Primary IOL implantation in children: the effect of the Infant Aphakia Treatment Study on practice patterns.

We report the long-term effects on practice patterns at a single institution before (1995-2004) and after (2009-2018) publication of the results of the Infant Aphakia Treatment Study (IATS). The medical records of children <7 months of age who underwent cataract surgery at the Medical University of South Carolina were reviewed. The main outcome measure was the treatment with primary IOL or primary aphakia at the time of surgery. A total of 273 eyes of 183 patients were analyzed. Of the unilaterally affected eyes, primary IOL was the treatment of choice in 28 of the pre-IATS cases (61%) and 3 of the post-IATS cases (6%). In bilaterally affected eyes, primary IOL was the treatment of choice in 18 of the pre-IATS cases (47%) and 11 of the post-IATS cases (23%). According to a year-wise calculation, treatment with primary IOL began to decrease in 2010 and 2011, following publication of the 1-year results of the IATS in 2010. A drastic decrease in primary IOL occurred in 2015, following publication of the 5-year results.

Association Between Dry Eye Disease and Migraine Headaches in a Large Population-Based Study.

Importance: Reports in the literature have conflicting findings about an association between dry eye disease (DED) and migraine headaches. Objective: To determine the strength of the association between DED and migraine headaches. Design, Setting, and Participants: This retrospective case-control study included 72 969 patients older than 18 years from University of North Carolina-affiliated health care facilities from May 1, 2008, through May 31, 2018. Deidentified aggregate patient data were queried; data were analyzed from June 1 through June 30, 2018. Exposures: Diagnosis of migraine headache. Main Outcomes and Measures: Odds ratios calculated between DED and migraine headaches for participants as a whole and stratified by sex and age group. Results: The base population consisted of 72 969 patients, including 41 764 men (57.2%) and 31 205 women (42.8%). Of these, 5352 patients (7.3%) carried a diagnosis of migraine headache, and 9638 (13.2%) carried a diagnosis of DED. The odds of having DED given a diagnosis of migraine headaches was 1.72 (95% CI, 1.60-1.85) times higher than that of patients without migraine headaches. After accounting for multiple confounding factors, the odds of having DED given a diagnosis of migraine headaches was 1.42 (95% CI, 1.20-1.68) times higher than that of patients without migraine headaches. Conclusions and Relevance: These findings suggest that patients with migraine headaches are more likely to have comorbid DED compared with the general population. Although this association may not reflect cause and effect if unidentified confounders account for the results, these data suggest that patients with migraine headaches may be at risk of carrying a comorbid diagnosis of DED.

Automated tube voltage selection for radiation dose and contrast medium reduction at coronary CT angiography using 3(rd) generation dual-source CT.

OBJECTIVES: To investigate the relationship between automated tube voltage selection (ATVS) and body mass index (BMI) and its effect on image quality and radiation dose of coronary CT angiography (CCTA). METHODS: We evaluated 272 patients who underwent CCTA with 3(rd) generation dual-source CT (DSCT). Prospectively ECG-triggered spiral acquisition was performed with automated tube current selection and advanced iterative reconstruction. Tube voltages were selected by ATVS (70-120 kV). BMI, effective dose (ED), and vascular attenuation in the coronary arteries were recorded. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Five-point scales were used for subjective image quality analysis. RESULTS: Image quality was rated good to excellent in 98.9 % of examinations without significant differences for proximal and distal attenuation (all p ≥ .0516), whereas image noise was rated significantly higher at 70 kV compared to ≥100 kV (all p < .0266). However, no significant differences were observed in SNR or CNR at 70-120 kV (all p ≥ .0829). Mean ED at 70-120 kV was 1.5 ± 1.2 mSv, 2.4 ± 1.5 mSv, 3.6 ± 2.7 mSv, 5.9 ± 4.0 mSv, 7.9 ± 4.2 mSv, and 10.7 ± 4.1 mSv, respectively (all p ≤ .0414). Correlation analysis showed a moderate association between tube voltage and BMI (r = .639). CONCLUSION: ATVS allows individual tube voltage adaptation for CCTA performed with 3(rd) generation DSCT, resulting in significantly decreased radiation exposure while maintaining image quality. KEY POINTS: • Automated tube voltage selection allows an individual tube voltage adaption in CCTA. • A tube voltage-based reduction of contrast medium volume is feasible. • Image quality was maintained while radiation exposure was significantly decreased. • A moderate association between tube voltage and body mass index was found.