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Gibbons AB, Van Brummen A, Bacorn C, Niknahad A, Chang SH, Jian-Amadi A, Chambers C, Zhang M, Li E. Orbital subperiosteal abscess in adolescents and adults: predictors and outcomes of nonsurgical management and surgical approaches. Orbit 2024:1-10. [PMID: 38815212 DOI: 10.1080/01676830.2024.2355650] [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: 11/30/2023] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The aim of this study was to assess predictors and outcomes of subperiosteal abscess (SPA) management in adolescents and adults at two tertiary care centers. METHODS This retrospective cohort study included cases of SPA from January 1 2000 to October 9 2022 at two institutions. Patients 9 years or older were categorized into surgical and nonsurgical cohorts. Surgical subgroups included those who underwent functional endoscopic sinus surgery (FESS) alone, external (transcutaneous or transconjunctival) orbitotomy alone, or combined FESS and external surgery. The presented features were assessed as potential treatment predictors. Outcomes included length of stay (LOS), final best-corrected visual acuity (BCVA), readmission rate, and reoperation rate. RESULTS Of the 159 SPA cases included, 127 (79.9%) underwent surgery and 32 (20.1%) were managed nonsurgically. The nonsurgical cohort was younger (p = .003) with smaller abscesses (p < .001) that were more likely to be medial (p < .001). The nonsurgical cohort had shorter LOS (p < .001); final BCVA and readmission rates were similarly favorable. Abscess location was correlated with surgical approach. Superior SPA that underwent FESS or external surgery alone had higher reoperation rates (57.1.0% and 58.3%, respectively) than combined (17.9%). External approach and FESS alone resulted in lower reoperation rates (15.4% and 15.0%, respectively) than combined (27.3%) for medial SPA. Subgroup analysis in the sinusitis cohort yielded similar results. CONCLUSIONS A trial of nonsurgical management may be safe and effective for select patients aged 9 years and older with sinusitis-derived, medial, and small SPA. When surgery is indicated, approach should be guided by abscess location to minimize reoperation risk.
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Van Brummen
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Colin Bacorn
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ava Niknahad
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shu-Hong Chang
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arash Jian-Amadi
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Chambers
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew Zhang
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily Li
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Awidi AA, Zhao J, Li X, Rajaii F, Ahmad M, Jensen A, Woreta FA. Etiology and Characteristics of Patients Presenting with Eyelid Lacerations at a Level 1 Trauma Center. Clin Ophthalmol 2024; 18:929-935. [PMID: 38544502 PMCID: PMC10967540 DOI: 10.2147/opth.s447452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 04/28/2024] Open
Abstract
Purpose To investigate the etiology and demographic associations of patients presenting with eyelid lacerations to a US level 1 trauma center emergency department (ED). Patient and Methods A retrospective chart review of all patients with eyelid lacerations presenting to the ED at a single level 1 trauma center was performed. Eyelid lacerations were categorized as simple eyelid lacerations, eyelid lacerations with eyelid margin involvement, and eyelid lacerations with nasolacrimal system involvement. Data on demographics and clinical characteristics were analyzed. Results A total of 303 eyelid laceration cases were identified, 56% were simple eyelid lacerations, followed by 24% with nasolacrimal involvement and 20% involving the eyelid margin. Sixty percent of animal bites/scratches resulted in a nasolacrimal system involving laceration, most commonly affecting children. Falls were the most common etiology in children and patients over the age of 60. Black patients, patients presenting with concomitant ophthalmic injuries, and those with Medicaid insurance were more likely to have an assault etiology (p < 0.05 for all). Conclusion Falls were the most common etiology for eyelid lacerations in children and the elderly, while assault was the most common in adults. Identifying the most common etiology by demographic factors can help raise awareness regarding targeted prevention strategies for high-risk populations.
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Affiliation(s)
| | - Jiawei Zhao
- Plastic Surgery Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ximin Li
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Fatemeh Rajaii
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Meleha Ahmad
- Ophthalmic Plastic and Reconstructive Surgery Department, University of California, San Francisco, CA, USA
| | - Adrianna Jensen
- Ophthalmic Plastic and Reconstructive Surgery Department, Pacific Center for Oculofacial and Aesthetic Plastic Surgery, San Francisco, CA, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, USA
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Iftikhar M, Canner JK, Latif A, Shah SMA, Justin GA, Woreta FA. Epidemiology of ophthalmic trauma in the United States from 2009-2018: A Nationwide Emergency Department Sample Analysis. Injury 2024; 55:111209. [PMID: 38012902 DOI: 10.1016/j.injury.2023.111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To determine the incidence, characteristics, disposition, and economic burden of emergency department (ED) visits for ophthalmic trauma in the United States (US). DESIGN Retrospective study. METHODS The Nationwide Emergency Department Sample was used to calculate and characterize ED visits for ophthalmic trauma in the US from 2009 to 2018. Linear regression was used to estimate trends in annual incidence and mean inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. RESULTS There were over 7.3 million ED visits for ophthalmic trauma in the US over the 10 years, with an annual incidence of 233 per 100,000 population. Patients