Background: To evaluate the long-term effects of combined endoscopic cyclophotocoagulation and phacoemulsification (phaco) versus phacoemulsification alone on intraocular pressure control and medication reliance in the treatment of mild to moderate glaucoma.

To the EditorAn increasing number of analyses use administrative claims data to study the epidemiology, risk factors, and resource consumption associated with patients with ocular diseases. These sources of voluminous data allow researchers to study common and uncommon conditions and assess care delivered by different providers in various communities. Since claims data are collected primarily for billing, not research purposes, a concern is whether the diagnoses listed in the billing records reflect the actual conditions described in the medical record. 1 If claims data were found to inaccurately reflect patients' conditions, the usefulness of these data for research would be limited. The accuracy of claims data has been examined for selected eye diseases but not for many common ophthalmic conditions. [2][3][4] We examine the accuracy of claims data for five such conditions. MethodsWith Institutional Review Board approval, 982 consecutive billing records of patients coded with the following ocular conditions were identified from two academic medical centers: cataract (International Classification of Disease-9 [ICD-9-CM] codes 366-366.4), glaucoma suspect (365.0), primary open angle glaucoma (OAG) (365.11), proliferative diabetic retinopathy (PDR) (362.02), and nonexudative macular degeneration (NEAMD) (362.51). One abstractor (KWM) reviewed the documentation in the medical record for each billed encounter and scored the billing code as correct or incorrect. An encounter was classified as billed correctly if evidence in the medical record substantiated that the patient had the condition indicated on the billing form. If no such confirmatory evidence was found, the encounter was classified as billed incorrectly. ResultsOf the 982 encounters reviewed, 949 (97%) were coded correctly. The proportion of encounters with correct codes ranged from 92% (NEAMD) to 100% (cataract) (Table 1).

ObjectiveTo evaluate various methods of operative sperm retrieval in men with non-obstructive azoospermia (NOA) and to determine the optimal surgical approach in terms of effectiveness, morbidity, and complications.Materials and methodsPubMed and Cochrane databases were searched to identify five recent reviews and meta-analyses evaluating outcomes for sperm retrieval in men with NOA.Results and ConclusionMicro-TESE is the most efficient method for retrieving sperm but requires special expertise and can be traumatic for the testes. Conventional biopsies are twice more likely to retrieve sperm than fine-needle aspiration. Testicular aspiration performed by multiple passes into the testis is traumatic and is not efficient for sperm retrieval. Needle-aspiration biopsy and open real-time testicular mapping by the single seminiferous tubule technique can offer less traumatic methods for sperm retrieval, which can be tried before proceeding to micro-TESE. The first attempt at sperm retrieval is the best chance the patient has and should combine various techniques sequentially to give the highest chance of success with the least morbidity.

ObjectiveTo review articles highlighting the effectiveness of conservative laparoscopic ureterolysis as a primary treatment option in patients with ureteric endometriosis and to report on a further three cases.Patients and methodsPubMed, EMBASE, Cochrane database were searched to identify articles reporting cases of laparoscopic management of ureteric endometriosis and, in particular management by ureterolysis. We further described three new cases of ureteric endometriosis managed at our institute.ResultsThe present study illustrates the significance of laparoscopic ureterolysis in the management of patients with ureteric endometriosis. In our cases, a systematic surgical approach was followed in order to perform complete but careful excision of the all visible endometriotic implants. During follow-up successful treatment was established by relief of hydroureteronephrosis by ultrasonographic evaluation.ConclusionConsidering the risk of loss of renal function and due to the nonspecific symptoms, a prompt clinical suspicion and thorough preoperative assessment can potentially help in the diagnosis. We conclude that laparoscopic ureterolysis is a minimally invasive technique with low complication and recurrence rates. It is a suitable option as a primary approach for selected patients with ureteric endometriosis, if done in a systematic step-by-step approach.

PurposeMany studies have shown improved semen parameters after varicocele surgery; however, the benefit in terms of improved pregnancy rates and live births is still disputed in cases of severe oligoasthenozoospermia (OAS). The present study evaluated the outcome of microscopic subinguinal varicocelectomy in terms of the spontaneous pregnancy rate in patients with severe OAS.Materials and MethodsThis was a retrospective, observational, analytic study of 56 men with OAS who underwent microscopic varicocelectomy at our center between 2008 and 2015. The subjects were followed for a mean period of 12.4 months. Outcome was compared among groups of men with mild (sperm concentration, 10.2–19 million/mL), moderate (5.7–9.5 million/mL), and severe (<5 million/mL) OAS who were operated on during the same period.ResultsA total of 13 of 35 men (37.1%) with severe OAS achieved spontaneous pregnancy. Mean sperm density increased from 2.29 million/mL preoperatively to 14.09 million/mL postoperatively. The mean time to pregnancy from the date of surgery was 8.5 months. The spontaneous pregnancy rate in men with mild and moderate OAS was 62.5% and 46.2%, respectively.ConclusionsAlthough pregnancy rates after varicocele surgery are lower preoperatively in men with severe OAS than in men with mild or moderate OAS, the spontaneous pregnancy rate of 37.1% still compares very favorably with outcomes after a single attempt at in vitro fertilization.