Nicholas G. Anderson

Incidence of endophthalmitis after intravitreal injection of antivascular endothelial growth factor medications using topical lidocaine gel anesthesia.

Purpose: The purpose of this study was to determine the incidence of infectious endophthalmitis after intravitreal injection of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia. Methods: Retrospective chart review of 4690 consecutive intravitreal injections of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia. All patients had at least 6 weeks of follow-up. Results: A total of 608 patients underwent intravitreal injection of antivascular endothelial growth factor medications during the study period. There were 428 injections of pegaptanib sodium, 1841 injections of bevacizumab, and 2421 injections of ranibizumab. There were no cases of infectious endophthalmitis. The per-injection infection rate was 0.0% (95% confidence interval, 0.0-0.06%). Conclusion: The incidence of infectious endophthalmitis after intravitreal injection of antivascular endothelial growth factor medications using 2% topical lidocaine gel anesthesia is low.

Short-term effectiveness of intravitreal bevacizumab versus ranibizumab injections for patients with neovascular age-related macular degeneration.

Purpose: To compare the effectiveness of three consecutive intravitreal injections of bevacizumab (Avastin) and ranibizumab (Lucentis) in patients with treatment-naïve neovascular age-related macular degeneration. Methods: This is a retrospective comparative study of qualifying consecutively treated patients (n = 176) with new-onset subfoveal choroidal neovascularization presenting at 6 retina referral centers. Patients were treated with 3 consecutive monthly injections of ranibizumab (0.5 mg) or 3 injections of bevacizumab every 6 weeks (1.25 mg) as determined by physician and patient preference. Ophthalmologic evaluations included monthly visual acuity measurements, ocular examinations, and optical coherence tomography imaging at each visit. Results: A 29.2% reduction in the mean central foveal thickness measurement through optical coherence tomography was found in the ranibizumab-treated patients versus a 20.9% reduction in the bevacizumab-treated patients (P ≤ 0.02). Fifty-three percent of ranibizumab-treated patients had returned to a central foveal thickness of <200 μm by the completion of 3 injections compared with 35% of patients treated with bevacizumab (P ≤ 0.07). No ocular or systemic adverse events were reported in either group. Conclusion: Short-term effectiveness of ranibizumab treatment, as measured by incremental improvement in optical coherence tomography parameters, was significantly greater than bevacizumab treatment, suggesting that there is a difference in the biologic activities of ranibizumab and bevacizumab.

Clinical features and management of subretinal abscesses secondary to methicillinresistant staphylococcus aureus endogenous endophthalmitis

BACKGROUND AND OBJECTIVE To describe the clinical features, management, and immediate outcomes of patients with subretinal abscesses secondary to methicillin-resistant Staphylococcus aureus (MRSA) endogenous endophthalmitis. PATIENTS AND METHODS Eleven eyes of seven patients were identified by retrospective chart review. Demographics, initial presentation, examination findings, imaging, cultures, treatments, and short-term outcomes were reviewed. RESULTS Eleven eyes of seven patients presented with subretinal abscesses secondary to MRSA endogenous endophthalmitis. Four had history of recurrent MRSA infections or active soft-tissue ulceration. Six underwent vitreous tap for culture without growth. Three had positive blood cultures for MRSA. Six received empiric therapy with intravenous vancomycin, one received oral trimethoprim-sulfamethoxazole, and six received intravitreal vancomycin. Consolidation of abscesses was seen within days of initial treatment. Visual outcomes were contingent on abscess location and time to initial treatment. CONCLUSION Prompt diagnosis and systemic antibiotic therapy is paramount in the treatment of this rare presentation. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:134-142.].

The value of healthcare data in ophthalmology.

Purpose of review The healthcare system creates a vast amount of data that are utilized by a wide variety of entities for a multitude of purposes. Physicians have traditionally been unable to control who has access to their data or how their data are used. The widespread adoption of the Electronic Health Record (EHR) by physicians will create a larger and more valuable healthcare data market with broad implications for the healthcare system. It is, therefore, important for physicians to understand the evolving healthcare data market and the importance of maintaining ownership of and control over their electronic health data. Recent findings Several entities, including private health insurance companies, federal payers, medical societies, and pharmaceutical companies are increasingly utilizing healthcare data to drive reimbursement policies and commercial initiatives. Summary Given the critical importance that EHR data will play in multiple aspects of the healthcare industry, it is in physicians’ interest to maintain ownership and control of the healthcare data that they generate. It would be prudent for physicians to exercise caution before relinquishing data rights to entities that may sell the data to payers or other customers with whom physicians’ interests may not be aligned.