RESUMO
PURPOSE: We describe a retrospective cohort study investigating the prevalence of pentosan polysulfate sodium (PPS) maculopathy in patients with PPS exposure, as well as the relationship between cumulative PPS exposure and the presence of PPS-maculopathy. METHODS: Patients were identified through review of the electronic medical record system. Available diagnostic imaging was reviewed for signs of PPS-maculopathy. Patients were also contacted to determine cumulative exposure. RESULTS: Of the 335 identified eligible patient records, 84 had sufficient diagnostic imaging. Sixteen patients had definitive signs of PPS-maculopathy, 6 had likely signs of PPS-maculopathy, and 62 had no signs. The mean cumulative PPS exposure and standard error of the mean (SEM) for patients with any signs of PPS-maculopathy was 1946.0 g (396.0 g), significantly higher than the mean cumulative PPS exposure for patients without such signs of 782.3 g (105.3 g). No significant difference in BCVA was noted. The odds ratio (OR, 95% confidence interval (95% CI)) of PPS-maculopathy was significantly elevated in patients with cumulative PPS exposures of 1500-2000 g [OR 4.72 (0.856-26.02 95% CI)] and greater than 2000 g [OR 28.33 (2.388-336.1, 95% CI)]. Logistic regression analysis confirmed a positive dose response relationship. CONCLUSIONS: We describe the concerning incidence of PPS-maculopathy in a multispecialty ophthalmology practice's patient population and investigate the dose-dependency of PPS-maculopathy. Patients with PPS-maculopathy were shown to have a higher average exposure to PPS than those without the maculopathy. Patients with cumulative PPS exposures greater than 1500 g were shown to have an increased risk of PPS-maculopathy.
Assuntos
Degeneração Macular , Doenças Retinianas , Humanos , Poliéster Sulfúrico de Pentosana/efeitos adversos , Prevalência , Estudos Retrospectivos , Degeneração Macular/induzido quimicamente , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologiaAssuntos
Anticoagulantes/efeitos adversos , Poliéster Sulfúrico de Pentosana/efeitos adversos , Distrofia Macular Viteliforme/induzido quimicamente , Idoso , Cistite Intersticial/tratamento farmacológico , Feminino , Humanos , Células Fotorreceptoras de Vertebrados/efeitos dos fármacos , Células Fotorreceptoras de Vertebrados/patologia , Tomografia de Coerência Óptica , Distrofia Macular Viteliforme/diagnóstico por imagemRESUMO
PURPOSE: To analyze practice patterns used for intravitreal injections (IVIs) by retinal specialists in the United States. DESIGN: Cross-sectional online survey. PARTICIPANTS: Retina specialists in the United States who responded to a web-based survey. METHODS: Retinal specialists in the United States were contacted via e-mail to complete a web-based, anonymous, 24-question survey. Multivariate analysis was performed on a selected question of interest focused on choice of anesthetic used for IVI. MAIN OUTCOME MEASURES: Differences in IVI practices, such as antibiotic preferences, and different odds of anesthetic use by demographic variables with 95% confidence intervals. RESULTS: A total of 281 retinal specialists responded to the survey (17% response rate). Respondents' average age was 53 years, with an average of 20 years in practice. Respondents practiced in 42 states, with 90% practicing in an urban or suburban area. For anesthesia, 14% used a topical anesthetic with cotton swab compression, 27% used a subconjunctival anesthetic, and 31% used an anesthetic gel. Age, gender, geographic location, and practice setting did not seem to impact choice of anesthetic for IVI significantly. Sixty-six percent of respondents always use a lid speculum, 21% administer topical antibiotics before injection, 36% wear a mask, 73% wear gloves, and 45% always dilate the eyes before injection. Most respondents use a 30-gauge needle and inject in the inferior temporal quadrant (70%). Forty-five percent always perform bilateral injections the same day if indicated. After the injection, 14% administer post operative nonsteroidal anti-inflammatory drugs, 28% administer postoperative antibiotics, and 31% routinely check intraocular pressure after injection. CONCLUSIONS: This study provided real-world trends in practices for IVI among retina specialists in the United States. In addition, age, gender, practice type, and geographic location did not influence anesthetic choice for IVI.
Assuntos
Oftalmologistas/tendências , Preparações Farmacêuticas/administração & dosagem , Padrões de Prática Médica/tendências , Doenças Retinianas/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Inibidores da Angiogênese/administração & dosagem , Antibacterianos/administração & dosagem , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Internet , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Especialização , Estados Unidos/epidemiologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
BACKGROUND AND OBJECTIVES: Ozurdex intravitreal injection is performed via a patented injection device. However, there is a common misconception among ophthalmologists regarding the relation between the speed of applicator button depression and the speed of pellet injection. PATIENTS AND METHODS: Six dexamethasone intravitreal implants were injected into a calibrated ex vivo water bath. Three of the pellets were injected via rapid compression, whereas the other three implants were injected using a 3-second compression technique. The procedures were recorded using high-speed photography followed by calculation of pellet velocity and impact force. RESULTS: The mean impact velocity and force of the pellet insertion is significantly higher in the fast injection group compared to the slow injection group. CONCLUSIONS: By depressing the Ozurdex implant injector during a 3-second time interval, the impact force of the implant pellet is reduced by about 95%. This new technique will theoretically reduce the risk of retinal injury and vitreous hemorrhage from Ozurdex injections. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e23-e25.].
