A 59-year-old woman with prior bilateral lower eyelid autologous fat transfer, subdermal micro-needling and fractional radiofrequency skin resurfacing presented with delayed left-sided preseptal cellulitis with small multinodular abscesses unresponsive to oral outpatient antibiotic regimens and inpatient intravenous antibiotics. Wound culture revealed Mycobacterium chelonae infection treated successfully with a 4-month regimen of clarithromycin and tedizolid without recurrence. This case highlights (1) the need for vigilance and a broad differential in delayed post-operative wound infections including non-tuberculous mycobacterial infections, (2) resolution of infection without recurrence on clarithromycin and novel tedizolid oral antibiotic therapy, and (3) that caution should be exercised when performing combination autologous fat transfers with subdermal micro-needling procedures as the breakdown in skin integrity may potentiate infection.
Purpose: To review the visual and anatomical outcomes of combined anterior and posterior segment surgery for retinal detachment repair. Methods and Patients: Eight patients with combined retinal and corneal disease underwent combined temporary keratoprosthesis with penetrating keratoplasty combined with pars plana vitrectomy for retinal detachment repair with silicone oil tamponade. Visual and anatomical outcomes were reviewed retrospectively. Follow-up ranged from 12 months to 37 months. Results: Preoperative visual acuity ranged from light perception to hand motion. All but one case had proliferative vitreoretinopathy present at the time of surgery. Postoperative visual acuity ranged from hand motion to light perception. At the most recent follow-up visit, all of the patients had attached retinas, no patients had phthisis bulbi, and all but one patient had a clear cornea. However, 3 of these cases (38%) required repeat retinal detachment repair and one of them also required repeat penetrating keratoplasty, which was performed at the time of retinal repair. Conclusion: Combined full-thickness penetrating keratoplasty and retinal detachment repair has good anatomical outcomes and is an efficient way to treat complex anterior and posterior segment abnormality. Although postoperative visual function is limited; almost all patients were agreeable to repeat surgery if they were presented with the choice again.
Lagophthalmos Following Idiopathic Bell.docx
We report the first case of cyanopsia following implantation of a non-diffractive extended depth-of-focus (EDOF) intraocular lens (IOL). A 79-year-old male artist underwent cataract extraction with a non-diffractive EDOF ultraviolet absorbing toric IOL (Alcon AcrySof IQ Vivity DAT315) and then experienced persistent cyanopsia in fluorescent lighting following surgery. His symptoms persisted and were visually debilitating. He underwent secondary IOL exchange with a yellow-tinted non-diffractive EDOF toric IOL (Alcon AcrySof IQ Vivity DFT315) and the recurrent cyanosis abated. Surgeons should be aware of cyanopsia following implantation of ultraviolet absorbing IOLs and be prepared to address these complaints should they arise.
Purpose of review The purpose of this review is to examine the differences between the current private equity model in ophthalmology practices and the failed physician practice management companies (PPMC) of the 1990s. Recent findings Over the past 5 years, there has been an accelerating expansion of private equity into ophthalmology. In 2022, there are approximately 1400 ophthalmologists affiliated with one of over 30 private equity-controlled entities and further growth appears likely. This contrasts with the PPMC era that had only a few hundred ophthalmologists across a handful of companies and collapsed within 5 years. The reasons for the failure of PPMC model included inadequate capitalization, limited experience managing ophthalmology practices, failure to grow acquired ophthalmology practices, and misperceptions about the future of healthcare. Current private equity entities are characterized by substantial capital, longer term business plans predicated on individual practice growth, increasing market share, physician controlled clinical care, and integration of physicians into administration and governance. Summary The current private equity model in ophthalmology continues to expand and presents a reasonable model for ophthalmologists considering a change in practice structure. Although distinctly different from the PPMC model, longer follow-up is required to determine the ultimate impact of private equity upon ophthalmology.
