ABSTRACT
PURPOSE: To describe the demographics and clinical characteristics of patients with herpetic anterior uveitis (HAU), and compare characteristics by pathogen, recurrence, and association to iris atrophy. METHODS: Multicenter, retrospective study of AU patients diagnosed clinically and by polymerase chain reaction (PCR). RESULTS: The study included 112 eyes in 109 patients: 54 (48.2%) HSV, 34 (30.4%) VZV, 2 (1.8%) CMV, and 22 (19.6%) unspecified diagnosis. HSV eyes, compared to VZV, had a higher recurrence rate, corneal involvement, KPs, iris atrophy, elevated IOP and posterior synechia (p < 0.05). VZV patients had more frequent immunomodulatory treatments and history of systemic herpetic disease (p < 0.05). Fifty-nine (52.7%) eyes had recurrent disease. Iris atrophy was associated with a higher prevalence of posterior synechia, dilated distorted pupil, and high IOP (p < 0.05). CONCLUSION: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease.
Subject(s)
DNA, Viral/analysis , Eye Infections, Viral/diagnosis , Herpes Zoster Ophthalmicus/diagnosis , Herpesvirus 3, Human/genetics , Polymerase Chain Reaction/methods , Uveitis, Anterior/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Aqueous Humor/virology , Child , Child, Preschool , Eye Infections, Viral/virology , Herpes Zoster Ophthalmicus/virology , Humans , Middle Aged , Retrospective Studies , Uveitis, Anterior/virology , Young AdultABSTRACT
PURPOSE: Assessing changes in foveal photoreceptor microstructure (FPM) following intravitreal anti-VEGF treatment may serve as a prognostic marker in patients with macular edema (ME). METHODS: Sixteen eyes belonging to newly diagnosed patients with ME were included in this prospective longitudinal study. FPM integrity was evaluated at baseline and at the end of a series of anti-VEGF injections. RESULTS: Treatment led to a significant improvement in mean visual acuity (VA) and central macular thickness. A larger FPM defect was associated with lower VA, both before and after treatment. Patients with larger FPM defects at baseline had smaller VA improvements, and the improvement in FPM integrity was associated with VA improvement (every 100-µm FPM recovery contributed to a gain of 0.04 logMAR). CONCLUSIONS: Recovery of FPM after anti-VEGF treatment was significantly associated with a VA improvement. Direct measurement of photoreceptor integrity might provide an additional tool for the assessment of retinal function and treatment response in patients newly diagnosed with ME.
Subject(s)
Bevacizumab/administration & dosage , Macular Edema/drug therapy , Photoreceptor Cells, Vertebrate/pathology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Aged , Angiogenesis Inhibitors/administration & dosage , Female , Fluorescein Angiography , Fundus Oculi , Humans , Intravitreal Injections , Macular Edema/diagnosis , Macular Edema/physiopathology , Male , Photoreceptor Cells, Vertebrate/drug effects , Prospective Studies , Tomography, Optical Coherence , Visual AcuityABSTRACT
OBJECTIVES: Health information technology, especially electronic health records (EHRs), can be used to improve the efficiency and effectiveness of healthcare providers. This study assessed the cost-savings of incorporating a list of preferred specialty care providers into the EHRs used by all primary care physicians (PCPs), accompanied by a comprehensive implementation plan. METHODS: On January 1, 2005, all specialty clinic providers at the Israeli Defense Forces were divided into one of four financial classes based on their charges, class 1, the least expensive, being the most preferred, followed by classes 2-4. This list was incorporated into the EHRs used by all PCPs in primary care clinics. PCPs received comprehensive training. Target referral goals were determined for each class and measured for 4 years, together with the total cost of all specialist visits in the first year compared to the following years. Quality assessment (QA) scores were used as a measure of the program's effect on the quality of patient care. RESULTS: During 2005-2008, a marginally significant decline in referrals to class 1 was observed (r=-0.254, p=0.078), however a significant increase in referral rates to class 2 was observed (r=0.957, p=0.042), concurrent with a decrease in referral rates to classes 3 and 4 (r=-0.312, p=0.024). An inverse correlation was observed between year and total costs for all visits to specialists (2008 prices; r=-0.96, p=0.04), and between the mean cost of one specialist visit over the 4 years, indicating a significant reduction in real costs (2008 prices; r=-0.995, p=0.005). QA was not affected by these changes (r=0.94, p=0.016). CONCLUSIONS: From a policy perspective, our data suggest that EHR can facilitate effective utilization of healthcare providers and decrease costs.
Subject(s)
Ambulatory Care Facilities/economics , Cost Savings , Electronic Health Records/economics , Ambulatory Care Facilities/organization & administration , HumansSubject(s)
Hyperlipidemias/physiopathology , Regional Blood Flow/physiology , Retina/physiopathology , Retinal Diseases/etiology , Adult , Follow-Up Studies , Humans , Hyperlipidemias/complications , Hyperlipidemias/diagnosis , Male , Retinal Diseases/diagnosis , Retinal Diseases/physiopathology , Severity of Illness Index , Visual AcuityABSTRACT
The use of eye cosmetics is a popular practice in modern times that dates back to ancient civilizations. This practice, however, is not without hazards. The most common adverse effect of eye cosmetics is eyelid dermatitis, although an array of other adverse effects has been reported. This article reviews the different types of eye cosmetics in current use, their composition and the adverse effects of both commercial and traditional products.