were predominantly male (65 %), 21-44 years old (39 %), and from low-income households (56 %). Only 1 % of patients were hospitalized. Older age, male sex, metropolitan teaching hospitals, and trauma centers were associated with significantly higher odds of inpatient admission. The mean inflation-adjusted ED charge per visit more than doubled over the decade ($1,333 to $3,187) with total charges exceeding $14 billion. Superficial injuries (44 %) and eyelid/orbit wounds (20 %) accounted for the majority of visits. Orbital floor fractures (4 %) and open globe injuries (2 %) accounted for a minority of visits but were responsible for most admissions (49 % and 29 %, respectively) and the highest mean ED charge ($7,157 and $6,808, respectively). CONCLUSIONS Ophthalmic trauma represents an increasingly significant burden to EDs in the US. Preventive efforts should target young males from low socioeconomic backgrounds. Strategies to improve outpatient access and redirect non-urgent injuries may help alleviate costs.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asad Latif
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Syed M A Shah
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Grant A Justin
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Xiao MT, Juang J, Kim LA, Macias AA. Retrospective Analysis of Perioperative Dexmedetomidine Use in Retina Surgeries: Impact on Postanesthesia Care. Ophthalmic Surg Lasers Imaging Retina 2024; 55:86-91. [PMID: 38346152 DOI: 10.3928/23258160-20240104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Dexmedetomidine (Precedex®) has been linked to depressive hemodynamic effects and increased length of stay in the post-anesthesia care unit (PACU) when used in ambulatory phacoemulsification procedures. We aimed to determine the prevalence and impact of dexmedetomidine use during ambulatory vitreoretinal procedures. PATIENTS AND METHODS This retrospective cohort study involved 9,666 adult vitrectomies. Cases were divided into groups by anesthesia type: general anesthesia (GA) and monitored anesthesia care (MAC). For each group, various factors were compared between those who did and did not receive dexmedetomidine. Chi-squared and t tests were used for comparisons. RESULTS Changes in mean arterial pressure in the MAC group were -1.69 ± 0.23 mmHg for no dexmedetomidine patients and -6.31 ± 0.39 mmHg for dexmedetomidine patients (P < 0.01). In the GA group, mean arterial pressure was -6.1 ± 0.35 mmHg for no dexmedetomidine patients and -11.18 ± 0.88 mmHg for dexmedetomidine patients (P < 0.01). PACU Phase II time in the MAC group was 36.93 ± 0.37 minutes and 40.67 ± 0.86 minutes for no dexmedetomidine and dexmedetomidine patients, respectively (P < 0.01). In the GA group, PACU Phase II time was 58.63 ± 0.95 minutes and 65.19 ± 2.38 minutes for no dexmedetomidine and dexmedetomidine patients, respectively (P < 0.01). CONCLUSIONS Dexmedetomidine use in vitrectomies was associated with significant PACU delays. These delays may stem from adverse hemodynamic effects. [Ophthalmic Surg Lasers Imaging Retina 2024;55:86-91.].
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Mike EV, Brandsdorfer A, Parsikia A, Mbekeani JN. Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma. JAMA Ophthalmol 2023; 141:564-571. [PMID: 37166790 PMCID: PMC10176177 DOI: 10.1001/jamaophthalmol.2023.1467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/15/2023] [Indexed: 05/12/2023]
Abstract
Importance Firearm injuries are associated with devastating visual outcomes. Several studies have demonstrated disparities in trauma care and discharge to rehabilitation and other advanced care facilities (ACFs) due to race and ethnicity and insurance status. The identification of possible disparities in disposition of patients admitted with firearms-associated ocular injuries (FAOIs) is a crucial step in moving toward health equity. Objective To describe disposition patterns following admission for FAOI trauma. Design, Setting, and Participants This retrospective analysis of National Trauma Data Bank (NTDB) from 2008 through 2014 used hospitalized trauma cases from over 900 US facilities detailed in the NTDB. Participants included patients admitted with ocular injuries. Statistical analysis was conducted between April 16, 2017, and December 15, 2021. Exposure Firearm injuries. Main Outcomes and Measures Patients admitted with FAOIs were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes. Demographic data, location, injury type and severity, and insurance status were documented. The primary outcome was the odds of discharge to ACFs. Results A total of 8715 of 235 254 firearms injuries involved the eye (3.7%). Of the 8715 included patients, 7469 were male (85.7%), 3050 were African American (35.0%), and 4065 White (46.6%), with a mean (SD) age of 33.8 (16.9) years. Common payments were government insurance (31.5%), self-paid insurance (29.4%), and commercial insurance plans (22.8%). Frequent dispositions were home (48.8%) and ACF (20.5%). Multivariate analysis demonstrated that the following factors were associated with the highest odds of discharge to an ACF: hospital stays 6 days or longer (odds ratio [OR], 3.05; 95% CI, 2.56-3.63; P < .001), age 65 years or older (OR, 2.94; 95% CI, 1.94-4.48; P < .001), associated traumatic brain injury (OR, 2.32; 95% CI, 1.94-2.78; P < .001), severe traumatic brain injury (OR, 2.10; 95% CI, 1.79-2.46; P < .001), and very severe Injury Severity Score (OR, 2.22; 95% CI, 1.88-2.62; P < .001). White race (OR, 2.00; 95% CI, 1.71-2.33; P < .001) was associated with higher odds than Medicare insurance (OR, 1.64; 95% CI, 1.16-2.31; P = .01). Conclusions and Relevance These findings suggest that older, more severely injured, Medicare-insured, or White patients have higher odds of ACF placement than younger, less severely injured, otherwise insured, and Black and Hispanic patients. This study is limited by its retrospective nature and the study team was unable to explore the basis for these disposition differences. Nevertheless, this work highlights that disparities may exist in disposition after FAOIs that may limit the rehabilitation potential of specific populations.
