Pub Date : 2024-02-26DOI: 10.1177/24741264241234132
Oluwasegun A. Akinyemi, Leslie S. Jones MD, Alejandro Ochoa, Luke Nelson, Terhas A. Weldeslase, Salman J. Yousuf
Purpose: To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). Methods: All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018–2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Results: Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; P = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; P < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; P < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; P = .001) compared with private insurance. Conclusions: The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.
{"title":"Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California","authors":"Oluwasegun A. Akinyemi, Leslie S. Jones MD, Alejandro Ochoa, Luke Nelson, Terhas A. Weldeslase, Salman J. Yousuf","doi":"10.1177/24741264241234132","DOIUrl":"https://doi.org/10.1177/24741264241234132","url":null,"abstract":"Purpose: To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). Methods: All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018–2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Results: Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; P = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; P < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; P < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; P = .001) compared with private insurance. Conclusions: The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140429567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1177/24741264241231091
Sean C. Drummond, J. N. Crosson, John O. Mason
Purpose: To evaluate the long-term visual results of vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) removal for idiopathic ERM in eyes with a preoperative visual acuity (VA) of 20/50 or better. Methods: This retrospective review of a consecutive case series comprised 337 patients. Of these, 36 eyes of 36 patients had ERM and ILM removal from 2017 to 2018. Inclusion criteria included a subjective decrease in VA, a preoperative VA of 20/50 or better, vitrectomy with ERM and ILM removal for ERM, and a minimum 6-month follow-up. Paired t tests were used to determine the statistical significance ( P < .05) of VA changes postoperatively. Results: The mean (±SD) best-corrected logMAR VA improved to a maximum of 0.125 ± 0.09 (Snellen equivalent 20/26.4) at a mean of 11.1 months postoperatively ( P < .001). The VA continued to significantly improve over the long term (mean, 41.6 months; range, 6-63; P < .001). Overall long-term data trended heavily toward VA improvement (25/36 patients [69.4%]) and stability (10/36 patients [27.7%)] after ERM and ILM removal, with only 1 patient (2.8%) having worse VA. There were no intraoperative or postoperative complications related to ERM and ILM removal. Conclusions: Surgery to remove idiopathic ERM and ILM for patients with significant symptoms and good preoperative VA may result in excellent long-term visual results.
目的：评估对术前视力（VA）在 20/50 或更佳的特发性视网膜外膜（ERM）进行玻璃体切除术并切除视网膜外膜和内限制膜（ILM）的长期视觉效果。方法：该回顾性系列病例包括 337 名患者。其中，36 名患者的 36 只眼睛在 2017 年至 2018 年期间进行了 ERM 和 ILM 摘除术。纳入标准包括VA主观下降、术前VA为20/50或更好、玻璃体切除术合并ERM和ILM摘除术治疗ERM，以及至少6个月的随访。采用配对 t 检验确定术后 VA 变化的统计学意义（P < .05）。结果：术后平均 11.1 个月时，最佳校正 logMAR VA 平均值（±SD）提高到 0.125 ± 0.09（斯奈伦等效值 20/26.4）（P < .001）。长期来看，视力持续明显改善（平均 41.6 个月；6-63 个月；P < .001）。总体长期数据显示，切除 ERM 和 ILM 后，视力明显改善（25/36 例患者[69.4%]）和稳定（10/36 例患者[27.7%]），只有 1 例患者（2.8%）视力恶化。切除 ERM 和 ILM 术中和术后均未出现并发症。结论：对症状明显、术前视力良好的特发性ERM和ILM患者进行手术切除，可获得良好的长期视觉效果。
{"title":"Long-Term Outcomes of Vitrectomy for Idiopathic Epiretinal Membrane With Internal Limiting Membrane Removal in Patients With Good Preoperative Visual Acuity","authors":"Sean C. Drummond, J. N. Crosson, John O. Mason","doi":"10.1177/24741264241231091","DOIUrl":"https://doi.org/10.1177/24741264241231091","url":null,"abstract":"Purpose: To evaluate the long-term visual results of vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) removal for idiopathic ERM in eyes with a preoperative visual acuity (VA) of 20/50 or better. Methods: This retrospective review of a consecutive case series comprised 337 patients. Of these, 36 eyes of 36 patients had ERM and ILM removal from 2017 to 2018. Inclusion criteria included a subjective decrease in VA, a preoperative VA of 20/50 or better, vitrectomy with ERM and ILM removal for ERM, and a minimum 6-month follow-up. Paired t tests were used to determine the statistical significance ( P < .05) of VA changes postoperatively. Results: The mean (±SD) best-corrected logMAR VA improved to a maximum of 0.125 ± 0.09 (Snellen equivalent 20/26.4) at a mean of 11.1 months postoperatively ( P < .001). The VA continued to significantly improve over the long term (mean, 41.6 months; range, 6-63; P < .001). Overall long-term data trended heavily toward VA improvement (25/36 patients [69.4%]) and stability (10/36 patients [27.7%)] after ERM and ILM removal, with only 1 patient (2.8%) having worse VA. There were no intraoperative or postoperative complications related to ERM and ILM removal. Conclusions: Surgery to remove idiopathic ERM and ILM for patients with significant symptoms and good preoperative VA may result in excellent long-term visual results.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.1177/24741264241233384
Natasha P. Kesav, Suzie Kim, Tsun-Kang Chiang, Maroun Matta, Kord Honda, Shree K. Kurup
Purpose: To examine an underreported and underdiagnosed phenomenon with implications for the pathophysiological mechanisms of tattoo-induced uveitis. Methods: Two cases highlighting the clinical presentation of tattoo-related uveitis were evaluated. Results: A 28-year-old man with biopsy-proven sarcoidosis and ocular manifestations presented with worsening retinal vasculitis after acquiring a red-ink tattoo. Each subsequent flare followed acquisition of a new tattoo. A 31-year-old woman without systemic sarcoidosis presented with multiple episodes of bilateral intermediate uveitis and macular edema concurrent with inflammatory granulomas to recently acquired black-ink tattoos. A skin biopsy in both patients showed cutaneous noncaseating granulomas. Conclusions: These cases add to those reported in the literature and emphasize the importance of understanding the modifiable factors of inflammatory ocular disease. Future study is necessary to understand the mechanisms of tattoo-related uveitis.
{"title":"Tattoo-Induced Exacerbations of Systemic Disease and Uveitis","authors":"Natasha P. Kesav, Suzie Kim, Tsun-Kang Chiang, Maroun Matta, Kord Honda, Shree K. Kurup","doi":"10.1177/24741264241233384","DOIUrl":"https://doi.org/10.1177/24741264241233384","url":null,"abstract":"Purpose: To examine an underreported and underdiagnosed phenomenon with implications for the pathophysiological mechanisms of tattoo-induced uveitis. Methods: Two cases highlighting the clinical presentation of tattoo-related uveitis were evaluated. Results: A 28-year-old man with biopsy-proven sarcoidosis and ocular manifestations presented with worsening retinal vasculitis after acquiring a red-ink tattoo. Each subsequent flare followed acquisition of a new tattoo. A 31-year-old woman without systemic sarcoidosis presented with multiple episodes of bilateral intermediate uveitis and macular edema concurrent with inflammatory granulomas to recently acquired black-ink tattoos. A skin biopsy in both patients showed cutaneous noncaseating granulomas. Conclusions: These cases add to those reported in the literature and emphasize the importance of understanding the modifiable factors of inflammatory ocular disease. Future study is necessary to understand the mechanisms of tattoo-related uveitis.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-18eCollection Date: 2024-03-01DOI: 10.1177/24741264241227684
Paul T Finger
Purpose: To describe the first use of high-dose-rate yttrium-90 disc brachytherapy for choroidal melanoma. Methods: A 72-year-old patient had a cT1-category choroidal melanoma characterized by the presence of orange pigment, increasing subretinal fluid (SRF), and enlarging tumor thickness. It was treated with single-session, light-guided, light-defined yttrium-90-disc brachytherapy. Results: A specialized handheld applicator provided with 4 encircling lights was used to guide plaque placement and localize treatment. Unlike low-dose-rate plaques, high-dose-rate yttrium-90 required only 3 minutes 39 seconds. In this case, treatment did not require episcleral sutures, muscle relocation, outpatient dwell time, or a second surgery. High-dose-rate treatment improved radiation safety by eliminating perioperative exposure to health care personnel, the community, and the family. At the 13-month follow-up, the SRF and tumor thickness were diminished. There was no secondary cataract, radiation retinopathy, maculopathy, or optic neuropathy, and the visual acuity was 20/20. Conclusions: Yttrium-90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of a choroidal melanoma.
