To assess the level and the determinants of compliance with outpatient retinopathy of prematurity (ROP) examination appointments at a tertiary academic center.
The medical records of babies scheduled ...for outpatient ROP examination between January 1, 2022, and December 31, 2022, were reviewed retrospectively. Data collected included appointments scheduled and attended, birth weight, gestational age, ROP staging at discharge, maternal ethnicity (self-identified), household type, proximity to hospital and median family income (US Census based on home zip codes). Univariate and multivariable analyses were performed. A P value of <0.05 was considered significant.
The records of 66 babies were analyzed. Forty-nine babies (74%) attended all scheduled ROP examination appointments (fully compliant). The mean appointment compliance rate was 86%, with a 1.5% no-show rate. Seven children (11%) required the intervention of Child Protective Services. One baby was never seen in the clinic. In unadjusted analysis, maternal ethnicity (P = 0.028) and median family income lower than the national average (P = 0.049) were sociodemographic factors associated with lower compliance. Clinical factors associated with lower compliance were lower gestational ages (P = 0.005) and lower birth weight (P = 0.006). In multivariable logistic regression adjusting for all candidate predictors, only birth weight remained significantly associated with lower compliance (P = 0.036).
Clinical and sociodemographic factors may be associated with compliance with outpatient ROP examination recommendations. Extremely low-birth-weight babies were at the greatest risk for noncompliance.
We describe a 61-year-old female patient with a retinal pigment epithelial detachment (PED) of the left eye in the setting of neovascular aged-macular degeneration (nAMD) with unanticipated responses ...to aflibercept and bevacizumab.
A reduction of PED size from 423 μm to 309 μm and vision improvement (20/150- to 20/40) were observed after five consecutive monthly injections of bevacizumab. A switch to aflibercept for the following two consecutive months showed an unanticipated incremental decline in vision (20/80- at month 1, 20/150- at month 2), increased PED size (749 μm), and the development of subretinal fluid (SRF). After a switch back to bevacizumab, the subretinal fluid resolved. After nine consecutive monthly injections of bevacizumab, final vision in the left eye was 20/25, and final PED height was 84 μm.
Different anti-VEGFs may induce varied and unpredictable responses among the most recalcitrant cases of nAMD. Unpredictably, PED size in our patient worsened with aflibercept treatment.
Treatment for nAMD with large PEDs has poor level 1 evidence for guidance, and customized treatment should be considered.
Diabetic retinopathy (DR) is a potentially blinding disease originating from small vessel damage in the retina in chronic hyperglycemic states. DR has a complex multi-pathway driven pathogenesis ...resulting in diabetic macular edema and retinal ischemia, the former being the most common cause of vision impairment in DR. Hypoxia induced cytokines stimulate vascular endothelial growth factor (VEGF) production and subsequent angiogenesis with resultant mechanical retinal damage over time. Anti-VEGF therapy is effective for the treatment of center-involving diabetic macular edema. There is evolving evidence showing the effectiveness of anti-VEGF as both adjuvant and monotherapy in the treatment of proliferative DR, however laser photocoagulation continues to remain the standard of care. DR in large cohort studies has been shown to be an independent risk factor for the development of cardiovascular disease and mortality. In addition, changes in retinal vascular caliber ratios may have implications for risk of macrovascular events with a gender discrepancy towards women.
This case report describes a patient with uncontrolled type 2 diabetes mellitus who received steroids for an outpatient infection of COVID-19. The steroid course combined with his acute illness ...likely contributed to his development of extremely high blood sugar levels (790 mg/dL) and subsequent hyperosmolar hyperglycemic syndrome. In this compromised state, he contracted invasive mucormycosis of the right sinuses and right orbit. This fungal infection caused him to lose his eye and, later, his life. Prescribing systemic steroids comes with many risks. Providers must be careful to use them only when absolutely indicated, especially in patients who are vulnerable to complications, such as those with uncontrolled type 2 diabetes. This case is a grim example of the dangers that can occur with systemic steroid usage.
This case demonstrates the dilemma in the diagnosis of ocular syphilis, as it can mimic many other ocular conditions where initial steroid therapy might complicate the disease course and can worsen ...the infection. Also, it represents an example of anchoring bias, where a provisional diagnosis resulted in unnecessary treatment that would have worsened her clinical outcomes.
Fungal empyema is an uncommon condition associated with high morbidity and mortality.
empyema thoracis is rare and is usually associated with preexisting chronic empyema, pulmonary tuberculosis, or ...rupture of aspergilloma cavity. This case describes a healthy 20-year-old man presenting with chronic intractable back pain and constitutional symptoms for 6 months who was eventually diagnosed with
empyema thoracis, complicated by empyema necessitans extending into multiple ribs and paravertebral areas. He was treated with surgical decortication, chest tube drainage, and systemic antifungal agents. The diagnostic difficulties of fungal empyema thoracis are highlighted.
This case demonstrates the dilemma in the diagnosis of ocular syphilis, as it can mimic many other ocular conditions where initial steroid therapy might complicate the disease course and can worsen ...the infection. Also, it represents an example of anchoring bias, where a provisional diagnosis resulted in unnecessary treatment that would have worsened her clinical outcomes.
Fungal empyema is an uncommon condition associated with high morbidity and mortality. Aspergillus empyema thoracis is rare and is usually associated with preexisting chronic empyema, pulmonary ...tuberculosis, or rupture of aspergilloma cavity. This case describes a healthy 20-year-old man presenting with chronic intractable back pain and constitutional symptoms for 6 months who was eventually diagnosed with Aspergillus empyema thoracis, complicated by empyema necessitans extending into multiple ribs and paravertebral areas. He was treated with surgical decortication, chest tube drainage, and systemic antifungal agents. The diagnostic difficulties of fungal empyema thoracis are highlighted.
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