervention for RRD repair. Our current anatomical closure rate is one of the highest reported in the literature and involved a large number of macula-off RRDs, with minimal complications and significant improvement in BCVA, primarily using 14% C3F8 for gas tamponade.

Outcomes of Primary Vitrectomy for Rhegmatogenous Retinal Detachment: Interventional Retrospective Consecutive Case Series of 116 Patients with no Post-operative Prone Positioning

Background: Retinal diseases such as neovascular age-related macular degeneration (nAMD), diabetic macular edema, and diabetic retinopathy are leading causes of irreversible blindness globally, despite the availability of anti-vascular endothelial growth factor (anti-VEGF) treatments. Current therapeutic protocols involve monthly intraocular injections of anti-VEGF agents, which impose a significant burden on patients and contribute to suboptimal treatment adherence. Genentech’s SUSVIMO, a titanium-based device implanted in the conjunctiva, offers a bi-annual refill schedule, dispensing ranibizumab over six months. However, its usage is associated with risks, including ocular infections, retinal detachment, implant dislocation, and hemorrhage. Our research aims to develop an improved intraocular device made from biocompatible silicone, designed to minimize these adverse effects while ensuring continuous medication delivery. The implantation procedure parallels cataract surgery, positioning the device within the ocular lens capsule. This approach leverages the need for cataract surgery in patients with progressive retinal diseases, allowing simultaneous implantation of the drug delivery device alongside an artificial intraocular lens. The device is refillable every six months, facilitating continuous diffusion of medication to the retina.
Methods: We used the cataract surgery technique to implant our intraocular silicone device into an artificial lens capsule. Three different injector prototypes were tested for device implantation reliability by conducting ten trials for each prototype injector.
Results: Device insertion reliability proved to be more successful using the type-2 injector prototype, due to less likelihood of the device ripping while pressure was applied to eject the device into the lens capsule. 
Conclusion: Our device has the potential to become an efficient intraocular drug delivery system that will benefit patients with progressive retinal diseases that require monthly injections of anti-VEGF. More testing is required in live animal models to determine the device medication diffusion rate and dependability. 


Testing the Reliability of an Intraocular Drug Delivery Device

The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES) 

Background
Dry Eye Syndrome (DES) poses a significant ocular health concern globally, leading to pain and visual changes that may persist for several years. This study investigates the incidence and risk factors associated with DES following four different upper eyelid surgeries: Muller's Muscle-Conjunctival Resection (MMCR), internal levator advancement and resection (internal LAR), external levator advancement and resection (external LAR), and Upper-Eyelid Blepharoplasty (UEB). Considering that these surgeries can affect the orbicularis muscle and lacrimal glands, we hypothesized that patients undergoing any of these surgeries could face an increased risk of developing DES post-operation.

Methods
Analyzing the TriNetX patient health database for surgeries conducted between 2003 and 2023, records of 4,551 patients undergoing MMCR, 4,534 patients undergoing internal LAR, 15,326 patients undergoing external LAR, and 27,696 patients undergoing UEB were examined after application of exclusion criteria. Exclusion criteria included ICD-10 codes for pre-existing DES, Meibomian gland dysfunction, Sjogren syndrome, pterygium, thyroid disease, and diabetes. Analysis encompassed linear regression to identify demographic and medical risk factors associated with post-surgical DES. Propensity score matching (PSM) facilitated pairwise outcome comparisons between the four surgeries. 

Results
Internal LAR (OR: 1.17, 95% CI: (1.057,1.296)) and external LAR ((OR: 1.07, 95% CI: (1.008,1.128)) were strongly associated with the development of postoperative DES. Post-PSM pairwise comparison analysis showed that internal LAR carried a greater risk than external LAR (RR = 1.18; 95% CI: (1.062,1.303)). UEB was strongly associated with a decreased risk of postoperative DES ((OR: 0.89, 95% CI: (0.852,0.924)), while MMCR was not significantly associated with postoperative DES (OR: 1.04, 95% CI: (0.939,1.154)). Among all four surgeries, common risk factors for postoperative DES included osteoarthritis (OA), nicotine dependence (ND), obstructive sleep apnea (OSA), and female gender, while Asian ethnicity was a risk factor only for post-UEB DES. 

Conclusion
Internal LAR and external LAR present increased risk for postoperative DES, with OA, ND, OSA, and female gender significantly influencing DES incidence. Notably, internal LAR presents a heightened risk compared to external LAR. These results can offer valuable insights for patients and healthcare providers deliberating on various ptosis repair procedures, emphasizing the critical need for thorough preoperative evaluations and tailored patient education to mitigate the risk of DES in eyelid surgical interventions.


The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES)

Background

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, and patient reported outcome measures (PROMs) are often used to measure long term success of treatment. The study’s goal was to investigate factors associated with clinically meaningful outcomes after ACL reconstruction, as measured by the Patient Acceptable Symptom State (PASS). Additionally, the study aimed to evaluate differences in factors between male and female patients. 


Methods
Patients above the age of 14 who received ACL reconstructions at a single institution were identified retrospectively. Data on demographics, operative notes, and medical history were collected from electronic medical records. These patients were followed up a minimum of two years after surgery with surveys that included an International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form and asked about subsequent diagnoses and surgeries. PASS was defined an IKDC score off 75.9 or higher based on the threshold identified by Muller et al. Univariate logistic regression was performed to identify predictors of achieving PASS, and variables were selected for inclusion in a multivariable logistic regression model based on univariate analysis, prior literature, and clinical relevance. The multivariate regression was stratified by sex. 


Results
A total of 479 patients were included in the study with a mean follow up of 10 ± 5 years. The cohort had an average age of 38 and was 57% female. PASS was achieved by 68% of patients and 9 patients underwent ACL revision surgery. Upon univariate analysis, age, BMI, meniscectomy, revisions and skiing were identified as potential predictors for the multivariable model. Multivariable analysis found that higher BMI (OR 0.95[0.91, 0.99], p = 0.019) and revisions (OR 0.2 [0.04, 0.78], p = 0.025) had independent, negative associations with achievement of PASS. Participation in skiing (OR 1.81 [1.12,2.99], p = 0.018) was found to be positively and independently associated with achieving PASS. Among males, higher BMI (0.9 [0.83, 0.99], p = 0.023) was negatively associated with PASS and participation in skiing (3.52 [1.63, 8.38], p = .002) was positively associated with PASS. Among females, revisions (OR 0.09 [0.00,0.63], p = 0.034) were negatively associated with achievement of PASS. 

Conclusion

Sex differences were observed in factors associated with achieving PASS after ACL reconstruction. Among males, BMI and skiing were found to be associated with PASS, while among females, revision surgery was a significant predictor. These results highlight the need for further investigation of sex specific factors in ACL reconstruction outcomes. 


Sex-specific factors associated with achieving Patient Acceptable Symptom State (PASS) at a mean ten year follow up after anterior cruciate ligament (ACL) reconstruction.

Premium content

Next from AMA Research Challenge 2024

Comparative Incidence of Endophthalmitis After Intravitreal Dexamethasone Versus Anti-VEGF Injections: A Retrospective Study

Similar lecture

Acute Corneal Hydrops as the Initial Presentation of Keratoconus in a Young Adult