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Affiliation(s)
- Elise V. Mike
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Ari Brandsdorfer
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center, Bronx, New York
- Consulting Ophthalmologists, Farmington, Connecticut
| | | | - Joyce N. Mbekeani
- Department of Surgery (Ophthalmology), Jacobi Medical Center, Bronx, New York
- Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Hsu CA, Hsu MH, Yen JC. Utilization of inpatient ophthalmology services in Taiwan-A nationwide population study. BMC Ophthalmol 2023; 23:15. [PMID: 36627584 PMCID: PMC9830613 DOI: 10.1186/s12886-022-02765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study attempted to illustrate the demographic of inpatient eye careservice from 1997 to 2011 in Taiwan, and also the ophthalmic disease landscape and utilization change over time. These insights might apply to resource allocation planning and trainees' better understandings of ophthalmic inpatient practice. METHODS This study utilized Taiwan's National Health Insurance Research Database (NHIRD). Admission records of eye service that occurred since 1997 and until 2011 were included. Records were separated into operative and non-operative. The records were further divided according to their time: a group of early time before 2006 and a late one after 2006. RESULTS Patients' mean age were 56 and 44 years for operative and non-operative records. The sex ratio (male to female) was 1.3, and the average of admission duration was 4 days. The average spending was around 1000 United State Dollars per admission and a gradually upgoing trend was also noted. The number of inpatient eye services decreased over time, from 3,248 to 2,174 in the studied period. Cases admitted for operation primarily underwent cataract surgery, vitrectomy, and scleral buckling during the studied period. Trabeculectomy emerged as another major indication of admission during the later time. Cases admitted for non-operative management were primarily corneal ulcer, glaucoma, and infection, including orbital cellulitis and lid abscess. Corneal ulcers made up a major proportion of admission records in the non-operative group during both periods. CONCLUSIONS This study described the demographics of inpatient eye service in Taiwan. Ophthalmologist, especially trainees, and officials could make better policies according to the presented results in this study.
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Affiliation(s)
- Chia-An Hsu
- grid.278247.c0000 0004 0604 5314Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Min-Huei Hsu
- grid.412896.00000 0000 9337 0481Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Neurosurgery, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ju-Chuan Yen
- grid.410769.d0000 0004 0572 8156Department of Education and Research, Taipei City Hospital, Taipei, Taiwan ,Department of Ophthalmology, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Zhong E, Chou TY, Chaleff AJ, Scofield-Kaplan SM, Perzia BM, Naqvi J, Hou W. Orbital Fractures and Risk Factors for Ocular Injury. Clin Ophthalmol 2022; 16:4153-4161. [PMID: 36544896 PMCID: PMC9760578 DOI: 10.2147/opth.s391175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose To identify factors predictive of serious ocular injury requiring urgent consultation by ophthalmology in patients presenting with blunt trauma orbital fractures. Methods This is a retrospective study of adult patients diagnosed with orbital fractures after blunt trauma at a university medical center emergency room. Patient records were examined over a three-year period. Data including mechanism of injury, fracture location, ocular symptoms, and examination findings were recorded. Ocular injuries were divided into three levels of severity: mild, moderate, and severe. Fracture characteristics, patient demographics, and examination findings were analyzed using multinomial regression to identify risk factors for more severe injury. Results One hundred and eighty-six patients met inclusion criteria. For 29.6% of patients, urgent ophthalmologic consultation was required. Ruptured globes occurred in 2.2% of injuries. There was a statistically significant association between severe ocular injury and three examination findings: poor vision (OR 14.5; p < 0.001), afferent pupillary defect (OR 44.8; p < 0.001), and abnormal pupillary reaction (OR 28.0; p < 0.001). Likewise, blurry vision (OR 3.6; p = 0.018), ocular pain (OR 3.7; p = 0.011), and facial pain (OR 4.4; p = 0.031) were also associated with an increased risk of severe ocular injury. Abnormal pupillary reaction was associated with moderate injury (OR 4.5; p = 0.041). Demographic factors, mechanism of injury, anti-coagulant use, fracture location, diplopia, no documented vision, subconjunctival hemorrhage, chemosis, and motility restriction were not associated with injury severity. Conclusion Most patients who presented to the emergency room with an orbital fracture did not require urgent ophthalmologic consultation. The presence of blurry vision, ocular pain, facial pain, poor vision, and afferent pupillary defect significantly increased the odds of severe injury. Abnormal pupillary reaction was associated with both moderate and severe injury.
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Affiliation(s)
- Eric Zhong
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Timothy Y Chou
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA,Correspondence: Timothy Y Chou, Stony Brook University Medical Center, Department of Ophthalmology, HSC L2, Room 152, Stony Brook, NY, 11794, USA, Tel +1 631-444-1131, Fax +1 631-444-4089, Email
| | - Alec J Chaleff
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stacy M Scofield-Kaplan
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Brittany M Perzia
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jaffer Naqvi
- Department of Ophthalmology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Wei Hou
- Department of Epidemiology and Biostatistics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Elam AR, Tseng VL, Rodriguez TM, Mike EV, Warren AK, Coleman AL. Disparities in Vision Health and Eye Care. Ophthalmology 2022; 129:e89-e113. [PMID: 36058735 PMCID: PMC10109525 DOI: 10.1016/j.ophtha.2022.07.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022] Open
Abstract
Significant disparities in vision health and eye care exist. To achieve health equity, we must understand the root causes and drivers of health disparities and inequities, including social determinants of health and systemic racism.
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Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Victoria L Tseng
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Elise V Mike
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis K Warren
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Anne L Coleman
- UCLA Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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Vongsachang H, Iftikhar M, Canner JK, Woreta F. Factors Associated with Length of Stay and Cost among Pediatric Hospitalizations with a Primary Ophthalmic Diagnosis. Ophthalmic Epidemiol 2022; 30:1-7. [PMID: 36131540 PMCID: PMC10027614 DOI: 10.1080/09286586.2022.2124278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. METHODS This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). RESULTS An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p = .03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p < .001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p = .04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p = .04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p = .02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p = .02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p < .001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p < .001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p < .05 for all). CONCLUSIONS Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care.
