Purpose: The principles of the Lean methodology, introduced by Toyota to improve productivity, are relevant to other settings, including healthcare. We aimed to use Lean methodology to design a new setting in our ophthalmology clinic to improve the management of patients receiving an intravitreal injection for ocular diseases.
Methods: The location of services, days of operation, scheduling and processing of patients, utilization of staff, data recording methods, and examination and surgical procedures were analyzed, and a new Intravitreal Injection Center was developed according to Lean principles.
A 45-year-old Caucasian myopic woman with a severe vision impairment (20/320) in the left eye due to a macula-off rhegmatogenous retinal detachment (RRD) underwent vitrectomy with silicone oil tamponade followed by an inferior relaxing retinectomy with heavy silicone oil tamponade during the second procedure for recurrence of RRD due to proliferative vitreoretinopathy. Four weeks after the second surgery, visual acuity was 20/200 and the patient complained metamorphopsia in the same eye due to a large full-thickness macular hole. A perfluorocarbon liquid-assisted inverted inner limiting membrane-flap technique was performed.
View Article and Find Full Text PDFPurpose: To report the occurrence of endophthalmitis and other complications after intravitreal injections (IVIs) in the Arc Sterile setting.
Methods: A retrospective study that enrolled all patients who underwent IVIs between November 2017 and March 2019, collecting data about the patient's gender and age, type of injected drug, diagnosis, other ocular pathologies, physician and possible occurrence of endophthalmitis, or other complications.
Results: Ten thousand and eighty-three IVIs were performed during the study period, involving 2014 eyes of 1,670 patients with an average age of 71.
Background: Inverted Internal Limiting Membrane (ILM)-flap technique would seem to lead to higher closure rate and better visual acuity than traditional procedure with ILM peeling for the treatment of large macular hole (LMH). Visual acuity recovery does not reveal many other functional changes related to surgical approach. Our purpose was to evaluate macular function and morphology over a 1-year follow-up after inverted ILM-flap technique for LMH by using microperimetry in order to predict visual prognosis.
View Article and Find Full Text PDFObjective: To evaluate the morphologic and functional outcomes of different optical coherence tomography (OCT) patterns of myopic foveoschisis after vitrectomy with Inner Limiting Membrane (ILM) peeling.
Methods: In this prospective non-randomised study, 62 consecutive eyes with Myopic Foveoschisis were categorised into three groups according to OCT pattern: retinoschisis type (Rt) Group (23/62), foveal detachment type (FDt) Group (20/62) and macular hole type (MHt) Group (19/62). All patients underwent 25-Gauge vitrectomy and ILM peeling.
Purpose: To analyze anatomic and functional retinal changes and their correlation after intravitreal dexamethasone implant (DEX implant) in patients with central retinal vein occlusion- (CRVO-) related macular edema (ME) using optical coherence tomography and microperimetry.
Methods: Fifteen treatment-naïve patients with functional impairment due to CRVO-related ME were enrolled in this prospective interventional case series. Main outcomes were best-corrected visual acuity (BCVA), retinal sensitivity (RS), and central retinal thickness (CRT).
Purpose: To analyze morphologic and functional changes after inverted internal limiting membrane-flap technique for optic disk pit maculopathy using optical coherence tomography, multifocal electroretinography, and microperimetry.
Methods: One case report.
Results: A 30-year-old woman presented us with decreased visual acuity (20/63) in the left eye because of retinoschisis and serous macular detachment associated with optic disk pit.
Purpose: To study if cauterization of the scleroconjuctival wound secondary to intravitreal dexamethasone implant in vitrectomized eyes is effective to avoid scleral leakage and hypotony.
Methods: A total of 35 vitrectomized eyes of 35 consecutive patients with macular edema who underwent a single intravitreal dexamethasone implant injection in the operating room at the Eye Clinic of the University of Bari, Italy, from 2013 to 2017 were retrospectively reviewed. At the end of the injection, transconjuctival/scleral bipolar cauterization was applied at the injection site and the presence or absence of leakage or hypotony was studied.
Purpose: To report optical coherence tomography and microperimetric correlated changes in a case of bilateral foveal schisis in progressive X-linked retinoschisis (XLRS) treated with vitrectomy, inner limiting membrane (ILM) peeling, and air tamponade.
Methods: One case report.
Results: An 18-year-old boy with bilateral foveal schisis in progressive XLRS underwent vitrectomy, ILM peeling and air tamponade in both eyes.
