Impact of the COVID-19 pandemic on uveitis patient care.

BACKGROUND: The COVID-19 pandemic has significantly changed practice of medicine and patient care worldwide. The impact of the pandemic on patients with uveitis is unknown. We developed the COVID-19 Practice Patterns Study Group to evaluate the effect of the pandemic on uveitis patient care. METHODS: This is a multicentre, cross-sectional survey of uveitis specialists practising worldwide. A web-based survey was distributed through the mailing lists of international uveitis societies to assess modifications in patient care, and use of immunomodulatory therapies (IMTs),aswell as considerations regarding COVID-19 vaccination. RESULTS: A diverse group consisting of 187 uveitis specialists from six continents participated in this survey. Most of these experts noted a disruption in clinical management of patients, including clinic closures or decrease in volume, patients missing in-person visits due to the fear of infection and difficulties obtaining laboratory testing. Most participants initiated (66.8%) and continued (93.3%) IMTs based on clinical presentation and did not modify their use of immunosuppressives. In cases of reported exposure to COVID-19 infection, most participants (65.3%) recommended no change in IMTs. However, 73.0% of the respondents did recommend holding all or select IMTs in case of COVID-19 infection. COVID-19 vaccine was recommended universally by almost all the specialists and 52% stated that they would counsel patients regarding the decreased immunogenicity and effectiveness of the vaccine in immunocompromised patients. CONCLUSIONS: Uveitis patient care has changed significantly since the beginning of the pandemic. The recommendations will continue to evolve as new data on IMTs and vaccination become available.

Prospective Cross-Sectional Study of Repeatability of Peripapillary Capillary Density Measurement Using Optical Coherence Tomography Angiography in Eyes With Optic Nerve and Retinal Vascular Pathology.

BACKGROUND: Optical coherence tomography angiography (OCTA) is a new noninvasive imaging modality that provides high resolution images of the optic nerve head and peripapillary retinal capillary vasculature which can be affected by optic nerve or retinal pathologies. High repeatability of peripapillary capillary density measurement using OCTA has been demonstrated in normal eyes and eyes with glaucoma. The purpose of our study was to quantify the repeatability of peripapillary capillary density measurement using OCTA in both normal eyes and eyes with optic atrophy, optic disc edema, and retinal vasculopathy. METHODS: This prospective cross-sectional study enrolled 31 patients (59 eyes) including 16 eyes with optic nerve pathology (7 with disc edema from papilledema and 9 with optic atrophy), 35 eyes with retinal vascular disease, and 8 normal eyes. All eyes were imaged twice (30 minutes apart) with the Optovue AngioVue OCTA instrument to obtain 4.5 × 4.5 mm peripapillary scans. Scans were considered good quality if signal strength was 6 or greater. The OCTA parameters obtained include the radial peripapillary capillary (RPC) density of the whole disc, inside the disc, peripapillary region, and the 4 quadrants of the disc (superior, nasal, inferior, and temporal). A Student's t test was used to compare means. Intraclass correlation coefficient (ICC) was calculated to measure repeatability. RESULTS: Repeatability of RPC density measurements for all regions analyzed demonstrated good to excellent repeatability for the whole cohort {ICC for the whole image was 0.915 (95% confidence interval [CI] = 0.855-0.951)}; ICC for the peripapillary region was 0.945 (95% CI = 0.905-0.969). In the subset of eyes with good image quality (i.e., signal strength ≥ 6), ICC was slightly higher for all regions, with excellent repeatability of the peripapillary region (ICC was 0.971 [95% CI = 0.943-0.986]). Conversely, for eyes with poor image quality scans (i.e., signal strength < 6), ICC was lower, corresponding to moderate to good repeatability for most parameters. For the subset of eyes with optic atrophy, disc edema from papilledema or retinal vasculopathy, all had good to excellent repeatability of the vessel density of the entire disc (ICC values were 0.954 [95% CI = 0.804-0.990], 0.921 [95% CI = 0.711-0.982], and 0.895 [95% CI = 0.788-0.951, respectively]) and of the peripapillary region (ICC values were 0.980 [95% CI = 0.904-0.996], 0.966 [95% CI = 0.854-0.993], and 0.916 [95% CI = 0.827-0.961], respectively). CONCLUSIONS: The peripapillary capillary density measurement obtained using a commercial OCTA instrument is highly repeatable in eyes with optic nerve atrophy, disc edema from papilledema, or retinal vasculopathy.

