Effect of fenestrated sterile drape and face mask on bacterial dispersion toward the periocular area during intravitreal injection

Abstract This experimental crossover study was performed to investigate whether fenestrated surgical drapes (covering the nose and mouth but with an opening over the periorbital area) with or without patients’ surgical face masks increase periorbital bacterial dispersion during simulated intravitreal injection conditions. Each of the 16 healthy volunteers performed 14 scenarios involving different mask and drape conditions in both silent and speaking situations. In each scenario, the subject lay down flat on the back with a blood agar plate being held at the inferior orbital rim perpendicular to the face to capture airflow from breathing/speaking. Another blood agar plate placed 50 cm away from the subject served as an experimental control. A total of 224 experiments were performed. Speaking situations significantly showed more colony forming units (CFUs) compared with their controls (P = 0.014). There were no significant differences in CFUs between wearing vs not wearing the masks (P = 0.887 for speaking and P = 0.219 for silent) and using vs not using the drapes (P = 0.941 for speaking and P = 0.687 for silent). Reusable and disposable drapes were also not significantly different (P = 1.00 for speaking and P = 0.625 for silent). Streptococcus spp., the oropharyngeal microbiota, were only cultivated from speaking scenarios. While refraining from speaking (for both practitioners and patients) is the mainstay of reducing bacterial dispersion and risks of post-injection endophthalmitis, the use of fenestrated surgical drapes or patients’ face masks did not significantly affect the amount of bacterial dispersion toward the periorbital area

Optical Coherence Tomography Angiography in Patients with Migraine with Aura Demonstrates Deceased Macular Vessel Density (abstract)

Patients with migraine with aura have an increased risk of cerebral and retinal vascular ischemic complications. We studied the retinal capillary vasculature in patients with a history of migraine using optical coherence tomography angiography (OCTA)

Non- Mydriatic Fundus Photograph Diabetic Retinopathy Screening in Primary Care Unit Setting by Paramedic Personnel

Objective: To study the accuracy and agreement of non-mydriatic fundus photographic screening of diabetic retinopathy (DR) by well-trained paramedic personnel compared to retinal specialists and to obtain the prevalence of DR stages in primary care unit (PCU). Methods: The non-mydriatic fundus photographs of diabetic patients taken at PCU were retrospectively reviewed and graded into three groups; no DR, non-proliferative DR (NPDR), proliferative DR (PDR) by two independent well-trained nurses compared to retinal specialists between November, 2015 to March, 2016. The results were statistically analyzed to determine the level of agreement between the nurses and the retinal specialists. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of each nurse were also calculated. Results: Fundus photographs of 475 patients were obtained. The patients included 129 (27.2%) males and 346 (72.8%) females with the age of 59.94 ± 8.62 years. The agreements between two readers and the retinal specialists were moderate (κ =0.46 and 0.54). The sensitivity and specificity of the first reader were 71.69% and 87.91% and the second reader were 75.50% and 90.8%, respectively. The PPV and NPV were 42.69% and 98.11% for the first reader and 50.60% and 96.70% for the second. The overall accuracy of the first nurse was 86.1% while the second was 96.0%. The prevalence of any stages of DR was 11.1%, NPDR 10.5% and PDR 0.6%. Conclusion: The single field non-mydriatic fundus photography read by trained paramedic personnel is one of the effective preliminary screening modalities. However, the continuous evaluation of the capabilities of the readers should be performed so that the patients with any stages of DR would be appropriately referred to ophthalmologists. This strategy would lead to the significant improvement of the DR screening in the country with high burden of diabetic patients

Foveal and Peripapillary Vascular Decrement in Migraine With Aura Demonstrated by Optical Coherence Tomography Angiography

