Focal Laser Photocoagulation for Diabetic Macular Edema Done by Resident Physicians: Predictors of Effective Treatment

Purpose: To evaluate the effectiveness of focal laser for the treatment of diabetic macular edema (DME) performed by ophthalmology residents. Methods: This retrospective chart review studies DME patients treated in a resident clinic with focal laser. Visual acuity (VA), OCT central subfield thickness (CST), and maximum subfield thickness (MST) at initial, 1-month, and 6-month visits were recorded. Results: For 32 reviewed patients, the average VA was 20/58 initially and 20/39 at 6 months (p=0.18). Mean CST was 311 µm initially and 305 µm at 6 months (p=0.09). Mean MST was 413 µm initially and 382 µm at 6 months (p=0.007). Factors favoring success are initial CST \u3c400 µm, treatment of localized microaneurysms, and prior focal laser treatments. Conclusion: Focal laser performed by residents was effective in decreasing MST and maintained visual acuity. Initial CST, localized microaneurysms, and repeat focal treatment predicted improved outcomes

Trends in the Sources of Endophthalmitis at Kresge Eye Institute

Purpose Endophthalmitis is a defined as a purulent inflammation of the intraocular fluids, namely the vitreous and aqueous humor. Endophthalmitis most commonly develops from infection, but can also be acquired from inflammatory and neoplastic conditions. We sought to determine these sources at our institute and to look for trends in our urban population. Methods A retrospective chart review of patients who attended the Kresge Eye Institute in Detroit, MI between 2003 to 2018 was performed. Patient list was identified from our EMR using the diagnoses codes related endophthalmitis. Information gathered included demographics, type of tissue/fluid cultured, the presumed source of endophthalmitis as well as culture results and sensitivities to anti-microbials, if known. Results From billing results, 168 patients were identified, of these, 101 with culture results were included. The average age of patients was 63.7 years old and 52% were female. Majority of the samples were of vitreous (72.3%), 21 were aqueous humor, and 3 from retinal tissue. Culture results were negative in 60 patients, positive for bacteria in 30, and positive for fungi and viruses respectively in 4 patients. Gram-positive bacteria including staph epidermidis were the most common pathogens cultured. Presumed sources of endophthalmitis included 29 patients who were post-op, 17 in whom the source was endogenous and exogenous in 14. Other sources included bleb-induced, post injection and unknown. Conclusion We believe this information will prove beneficial in guiding diagnosis and management strategies of endophthalmitis in urban populations. Future directions include the analysis of the specific organisms involved and their susceptibilities. We will use this information to create an institutional biogram which will prove especially useful in the age of antibiotic resistance

Replacing Adjunctive Medications for Treatment-Resistant Depression Using Repetitive Transcranial Magnetic Stimulation: Case Report

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression. As the left prefrontal cortex activity is linked to depression, rTMS induces blood flow in the left dorsolateral prefrontal cortex (dlPFC). Long acting psychostimulants are sometimes prescribed as an adjunctive antidepressant treatment throughout rTMS therapy. We used rTMS to treat resistant depression in a middle-aged male patient over a twelve month period where a psychostimulant medication was also discontinued. He had been consistently taking duloxetine 60 mg BID, clonazepam 0.5 mg BID, and dextroamphetamine-amphetamine extended release 30 mg once daily prior to the onset of rTMS treatment. The patient achieved depression remission through the course of 39 high-frequency left dlPFC rTMS treatments. The treatment was repeated for a course of 11 treatments in 2020 and 17 treatments in 2021 for symptom recurrences while the stimulant was discontinued. We assessed progress using Quick Inventory of Depressive Symptomatology (QIDS) and we took blood pressure measurements before each session of rTMS. After tapering DX-AM XR from 30 mg to 10 mg and then discontinuing it, QIDS increased slightly to 7 and then dropped to 0 after re-treatment. A second recurrence was treated with rTMS and adjunctive liothyronine 25 mcg once daily. QIDS score dropped from 20 to 10. It is noteworthy that there appeared to be a gradual decline in the patient’s blood pressures from the first day of treatment to the last. Results indicate that interval rTMS may be used to replace an adjunctive psychostimulant and lower blood pressure