{"title":"Yttrium-90 Episcleral Plaque Brachytherapy for Choroidal Melanoma.","authors":"Paul T Finger","doi":"10.1177/24741264241227684","DOIUrl":"10.1177/24741264241227684","url":null,"abstract":"<p><p><b>Purpose:</b> To describe the first use of high-dose-rate yttrium-90 disc brachytherapy for choroidal melanoma. <b>Methods:</b> A 72-year-old patient had a cT1-category choroidal melanoma characterized by the presence of orange pigment, increasing subretinal fluid (SRF), and enlarging tumor thickness. It was treated with single-session, light-guided, light-defined yttrium-90-disc brachytherapy. <b>Results:</b> A specialized handheld applicator provided with 4 encircling lights was used to guide plaque placement and localize treatment. Unlike low-dose-rate plaques, high-dose-rate yttrium-90 required only 3 minutes 39 seconds. In this case, treatment did not require episcleral sutures, muscle relocation, outpatient dwell time, or a second surgery. High-dose-rate treatment improved radiation safety by eliminating perioperative exposure to health care personnel, the community, and the family. At the 13-month follow-up, the SRF and tumor thickness were diminished. There was no secondary cataract, radiation retinopathy, maculopathy, or optic neuropathy, and the visual acuity was 20/20. <b>Conclusions:</b> Yttrium-90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of a choroidal melanoma.</p>","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10924596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-17DOI: 10.1177/24741264241228652
Katherine Harbeck, Connor J. Ericksen, William Johnson, David Massop, Peter Bracha
Purpose: To report a case of pachychoroid associated with acute retinal necrosis secondary to varicella zoster virus (VZV). Methods: A retrospective review of a single case was performed. Results: The VZV-related acute retinal necrosis with pachychoroid resolved with quiescence of the acute infectious process. Conclusions: Acute retinal necrosis can result in choroidal thickening adjacent to retinitis. Previous reports have described choroidal sparing in these cases.
{"title":"Pachychoroid Associated With Acute Retinal Necrosis Secondary to Varicella Zoster Virus","authors":"Katherine Harbeck, Connor J. Ericksen, William Johnson, David Massop, Peter Bracha","doi":"10.1177/24741264241228652","DOIUrl":"https://doi.org/10.1177/24741264241228652","url":null,"abstract":"Purpose: To report a case of pachychoroid associated with acute retinal necrosis secondary to varicella zoster virus (VZV). Methods: A retrospective review of a single case was performed. Results: The VZV-related acute retinal necrosis with pachychoroid resolved with quiescence of the acute infectious process. Conclusions: Acute retinal necrosis can result in choroidal thickening adjacent to retinitis. Previous reports have described choroidal sparing in these cases.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139959965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. HbA1c at the follow-up was significantly lower in the bariatric surgery group (6.4 vs 8.5; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group ( P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusion: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden after bariatric surgery, which may have a significant impact on quality of life for patients with DR.
