Post-traumatic vancomycin-resistant enterococcal endophthalmitis

The emergence of antibiotic-resistant organisms among severe ocular infections is of grave concern. We describe the first reported case of vancomycin-resistant enterococcal endophthalmitis following ocular trauma, uniquely caused by Enterococcus gallinarum. The organism demonstrated intrinsic resistance to ceftazidime and vancomycin but responded favorably to a combination of intravitreal and intravenous ampicillin, plus intravitreal amikacin. When faced with a multidrug-resistant organism, the ophthalmologist must consider alternative antibiotic strategies

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis

Objective To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell’s palsy than steroids alone

Impact of the Time to Surgery on Visual Outcomes for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis

PURPOSE: To determine the relationship between time from symptom onset or presentation to repair and visual outcomes for macula-on and macula-off rhegmatogenous retinal detachment (RRD). DESIGN: Meta-analysis. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library for randomized controlled trials and observational studies comparing best-corrected visual acuity (BCVA) based on time to RRD repair. Study identifiers, baseline characteristics, intervention characteristics, and visual outcomes were extracted. We conducted a random effects meta-analysis. Sensitivity analyses included leave-1-out and influence analyses. Primary outcomes included mean difference (MD) in final BCVA, MD between preoperative and final BCVA (∆BCVA), and relative risk of final BCVA24 hours. Secondary outcomes assessed other time points. RESULTS: Twenty observational studies reported on 1929 patients. Macula-off RRD repair in 0-3 days from symptom onset was superior to 4-7 days for final BCVA (MD -0.06 [95% CI -0.09, -0.03], P \u3c .001) but was not different for ∆BCVA (P \u3e .05). Macula-on repair in 0-24 hours from presentation was superior to \u3e24 hours for final BCVA (MD -0.02 [95% CI -0.03, -0.01], P \u3c .05) but was not different for ∆BCVA (P \u3e .05). CONCLUSIONS: Macula-off RRD repair in 0-3 days from symptom onset may have better final BCVA compared to repair in 4-7 days. Macula-on RRD repair in 0-24 hours of presentation may have better final BCVA compared to repair in \u3e24 hours. These results were supported by moderate- and low-quality evidence, respectively, and may have been influenced by differences in baseline BCVA

Management of pediatric choroidal neovascular membranes with intravitreal anti-VEGF agents: A retrospective consecutive case series

Objective: To report the results of pediatric choroidal neovascular membranes (CNVMs) secondary to a variety of etiologies treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents. Design: Retrospective case series. Participants: Four pediatric patients at the Hosptial for Sick Children with CNVMs secondary to a variety of etiologies. Methods: Each patient received multiple treatments with one of the following anti-VEGF agents: pegaptanib sodium, bevacizumab, or ranibizumab. Progress was monitored by clinical exam, optical coherence tomography (OCT), and fluorescein angiography. Results: The mean age of our patients was 11.5 years (range, 8-15 years). Patients were followed for a mean of 10 months (range, 4-14 months). One patient was treated with pegaptanib sodium, 2 with bevacizumab, and 1 with ranibizumab. Following treatment, 1 patient showed an improvement and 3 showed stabilization of vision with reduction of fluid on clinical exam and OCT, and cessation of leakage on the fluorescein angiogram. Patients required 2-5 injections of the anti-VEGF agent. No ocular or systemic adverse events were observed in any of our treated patients. Conclusions: Anti-VEGF agents were effective in the treatment of pediatric CNVMs in this case series. However, we do not know how these results would have differed from other treatment modalities, including observation. We did not observe any adverse side effects; however, larger studies are required to document the safety of these medications in the pediatric population where normal angiogenesis is occurring.Link_to_subscribed_fulltex

Real-time evaluation of diffusion of the local anesthetic solution during peribulbar block using ultrasound imaging and clinical correlates of diffusion

The aims of this prospective observational study were to assess the incidence of intraconal spread during peribulbar (extraconal) anesthesia by real-time ultrasound imaging of the retro-orbital compartment and to determine whether a complete sensory and motor block (with akinesia) of the eye is directly related to the intraconal spread

Pathophysiology of outer retinal corrugations: Imaging dataset and mechanical models

