RESUMEN
BACKGROUND AND OBJECTIVE: Drainage retinotomies are a technique used for treating rhegmatogenous retinal detachments (RRDs). These retinotomies are commonly surrounded by barricade laser. This paper aims to evaluate operative success of non-lasered drainage retinotomies during 25-gauge pars plana vitrectomy (PPV) for repair of primary RRD. PATIENTS AND METHODS: Retrospective review of a consecutive interventional case series. Study includes 45 eyes of 45 patients who underwent 25-gauge PPV with a non-lasered drainage retinotomy for primary RRD. Eyes with previous retinal detachments or less than 3 months of follow-up were excluded. RESULTS: All PPV with non-lasered drainage retinotomies were carried out by one surgeon (RFI); 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and air or sulfur hexafluoride gas tamponade were utilized for each eye. Single surgery anatomical success was achieved in 42 out of 45 eyes (93%). CONCLUSION: Retinal detachment repair utilizing non-lasered drainage retinotomies had a high anatomic success rate comparable to that of standard retinal detachment repair.1,2 [Ophthalmic Surg Lasers Imaging Retina. 2018;49:955-960.].
Asunto(s)
Drenaje/métodos , Microcirugia/métodos , Retina/cirugía , Desprendimiento de Retina/cirugía , Agudeza Visual , Vitrectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Retina/diagnóstico por imagen , Desprendimiento de Retina/diagnóstico , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe utilization trends of an ophthalmology-specific emergency department (ED). METHODS: Prospective cohort study of new patients presenting in the ophthalmology ED for at least a 30-day period in the spring of each year for five consecutive years (2010-14) at a university referral center. A data form, including information about the ED visit and patient demographics, was included in each patient chart. Data were analyzed with Pearson chi-square test and multiple logistic regression. RESULTS: A total of 5323 chart data forms were completed. An average of 42.2 new patients per day presented to the ophthalmology ED. Most common diagnoses were viral conjunctivitis (8.7%), dry eye syndrome (6.6%), and corneal abrasion (6.6%). Non-emergent visits accounted for 35.8% of surveys completed. Factors associated with non-emergent visits included female gender, age 65 years or older, weekday visits, and patient symptom duration greater than one week (p < 0.0001 for each factor). When compared to all other insurance categories combined, patients who were members of the regional public assistance program were the most likely to present with a non-emergency (48.5% versus 34.9%, p < 0.001), while Workers' Compensation patients were least likely to present with a non-emergency (16% versus 36.5%, p < 0.001). CONCLUSIONS: Over one-third of new patient visits were non-emergent. Factors predictive of non-emergent patient visits were female gender, age 65 years or older, duration of symptoms greater than one week, weekday visits, and the form of insurance coverage.
Asunto(s)
Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Oftalmopatías/terapia , Encuestas de Atención de la Salud , Visita a Consultorio Médico/estadística & datos numéricos , Oftalmología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Derivación y Consulta/estadística & datos numéricos , Factores Socioeconómicos , Adulto JovenRESUMEN
Acute macular neuroretinopathy (AMNR) is a rare condition that primarily affects young women in their reproductive years. Many of the affected young women are on oral contraceptives. Patients report a sudden decrease in visual acuity, usually a few days after the onset of a febrile illness, with paracentral scotomas either unilaterally or bilaterally. Although AMNR was initially thought to be an inner retinal pathology, with the publication of 84 case reports in the English medical literature and the advent of new imaging modalities, it is now thought to be a disease of the outer retina. In 2003, Turbeville et al published a review of more than 41 AMNR cases reported from 1975 to March 2002, which summarized the available literature and suggested potential fields of research to be explored. This article summarizes the 43 case reports that were published in the English literature from April 2002 to October 2012 and also presents a unique case of AMNR.