目的：与对照组相比，评估减肥手术后患者糖尿病视网膜病变（DR）的严重程度、进展和治疗负担。方法：对接受过减肥手术的糖尿病视网膜病变患者进行回顾性队列研究：对 2014 年至 2023 年期间在杜克大学眼科中心就诊的 2 型糖尿病和 DR 患者进行回顾性队列研究。临床数据包括血红蛋白 A1c (HbA1c)、DR 诊断阶段、糖尿病黄斑水肿 (DME) 或玻璃体出血 (VH)、视力 (VA) 以及基线和随访时的治疗负担。为了考虑同一患者两只眼睛之间的相关性，采用了广义估计方程分析法。结果根据年龄、性别和糖尿病病程，将 16 名接受减肥手术的患者与同期接受药物治疗的 60 名对照组患者进行配对。在基线检查时，患者的 HbA1c 水平、DR 严重程度、是否存在 DME 或 VH、VA 和治疗负担均无显著差异（均 P > .05）。患者平均接受了 6 年的随访。随访时，减肥手术组的 HbA1c 明显降低（6.4 vs 8.5；P < .001）。在随访中，减肥手术组的治疗负担比对照组有所减轻（P = .04）。在随访过程中，减肥手术组的 DR 进展和治疗负担都有明显的减少趋势。结论减肥手术可改善血糖控制、稳定 DR 进展并减轻减肥手术后的治疗负担，这可能会对 DR 患者的生活质量产生重大影响。
{"title":"Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy","authors":"Ariana Allen, Hemal Patel, Sandra Stinnett, Jullia A. Rosdahl, Stefanie Schuman","doi":"10.1177/24741264241231185","DOIUrl":"https://doi.org/10.1177/24741264241231185","url":null,"abstract":"Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. HbA1c at the follow-up was significantly lower in the bariatric surgery group (6.4 vs 8.5; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group ( P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusion: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden after bariatric surgery, which may have a significant impact on quality of life for patients with DR.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1177/24741264241230147
Tessnim R. Ahmad, Sriranjani Padmanabhan, Jesse J. Jung
Purpose: To report a case of severe eye pain developing during dialysis. Methods: A case report was performed. Results: A 41-year-old man with uncontrolled type 2 diabetes and end-stage nephropathy developed severe left eye pain during hemodialysis. A decline in vision in both eyes was reported over the preceding year, with blindness in the left eye for 6 months. The best-corrected visual acuity was 20/150 right eye (OD) and light perception left eye (OS). The intraocular pressure was 14 mm Hg and 59 mm Hg, respectively. An examination found disc neovascularization with a “volcanic eruption” of vitreous hemorrhage from the optic nerve in the right eye and significant corneal edema and iris neovascularization with no posterior view in the left eye. The patient required urgent cyclophotocoagulation for neovascular glaucoma (NVG) in the left eye, bilateral antivascular endothelial growth factor injections, and panretinal photocoagulation in the right eye for proliferative diabetic retinopathy. Conclusions: Worsening eye pain during hemodialysis in a patient with NVG indicates severely limited outflow capacity and requires immediate intervention.
{"title":"Eye Pain During Hemodialysis in Severe Proliferative Diabetic Retinopathy With Neovascular Glaucoma","authors":"Tessnim R. Ahmad, Sriranjani Padmanabhan, Jesse J. Jung","doi":"10.1177/24741264241230147","DOIUrl":"https://doi.org/10.1177/24741264241230147","url":null,"abstract":"Purpose: To report a case of severe eye pain developing during dialysis. Methods: A case report was performed. Results: A 41-year-old man with uncontrolled type 2 diabetes and end-stage nephropathy developed severe left eye pain during hemodialysis. A decline in vision in both eyes was reported over the preceding year, with blindness in the left eye for 6 months. The best-corrected visual acuity was 20/150 right eye (OD) and light perception left eye (OS). The intraocular pressure was 14 mm Hg and 59 mm Hg, respectively. An examination found disc neovascularization with a “volcanic eruption” of vitreous hemorrhage from the optic nerve in the right eye and significant corneal edema and iris neovascularization with no posterior view in the left eye. The patient required urgent cyclophotocoagulation for neovascular glaucoma (NVG) in the left eye, bilateral antivascular endothelial growth factor injections, and panretinal photocoagulation in the right eye for proliferative diabetic retinopathy. Conclusions: Worsening eye pain during hemodialysis in a patient with NVG indicates severely limited outflow capacity and requires immediate intervention.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139780535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1177/24741264241229262
Tianyuan Yao, Muhammad Z. Chauhan, Sami H. Uwaydat
Purpose: To determine the impact of oral prednisone on final visual acuity (VA) and prevention of proliferative vitreoretinopathy (PVR) in patients having pars plana vitrectomy (PPV) for globe injuries. Methods: A retrospective chart review was performed of all globe injuries with an initial repair and subsequent PPV between 2009 and 2018. Data included the initial VA, zones of injury, initial closure date, time to secondary intervention (PPV), oral prednisone (1 mg/kg/day) use, the final VA, and enucleation rate. Multivariable regression models were used to assess the impact of oral prednisone use on anatomic and functional outcomes. Results: The mean (±SD) patient age was 46.25 ±18.56 years (range, 13-92); 131 (83.9%) were men. Oral prednisone intake was recorded in 81 patients (52.3%). The prednisone group had significantly more zone 3 involvement ( P = .001), worse initial VA (2.28 vs 1.92; P = .003), and a greater mean number of surgeries ( P = .020) than the no-steroids (control) group but an equivalent final logMAR VA (1.57 vs 1.52; P = .881). The prednisone group had significant VA improvement ( P = .025); however, oral prednisone use did not predict the development of PVR (29.23% vs 12.90%; odds ratio [OR], 2.81; 95% CI, 0.89-8.85) or retinal detachment (27.27% vs 29.58%; OR, 0.59; 95% CI, 0.23-1.56). Conclusions: Despite a worse initial clinical presentation, patients who received oral prednisone had significant visual improvement compared with the control group. However, oral prednisone (1 mg/kg/day) use at the time of injury did not decrease the PVR rate.
