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Niu L, Luo Y, Xu H, Huang H, Jiang R, Sun X. Clinical analysis of infectious endophthalmitis following glaucoma filtration surgery. J Ophthalmic Inflamm Infect 2024; 14:11. [PMID: 38421465 PMCID: PMC10904707 DOI: 10.1186/s12348-024-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical correlative factors and outcomes of treatment of bleb-associated endophthalmitis (BAE) following glaucoma filtration surgery in a Chinese population from the year 2012 to 2022, and to compare them with the clinical course during the coronavirus disease (COVID-19) pandemic period. METHODS This was a retrospective analysis of consecutive cases of BAE treated at the Eye & ENT Hospital of Fudan University, Shanghai, China, between January 1, 2012, and December 31, 2022. The clinical presentation, treatment modality, microbiological data, clinical course, and outcomes of visual acuity (VA) and intraocular pressure (IOP) in all BAE cases were collected and analyzed. RESULTS A total of 28 eyes with BAE were examined, predominantly in male patients (71.4%, p = 0.023). Most patients underwent trabeculectomy (89.3%, p ≤ 0.001), while a smaller proportion underwent Ex-PRESS implantation (10.7%). Primary open-angle glaucoma (POAG) was the most common type of glaucoma (39.3%, p ≤ 0.001). Most patients (96.4%) presented with poor visual acuity, worse than 20/400, and IOP ranged from 3-60 mmHg. Treatment, including initial tap-and-inject procedure of antibiotics (Ceftazidime and Norvancomycin) or initial pars plana vitrectomy (PPV), was initiated 5.0 ± 7.1 days after BAE onset. Streptococcus was the most common causative organism (53.6% of cases, p ≤ 0.001). The visual acuity significantly improved from 2.58 ± 0.27 to 2.14 ± 0.85 (reported in logMAR) after treatment (p ≤ 0.001), and most patients maintained normal tension during follow-up. Poisson regression model analysis showed the annual incidence of BAE during the COVID-19 pandemic period was significantly twice greater than that of previous years. CONCLUSIONS BAE may cause irreversible visual impairment. POAG filtering surgery with male sex and the COVID-19 pandemic period might be potentially relevant factors for BAE. Culture positivity was closely related to BAE prognosis, with Streptococcus species being the leading pathogenic organisms. Online outpatient services, early diagnosis, and timely treatment may rescue vision and maintain IOP control in the presence of BAE.
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Affiliation(s)
- Liangliang Niu
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Yan Luo
- Hospital-Acquired Infection Control Department, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Huan Xu
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Haili Huang
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Rui Jiang
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
- Ocular Trauma Center, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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Burgos-Blasco B, Vidal-Villegas B, Yap TE, Normando EM, Ameen S, Crawley L, Ahmed F, Bloom PA, Cordeiro MF. Effects of COVID-19 pandemic on glaucoma appointment scheduling in a tertiary hospital in London, UK. Eur J Ophthalmol 2024; 34:204-216. [PMID: 37097882 PMCID: PMC10130936 DOI: 10.1177/11206721231171704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the impact of the delay in patient appointments caused by the COVID-19 pandemic and the triage system on the glaucomatous disease of patients in a London tertiary hospital. METHODS Observational retrospective study that randomly selected 200 glaucoma patients with more than 3 months of unintended delay for their post-COVID visit and other inclusion and exclusion criteria. Demographic information, clinical data, number of drugs, best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) mean deviation (MD), and global peripapillary retinal nerve fibre layer (pRNFL) thickness were obtained from the pre- and post-COVID visit. At the post-COVID visit, the clinical outcomes subjective clinical concern and change of treatment or need for surgery were also annotated. The variables were stratified by glaucoma severity (according to the MD into early, moderate and advanced) and by delay time (more and less than 12 months) and analysed using SPSS. RESULTS We included 121 eyes (from 71 patients). The median patient age was 74 years (interquartile range -IQR- 15), 54% were males and 52% Caucasians. Different glaucoma types and all glaucoma severities were included. When data was stratified for glaucoma severity, at the pre-COVID visit, significant differences in BCVA, CCT and IOP were observed and there were significantly higher values in the early glaucoma group. The median follow-up delay was 11 months (IQR 8), did not differ between the glaucoma severity groups and did not correlate to the glaucoma severity. At the post-COVID visit, significant differences in BCVA, IOP, and Global pRNFL thickness were observed between the glaucoma severity groups, as lower BCVA and higher IOP and pRNFL thickness were observed in the early glaucoma group. At the post-COVID visit there was cause for concern in 40 eyes: 5 were followed more closely, 22 had a change of treatment and 13 were