Lindsay Smithen

Transient vision loss after ocriplasmin injection.

Purpose: Transient vision loss is a poorly understood complication of ocriplasmin injection. Methods: The authors performed a retrospective medical records review of consecutive patients who received ocriplasmin for the treatment of vitreomacular adhesion at The George Washington University Department of Ophthalmology and the Virginia Retinal Center from January 1, 2013, to March 1, 2014, and who had at least 28 days of follow-up. Ellipsoid zone loss on optical coherence tomography was analyzed using the National Institutes of Healths Medical Imaging, Processing, Analysis, and Visualization (MIPAV) software. Results: Ten patients received ocriplasmin injection. Three of the 10 patients (30%) had release of vitreomacular adhesion, and 8 of the 10 (80%) experienced vision loss within the first month. Average baseline visual acuity was 66 Early Treatment Diabetic Retinopathy Study letters. Average visual acuity at Weeks 1, 2, 3, and 4 was 62, 43, 57, and 56 Early Treatment Diabetic Retinopathy Study letters, respectively. Average final visual acuity was 58 Early Treatment Diabetic Retinopathy Study letters. Ellipsoid loss occurred in 5 patients and reached a nadir (−36.9% decrease from baseline) 2 weeks later. Conclusion: Vision loss after ocriplasmin occurred in the majority of patients and was correlated with loss of the ellipsoid layer on optical coherence tomography. More data are needed to analyze this side effect.

Dollars and sight: the economics of ophthalmology.

Purpose of review The purpose of this paper is to detail the economics of ophthalmology including trends in utilization, cost, and expenditure. Recent findings Eye care accounts for

Acute vision loss after ocriplasmin use.

23.1 billion, or approximately 1.93% of total health care expenditures annually. In 1991, eye care service costs in those 65 years or older were

A self-administered health questionnaire for the preoperative risk stratification of patients undergoing cataract surgery

5.5 billion, comprising 4.7% of Medicare spending. By 1999, the cost of eye care services in the 65 or older group had increased to

Using ranibizumab to successfully treat choroidal neovascularization in a patient with persistent placoid maculopathy.

6 billion, but comprised only 2.8% of Medicare spending. Summary Although it is imperative that national health expenditure be controlled, ophthalmology has shouldered a disproportionate share of the cost cutting in recent years. When we consider the advances in ophthalmology and the contributions of ophthalmology to improved quality of life, the financial burden absorbed by ophthalmology is striking.

Intravitreal triamcinolone acetonide and intraocular pressure

PURPOSEnThere have been reports in the literature of transient vision loss after ocriplasmin injection and ellipsoid layer disruption on spectral domain optical coherence tomography. The authors report a patient with transient vision loss and more prolonged ellipsoid layer dysfunction.nnnPATIENTnThe authors present a 55-year-old woman with vitreomacular traction and a small foveal schisis who received ocriplasmin injection and experienced sudden transient vision loss. Spectral domain optical coherence tomography imaging revealed significantly increased schisis, new subretinal cavity, and prolonged ellipsoid layer disruption at 9 months.nnnDISCUSSIONnPrevious reports suggested that acute vision loss after ocriplasmin injection may be due to ellipsoid layer disruption. This case showed vision loss, which may due to increased foveal schisis and a new subretinal cavity on spectral domain optical coherence tomography imaging. There was little correlation between ellipsoid layer loss and visual function.

Photodynamic therapy and intravitreal triamcinolone for a subretinal neovascularization in bilateral idiopathic juxtafoveal telangiectasis

PURPOSEnTo determine if a self-administered health status questionnaire completed by candidates for cataract surgery is beneficial for identifying medical comorbidities and patients at risk for adverse intraoperative and postoperative medical events.nnnDESIGNnProspective cohort study.nnnMETHODSnData were obtained from a large, randomized clinical trial of 19,250 cataract surgeries performed between June 1, 1995, and June 30, 1997. Preoperative data were obtained from a standardized, self-administered patient health questionnaire and a history and physical form completed by the patients physician. A record of adverse medical events on the day of surgery and through the first 7 postoperative days was recorded.nnnRESULTSnResponses to 21 questions on the questionnaire were highly specific for 12 comorbid conditions identified by the physician history and physical, ranging from 100% specificity for arrhythmia to 91.3% specificity for coronary artery disease. Comorbid conditions identified by the questionnaire were associated with similar relative risks of adverse events as those identified by the physician history and physical. Patients who had no comorbidities identified by the questionnaire had adverse medical event rates indistinguishable from patients with no comorbid conditions identified by the health provider history and physical.nnnCONCLUSIONSnThe self-administered questionnaire showed a high degree of specificity for 12 common comorbid conditions in cataract patients. A questionnaire such as this may be useful in preoperative risk stratification.

Coats’ Disease Diagnosed in Adulthood

PURPOSEnThe purpose of this study was to report the successful treatment of persistent placoid maculopathy with intravitreal ranibizumab.nnnMETHODSnA 60-year-old man with an 8-year history of blurry vision was diagnosed with bilateral persistent placoid maculopathy complicated by a choroidal neovascular membrane. The left eye received two laser photocoagulation treatments. The right eye was injected twice with intravitreal bevacizumab and then 3 times with intravitreal ranibizumab over the course of 1 year.nnnRESULTSnVisual acuity in the left eye dropped from 20/30 to 20/100 despite gradual resolution of fluid. However, visual acuity in the right eye improved from 20/50 to 20/25 where it remained for 24 months after the last injection.nnnCONCLUSIONnRanibizumab seems to be efficacious in the treatment of choroidal neo-vascularization in persistent placoid maculopathy.