Ophthalmologic Consultation Research Articles

Preventive screening of open‐angle glaucoma: an innovative machine learning risk assessment tool based on health insurance claims data

AbstractPurposeDespite progress in management of open‐angle glaucoma, early diagnosis remains difficult due to delayed ophthalmologist consultation. Early glaucoma treatment avoids vision loss, thus developing automated detection methods is of importance for public health. We used supervised machine learning models on medical insurance claims data to identify at‐risk patient profiles that would benefit from undergoing glaucoma diagnosis, leading to early detection.MethodsUsing medical claims records from a Swiss health insurance company, we identified a “glaucoma group” composed by 2700 patients (18–65 yo) with at least 3 years of historical data in the database and at least one year of medications for lowering intraocular pressure. To complete the training dataset, we randomly selected a “non‐glaucoma control group” (N = 2700) with same age range and medical criteria. Random Forest models were then trained using patient medical consumption data (e.g. number of drugs, number of consultations, ocular tests) in order to estimate individual’s probability of having glaucoma based on medical claims records. Population was split into training set (70%) and test set (30%) to estimate the model prediction performance.ResultsThe mean age of population with glaucoma was 55.3 (SD: 11.3), and had an average of 1.96 (SD: 2.8) eye visits within the 3 years period prior to their first glaucoma prescription. t‐test showed significant association between consumption of eye products (e.g. artificial tears) during the two years prior to glaucoma medication. The Random Forest classifier accuracy computed on the test set (N = 1600) showed a positive predictive value of 78.5%, a negative predictive value of 79.2%. Sensitivity and specificity were of 79.4% and 77.2% respectively.ConclusionsTo our knowledge, this study is the first to attempt estimating glaucoma probabilities from medical consumption invoice data. Our preliminary results show that using supervised machine learning algorithms could identify high‐risk patient profiles of glaucoma with an accuracy of almost 80%. These patients may benefit from an early ocular examination. Automated screening based on medical claims data could thus allow improving open‐angle glaucoma‐related health outcomes, minimizing serious vision loss, and reducing health costs.

Antibiotic therapy of bacterial conjunctivitis – a practical approach

The most common cause of ophthalmological consultations in an ophthalmological clinics are conjunctivitis, often caused by bacteria. The main form of its treatment is topical antibiotic therapy. The paper presents the current possibilities of treatment of conjunctivitis, with particular emphasis on the problem of development of the antibiotic resistance and the practical principles of antibiotic therapy. In the light of current knowledge, the best results in the treatment of bacterial conjunctivitis are achieved by the use of IV- and then III-generation of fluoroquinolones. These drugs have the best spectrum of action, and additionally, they have a very good penetration into the conjunctiva and are at the lowest risk of developing antibiotic resistance.

Stargardt's Disease Diagnosed in Adults: Case Report

Aims: To describe a Stargardt disease, (STGD1) is an autosomal recessive inherited disease often associated with mutations in ABCA4 and characterized by the accumulation of autofluorescent lipofuscin deposits in the retinal pigment epithelium (RPE).
 Presentation of Case: J.A.D.L, male, 52 years old, foreman, born in Rio de Janeiro, attends the ophthalmologic consultation complaining of progressive low visual acuity, noticed at around 31 years of age.
 Discussion: Stargardt disease is the most common hereditary macular dystrophy, representing 7% of retinal dystrophies. The first and only clinical manifestation is the decrease in central vision, which predominantly starts between six and fifteen years of age.
 Methodology: Case report.
 Results: Therefore, the referral of young patients with visual complaints without initial abnormalities of the fundus of the eye for ophthalmological evaluation is essential, since the diagnosis of patients at an early stage of the disease is increasingly important with the advent of new therapeutic possibilities.
 Conclusion: Although many factors contribute to the phenotype of patients with STGD1, the expression and residual activity of ABCA4 mutants play an important role in determining disease severity.
 Retinal thickness and disease duration influence the visual prognosis of patients. Patients with Stargardt's disease have a smaller macular thickness when compared to normal individuals, and this reduction is related to the duration of the pathology. Therefore, OCT is fundamental for the follow-up of these patients, contributing to a better prognostic assessment of the disease.

Immune Checkpoint Inhibitor Treatment and Ophthalmologist Consultations in Patients with Malignant Melanoma or Lung Cancer-A Nationwide Cohort Study.

