Short communications: an ear-attached accelerometer detects effects of regrouping on lying, rumination, and activity times in calves.

The objective of this study was to use a sensor-based accelerometer (ACC) to identify changes in lying, rumination, and activity times in weaned calves during the moving and regrouping process. Overall, 270 healthy Holstein calves (from approximately 16 regrouping events) at the age of approximately 4 months were enrolled and equipped with an ear-attached ACC (SMARTBOW, Smartbow GmbH/ Zoetis LLC). Sensor data were recorded for 5 d before (d -5) until 4 d after moving and regrouping (d 4). The day of regrouping was defined as d 0. Acceleration data were continuously processed by specific algorithms (developed by SMARTBOW) for lying, rumination, and activity. Lying, rumination, and activity times were averaged from d -5 to d -3 to generate a baseline value for each parameter. Parameters on d 0 to d 4 after regrouping were compared to this baseline. All parameters showed significant changes compared with the baseline at d 0. Significant decreases in rumination and inactive times were seen up to d 2. Lying time was significantly lower until d 3. The study results indicate that the ACC can be used to monitor the disruptive effects of regrouping on lying and rumination behaviors. Further research is necessary to elucidate how these changes have an impact on health, performance, and welfare and to evaluate how to reduce these potentially negative effects.

Temperature-dependent structure of liquid water investigated by means of energy-dispersive x-ray diffraction and molecular dynamics simulations.

X-ray diffraction is investigated in the supercooled region (263-273 K) and, for comparison, at ambient conditions. By means of an energy-dispersive set-up coherent x-ray scattering cross sections within a wide range of momentum transfer values are monitored simultaneously using in-house laboratory equipment. The data are corrected for the energy-dependent detector response, geometric broadening effects, sample absorption and Compton scattering. The corrected diffraction curves are in good agreement with results from the Advanced Light Source (ALS). Additional comparisons with available literature data and with computer simulation results of different rigid water models are presented, relating the scattering intensities to the microscopic H-bond structure and dynamics.

Medical injuries among hospitalized children.

BACKGROUND: Inpatient medical injuries among children are common and result in a longer stay in hospital and increased hospital charges. However, previous studies have used screening criteria that focus on inpatient occurrences only rather than on injuries that also occur in ambulatory or community settings leading to hospital admission. OBJECTIVE: To describe the incidence and outcomes of medical injuries among children hospitalized in Wisconsin using the Wisconsin Medical Injury Prevention Program (WMIPP) screening criteria. METHODS: Cross sectional analysis of discharge records of 318,785 children from 134 hospitals in Wisconsin between 2000 and 2002. RESULTS: The WMIPP criteria identified 3.4% of discharges as having one or more medical injuries: 1.5% due to medications, 1.3% to procedures, and 0.9% to devices, implants and grafts. After adjusting for the All Patient Refined-Diagnosis Related Groups disease category, illness severity, mortality risk, and clustering within hospitals, the mean length of stay (LOS) was a half day (12%) longer for patients with medical injuries than for those without injuries. The similarly adjusted mean total hospital charges were 1614 dollars (26%) higher for the group with medical injuries. Excess LOS and charges were greatest for injuries due to genitourinary devices/implants, vascular devices, and infections/inflammation after procedures. CONCLUSIONS: This study reinforces previous national findings up to 2000 using Wisconsin data to the end of 2002. The results suggest that hospitals and pediatricians should focus clinical improvement on medications, procedures, and devices frequently associated with medical injuries and use medical injury surveillance to track medical injury rates in children.

Programmable implants--from pulsatile to controlled release.

The aim of this study was to develop programmable implants with a reproducible delayed onset of release followed by several weeks of controlled release. For this purpose, a drug-loaded core was embedded into a drug-free bulk-eroding poly(D,L lactic-co-glycolic acid) or poly(D,L lactic acid) mantle. The manufacturing procedure was established and optimized for three mantle materials, which showed delay times ranging from 7 to 83 days. Triglycerides with fatty acid chain lengths from C12 to C18 were investigated as core materials, producing release periods from 2 to 16 weeks. Concomitantly, applying a convolution/deconvolution model showed the possibility of theoretical prediction of the resulting release profiles.

