What explains health in persons with visual impairment?

BACKGROUND: Visual impairment is associated with important limitations in functioning. The International Classification of Functioning, Disability and Health (ICF) adopted by the World Health Organisation (WHO) relies on a globally accepted framework for classifying problems in functioning and the influence of contextual factors. Its comprehensive perspective, including biological, individual and social aspects of health, enables the ICF to describe the whole health experience of persons with visual impairment. The objectives of this study are (1) to analyze whether the ICF can be used to comprehensively describe the problems in functioning of persons with visual impairment and the environmental factors that influence their lives and (2) to select the ICF categories that best capture self-perceived health of persons with visual impairment. METHODS: Data from 105 persons with visual impairment were collected, including socio-demographic data, vision-related data, the Extended ICF Checklist and the visual analogue scale of the EuroQoL-5D, to assess self-perceived health. Descriptive statistics and a Group Lasso regression were performed. The main outcome measures were functioning defined as impairments in Body functions and Body structures, limitations in Activities and restrictions in Participation, influencing Environmental factors and self-perceived health. RESULTS: In total, 120 ICF categories covering a broad range of Body functions, Body structures, aspects of Activities and Participation and Environmental factors were identified. Thirteen ICF categories that best capture self-perceived health were selected based on the Group Lasso regression. While Activities-and-Participation categories were selected most frequently, the greatest impact on self-perceived health was found in Body-functions categories. The ICF can be used as a framework to comprehensively describe the problems of persons with visual impairment and the Environmental factors which influence their lives. CONCLUSIONS: There are plenty of ICF categories, Environmental-factors categories in particular, which are relevant to persons with visual impairment, but have hardly ever been taken into consideration in literature and visual impairment-specific patient-reported outcome measures.

Prospective study of risk factors for conjunctival bacterial contamination in patients undergoing intraocular surgery.

PURPOSE: To determine whether a patient's age, gender, local or systemic risk factors affect the rate of preoperative bacterial contamination. METHODS: Consecutive 1,474 patients undergoing intraocular surgery were enrolled in this prospective masked study. Past medical history was noted and examinations were performed. The patients were divided into four groups: a control group (without local or systemic risk factors), those with local risk factors (chronic use of topical medications, contact lens wear, blepharitis, chronic eyelid or conjunctival inflammation), those with systemic risk factors (immunosuppression, diabetes, autoimmune conditions, and asthma), and those with both. Conjunctival cultures were obtained before surgery. RESULTS: Among the 1,474 patients, 914 bacteria were isolated from 214 (14.9%) patients. Advanced age was associated with a higher rate of positive conjunctival cultures (p<0.005). No statistical difference was found with regard to gender (p=0.7173). Among the 282 patients in the control group, 14 (5%) had a positive conjunctival culture. Compared to the control group, positive conjunctival cultures were found in 118 out of 503 patients (23.5%) with local risk factors (p<0.0001), 65 out of 545 patients (11.9%) with systemic risk factors (p=0.0019), and 22 out of 144 (15.3%) with both (p=0.0006). Two patients developed postoperative endophthalmitis (0.14%), one with both local risk and systemic factors and the other with a systemic risk factor. CONCLUSIONS: Patients with local or systemic risk factors or advanced age were found to have a higher rate of bacterial conjunctival contamination before intraocular surgery.

Bacterial contamination of needle points after intravitreal injection.

PURPOSE: Evaluation of the magnitude and pattern of bacterial contamination of needle points with conjunctival bacteria during the intravitreal injection. Analysis of the efficacy of preinjection prophylaxis. METHODS: A total of 550 intravitreal injections were done in 414 patients (n=425 eyes). A total of 289 patients were injected once, while 125 patients received several injections. Before the intravitreal injection in the operation room, the following standard preoperative preparation of the eye-10% povidone iodine scrub on the eyelids, eyelashes, and forehead and irrigation of the conjunctival sac with 1% povidone iodine-was carried out. Immediately after the injection, the needle points were rinsed three times in thioglycolate broth, which was cultured at 35 degrees C for 5 days afterwards. As a negative control, 200 sterile unused needle points were treated the same way. RESULTS: Only 2 out of 550 (0.36%) needle points were contaminated after intravitreal injection. In sensitivity testing, the isolated Staphylococcus epidermidis and Corynebacterium sp did not show multidrug resistance. All 200 unused needle points proved to be sterile after 5 days of cultivation. CONCLUSIONS: Contamination of needle points is minimal after iodine irrigation prophylaxis before intravitreal injection. Therefore, we recommend this prophylaxis technique before intravitreal injections. The low incidence of contaminated needle points, however, shows that there still is a risk of bacteria entering into the eye during injection.

Epi-LASIK using the Amadeus II microkeratome: evaluation of cut quality using light and electron microscopy.

PURPOSE: To investigate the cut quality and surface characteristics of the epithelial flap and underlying Bowman's membrane created by the Amadeus II (AMO) microkeratome on human corneas using light and electron microscopy. SETTING: Center for Refractive Therapy, Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany. METHODS: Using a 9.0 mm type II suction ring and settings, as recommended by the manufacturer, epithelial laser in situ keratomileusis (epi-LASIK) was performed in 2 fresh human eyes of 1 donor. Ocular pathology and previous ocular surgery were ruled out. Tissues for light microscopy were examined using hematoxylin-eosin and periodic acid-Schiff reaction staining. Further tissue samples were examined using scanning electron microscopy and transmission electron microscopy. RESULTS: Light microscopy showed a thoroughly separated epithelial sheet with no evident anatomical abnormalities. Stratification of the separated epithelium layer and cell shape was conserved. The cleavage plane was located at Bowman's membrane. Scanning electron microscopy showed a consistent transition from adherent epithelium to the denuded area. Bowman's layer showed a very smooth surface without remains of basal lamina. Transmission electron microscopy examination showed interruptions of the basement membrane at high magnification. CONCLUSIONS: This in vitro study found a high cut quality using the epi-LASIK separator of the Amadeus II microkeratome. The resulting cleavage plane at Bowman's membrane was well suited for the subsequent laser ablation.

Ocular alterations in patients with cutaneous and mucocutaneous leishmaniasis.

Leishmaniasis is a parasitosis with high prevalence and increasing epidemiologic relevance. Ocular manifestations of visceral leishmaniasis (kala-azar) have been well studied, but less is known about ocular alterations in cutaneous and mucocutaneous leishmaniasis (CL/MCL). Fifty-five patients with CL/MCL and a seronegative control group of 39 were examined ophthalmologically in Paraguay. CL/MCL was diagnosed clinically by detection of the parasite, with serological methods and/or intradermal reaction.