Simple SummaryImmune checkpoint inhibitors are increasingly being used for treating advanced malignant cutaneous melanoma and lung cancer. Immune-related side effects in multiple organs are common but the frequencies of ophthalmic side effects in national cohorts of unselected patients are undescribed. This study estimated frequencies of first-time ophthalmologist consultations and inflammatory conditions in consecutive patients with malignant melanoma or lung cancer treated with immune checkpoint inhibitors in Denmark from 2011–2018. The one-year risks of first-time consultation and ocular inflammation were 6% and 1%, respectively. These numbers were increased compared with patients with the same type of cancer who were not treated with immune checkpoint inhibitiors.Purpose: To estimate the frequency of first-time ocular events in patients treated with immune checkpoint inhibitors (ICI). Methods: Patients with cancer in 2011–2018 in Denmark were included and followed. The outcomes were first-time ophthalmologist consultation and ocular inflammation. One-year absolute risks of outcomes and hazard ratios were estimated. Results: 112,289 patients with cancer were included, and 2195 were treated with ICI. One year after the first ICI treatment, 6% of the patients with cancer, 5% and 8% of the lung cancer (LC) and malignant cutaneous melanoma (MM) patients, respectively, had a first-time ophthalmologist consultation. The risk of ocular inflammation was 1% (95% confidence interval (CI) 0.4–1.2). Among patients with MM, ICI was associated with ocular inflammation in women (HR 12.6 (95% CI 5.83–27.31) and men (4.87 (95% CI 1.79–13.29)). Comparing patients with and without ICI treatment, the risk of first-time ophthalmologist consultation was increased in patients with LC (HR 1.74 (95% CI 1.29–2.34) and MM (HR 3.21 (95% CI 2.31–4.44). Conclusions: The one-year risks of first-time ophthalmologist consultation and ocular inflammation were 6% and 1%, respectively, in patients treated with ICI. In patients with LC and MM, the risk was increased in patients with ICI compared with patients without ICI.

10. Impact of Infectious Disease Consultation and Theoretical Management Bundle in Patients with Candidemia

BackgroundCandidemia is associated with significant morbidity and mortality. The impact of infectious diseases consultation (IDC) on clinical outcomes in patients with candidemia is not well established. We evaluated the impact of IDC and a management bundle on clinical outcomes in patients with candidemia.MethodsA retrospective chart review of adult (age ≥ 18 years) patients with at least 1 blood culture growing Candida species identified at Alberta Precision Laboratories between December 1, 2019 to November 30, 2020 and hospitalized at the University of Alberta Hospital, Edmonton, Canada were included. Patients who died within 48 hours and those who left against medical advice within 24 hours of initial positive blood culture result were excluded. Demographics, management, and outcome data were collected. A complete management bundle was defined as having all the following elements performed: IDC, repeat blood cultures, empiric echinocandin therapy, ophthalmology consult, and echocardiogram.ResultsThirty-one patients were included for study; mean age was 56 ± 17 years and 65% were male. 14 (45%) cases were admitted under critical care, 7 (23%) surgery, and 10 (32%) medicine. 3/17 (18%) required intensive care unit admission following candidemia diagnosis. Candida albicans was identified in more than half the cases. The primary source was intra-abdominal in 12 (39%), central-line associated in 8 (26%), and urinary in 6 (19%). IDC occurred in 27 cases (87%), echocardiogram in 22 (71%), ophthalmology consult in 10 (32%), and follow-up blood cultures in 30 (97%). 20 (65%) patients received empiric echinocandin. Of the remainder who received empiric fluconazole, 4 (36%) grew non albicans Candida species.Higher in-hospital mortality was observed in cases without IDC than those with IDC (4/4, 100% vs 8/27, 29.6%, p=0.016) and in those that did not have a complete bundle (12/25, 48% vs 0/6, p=0.059). However, IDC was not associated with the receipt of individual bundle components nor the complete bundle (p=NS).ConclusionIn patients with candidemia, lower in-hospital mortality was observed in patients who received IDC. Larger studies are required to confirm our findings and assess whether the implementation of a candidemia management bundle is beneficial. Disclosures Dima Kabbani, MD, AVIR Pharma (Grant/Research Support, Other Financial or Material Support, Speaker)Edesa Biotech (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)

