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Mishra AV, Tong CM, Faes L, Cheema MK, Plemel D, Rubin U, Bao B, Nazarali S, Lapere SRJ, Somani R, Hinz BJ, Tennant MTS. Comparison of Endophthalmitis Rates after Alcohol-Based Chlorhexidine and Povidone-Iodine Antisepsis for Intravitreal Injections. Ophthalmol Retina 2024; 8:18-24. [PMID: 37611695 DOI: 10.1016/j.oret.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Intravitreal injections (IVIs) are the most frequently performed intraocular procedure in Canada. Povidone-iodine (PI) is the current gold standard for antisepsis for IVI and is widely used; chlorhexidine (CH) is a possible alternative antiseptic agent. This study aims to compare rates of endophthalmitis after IVI with 0.05% chlorhexidine with a 4% alcohol base antisepsis to rates of endophthalmitis after IVI with 10% PI antisepsis. DESIGN Retrospective cohort study. SUBJECTS Eyes that received IVI between May 2019 and October 2022 at a group retina practice in Edmonton, Canada. METHODS Eyes at a single center received focal conjunctival application of either 10% PI antisepsis or 0.05% CH in 4% alcohol antisepsis for 30 seconds before each IVI. MAIN OUTCOME MEASURE Rates of endophthalmitis between the PI and CH groups. RESULTS A total of 170 952 IVIs were performed during the study period. A total of 31 135 were performed using CH prophylaxis compared with 139 817 with PI prophylaxis. Among all IVIs there were 49 total cases of endophthalmitis, 29 in the PI group (0.021%) and 20 in the CH group (0.064%). There was a statistically significant difference in the rates of endophthalmitis between the 2 groups (P < 0.001). The odds ratio for developing endophthalmitis with CH antisepsis was 3.1 (95% confidence interval, 1.9-5.2) compared with PI antisepsis. There were increased odds of developing endophthalmitis with aflibercept injection compared with bevacizumab (odds ratio, 3.48; 95% confidence interval, 2.09-7.24). CONCLUSIONS There is a statistically significant difference in rates of endophthalmitis between alcohol-based CH and PI antisepsis for IVI in our patient population utilizing the methods discussed. In our center, alcohol-based CH is now considered a second-line antiseptic agent. Further studies are warranted to further assess the endophthalmitis rate utilizing these 2 antiseptic agents. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Amit V Mishra
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | | | - Livia Faes
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL, Institute of Ophthalmology, London, United Kingdom
| | | | | | - Uriel Rubin
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Bo Bao
- University of Alberta, Edmonton, Canada
| | | | - Steven R J Lapere
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Rizwan Somani
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Brad J Hinz
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada
| | - Matthew T S Tennant
- University of Alberta, Edmonton, Canada; Alberta Retina Consultants, Edmonton, Canada.
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Abstract
Since the introduction of artificial intelligence (AI) in 1956 by John McCarthy, the field has propelled medicine, optimized efficiency, and led to technological breakthroughs in clinical care. As an important frontier in healthcare, AI has implications on every subspecialty within medicine. This review highlights the applications of AI in ophthalmology: a specialty that lends itself well to the integration of computer algorithms due to the high volume of digital imaging, data, and objective metrics such as central retinal thickness. The focus of this review is the use of AI in retina, cornea, anterior segment, and pediatrics.
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Affiliation(s)
- Ojas Srivastava
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta, Canada
| | - Matthew Tennant
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta, Canada
| | - Parampal Grewal
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont, Canada
| | - Uriel Rubin
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta, Canada
| | - Mark Seamone
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta, Canada
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Alshahrani ST, Rubin U, Gupta V, Gonder T, Sharma S. Reflux, Intraocular Pressure Variation and Pain Following Intravitreal Ranibizumab Injections Using 30-Gauge or 32-Gauge Needles for Patients With Retinal Pathologies: A Randomized Clinical Trial. Cureus 2021; 13:e14320. [PMID: 33968530 PMCID: PMC8101509 DOI: 10.7759/cureus.14320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia. METHODS A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr1) or 32-gauge (Gr2) needles. The amount of reflux of injected material, IOP before (IOP1) and five minutes after injection (IOP2) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared. RESULTS The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr1 [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr2 [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr1 [interquartile range (IQR) 1.0: 3.0] and Gr2 (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr1, the IOP1 and IOP2 were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr2, the IOP1 and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr1 and Gr2 was not significantly different (Mann Whiney P=0.3). CONCLUSIONS IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.