目的：确定口服泼尼松对因眼球损伤而接受玻璃体旁切除术（PPV）的患者最终视力（VA）和预防增殖性玻璃体视网膜病变（PVR）的影响。方法：对2009年至2018年期间所有初次修复并随后进行PPV的眼球损伤患者进行回顾性病历审查。数据包括初始VA、损伤区域、初始闭合日期、二次干预（PPV）时间、口服泼尼松（1 mg/kg/天）使用情况、最终VA和去核率。多变量回归模型用于评估口服泼尼松对解剖和功能结果的影响。研究结果患者平均年龄（±SD）为 46.25±18.56 岁（13-92 岁不等）；131 名患者（83.9%）为男性。81名患者（52.3%）口服泼尼松。泼尼松组的第 3 区受累程度（P = .001）、初始视力（2.28 vs 1.92；P = .003）和平均手术次数（P = .020）均明显多于无类固醇（对照组）组，但最终的对数马尔视力（1.57 vs 1.52；P = .881）却与无类固醇（对照组）组相当。泼尼松组的 VA 有明显改善 ( P = .025)；但是，口服泼尼松并不能预测 PVR（29.23% vs 12.90%；几率比 [OR]，2.81；95% CI，0.89-8.85）或视网膜脱离（27.27% vs 29.58%；OR，0.59；95% CI，0.23-1.56）的发生。结论尽管初始临床表现较差，但与对照组相比，口服泼尼松的患者视力明显改善。不过，受伤时口服泼尼松（1 毫克/千克/天）并不会降低 PVR 率。
{"title":"Effect of Oral Prednisone on the Prevention and Management of Proliferative Vitreoretinopathy After Open-Globe Injury","authors":"Tianyuan Yao, Muhammad Z. Chauhan, Sami H. Uwaydat","doi":"10.1177/24741264241229262","DOIUrl":"https://doi.org/10.1177/24741264241229262","url":null,"abstract":"Purpose: To determine the impact of oral prednisone on final visual acuity (VA) and prevention of proliferative vitreoretinopathy (PVR) in patients having pars plana vitrectomy (PPV) for globe injuries. Methods: A retrospective chart review was performed of all globe injuries with an initial repair and subsequent PPV between 2009 and 2018. Data included the initial VA, zones of injury, initial closure date, time to secondary intervention (PPV), oral prednisone (1 mg/kg/day) use, the final VA, and enucleation rate. Multivariable regression models were used to assess the impact of oral prednisone use on anatomic and functional outcomes. Results: The mean (±SD) patient age was 46.25 ±18.56 years (range, 13-92); 131 (83.9%) were men. Oral prednisone intake was recorded in 81 patients (52.3%). The prednisone group had significantly more zone 3 involvement ( P = .001), worse initial VA (2.28 vs 1.92; P = .003), and a greater mean number of surgeries ( P = .020) than the no-steroids (control) group but an equivalent final logMAR VA (1.57 vs 1.52; P = .881). The prednisone group had significant VA improvement ( P = .025); however, oral prednisone use did not predict the development of PVR (29.23% vs 12.90%; odds ratio [OR], 2.81; 95% CI, 0.89-8.85) or retinal detachment (27.27% vs 29.58%; OR, 0.59; 95% CI, 0.23-1.56). Conclusions: Despite a worse initial clinical presentation, patients who received oral prednisone had significant visual improvement compared with the control group. However, oral prednisone (1 mg/kg/day) use at the time of injury did not decrease the PVR rate.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139840993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. HbA1c at the follow-up was significantly lower in the bariatric surgery group (6.4 vs 8.5; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group ( P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusion: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden after bariatric surgery, which may have a significant impact on quality of life for patients with DR.
