One-year follow-up of a new posterior chamber toric phakic intraocular lens implantation for moderate-to-high myopic astigmatism.

PURPOSE: To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. METHODS: The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from - 4.50 to - 18.50 diopters (D) and cylindrical refraction from - 0.50 to - 5.50 D. RESULTS: This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from - 10.45 ± 2.74 D preoperatively to - 0.34 ± 0.51 D and - 0.40 ± 0.56 D at 6 and 12 months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00 D and ± 0.50 D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. CONCLUSIONS: The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

Effects of Nd-YAG Laser iridotomy on anterior segment measurements in pigment dispersion syndrome and ocular hypertension.

PURPOSE: To compare the anterior segment optical coherence tomography (AS-OCT) measurements of eyes with pigment dispersion syndrome (PDS) and ocular hypertension (OHT) before and after neodymium:yttrium-aluminum-garnet (Nd:YAG) laser peripheral iridotomy (LPI). METHODS: A total of 23 eyes of 23 patients with PDS and OHT with features of PDS were included in this retrospective study. All of the eyes with PDS and OHT were examined by AS-OCT before and after Nd:YAG LPI. Anterior chamber depth, angle opening distance 500, angle opening distance 750, trabecular iris space 500, trabecular iris space 750 and scleral spur angle, iris bowing and iris shape were measured with AS-OCT by the same examiner. RESULTS: The differences in all parameters before and after Nd:YAG LPI were statistically significant. Iris configuration was concave in all eyes prior to iridotomy. After Nd:YAG laser iridotomy, the iris configuration became convex in 7 eyes, flat in 9 eyes and remained concave in 7 eyes. CONCLUSION: Nd:YAG laser peripheral iridotomy is an effective method for reversing the iris concavity and iris bowing in pigment dispersion syndrome.

Long-term assessment of visual and refractive outcomes of laser in situ keratomileusis for hyperopia using the AMARIS® 750S Excimer laser.

PURPOSE: To evaluate the long-term efficacy and safety of hyperopic laser in situ keratomileusis (LASIK) using the AMARIS® 750S (Schwind, Eye-tech-solutions, GmbH) excimer laser. METHODS: The medical records of one hundred eleven eyes of 62 patients who underwent LASIK for hyperopia using the AMARIS® 750S excimer laser were reviewed retrospectively. Patients were divided into three groups based on preoperative spherical equivalent (SE) refraction: low hyperopia (less than +2.50 diopters [D]), moderate hyperopia (+2.75D to +4.00D), and high hyperopia (over +4.00D). Uncorrected and best corrected visual acuity (BCVA), long-term stability of refraction, and complications were evaluated. RESULTS: Of the entire sample, the mean preoperative SE was +3.64D±1.22D. The mean age was 37.4±11.2 years (20-59). The mean follow-up for all eyes was 51 months. At the last visit, the mean SE was +0.85D±0.34D (SD) in the low hyperopia group, +1.09D±0.43D in the moderate hyperopia group, and +1.63D±0.47D in the high hyperopia group. (+1.15D±0.49D overall). Preoperative uncorrected visual acuity (UCVA) was 0.52±0.34 logMAR and increased to 0.18±0.15 logMAR at 4 years follow-up (P<0.01). There was no statistically significant difference between preoperative and postoperative BCVA. The UCVA was 0.30 logMAR or better in 100% of eyes in the low hyperopia group, 93.7% in the moderate hyperopia group, and 69.9% in the high hyperopia group (%89.2 overall). CONCLUSIONS: LASIK is safe and effective for correcting hyperopia in the short term; however, the efficacy of the procedure is limited in the patients with high hyperopia and longer follow-up.

Monitoring adherence to evidence-based practices: a method to utilize HL7 messages from hospital information systems.

BACKGROUND: Clinical pathways are evidence-based recommendations for treating a diagnosis. Although implementations of clinical pathways have reduced medical errors, lowered costs, and improved patient outcomes, monitoring whether a patient is following the intended pathway is problematic. Implementing a variance reporting program is impeded by the lack of a reliable source of electronic data and automatic retrieval methods. OBJECTIVES: Our objective is to develop an automated method of measuring and reporting patient variance from a clinical pathway. METHODS: We identify a viable and ubiquitous data source for establishing the realized patient's path- Health Level Seven (HL7) formatted message exchanges between Hospital Information Systems. This is in contrast to current practices in most hospitals where data for clinical pathway variance reporting is obtained from multiple data sources, often retrospectively. This paper develops a method to use message exchanges to automatically establish and compare a patient's path against a clinical pathway. Our method not only considers pathway activities as is common practice, but also extracts patient outcomes from HL7 messages and reports this in addition to the variance. RESULTS: Using data from our partner hospital, we illustrate our clinical pathway variance analysis tool using major joint replacement patients. We validate our method by comparing audit results for a random sample of HL7 constructed pathways with data extracted from patient charts. We report several variances such as omitted laboratory tests or additional activities such as blood transfusions. Our method successfully identifies variances and reports them in a quantified way to support decisions related to quality control. CONCLUSIONS: OUR APPROACH DIFFERS FROM PREVIOUS STUDIES IN THAT A QUANTITATIVE MEASURE IS ESTABLISHED OVER THREE DIMENSIONS: (1) omissions from the pathway, (2) additions to the pathway, and (3) patient outcomes. By examining variances providers can evaluate clinical decisions, and support quality feedback and training mechanisms.