Biocompatibility and erosion behavior of implants made of triglycerides and blends with cholesterol and phospholipids.

Triglycerides are a promising class of material for the parenteral delivery of drugs and have become the focus of tremendous research efforts in recent years. The aim of this study was to investigate the biocompatibility of glyceroltripalmitate as well as the influence of cholesterol and distearoyl-phosphatidyl-choline (DSPC) on the erosion behavior of the lipid. For these investigations, two in vivo studies were carried out, in which cylindrical matrices of 2 mm diameter were manufactured and subcutaneously implanted in immunocompetent NMRI-mice. After excision of the implants, tissue reactions of the animals as well as changes in the weight, shape and microstructure of the implants were investigated. The triglyceride and cholesterol showed good biocompatibility, as indicated by their minimal encapsulation in connective tissue and the absence of inflammatory reactions. Increasing the levels of phospholipid in the implants, however, led to an increased inflammatory reaction. In contrast to cholesterol, which did not affect erosion, the incorporation of DSPC into the triglyceride matrices led to clearly visible signs of degradation.

Drug release from lipid-based implants: elucidation of the underlying mass transport mechanisms.

The aim of this study was to better understand the mass transport mechanisms involved in the control of drug release from lipid-based implants. Different types of triglyceride-based cylinders were prepared by compression. Glycerol-trilaurate, -trimyristate, -tripalmitate and -tristearate were used as model lipids, lysozyme and pyranine as model drugs. The effects of several formulation and processing parameters on the resulting drug release kinetics in phosphate buffer pH 7.4 were studied and the obtained results analyzed using Fick's second law of diffusion. Interestingly, lysozyme release from implants prepared by compression of a lyophilized emulsion (containing dissolved drug and lipid) was found to be purely diffusion-controlled, irrespective of the type of triglyceride. In contrast, the dominating release mechanism depended on the type of lipid in the case of pyranine-loaded implants prepared by compression of a lyophilized lipid-drug solution: with glycerol-trilaurate and -tristearate the systems were found to be purely diffusion-controlled, whereas also other mass transport phenomena are of importance in glycerol-trimyristate and -tripalmitate-based devices. Similarly, changes in the size of the compressed lipid-drug particles, drug loading and compression force significantly affected the underlying release mechanisms. The addition of a drug-free, poly(lactic-co-glycolic acid) (PLGA)-based coating around the implants delayed the onset of pyranine release for about 20 days. Interestingly, the subsequent drug release was purely diffusion-controlled, irrespective of the type of triglyceride. Also the addition of different amounts (and particle size fractions) of saccharose to pyranine-loaded implants led to purely diffusion-controlled drug release.

Paclitaxel-loaded microparticles and implants for the treatment of brain cancer: preparation and physicochemical characterization.

The aim of this study was to prepare different types of paclitaxel-loaded, PLGA-based microparticles and lipidic implants, which can directly be injected into the brain tissue. Releasing the drug in a time-controlled manner over several weeks, these systems are intended to optimize the treatment of brain tumors. The latter is particularly difficult because of the blood-brain barrier (BBB), hindering most drugs to reach the target tissue upon systemic administration. Especially paclitaxel (being effective for the treatment of ovarian, breast, lung and other cancers) is not able to cross the BBB to a notable extent since it is a substrate of the efflux transporter P-glycoprotein. Both, biodegradable microparticles as well as small, cylindrical, glycerol tripalmitate-based implants (which can be injected using standard needles) were prepared with different paclitaxel loadings. The effects of several formulation and processing parameters on the resulting drug release kinetics were investigated in phosphate buffer pH 7.4 as well as in a diethylnicotinamide (DENA)/phosphate buffer mixture. Using DSC, SEM, SEC and optical microscopy deeper insight into the underlying drug release mechanisms could be gained. The presence of DENA in the release medium significantly increased the solubility of paclitaxel, accelerated PLGA degradation, increased the mobility of the polymer and drug molecules and fundamentally altered the geometry of the systems, resulting in increased paclitaxel release rates.

Incidence of sports and recreation related injuries resulting in hospitalization in Wisconsin in 2000.

