Opportunity Cost of Retinal Detachment Surgery vs Office-Based Patient Care.

This work compares physician reimbursements for retinal detachment (RD) surgery with office-based patient care. A theoretical model was constructed from the physician's perspective for performing a 90-minute uncomplicated RD surgery with its associated perioperative work in the global period (Current Procedural Terminology code 67108) compared with managing 40 patients per 8-hour clinic day in the equivalent time period. The reimbursement rates were based on the 2019 values set by the US Centers for Medicare and Medicaid Services (CMS).

Office Examinations-Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy.

Purpose: In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD).

Methods: An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed.

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms.

Background: While the development of targeted molecular therapy to inhibit vascular endothelial growth factor (VEGF) has revolutionized the treatment and visual prognosis of highly prevalent retinal diseases such as diabetic retinopathy and age-related macular degeneration, each intravitreal injection of these agents carries a small risk of endophthalmitis which can be visually devastating. In the absence of specific guidelines, current management of post-injection endophthalmitis is typically extrapolated from data regarding endophthalmitis occurring after cataract surgery despite potential differences in pathogenic organisms and clinical course. Here, we assess the contribution of intravitreal injections of anti-VEGF agents to all cases of endophthalmitis at our tertiary care referral center and characterize the clinical outcomes and microbial pathogens associated with post-injection endophthalmitis in order to inform management of this serious iatrogenic condition.

Choroidal metastases of choriocarcinoma.

Purpose: We present here a patient with choroidal metastases of choriocarcinoma; her clinical and pathologic findings are described.

Methods: Retrospective case study with fundus photographs. A 23-year-old woman presented with a dense vitritis, retinal detachment, and underlying chorioretinal lesions.

Periocular triamcinolone acetonide injections for control of intraocular inflammation associated with uveitis.

Purpose: To describe the effectiveness of periocular corticosteroid injections for the control of intraocular inflammation associated with noninfectious uveitis.

Methods: A total of 81 patients (109 eyes) who received a periocular injection were evaluated for active inflammation, visual acuity, intraocular pressure, degree of intraocular inflammation, and the presence of ocular complications, including macular edema.

Results: Of all eyes, 36% (95%CI: 25%, 45%) demonstrated clinical resolution of inflammation at the 1-month visit after first injection, and 48% (95%CI: 37%, 59%) at 3 months.

Ocular tolerability and efficacy of intravitreal and subconjunctival injections of sirolimus in patients with non-infectious uveitis: primary 6-month results of the SAVE Study.

Background: The purpose of this study is to evaluate the ocular tolerability and efficacy of sirolimus administered as subconjunctival or intravitreal injections in patients with non-infectious uveitis. Sirolimus as a Therapeutic Approach for Uveitis (SAVE) is a prospective, randomized, open-label, interventional study. Thirty patients were enrolled and randomized in 1:1 ratio to receive either intravitreal injections of 352 μg sirolimus or subconjunctival injections of 1,320 μg at days 0, 60, and 120, with primary endpoint at month 6.

Ultra-wide-field retinal imaging in the management of non-infectious retinal vasculitis.

Background: The purpose of this study is to describe and quantify the benefit of ultra-wide-field imaging and fluorescein angiography (FA) in the management of non-infectious retinal vasculitis. In this prospective observational cohort series, patients with non-infectious retinal vasculitis were evaluated and enrolled by four investigators from the Divisions of Retina and Ocular Immunology at the Wilmer Eye Institute. In each patient, disease activity and the need for management changes were assessed, based on clinical examination with or without standard (60°) imaging and then with the addition of ultra-wide-field pseudo-color scanning laser ophthalmoscope (SLO) images and FA using the Optos ultra-wide-field SLO (Optos Panoramic 200MA™, Optos PLC, Dunfermline, Scotland, UK).

Wide-field retinal imaging in the management of noninfectious posterior uveitis.

Purpose: To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis.

Design: Prospective, observational case series.

Methods: setting: Divisions of Retina and Ocular Immunology at single academic medical center.

Rabbit intraocular reactivity to endotoxin measured by slit-lamp biomicroscopy and laser flare photometry.

Objective: To evaluate the ocular reactivity of the rabbit to an intracameral injection of a dispersive ophthalmic viscosurgical device (OVD) containing various levels of bacterial endotoxin using slit-lamp biomicroscopy and laser flare photometry.

Design: Experimental, randomized, masked animal study.

Participants: Thirty Dutch-Belted rabbits.

An investigation of enzymatic detergents as a potential cause of toxic anterior segment syndrome.

Objective: To investigate whether enzymatic detergents used in cleaning ophthalmic surgical instruments can cause toxic anterior segment syndrome (TASS)-like responses in a rabbit model.

Design: Randomized, investigator-masked, controlled experimental animal study.

Participants: Thirty-five New Zealand white rabbits.

Periocular triamcinolone acetonide injections for cystoid macular edema complicating noninfectious uveitis.

Purpose: To describe the effectiveness of periocular corticosteroid injections in the treatment of cystoid macular edema (CME) complicating noninfectious uveitis.

Design: Retrospective cohort study.

Methods: A total of 126 patients (156 eyes) were evaluated for presence of CME, visual acuity, intraocular pressure, degree of intraocular inflammation, and the presence of ocular complications.

Transient band keratopathy associated with ocular inflammation and systemic hypercalcemia.

Purpose: To report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors.

Methods: Retrospective case report.

Results: A 53-year-old Asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea.

Papillary conjunctivitis associated with Kikuchi disease.

Purpose: To describe a case of papillary conjunctivitis associated with Kikuchi-Fujimoto disease (KFD).

Methods: Case report.

Results: A 35-year-old black man developed bilateral eye redness before developing high fevers and cervical lymphadenopathy.

Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammation.

Purpose: To compare the relative effectiveness and side effect profiles of antimetabolite drugs in the treatment of noninfectious ocular inflammation.

Design: Retrospective cohort study.

Participants: A total of 257 patients with inflammatory eye disease seen in a single-center, academic practice and treated with an antimetabolite as a first-line immunosuppressive agent from 1984 to 2006.

Six days in Charity Hospital: two doctors' ordeal in Hurricane Katrina.

Hurricane Katrina devastated the city of New Orleans as well as a large section of the Gulf Coastal region of the United States. Herein, we present a first-hand view of physicians who were actually running the hospital of a major medical center during this natural disaster. This event demonstrates the vulnerability of basic human services, including health care even in industrialized, wealthy countries.

Six days in Charity Hospital: two doctors' ordeal in Hurricane Katrina.

Hurricane Katrina devastated the city of New Orleans as well as a large section of the Gulf Coastal region of the United States. Herein, we present a first-hand view of physicians who were actually running the hospital of a major medical center during this natural disaster. This event demonstrates the vulnerability of basic human services, including health care even in industrialized, wealthy countries.