booked for surgery (3 for cataract and 10 for glaucoma surgery). However, the number of eyes with causes for concern were similar between the glaucoma severity groups and there was no correlation between these clinical outcomes and the delay of the post-COVID visit. The number of topical hypotensive medications increased significantly after the post-COVID visit, higher number of medications were observed in the advanced glaucoma group. When differences of IOP, MD and pRNFL thickness between the pre and post-COVID visit, only the MD difference was significantly different between the glaucoma severity groups because it was higher in the severe group. When data was stratified for delay longer or shorter than 12 months, no differences were observed between the groups except at the pre-COVID visit, when the numbers of patients with MD deviation >-6 dB had longer delay time. When differences in IOP, MD and RNFL thickness were calculated, only the pRNFL thickness showed significant differences between the delay groups, because it was higher in the longer delay group. Finally, when paired analysis of the variables at the pre- and post-COVID visits, stratified by glaucoma severity and delay were conducted, although there were no significant differences in IOP in any group, the BCVA decreased significantly in the overall group and in the longer delay groups, the number of hypotensive drugs increased significantly overall and in the moderate and advanced glaucoma, the MD of the VF worsened significantly in the overall group and in the early glaucoma and longer delay groups and the pRNFL thickness decreased significantly in all groups. CONCLUSIONS We document that delayed care impacts negatively on the glaucomatous disease of our patients because at the post-COVID visit there were reasons for clinical concern in a third of eyes that resulted in change of treatment or surgery. However, these clinical consequences were not related to IOP, glaucoma severity or delay time and reflect that the triage methods implemented worked adequately. The most sensitive parameter to indicate progression in our sample was the pRNFL thickness.
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Affiliation(s)
- Barbara Burgos-Blasco
- Department of Ophthalmology, Hospital
Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San
Carlos (IdISSC), Madrid, Spain
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
| | - Beatriz Vidal-Villegas
- Department of Ophthalmology, Hospital
Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San
Carlos (IdISSC), Madrid, Spain
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
| | - Timothy E. Yap
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - Eduardo M Normando
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - Sally Ameen
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - Laura Crawley
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - Faisal Ahmed
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - Philip A Bloom
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
| | - M Francesca Cordeiro
- Imperial College Ophthalmology Research
Group (ICORG), Imperial College London, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS
Trust, London, UK
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Lin Y, Jiang B, Cai Y, Luo W, Zheng C, Zhu X, Lin Q, Tang M, Li X, Xie L. The causal relationship between COVID-19 and increased intraocular pressure: A bidirectional two-sample Mendelian randomization study. Front Public Health 2023; 11:1039290. [PMID: 36950097 PMCID: PMC10025528 DOI: 10.3389/fpubh.2023.1039290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has brought great challenges to the global public health system and huge economic burdens to society, the causal effect of COVID-19 and intraocular pressure was blank. Objective This study aimed to explore the causal association between coronavirus disease (COVID-19) susceptibility, severity and criticality and intraocular pressure (IOP) by bidirectional Mendelian randomization (MR) analysis. Materials and methods Genetic associations with COVID-19 susceptibility, severity and criticality were obtained from the COVID-19 Host Genetics Initiative. Genetic associations with IOP were obtained from GWAS summary data. The standard inverse variance weighted (IVW) method was used in the primary assessment of this causality. Other methods were also implemented in supplementary analyses. Finally, sensitivity analysis was performed to evaluate the reliability and stability of the results. Results The results showed that COVID-19 susceptibility had null effect on IOP (β = 0.131; Se = 0.211; P = 0.533) as assessed by the IVW method. Moreover, the results revealed that COVID-19 severity, specifically, hospitalization due to COVID-19, had a positive effect on IOP with nominal significance (β = 0.228; Se = 0.116; P = 0.049). However, there were null effect of COVID-19 criticality on IOP (β = 0.078; Se = 0.065; P = 0.227). Sensitivity analysis showed that all the results were reliable and stable. The reverse MR analysis revealed that there was null effect of IOP on COVID-19. Conclusions We demonstrated that hospitalization due to COVID-19 might increase IOP; therefore, greater attention should be given to monitoring IOP in inpatients with COVID-19.