OBJECTIVE: To describe the incidence and patterns of sports and recreation related injuries resulting in inpatient hospitalization in Wisconsin. Although much sports and recreation related injury research has focused on the emergency department setting, little is known about the scope or characteristics of more severe sports injuries resulting in hospitalization. SETTING: The Wisconsin Bureau of Health Information (BHI) maintains hospital inpatient discharge data through a statewide mandatory reporting system. The database contains demographic and health information on all patients hospitalized in acute care non-federal hospitals in Wisconsin. METHODS: The authors developed a classification scheme based on the International Classification of Diseases External cause of injury code (E code) to identify hospitalizations for sports and recreation related injuries from the BHI data files (2000). Due to the uncertainty within E codes in specifying sports and recreation related injuries, the authors used Bayesian analysis to model the incidence of these types of injuries. RESULTS: There were 1714 (95% credible interval 1499 to 2022) sports and recreation-related injury hospitalizations in Wisconsin in 2000 (32.0 per 100,000 population). The most common mechanisms of injury were being struck by/against an object in sports (6.4 per 100,000 population) and pedal cycle riding (6.2 per 100,000). Ten to 19 year olds had the highest rate of sports and recreation related injury hospitalization (65.3 per 100,000 population), and males overall had a rate four times higher than females. CONCLUSIONS: Over 1700 sports and recreation related injuries occurred in Wisconsin in 2000 that were treated during an inpatient hospitalization. Sports and recreation activities result in a substantial number of serious, as well as minor injuries. Prevention efforts aimed at reducing injuries while continuing to promote participation in physical activity for all ages are critical.

Monolithic triglyceride matrices: a controlled-release system for proteins.

Matrices made of glyceryl trimyristate as a bioerodible and biocompatible material were manufactured by compression in dimensions that would still allow an application via injection. Pyranine, as a low molecular hydrophilic compound with a low detection limit, and tetramethylrhodamine labeled bovine serum albumin (TAMRA-BSA), as a high molecular weight (66 kDa) protein compound, served as model drugs for release investigations. In vitro studies with pyranine revealed that release depends substantially on the gelatin content of the matrices, which proved to be a useful tool as a release modifier. The duration of the drug release period can be adjusted to a desired time interval ranging from days to weeks by choosing the right gelatin content. Moreover, results illustrated the importance of the molecular weight and the nature of the compound to be incorporated into such matrices, since investigations with TAMRA-BSA showed a more pronounced burst release and altered release profiles and periods. Experiments with hyaluronidase, which served as a model enzyme to assess the problem of protein integrity in such matrices, suggested that proteins may display sufficient stability during the manufacturing procedure of the cylinders or while in contact with the triglyceride matrices. In addition to in vitro investigations, a study in mice revealed that after 15 days of subcutaneous implantation the matrices showed a good in vivo stability. The main conclusion that could be drawn from these results was that triglycerides are a promising alternative to biodegradable polymers for the development of parenteral release systems for protein and peptide drugs.

Economics versus alleles: balancing integrated pest management and insect resistance management for rotation-resistant western corn rootworm (Coleoptera: Chrysomelidae).

Western corn rootworm, Diabrotica virgifera virgifera LeConte, has overcome crop rotation in several areas of the central United States. We expanded a simple model of adult behavior and population genetics to explain how rotation resistance may have developed and to study ways to manage the western corn rootworm in a landscape of corn, soybean, and winter wheat where evolution of resistance may occur. We modeled six alternative management strategies over a 15-yr time horizon, as well as a strategy involving a 2-yr rotation of corn and soybean in 85% of the landscape, to investigate their effectiveness from both a biological and economic perspective. Generally, resistance to crop rotation evolves in fewer than 15 yr, and the rate of evolution increases as the level of rotated landscape (selection pressure) increases. When resistance is recessive, all six alternative strategies were effective at preventing evolution of rotation resistance. The two most successful strategies were the use of transgenic rotated corn in a 2-yr rotation and a 3-yr rotation of corn, soybean, and wheat with unattractive wheat (for oviposition) preceding corn. Results were most sensitive to increases in the initial allele frequency and modifications of the density-dependent survival function. Economically, three alternative strategies were robust solutions to the problem, if technology fees were not too high. Repellant soybean, attractive rotated corn, and transgenic rotated corn, all in 2-yr rotations, were economically valuable approaches. However, even the currently common 2-yr rotation was economical when resistance was recessive and the actual costs of resistance would not be paid until far in the future.