988. Is There Value of Infectious Diseases Consultation in Candidemia? A Single Center Retrospective Review From 2016-2019

BackgroundCandidemia is the second most common cause of healthcare-associated bloodstream infections in the US with mortality of approximately 25%. Studies demonstrate lower candidemia mortality with infectious diseases consultation (IDC). We evaluated effects of IDC on mortality and guideline-adherence at our institution to determine if mandatory IDC was warranted.MethodsWe retrospectively reviewed adults hospitalized with candidemia (≥ 1 blood culture positive for Candida) between 1/1/2016-12/31/2019. Exclusion criteria included age < 19 years, polymicrobial blood culture, or death or hospice within 48 hours. Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-adherence and treatment choice. Guideline-adherence was assessed with a modified EQUAL Candida score (Table 1). Descriptive statistics were performed.Table 1. Original vs Modified EQUAL Candida Score Abbreviations. CVC: central venous catheter, BCx: blood cultureResultsOf 187 patients reviewed, 92 episodes of candidemia with 94 species of Candida were included. Patient characteristics are shown in Table 2. Central venous catheters (CVCs) were present in 66 (71.7%) patients and were the most common infection source (N=38 [41.3%]) followed by intra-abdominal (N=23 [25%]). The most isolated species were Candida glabrata (40/94 [42.6%]) and C. albicans/dublienensis (35/94 [37.2%]). 30-day mortality was 21.7%. IDC was performed in 84 (91.3%) cases. Outcomes are in Table 3. Mortality was not different between IDC vs no IDC (18 [21.4%] vs 2 [25%]); other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%), echocardiography (70.2% vs 50%), CVC removal (91.7% vs 83.3%), and initial treatment echinocandin (67.9% vs 50%). All patients received antifungal therapy. IDC resulted in more ophthalmology consultations (77.4% vs 12.5%, p< 0.01). Mean modified EQUAL Candida score was higher with IDC (17.4 vs 13.9, p< 0.01).Table 2. Patient Characteristics Abbreviations. TPN: total parenteral nutrition, ICU: intensive care unit, AIDS: acquired immunodeficiency syndromeTable 3. Outcomes Abbreviations. NS: non-significant, CVC: central venous catheterConclusionIDC was common in candidemic patients and not associated with significant differences in outcomes. Current antimicrobial stewardship and consultation practices at our center do not warrant mandated IDC for candidemia.Disclosures Trevor C. Van Schooneveld, MD, FACP, BioFire (Individual(s) Involved: Self): Consultant, Scientific Research Study Investigator; Insmed (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): Scientific Research Study Investigator; Rebiotix (Individual(s) Involved: Self): Scientific Research Study Investigator

Characteristics and Outcomes of a Series of COVID-Associated Mucormycosis Patients in Two Different Settings in Egypt Through the Third Pandemic Wave.

PurposeTo report on the underlying risk factors, clinical characteristics, presentation, and survival of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM) cases referred for ophthalmological consultation in two different Egyptian settings during the third viral pandemic wave (April to August of 2021).MethodsA multicentric, retrospective analysis involving one public and two private hospitals in metropolitan Cairo, and two university hospitals in upper Egypt (Aswan and Assuit). Cases that fulfilled the diagnostic criteria of mucormycosis, with a prior or concurrent COVID-19 infection, were included.ResultsOf the 26 patients included in the final analysis, 15 (57.7%) were from Cairo and 11 (42.3%) were from upper Egypt. Twenty-five patients (96.2%) had poorly controlled diabetes mellitus and 20 (76.9%) had received corticosteroid treatment for COVID-19, of which 30.8% had mild or moderate disease. The median duration from COVID-19 till the onset of CAM was 20.5 days. No visual function could be detected in the affected eye of 16 patients (61.6%) on presentation. The mortality rate was 46.2% despite surgical debridement in half of the cases that died.ConclusionCAM continues to be a concrete threat throughout Egypt, especially in patients with poorly controlled diabetes mellitus and those who inadvertently receive steroid therapy. It remains to be seen if increased vaccination coverage and early detection due to increased awareness would result in declining rates and adverse sequelae of CAM. A national registry would allow for better monitoring of the disease trends.