Factors Affecting Repeatability of Foveal Avascular Zone Measurement Using Optical Coherence Tomography Angiography in Pathologic Eyes.

PURPOSE: To determine factors that may affect the repeatability of the foveal avascular zone (FAZ) measurement obtained using optical coherence tomography angiography (OCTA) including instrument type, image segmentation, image quality, and fundus pathology. PATIENTS AND METHODS: This prospective single-center study enrolled 43 subjects (85 eyes) with retinal vasculopathy, macular edema, optic pathology or normal contralateral eye. The macula was imaged twice using Optovue Angiovue and once using Cirrus Angioplex to obtain 3x3mm OCTA images centered on the fovea. Images were generated by the same operator within 30 mins. The FAZ size for the entire retinal thickness ("overall FAZ") was measured automatically using the OCTA software. The FAZ size of the superficial and deep retinal vascular plexus layers was measured manually using the enface OCTA images of the segmented layers and Image J analysis. Intraclass correlations coefficient (ICC) was calculated to determine repeatability. RESULTS: For the overall FAZ measurement, repeatability was excellent (ICC 0.953 right eye, 0.938, left eye) using the same machine (intra-instrument) and somewhat lower but still good to excellent (ICC 0.803 right eye, 0.917 left eye) using machines made by different vendors (inter-instrument). For the segmented layers, intra-instrument repeatability of FAZ measurement was excellent (ICC > 0.95) for both plexus layers. Inter-instrument repeatability was good for the superficial plexus layer (ICC 0.86 right eye, 0.88 left eye) but reduced for the deep plexus layer (ICC 0.63 right eye, 0.57 left eye). Suboptimal image quality and presence of retinal vasculopathy and macular edema tended to reduce FAZ repeatability but to a lesser degree. CONCLUSION: Inter- and intra-instrument repeatability of the overall FAZ measurement was high using commercial OCTA instruments and only mildly reduced by suboptimal image quality and fundus pathology. For segmented layers, intra-instrument repeatability remained high but inter-instrument repeatability was reduced for the deep plexus layer.

Recurrent Orbital Solitary Fibrous Tumor in a 12-Year-Old.

PURPOSE: To report the clinical features and pathology of orbital solitary fibrous tumors and present a case of a recurrence in a 12-year-old boy. METHODS: Case Report. RESULTS: A 12-year-old boy presented to our institution with double vision in upgaze for 6 months. Examination revealed 3 mm of left-sided proptosis, hypoglobus, and -3 impairment of supraduction. Magnetic resonance imaging of the orbits showed an avidly enhancing mass within the superolateral aspect of the orbit. Biopsy revealed a solitary fibrous tumor with STAT6 and CD34 positivity. Positron emission tomography-computed tomography was negative for metastatic disease. The tumor underwent excision. However, 4 months postoperatively, imaging revealed changes consistent with recurrence. A repeat lateral orbitotomy with orbital rim marginotomy was performed with complete gross excision of the tumor. The patient remains tumor-free 22 months after reoperation. CONCLUSION: Orbital solitary fibrous tumor rarely occurs in the pediatric population. Despite initial complete gross tumor excision, this case represents the youngest individual with a recurrence to the authors' knowledge. This case of rapid recurrence may have been due to tumor seeding at the time of initial biopsy or other factors. This case increases the known spectrum of orbital solitary fibrous tumors.

Comparison of the FaroArm Laser Scanner With the MicroScribe Digitizer Using Basicranial Measurements.

