2024 Glaucoma Pipeline

Cataract and Refractive Surgery Today

Consultation-to-Surgery Same-Day Bilateral RLE in an OBS Suite

A streamlined workflow can make refractive lens exchange feel more like refractive surgery than a traditional cataract pathway.

Dagny C. Zhu, MD

Cataract and Refractive Surgery Today

In my practice, refractive lens exchange (RLE) is performed in our office-based surgery (OBS) suite on an elective, cash-pay basis, and immediately sequential bilateral procedures are offered routinely. Many motivated patients who present for a consultation proceed to surgery on the same day if their diagnostic workup and IOL inventory permit. In my experience, the OBS environment complements the RLE value proposition by providing patients with a familiar, low-anxiety setting and a streamlined scheduling pathway—from consultation through bilateral surgery—in a single visit. Ultimately, positioning RLE competitively as a premium refractive procedure entails delivering a patient experience that rivals LASIK instead of one that mirrors traditional, insurance-based cataract surgery. This article shares how we achieve the former in our OBS suite. SAME-DAY CONSULTATION-TO-SURGERY WORKFLOW Initial Triage and Scheduling The pathway begins at the point of initial contact. When a prospective patient calls to inquire about RLE, our staff assesses their interest in same-day surgery and coordinates scheduling accordingly. This is particularly valuable for out-of-state patients who prefer to consolidate the consultation and procedure into a single visit. They are advised that same-day surgery is contingent on favorable diagnostic findings and IOL availability. Our team prepares the day’s schedule to accommodate a potential 3- to 4-hour consultation-to-discharge window.

Vigabatrin-Related Retinal Toxicity

Patients taking this medication for epilepsy should be monitored carefully for visual disturbances.

Natalia Londoño De Vivero, MD; Rafael Méndez Marulanda, MD; Daniela Rojas Pérez, MD; Clemencia De Vivero Arciniegas, MD; and Álvaro Mejía Vergara, MD

Retina Today

KEY TAKEAWAYS Vigabatrin, a drug used as an adjuvant therapy for refractory focal onset epilepsy and for the treatment of infantile spasms, can lead to retinal toxicity in some cases. Onset of retinal toxicity has been reported between 6 months to 5 years after initiating treatment, with a 5.3% risk of developing toxicity at 6 months in pediatric patients. Multifocal electroretinogram can be helpful in confirming a diagnosis of vigabatrin-related retinal toxicity. Vigabatrin, an adjuvant therapy for refractory focal onset epilepsy and the treatment of infantile spasms, is a structural analog of gamma-aminobutyric acid (GABA) that irreversibly inhibits GABA transaminase.1,2 It has a high response rate and overall good tolerability.2 In 1997, researchers reported a series of cases of bilateral concentric visual field constriction related to vigabatrin,3 with a frequency of 52% in adults and 34% in children.1 Although approximately 90% of cases are asymptomatic, severity can range from mild to severe, including potential compromise of central vision and reduced quality of life.2 Herein, we report a case of severe, fast-onset vigabatrin retinal toxicity in a pediatric patient.4 CASE REPORT A 13-year-old Hispanic girl with a long-standing history of refractory epilepsy since her second year of life presented with difficulties going down a staircase due to bilateral inferior scotomas. The patient had been prescribed vigabatrin 3 months earlier, and symptoms began within 3 weeks of use. She had no prior visual complaints and a past medical history of prior ictal frequency of two seizures per week and approximately one status epilepticus per month. She was being treated with levetiracetam, lamotrigine, and lacosamide, but her seizures persisted, so she was started on vigabatrin initially at a dose of 500 mg twice daily and later 1,000 mg twice daily. The patient also reported obstructive sleep apnea with use of a continuous positive airway pressure machine at night. The ophthalmic examination showed a VA of 20/20 OU, normal Ishihara plates in each eye, and 0.6 log units of an afferent pupillary defect in her left eye. Motility and anterior segment examinations where normal in each eye.