Purpose: To report the clinical features and management of mitogen-activated protein kinase kinase inhibitor-associated ocular side effects in 4 patients with advanced melanoma and a review of literature.
Design: Interventional case series.
Methods: Four patients with advanced cutaneous melanoma were treated with a mitogen-activated protein kinase kinase (MEK) inhibitor as single therapy or together with a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitor.
Purpose: To study the efficacy of a single 0.7 mg dexamethasone intravitreal implant in vitrectomized eyes with refractory macular edema secondary to combined cataract extraction and macular pucker removal.
Methods: In 8 eyes of 8 consecutive patients with refractory macular edema secondary to combined cataract extraction and 25-gauge vitrectomy with internal limiting membrane peeling for macular pucker removal, the injection of the 0.
Purpose: To retrospectively study the efficacy of a single 0.7-mg dexamethasone intravitreal implant in eyes with refractory macular edema secondary to uncomplicated phacoemulsification and intraocular lens implant.
Methods: In 11 eyes of 11 consecutive patients with persistent refractory macular edema, secondary uncomplicated cataract extraction, and intraocular lens implant, the injection of 0.
Purpose: To evaluate the efficacy of bipolar diathermy in ensuring closure of leaking sclerotomies after complete 23-gauge transconjunctival sutureless vitrectomy.
Methods: In this prospective, interventional case series, in 136 eyes of 136 patients with at least one leaking sclerotomy at the end of a complete 23-gauge transconjunctival sutureless vitrectomy, external bipolar wet-field diathermy was applied to leaking sclerotomies, including the conjunctiva and sclera. Intraoperative wound closure, and postoperatively, at 6 hours, 1 day and 3 days, sclerotomies leakage, intraocular pressure, hypotony, and hypotony-related complications were evaluated.
Unlabelled: We describe a technique to stain the anterior lens capsule with micronized triamcinolone to perform a continuous curvilinear capsulorhexis (CCC) during phacoemulsification in the absence of a red reflex due to vitreous hemorrhage. After a self-sealing clear corneal tunnel incision is performed using a 2.75 mm blade, a dispersive ophthalmic viscosurgical device (OVD) is injected to protect the iridocorneal angle.
View Article and Find Full Text PDFPurpose: This study aimed to evaluate the efficacy of multiple injections of intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
Methods: Twelve eyes of 12 patients (mean age 76 +/- 6 years) with mean best corrected visual acuity (BCVA) of 20/100 and occult subfoveal CNV at fluorescein angiography (FA), indocyanine-green (ICG) angiography and optical coherence tomography (OCT), showing intra- or subretinal fluid with or without retinal pigment epithelial detachment (PED), underwent multiple intravitreal injections (mean 2.4 +/- 0.
Background: To compare pars plana vitrectomy (PPV) with 1300 cs silicone oil and scleral buckle (SB) vs PPV with Oxane HD tamponade for rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRB).
Methods: Twenty eyes of 20 consecutive patients with primary inferior RRD and PVR >or=CP2 were alternatively assigned to PPV and 1300 cs silicone oil and segmental SB in the inferior periphery (group 1, n = 10) or PPV with Oxane HD (group 2, n = 10) in order of presentation. Silicone oil/Oxane HD removal was performed 12 weeks after surgery.
Purpose: To determine whether triamcinolone acetonide (TAAC) staining facilitates posterior hyaloid and epiretinal membrane (ERM) removal in patients undergoing pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR).
Methods: Ten consecutive pseudophakic patients (10 eyes) underwent PPV for RRD with PVR. After a core PPV, a few drops of a commercially available TAAC aqueous suspension (40 mg/mL) with vehicle were injected into the mid vitreous cavity to visualize the posterior hyaloid, thus allowing a complete posterior hyaloidectomy.
Purpose: To evaluate the effect on the corneal endothelium of phacoemulsification combined with passive silicone oil removal and intraocular lens (IOL) implantation under topical anesthesia after pars plana vitrectomy.
Setting: Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy.
Methods: This retrospective study evaluated the corneal endothelium in 17 consecutive patients (17 eyes) who had phacoemulsification with transpupillary passive silicone oil washout (1300 centistokes) through a posterior capsulorhexis and single clear corneal incision and foldable acrylic IOL implantation.
Purpose: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia.
Setting: Department of Ophthalmology, University of Bari, Bari, Italy.
Methods: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes).