ABSTRACT
Purpose: To present a case of central retinal artery occlusion (CRAO) leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) within 1 week of an adenovirus vector COVID-19 vaccination. Methods: A case was reviewed. Results: A 50-year-old man with atopic dermatitis and asthma presented with acute painless vision loss in 1 eye. An examination and imaging findings showed CRAO. Further evaluation found eosinophilia and elevated inflammatory markers. A workup for vasculitis showed elevated cytoplasmic-antineutrophil cytoplasmic antibody, perinuclear-antineutrophil cytoplasmic antibody, myeloperoxidase antibody, rheumatoid factor, and total immunoglobulin E. Skin biopsies were consistent with eosinophilic granulomatosis with polyangiitis. Steroids, cyclophosphamide, and mepolizumab were initiated. At 1 year, the patient's systemic symptoms had improved but his vision had not. Conclusions: Few reports exist of CRAO associated with eosinophilic granulomatosis with polyangiitis, with no other instances related to an adenovirus vector COVID-19 vaccination. Treating a systemic vasculitis early can be vision saving in the fellow eye and prevent systemic life-threatening complications.
ABSTRACT
BACKGROUND AND OBJECTIVE: To report the 3-year outcomes for endolaserless vitrectomy with intravitreal aflibercept injection (IAI) monotherapy for proliferative diabetic retinopathy (PDR)-related vitreous hemorrhage (VH). MATERIALS AND METHOD: Eyes underwent endolaserless vitrectomy and received one preoperative and intraoperative IAI followed by randomization to a q8week or q16week IAI group. Additional IAI was administered as needed. RESULTS: 31/40 eyes were randomized (14 q8week eyes, 17 q16week eyes). Through 152 weeks, q8week and q16week eyes received 18.6 and 12.1 IAI, respectively. Q8week eyes observed a 34 letter visual acuity (VA) increase (P = 0.003) compared to a 27 letter increase in the q16week group (P = 0.013). CONCLUSIONS: Endolaserless vitrectomy with aflibercept monotherapy for PDR-related VH provides significant long-term visual gains. Frequent IAI is required for fewer proliferative consequences. [Ophthalmic Surg Lasers Imaging Retina 2023;54:89-96.].
Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Humans , Angiogenesis Inhibitors , Antibodies, Monoclonal, Humanized , Bevacizumab/therapeutic use , Diabetes Mellitus/drug therapy , Diabetes Mellitus/surgery , Diabetic Retinopathy/complications , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/drug therapy , Intravitreal Injections , Vascular Endothelial Growth Factor A , Vitrectomy/adverse effects , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/etiology , Vitreous Hemorrhage/surgeryABSTRACT
PURPOSE: Training of compassionate and empathetic physicians requires commitment by educators to make it a priority. Chaplains typically have time and training to effectively demonstrate compassionate care in the clinical setting. This qualitative study aims to explore perceived benefits among medical students from pastoral care shadowing in integrating compassion and spirituality into education curricula. METHODS: Sixty-four written reflections from first- and second-year medical students were collected from December 2018 to January 2020 after shadowing with hospital chaplains. Unprompted reflections were analyzed using coding networks. RESULTS: Four major themes identified included (1) learned values within pastoral care, (2) learned roles of pastoral care in the healthcare setting, (3) practiced spiritual assessment tools and resource identification, and (4) reflected personal impact on future career. Within each major theme, three to four sub-themes were further identified. CONCLUSIONS: Reflections support chaplain shadowing as a model for emphasizing spiritual and compassionate care through role-modeling, hands-on learning and reflective practices.