Asunto(s)
Enfermedades de la Retina/complicaciones , Enfermedad Aguda , Colorantes , Angiografía con Fluoresceína , Humanos , Verde de Indocianina , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Escotoma/diagnóstico , Escotoma/etiología , Escotoma/fisiopatología , Tomografía de Coherencia Óptica , Agudeza Visual/fisiología , Pruebas del Campo VisualAsunto(s)
Candida glabrata/aislamiento & purificación , Candidiasis/transmisión , Queratoplastia Endotelial de la Lámina Limitante Posterior , Transmisión de Enfermedad Infecciosa , Endoftalmitis/microbiología , Infecciones Fúngicas del Ojo/transmisión , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Donantes de Sangre , Candidiasis/microbiología , Quimioterapia Combinada , Endotelio Corneal/microbiología , Infecciones Fúngicas del Ojo/microbiología , Glucocorticoides/uso terapéutico , Humanos , Masculino , Donantes de Tejidos , Cuerpo Vítreo/microbiologíaRESUMEN
PURPOSE: To report the outcomes of current vitreoretinal surgical management of proliferative sickle retinopathy and to compare current methods to previous studies. DESIGN: A retrospective, interventional case series. METHODS: Fifteen eyes of 14 patients with proliferative sickle retinopathy were managed with vitreoretinal surgery over a 12-year period at a single institution. RESULTS: Nine patients had a sickle cell-hemoglobin C (SC) profile, 1 was sickle cell-beta(+) thalassemia (S beta(+)-thal), and 4 were sickle cell trait (AS). All 15 eyes underwent pars plana vitrectomy (PPV): 6 for vitreous hemorrhage (VH), 1 for epiretinal membrane (ERM), and an additional 8 for tractional retinal detachment (RD) and/or rhegmatogenous RD. In addition, an encircling scleral buckle (SB) was used in 2 cases. In 7 cases, 20 gauge PPV was used; 23 gauge was used in 3; and 25 gauge was used in 5. All 7 eyes with VH or ERM had improved vision postoperatively. Four of the 8 patients with traction and/or rhegmatogenous RD developed recurrent detachments and required a second operation. All retinas were attached at last follow-up, and visual acuity was 20/400 or better in all eyes. No cases of anterior segment ischemia were encountered. CONCLUSIONS: Anterior segment ischemia is no longer a common occurrence in eyes undergoing surgery for proliferative sickle retinopathy. Although PPV has replaced the use of SB in many situations, an encircling SB may still be used in this population when necessary. Surgery for VH and ERM generally results in favorable outcomes, but eyes undergoing surgery for traction/rhegmatogenous RD carry a more guarded prognosis.
Asunto(s)
Enfermedad de la Hemoglobina SC/cirugía , Enfermedades de la Retina/cirugía , Rasgo Drepanocítico/cirugía , Cirugía Vitreorretiniana , Adulto , Anciano , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/cirugía , Femenino , Angiografía con Fluoresceína , Enfermedad de la Hemoglobina SC/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/cirugía , Enfermedades de la Retina/diagnóstico , Estudios Retrospectivos , Rasgo Drepanocítico/diagnóstico , Resultado del Tratamiento , Vitrectomía , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/cirugía , Adulto JovenAsunto(s)
Complicaciones Posoperatorias , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Vitrectomía/efectos adversos , Adulto , Endotaponamiento , Femenino , Humanos , Terapia por Láser , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/diagnóstico , Perforaciones de la Retina/cirugíaRESUMEN
PURPOSE: To report the 1-year clinical outcomes of an outbreak of Streptococcus endophthalmitis after intravitreal injection of bevacizumab, including visual acuity outcomes, microbiological testing, and compound pharmacy investigations by the Food and Drug Administration (FDA). DESIGN: Retrospective consecutive case series. PARTICIPANTS: Twelve eyes of 12 patients who developed endophthalmitis after receiving intravitreal bevacizumab prepared by a single compounding pharmacy. METHODS: Medical records of patients were reviewed; phenotypic and DNA analyses were performed on microbes cultured from patients and from unused syringes. An inspection report by the FDA based on site visits to the pharmacy that prepared the bevacizumab syringes was summarized. MAIN OUTCOME MEASURES: Visual acuity, interventions received, time to intervention, microbiological consistency, and FDA inspection findings. RESULTS: Between July 5 and 8, 2011, 12 patients developed endophthalmitis after intravitreal bevacizumab from syringes prepared by a single compounding pharmacy. All patients received initial vitreous tap and injection, and 8 patients (67%) subsequently underwent pars plana vitrectomy (PPV). After 12 months follow-up, outcomes have been poor. Seven patients (58%) required evisceration or enucleation, and only 1 patient regained pre-injection visual acuity. Molecular testing using real-time polymerase chain reaction, partial sequencing of the groEL gene, and multilocus sequencing of 7 housekeeping genes confirmed the presence of a common strain of Streptococcus mitis/oralis in vitreous specimens and 7 unused syringes prepared by the compounding pharmacy at the same time. An FDA investigation of the compounding pharmacy noted deviations from standard sterile technique, inconsistent documentation, and inadequate testing of equipment required for safe preparation of medications. CONCLUSIONS: In this outbreak of endophthalmitis, outcomes have been generally poor, and PPV did not improve visual results at 1-year follow-up. Molecular testing confirmed a common strain of S. mitis/oralis. Contamination seems to have occurred at the compounding pharmacy, where numerous problems in sterile technique were noted by public health investigators.