The Wisconsin silicone oil study (report #1): anatomical and functional outcomes of repair of retinal detachment with proliferative vitreoretinopathy.

BACKGROUND: Silicone oil (SO) is a long-term tamponade for repair of complex retinal pathology but has limitations including late redetachment. This study describes our experience with SO tamponade for repair of retinal detachment with proliferative vitreoretinopathy (PVR), with attention to anatomic and functional outcomes. METHODS: Retrospective consecutive case series of eyes with retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) receiving SO tamponade at the University of Wisconsin between 2013 and 2019. Group 1 defined as primary SO placement; Group 2 had SO placed after failing prior retinal detachment repair. RESULTS: Inclusion criteria of SO placement for repair of RD with PVR was met for 117 eyes. The final reattachment rate was 84% for all eyes, with no difference between Groups 1 and 2. Vision improvement was 2.1 lines for Group 1 (p = 0.06 from baseline) and 4.6 lines for Group 2 (p < 0.0001). The mean number of silicone oil placements was 1.4. Less improvement in vision was noted with repeat SO placement, though overall functional vision of 5/200 or better was achieved in 63.2% of patients. CONCLUSIONS: SO tamponade allows long-term anatomical stabilisation and substantial vision recovery in eyes with retinal detachment complicated by PVR. Rates of anatomic and functional success have improved significantly when compared to prior studies using oil tamponade for repair of PVR.

Injury incidence and predictors on a multiday recreational bicycle tour: The Register's Annual Great Bike Ride Across Iowa, 2004 to 2008.

OBJECTIVE: The "Register's Annual Great Bike Ride Across Iowa" (RAGBRAI) is a 7-day recreational bicycle ride with more than 10,000 participants covering 500 miles. The heat and humidity of late July in Iowa, the prevalence of amateur riders, and the consumption of alcohol can combine creating the potential for a significant number of injuries. The purpose of this study is to determine the type, quantity, and severity of injuries on RAGBRAI and gather data on the factors related to these incidents. METHODS: This retrospective chart review examined ambulance "run sheets" for patients requiring transport to the hospital from the bike route between 2004 and 2008. These run sheets included name, age, chief complaint, anatomic location of injuries, medications administered, procedures performed, and a full narrative describing the initial scene, patient's account of the incident, services provided, and ongoing condition of the patient while en route to the hospital. Chi-square tests, Pearson's correlation tests, and t tests were applied to determine significant statistical outcomes. RESULTS: From 2004 to 2008, Care Ambulance Inc provided on-route medical services for 419 RAGBRAI participants. Of these participants, 190 (45.3%) required transport to a local hospital by Care Ambulance Inc. Females were more likely to require transport, as they comprised 46.3% of transported patients while only representing 35% of all RAGBRAI participants (P = .001). For men, increasing age was a significant predictor of transport, particularly males between the ages of 60 and 69 years old (P = .01). Of the 148 run sheets where mechanism of incident was documented, 114 incidents were caused by rider factors (77.0%), 29 by road factors (19.6%), and 5 by bicycle factors (3.4%). Higher heat indexes were correlated with an increased number of dehydration cases (r = 0.979, P = .02). Of participants who reported with minor injuries to a mobile first aid station and did not require transport, 90.1% had not imbibed any alcohol. Bony injuries were more common above the waistline as 39/45 (86.7%) fractures occurred to the clavicle, shoulder/proximal humerus, hand, or head. The most common bony injury each year of RAGBRAI was a clavicle fracture, which represented 44.4% of all recorded fractures from 2004 to 2008. Lacerations and abrasions were also more common above the waist, as 63.5% (127/200) of soft tissue injuries requiring treatment were either to the head or upper extremities. No specific event day showed any correlation with increased injury (P >.05). CONCLUSIONS: This study suggests that females and older males are more likely to require transport for injuries sustained on RAGBRAI, the majority of injuries occur around the head and upper extremities, dehydration case load is correlated with heat index, and that incidents are usually caused by rider factors. This research could be used by multiday recreational bicycle tour organizers to continue educating riders on riding carelessness and etiquette and prepare medical services for certain quantities and types of injuries.

STENOTROPHOMONAS MALTOPHILIA ENDOPHTHALMITIS 1 MONTH AFTER INTRAVITREAL AFLIBERCEPT.

PURPOSE: Endophthalmitis caused by Stenotrophomonas maltophilia is rare and has been described after cataract surgery and open globe injuries. We report a patient with endophthalmitis caused by this organism after uncomplicated intravitreal aflibercept injection. METHODS: A 70-year-old man with a history of anti-vascular endothelial growth factor therapy for diabetic macular edema presented 23 days after aflibercept injection with clinical diagnosis of endophthalmitis. The patient initially had mild pain, conjunctival congestion, and anterior chamber cell; 2 days later, the patient returned with hand motion visual acuity, hypopyon, and dense vitritis. RESULTS: A tap and inject procedure was performed. The aqueous sample confirmed the presence of S. maltophilia. Antimicrobial testing showed susceptibility to ceftazidime which was used during the initial treatment. After resolution of the vitritis and hypopyon, the visual acuity returned to 20/70 at his 3-month follow-up examination. CONCLUSION: Stenotrophomonas maltophilia is a rare infectious agent associated with intravitreal injection and may present 1 month after treatment.