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Affiliation(s)
- Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph K. Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Epidemiology and trends of ocular trauma hospitalizations in Chile from 2001 to 2020. J Fr Ophtalmol 2022; 45:1055-1062. [DOI: 10.1016/j.jfo.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/27/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
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Sisk CD, Wright AT, Warrier R. Monocular Vision Loss Subsequent to Complicated Orbital Cellulitis. Clin Pediatr (Phila) 2022; 61:384-386. [PMID: 35152724 DOI: 10.1177/00099228221080340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rossi T, Speciale A, Menichini P, Izzotti A, D'Agostino I, Trillo C, Telani S, Querzoli G, Ripandelli G. Human Vitreous Collagen Fragments Dimension As a Function of Vitrectomy Cut Rate. Transl Vis Sci Technol 2022; 11:29. [PMID: 35333285 PMCID: PMC8963665 DOI: 10.1167/tvst.11.3.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To study the dimensions and distribution of human vitreous collagen type II fragments collected after vitrectomy performed at varying cut rates and to evaluate if increasing the cut rate produces smaller collagen fragments, thus reducing retinal traction and/or viscosity. Methods Fluid was collected during core vitrectomies performed for macular surgery at cut rates from 1000 to 16,000 cuts per minute (CPM) and immediately refrigerated. Protein fractions were separated by molecular weight (MW; >100 kDa, 50–100 kDa, 50–30 kDa, 30–10 kDa, and <10 kDa) through centrifugal filters. The Human Collagen II ELISA Kit colorimetric assay was then used to measure the COL2A1 in unfiltered and filtered samples. Results Vitreous samples collected after vitrectomy performed at 16,000 CPM contained a higher concentration of protein with MW over 100 kDa than at any other cutting frequency (P < 0.01). No significant differences were found in fractions collected with a MW between 50 and 100 kDa. Collagen type II fragments over 100 kDa were significantly more represented than smaller fragments at each cut rate. The proportion of smaller (50–100 kDa) collagen fragments compared with those over 100 kDa was higher at 2000 CPM than at higher cut rates. Conclusions Vitreous samples collected at different cut rates do not contain a significantly different proportion of collagen type II fragments of the tested MW. The extreme variability of vitreous flow through the cutter port may explain the uncertain predictability of collagen fragment MWs. Translational Relevance Increasing the cut rate does not produce vitreous fragments of proportionally smaller dimension. It is necessary to achieve an invariant instantaneous flow through the cutter port in order to decrease retinal traction during vitrectomy.
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Affiliation(s)
- Tommaso Rossi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Speciale
- Mutagenesis and Cancer Prevention Unit, Comprehensive Cancer Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Menichini
- Mutagenesis and Cancer Prevention Unit, Comprehensive Cancer Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Izzotti
- Mutagenesis and Cancer Prevention Unit, Comprehensive Cancer Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Serena Telani
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Ahmad M, Zhao J, Iftikhar M, Canner JK, Rajaii F, Mahoney N, Zafar S, Woreta F. Epidemiologic Trends in Oculoplastics-Related Emergency Department Visits in the United States, 2006-2015. Ophthalmic Plast Reconstr Surg 2022; 38:199-206. [PMID: 34380999 DOI: 10.1097/iop.0000000000002047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize demographics and trends in oculoplastics-related emergency department (ED) visits. METHODS The authors conducted a retrospective, multiyear study of the nationwide ED sample database. The nationwide ED sample was queried for oculoplastics-related International Classification of Disease-ninth revision codes identified from a comprehensive list and categorized based on anatomic location, urgency, and trauma status. Demographics, clinical characteristics, procedure requirement, and cost data were analyzed. Variables associated with inpatient admission were assessed using univariate and multivariate logistic regression. RESULTS The authors identified an estimated 4.2 million ED visits in the United States with oculoplastics-related primary diagnoses, of which pathology was 80.8% eyelid/adnexal, 17.4% orbital, and 1.74% lacrimal. Overall, 31.3% of the visits were deemed to be nonurgent. Orbital pathology was more likely to be caused by trauma (70.6%), to be urgent (98.0%), and to require a procedure (45.6%) (p < 0.001). While less than 5% of all patients required hospitalization, predictors for inpatient admission were urgent diagnoses (odds ratio, 14.9; CI, 13.7-16.1), presentation to a level 1 trauma center (odds ratio, 3.19; CI, 2.7-3.79), and presence of orbital pathology (odds ratio, 6.09; CI 5.73-6.47). Incidence of ED visits decreased in all categories; however, total inflation-adjusted charges increased. CONCLUSIONS Over half of oculoplastics-related ED visits are for trauma, with orbital pathology being less common but requiring a high level of care. Although trends show a potentially decreasing incidence of oculoplastics-related ED visits, increasing costs and high proportion of nonurgent visits pose an opportunity for mitigating periocular trauma and increasing outpatient access to care, respectively.
