Ten-year follow-up from the CRYO-ROP study.
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Child↗
Biomedical subjects
W Tasman
Publications and source records attributed to W Tasman.
Patient-initiated second medical opinions: their necessity and economic cost.
PURPOSE: To assess the value of patient-initiated second medical opinions (SMO). METHODS: The authors prospectively collected demographic data from 100 consecutive patients. The authors recorded major changes in the patients' care, such as inappropriate surgery recommended, inadequate treatment performed, and appropriate treatment not recommended. The authors also recorded costs incurred or saved by the patients and the third-party payers. RESULTS: In nearly 15 of the cases, the authors had major disagreements with the initial diagnosis or management. Surgery had been recommended in 28 cases. They advised against it in nine. In 72 cases, no surgery had been recommended. They advised and performed it in five. The management of five other patients was not in accordance with that recommended by large clinical trials or was inadequately done. Including the consultation fees, surgery performed or advised against, retinal angiography, and ultrasonography, the 100 SMO cost third-party payers $12,426. If the authors subtract the cost of noncontroversial surgery they recommended and if the patients had paid the consultation fee and had brought along their fluorescein angiograms, third-party payers would have saved $4,079. CONCLUSION: The savings SMO generated by eliminating unnecessary surgery resulted in improved patient care at minimal cost to third-party payers.
Adolescent↗
Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization.
OBJECTIVE: To perform a patient preference-based, incremental cost-effectiveness analysis for laser treatment of subfoveal choroidal neovascularization. DESIGN: Computer-based econometric modeling. METHODS: The cost effectiveness of laser photocoagulation therapy was compared with the natural course of subfoveal choroidal neovascularization. The model applied long-term visual data from previous clinical trials, utility analysis (which reflects patient perceptions of quality of life associated with a health state), decision analysis with Markov modeling, and the economic principles of present value analysis with discounting to account for the time value of money. DATABASE: Data from patients eligible for treatment of subfoveal choroidal neovascularization obtained by researchers in the Macular Photocoagulation Study were used for the analysis. INTERVENTION: Modeled laser therapy for subfoveal choroidal neovasacularization in patients with age-related macular degeneration. MAIN OUTCOME MEASURE: Cost per quality-adjusted life-year ($/QALY gained) associated with laser therapy. RESULTS: Laser photocoagulation therapy for subfoveal choroidal neovascularization, as compared with no treatment, resulted in a mean gain of 0.257 QALYs per treated patient. Using a yearly discount rate of 3% to account for the time value of money and inflation, the resultant $/QALY gained was $5629. Sensitivity analysis used in the cost-effectiveness analysis resulted in a $/QALY gained of $4974 with no gained discount rate and $11,633 with a yearly discount rate of 10%. CONCLUSIONS: The incremental expense of laser therapy for the treatment of subfoveal choroidal neovascularization appears to be highly cost effective. The result, which takes into account patient preference-based utility data, compares quite favorably with other interventional therapies across different medical specialties.
Aged↗
Diabetes and retinopathy.
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Diabetes Complications↗
Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis.
OBJECTIVE: To compare visual outcomes between cases of acute postoperative endophthalmitis that did or did not receive intravitreal steroids. DESIGN: Retrospective nonrandomized comparative trial. PARTICIPANTS: Fifty-seven patients with postoperative endophthalmitis. INTERVENTION: Thirty-one patients with postoperative endophthalmitis resulting from cataract extraction received both intravitreal antibiotics and steroids, whereas the remaining 26 received only intravitreal antibiotics. MAIN OUTCOME MEASURES: Improvement in visual acuity. RESULTS: Multivariate logistic regression was used to analyze the variables that potentially influence a three-line visual acuity improvement. The mean baseline visual acuities of both groups were comparable. The use of intravitreal steroids reduced the probability of developing a three-line improvement in visual acuity (odds ratio [OR] = 0.287; 95% confidence interval [CI] [0.072-0.852]). On the basis of logistic regression analysis using our multivariate model, gender, baseline visual acuity, and pars plana vitrectomy were not significantly associated with visual outcome differences between the two groups. CONCLUSIONS: Patients who received intravitreal steroids had a significantly reduced likelihood of obtaining a three-line improvement in visual acuity. At a minimum our study provides no support for their use and, therefore, steroids may not be efficacious for acute endophthalmitis related to cataract extraction.
Acute Disease↗
Visual outcomes after laser photocoagulation for threshold retinopathy of prematurity.