PurposeMigraine, particularly with aura, has been associated with ocular and systemic ischemic complications, but there are limited data on the ocular vasculature in migraine. We used optical coherence tomography angiography (OCTA) to assess perfusion of the macula and optic nerve in migraine patients, with (MA) and without (MO) aura, compared to healthy controls (HC).MethodsWe recruited 15 MA (mean age 42 years), 12 MO (mean age 46 years), and 22 HC (mean age 39 years) participants from neurology and neuro-ophthalmology clinics. Participants underwent optical coherence tomography and 3 × 3 mm OCTA of the macula and optic nerve. Foveal avascular zone area was automatically measured using AngioVue software, and vessel density was calculated as blood vessel length divided by scan area (mm-1) after skeletonization of OCTA images.ResultsOn macular OCTA, MA participants had an enlarged foveal avascular zone area when compared with HC (0.300 ± 0.019 vs. 0.220 ± 0.066 mm2, P = 0.006). In addition, superficial foveal vessel density was decreased in MA participants when compared with MO participants (7.8 ± 0.31 vs. 9.3 ± 0.44, P = 0.04) and HC (7.8 ± 0.31 vs. 9.4 ± 0.21 mm-1, P = 0.002). On optic nerve OCTA, the MA participants had reduced superior peripapillary vessel density when compared with the MO participants (12.0 ± 0.45 vs. 14.0 ± 0.38 mm-1, P = 0.031) and HC (12.0 ± 0.45 vs. 14.1 ± 0.53 mm-1, P = 0.035). There were no significant differences between the MO and HC groups.ConclusionsMigraine with, but not without, aura was associated with foveal and peripapillary vascular decrements, which may possibly mediate increased risk of ocular and systemic vascular complications in these patients. OCTA could potentially be useful as a biomarker for migraine with aura

Myopic macular schisis: Insights into distinct morphological subtypes and novel biomechanical hypothesis

Purpose To analyze the features of myopic macular schisis (MMS) in different retinal layers and to explore the role of Müller cells in the pathophysiology of such condition. Methods Spectral-domain optical coherence tomography (SD-OCT) images of myopic eyes with staphyloma and macular schisis were reviewed. The morphological features of MMS were analyzed and correlated with their geographical location in the parafoveal and perifoveal region. A biomechanical model was adopted to explain MMS morphological differences. The effect of the different schisis subtypes with best corrected visual acuity (BCVA) was also explored. Results A total of 36 eyes from 26 patients were included in this study. MMS was classified into inner, middle and outer retinal subtypes. The prevalence of middle retinal schisis was significantly lower in the parafovea, within a central 3 mm-diameter circle (p < 0.001) centered at the fovea . The prevalence of inner retinal schisis was significantly higher outside the central 3-mm diameter circle, in the perifoveal region (p < 0.001). No significant differences were noted in the prevalence of outer retinal schisis for these two locations (p = 0.475). The presence of middle retinal schisis within the central 3-mm diameter circle showed a weak association with lower BCVA (p = 0.058). The presence of outer retinal schisis within the central 3-mm diameter circle was significantly related with lower BCVA (p = 0.024). Conclusion Three major forms of MMS are distinguished: inner, middle and outer retinal schisis. This classification may have clinical importance as only the outer grade of schisis was associated with vision loss

The expanded spectrum of perifoveal exudative vascular anomalous complex

PURPOSE: To expand our understanding of the uncommon entity, referred to as perifoveal exudative vascular anomalous complex (PEVAC) by describing multimodal imaging findings, including optical coherence tomography angiography (OCT-A). DESIGN: Retrospective cohort study. METHODS: Patients diagnosed with PEVAC were identified at 4 retina referral centers worldwide and underwent complete ophthalmologic examination including structural OCT, OCT-A, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Demographics and clinical findings were analyzed at baseline and at available follow-ups. RESULTS: Fifteen eyes (15 patients, mean age 73 \ub1 13 years) were included. Six of 15 eyes were diagnosed with coincident age-related macular degeneration (AMD) and 2 with myopic macular degeneration. On fundus examination PEVAC presented as a large perifoveal isolated aneurysm, unifocal in 12 of 15 eyes, associated with small retinal hemorrhages and intraretinal exudation. On structural OCT, PEVAC appeared as a round hyperreflective lesion with hyporeflective lumen, typically surrounded by intraretinal cystic spaces. Dye angiography demonstrated a well-defined hyperfluorescent lesion with variable leakage on FA and without leakage on ICGA. OCT-A showed flow signal correlating with the aneurysmal lesion connecting to retinal capillary plexuses. Seven patients were followed for 13.0 \ub1 10.5 months with no evidence of functional/anatomic changes. Three patients underwent anti-vascular endothelial growth factor (VEGF) intravitreal injections without improvement. Two eyes were associated with a type 3 neovascularization eccentric to PEVAC. CONCLUSIONS: PEVAC is an isolated, perifoveal, aneurysmal abnormality, occurring in otherwise healthy patients who may manifest other macular disease including AMD and myopic macular degeneration. PEVAC did not typically respond to anti-VEGF therapy, and may be associated with type 3 neovascularization