This article presents high-resolution swept-source optical coherence tomography (SS-OCT) imaging data used to elaborate a mechanical model that elucidates the formation of outer retinal corrugations (ORCs) in rhegmatogenous retinal detachments (RRD). The imaging data shared in the repository and presented in this article is related to the research paper entitled “Outer Retinal Corrugations in Rhegmatogenous Retinal Detachment: The Retinal Pigment Epithelium-Photoreceptor Dysregulation Theory” (Muni et al., AJO, 2022). The dataset consists of 69 baseline cross-sectional SS-OCT scans from 66 patients that were assessed for the presence of ORCs and analyzed considering the clinical features of each case. From the 66 cases, we selected SS-OCT images of 4 RRD patients with visible ORCs and no cystoid macular edema (CME) to validate the mechanical model. We modelled the retina as a composite material consisting of the outer retinal layer (photoreceptor layer) and the inner retinal layer (the part of the retina that excludes the photoreceptor layer) with thicknesses To and Ti and elastic modulus Eo and Ei, respectively. The thickness of the outer and inner retinal layers and the relative increase in the length of the outer retinal layer (γ) were measured from the SS-OCT images. Measurements from the SS-OCT images of patients with RRD demonstrated a 30% increase (γ=0.3) in the length of the outer retinal layer and a 400% increase in the thickness of the outer retinal layer (To). Using the mathematical model, Eo/Ei ranged between 0.05 to 0.5 to result in ORCs with a similar frequency to those observed in the SS-OCT scans

Demographic Risk Factors of Retinopathy of Prematurity: A Systematic Review of Population-Based Studies

Introduction: Current national guidelines use gestational age (GA) and birth weight (BW) as their basis for retinopathy of prematurity (ROP) screening. The strength of association of these and other demographic risk factors is inconsistent across studies. This review aims to evaluate the strength of association of documented risk factors for ROP in large sample, population-based studies. Methods: MEDLINE, EMBASE, and Cochrane Library were searched from January 2010 to May 2020. Original studies reporting the risk of ROP in a region and demographic risk factors were included. Results: Eighteen studies comprising 342,005 infants were included. The overall risk of ROP in preterm infants was 18.8%. For every week decrease in GA, there was a median adjusted odds ratio (aOR) of 1.4 times (range 1.2–1.9) of developing ROP. For every 100-g decrease in BW, the median aOR was 1.8 times (range 1.2–2.7). Higher risk was found in infants with neonatal sepsis and bronchopulmonary dysplasia. The risk of any, severe, and treatment-requiring ROP was highest for 23 weeks GA, which was 66.5, 40.3, and 39.4%, respectively. Regions with higher neonatal mortality rates had the highest mean GA of infants with ROP. Conclusion: For every week decrease in GA and every 100-g decrease in BW, there was a median of 1.4 times and 1.8 times the odds of developing ROP, respectively. Further research is required to clarify the role of additional risk factors

Association Between Sociodemographic Factors and Vision Difficulty in the National Health Interview Survey: A Population-Based Analysis

•Sex, sex orientation, race, education, and income are associated with vision difficulty in the United States population•Low income more than doubles the odds of self-reported vision difficulty•Black race is associated with 1.5 times the odds of self-reported vision difficulty To investigate the relationship between social determinants of health (SDH) with self-reported vision difficulty. Cross-sectional, population-based analysis. The National Health Interview Survey (NHIS) is an annual survey based on the U.S population age 18 and older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and health care access. The 2021 NHIS database was used in this study. Adult participants of the NHIS who responded to the vision difficulty question “Do you have difficulty seeing, even when wearing glasses or contact lenses?” were included in this analysis. The outcome of interest was self-reported vision difficulty by participants. Analysis was done through univariable and multivariable logistic regression. Overall, there were 29,464 participants included in the analysis. Univariable logistic regression showed an increased odds of self-reported vision difficulty among female (OR 1.28; 95% CI, 1.20-1.38; p<0.001), gay, lesbian, or bisexual participants (OR 1.24; 95% CI, 1.04-1.49; p=0.02), those who possessed public compared to private insurance (OR 1.83; 95% CI, 1.69-1.99; p<0.001), those with less than a high school education (OR 1.88; 95% CI, 1.67-2.13; p<0.001), and those with an income below the poverty threshold (OR 2.22; 95% CI, 1.96-2.51-0.67; p<0.001). Multivariable analysis revealed an increased risk of vision difficulty reported amongst non-Hispanic Black participants (OR 1.65; 95% CI, 1.21-2.25; p=0.002). A multitude of sociodemographic factors are associated with self-reported vision difficulty in the United States population. Our findings emphasize the importance of considering SDH factors in clinical practice and policymaking for patients with vision loss