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Affiliation(s)
- Meleha Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Tang VD, Safi M, Mahavongtrakul A, Mahmood B, Ling J, Kyrillos R, Li J, Mannis M. Ocular Anterior Segment Pathology in the Emergency Department: A 5-Year Study. Eye Contact Lens 2021; 47:203-207. [PMID: 32568931 DOI: 10.1097/icl.0000000000000720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with ocular complaints frequently present to emergency departments (EDs) for care. Emergency department practitioners are often the first to evaluate these patients and determine the next steps in their care, which can be a challenging task. The purpose of this study is to determine the frequency of anterior segment pathology in the setting of the ED in hopes that this information will be useful in creating more effective management algorithms. METHODS A retrospective study based on electronic patient charts from the University of California Davis ED that included ophthalmology consults. We reviewed the charts for demographic data, as well as visual acuity (VA), intraocular pressure (IOP), and diagnosis as determined by ED and ophthalmology personnel, respectively. RESULTS The most common anterior segment diagnoses were uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction/dry eyes/blepharitis/punctate epithelial erosions, and conjunctivitis/epidemic keratoconjunctivitis. Emergency Department personnel measured the VA and IOP in 40.8% and 16.7% of patients, respectively. The ophthalmologist measured the VA and IOP in 78.4% and 95.1% of patients, respectively. The percentage agreement in VA measurement between ophthalmology and ED was 11.8%. The percentage agreement in IOP measurement between ophthalmology and ED was 0.86%. The percentage agreement in diagnosis between ophthalmology and ED was 49.4%. CONCLUSIONS Most ocular conditions that present in the ED are nonurgent and can be treated in an outpatient setting. However, ED personnel are often unable to obtain the proper "ocular vital signs" (the VA and IOP) and diagnoses. Our findings suggest a need for clear interprofessional discussion in creating an algorithm for triage and the management of eye conditions in the ED to deliver effective care.
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Affiliation(s)
- Vincent D Tang
- Department of Ophthalmology and Vision Science, UC Davis Eye Center, University of California, Davis, Sacramento, CA
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Pradeep T, Kalra G, Leader JK, McCoy J, Dixit R, Dohar J, Tobey A, Sahel JA, Pu J, Fu R. Lesion-Mapping Software for the Measurement of Subperiosteal Abscess Volume for Pediatric Orbital Cellulitis: A Retrospective Chart Review. Ophthalmol Ther 2021; 10:261-271. [PMID: 33537950 PMCID: PMC8079525 DOI: 10.1007/s40123-021-00333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Our objective was to assess the utility of using lesion-mapping software to calculate precise orbital volumes to predict patients who would benefit from early surgical intervention. Methods We retrospectively reviewed patients diagnosed with subperiosteal orbital abscess (SPOA) secondary to sinusitis at a tertiary pediatric hospital from 2005 to 2016. Diagnoses were confirmed by CT scans. Lesion-mapping software was used to measure SPOA volume using initial CT images. Data collected included patient demographics, length of hospital stay, and subsequent medical or surgical treatment. Results Thirty-three (52%) patients ultimately underwent surgical intervention, while 30 (48%) were managed medically. Between the surgical and medical groups, there were no differences in gender, age, or comorbidities. The surgical group had larger abscess volumes than the medically managed group (0.94 mL vs. 0.31 mL, p < 0.01). Overall, increased SPOA volume was associated with increased age (Pearson’s coefficient = 0.374, p ≤ 0.01) and increased total days of intravenous (IV) antibiotic administration (Pearson’s coefficient = 0.260, p = 0.039). Patients who underwent surgery on the day of admission had 25% shorter hospital stay than patients who had delayed surgery (p < 0.01). Our calculated sensitivity-optimized SPOA volume cutoff of 0.231 mL yielded sensitivity of 90.9% and specificity of 70.0%. Conclusions This is the first study to use lesion-mapping software for precise calculation of SPOA volumes, which can help refine indications for early surgical intervention and help decrease length of hospital stay.
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Affiliation(s)
- Tejus Pradeep
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gagan Kalra
- Government Medical College and Hospital, Chandigarh, India
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jennifer McCoy
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ronak Dixit
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph Dohar
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Allison Tobey
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Vloka CN, Kim DH, Ng JD. Microbiology of orbital cellulitis with subperiosteal abscess in children: Prevalence and characteristics of Streptococcus anginosus group infection. Orbit 2021; 41:204-210. [PMID: 33386062 DOI: 10.1080/01676830.2020.1862247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the predominant pathogens and clinical course in pediatric patients with orbital cellulitis (OC) complicated by subperiosteal abscess (SPA).Methods: This is a single-center retrospective chart review evaluating pediatric patients with OC complicated by SPA treated at a tertiary care center in the Pacific Northwest. Data were analyzed for characteristics, rates of infection, and antibiotic resistance of the predominant pathogens in pediatric patients.Results: Twenty-seven children were identified with OC complicated by SPA and bacterial cultures drawn. The average age (SD) of the patients was 9.2 years (4.8), median 9.6; 15 range 5 months to 17.2 years. Seventeen (63.0%) were male. Sinusitis was present in all patients. Streptococcus species were the most common pathogen accounting for 52% (17/33) of isolates. Streptococcus anginosus group (SAG) was the predominant species and were isolated in 10 out of 27 (37%) children in the study. Twenty-one (78%) patients required surgery for the treatment of SPA. Among surgically treated patients, females tended to be younger than males (p = .068). Pediatric patients with SAG infections required more surgery than children without this isolate, 100% and 65%, respectively (p = .030). Female patients tended to have SAG infections more often than males (p = .063).Conclusions: Orbital infections caused by SAG require surgical management more often than those caused by other pathogens. Our results suggest a difference in pathogenic organisms in male and female patients with SPA. SAG is one of the most common pathogens isolated in orbital cellulitis complicated by SPA in children.
