Validation of a new technique using 4-0 nylon thread as a guide for tube insertion of the Ahmed glaucoma valve into the ciliary sulcus.

ABSTRACT: In this study, we validated the new technique for inserting the tube of the Ahmed glaucoma valve (AGV) into the ciliary sulcus. AGV tube insertion was performed by introducing a 4-0 nylon thread into the anterior chamber from the corneal incision on the opposite side of the AGV. The thread was placed in the lumen of a 23-G needle that was inserted into the sclera and ciliary sulcus from the AGV side. Withdrawing the 23-G needle, the thread was led out of the eye from the scleral wound, passing through the ciliary sulcus. The thread was then placed in the AGV tube lumen, and the tube was inserted through the scleral wound into the ciliary sulcus by using the thread as a guide, as per the Seldinger technique. In all seven eyes, the tube was precisely inserted into the ciliary sulcus without serious intraoperative complications such as vitreous straying of the tube.

TREAT-AND-EXTEND REGIMEN WITH AFLIBERCEPT FOR RETINAL ANGIOMATOUS PROLIFERATION.

PURPOSE: To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve retinal angiomatous proliferation (RAP) and development of retinal pigment epithelium (RPE) atrophy. METHODS: We retrospectively studied 17 treated eyes with RAP and 13 untreated fellow eyes. We assessed best-corrected visual acuity (BCVA) in logarithm of the minimal angle of resolution (logMAR) units and recorded the total number of injections for 12 months. Central macular thickness (CMT) and central choroidal thickness (CCT) were assessed by optical coherence tomography (OCT), and RPE atrophy extent in the macular area was assessed by fundus autofluorescence. RESULTS: Average BCVA in eyes with RAP was 0.57 logMAR units (Snellen 20/74 or approximately 56.5 ETDRS letters) before treatment and significantly improved to 0.38 (Snellen 20/48 or approximately 66 ETDRS letters, P < 0.01) after 3 months and 0.32 (Snellen 20/42 or approximately 69 ETDRS letters, P < 0.01) after 12 months. Average CMT was 340 µm before treatment and significantly reduced to 133 µm (P < 0.001) after 3 months and 130 µm (P < 0.001) after 12 months. Average CCT was 147 µm before treatment, 123 µm (P < 0.01) after 3 months, and 131 µm (P < 0.01) after 12 months. Average total number of injections was 7.2. Average area of RPE atrophy enlarged by 1.00 mm in treated eyes compared with 0.34 mm in fellow eyes (P < 0.01). The enlarged area of RPE atrophy was inversely correlated with central choroidal thickness after 12 months (rs = -0.49, P < 0.01) and positively correlated with the number of injections (rs = 0.58, P < 0.01). CONCLUSION: Treat-and-extend intravitreal therapy with aflibercept may be effective for improvement and stabilization of visual acuity and exudative change in eyes with RAP. However, choroidal thinning during the treatment regimen may accelerate enlargement of RPE atrophy.

Characteristics associated with the uptake of influenza vaccination among adults in the United States.

OBJECTIVE: Existing data suggest that influenza vaccination rates among adults in the United States fall far short of the Healthy People 2010 goals and the updated Healthy People 2020 targets. We identified characteristics associated with influenza vaccination that might inform strategies for increasing coverage. METHODS: We used data from the 2009 Behavioral Risk Factor Surveillance System to estimate adjusted prevalence ratios for receiving the influenza vaccine in the past 12 months. RESULTS: Among 134,101 adults aged ≥65 years, the influenza vaccination coverage level was 68.9%. Among 286,867 younger adults aged 18-64 years, coverage was markedly lower: 31.8%. Having health care coverage was the strongest predictor of vaccination in both age groups, after accounting for other sociodemographic characteristics, health behaviors, and health status. Those reporting older age, white race, higher education, non-smoking status, being physically active, or having poor physical health or a personal history of various chronic conditions were also more likely to report having received the influenza vaccine. CONCLUSION: Our results show clearly that vaccine uptake in the United States is related to social position as well as other health behaviors. These findings call for renewed attention to vaccination strategies to meet the updated Healthy People 2020 goals.