Microbial Keratitis After Penetrating and Endothelial Keratoplasty

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes. Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial keratitis after PK (7.5%) was significantly higher than after EK (1.3%) (p Discussion: : Microbial keratitis is a relatively common occurrence in patients with prior keratoplasty, and particularly in eyes with prior PK or multiple prior transplants. Infection is an important cause of graft failure and further surgical intervention. To the best of our knowledge, this is the largest review of microbial keratitis in cases of prior PK, and the only review in eyes with prior EK

Efficacy of an Appointment Specialist in Reducing Loss to Follow Up in a Retina Practice

Introduction: Although a new armamentarium has greatly benefitted patients with retinal disease, novel therapeutic approaches require more frequent clinic visits, which may lead to missed treatments and vision loss. This study characterizes patient-reported reasons for missed visits and assesses the efficacy of calling patients for rescheduling missed visits. Methods: This retrospective cohort study included patients who missed an appointment for an intravitreal injection between January 2018 and February 2020 at the Retina Service of Wills Eye Hospital. Two calls were made to each patient by an appointment specialist to reschedule the visit and record a reason for the missed appointment. Reasons were categorized and the efficacy of each round of phone calls was assessed with stratification by sociodemographic information. Multivariate regression analyses were conducted (SPSS). Results: Patients from 8,794 missed intravitreal injection visits received up to two phone calls. The most common patient-reported reasons for missed visits were: Medical Issues (776, 9%) and Hospitalization (720, 8%). On the first call, 1,000/7,667 (13%) patients were rescheduled and 2,456/5,645 (44%) patients were rescheduled on the second call. In multivariate analyses, oldest age quartile [OR 0.70 (CI 0.6-0.8), p\u3c0.001] and 2nd lowest adjusted-gross income quartile [OR 0.83 (CI 0.7-0.9), p=0.004] were significantly associated with worse rescheduling rates, while sex and race were not significantly associated. Discussion: Comorbid medical conditions pose a challenge to patients and physicians managing retinal disease with frequent, in-clinic treatments. Phone calls may be an effective mechanism for rescheduling missed visits, although alternative strategies may be needed to improve rescheduling rates among certain populations

Almost Men

Includes the following poems: Tim; On Movement and Cessation; Florida; Frontier; Reconciliation Pending; Observation and Inquiry; Sidewalk Song; Craft; Almost Men; Canopy; Chasm; Oceanview Wine & Spirits; First Year; Verbum Fugit; Home; A Love Poem; Pulse; Tuesday; On What My Body Says; Inflection; Ink; On Movement and Cessation; Nessun DormaBachelor of Scienc

Delayed Retinal Breaks and Detachments after Acute Posterior Vitreous Detachment

Purpose: To determine the incidence and timing of delayed retinal breaks and retinal detachments (RDs) after acute posterior vitreous detachment (PVD) and associated risk factors. Design: Retrospective case-control study. Participants: Acute PVD eyes treated between October 2015 and August 2018 at a single academic retina practice. Methods: Eyes with a PVD diagnosis and history of extended ophthalmoscopic examination on presentation were identified using diagnostic billing codes. The number of eyes with a history of laser retinopexy, cryotherapy for retinal tear, or RD repair was determined using procedural billing codes, and the duration between initial and treatment visits was measured. Records of eyes with a delayed retinal break or RD and of a reference group comprising the first 100 presenting eyes with no initial or delayed retinal break or RD were reviewed to determine and compare the presence of select risk factors on initial examination. Main Outcome Measures: Development of a delayed retinal break or RD. Results: Of 7999 eyes with acute PVD, 1280 (16.0%) showed a retinal break and 499 (6.2%) showed an RD on presentation. Delayed retinal breaks and RDs were found in 209 (2.6%) and 80 (1.0%) eyes, respectively. Of delayed breaks, 116 (55.5%) were found in 6 weeks or less and 93 (44.5%) were found more than 6 weeks after presentation. Of delayed RDs, 26 (32.5%) were found in 6 weeks or less and 54 (67.5%) were found more than 6 weeks after presentation. Compared with the reference group, vitreous hemorrhage (hazard ratio, 2.53 [P 6 weeks; odds ratio, 3.58; P < 0.001). Conclusions: Clinically significant rates of newly detected retinal breaks and RDs may occur after acute PVD, suggesting that repeat examination may be prudent in these patients. (C) 2019 by the American Academy of Ophthalmolog