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Affiliation(s)
- Caroline N Vloka
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Donna H Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - John D Ng
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
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Mir TA, Canner JK, Zafar S, Srikumaran D, Friedman DS, Woreta FA. Characteristics of Open Globe Injuries in the United States From 2006 to 2014. JAMA Ophthalmol 2020; 138:268-275. [PMID: 31971539 DOI: 10.1001/jamaophthalmol.2019.5823] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Open globe injuries can lead to substantial visual morbidity and lifelong sequelae. Interventions to reduce the burden of open globe injuries in the United States require a better understanding of these injuries through well-designed epidemiologic investigations. Objective To examine the incidence, common injury mechanisms, and economic burden of open globe injuries in the United States. Design, Setting, and Participants This retrospective, cross-sectional study of US nationwide emergency department (ED) data assessed all ED visits of patients with a primary diagnosis of open globe injury in the Nationwide Emergency Department Sample (NEDS) from January 1, 2006, to December 31, 2014. Data analysis was performed from August 29, 2018, to November 11, 2019. Main Outcomes and Measures Annual incidence of open globe injuries by age, sex, mechanism of injury, and concomitant diagnosis, as well as median charges associated with open globe injuries and variables associated with hospitalization. Results A total of 124 989 ED visits for open globe injuries were assessed, with an incidence of 4.49 per 100 000 population in the United States from 2006 to 2014 (mean [SD] age of study participants, 37.7 [22.5] years; 94 078 [75.3%] male). The incidence was highest in 2006 (5.88 per 100 000 population) and decreased by 0.3% per month between 2006 and 2014 (incidence rate ratio, 0.99; 95% CI, 0.99-0.99; P < .001). Open globe injuries occurred in 37 060 individuals (30.6%) of low socioeconomic status. The most common injury mechanism was being struck by or against an object or person (40 119 of all 124 989 injury mechanisms [32.1%]). Open globe injuries associated with falls increased 6.6% between 2006-2010 and 2011-2015 (95% CI, 1.04-1.08; P < .001) and were the most common injury mechanism in individuals older than 70 years. The total cost associated with open globe injuries was $793 million. The cost of ED visits increased from $865 during 2006-2010 to $1557 during 2011-2015. Inpatient costs similarly increased from $21 527 during 2006-2010 to $30 243 during 2011-2015. Conclusions and Relevance The incidence of open globe injuries in the United States decreased from 2006 to 2014. Although the data are from 5 to 13 years ago, these findings appear to provide valuable information for targeting preventive measures toward individuals at highest risk; targeting young men with lower socioeconomic status and individuals 70 years or older at an increased risk of falls may help lower the incidence of open globe injuries.
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Affiliation(s)
- Tahreem A Mir
- West Virginia University School of Medicine, Morgantown
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sidra Zafar
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David S Friedman
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Iftikhar M, Canner JK, Hall L, Ahmad M, Srikumaran D, Woreta FA. Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017. Ophthalmology 2020; 128:463-470. [PMID: 32659309 DOI: 10.1016/j.ophtha.2020.06.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States. DESIGN Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS). PARTICIPANTS Patients in the Emergency Department (ED). METHODS The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission. MAIN OUTCOME MEASURES Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden. RESULTS From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (P < 0.001): from 7.7 (95% confidence interval [CI], 6.9-8.5) to 11.3 (95% CI, 10.0-12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P = 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P < 0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99-2.46; P < 0.001) and falls (OR, 1.54; 95% CI, 1.27-1.86; P < 0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (P < 0.001): from $5881 (95% CI, 5499-6263) to $8728 (95% CI, 8074-9382). CONCLUSIONS Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leangelo Hall
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meleha Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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To What Extent Can Orbital Cellulitis Emergency Aspect Influence the Diagnosis of Maxillary Sinus Lymphoma? Case Rep Ophthalmol Med 2020; 2020:2304861. [PMID: 32328330 PMCID: PMC7168696 DOI: 10.1155/2020/2304861] [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: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 46-year-old woman admitted to the emergency department for acute swelling and erythema of the right eyelid for 3 days. Ophthalmological examination was notable for 10/10, P2 best visual acuity, and inflammatory periorbital edema, without exophthalmia nor extraocular motility disturbance. Intraocular pressure was 14 mmHg and fundoscopic examination was not notable for any abnormality. Preseptal cellulitis diagnosis was made, and oral antibiotherapy was immediately started; after 72 hours, the patient did not improve and started complaining of pain on ocular movements. Brain and orbit MRI scan revealed right retroseptal cellulitis associated with homolateral pansinusitis. Intravenous antibiotherapy with oral corticosteroid was started simultaneously leading to full remission but with steroid dependency; 5 days after finishing prednisone, orbital cellulitis symptoms reappeared. The same treatment protocol was given but with corticosteroid tapering over weeks. Nevertheless, steroid dependency persisted. Except for the inflammatory syndrome, complete biological examinations did not disclose any abnormalities. The patient underwent maxillary sinus and fat orbital biopsy; however, histopathological examination was not contributory. Persistence of steroid dependency, chronic atypical rhinosinusitis, normal paraclinical investigations, and age of patient let us suspect lymphoma origin hidden by chronic corticosteroid. We carried out for the second time a maxillary sinus biopsy after stopping steroids, which disclosed primitive non-Hodgkin lymphoma of the maxillary sinus. The aim of this observation is firstly to evoke though it is exceptional the diagnosis of maxillary lymphoma in case of atypical orbital cellulitis and secondly to incite clinicians to be more vigilant in prescribing corticosteroid even if there is an emergency character of orbital cellulitis.
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Usmani B, Latif A, Amarasekera S, Mukhtar S, Iftikhar M, Kherani S, Sepah YJ, Raghavan D, Smith WD, Jhanji V, Dansingani KK, Shah SMA. Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis. Ophthalmic Epidemiol 2020; 27:300-309. [PMID: 32223491 DOI: 10.1080/09286586.2020.1744165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US). METHODS This retrospective cross-sectional study used National ED Sample (NEDS) (2006-2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers. RESULTS An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50-32.87]). CONCLUSIONS In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden.
