A Cross-Sectional Survey of the Association between Bilateral Topical Prostaglandin Analogue Use and Ocular Adnexal Features

We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR) = 2.30; 95% confidence interval (CI) 1.43–3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR = 2.49; 95% CI, 1.54–4.03; p = 1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR = 4.04; 95% CI, 2.43–6.72; p = 7.37E-08), levator dysfunction (OR = 7.51; 95% CI, 3.39–16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58–4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between prostaglandin analogue use and upper lid ptosis represent significant side effects that could impact visual function in glaucoma patients

High-risk Escherichia coli clones that cause neonatal meningitis and association with recrudescent infection

Neonatal meningitis is a devastating disease associated with high mortality and neurological sequelae. Escherichia coli is the second most common cause of neonatal meningitis in full-term infants (herein NMEC) and the most common cause of meningitis in preterm neonates. Here, we investigated the genomic relatedness of a collection of 58 NMEC isolates spanning 1974–2020 and isolated from seven different geographic regions. We show NMEC are comprised of diverse sequence types (STs), with ST95 (34.5%) and ST1193 (15.5%) the most common. No single virulence gene profile was conserved in all isolates; however, genes encoding fimbrial adhesins, iron acquisition systems, the K1 capsule, and O antigen types O18, O75, and O2 were most prevalent. Antibiotic resistance genes occurred infrequently in our collection. We also monitored the infection dynamics in three patients that suffered recrudescent invasive infection caused by the original infecting isolate despite appropriate antibiotic treatment based on antibiogram profile and resistance genotype. These patients exhibited severe gut dysbiosis. In one patient, the causative NMEC isolate was also detected in the fecal flora at the time of the second infection episode and after treatment. Thus, although antibiotics are the standard of care for NMEC treatment, our data suggest that failure to eliminate the causative NMEC that resides intestinally can lead to the existence of a refractory reservoir that may seed recrudescent infection

Thin minimal rim width at Bruch’s membrane opening is associated with glaucomatous paracentral visual field loss

Purpose To compare optic nerve head (ONH) measurements in glaucomatous eyes with paracentral visual field (VF) loss to eyes with peripheral VF loss and controls. Methods: Open-angle glaucoma (OAG) patients with early paracentral VF loss or isolated peripheral VF loss as well as control subjects underwent ONH imaging with swept-source optical coherence tomography (OCT) and retinal nerve fiber layer (RNFL) imaging with spectral-domain OCT. Minimum rim width at Bruch’s membrane opening (BMO-MRW), lamina cribrosa depth (LCD), and RNFL thickness were compared among the glaucoma and control groups with one-way analysis of variance, Kruskal–Wallis test, and multiple regression analysis. Results: Twenty-nine eyes from 29 OAG patients (15 early paracentral and 14 isolated peripheral VF loss) and 20 eyes of 20 control subjects were included. The early paracentral and isolated peripheral VF loss groups had similar VF mean deviation (MD) (−5.3±2.7 dB and −3.7±3.0 dB, p=0.15, respectively). Global BMO-MRW was lower in OAG eyes than in controls (193.8±40.0 vs 322.7±62.2 μm, p0.99). In contrast, the minimal BMO-MRW was lower in eyes with early paracentral loss (69.0±33.6 μm) than in eyes with isolated peripheral loss (107.7±40.2 μm; p=0.03) or control eyes (200.1±40.8 μm; p<0.001). Average and thinnest RNFL thickness did not differ between OAG groups (p=0.61 and 0.19, respectively). Horizontal and vertical LCD did not differ among the OAG groups and controls (p=0.80 and 0.82, respectively). Multivariable linear regression analysis among OAG cases confirmed the association between lower minimal BMO-MRW and early paracentral VF loss (β=−38.3 μm; 95% confidence interval, −69.8 to −6.8 μm; p=0.02) after adjusting for age, gender, MD, and disc size. Conclusion: Thin minimal BMO-MRW may represent a new structural biomarker associated with early glaucomatous paracentral VF loss

Healthcare disparities contribute to missed follow-up visits after cataract surgery in the USA: results from the perioperative care for intraocular lens study

Objective To identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors.Methods In this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded.Results A total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age&lt;30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70–79 years, estimated travel time of &gt;2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50–20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90–20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits.Conclusions Medical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them

Multivariable odds ratio (95% confidence interval; p-value) for current prostaglandin analogue (PGA) use associated with selected ocular adnexal features.

<p>The reported odds ratios (ORs) reflect likelihood of increasing scores. Increasing digital D score reflects loss of upper lid dermatochalasis judged from digital photos. Increasing digital S score reflects loss of lower lid steatoblepharon judged from digital photos. Increasing clinical P score reflects increasing upper lid ptosis as judged by a masked clinical observer. Increasing clinical L score reflects worsening levator function as judged by a masked clinical observer. Increasing clinical I score reflects increasing inferior scleral show as judged by a masked clinical observer.</p><p>• Data is for the right eye. Digital scores reflect mean of 2 readers.</p><p>• Bonferroni correction calculation: 0.05/9 exposures x 5 outcomes =  1.11E-03. p-values that are significant after Bonferroni correction are in bold.</p><p>• ORs are corrected for age, ethnicity, sex, use of other glaucoma medications, ocular disease such as age-related macular degeneration and glaucoma, systemic disease such as hypertension and diabetes, and history of ocular laser surgery using ordinal logistic regression.</p>*<p>Patients who were current travoprost users and current latanoprost users were excluded from this analysis. ** Patients who were current bimatoprost users and current latanoprost users were excluded from this analysis. *** Patients who were current bimatoprost users and current travoprost users were excluded from this analysis.</p

Characteristics of Study Participants.

<p>Values are means ± standard deviation or percentages and are standardized to the age distribution of the study population. *The above parameters refer to the right eye. Results were similar for the left eye and are not shown. Abbreviations used: PGA =  prostaglandin analogue; STD = standard deviation; BMI =  body mass index;</p><p>CAI =  carbonic anhydrase inhibitor; AA = alpha agonist</p

Multivariable odds ratio (95% confidence interval; p-value) for duration of current prostaglandin analogue (PGA) use in months associated with selected ocular adnexal features.

<p>The reported odds ratios (ORs) reflect likelihood of increasing scores. Increasing digital D score reflects loss of upper lid dermatochalasis judged from digital photos. Increasing digital S score reflects loss of lower lid steatoblepharon judged from digital photos. Increasing clinical P score reflects increasing upper lid ptosis as judged by a masked clinical observer. Increasing clinical L score reflects worsening levator function as judged by a masked clinical observer. Increasing clinical I score reflects increasing inferior scleral show as judged by a masked clinical observer.</p><p>• Data is for right eye. Digital scores reflect mean of 2 readers.</p><p>• Bonferroni correction calculation: 0.05/9 exposures×5 outcomes =  1.11E-03. p-values that are significant after Bonferroni correction are in bold.</p><p>• ORs are corrected for age, ethnicity, sex, use of other glaucoma medications, ocular disease such as age-related macular degeneration and glaucoma, systemic disease such as hypertension and diabetes, and history of ocular laser surgery using ordinal logistic regression.</p>*<p>Patients who were current travoprost users and current latanoprost users were excluded from this analysis. ** Patients who were current bimatoprost users and current latanoprost users were excluded from this analysis. *** Patients who were current bimatoprost users and current travoprost users were excluded from this analysis.</p

Grading Scheme for Dermatochalasis (D) & Steatoblepharon (S).

<p>Digital external photographs representing each grade of D and S for selected participants enrolled in the study.</p