Ophthalmology 2019 Projects

Project Title: Anesthetic Technique and Perioperative Outcomes in Diabetic Vitrectomy

Faculty Mentor’s Name: Dr. Siva Iyer
Email: ssr@ufl.edu

Student’s Name: Tarone Thirawatananond
Email: tarone@ufl.edu

Project Description:

There is a strong need for studies looking specifically at diabetic vitrectomy patients to learn more about outcomes associated with general anesthetic techniques compared to regional anesthesia. Our hypothesis is that regional ophthalmic anesthesia plus monitored anesthetic care will be associated with fewer perioperative complications. General anesthesia is administered systemically and associated with increased likelihood of hemodynamic instability. With the results of this study we hope to help guide anesthetic choices in diabetic patients undergoing PPV by elucidating characteristics of patients who are chosen for different anesthetic techniques, and helping to describe the complications experienced by each group.

Project Title: Visual Field Loss Following Intravenous Fluorescein Angiography Guided Pan-retinal Photocoagulation in the Treatment of Proliferative Retinopathy

Faculty Mentor’s Name: Dr. Siva Iyer
Email: ssr@ufl.edu

Student’s Name: Samuel Korntner
Email: korntner@ufl.edu

Project Description:

Diabetic retinopathy is the most common cause of blindness in middle-aged subjects in the USA each year.1 It is a common complication of type 1 and type 2 diabetes mellitus thought to be caused by chronic hyperglycemia.2 Specifically, chronic hyperglycemia is associated with increased retinal blood flow and glycosylation, which cause stress on the retinal blood vessels. Untreated, this can develop into macular edema and retinal damage, which can cause blindness.3 Other forms of proliferative retinopathies (for example secondary to retinal vein occlusions, sickle cell retinopathy) also can cause blindness from ischemia-driven aberrant angiogenic damage.

Proliferative retinopathy, a model of microvascular damage, can benefit from anti-vascular endothelial growth factor or pan-retinal photocoagulation as reasonable treatment options. Pan-retinal photocoagulation (PRP) utilizes a laser that radiates at a wavelength specifically absorbed by the retinal pigment causing microscopic burns to ablate ischemic retina and prevent blinding consequences of the disease.4

PRP is the gold standard of care treatment for severe proliferative retinopathies. This is typically performed based upon the clinical exam alone and often in a full field form (hence the name pan-retinal). While pan-retinal photocoagulation has been shown to reduce the risk of blindness in proliferative retinopathy, the procedure can have significant long-term side effects, including loss of accommodation, night-time vision impairment, and visual field decline.5 The severity of these effects vary depending upon the technique used, the type of laser employed, as well as extent of laser used during treatment.6,7 The effects specifically on the visual field can heavily influence everyday activities such as driving and occupational requirements. The balance between sufficient treatment of disease with pan-retinal photocoagulation and consideration of permanent visual field impairment is an important consideration that has not been sufficiently explored. The purpose of this project is to determine the effects of a guided laser technique on disease activity and the visual field.

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