JAMA ophthalmology
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Multicenter Study Comparative Study
Comparison of Aflibercept, Bevacizumab, and Ranibizumab for Treatment of Diabetic Macular Edema: Extrapolation of Data to Clinical Practice.
The Diabetic Retinopathy Clinical Research Network (DRCR Network), sponsored by the National Eye Institute, reported the results of a comparative effectiveness randomized clinical trial (RCT) evaluating the 3 anti-vascular endothelial growth factor (anti-VEGF) agents aflibercept (2.0 mg), bevacizumab (1.25 mg), and ranibizumab (0.3 mg) for treatment of diabetic macular edema (DME) involving the center of the retina and associated with visual acuity loss. The many important findings of the RCT prompted the American Society of Retina Specialists to convene a group of experts to provide their perspective regarding clinically relevant findings of the study. ⋯ On average, all 3 anti-VEGF agents led to improved visual acuity in eyes with DME involving the center of the retina and visual acuity impairment. Worse visual acuity when initiating therapy was associated with greater visual acuity benefit of aflibercept over bevacizumab or ranibizumab 1 year later. Care needs to be taken when attempting to extrapolate outcomes of this RCT to differing treatment regimens. With access to adequately repackaged bevacizumab, many specialists might initiate therapy with bevacizumab when visual acuity is good (ie, 20/32 to 20/40 as measured in the DRCR Network), recognizing that the cost-effectiveness of bevacizumab outweighs that of aflibercept or ranibizumab.
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Fluoroquinolones are the most commonly prescribed antibiotic class in the outpatient setting. Recent reports have implicated an association between oral fluoroquinolones and an increased risk of uveitis. ⋯ These data do not support an association between oral fluoroquinolone use and uveitis. Instead, this study shows an association between oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses, which is a possible source of bias that could explain the findings of previous studies.
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The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study is the only ongoing nationwide antibiotic resistance surveillance program specific to ocular pathogens. ⋯ Methicillin resistance was prevalent among staphylococcal isolates from ocular infections, with many strains demonstrating multidrug resistance. These findings are consistent with resistance trends reported for nonocular staphylococcal isolates. Overall ocular resistance did not increase during the 5-year study period. Continued surveillance of ocular isolates provides critical information to guide selection of topical antibacterials used for empirical management of ocular infections.
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The timing and indications for repair of orbital floor fractures have been controversial. Current practice dictates that fractures involving more than 50% of the orbital floor should be repaired. Early management is initiated in such situations to prevent long-term sequelae of enophthalmos and diplopia. Because fracture size as measured by computed tomography (CT) is one of the criteria to determine the need for surgical repair, there is a need to know the reliability of this parameter. ⋯ Although the literature has long held that a floor fracture seen radiographically to involve 50% of the orbital floor has a high likelihood of enophthalmia and should be repaired, this study shows how variable CT measurements of orbital floor fractures can be in a clinical setting, even in trained hands. We question the dependence on such a criterion and reemphasize the importance of making surgical decisions based on clinical findings rather than radiological interpretations.
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Visual impairment (VI) causes a considerable public health burden and substantial deterioration in health-related quality of life (HRQoL). However, the relative effect of VI on HRQoL compared with other chronic health conditions is unknown as is the additive effect of VI with other conditions. ⋯ These results suggest that VI has a substantial effect on HRQoL, even in the presence of concurrent chronic health conditions, and the combined effect of VI and stroke, osteoarthritis/rheumatic arthritis, hepatitis, or depression on HRQoL was greater. However, because this study group was a representative sampling of South Koreans, generalization to other races/ethnicities and countries should be approached with caution.