Rare Case of Thygeson Superficial Punctate Keratitis After COVID-19 Vaccination.

PURPOSE: The aim of this study was to elucidate a rare corneal association of the coronavirus disease 2019 (COVID-19) vaccine. Although cases of corneal involvement after vaccination have been reported, we present the first case of Thygeson superficial punctate keratitis (TSPK) linked to the COVID-19 vaccine. METHODS: This study is a case report. RESULTS: A 25-year-old woman was assessed in the ophthalmology clinic for recurrent ocular surface symptoms after receiving the COVID-19 vaccine. She was followed in clinic and was found to have a remitting and recurring pattern of bilateral intraepithelial corneal opacities with associated subepithelial haze primarily overlying the pupillary area. These corneal lesions responded well to topical corticosteroid ophthalmic drops. Based on the clinical appearance, the response to treatment, negative herpes simplex virus serology, and the temporal relationship between vaccination and ocular findings, a diagnosis of COVID-19 vaccine-induced TSPK was suspected. CONCLUSIONS: Although the COVID-19 vaccine remains overwhelmingly safe, clinicians should be aware of possible corneal side effects, including TSPK. Prompt ophthalmic assessment in those presenting with ocular symptoms after vaccination is encouraged.

Non-invasive monitoring of cyclodialysis cleft using anterior segment optical coherence tomography and its role in informing clinical treatment decisions.

PURPOSE: Anterior segment optical coherence tomography (AS-OCT) is an emerging imaging modality with an expanding role in glaucoma diagnosis and management. We present a series of two cases of iatrogenic cyclodialysis cleft and their conservative management being directly informed by non-invasive AS-OCT monitoring. OBSERVATIONS: Retrospective case series. A 51 year-old male and a 29 year-old male each underwent gonioscopy-assisted transluminal trabeculotomy for uncontrolled glaucoma with a cyclodialysis cleft being diagnosed postoperatively and then monitored using serial AS-OCT images. In both cases, conservative medical management was initially employed. Worsening hypotony maculopathy and decreasing best corrected visual acuity were evident in both cases at times when gonioscopy yielded inadequate visualization to meaningfully inform treatment decisions. Escalation to more invasive therapies was therefore considered. AS-OCT imaging revealed consistent anatomical improvement at each follow-up and ultimately both clefts closed without treatment escalation. CONCLUSIONS AND IMPORTANCE: AS-OCT played a critical role in the diagnosis and directly informed the conservative management of both of these cases. This non-invasive imaging modality may allow for deferral of invasive treatment escalation in some cases of cyclodialysis cleft.

Determining the cost of implementing and operating a remote patient monitoring programme for the elderly with chronic conditions: A systematic review of economic evaluations.

Introduction Remote patient monitoring (RPM) in conjunction with home nursing visits is becoming increasingly popular for the follow-up of patients with chronic conditions and evidence exists that it improves patients' health outcomes. Current cost data is reported inconsistently and often gathered from studies of poor methodological quality, making it difficult for decision-makers who consider implementing this service in their organizations. This study reviewed the cost of RPM programmes targeting elderly patients with chronic conditions. Methods After evaluation against the inclusion and exclusion criteria and appraisal against two criteria which are important for economic evaluations, data from selected studies were extracted and grouped into meaningful cost categories, then adjusted to reflect November 2015 US dollars. Results In the 13 selected studies, the newly-created cost category 'Combined intervention cost' (reflecting equipment purchasing, servicing and monitoring cost) for the various RPM programmes ranged from US$275-US$7963 per patient per year. The three main findings are: (a) RPM programme costs have decreased since 2004 due to cheaper technology; (b) monitoring a single vital sign is likely to be less costly than monitoring multiple vital signs; and (c) programmes targeting hypertension or congestive heart failure are less costly than those targeting respiratory diseases or multiple conditions. Conclusions This review recommends that future studies present their cost data with more granularity, that grouping of costs should be minimized and that any assumptions, such as amortization, should be made explicit. In addition, studies should compare programmes with similar characteristics in terms of type of conditions, number of vital signs monitored, etc. for more generalizable results.