Temporary Lumbar Drain as Treatment for Pediatric Fulminant Idiopathic Intracranial Hypertension.

Fulminant idiopathic intracranial hypertension (FIIH) is a subtype of idiopathic intracranial hypertension (IIH) characterized by rapid, severe, progressive vision loss. Surgical intervention is often performed either as a cerebrospinal fluid (CSF) shunt procedure or an optic nerve sheath fenestration or, at times, both. These surgical procedures carry a significant risk of morbidity and failure. We present 2 patients in whom a temporary lumbar drain was successfully used in the management of medically undertreated pediatric FIIH, and circumvented the need for surgical intervention.

Assessment of the American Board of Ophthalmology's Maintenance of Certification Part 4 (Improvement in Medical Practice).

IMPORTANCE: There is disagreement as to whether Maintenance of Certification is creating value for physicians and their patients. To our knowledge, this report provides the first measures of the effectiveness of Part 4 of this activity in assisting ophthalmologists with quality improvement in their practices. OBJECTIVE: To evaluate the effectiveness of the American Board of Ophthalmology's quality improvement program-Maintenance of Certification Part 4 (Improvement in Medical Practice)-in assisting its diplomates with quality improvement in their practices. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis was conducted of the performance of 1046 American Board of Ophthalmology diplomates on Practice Improvement Modules between September 1, 2012, and December 31, 2014. The mean baseline scores for each process or outcome measure on a medical record abstraction were calculated before and after the practice improvement activity. Paired t tests were used to assess improvement before and after the activity. Diplomates' comments and ratings of the usefulness of the activity in assisting them with quality improvement were also analyzed. MAIN OUTCOME MEASURES: Diplomate performance on process and outcome measures before and after a performance improvement activity and diplomate satisfaction that the activity met the stated goals of assistance with quality improvement in their practices. RESULTS: The 1046 American Board of Ophthalmology diplomates completed 1408 Practice Improvement Modules. When measures with participation by at least 20 diplomates were analyzed, there was improvement in 24 of 30 individual process measures (80.0%; 95% CI, 61.4%-92.3%) and in 7 of 18 individual outcome measures (38.9%; 95% CI, 17.3%-64.3%) chosen for improvement by diplomates. Analysis of the mean results for each diplomate on process measures chosen for improvement showed gains occurring in 9 of 12 modules and, for outcomes chosen for improvement, in 6 of 12 modules with at least 20 participants. A total of 826 of 1115 modules (74.1%) assessed by diplomates were rated from good to excellent; positive comments outnumbered negative ones by a ratio of 5:1. CONCLUSIONS AND RELEVANCE: Quantitative and qualitative analyses, while limited by self-report that has not been validated, suggest that the American Board of Ophthalmology's Maintenance of Certification Part 4 can help diplomates improve quality on process, and to a lesser extent, outcome measures. Findings of this study may provide a basis to improve this activity.

Twenty-five years of professional liability in pediatric ophthalmology and strabismus: the OMIC experience.

PURPOSE: To summarize the claims statistics of the Ophthalmic Mutual Insurance Company (OMIC) in the field of pediatric ophthalmology and strabismus (POS). METHODS: Internal OMIC case summaries and defense counsel case evaluations of all claims in the field of POS closed between December 1, 1988, and February 19, 2013 were retrospectively analyzed. RESULTS: A total of 140 claims were closed over the 25-year study period, of which 44 were closed with an indemnity payment. Claims related to strabismus and retinopathy of prematurity (ROP) were most common, and claims related to ROP resulted in the highest indemnity and expense payments. Issues related to follow-up represented the most significant risk factor among system-related claims. CONCLUSIONS: Claims in pediatric ophthalmology and strabismus were infrequent but associated with three times higher average indemnity payments relative to all claims paid by OMIC during the course of the study.

Metastatic tumor to the extraocular muscles: report of 5 cases.

We report the findings in 5 patients with metastases to the extraocular muscles. Familiarity with this condition will aid ophthalmologists in differentiating it from thyroid ophthalmopathy, the most common form of muscle enlargement. Palliative treatment is effective in ameliorating visual symptoms.