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Brotes de Enfermedades , Contaminación de Medicamentos , Endoftalmitis/epidemiología , Infecciones del Ojo/epidemiología , Infecciones Estreptocócicas/epidemiología , Bevacizumab , Chaperonina 60/genética , ADN Bacteriano/análisis , Composición de Medicamentos , Endoftalmitis/microbiología , Endoftalmitis/cirugía , Infecciones del Ojo/microbiología , Infecciones del Ojo/cirugía , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/cirugía , Streptococcus mitis/genética , Streptococcus mitis/aislamiento & purificación , Streptococcus oralis/genética , Streptococcus oralis/aislamiento & purificación , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Cuerpo Vítreo/microbiologíaRESUMEN
UNLABELLED: A systematic review of 27 reports of endophthalmitis outbreaks following cataract surgery between 1985 and 2011 found the 2 most common causes associated with the outbreaks were contaminated solutions, 10 reports (37%), and contaminated phacoemulsification machines, 6 reports (22.2%). Other possible sources of contamination included ventilation systems, 3 (11.1%); defective sterilization, 3 (11.1%); miscellaneous, 3 (11.1%); in 5 outbreaks (18.5%), no possible source could be identified. Bacteria occurred in 23 outbreaks (85.2%) and fungus in 4 (14.8%). Causative organisms were gram-negative bacteria, 15 (65.2%); gram-positive bacteria, 5 (21.7%); and both gram-positive and gram-negative bacteria, 3 (13.1%). Pseudomonas aeruginosa was causative in 14 of 27 (51.8%) gram-negative bacteria. After treatment in 229 patients, a visual acuity outcome of 20/400 or better was achieved in 127 patients (55.5%). Outbreaks of endophthalmitis following cataract surgery are often caused by gram-negative organisms and can be associated with poor visual outcomes. In this review, the most common source was irrigation solutions used perioperatively. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Asunto(s)
Brotes de Enfermedades , Endoftalmitis/epidemiología , Infecciones Bacterianas del Ojo/epidemiología , Facoemulsificación/estadística & datos numéricos , Agudeza Visual/fisiología , Contaminación de Medicamentos , Endoftalmitis/microbiología , Endoftalmitis/fisiopatología , Contaminación de Equipos , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/fisiopatología , HumanosRESUMEN
PURPOSE: To report a series of patients with Streptococcus endophthalmitis after injection with intravitreal bevacizumab prepared by the same compounding pharmacy. DESIGN: Noncomparative consecutive case series. METHODS: Medical records and microbiology results of patients who presented with endophthalmitis after injection with intravitreal bevacizumab between July 5 and July 8, 2011, were reviewed. RESULTS: Twelve patients were identified with endophthalmitis, presenting 1 to 6 days after receiving an intravitreal injection of bevacizumab. The injections occurred at 4 different locations in south Florida. All patients received bevacizumab prepared by the same compounding pharmacy. None of the infections originated at the Bascom Palmer Eye Institute, Miami, Florida, although 9 patients presented to its tertiary-care ophthalmic emergency room for treatment, and 3 additional patients were seen in consultation. All patients were treated initially with a vitreous tap and injection; 8 patients subsequently received a vitrectomy. Microbiology cultures for 10 patients were positive for Streptococcus mitis/oralis. Seven unused syringes of bevacizumab prepared by the compounding pharmacy at the same time as those prepared for the affected patients also were positive for S. mitis/oralis. After 4 months of follow-up, all but 1 patient had count fingers or worse visual acuity, and 3 required evisceration or enucleation. Local, state, and federal health department officials have been investigating the source of the contamination. CONCLUSIONS: In this outbreak of endophthalmitis after intravitreal bevacizumab injection, Streptococcus mitis/oralis was cultured from the majority of patients and from all unused syringes. Visual outcomes were generally poor. The most likely cause of this outbreak was contamination during syringe preparation by the compounding pharmacy.