Modeling the development of resistance by stalk-boring lepidopteran insects (Crambidae) in areas with transgenic corn and frequent insecticide use.

We simulated the population dynamics and population genetics of two bivoltine species of corn borers, the European corn borer, Ostrinia nubilalis (Hübner), and the southwestern corn borer, Diatraea grandiosella Dyar, in a hypothetical region of irrigated transgenic and nontransgenic corn where insecticide was applied only to the nontransgenic refuge crop. Over the 100-yr time horizon, resistance developed quickly in both species and to both transgenic corn and the insecticide when the allele for resistance to the respective toxin was dominant. When the allele for transgenic resistance was not dominant and the refuge location was constant over the time horizon, spraying the refuge to control southwestern corn borer had no effect on how quickly resistance to the transgenic corn developed. In contrast, the European corn borer developed resistance to transgenic corn much sooner when the refuge was sprayed once per year, and the time to 3% resistance allele frequency decreased as efficacy of the insecticide increased. Only when the refuge was treated less than once every 5 yr (10 generations) did the frequency of application decline enough to permit resistance management for the European corn borer to approximate the effectiveness of an unsprayed refuge. A consistently sprayed refuge <40% of the corn acreage was an inadequate resistance management strategy for the European corn borer even when a low efficacy insecticide (70% mortality) was used. When assumptions about European corn borer adult behavior were changed and the adults behaved similarly to adult southwestern corn borer, the development of resistance to the transgenic crop was slowed significantly.

Modeling the dynamics of adaptation to transgenic corn by western corn rootworm (Coleoptera: Chrysomelidae).

A simulation model of the population dynamics and genetics of the western corn rootworm, Diabrotica virgifera virgifera LeConte, was created for a landscape of corn, soybean, and other crops. Although the model was created to study a 2-locus problem for beetles having genes for resistance to both crop rotation and transgenic corn, during this first phase of the project, the model was simulated to evaluate only resistance management plans for transgenic corn. Allele expression in the rootworm and toxin dose in the corn plant were the two most important factors affecting resistance development. A dominant resistance allele allowed quick evolution of resistance to transgenic corn, whereas a recessive allele delayed resistance >99 yr. With high dosages of toxin and additive expression, the time required to reach 3% resistance allele frequency ranged from 13 to >99 yr. With additive expression, lower dosages permitted the resistant allele frequency to reach 3% in 2-9 yr with refuges occupying 5-30% of the land. The results were sensitive to delays in emergence by susceptible adults and configuration of the refuge (row strips versus blocks).

Self-rated health status: a new vital sign for primary care?

Self-reported health status ratings depend on whether one references health problems or health behaviors. Pessimistic health perceptions may indicate underlying emotional distress or predict mortality. This study explores the association between a single-item health status question and self-reported health problems or behaviors among women in a Wisconsin family medicine clinic. All women who present for health maintenance complete a health history form that includes a single item health status rating. Health status ratings from 251 randomly selected records were compared with certain reported demographics, health behaviors (e.g. smoking, exercise), health concerns, depression and anxiety symptoms, vital signs and body mass index. Health status ratings of fair or poor were found to be associated with race, marital and employment status, obesity, exercise, and depressive symptoms. Smokers were 4.22 times more likely to report a less favorable health category than non-smokers. Implications for future research are discussed.

Conference formats in family practice residencies.

BACKGROUND: This study was intended to establish national baseline data of the current structure of conferences at family practice residencies and to determine if there are differences in conference formats among types of residencies. METHODS: An author-developed survey was mailed to 331 programs stratified by type and randomly selected. Statistical analysis included chi-square tests and non-parametric tests. RESULTS: The response rate was 84%. The average time devoted to lectures was 4.5 hours a week, with the noon hour the most common time. Most speakers were from within the program, and community-based family physicians were rarely present. Structural changes were frequent. CONCLUSIONS: Results indicate that a variety of formats are implemented for meeting Residency Review Committee requirements in the structure of family practice residencies' conferences. Program settings do influence how conferences are structured. More research is needed on this neglected area of formal resident education.

