a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists. Methods: A retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/ posterior segment findings. Ocular injuries were categorized as either minor or major. Results: Of 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture. Conclusion: Knowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.

To compare the predictive refractive accuracy of intraoperative aberrometry (ORA) to the preoperative Barrett True-K formula in the calculation of intraocular lens (IOL) power in eyes with prior refractive surgery undergoing cataract surgery at the Loma Linda University Eye Institute, Loma Linda, California, USA. We conducted a retrospective chart review of patients with a history of post-myopic or hyperopic LASIK/PRK who underwent uncomplicated cataract surgery between October 2016 and March 2020. Pre-operative measurements were performed utilizing the Barrett True-K formula. Intraoperative aberrometry (ORA) was used for aphakic refraction and IOL power calculation during surgery. Predictive refractive accuracy of the two methods was compared based on the difference between achieved and intended target spherical equivalent. A total of 97 eyes (69 patients) were included in the study. Of these, 81 eyes (83.5%) had previous myopic LASIK/PRK and 16 eyes (16.5%) had previous hyperopic LASIK/PRK. Median (MedAE)/mean (MAE) absolute prediction errors for preoperative as compared to intraoperative methods were 0.49 D/0.58 D compared to 0.42 D/0.51 D, respectively (P = 0.001/0.002). Over all, ORA led to a statistically significant lower median and mean absolute error compared to the Barrett True-K formula in post-refractive eyes. Percentage of eyes within ± 1.00 D of intended target refraction as predicted by the preoperative versus the intraoperative method was 82.3% and 89.6%, respectively (P = 0.04). Although ORA led to a statistically significant lower median absolute error compared to the Barrett True-K formula, the two methods are clinically comparable in predictive refractive accuracy in patients with prior refractive surgery.

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predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with increased rates of new persistent opioid use at each follow up interval compared to the control sample (p <0.0001). Prevalence of persistent opioid use across the discrete time intervals ranged from 4.72-5.27%, 5.52-6.54%, 8.20-8.80% and 3.46-3.80% for abdominal, endoscopic, percutaneous, and scrotal/penile/perineal/vaginal procedures, respectively. In the non-operative cohort, rates of new opioid use ranged from 3.26-3.59%. There were no clear trends over time in any group. Preoperative risk factors independently associated with persistent opioid use included tobacco use (OR 1.33; 95% CI 1.24-1.44), substance use disorders (OR 1.36; 95% CI 1.08-1.69), any mental health, substance, or pain-related diagnoses (!3 diagnoses: OR 1.89; 95% CI 1.77-2.01), Charlson comorbidity index (!2: OR 1.29; 95% CI 1.21-1.37), and total initial opioid prescription !300 morphine milligram equivalents (OR 1.35; 95% CI 1.26-1.45).CONCLUSIONS: A meaningful fraction of previously opioidnaive patients receiving outpatient opioid analgesia following urologic procedures will go on to develop persistent opioid use. The data reinforce a national need amongst urologists to reduce post-operative opioid usage and validate recent efforts to adopt multimodal narcoticfree pathways.