Intravitreal injection analysis at the Bascom Palmer Eye Institute: evaluation of clinical indications for the treatment and incidence rates of endophthalmitis

To report the incidence of endophthalmitis, in addition to its clinical and microbiological aspects, after intravitreal injection of vascular-targeting agents. A retrospective review of a consecutive series of 10,142 intravitreal injections of vascular targeting agents (bevacizumab, ranibizumab, triamcinolone acetonide, and preservative-free triamcinolone acetonide) between June 1, 2007 and January 31, 2010, performed by a single service (TGM) at the Bascom Palmer Eye Institute. One case of clinically-suspected endophthalmitis was identified out of a total of 10,142 injections (0.009%), presenting within three days of injection of bevacizumab. The case was culture-positive for Staphylococcus epidermidis. Final visual acuity was 20/40 after pars plana vitrectomy surgery. In this series, the incidence of culture-positive endophthalmitis after intravitreal injection of vascular agents in an outpatient setting was very low. We believe that following a standardized injection protocol, adherence to sterile techniques and proper patient follow-up are determining factors for low incidence rates

Ocular trauma and visual outcome secondary to paintball projectiles

To describe ocular injuries attributable to paintball-related trauma and their management and results. Retrospective, interventional case series. setting: University practice and emergency department. patient population: Thirty-six eyes of 36 patients who sustained ocular injuries secondary to paintballs between July 1, 1998 and January 1, 2005. observation procedure: Age, gender, laterality, setting, eye protection, best-corrected visual acuity (BCVA), and initial diagnosis were documented. main outcome measures: Medical and surgical intervention within the first three days postinjury and further treatment after this time period were recorded. BCVA at the initial and final clinical visit were compared. The mean follow-up interval was 11.7 months (one to 40). Mean age was 21 years (three to 64), 31 (86%) were male, 34 (97%) were not wearing eye-protection device when injured, and initial BCVA was worse than 20/200 in 28 eyes (78%). The most common ocular finding was hyphema in 29 eyes (81%). Initially, 20 eyes (56%) were managed medically and nine eyes (25%) required primary repair of a ruptured globe. Ultimately, 29 eyes (81%) had surgical intervention including eight eyes (22%) enucleations. Final visual acuity was 20/40 or better in 13 eyes (36%), whereas 18 eyes (50%) were worse than 20/200. Visual acuity (VA) at initial presentation correlated strongly with final VA (r = 0.64; P < .001). Paintball-related ocular injuries are frequently severe and visually devastating. The compulsive use of protective eyewear may have eliminated 97% of injuries in this series and continues to need emphasis to paintball users

A profile of the genetic counsellor and genetic nurse profession in European countries

Quality genetic healthcare services should be available throughout Europe. However, due to enhanced diagnostic and genetic testing options, the pressure on genetic counselling services has increased. It has been shown in many countries that appropriately trained genetic counsellors and genetic nurses can offer clinical care for patients seeking information or testing for a wide range of genetic conditions. The European Society of Human Genetics is setting up a system of accreditation for genetic counsellors, to ensure safe practice, however there has been little information about the practice and education of non-medical genetic counsellors in Europe. To collect baseline data, we approached key informants (leaders in national genetics organisations or experienced practitioners) to complete an online survey, reporting on the situation in their own country. Twenty-nine practitioners responded, providing data from 18 countries. The findings indicate huge variation in genetic counsellor numbers, roles, and education across Europe. For example, in UK and The Netherlands, there are more than four counsellors per million population, while in Germany, Hungary, Turkey, and Czech Republic, there are no non-medical counsellors. There are specific educational programmes for genetic counsellors in seven countries, but only France has a specific governing legal framework for genetic counsellors. In the post-genomic era, with added pressure on health systems due to increases in availability and use of genetic testing, these disparities are likely to result in inequalities in service provided to European citizens. This study underpins the need for a coherent European approach to accreditation of genetic counsellors