Outcomes of Eyes With Diabetic Macular Edema That Are Lost to Follow-up After Anti-Vascular Endothelial Growth Factor Therapy.

PURPOSE: To evaluate the effect of loss to follow-up (LTFU) on outcomes in eyes with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (VEGF). DESIGN: Retrospective cohort study. METHODS: Single-center study of 90 eyes of 73 patients with nonproliferative diabetic retinopathy (NPDR) and DME treated with anti-VEGF injections who were LTFU for >6 months. Main outcomes were the change in mean visual acuity (VA) and central foveal thickness at the return and final visits compared with the visit before LTFU. RESULTS: The mean age was 64.5 years, the mean LTFU duration was 322 days, and the mean follow-up duration after return was 502 days. Compared with the mean VA at the visit before LTFU (0.42, Snellen ∼20/52), mean VA worsened at the return visit (0.54, Snellen ∼20/69, P = .004). No significant change in the mean VA was noted at the 3-month after return visit (0.50, Snellen ∼20/63), the 6-month after return visit (0.46, Snellen ∼20/57), the 12-month after return visit (0.42, Snellen ∼20/52), or the final follow-up (0.47, Snellen ∼20/59). When analyzed by NPDR severity before LTFU, no difference in VA was found from the visit before LTFU to the final visit. Mean central foveal thickness increased when comparing the visit before LTFU (270 µm) with the return visit (305 µm, P = .012), but no difference was found by the final visit (247 µm, P = .07). CONCLUSIONS: Anti-VEGF-treated patients with DME who were LTFU for a prolonged period experienced a modest decline in VA that recovered after restarting treatment.

Surgical Cancellations in Glaucoma Practice: Causes, Delays, and Effect on Patient Care and Revenue.

PURPOSE: To assess the incidence of glaucoma surgery cancellations, as well as their characteristics, underlying reasons, resultant surgical delay, and estimated lost potential reimbursement, at a tertiary eye hospital. DESIGN: Retrospective observational study of planned surgical procedures of 4 glaucoma specialists at a tertiary eye center over a 2-year period (May 2017-May 2019). An additional prospective survey of patients was conducted. PARTICIPANTS: Patients who canceled glaucoma surgeries. METHODS: Demographics and clinical information were recorded from the electronic medical record. A brief phone survey was implemented to determine the reason for cancellation and whether the patient rescheduled. Lost reimbursement was estimated assuming Medicare reimbursement rates for each procedure based on facility fee, surgeon fee, and anesthesia fee. MAIN OUTCOME MEASURES: Reasons for surgical cancellation, delay related to surgical cancellations, and annual lost reimbursement potential. RESULTS: One hundred twenty-three of 1384 glaucoma surgeries (8.9%) to be performed by 4 glaucoma specialists at Wills Eye Hospital during the 2-year study period were canceled. Among those canceled, the mean age ± standard deviation (SD) of the patients was 70.3 ± 14.4 years and 51% were men. Of the cancellations, 56.9% were made within 1 day of the planned date of surgery and 96.7% were canceled within 7 days. Of the reasons for surgical cancellation, 28% were considered preventable, 50% were considered unpreventable, and 23% were categorized as "no reason given." Most of the surgeries eventually were performed-to-date (64.2%); the mean ± SD delay in surgery was 63.4 ± 68.6 days. The 3 most common preventable reasons for cancellation were lack of transportation (34%), lack of timely clearance (26%), and insurance-related issues (14%). Assuming Medicare reimbursement rates, the estimated annual lost potential reimbursement from surgical cancellations of the 4 glaucoma specialists was $208 306. CONCLUSIONS: This study highlights a significant number of cancellations in a glaucoma practice, most of which occurred within 1 day of planned surgery. Minimizing preventable causes of cancellations could decrease the likelihood of surgical delays as well as lost reimbursement. Further comparison with patients who successfully underwent surgery performed without delay may identify predictive factors or interventions that could decrease the number of surgical cancellations.

Isolated Penile Edema After Diagnostic Paracentesis.

Diagnostic paracentesis is a routinely practiced, typically safe procedure performed in the emergency department. Genital swelling post-paracentesis is a rare complication with few documented case reports. We report a case of isolated penile edema after a diagnostic paracentesis performed in the emergency department. The patient is a 63-year-old male who came to the emergency department with a two-day history of isolated penile swelling after undergoing a diagnostic paracentesis in the emergency department as part of his workup during a recent hospital admission. On exam, the paracentesis site was noticeably low, beneath the inguinal ligament on the right side. His genital exam showed a circumcised penis with significant soft tissue swelling that involved the entire penile shaft sparing the glans and scrotum. There was no penile tenderness on palpation or urethral discharge. The testicles and scrotum revealed no signs of edema or tenderness, hernias, or abnormal lie. Of note, the patient reported that he had a less severe episode of penile swelling approximately one year ago after a paracentesis in a similarly low site, which resolved spontaneously. The features and timing of this presentation, added to the patient's previous episode over a year ago, pointed to this being a sequela of the paracentesis he had undergone during his last hospital stay. After evaluation and consultation with the urology service, he was discharged home with expectant management and outpatient follow-up. His symptoms resolved spontaneously after one week. To our knowledge, there have been no published reports of isolated penile edema after a diagnostic paracentesis. This case could be used when teaching the proper technique for performing a paracentesis and its potential complications.