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Affiliation(s)
- Yi Lin
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bingcai Jiang
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanqing Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wangdu Luo
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changwei Zheng
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaomin Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qianyi Lin
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Tang
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangji Li
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Xie
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Lin Xie
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Abstract
PURPOSE OF REVIEW The current article reviews enhancements to the delivery of glaucoma care that developed in response to the coronavirus disease 19 (COVID-19) pandemic and are likely to persist beyond its resolution. RECENT FINDINGS Literature from the review period (2020-2021) includes reports highlighting contributions of the ophthalmology community to global health during the pandemic. Glaucoma practices worldwide have instituted more robust infection control measures to mitigate severe acute respiratory syndrome coronavirus 2 transmission in the outpatient setting, and many of these modifications will endure in the post-COVID era. Operational adjustments have led to the provision of more efficient glaucoma care. A hybrid care model involving technician-based diagnostic testing and subsequent virtual consultation with a glaucoma specialist has evolved as a useful adjunct to traditional face-to-face encounters with patients. SUMMARY Glaucoma specialists, patients, and staff have adapted to a 'new normal' of glaucoma care delivery during the COVID-19 pandemic. Although innovation has propelled several improvements to glaucoma care during this global health crisis, significant barriers to more widespread implementation of teleglaucoma still exist. Whether, and in what capacity, the pandemic has permanently altered glaucoma practice patterns remains to be seen.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York USA
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Pidgeon JH, Bhardwaj MK, Titterington P, Latulippe K, Roh S, Ramsey DJ. Assessing optometric care delivered by telehealth during the COVID-19 public health emergency. Ther Adv Ophthalmol 2022; 14:25158414221123526. [PMID: 36199812 PMCID: PMC9527121 DOI: 10.1177/25158414221123526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The emergence of coronavirus disease 2019 (COVID-19) forced many eye care providers to implement telehealth services while in-person visits were reserved for essential and/or emergency eye care. Objective: This study documents how an optometry group successfully implemented telehealth to care for patients during the outbreak of the COVID-19 pandemic in the United States. Design: Retrospective, comparative case series. Methods: Records were reviewed for patients seen in an academic optometry clinic from 23 March through 7 April 2020, the period of the Massachusetts stay-at-home advisory issued in response to COVID-19. Patients who completed telehealth visits were compared with those who received in-person care. Services delivered by telehealth included a check of symptoms, medication refills, health education, and assurance of future follow up. The study took into account the reason for each visit, as well as the rate of scheduled and completed follow-up appointments. Patient satisfaction with in-person care was evaluated by Press Ganey patient experience surveys. Results: Out of 855 patients scheduled, 421 patients completed telehealth encounters (49%), and 46 patients completed in-clinic visits (5.4%). A further 272 patients canceled appointments (32%), 123 patients were unable to be contacted (14%), and 8 patients declined care offered by telehealth (0.94%). Most patients who were cared for by telehealth returned to see optometrists (88%). By contrast, most patients who required in-person visits during this period were subsequently seen by ophthalmologists (58%, p < 0.001). Patient satisfaction remained high for in-person visits that took place during the COVID-19-related emergency, with improvements noted in patient satisfaction regarding ‘information about delays’ (47 % versus 100%, p = 0.007) and ‘concern for questions or worries’ (76% versus 100%, p = 0.037) compared with the same period 1 year prior. Conclusion: Optometrists rapidly embraced telehealth to deliver eye care to their patients during the COVID-19 public health emergency. Most eye issues were able to be addressed through telehealth; urgent eye problems were triaged and referred to the optometry clinic, when appropriate.
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Affiliation(s)
- Justine H. Pidgeon
- New England College of Optometry, Boston, MA, USA
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
| | - Mahesh K. Bhardwaj
- New England College of Optometry, Boston, MA, USA
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Patrick Titterington
- New England College of Optometry, Boston, MA, USA
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
| | - Karen Latulippe
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
| | - Shiyoung Roh
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - David J. Ramsey
- Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA 01960, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
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Kim SE, Logeswaran A, Kang S, Stanojcic N, Wickham L, Thomas P, Li JPO. Digital Transformation in Ophthalmic Clinical Care During the COVID-19 Pandemic. Asia Pac J Ophthalmol (Phila) 2021; 10:381-387. [PMID: 34415246 DOI: 10.1097/apo.0000000000000407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT COVID-19 has placed unprecedented pressure on health systems globally, whereas simultaneously stimulating unprecedented levels of transformation. Here, we review digital adoption that has taken place during the pandemic to drive improvements in ophthalmic clinical care, with a specific focus on out-of-hospital triage and services, clinical assessment, patient management, and use of electronic health records. We show that although there have been some successes, shortcomings in technology infrastructure prepandemic became only more apparent and consequential as COVID-19 progressed. Through our review, we emphasize the need for clinicians to better grasp and harness key technology trends such as telecommunications and artificial intelligence, so that they can effectively and safely shape clinical practice using these tools going forward.
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Affiliation(s)
- Soyang Ella Kim
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
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