Hypochlorous acid as an antiseptic in the care of patients with suspected COVID-19 infection.

PurposeThe SARS-CoV-2 virus, which causes COVID-19 disease, is transmitted by aerosols or by contact with infected surfaces. The route of entry to the body is through the nasal, oral or conjunctival mucosa. Health workers must use effective protection measures against the entry of the virus into mucous membranes, both physical and antiseptic filters. There is an antiseptic used in Ophthalmology that we believe could have virucidal action against the SARS-CoV-2 virus, formulated based on 0.01% hypochlorous acid.MethodsAn exhaustive search has been carried out in the databases of Pubmed and Web of Science to identify relevant articles on the virucidal activity of hypochlorous acid in different concentrations until October 4, 2020.ResultsThere is evidence of the virucidal efficacy of 0.01% hypochlorous acid against SARS-CoV-2. According to the different scientific publications reviewed, hypochlorous acid has virucidal efficacy against different viruses, among them, SARS-CoV-2.ConclusionsThe 0.01% hypochlorous acid could act as an effective antiseptic against SARS-CoV-2, exerting a barrier on the mucosa to prevent COVID-19 infection. It can be used on the eyes, nose and mouth. We consider it necessary to assess its use in the protocol for patient health care in ophthalmology consultations, as well as to recommend its use to the general population to reduce viral load and/or prevent transmission of infection. Additional in vivo studies would be required to confirm its antiseptic action.

Superior Ophthalmic Vein Thrombosis Induced by Orbital Cellulitis: An Ophthalmic Emergency

Superior ophthalmic vein thrombosis (SOVT) is a rare ophthalmologic emergency. The most common etiologies include infection, trauma, inflammation, and malignancy, as well as thyroid-related orbitopathy. Early identification and timely intervention can lead to a significant decrease in complications that include cavernous sinus thrombosis (CST), vision loss, and death. This rare disease entity almost always makes its initial presentation to internal medicine or emergency medicine (EM) physicians. In this report, we present a case of SOVT that presented overnight to the emergency department for worsening right facial swelling and orbital pain. We discuss our experience with the evaluation and management of SOVT and provide a review of the currently available literature to emphasize the importance of obtaining a full history and physical examination, seeking early imaging studies, and ophthalmology consultation for patients with suspected SOVT.

Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit.

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients’ severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient’s evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro–Wilk test, the Spearman’s rank correlation test, the Mann–Whitney U test and the Friedman’s ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

Initial Management of Orbital Trauma: Is an Ophthalmologic Evaluation Necessary?

BACKGROUND: Orbital fractures may be associated with globe injuries, resulting in delayed ophthalmic complications and visual disturbance. The debate regarding the necessity of ophthalmologic evaluation in the initial management of orbital trauma continues. Therefore, there is a need to establish the rate of ocular injuries associated with orbital fractures. METHODS: A retrospective review of patients with orbital fractures who received ophthalmologic consultation and computed tomography scan analysis at a level 1 trauma center, from 2014 to 2020 was performed. The inclusion criteria were patients 18 years or older with confirmed computed tomography scan diagnosis of orbital fracture and ophthalmology consultation. Patient demographics, injuries, comorbidities, and surgical outcomes were collected. RESULTS: A total of 201 patients with 224 orbital fractures (11.4% bilateral) were included. The mean age at injury was 50.5 ± 25.2 years; 21.9% of patients had an associated neurologic injury at the time of ED evaluation. The most common mechanisms of injury were mechanical fall (41%), occupational injuries (26.9%), and motor vehicle accident (25%). The posterior segment of the eye was most affected (16.1%), followed by the anterior segment (13.4%) and ocular adnexa (13.4%). A significant ocular injury was present in 21.9% of orbital fractures. These included choroidal hemorrhage (6.1%), hyphema (5.4%), retinal hemorrhage (4.5%), retrobulbar hematoma (4%), globe rupture (3.6%), choroidal hemorrhage (1.4%), retinal detachment (1.3%), corneal laceration (0.9%), choroidal rupture (0.4%), macular hemorrhage (0.6%), and retinal tear (0.4%). The mechanism of injury was not associated with an increased risk for a serious ocular injury. The most common ophthalmologic findings on examination were diplopia (30.4%), reduced extraocular movement (9.8%), and periorbital laceration (8.9%). Of all patients, 53.1% presented with one orbital wall fracture, of which, the orbital floor was the most commonly involved (44.2%). Associated facial fractures were found in 68.8% of patients. computed tomography scans showed displaced fracture in 44.6% of orbits, comminution in 45.3% and herniation of orbital contents in 42.9%. On multiple variable analysis, motor vehicle accident (OR = 2.5 [1.4–4.7], P = 0.003) and injury to the posterior segment (OR = 2.6 [1.2–5.8], P = 0.045) were associated with the need of surgical treatment. However, injury to the anterior segment (OR = 3.4 [1.5–8.0], P = 0.028) and ocular adnexa (4.0 [1.6–10.1], P = 0.002) were associated with the need of medical treatment alone. CONCLUSIONS: Our retrospective series demonstrated a 22% incidence of ocular trauma in orbital fractures. There were no association between mechanism of injury and serious ocular trauma. This emphasizes that the management of orbital traumas requires a multidisciplinary approach, including the facial trauma team and ophthalmology.