PURPOSE: To compare the results of a mechanical 3-dimensional laser scanner for craniofacial measurements of the basicranium to a validated coordinate device. METHODS: Access was granted by the Cleveland Natural History Museum to evaluate the Hamann-Todd Human Osteological Collection for this study. The MicroScribe and the FaroArm were used to gather coordinate data of various bony landmarks measurements including the prosthion, staphylion, hormion, and basion. Seventy-three human skulls were measured and scanned. Distances calculated from the coordinates were tested for agreement using the Bland-Altman test. RESULTS: There were no significant differences in the bias or slope measures between the MicroScribe and the FaroArm. In addition to the univariate test for slope significance, multivariable analysis using age, gender, and race as additional predictors showed no significant difference in any variable (P < 0.05). CONCLUSION: This is the first study demonstrating agreement of the FaroArm in any human skull measurement with the validated MicroScribe digitizer. Compared with the MicroScribe digitizer, the FaroArm allows for 3-dimensional imaging and the ability to store, handle, and view data digitally. Future use of real-time facial measurements using the FaroArm offers potential for improved surgical planning and outcomes.

Online Ratings of ASOPRS Surgeons: What Do Your Patients Really Think of You?

PURPOSE: To characterize patient evaluations of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) surgeons on a popular online physician rating website in an effort to determine which factors play a role in determining the likelihood of a patient recommending an ASOPRS surgeon to family and friends. METHODS: After obtaining approval and access from Healthgrades.com, the website database was searched for 612 U.S.-based ASOPRS members using their name as published on http://www.asoprs.org/ as of May 2015. For each surgeon, the total number of ratings and average ratings were recorded under each category. The evaluator recommendation, defined as the response to the questions of "likelihood of recommending Dr. X to family and friends," constituted the main outcome measure. Variables from each surgeon were compared using unpaired t tests, with statistical significance set at p < 0.05. Correlations were analyzed using Spearman correlation (rs), with coefficients of greater than or equal to 0.40 or less than or equal to -0.40 considered significant. RESULTS: Five-hundred nineteen members (85%) had at least 1 rating while 222 members (36%) had 10 or more ratings. The mean number of ratings for all rated members was 11.4 (range, 1-77; standard deviation [SD] = 11.1) and mean evaluator recommendation score was 4.16 (range, 1-5; SD = 0.79). There was a strong negative correlation between total wait time and evaluator recommendation score (rs = -0.409, p < 0.001). The average number of ratings and rating scores for all categories were not significantly different when comparing male with female members. University-employed members had significantly fewer ratings (8.46; range, 1-52; SD = 9.3) compared with other members (11.9; range, 1-77; SD = 11.3) (p < 0.016). There were no differences in any other rating score when comparing those university-employed members with other members. CONCLUSION: Online patient-reported evaluations of ASOPRS surgeons appear high in many categories. Long wait times correlate strongly with lower recommendation scores. Further study is required to determine how online patient reviews correlate to objective outcome measures, and how these reviews affect surgeon selection by patients.

Effect of general anesthesia in infancy on long-term recognition memory in humans and rats.

Anesthesia in infancy impairs performance in recognition memory tasks in mammalian animals, but it is unknown if this occurs in humans. Successful recognition can be based on stimulus familiarity or recollection of event details. Several brain structures involved in recollection are affected by anesthesia-induced neurodegeneration in animals. Therefore, we hypothesized that anesthesia in infancy impairs recollection later in life in humans and rats. Twenty eight children ages 6-11 who had undergone a procedure requiring general anesthesia before age 1 were compared with 28 age- and gender-matched children who had not undergone anesthesia. Recollection and familiarity were assessed in an object recognition memory test using receiver operator characteristic analysis. In addition, IQ and Child Behavior Checklist scores were assessed. In parallel, thirty three 7-day-old rats were randomized to receive anesthesia or sham anesthesia. Over 10 months, recollection and familiarity were assessed using an odor recognition test. We found that anesthetized children had significantly lower recollection scores and were impaired at recollecting associative information compared with controls. Familiarity, IQ, and Child Behavior Checklist scores were not different between groups. In rats, anesthetized subjects had significantly lower recollection scores than controls while familiarity was unaffected. Rats that had undergone tissue injury during anesthesia had similar recollection indices as rats that had been anesthetized without tissue injury. These findings suggest that general anesthesia in infancy impairs recollection later in life in humans and rats. In rats, this effect is independent of underlying disease or tissue injury.