Personal values of family physicians, practice satisfaction, and service to the underserved.

BACKGROUND: Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. METHODOLOGY: We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. RESULTS: Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). CONCLUSIONS: Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians who rate the universalism values highly are more likely to provide care to the indigent.

An office-based Internet patient education system: a pilot study.

BACKGROUND: Patients' use of the Internet to find medical information is increasing, and physicians are exploring ways to incorporate the Internet into patient education programs and physician-patient encounters. We performed a pilot study of an Internet patient education system to obtain information on the usefulness of, feasibility of, and patient satisfaction with this type of information. METHODS: We developed a hypertext Web page directory to patient education sites on the Internet and made it available to patients in a community-based family practice residency clinic during their office visit. During a 1-month period, a medical student assisted patients with using the Internet, answered questions, interviewed patients, and collected data. Information was collected on sites visited, level of assistance required, amount of time spent "surfing" on-line versus intense reading on-line, quality of the experience, perceived usefulness of the educational materials, and patients' satisfaction with the materials. RESULTS: Fifty patients participated in the study. Forty-seven patients (94%) found the Internet information helpful. Most patients spent their time on-line intensely reading, and men spent significantly more time on-line (P = .007). Thirty-seven patients (77%) stated they would change a health behavior because of information they had read on the Internet; 45 (90%) were more satisfied with their visit than usual, and 46 (92%) would use the Internet center at the clinic again. CONCLUSIONS: Patients can obtain useful information from moderated Internet patient education systems and may plan to change health behaviors on the basis of that information. Internet patient information in the physician's office can improve patient satisfaction with clinic visits.

A sequential chart for the audit-based evaluation of screening mammogram interpretation.

RATIONALE AND OBJECTIVES: Auditing has received much attention recently as a method for radiologists to use to evaluate their interpretation of screening mammograms. U.S. Food and Drug Administration regulations require that some sort of audit be in place before a mammography screening facility can receive accreditation. Auditing presents a unique opportunity to monitor accuracy continually and identify problems early. Audit data present unique challenges, however, and appropriate methods must be used to control the risk of errors. MATERIALS AND METHODS: This article introduces a simple method for the task of deciding if a radiologist yields an acceptable positive predictive value based on audit. The method is based on "sequential" decision-making techniques that have found wide application in quality control problems. These techniques are developed for diagnostic radiology and embodied in an easy-to-use decision-making chart. RESULTS: Several examples, based on audit data from actual mammography facilities, provide insights into the use of these charts and the influence of (a) the selection of standards, (b) the selection of error risks, and (c) radiologist variability. The examples also serve to demonstrate another important property of this method--that is, it specifies the minimum amount of data that has to be collected before any decision can reliably be made. CONCLUSION: The chart presented in this article provides a method by which audit data can be used objectively to evaluate the accuracy of screening mammogram interpretation. The method controls the risk of either falsely accepting an unqualified radiologist or falsely rejecting a qualified radiologist. It should be a useful tool to radiologists who must evaluate their own practices.

Comparison of pneumatic retinopexy and scleral buckling in the management of primary rhegmatogenous retinal detachment. Southern Wisconsin Pneumatic Retinopexy Study Group.