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Affiliation(s)
- Saeed T Alshahrani
- Ophthalmology Department, King Fahad Medical City, Riyadh, SAU.,Ophthalmology, Queens University, Kingston, CAN
| | - Uriel Rubin
- Ophthalmology, Queens University, Kingston, CAN
| | | | - Tom Gonder
- Ophthalmology, Queens University, Kingston, CAN
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Seamone ME, Rubin U, Grewal PS, Greve M. Pneumatic Vitreolysis With Intravitreal Air for Focal Vitreomacular Traction. Journal of VitreoRetinal Diseases 2020; 5:348-353. [PMID: 37007599 PMCID: PMC9976235 DOI: 10.1177/2474126420962649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT). Methods: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT. Results: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion ( P < .01), area under VMT ( P < .05), and subfoveal cyst area ( P < .05). Conclusions: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.
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Affiliation(s)
- Mark E. Seamone
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Uriel Rubin
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Parampal S. Grewal
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Greve
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
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Benson MD, Rubin U, Cheema M, MacDonald IM, Tennant MT, Hinz BJ, Somani R. Diffuse Pigmented Lesions in the Outer Retina: An Unusual Fundus Appearance. Journal of VitreoRetinal Diseases 2020; 4:243-247. [PMID: 37007451 PMCID: PMC9982251 DOI: 10.1177/2474126419873547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This report describes and provides a differential diagnosis for a patient with unusual bilateral retinal pigmented lesions. Methods: A 40-year-old woman was found to have multiple flat, gray lesions scattered across her fundi, becoming larger and more confluent toward the periphery. There were small drusenlike deposits in her foveae. The hyperpigmented lesions demonstrated hypoautofluorescence with thickening of the retinal pigment epithelium and disruption of the overlying layers on optical coherence tomography (OCT). Full-field electroretinography revealed generalized reduced a- and b-wave amplitudes. Results: Chest x-ray, breast ultrasound, mammography, and pelvic ultrasound findings were negative for malignant etiologic factors. Panel testing results for hereditary retinal dystrophy were negative. Conclusions: Although the clinical and OCT appearance of the lesions is similar to congenital grouped pigmentation, the symmetric and bilateral nature of ocular findings coupled with electroretinographic changes suggest a possible retinal dystrophy. This case adds to the phenotypic diversity of pigmented fundus lesions.
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Affiliation(s)
- Matthew D. Benson
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Uriel Rubin
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Marvi Cheema
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ian M. MacDonald
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew T.S. Tennant
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Brad J. Hinz
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Rizwan Somani
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
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Henry T, Palakkamanil M, Rubin U, Tennant M. Traumatic retinal dialysis resulting from Nerf foam bullet. Can J Ophthalmol 2019; 54:e100-e102. [PMID: 31109489 DOI: 10.1016/j.jcjo.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tyler Henry
- University of Alberta, Department of Ophthalmology, Alberta, Canada
| | | | - Uriel Rubin
- University of Alberta, Department of Ophthalmology, Alberta, Canada
| | - Matthew Tennant
- University of Alberta, Department of Ophthalmology, Alberta, Canada.
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Rubin U, Benson MD, Kulkarni S, Greve MD. Endogenous endophthalmitis due to Klebsiella pneumoniae from an infected gallbladder. Can J Ophthalmol 2018; 53:e258-e260. [DOI: 10.1016/j.jcjo.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 01/14/2023]
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Grewal PS, Oloumi F, Rubin U, Tennant MTS. Deep learning in ophthalmology: a review. Can J Ophthalmol 2018; 53:309-313. [PMID: 30119782 DOI: 10.1016/j.jcjo.2018.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/22/2018] [Accepted: 04/25/2018] [Indexed: 01/22/2023]
Abstract
Deep learning is an emerging technology with numerous potential applications in Ophthalmology. Deep learning tools have been applied to different diagnostic modalities including digital photographs, optical coherence tomography, and visual fields. These tools have demonstrated utility in assessment of various disease processes including cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy. Deep learning techniques are evolving rapidly, and will become more integrated into ophthalmic care. This article reviews the current evidence for deep learning in ophthalmology, and discusses future applications, as well as potential drawbacks.
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Affiliation(s)
- Parampal S Grewal
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | | | - Uriel Rubin
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Matthew T S Tennant
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta..
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