OBJECTIVE: To determine the long-term visual acuity after diode laser photocoagulation for threshold retinopathy of prematurity. DESIGN: Retrospective, noncomparative case series. INTERVENTION: Photocoagulation of the peripheral avascular retina with a diode laser indirect ophthalmoscope. MAIN OUTCOME MEASURES: The principal outcome evaluated was best-corrected visual acuity (BCVA). The most recent refractions for these eyes were also collected for analysis. PARTICIPANTS: Thirty-five infants with threshold retinopathy of prematurity treated with laser photocoagulation from 1991 to 1996. RESULTS: After bilateral laser treatment, 14 (56%) of 25 patients who were capable of accurate visual acuity testing had 20/50 or better BCVA in at least 1 eye with 11 (44%) of 25 patients having at least 20/50 BCVA in both eyes. After unilateral treatment, four (40%) of ten had 20/50 or better BCVA in the treated eye while five (50%) of ten laser-treated eyes had a BCVA at least equal to the untreated fellow eye. Compared to eyes with 4 or more diopters (D) of myopia, those with less than 4 D of myopia were 6.4 times more likely to achieve 20/50 or better BCVA (95% confidence interval, 1.7-22.7). The average age at follow-up was 3.7 years. CONCLUSIONS: After laser photocoagulation for threshold retinopathy of prematurity, 29 (48%) of 60 eyes had 20/50 or better visual acuity. Eyes with 4 or more D of myopia were significantly less likely to achieve 20/50 or better visual acuity than eyes with less than 4 D of myopia.
Child, Preschool↗
General Mikhail Kutuzov: one-eyed defender of Moscow.
General Mikhail Kutuzov was a charismatic Russian general, most remembered for his defense of Moscow against Napoleon. He was in and out of favor with the emperor, Alexander I, but in times of crisis, on more than one occasion he was called back to lead the Russian Forces. From the standpoint of ophthalmology, it is of interest that while fighting the Turks, Kutuzov sustained two separate severe head wounds that ultimately led to loss of sight in his right eye. A portrait of General Kutuzov hangs in the Hermitage Museum in St. Petersburg, Russia, Kutuzov's birthplace. In the portrait Kutuzov is standing with his left side facing forward, presumably to hide his disfigured right eye. He lost the Battle of Austerlitz against Napoleon and at best gained a draw at the Battle of Borodino. Nevertheless, the latter battle was the beginning of the end for Napoleon's Grand Armée. They entered a deserted Moscow, part of Kutuzov's scorched earth policy that left no food or housing for the enemy, and with the Russian winter rapidly approaching, Napoleon began his long retreat from Russia. As with the German army, the harsh winter claimed many casualties while Kutuzov added to the French misery by harassing the retreating army from the rear. Of 450,000 French soldiers, only 10,000 returned to France.
Brain Injuries↗
Cost-effectiveness of treatment for threshold retinopathy of prematurity.
OBJECTIVE: Retinopathy of prematurity (ROP) is a leading cause of adverse visual outcomes in premature infants. Both laser photocoagulation and cryotherapy have been demonstrated in clinical trials to be efficacious in reducing the incidence of visual loss occurring secondary to threshold ROP. Visual data recently have become available concerning the long-term clinical efficacy of both treatments, as have data concerning the utility value of visual states in general. Accordingly, we undertook an analysis to ascertain the cost-effectiveness of laser photocoagulation and cryotherapy in the treatment of threshold ROP. DESIGN: A computer simulation economic model is presented to evaluate the cost-effectiveness of cryotherapy and laser photocoagulation therapy, compared with the natural course of the disease, for treating premature infants with threshold ROP. The model applies long-term visual data from previous clinical trials, utility analysis, decision analysis, and economic principles, such as present value analysis, to account for the time value of money to arrive at a cost per quality-adjusted life-year (QALY) gained. OUTCOME MEASURES: Cost per QALY gained from laser therapy and cryotherapy. RESULTS: Laser photocoagulation therapy for threshold ROP costs $678 1998 US dollars (at a 3% discount rate to account for the time value of money) for each QALY gained from treatment. Cryotherapy for the same disease costs $1801 per QALY at a similar discount rate. CONCLUSIONS: From the point of view of cost-effectiveness, laser therapy seems to have an advantage over cryotherapy for the treatment of threshold ROP.
Computer Simulation↗
A comparison of laser photocoagulation with trans-scleral cryotherapy in the treatment of threshold retinopathy of prematurity.