Assuntos
Dexametasona/administração & dosagem , Implantes de Medicamento , Glucocorticoides/administração & dosagem , Injeções Intravítreas/métodos , Humanos , Injeções Intravítreas/instrumentação , Edema Macular/tratamento farmacológicoRESUMO
BACKGROUND AND OBJECTIVE: The purpose of this study is to compare cancellation and no-show rates in patients with diabetic macular edema (DME) and exudative macular degeneration (wet AMD). PATIENTS AND METHODS: An anonymous survey was sent to 1,726 retina specialists inquiring as to the number of appointments their patients with DME and wet AMD attended, cancelled, or did not show up for in 2014 and 2015. RESULTS: Data were obtained on 109,599 appointments. Patients with DME in the U.S. had a 1.591-times increased odds of cancelling or no-showing to their appointments than patients with wet AMD (P < .0001). Patients with DME in Europe had a 1.918-times increased odds of cancelling or no showing to their appointments than patients with wet AMD (P < .0001). CONCLUSION: Patients with DME in the U.S. and Europe cancelled and no-showed to their appointments significantly more often than patients with wet AMD. These findings can be taken into consideration when establishing treatment plans for patients with DME. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:186-190.].
Assuntos
Inibidores da Angiogênese/administração & dosagem , Agendamento de Consultas , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Cooperação do Paciente , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Masculino , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/diagnósticoRESUMO
PURPOSE: To present the case of a patient who developed spontaneous closure of an idiopathic macular hole after four failed attempts at surgical closure. METHODS: This is a retrospective case review of the medical record of a single patient. No statistical analysis was performed. The patient is a 71-year-old white woman with neurofibromatosis Type 1 who presented to the retina clinic of one of the authors. RESULTS: The patient underwent four vitrectomies with long acting gas by two surgeons over the course of 2 years. After each surgery, the hole either did not close or it closed and then reopened within 1 year. Five months after the last surgery (1 year after the hole last reopened), the patient presented with improved vision and spontaneous closure of the macular hole. The hole has remained closed since then. CONCLUSION: This case demonstrates that spontaneous closure of a macular hole, associated with excellent visual recovery, can occur after multiple surgical failures. We propose that enhanced scar formation due to neurofibromatosis Type 1 was responsible for both the numerous failures following initially successful surgery (centrifugal traction) and for the spontaneous closure (centripetal traction).
Assuntos
Neurofibromatose 1/cirurgia , Retina/patologia , Neoplasias da Retina/cirurgia , Perfurações Retinianas/diagnóstico , Acuidade Visual , Vitrectomia/efeitos adversos , Feminino , Humanos , Neurofibromatose 1/diagnóstico , Remissão Espontânea , Neoplasias da Retina/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Falha de TratamentoRESUMO
AIMS: To compare outcomes of resident-performed Ahmed valve surgery vs trabeculectomy in a Veteran Affairs medical facility. MATERIALS AND METHODS: A retrospective cohort of 103 eyes in 91 patients receiving Ahmed valve (valve) or trabeculectomy (trab) performed at a Veterans Administration Medical Center by residents in their third year of training. The primary outcomes included intraocular pressure (IOP), treatment failure, and complications over 1 year. RESULTS: Of 103 eyes, 44 received valve and 59 received trab. Primary open-angle glaucoma was primary diagnosis more often in trab, while neovascular glaucoma predominated in the valve group (p < 0.001). Preoperative mean IOP was 35.1 ± 11.8 and 24.5 ± 7.1 mm Hg for valve and trabeculectomy respectively (p < 0.001), but at 1 year the IOP difference between groups was not statistically significant (p = 0.064). Overall, 11 (25.0%) and 11 (18.6%) eyes met any criteria for failure for valve and trab respectively. At 1 year, 22.5% of valves had IOP > 21 mm Hg vs only 4.3% of trab (p = 0.02). Complications were infrequent. There were no intraoperative complications for valve, whereas five for trab. Most common immediate complication for valve was hyphema. Both groups had low rates of choroidal effusions and reoperation. CONCLUSION: Ahmed valve implantation and trabeculectomy produce significant reductions in IOP when performed by residents-in-training. Valves tend to be used more frequently in patients with secondary glaucoma. Although complication profiles differ between procedures, both are safe and well tolerated when performed by resident physicians. CLINICAL SIGNIFICANCE: This study provides support for evidence-based patient counseling that supervised, resident-performed Ahmed valve implantation and trabeculectomy are indeed safe and effective. How to cite this article: Sharpe RA, Kammerdiener LL, Wannamaker KW, Fan J, Sharpe ED. Comparison of Outcomes of Resident-performed Ahmed Valve Implantation vs Trabeculectomy. J Curr Glaucoma Pract 2016;10(2):60-67.