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1.
J AAPOS ; 28(1): 103813, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38242229

RESUMEN

PURPOSE: To assess the level and the determinants of compliance with outpatient retinopathy of prematurity (ROP) examination appointments at a tertiary academic center. METHODS: The medical records of babies scheduled for outpatient ROP examination between January 1, 2022, and December 31, 2022, were reviewed retrospectively. Data collected included appointments scheduled and attended, birth weight, gestational age, ROP staging at discharge, maternal ethnicity (self-identified), household type, proximity to hospital and median family income (US Census based on home zip codes). Univariate and multivariable analyses were performed. A P value of <0.05 was considered significant. RESULTS: The records of 66 babies were analyzed. Forty-nine babies (74%) attended all scheduled ROP examination appointments (fully compliant). The mean appointment compliance rate was 86%, with a 1.5% no-show rate. Seven children (11%) required the intervention of Child Protective Services. One baby was never seen in the clinic. In unadjusted analysis, maternal ethnicity (P = 0.028) and median family income lower than the national average (P = 0.049) were sociodemographic factors associated with lower compliance. Clinical factors associated with lower compliance were lower gestational ages (P = 0.005) and lower birth weight (P = 0.006). In multivariable logistic regression adjusting for all candidate predictors, only birth weight remained significantly associated with lower compliance (P = 0.036). CONCLUSIONS: Clinical and sociodemographic factors may be associated with compliance with outpatient ROP examination recommendations. Extremely low-birth-weight babies were at the greatest risk for noncompliance.


Asunto(s)
Recien Nacido Prematuro , Retinopatía de la Prematuridad , Recién Nacido , Lactante , Niño , Humanos , Peso al Nacer , Estudios Retrospectivos , Retinopatía de la Prematuridad/diagnóstico , Pacientes Ambulatorios , Factores de Riesgo , Edad Gestacional , Recien Nacido con Peso al Nacer Extremadamente Bajo
2.
Am Heart J Plus ; 29: 100270, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-38510674

RESUMEN

Diabetic retinopathy (DR) is a potentially blinding disease originating from small vessel damage in the retina in chronic hyperglycemic states. DR has a complex multi-pathway driven pathogenesis resulting in diabetic macular edema and retinal ischemia, the former being the most common cause of vision impairment in DR. Hypoxia induced cytokines stimulate vascular endothelial growth factor (VEGF) production and subsequent angiogenesis with resultant mechanical retinal damage over time. Anti-VEGF therapy is effective for the treatment of center-involving diabetic macular edema. There is evolving evidence showing the effectiveness of anti-VEGF as both adjuvant and monotherapy in the treatment of proliferative DR, however laser photocoagulation continues to remain the standard of care. DR in large cohort studies has been shown to be an independent risk factor for the development of cardiovascular disease and mortality. In addition, changes in retinal vascular caliber ratios may have implications for risk of macrovascular events with a gender discrepancy towards women.

3.
Am J Ophthalmol Case Rep ; 24: 101216, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34693076

RESUMEN

PURPOSE: We describe a 61-year-old female patient with a retinal pigment epithelial detachment (PED) of the left eye in the setting of neovascular aged-macular degeneration (nAMD) with unanticipated responses to aflibercept and bevacizumab. OBSERVATIONS: A reduction of PED size from 423 µm to 309 µm and vision improvement (20/150- to 20/40) were observed after five consecutive monthly injections of bevacizumab. A switch to aflibercept for the following two consecutive months showed an unanticipated incremental decline in vision (20/80- at month 1, 20/150- at month 2), increased PED size (749 µm), and the development of subretinal fluid (SRF). After a switch back to bevacizumab, the subretinal fluid resolved. After nine consecutive monthly injections of bevacizumab, final vision in the left eye was 20/25, and final PED height was 84 µm. CONCLUSIONS: Different anti-VEGFs may induce varied and unpredictable responses among the most recalcitrant cases of nAMD. Unpredictably, PED size in our patient worsened with aflibercept treatment. IMPORTANCE: Treatment for nAMD with large PEDs has poor level 1 evidence for guidance, and customized treatment should be considered.

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