New devices in glaucoma

Glaucoma remains a leading cause of blindness globally. Minimally invasive treatment techniques are rapidly expanding the availability of therapeutic options for glaucoma. These include devices aimed at enhancing outflow through the subconjunctival space, Schlemm\u27s canal, and suprachoroidal space, sustained-release drug delivery devices, and extraocular devices aiming to reduce glaucomatous progression through other novel means. In this review, we provide an overview of several novel devices either newly available or in development for the medical and surgical management of glaucoma. Further studies are required to determine the long-term efficacy of these devices and how they will integrate into the current landscape of glaucoma management

The use of collagen matrix (Ologen) as a patch graft in glaucoma tube shunt surgery, a retrospective chart review [version 1; referees: 2 approved, 1 approved with reservations]

Purpose: To determine the safety and efficacy of collagen matrix as a patch graft in glaucoma drainage surgery. Collagen matrix grafts may be advantageous because they do not need to be harvested from human donors. Methods: An institutional, retrospective review of 43 patients with at least 12 months follow-up status post-glaucoma drainage implant surgery were evaluated for signs of tube erosion after initial placement of collagen matrix patch graft. Results: Forty-one of 43 eyes (95.3%) required no intervention for patch graft melting with tube erosion. Average time of follow-up was 32 months (range: 12-45). Two cases had tube erosion at 4 months and 26 months post-op requiring tube revision, which was successfully revised with conjunctiva (4 month erosion) and donor sclera (26 month erosion). Conclusion:  Our results suggest that collagen matrix patch grafts may be used successfully as a patch graft in glaucoma tube shunt surgery, and may be advantageous because they do not have to be harvested from human donors. It is possible that exposure rates may be higher after longer follow-up and with larger numbers of patients. Further research is needed to compare Ologen to traditional graft materials to conclusively determine the safety and efficacy of collagen matrix as a novel patch graft material

Qualitative factors in patients who die shortly after emergency department discharge.

ObjectivesEarly death after emergency department (ED) discharge may signal opportunities to improve care. Prior studies are limited by incomplete mortality ascertainment and lack of clinically important information in administrative data. The goal in this hypothesis-generating study was to identify patient and process of care themes that may provide possible explanations for early postdischarge mortality.MethodsThis was a qualitative analysis of medical records of adult patients who visited the ED of any of six hospitals in an integrated health system (Kaiser Permanente Southern California [KPSC]) and died within 7 days of discharge in 2007 and 2008. Nonmembers, visits to non-health plan hospitals, patients receiving or referred to hospice care, and patients with do not attempt resuscitation or do not intubate orders (DNAR/DNI) were excluded. Under the guidance of two qualitative research scientists, a team of three emergency physicians used grounded theory techniques to identify patient clinical presentations and processes of care that serve as potential explanations for poor outcome after discharge.ResultsThe source population consisted of a total of 290,092 members with 446,120 discharges from six KPSC EDs in 2007 and 2008. A total of 203 deaths occurred within 7 days of ED discharge (0.05%). Sixty-one randomly chosen cases were reviewed. Patient-level themes that emerged included an unexplained persistent acute change in mental status, recent fall, abnormal vital signs, ill-appearing presentation, malfunctioning indwelling device, and presenting symptoms remaining at discharge. Process-of-care factors included a discrepancy in history of present illness, incomplete physical examination, and change of discharge plan by a third party, such as a consulting or admitting physician.ConclusionsIn this hypothesis-generating study, qualitative research techniques were used to identify clinical and process-of-care factors in patients who died within days after discharge from an ED. These potential predictors will be formally tested in a future quantitative study