目的：与对照组相比，评估减肥手术后患者糖尿病视网膜病变（DR）的严重程度、进展和治疗负担。方法：对接受过减肥手术的糖尿病视网膜病变患者进行回顾性队列研究：对 2014 年至 2023 年期间在杜克大学眼科中心就诊的 2 型糖尿病和 DR 患者进行回顾性队列研究。临床数据包括血红蛋白 A1c (HbA1c)、DR 诊断阶段、糖尿病黄斑水肿 (DME) 或玻璃体出血 (VH)、视力 (VA) 以及基线和随访时的治疗负担。为了考虑同一患者两只眼睛之间的相关性，采用了广义估计方程分析法。结果根据年龄、性别和糖尿病病程，将 16 名接受减肥手术的患者与同期接受药物治疗的 60 名对照组患者进行配对。在基线检查时，患者的 HbA1c 水平、DR 严重程度、是否存在 DME 或 VH、VA 和治疗负担均无显著差异（均 P > .05）。患者平均接受了 6 年的随访。随访时，减肥手术组的 HbA1c 明显降低（6.4 vs 8.5；P < .001）。在随访中，减肥手术组的治疗负担比对照组有所减轻（P = .04）。在随访过程中，减肥手术组的 DR 进展和治疗负担都有明显的减少趋势。结论减肥手术可改善血糖控制、稳定 DR 进展并减轻减肥手术后的治疗负担，这可能会对 DR 患者的生活质量产生重大影响。
{"title":"Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy","authors":"Ariana Allen, Hemal Patel, Sandra Stinnett, Jullia A. Rosdahl, Stefanie Schuman","doi":"10.1177/24741264241231185","DOIUrl":"https://doi.org/10.1177/24741264241231185","url":null,"abstract":"Purpose: To assess the severity, progression, and treatment burden of diabetic retinopathy (DR) in patients after bariatric surgery compared with controls. Methods: A retrospective cohort study was performed of patients with type 2 diabetes and DR seen at the Duke Eye Center between 2014 and 2023. Clinical data included hemoglobin A1c (HbA1c), diagnostic stage of DR, diabetic macular edema (DME) or vitreous hemorrhage (VH), visual acuity (VA), and treatment burden at baseline and follow-up. Generalized estimating equation analysis was used to account for the correlation between 2 eyes of the same patient. Results: Sixteen patients who had bariatric surgery were matched by age, sex, and duration of diabetes with 60 control patients managed medically during the same time period. The HbA1c level, severity of DR, presence of DME or VH, VA, and treatment burden were not significantly different (all P > .05) at the baseline examination. On average, patients were followed for 6 years. HbA1c at the follow-up was significantly lower in the bariatric surgery group (6.4 vs 8.5; P < .001). At the follow-up, the treatment burden was reduced in the bariatric surgery group compared with the control group ( P = .04). There was a clear trend toward reduced progression of DR and treatment burden in the bariatric surgery group over the follow-up. Conclusion: Bariatric surgery may improve glycemic control, stabilize DR progression, and reduce the treatment burden after bariatric surgery, which may have a significant impact on quality of life for patients with DR.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1177/24741264241229262
Tianyuan Yao, Muhammad Z. Chauhan, Sami H. Uwaydat
Purpose: To determine the impact of oral prednisone on final visual acuity (VA) and prevention of proliferative vitreoretinopathy (PVR) in patients having pars plana vitrectomy (PPV) for globe injuries. Methods: A retrospective chart review was performed of all globe injuries with an initial repair and subsequent PPV between 2009 and 2018. Data included the initial VA, zones of injury, initial closure date, time to secondary intervention (PPV), oral prednisone (1 mg/kg/day) use, the final VA, and enucleation rate. Multivariable regression models were used to assess the impact of oral prednisone use on anatomic and functional outcomes. Results: The mean (±SD) patient age was 46.25 ±18.56 years (range, 13-92); 131 (83.9%) were men. Oral prednisone intake was recorded in 81 patients (52.3%). The prednisone group had significantly more zone 3 involvement ( P = .001), worse initial VA (2.28 vs 1.92; P = .003), and a greater mean number of surgeries ( P = .020) than the no-steroids (control) group but an equivalent final logMAR VA (1.57 vs 1.52; P = .881). The prednisone group had significant VA improvement ( P = .025); however, oral prednisone use did not predict the development of PVR (29.23% vs 12.90%; odds ratio [OR], 2.81; 95% CI, 0.89-8.85) or retinal detachment (27.27% vs 29.58%; OR, 0.59; 95% CI, 0.23-1.56). Conclusions: Despite a worse initial clinical presentation, patients who received oral prednisone had significant visual improvement compared with the control group. However, oral prednisone (1 mg/kg/day) use at the time of injury did not decrease the PVR rate.