Ophthalmic findings of Mycoplasma-induced rash and mucositis (MIRM) distinct from Stevens-Johnson syndrome

To identify ophthalmic manifestations of Mycoplasma-induced rash and mucositis (MIRM). The medical records of patients with MIRM treated by the inpatient ophthalmology consult service at a single institution over a period of 4 years were reviewed retrospectively. Eye and skin findings, treatment, hospital course, and follow-up findings were documented and reviewed. MIRM was identified in 10 patients, 10-20 years of age (mean, 13.) All presented with oral mucosal findings and a prodrome. On initial examination, conjunctival epithelial defects were present in 2 patients; pseudomembranes, in 3. Five patients experienced progressive ophthalmic manifestations during hospitalization, including a new cornea epithelial defect in 1 patient and a new conjunctival epithelial defect in 3 patients. All were treated with topical steroids and antibiotics. Post-discharge follow-up obtained for 7 patients documented good visual outcomes and lack of significant ocular sequelae without requiring invasive intervention. MIRM, previously referred to as mycoplasma-associated Stevens-Johnson syndrome (SJS) among other names, is now understood to be distinct from SJS in the dermatology community. Our MIRM patients present with mild eye findings and required no surgery, similar to the mild course published in the dermatology literature. Patients with MIRM may have a more benign course than those with SJS.

Ácido hipocloroso como antiséptico en la atención al paciente con sospecha de infección por COVID-19

PurposeThe SARS-CoV-2 virus, which causes COVID-19 disease, is transmitted by aerosols or by contact with infected surfaces. The route of entry to the body is through the nasal, oral or conjunctival mucosa. Health workers must use effective protection measures against the entry of the virus into mucous membranes, both physical and antiseptic filters. There is an antiseptic used in Ophthalmology that we believe could have virucidal action against the SARS-CoV-2 virus, formulated based on 0.01% hypochlorous acid. MethodsAn exhaustive search has been carried out in the databases of Pubmed and Web of Science to identify relevant articles on the virucidal activity of hypochlorous acid in different concentrations until October 4, 2020. ResultsThere is evidence of the virucidal efficacy of 0.01% hypochlorous acid against SARS-CoV-2. According to the different scientific publications reviewed, hypochlorous acid has virucidal efficacy against different viruses, among them, SARS-CoV-2. ConclusionsThe 0.01% hypochlorous acid could act as an effective antiseptic against SARS-CoV-2, exerting a barrier on the mucosa to prevent COVID-19 infection. It can be used on the eyes, nose and mouth. We consider it necessary to assess its use in the protocol for patient health care in ophthalmology consultations, as well as to recommend its use to the general population to reduce viral load and / or prevent transmission of infection. Additional in vivo studies would be required to confirm its antiseptic action.

