Health Care Disparities in Diabetes and Diabetic Retinopathy.

PURPOSE: To investigate prevalence of diabetes (DM), diabetic retinopathy (DR), and areas with highest rates of undetected DR. To quantify and map locations of disparities as they relate to poverty and minority populations. METHODS: Retrospective cohort study from large regional health data repository (HealthLNK). Geographic Information System (GIS) analysis mapped rates of DM and DR in Chicago area ZIP Codes. RESULTS: Of 1,086,921 adults who met the inclusion criteria, 143,790 with DM were identified. ZIP Codes with higher poverty rates were correlated with higher prevalence of DM and DR (Pearson's correlation coefficient 0.614, p < .05, 0.333, p < .05). Poverty was negatively correlated with likelihood of DR diagnosis (-0.638, p < .05). Relative risks of DM and DR were calculated in each ZIP Code and compared to actual rates. 36 high-risk ZIP Codes had both high-risk of DM and low DR detection. In high-risk ZIP Codes 85.4% of households self-identified as ethnic minority and 33.0% were below the Federal Poverty Level (FPL). Both percentages were significantly higher than the Chicago average of 50.5% minority and 19.9% below FPL (p < .05). 67 ideal ZIP Codes had both low risk of DM and high DR detection. In ideal ZIP Codes 32.6% of households self-identified as minority, and 10.2% were below the FPL (p < .05). CONCLUSIONS: A health care disparity exists with regards to DM and DR. High-risk ZIP Codes are associated with higher poverty and higher minority population, and they are highly concentrated in just 17% of the ZIP codes in the Chicago area.

Pediatric Nd:YAG laser capsulotomy in the operating room: review of 87 cases.

AIM: To report a large series of children having Nd:YAG laser capsulotomy in the operating room using the lateral decubitus position. METHODS: Medical records of children who underwent Nd:YAG laser capsulotomy in the operating room at Ann & Robert H. Lurie Children's Hospital of Chicago between September 2008 and April 2017 were reviewed. Induction of general anesthesia and intubation was performed in the supine position after which the patient was placed in lateral decubitus position. The Nd:YAG laser capsulotomy was performed using a standard protocol. At the completion of the procedure, the patient was turned back into the supine position and extubated. RESULTS: This study included 87 eyes of 60 patients. Patient's age ranged from 1 to 18y (mean 6.4±4.1y). In most cases (84/87, 97%), the procedure was performed under general anesthesia. In all cases, good focus on the membrane was achieved, and the procedure was performed successfully. There were no intraoperative ocular or anesthesia-related complications. CONCLUSION: When performing Nd:YAG laser capsulotomy in the operating room, the lateral decubitus position allows an easy and safe approach without the risk of potentially devastating complications that have been associated with the previously described sitting and prone positions.

Cataract surgery in children with uveitis: retrospective analysis of intraocular lens implantation with anterior optic capture.

PURPOSE: To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uveitis and compare the technique of anterior optic capture in 5 eyes that underwent cataract extraction without optic capture of the intraocular lens (IOL) or were left aphakic. METHODS: A retrospective review of pediatric patients with chronic uveitis undergoing cataract surgery was performed, examining the preoperative and postoperative visual acuity, immunosuppressive therapy, surgical technique, complications, subsequent procedures, and need for escalation of systemic immunosuppressive therapy. The technique of anterior optic capture is described in detail. RESULTS: Of the 9 eyes, 5 underwent cataract extraction with IOL placement with the haptics in the capsular bag and optic prolapsed through the anterior capsulorhexis. One eye underwent cataract extraction with IOL implantation in the bag. Three eyes had lensectomy without IOL placement. The eyes with anterior optic capture had no adverse outcomes and uveitis flares were controlled with topical medications and systemic immunosuppressants; the eye with IOL placement without optic capture had recurrent membranes and uveitis flares, necessitating increased systemic immunosuppression. All eyes achieved best-corrected visual acuity of 20/60 or better by 6 months following surgery and 20/30 or better at the most recent follow-up. CONCLUSIONS: The technique of cataract extraction with IOL placement and anterior prolapse of the optic through the anterior capsulorhexis shows promise to be a safe and viable option for pediatric patients with chronic uveitis treated with systemic immunotherapy.