目的：确定口服泼尼松对因眼球损伤而接受玻璃体旁切除术（PPV）的患者最终视力（VA）和预防增殖性玻璃体视网膜病变（PVR）的影响。方法：对2009年至2018年期间所有初次修复并随后进行PPV的眼球损伤患者进行回顾性病历审查。数据包括初始VA、损伤区域、初始闭合日期、二次干预（PPV）时间、口服泼尼松（1 mg/kg/天）使用情况、最终VA和去核率。多变量回归模型用于评估口服泼尼松对解剖和功能结果的影响。研究结果患者平均年龄（±SD）为 46.25±18.56 岁（13-92 岁不等）；131 名患者（83.9%）为男性。81名患者（52.3%）口服泼尼松。泼尼松组的第 3 区受累程度（P = .001）、初始视力（2.28 vs 1.92；P = .003）和平均手术次数（P = .020）均明显多于无类固醇（对照组）组，但最终的对数马尔视力（1.57 vs 1.52；P = .881）却与无类固醇（对照组）组相当。泼尼松组的 VA 有明显改善 ( P = .025)；但是，口服泼尼松并不能预测 PVR（29.23% vs 12.90%；几率比 [OR]，2.81；95% CI，0.89-8.85）或视网膜脱离（27.27% vs 29.58%；OR，0.59；95% CI，0.23-1.56）的发生。结论尽管初始临床表现较差，但与对照组相比，口服泼尼松的患者视力明显改善。不过，受伤时口服泼尼松（1 毫克/千克/天）并不会降低 PVR 率。
{"title":"Effect of Oral Prednisone on the Prevention and Management of Proliferative Vitreoretinopathy After Open-Globe Injury","authors":"Tianyuan Yao, Muhammad Z. Chauhan, Sami H. Uwaydat","doi":"10.1177/24741264241229262","DOIUrl":"https://doi.org/10.1177/24741264241229262","url":null,"abstract":"Purpose: To determine the impact of oral prednisone on final visual acuity (VA) and prevention of proliferative vitreoretinopathy (PVR) in patients having pars plana vitrectomy (PPV) for globe injuries. Methods: A retrospective chart review was performed of all globe injuries with an initial repair and subsequent PPV between 2009 and 2018. Data included the initial VA, zones of injury, initial closure date, time to secondary intervention (PPV), oral prednisone (1 mg/kg/day) use, the final VA, and enucleation rate. Multivariable regression models were used to assess the impact of oral prednisone use on anatomic and functional outcomes. Results: The mean (±SD) patient age was 46.25 ±18.56 years (range, 13-92); 131 (83.9%) were men. Oral prednisone intake was recorded in 81 patients (52.3%). The prednisone group had significantly more zone 3 involvement ( P = .001), worse initial VA (2.28 vs 1.92; P = .003), and a greater mean number of surgeries ( P = .020) than the no-steroids (control) group but an equivalent final logMAR VA (1.57 vs 1.52; P = .881). The prednisone group had significant VA improvement ( P = .025); however, oral prednisone use did not predict the development of PVR (29.23% vs 12.90%; odds ratio [OR], 2.81; 95% CI, 0.89-8.85) or retinal detachment (27.27% vs 29.58%; OR, 0.59; 95% CI, 0.23-1.56). Conclusions: Despite a worse initial clinical presentation, patients who received oral prednisone had significant visual improvement compared with the control group. However, oral prednisone (1 mg/kg/day) use at the time of injury did not decrease the PVR rate.","PeriodicalId":17919,"journal":{"name":"Journal of VitreoRetinal Diseases","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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