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Affiliation(s)
- Bushra Usmani
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Sohani Amarasekera
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Sabrina Mukhtar
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Saleema Kherani
- Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University , Palo Alto, California, USA
| | - Deepta Raghavan
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - William D Smith
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Syed M A Shah
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
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Usmani B, Iftikhar M, Latif A, Shah SM. Epidemiology of primary ophthalmic procedures performed in the United States. Can J Ophthalmol 2019; 54:727-734. [DOI: 10.1016/j.jcjo.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/21/2018] [Accepted: 03/17/2019] [Indexed: 12/21/2022]
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Applying Pharmacodynamics and Antimicrobial Stewardship to Pediatric Preseptal and Orbital Cellulitis. Paediatr Drugs 2019; 21:427-438. [PMID: 31608423 DOI: 10.1007/s40272-019-00357-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Orbital and preseptal cellulitis are most commonly caused by organisms that originate in the upper respiratory tract or from the skin. There is significant variation in antibiotics used, but ampicillin-sulbactam, ceftriaxone, metronidazole, clindamycin, amoxicillin, amoxicillin-clavulanate, cefuroxime, and vancomycin are often used in the treatment of these infections. The choice of antibiotic, however, is only one consideration. It is also important that antibiotics are dosed to optimize their pharmacodynamic target attainment. Like other serious infections, therapy can be transitioned from initial intravenous therapy to an oral regimen when there are clear signs of clinical and laboratory improvement. The total duration of therapy for these infections have also been decreasing in recent years with durations of approximately 2 weeks becoming more common, even for orbital or subperiosteal infections. Antimicrobial stewardship programs can work closely with providers who manage these infections to create pathways, choose optimal antibiotics and dosage, transition from intravenous to oral therapy, and provide shortest effective durations.
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Iftikhar M, Latif A, Farid UZ, Usmani B, Canner JK, Shah SMA. Changes in the Incidence of Eye Trauma Hospitalizations in the United States From 2001 Through 2014. JAMA Ophthalmol 2019; 137:48-56. [PMID: 30286226 DOI: 10.1001/jamaophthalmol.2018.4685] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Eye trauma is a common cause of vision loss and a substantial public health problem. Objective To determine the changes in the incidence of eye trauma hospitalizations in the United States and compare the demographics of affected patients and outcomes of eye trauma as a primary or secondary admitting diagnosis. Design, Setting, and Participants This retrospective longitudinal cohort study used the National Inpatient Sample, a representative sample of all US community hospitals, to determine the incidence, characteristics, and causes of primary and secondary inpatient eye trauma admissions from 2001 through 2014. All inpatients with relevant diagnoses were included. Linear regression was used to estimate changes in incidence. Logistic regression was used to compare demographics and outcomes between primary and secondary diagnoses, including age, sex, race, income, primary payer, region, year of admission, length of stay, cost, and disposition at discharge. Exposures Eye trauma. Main Outcomes and Measures Incidence and characteristics of inpatient primary and secondary eye trauma. Results From 2001 to 2014, there were an estimated 939 608 inpatient admissions (of whom 556 886 were male patients [59.3%]; overall mean [SD] age, 49.4 [25.2] years) in the United States because of eye trauma diagnoses, with 778 967 of these (82.9%) as a secondary diagnosis. The incidence of primary eye trauma decreased from 3.9 to 3.0 per 100 000 population (difference, 0.9 [95% CI, 0.2-1.6] per 100 000 population; P = .001). The incidence of eye trauma as a secondary admitting diagnosis increased from 14.5 to 19.0 per 100 000 population (difference, 4.5 [95% CI, 1.9-7.2] per 100 000 population; P = .004). This was largely attributed to an increasing number of falls in individuals older than 65 years. The most frequent diagnosis was orbital fracture (64 149 [39.9%]) for primary trauma and contusion of eye and adnexa (19 301 [37.8%]) for secondary trauma. Primary trauma was more common in children (adjusted odds ratio [aOR], 2.21 [95% CI, 2.09-2.32]) and adolescents (aOR, 1.25 [95% CI, 1.19-1.32]) than adults (reference), African American individuals (aOR, 1.89 [95% CI, 1.81-1.97]) and Hispanic individuals (aOR, 1.52 [95% CI, 1.45-1.59]) than white individuals, and uninsured patients (aOR, 1.14 [95% CI, 1.07-1.22]) and those receiving Medicaid (aOR, 1.12 [95% CI, 1.05-1.19]) than Medicare beneficiaries. Patients with a primary diagnosis were more likely to have a stay of less than 3 days (patients with a primary diagnosis: 101 796 [63.4%]; secondary diagnosis: 274 538 [35.2%]), more likely to have costs in the lowest quartile (patients with a primary diagnosis: 51 212 [31.9%]; secondary diagnosis: 166 260 [21.3%]), and less likely to die (patients with a primary diagnosis: 526 [0.3%]; secondary diagnosis: 20 929 [2.7%]). Conclusions and Relevance These findings suggest that the increasing number of falls in individuals older than 65 years and the high risk of primary eye trauma in populations such as children and adolescents warrant the development and implementation of effective preventive strategies. Many of these patients are seen in ophthalmology practices where proactive risk assessment and counseling can play a critical role.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ummarah Z Farid
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bushra Usmani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed M A Shah