PURPOSE: To compare pneumatic retinopexy and scleral buckling for repair of primary rhegmatogenous retinal detachment with respect to visual outcome, single-procedure reattachment rate, and development of proliferative vitreoretinopathy. METHODS: A consecutive series of eyes initially treated with pneumatic retinopexy (n = 56) between March 1986 and February 1996 were compared with a selected group of eyes treated with scleral buckling (n = 86) with similar location and distribution of retinal breaks and absence of proliferative vitreoretinopathy. A regression model was developed to adjust for underlying differences between treatment groups, resulting in a cohort of 50 eyes in each group for final comparison. A minimum follow-up of 6 months was obtained. RESULTS: Single-procedure reattachment rate was significantly higher for scleral buckle eyes (42 of 50 eyes, 84%) than for pneumatic retinopexy eyes (31 of 50 eyes, 62%; P < or = .01). Correspondingly, reoperation rate was significantly higher for pneumatic retinopexy eyes (19 of 50 eyes, 38%) than for scleral buckle eyes (7 of 50 eyes, 14%; P < or = .01). Multiple regression analysis evaluating perioperative factors demonstrated that the use of pneumatic retinopexy was the sole factor predictive of retinal detachment after a single procedure (relative odds = 2.20, P = .02). Final reattachment rate, after reoperations, was 98% (49 of 50 eyes) in each group. Except for nonphakic eyes, final visual outcome and rate of postoperative proliferative vitreoretinopathy development did not differ significantly between the two procedures. CONCLUSIONS: In phakic eyes, pneumatic retinopexy was associated with a significantly higher reoperation rate than scleral buckling, but resulted in equivalent final visual outcome and reattachment rate after reoperations. If used, it must be incorporated into a strategy in which patient and physician are prepared for a greater chance of reoperation compared to initial management with scleral buckling.

Improvement in resource utilization after development of a clinical pathway for patients with pressure ulcers.

Clinical pathways are interdisciplinary patient care plans intended to reduce variance and improve quality of care while lowering health care cost. This study was undertaken to determine whether the development of a clinical pathway for care of patients with pressure ulcers can indeed decrease health care costs while preserving quality of care. A clinical pathway for surgical reconstruction of pressure ulcers was developed by standardizing the current practices of our plastic surgeon group. The pathway provided direction in optimal scheduling of physician interventions along with nursing, physical and occupational therapies, and spinal cord rehabilitation interventions. It covered all potential elements of patient care, including laboratory, radiology, dietary services, intravenous fluids, and use of specialty beds. It defined patient outcomes and outlined discharge planning. Pathways were distributed throughout all services caring for patients with pressure ulcers. Patient charts and billing data were reviewed for the 16-month periods before and after initiation of the pathway. No other significant changes in treatment occurred during this time frame. Ninety-seven patient charts were examined (54 before pathway and 43 after pathway implementation). Parameters evaluated included length of stay and total charges (including bed use, medications, laboratory tests, and radiology). Patient readmission rate was also examined. A significant reduction in patient length of stay and total charges was achieved after implementation of the clinical pathway. Reduction was seen not only for patients treated with flaps by plastic surgery but also for patients with pressure ulcers who were not specifically targeted such as those from other services. The readmission rate decreased slightly, although not significantly, after the pathway inception. Total cost saving was almost $11,000 per patient (23 percent). In conclusion, implementation of a clinical pathway, because it standardizes care and reduces variations and duplication of care, can reduce health care cost without impairing quality of care in the treatment of decubitus ulcer patients.

Long-term follow-up of iatrogenic phototoxicity.

OBJECTIVE: To evaluate the outcomes of a group of patients who suffered iatrogenic phototoxic injury. METHODS: The medical records of 24 patients (24 eyes) with iatrogenic phototoxicity from 3 medical centers were reviewed. We report the findings from long-term follow-up of these patients with particular attention to visual outcome, type and duration of procedure, and location of the phototoxic lesion. RESULTS: Phototoxic injury occurred after anterior segment surgery in 20 eyes and after vitrectomy in 4 eyes. The mean duration of surgery was 109 minutes; there was no statistically significant difference in duration between the anterior segment procedures and the vitrectomies. Mean final visual acuity was 20/40 for all cases (range, 20/15 to counting fingers) and 20/25 for all anterior segment cases. In vitrectomized eyes, the mean final visual acuity was 20/900. Phototoxic lesions tended to spare the fovea after anterior segment surgery and involve the foveal center after vitrectomy. CONCLUSIONS: In general, patients who suffer phototoxicity do well, and the prognosis is good for extrafoveal lesions. Foveal injury, which often occurs with vitrectomy, usually leads to a worse visual outcome. The development of choroidal neovascularization may have an effect on the ultimate visual outcome as well.