Factors affecting visual outcomes in patients with diabetic macular edema treated with ranibizumab.

PURPOSE: To identify factors associated with visual outcomes in patients with diabetic macular edema (DME) treated with ranibizumab (RBZ) in the Ranibizumab for Edema of the mAcula in Diabetes-Protocol 2 (READ-2) Study. PATIENTS AND METHODS: Optical coherence tomography scans, fundus photographs, and fluorescein angiograms (FAs) were graded and along with baseline characteristics were correlated with month (M) 24 visual outcome of best-corrected visual acuity (BCVA) ≤20/100 (poor outcome) vs >20/100 (better outcome). RESULTS: Of 101 patients with a M20 visit or beyond, 27 (27%) had BCVA ≤20/100. Comparison of patients with or without poor outcome showed mean baseline BCVA of 16.8 letters (20/125) in the former compared with 30.4 letters (20/63; P<0.001). Mean change in BCVA between baseline and M24 was -2.6 letters in the poor outcome group compared with +9.8 letters (P<0.001). Foveal thickness (FTH) at M24 was 374.1 µm in the poor outcome group compared with 268.8 µm (P<0.01), a difference driven by 14 patients with mean FTH of 450.3 µm. Foveal atrophy occurred in 65% (11/17) in the poor outcome group compared with 17%(12/71, P=0.001). Persistent edema was noted in 52% (14/27) of patients with poor outcome. Laser scars near foveal center were significantly more common in patients with poor outcome who did not have edema vs those who did (78% (7/9) vs 23% (3/13) P=0.03). CONCLUSION: Poor baseline BCVA (≤20/125) in DME patients predicts poor visual outcome (≤20/100) after 2 years of treatment with RBZ and/or focal/grid laser, often due to foveal atrophy and/or persistent edema.

Risk factors for clinical infection in patients colonized with methicillin resistant Staphylococcus aureus (MRSA).

OBJECTIVE: To identify the risk factors involved in development of infection in individuals colonized with Methicillin-resistant Staphylococcus aureus (MRSA) among intensive care unit (ICU) patients. METHODS: A total of 1431 patients were admitted in ICU of which 63 grew MRSA during January 1998 to December 1999. Patients who developed infection with MRSA in less than 48 hours of their admission to ICU were excluded. Medical records of all patients who grew MRSA were reviewed and 57 patients were identified for inclusion in the study. Thirty-seven of these had features of infection with MRSA and were selected as cases and 20 were identified as asymptomatic colonizers and labeled as controls. Risk factors like age of the patient, duration of ICU stay, gender, co-morbidity, presence and duration of central lines, number of arterial-punctures and number and duration of intubations were compared between cases and controls. RESULTS: Cases were found to be significantly older (52.8 +/- 15.1) than controls (34.9 +/- 21.2). Other identified risk factors were diabetes mellitus (p = 0.001) and the first 15 days of central line placement (p = 0.025). Although chronic liver disease and hypertension could not be identified as significant risk factors, they clearly showed association. Other risk factors were not significantly different from controls. CONCLUSION: It is suggested that greater care is required for the elderly, diabetic patients with a central venous line in place especially during the first fifteen days of its introduction.

Aortoiliac stent placement in patients treated for intermittent claudication.

PURPOSE: To assess the results of iliac artery stent placement for the treatment of patients with intermittent claudication. MATERIALS AND METHODS: Lesions in 90 iliac arteries were treated in 65 patients with 111 Wallstents and 21 Palmaz stents. Stents were placed for symptoms of intermittent claudication classified as grade I, categories 1-3 by the SVS/ISCVS/SCVIR reporting standards. Sixty-two stenosed arteries and 28 chronically occluded arteries were treated. Patients were followed for up to 57.1 months (mean, 17.4 months +/- 14.9). RESULTS: Technical success was achieved in 87 of 90 iliac limbs (97%), with major complications in seven of 65 patients (11%). The 30-day mortality was zero. Mean pressure gradients across stenoses improved from 14.7 mm Hg +/- 9.8 to 1.4 mm Hg +/- 1.4 (P < .001). Ankle-brachial indices improved from 0.62 +/- 0.21 to 0.90 +/- 0.18 (P < .001). With use of the Rutherford criteria, 84% demonstrated +2 or +3 improvement. The cumulative patency rates were 77%, 71%, 62%, and 62% at 1, 2, 3, and 4 years (standard error [SE] < 10%). Continued clinical and noninvasive test benefit was present in 80%, 80%, 73%, and 73% at 1, 2, 3, and 4 years, respectively (SE < 10%). CONCLUSIONS: Significant hemodynamic improvement can be achieved by percutaneous stent placement, with excellent clinical results. Observed mortality in this series was zero, but major complications, requiring modification of the treatment plan, were seen in 11% of patients. Clinical results were better than suggested using current accepting reporting standards for "patency."