380 Evaluating the Use of Advanced Neuroimaging in the Emergency Department for Ocular Complaints

According to a 2008 report by America’s Health Insurance Plans, up to half of all diagnostic testing including computed tomographic (CT) imaging and magnetic resonance imaging (MRI) is thought to be medically unnecessary. In ophthalmology, many isolated ocular emergencies can be diagnosed by fundus examination and do not require advanced neuroimaging. The purpose of this study was to evaluate the use of advanced neuroimaging in the emergency department (ED) for ocular complaints. This is a retrospective chart review of all patients with ophthalmic emergencies presenting to the Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Sibley Memorial Hospital ED’s between June 2016 and May 2017 who received advanced neuroimaging and ophthalmology consultation. Necessity of advanced neuroimaging was determined based on whether or not presentations could be diagnosed by ophthalmic exam. Five hundred thirty-six patients were identified. The mean age of patients (±SD) was 44.9 (±21.0) years and 50.9% (n=273) were male. Forty-eight percent of patients (n=259) were White, 39.4% (n=211) Black, 8.4% (n=45) Hispanic, 3.0% (n=16) Asian, and 9.3% (n=50) other. All patients with final diagnoses of orbital fracture (n=26, 4.9%), optic neuritis (n=26, 4.9%), cranial nerve palsy (n=15, 2.8%), stroke (n=13, 2.4%), ruptured globe (n=12, 2.2%), malignancy (n=11, 2.1%), idiopathic intracranial hypertension (n=11, 2.1%), diplopia (n=10, 1.9%), visual loss (n=9, 1.7%), amaurosis fugax (n=5, 0.9%), optic nerve disorder (n=4, 0.7%), retrobulbar hemorrhage (n=4, 0.7%), abscess (n=3, 0.6%), eye problem (n=3, 0.6%), eye swelling (n=2, 0.4%), giant cell arteritis (n=2, 0.4%), retinal artery branch occlusion (n=2, 0.4%), and strabismus (n=2, 0.4%) received necessary advanced neuroimaging. All patients with final diagnoses of conjunctivitis (n=11, 2.1%), retinal detachment (n=7, 1.3%), cataract (n=4, 0.7%), acute angle closure glaucoma (n=3, 0.6%), hordeolum (n=3, 0.6%), dacrocystitis (n=2, 0.4%), floaters (n=2, 0.4%), uveitis (n=2, 0.4%), vitreous detachment (n=2, 0.4%), and zoster ophthalmicus (n=2, 0.4%) received unnecessary advanced neuroimaging. Eighty-one percent (n=435) of patients underwent CT only, 14.9% (n=65) underwent MRI only, and 6.7% (n=36) underwent both. Sixty-two percent (n=330) of patients were discharged from the ED, 37.5% (n=201) were admitted, 0.7% (n=4) left against medical advice, and 0.2% (n=1) placed in observation. Of various ocular emergencies in which advanced neuroimaging was not required, conjunctivitis and retinal detachment were the most common causes of unnecessary imaging. Imaging was necessary for most patients with final diagnoses of trauma and neurologic disorders. CT was the most common type of imaging modality performed.

A Pigmented Cyst in the Anterior Vitreous of a 4-year old Child: Case Report

Vitreous cysts are a rare and mostly accidental finding. We report a case of a 4-year-old male without a relevant medical history who resorted to a routine ophthalmology consultation. On ophthalmological examination, he had a 6/10 (Snellen decimal scale) best corrected visual acuity in both eyes. Biomicroscopy showed a pigmented and rounded lesion (3 mm of larger diameter), located in the anterior vitreous of the left eye, that moved with eye movements. Besides this lesion and the shadow-effect it produced in the retina, there were no other changes in fundus examination. Associated inflammatory/infectious pathologies were excluded. At 6-month and 1-year follow-up, no new symptoms or morphological changes of the lesion were found. The etiology of vitreous cysts is diverse, requiring a thorough study and close follow-up in order to decide the most appropriate approach.

Болезнь Норри: основные симптомы заболевания и важность раннего генетического анализа (клинический случай)

We present a clinical case of Norrie disease in a 6-year-old boy. The parents had in time an ophthalmologist consultation when the child was 4 months old, but the final diagnosis was made more than 5 years later. A specific feature of this case in addition to vitreoretinopathy and bilateral retinal detachment was the presence of a congenital malformation of the iris - aniridia, which is not a typical sign of Norrie disease. A modern method of genetic testing (next generation sequencing - NGS) made it possible to detect a previously undescribed mutation in the NDP gene and make a final clinical and genetic diagnosis. Key words: Norrie disease; vitreoretinopathy; retinal detachment; NDP gene.

Factors Associated with Ocular Injury in Orbital Fracture Patients: Who Requires Urgent Ophthalmic Evaluation?