OBJECTIVE: The goal of this study was to determine whether there was a significant difference between the visual outcomes of eyes with threshold retinopathy of prematurity (ROP) treated with trans-scleral cryotherapy compared to those treated with laser photocoagulation. DESIGN: Extended follow-up study of a prospective, randomized clinical trial. PARTICIPANTS: Fifty-two patients with bilateral threshold ROP participated. Follow-up data were available for 25 of these patients. INTERVENTION: Patients were randomized to receive cryotherapy in one eye and laser photocoagulation in the other eye. MAIN OUTCOME MEASURES: The best-corrected visual acuity of each eye was measured. Best-corrected visual acuities of 20/50 or better were classified as "good" clinical outcomes, whereas those 20/60 or worse were considered "poor" outcomes. A secondary outcome of this study was the spherical equivalent (SE) of each eye's most recent refraction. RESULT: At an average follow-up point of 5.8 years (range, 4.3-7.6 years), the odds that an eye treated with laser had a good clinical outcome were 6.91 times greater than for eyes treated with cryotherapy (95% confidence interval, 1.70-28.0; n = 21). Additionally, the laser-treated eyes were less myopic with a mean SE of-3.05 diopters compared to a mean SE of -5.08 diopters for the cryotherapy-treated eyes (P = 0.0072, n = 23). CONCLUSION: The authors' study suggests that laser photocoagulation for threshold ROP was more likely to result in a good clinical outcome with better final visual acuity and less myopia compared to cryotherapy treatment.
Child↗
Bilateral Candida parapsilosis endophthalmitis.
We describe a patient with bilateral, delayed endophthalmitis who underwent bilateral pars plana vitrectomy, total capsulectomy, intraocular lens exchange, intravitreal injection of amphotericin B, and oral fluconazole therapy. The long-term inflammation resolved, and vitreous cultures from both eyes yielded Candida parapsilosis. Histopathologic examination revealed sequestered yeast forms in the capsular bags.
Aged↗
Familial exudative vitreoretinopathy: surgical intervention and visual acuity outcomes.
BACKGROUND: Familial exudative vitreoretinopathy (FEVR) is a hereditary condition that may lead to vitreous hemorrhage and traction retinal detachment necessitating surgical intervention. In this paper we review the results of surgery on seven such patients (eight eyes). METHODS: Seven patients (eight eyes) were followed up after surgery that had been performed because of vitreous hemorrhage and/or traction retinal detachment due to FEVR, in an effort to evaluate outcomes. Parameters that were noted were the current age, gender, age at the time of first surgery, length of follow-up and postoperative retinal status and visual acuity. RESULTS: Seven patients (eight eyes) ranging in age from 6 months to 44 years with a mean of 24.7 and a median of 26 years were followed. There were three females and four males. The lowest age at which surgery was first performed was 6 months and the highest was 28 years, with a mean of 14.7 and a median of 17 years. Six of the 8 eyes were reattached following surgery, although some required multiple procedures. CONCLUSION: Vitreoretinal surgery may be of benefit in helping to preserve some degree of vision in eyes of patients with FEVR who develop vitreous hemorrhage and/or retinal detachment.
Adolescent↗
Stephen Girard (1750-1831): a one-eyed American patriot.
Stephen Girard trader, banker, millionaire, and patriot lived 81 full and exciting years. Apparently born with a blind or amblyopic right eye, he emigrated from Bordeaux, France, via Santa Domingo to the United States, and finally settled in Philadelphia, where he developed a successful maritime trade. Ultimately, Girard became the first multimillionaire in the United States. Extremely generous, he often walked from his home in the center of Philadelphia to his farm in what is now South Philadelphia distributing shoes to needy children. Probably Girard's most heroic gestures were his gallant fight against the yellow fever epidemic in 1793 and his loan to the U.S. government during the War of 1812, which allowed the bankrupt country to continue the conflict and ultimately to win the war.
Blindness↗
Diode laser photocoagulation for retinopathy of prematurity.
OBJECTIVE: The purpose of this study was to determine the effectiveness of laser photocoagulation in eyes with threshold retinopathy of prematurity (ROP), defined as stage 3+, zone 2, with 5 or more contiguous or 8 cumulative clock hours of extraretinal fibrovascular proliferation. METHODS: Indirect ophthalmoscopic retinal examinations were performed on 18 premature infants born between 1991 and 1993 to identify those eyes with threshold ROP. Diode laser was used to treat 31 eyes within 48 hours of diagnosis. Each patient was followed post treatment at weekly intervals until regression was starting to occur. Subsequent follow-up visits were tailored to each patient. RESULTS: During the 41 to 60 month follow-up (average 49 months, median 46 months), 27 of 31 lasered eyes (87%) demonstrated regression of the extraretinal neovascularization, and 26 (84%) had functional vision. This includes two Stage 4B eyes that were reattached with scleral buckles. Twenty-two eyes (71%) were myopic and four (13%) progressed to stage 5 retinal detachment that could not be repaired. No cataracts occurred in this group of patients. CONCLUSIONS: Although a potentially blinding disorder, threshold ROP is, in many cases, treatable with laser photocoagulation, which may be easier to administer than cryotherapy. Follow-up of patients treated with diode laser demonstrates that functional vision is attainable.