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Iftikhar M, Latif A, Usmani B, Canner JK, Shah SMA. Trends and Disparities in Inpatient Costs for Eye Trauma in the United States (2001-2014). Am J Ophthalmol 2019; 207:1-9. [PMID: 31170390 DOI: 10.1016/j.ajo.2019.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the trends and disparities in inpatient costs for eye trauma in the United States from 2001 through 2014. DESIGN Retrospective population-based cross-sectional study. METHODS National Inpatient Sample, a representative sample of U.S. hospital discharges, was used to determine costs of eye trauma hospitalizations. Linear regression was used to estimate changes in mean inflation-adjusted cost per admission. Multivariable logistic regression was used to evaluate factors associated with a cost in the highest quartile (>$13 000) including age, sex, race, income quartile, primary payer, hospital location, size, and type. The model was adjusted for year of admission, length of stay, type of trauma, comorbidities, and the type and number of procedures performed. RESULTS The inpatient costs for eye trauma from 2001 through 2014 totaled $1.72 billion. The mean cost (95% confidence interval [CI]) per stay remained relatively constant: $12 000 ($11 000-13 000) in 2001 to $11 000 ($10 000-12 000) in 2014 (P = .643). A cost in the highest quartile was more likely in African Americans compared to whites (adjusted odds ratio, 1.3; 95% CI, 1.2-1.5), patients in the highest income quartile compared to those in the lowest (1.3; 1.2-1.5), uninsured patients compared to publicly insured patients (1.2; 1.1-1.4), teaching hospitals compared to non-teaching ones (1.5; 1.2-1.8), and the West compared to the South (2.4; 2.0-2.8). CONCLUSIONS Inpatient costs of eye trauma have remained steady and can be potentially reduced by addressing associated disparities. Further research including outpatient costs and eye trauma in vulnerable populations will be key to optimizing care and advancing healthcare equity.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bushra Usmani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Syed M A Shah
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Young BK, Kohli AA. Cost analysis of medications in ophthalmology consultations using Mobile applications. Graefes Arch Clin Exp Ophthalmol 2019; 257:1809-1810. [DOI: 10.1007/s00417-019-04363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
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National Study of Ocular Hospitalizations in Medicare Beneficiaries. Am J Ophthalmol 2019; 199:238-245. [PMID: 30553807 DOI: 10.1016/j.ajo.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To study the characteristics of Medicare beneficiaries hospitalized for ophthalmic conditions. DESIGN Cross-sectional study. METHODS The 2015 National Medicare 100% Inpatient Limited Dataset was analyzed to identify all patients with either an admitting or primary diagnosis for an ophthalmic condition using ICD-9-CM codes. All other hospitalized Medicare patients served for comparison. Comorbidities were calculated using the Elixhauser Comorbidity Index. Multivariable logistic regression was used to determine odds of primary ophthalmic hospitalization after controlling for patient characteristics and medical comorbidities. RESULTS For 2015, there were a total of 13 152 Medicare patients with ocular hospitalizations compared to 6 621 005 patients with nonophthalmic events. Most ophthalmic patients were emergent admissions (73.19%) with routine discharges (75.50%) and low rates of inpatient mortality (0.62%). The top admitting diagnoses for nontraumatic and traumatic eye conditions were diplopia (11.69%) and closed fracture of the orbital floor (3.76%), respectively. Patients admitted for eye conditions were more likely to be younger, to be African American, and to have hypertension, valvular heart disease, diabetes, hypothyroidism, AIDS, lymphoma, solid tumor without metastasis, rheumatologic diseases, alcohol and drug abuse, psychoses, and depression compared to the general Medicare inpatient population. CONCLUSIONS Most inpatient admissions for US Medicare beneficiaries with primary ophthalmic diagnoses were for nontraumatic disorders of the eye and adnexa. Ophthalmic admissions were on average shorter in duration and had lower rates of inpatient mortality compared to nonophthalmic admissions. Patients admitted for eye conditions were more likely to have comorbidities such as hypertension, diabetes, and depression compared to the general Medicare inpatient population.
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Kollross B, Gelfuso GM, Cunha-Filho M, Gratieri T. Topical ophthalmic antimicrobials: unfulfilled demands and possibility of new investments in Brazil and in the United States. BRAZ J PHARM SCI 2019. [DOI: 10.1590/s2175-97902019000218481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Bianca Kollross
- Brazilian Health Regulatory Agency (ANVISA), Brazil; University of Brasília (UnB), Brazil
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Liu L, Li Y, Zhang GS, Wu JY, Majithia S, Tham YC, Zhang H, Chen L. Top 100 cited articles in ophthalmic epidemiology between 2006 and 2016. Int J Ophthalmol 2018; 11:1994-1998. [PMID: 30588435 DOI: 10.18240/ijo.2018.12.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To identify the most-cited articles in ophthalmic epidemiology over the last decade. METHODS We performed a cited reference search on articles that were included in the ISI Web of Science database using the terms "Epidemi*" AND "ophthalm*" AND "population*" during year 2006 to 2016. TOP 100 most cited articles (T100) in ophthalmic epidemiology were short listed and analysed using bibliometrics. RESULTS These top 100 articles in ophthalmic epidemiology were cited between 61 to 333 times. Of these T100 articles, 36% originated from United States, and 34% were published in the Ophthalmology journal. The three major topics identified were age-related macular degeneration (AMD, n=23), glaucoma (n=16) and visual impairment (n=12). The top-cited article was a study on outdoor activities and its association with the prevalence of myopia in school-aged children, published in 2008. CONCLUSION This bibliometric analysis provides useful insights into the current development in ophthalmic epidemiology in the past decade and can help recognizing the quality of the researches, discoveries, and trends steering ophthalmic epidemiology.
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Affiliation(s)
- Lei Liu
- Department of Ophthalmology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.,Department of Public Service, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.,Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Yan Li
- Department of English, School of Fundamental Sciences, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Gui-Sen Zhang
- Department of Ophthalmology, Hohhot Chao Ju Eye Hospital, Hohhot 010052, Inner Mongolia Autonomous Region, China
| | - Jing-Yang Wu
- Department of Ophthalmology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Han Zhang
- Department of Ophthalmology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Lei Chen
- Department of Ophthalmology, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.,Liaoning Diabetic Eye Center, Shenyang 110001, Liaoning Province, China
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