Louisiana Via Research Day Book 2026

Clinical Research

Clinical Research

Russel T. Wagner, OMS-I 1,2 ; Hannah L. Walsh, BS 1 ; Treyton O’Connor, OMS-I 2 ; Amin B. Kassam, MD 1 ; Melanie B. Fukui, MD 1 ; Neil S. Mundi, MD 1 ; Cenorina Martinez, BS 1 ; Emily Sitkowski, BS 1 ; Sammy Khalili, MD 1 1 Intent Medical Group, Northwest Community Hospital, Arlington Heights, Illinois; 2 VCOM-Louisiana 103 RETAINED FRONTAL ETHMOID CELLS CAUSING DELAYED INFECTIOUS COMPLICATIONS FOLLOWING COMPLEX FRONTAL SINUS SURGERY: A CASE SERIES HIGHLIGHTING MULTIDISCIPLINARY MANAGEMENT AND ANATOMIC PITFALLS

104 A PILOT EVALUATION OF P SCORE IMPLEMENTATION IN RETINOPATHY OF PREMATURITY CARE

Julia Moore, BA 1 ; Emily Auer, MS 1 ; Anne Lynch, MD 1 ; Scott Oliver, MD 1 ; Marc Mathias, MD 1 ; Paul Chan, MD 2 ; Peter Campbell, MD 3 ; Praveer Singh, PhD 1 ; Jay Cramer 1 ; Becca Edwards, MD 1 ; Jen Jung, MD 1 ; Emily McCourt, MD 1 ; Emily Cole, MD 1 1 Dept. of Ophthalmology, Sue Anschutz Rodgers Eye Center, University of Colorado; 2 Dept. of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois; 3 Dept. of Ophthalmology, Oregon Health & Sciences University

Context: Delayed infectious complications following open frontal sinus surgery can be difficult to manage, particularly in patients with complex surgical histories. Retained ethmoid air cells, especially within the lateral frontal sinus region, may serve as persistent sources of infection even after cranialization, obliteration, or cranioplasty. Objective: To describe delayed infectious complications arising from retained ethmoid air cells following complex open frontal sinus surgeries and emphasize the importance of comprehensive anatomic management and multidisciplinary collaboration in preventing these outcomes. Methods: We present a case series of four patients with extensive surgical histories, including open frontal sinus cranialization, obliteration, and multiple cranioplasties, who developed delayed postoperative infections. Imaging and operative findings revealed residual ethmoid air cells as persistent infectious sources. Surgical management included removal of infected hardware, debridement of osteomyelitic bone, eradication of retained air

cells, and reconstruction using vascularized flaps and titanium mesh.

preventing these complications. Thorough imaging review, meticulous dissection, and multidisciplinary management are essential to addressing these anatomic contributors to prevent such complications.

Purpose: The International Classification of Retinopathy of Prematurity (ROP) Committee introduced a 9-photo reference image to describe the P score, a grading system for plus-like changes.[1] This study examines P score trends in infants using an institutional ROP Registry and considers its application in patient care. Methods: ROP care at the University of Colorado follows a model in which pediatric ophthalmologists perform initial screening, refer high-risk cases to retina specialists, and reassume care after regression to monitor vascularization. Key processes in our implementation efforts included planning and education.[2] Education on the P score was provided by departmental leadership, and the 9-photo reference image was displayed on the NICU retinal imaging device and in clinic. Results: Infants delivered from 2024 to present with ≥3 P scores were included (n=78; 156 eyes). 17 infants had treatment-requiring ROP (TR ROP) 9 received a single anti-VEGF injection, 3 required repeat injection(s), 15 underwent peripheral avascular retina (PAR) laser (±

prior injection), and 5 required acute laser or surgery. Maximum P scores in eyes treated with aflibercept ± PAR laser (n=33) ranged from 3-9 (median 7), compared with 1-6 (median 3) in non-TR ROP eyes (n =123). Mean (SD) P scores were 5.4 (1.9) at injection and 5.0 (1.4) at handoff between pediatric ophthalmology and retina. In treated infants, P scores increased with disease severity and decreased after treatment. Conclusion: The P score helped inform escalation from screening to treatment teams and supported decisions to intervene with injections or laser, enhancing consistency in ROP care across providers.

Results: All four patients experienced delayed postoperative infections several months to years following their initial open frontal sinus surgeries performed at outside institutions. In each case, retained ethmoid air cells in the lateral frontal sinus region acted as reservoirs for chronic infection despite prior interventions. Effective management necessitated multiple complex revision surgeries facilitated by a multidisciplinary team including neurosurgery, skull base surgery, head and neck reconstructive surgery, neuroradiology, and oculoplastics. All patients achieved resolution of acute infection following definitive surgery and prolonged antibiotics. Conclusion: Retained ethmoid air cells are an underrecognized source of persistent infection following complex frontal sinus and skull base surgeries. These cells can remain viable despite extensive sinus exenteration and contribute to osteomyelitis, hardware infection, and wound breakdown. A comprehensive understanding of sinus drainage pathways is essential to

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2026 Research Recognition Day