Tarin T. Tanji

Purpose: To evaluate long-term outcomes of in-office laser barricade for large (≥2 clock hours) rhegmatogenous retinal detachments (RRDs) and to report the frequency of additional laser treatment or pars plana vitrectomy (PPV). Methods: A retrospective chart review was performed of patients treated between 2015 and 2023 at a retina-only private practice in Chicago, Illinois. Included cases were eyes with fundus diagram–confirmed RRDs involving ≥2 clock hours of circumference, and ≥3 months of follow-up. Procedure success was defined as RRD management without requiring PPV. Results: Seventy-six eyes of 72 patients (mean ± SD age, 52.1 ± 17.7 years) were analyzed, with a mean follow-up of 38.6 months. RRD size was a mean ± SD 2.9 ± 1.1 clock hours (range, 2–6). Mean best-corrected visual acuity (BCVA) was 20/31 at baseline and 20/30 at final follow-up. Procedure success rate was 92.1%, with 6 eyes (7.9%) requiring PPV. Thirteen eyes (17.1%) required additional laser barricade. Eyes with phakic lens status, worse baseline BCVA, vitreous hemorrhage, or baseline posterior vitreous detachment were more likely to require PPV, though these associations did not reach statistical significance ( P = .06–.08). Laser barricade was performed on same day of diagnosis in 47 eyes (61.8%) and delayed by ≥1 day in 29 eyes (38.2%). Same-day treatment trended toward a higher need for PPV ( P = .08 vs delayed treatment). Conclusions: In-office laser barricade is an effective treatment for RRDs spanning ≥2 clock hours, with a 92.1% long-term success rate. Patients not requiring same-day intervention may achieve excellent outcomes with laser barricade alone.

Background: Lenticulostriate Arteries (LSA) are small perforating vessels originating from the middle cerebral artery (MCA), playing a critical role in the pathophysiology of cerebral small vessel disease and cognitive function. ^1,2 We aimed to analyze age‐related morphological changes in LSAs utilizing 7T high‐resolution Time‐Of‐Flight (TOF) Magnetic Resonance Angiography. Methods: Twenty‐nine participants (8 young, 23.0 ± 1.5 yrs; 21 older, 72.0 ± 9.4 yrs) were enrolled and underwent cognitive and vascular assessment. High‐resolution 3D TOF was acquired on a 7T MRI Scanner (Siemens Healthineers) with FOV = 158 x 200 x 75 mm ³ , voxel size = 0.2 x 0.2 x 0.4 mm ³ , TR/TE = 12/4.67 ms, flip angle = 17°, and time = 8 min. LSAs were manually segmented using 3D Slicer and ITK‐SNAP. LSA stems (directly connected to the MCA) and branches (daughter vessels arising from stems) were analyzed. Longest LSA lengths were determined using the centerline. Two‐sample t‐tests were used for group comparison. A linear mixed‐effect model was used for associations between LSA geometry and clinical tests, adjusting for age, gender, and education. Results: Older participants had significantly fewer LSA stems and branches than younger participants ( p < 0.05), indicating an aging effect on LSA morphology (Figure 2). The longest LSA was shorter in older participants, though not significantly ( p = 0.11). In older participants (Table 1), the number of LSA branches was correlated with both systolic and diastolic BP ( p = 0.007 and 0.013), while the number of stems showed a negative trend with systolic BP ( p = 0.07) and diastolic BP ( p = 0.13). The longest LSA length was associated with cognitive function ( p = 0.04 for MMSE, p = 0.08 for MoCA), and with total cholesterol ( p < 0.001) and LDL cholesterol levels ( p = 0.005). Conclusion: These results aligned with another study showing age‐related deterioration in LSA geometry. ¹ This study further demonstrated that age‐related changes in LSA geometry are closely associated with cognitive decline and vascular risk factors, including hyperlipidemia and hypertension. References 1. Wei et al., 2022 2. Xu et al., 2021

This paper introduces a 48-page guide for conducting qualitative interviews with Native Hawaiian elders. The guide was developed based on work with and for Native Hawaiian elders through a partnership between ALU LIKE, Inc., a community-based service provider, and Hā Kūpuna National Resource Center for Native Hawaiian Elders at the University of Hawai‘i at Mānoa. Components of the guide include a brief history of research harms experienced by Native Hawaiians, a summary of advancements in Hawaiian-led research, tips for researcher self-reflection as required by community-based research, and recommendations for successfully engaging community, developing research questions, gathering and analyzing data, and reporting findings in ways meaningful to community members. Although experiences of colonization and discrimination are unique to each group, this protocol has application for qualitative research with other Indigenous and minority communities.

