Search

Denise A John, Beth Hansemann, Philip Lieu, Jennifer Weizer Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USACorrespondence: Denise A John, Department of Ophthalmology, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1-615-545-8940, Fax +1-734-647-3555, Email denisejo@med.umich.eduPurpose: At the Kellogg Eye Center, we identified a series of injection-related patient safety events that led to a systematic review and redesign of our intravitreal injection protocol. The objective was to reduce injection-related patient safety events to zero.Methods: A retroactive review, using the Healthcare Failure Mode and Effect Analysis model as a guide, was performed on our process for delivering intravitreal injections to identify potential failure modes and their impact.Results: The total number of injection-related safety events was 1 in 2017 and 16 in 2018 at baseline. Potential vulnerabilities identified included errors in communication, patient identification, clinical documentation, and medication orders. The injection protocol was redesigned. After implementation, there were zero injection-related safety events in all Kellogg Eye Center Retina clinics for the subsequent 18-month follow-up period.Conclusion: It is possible to redesign and implement an intravitreal injection protocol to reduce the rate of safety events in a large academic eye center.Keywords: adverse event, healthcare failure mode and effect analysis, intravitreal injections, patient safety

Background: There has been little previous study reporting the eye findings and presentation of elderly patients with myasthenia gravis. The purpose of this study was to review the findings and course of myasthenia gravis after the sixth decade of life., Methods: Retrospective observational case series. The authors reviewed the clinical records of 27 patients with onset of myasthenia gravis at age 60 years or more who were seen at a tertiary care academic ophthalmology centre in Houston between January 1992 and March 1999. The diagnosis of myasthenia gravis was based on conventional clinical and laboratory criteria., Results: Twenty patients (74%) were men. Of the 16 patients who underwent testing for anti-acetylcholine receptor antibodies, 11 (69%) were seropositive. Concurrent thyroid disease was found in seven patients (26%), including five (71%) of the seven women. No patient had thymoma. Sixteen patients (59%) manifested generalized symptoms during follow-up; 12 did so within 1 year of disease onset. Patients responded well to both anticholinesterase and corticosteroid therapy. At the most recent follow-up visit 18 patients (67%) were clinically improved, and no patient was clinically worse., Interpretation: Myasthenia gravis in this study was characterized by a male predominance, high rate of concurrent thyroid disease, high rate of progression to mild generalized symptoms, absence of thymoma, good response to medical therapy and minimal life-threatening complications. Clinicians should consider the diagnosis of myasthenia gravis in an older patient presenting with diplopia or ptosis.

Objective: To review cases of juvenile neuronal ceroid lipofuscinosis (JNCL) and highlight salient clinical and diagnostic features, thereby enhancing recognition of this disease among ophthalmologists., Materials and Methods: Twelve cases of JNCL seen from 1982 to 1999 were reviewed. Diagnosis was based on characteristic clinical history, ophthalmoscopic findings, electroretinography, neuroimaging, histopathology, and molecular analysis., Results: Vision loss was the first subjective symptom of the disease in all 12 cases. Among these cases, nine of 12 patients (75%) developed neurologic deficits an average of 3 years after the onset of visual deterioration., Conclusion: Because visual symptoms usually precede neurologic dysfunction, JNCL should be considered in the differential diagnosis when an apparently healthy child presents with unexplained bilateral vision loss.

A simplified and rapid in vivo bioassay for glucagon is described. The test involves continuous monitoring of blood glucose which makes possible an exact rendering of the glucose peaks induced by intravenous injection of glucagon. Two injections of known amounts of glucagon (0.002 and 0.004 U) are followed by an intravenous injection of a solution containing an unknown amount of glucagon for testing. The whole procedure can be completed in 8 h. The interassay variability of 6 bioassay procedures was +/- 12.4%. The intra-assay variability was +/- 3%.