Follow-Up Studies↗
Turner's syndrome associated with bilateral retinal detachments.
PURPOSE: To report a case of Turner's syndrome associated with bilateral funnel-shaped retinal detachments. METHODS: We examined a 2-month-old female infant with Turner's syndrome who was referred with a diagnosis of bilateral leukocoria. RESULTS: Clinical examination showed bilateral funnel-shaped retinal detachments resembling stage V retinopathy of prematurity. CONCLUSION: Bilateral retinal detachments should be added to the list of ocular findings in Turner's syndrome. Patients with Turner's syndrome need early ophthalmologic examinations not only to treat common strabismus abnormalities but also to diagnose and treat posterior segment abnormalities.
Diagnosis, Differential↗
Outcomes of vitrectomy for retained lens fragments.
PURPOSE: Retained lens fragments after cataract surgery is an infrequent, but potentially serious surgical complication. The aim of this study is to evaluate outcomes after vitrectomy has been performed for removal of retained lens material. METHODS: A retrospective review was conducted to evaluate all cases of pars plana vitrectomy for removal of retained lens fragments performed at Wills Eye Hospital from April 1991 through August 1994. RESULTS: A total of 121 eyes of 121 patients underwent pars plana vitrectomy with removal of retained lens material over the 3 1/2-year period. Visual acuity on presentation was 20/200 or worse in 95 eyes (79 percent). Visual acuity after vitrectomy was 20/40 or better in 82 eyes (68 percent). The postoperative visual acuity was 20/50 to 20/400 in 21 eyes (17 percent), and counting fingers or worse in 18 eyes (15 percent). Nineteen eyes (16 percent) had retinal detachment (RD), 8 were noted at the time of vitrectomy and 11 occurred after vitrectomy. Of the 19 eyes with RD, visual acuity was 20/200 or worse in 12 (63 percent) and counting fingers or worse in 6 (32 percent) at the time of last follow-up. The use of posterior segment phacofragmentation was associated with higher rate of RD, but the difference did not reach statistical significance. Major causes of poor final visual outcome included RD (6 eyes), cystoid macular edema (4 eyes), and glaucoma (2 eyes). CONCLUSION: The timing of vitrectomy did not have a statistically significant impact on visual outcome. Neither the type of intraocular lens nor the timing of lens implantation significantly altered the final visual acuity. Most eyes with retained lens fragments do well after vitrectomy, with the majority recovering good vision. However, the risk of RD is increased, and visual outcome may be adversely affected if RD occurs.
Adult↗
History of retina 1896-1996.
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History, 19th Century↗
Cataract extraction in adults with retinopathy of prematurity.
OBJECTIVE: To review the results of lensectomies performed to remove visually significant cataracts in adults with regressed retinopathy of prematurity, with special reference to postoperative vision and retinal complications. METHODS: A chart review of consecutive cases of cataract extraction in eyes with visually significant lens opacities and regressed retinopathy of prematurity was conducted. RESULTS: Fourteen consecutive eyes with retinopathy of prematurity in 10 adult patients were identified as having undergone lensectomy to manage a visually significant cataract. These cataract extractions were performed between June 1970 and February 1993. There were eight women and two men aged 16 to 43 years at the time of lensectomy. A variety of lenticular opacities were noted, the most common of which was nuclear sclerosis. Additionally, the nuclei were frequently much harder than would be expected for the patient's age. Phacoemulsification with implantation of a posterior chamber intraocular lens was the most common technique for cataract extraction. Eight eyes experienced improvement in visual acuity. However, when preoperative visual acuity was less than 20/200, postoperative acuity of 20/60 or better was uncommon. Six eyes were being treated for glaucoma before lensectomy. Glaucoma control was facilitated after lensectomy in six eyes. No combined cataract extraction and filtering procedures were performed. One eye developed a rhegmatogenous retinal detachment 76 months after cataract extraction. The retina was successfully reattached, but the eye suffered a substantial decrease in visual acuity. CONCLUSION: Cataract extraction in adult patients with retinopathy of prematurity may improve visual acuity, facilitate examination and treatment of the posterior segment, and aid in the management of glaucoma. The risk of retinal complications in these patients does not appear to be excessive.
Adolescent↗
[Prevention: the current realities. A report on Scandinavia Meets Switzerland in Oral Prevention on 9 February 1995 at Bern].
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Dental Prophylaxis↗