Background: Epiretinal proliferation (ERP) is an extension of preretinal tissue, creating a thin, semi-translucent layer of fibrous tissue on the retina. ERP has been recently associated with degenerative lamellar macular holes (DLMH) and full-thickness macular holes (FTMH). The proposed surgery for patients has been vitrectomy and ERM peeling, but there is no consensus on whether DLMH is a stable condition or should be resolved with surgical treatment. The purpose was to investigate optical coherence tomography (OCT) changes and visual outcomes of degenerative LMH and FTMH secondary to ERP after pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Methods: This retrospective case series evaluated 14 eyes with DLMH and eight eyes with FTMH. All 22 eyes were associated with ERP and treated with PPV with ILM peeling. Best-corrected visual acuity (BCVA, in logMAR), OCT findings, including presence of foveal bump and ellipsoid zone integrity, were documented. Wilcoxon signed-rank tests were used for numerical data. Statistical significance was based on a value of p < 0.05. Results: Among the 14 DLMH cases, the mean Snellen equivalent VA was 20/75 at baseline; 20/59 at the 4–12-month postoperative period; and 20/56 at the final follow-up visit. For the eight FTMH cases, the mean Snellen equivalent VA was 20/94 at baseline; 20/45 at the 4–12-month postoperative period; and 20/38 at the final follow-up visit. Compared to baseline VA, FTMH cases demonstrated a statistically significant improvement in the 4–12-month postoperative VA (p < 0.05) and in the final postoperative VA (p < 0.05). Among all cases, a strong correlation was observed between baseline logMAR and change in logMAR from baseline to final follow-up (R² = 0.671). Conclusion: This study demonstrated that surgical intervention led to improved visual and anatomic outcomes in patients with DLMH and FTMH, with a correlation between baseline VA and postoperative visual outcomes. The results suggest that patients with worse preoperative VA experienced the greatest benefit in visual outcome from PPV and ILM peeling. Future studies would look at the timing of when to ideally intervene to improve anatomic and visual outcomes.

Background: Formal assessment of What Matters in end-of-life care is often done in medical settings through legal forms. Past research indicates that Native Hawaiians are less likely to complete these forms than Whites. The purpose of this study was to explore health care preferences among Native Hawaiian elders and to identify cultural themes that may impact quality care at end of life. Objective: To explore What Matters to Native Hawaiian elders, as culture likely impacts health care and end-of-life preferences. Design: A secondary analysis of qualitative data collected through a multiyear interview project in Hawai'i. Setting/Participants: Twenty participants age 60+ living in rural Hawai'i. Measurement: Deductive coding was informed by guidelines on What Matters according to the Institute of Healthcare Improvement's 4Ms Framework. Inductive coding identified themes specific to Native Hawaiian elders as part of their culture. Results: Themes suggest the criticality of: (1) incorporating cultural traditions into health care routines; (2) involving family in health and end-of-life decisions; (3) supporting home-based care at the end of life; and (4) building strong patient-provider relationships. Conclusion: Although findings parallel preferences expressed in other populations, the data provide additional insights into the preferences of Native Hawaiian elders anticipating end-of-life care. Recommendations for culturally competent care include: (1) develop relationships with Native Hawaiian patients well before end-of-life care is needed to facilitate discussions of care preferences; (2) work collaboratively with the patient and the patient's defined family; (3) ask about cultural practices and engage traditional healers as directed by the patient; and (4) provide services in patients' homes and communities.

The Prevent Suicide Hawaiʻi Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawaiʻi. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform the upcoming 2025 Hawaiʻi Suicide Prevention Strategic Plan in the following areas: Hope, Help, Heal, Research and Evaluation, and Policy and Advocacy. Utilizing a sequential exploratory mixed-methods approach, 18 key informants were interviewed, followed by a 13-question survey sent to the Taskforce member listserv. Results were analyzed using qualitative coding techniques and descriptive statistics. Interview findings contained six themes: importance of community relationships, interconnection of suicide prevention efforts, progress in diversifying training, organizational challenges, adaptations to the COVID-19 pandemic, and funding challenges. Of the 34 survey respondents, most were involved in the area of Hope (91%). The respondents reported the area with most progress was Hope (87%), and the most important area to address was Help (41%). The majority (82%) of the respondents characterized the level of Taskforce communication as Excellent or Good. Interview and survey data corroborated each other and revealed new insights about the successes and barriers of the Taskforce and their progress in implementing the Strategic Plan. Recommendations included advocating for long-term funding for suicide prevention and building community relationships.

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.

Glaucoma is the leading cause of irreversible blindness worldwide, with elevated intraocular pressure (IOP) as the only known modifiable risk factor. Trabecular meshwork (TM)-inducible myocilin (the MYOC gene) was the first to be identified and linked to juvenile and primary open-angle glaucoma. It has been suggested that mutations in the MYOC gene and the aggregation of mutant myocilin in the endoplasmic reticulum (ER) of TM may cause ER stress, resulting in a reduced outflow of aqueous humor and an increase in IOP. We selected 20 MYOC mutations with experimentally determined melting temperatures of mutated myocilin proteins. We included 40 published studies with at least one glaucoma patient with one of these 20 MYOC mutations and information on age at glaucoma diagnosis. Based on data from 458 patients, we found that a statistically significant but weak correlation was present between age and melting temperature based on various assumptions for age. We therefore conclude that genetic analysis of MYOC mutations alone cannot be used to accurately predict age at glaucoma diagnosis. However, it might be an important prognostic factor combined with other clinical factors for critical and early detection of glaucoma.

Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.