Importance: Create validated criteria to identify orbital fracture patients at higher risk for significant ocular injuries. Objective: Determine history and physical examination findings in orbital fracture patients who are associated with ocular injury and warrant urgent assessment by an ophthalmologist. Design, Setting, and Participants: Retrospective chart review of 535 adult orbital fracture patients evaluated at a Level I emergency department between 2014 and 2017, without prior history of orbital fracture, ocular injury, or ocular/orbital surgery. Main Outcomes and Measure: Presence of ocular injury. Results: In total, 195 (36%) patients had an ocular injury. Those with and without ocular injury were compared in a multivariate logistic regression model including demographics, fracture characteristics, injury mechanism, and physical examination findings. Visual acuity change, radiographic retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye all had significant associations with ocular injury when other findings were controlled. Conclusion: This study shows a significant association between ocular injury and visual acuity change, retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye. These factors can help triage when to obtain an urgent ophthalmology consult.

Acil Oftalmolojik Konsültasyonların Aciliyet, Oftalmik Patoloji ve Hafta Sonu Etkisi Açısından İrdelenmesi

Aim: To evaluate the urgency of ophthalmology consultations in the emergency department (ED) and the presence of ophthalmic pathology. This study also aimed to determine whether the weekend phenomenon affected emergency ophthalmologic consultation requests. Materials and Methods: Ophthalmology consultations requested by the emergency physician for patients who visited the academic ED of a tertiary care hospital in Turkey from January to December 2019 were retrospectively investigated. Consultation requests were grouped as possible emergent, unlikely to be emergent, and undetermined. Results: A total of 256 eligible patients were included in the study. The top three reasons for emergency ophthalmologic consultations were blunt trauma (29.7%), foreign body (24.2%), and conjunctivitis (13.3%). 70.3% of the patients were categorized as a possible emergent, 18.4% as unlikely to be emergent, and 11.3% undetermined. The frequency of consultation requests with diagnoses that are unlikely to be emergent at weekends and out of working hours was lower than during weekdays and working hours (p = 0.032, p = 0.029, respectively). Most of the possible emergent consultations had ophthalmic pathology (p = 0.001). Conclusion: Traumatic injuries are the most common cause of ophthalmology consultation in the ED. Approximately one-fifth of patients are unlikely to be emergent. Early ophthalmology evaluation is required in possible emergent category patients. The weekend effect does not influence ophthalmology consultations. Establishing eye emergency services or having an available ophthalmologist is crucial in the emergency diagnosis and treatment of patients who require special practice skills.

Neonatal Hyperbilirubinemia and Cholestasis.

Neonatal Hyperbilirubinemia and Cholestasis.

Telemedical applications in ophthalmology in times of COVID-19

HintergrundWährend der COVID-19-Pandemie war die augenärztliche Versorgung teilweise eingeschränkt.FragestellungEs wird ein Überblick über bereits verfügbare oder noch in Entwicklung befindliche teleophthalmologische Anwendungen zur besseren Versorgung während der Pandemie gegeben.Material und MethodeEs erfolgten die Auswertung aktueller wissenschaftlicher Publikationen, die Analyse von frei erhältlichen Screeninganwendungen in App-Stores mobiler Endgeräte sowie telemetrischer Medizinprodukte für Monitoringanwendungen und die Diskussion der Ansprüche an eine ophthalmologische Videosprechstunde.ErgebnisseDas gesteigerte Interesse an teleophthalmologischen Anwendungen spiegelt sich in einem deutlichen Anstieg von Publikationen zum Thema wider. Frei erhältliche Anwendungen für Smartphones und Tablets sind in der Regel nicht validiert und weisen teils starke Abweichungen von etablierten Standardtests auf. Telemedizinische Medizinprodukte zum Home-Monitoring bei chronischen Anwendungen bergen großes Potenzial, müssen sich aber erst im klinischen Alltag durchsetzen.SchlussfolgerungenEs besteht ein hoher Bedarf an systematischer Analyse, Weiterentwicklung und Validierung von telemedizinischen Anwendungen und Medizinprodukten für die Ophthalmologie, um das Potenzial der Telemedizin gewinnbringend zu nutzen und in einer ophthalmologischen Videosprechstunde zu bündeln.