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Curtis E Margo

Publications and source records attributed to Curtis E Margo.

14 recordsLinked to original sources
PubMed2006

Topical gel vs subconjunctival lidocaine for intravitreous injection: a randomized clinical trial.

PURPOSE: To determine if topical gel is superior to subconjunctival injection of lidocaine in relieving pain of intravitreous injection of corticosteroid. DESIGN: Randomized clinical trial. METHODS PATIENT POPULATION: One hundred patients receiving intravitreous injection of triamcinolone. INTERVENTIONAL PROCEDURE: Topical lidocaine 2% gel and subconjunctival lidocaine 2% injection. OUTCOME MEASURE: Analog pain score assessment, conducted by technician masked to treatment. RESULTS: There was no statistically significant difference in pain scores between the treatment groups (P = .1). CONCLUSIONS: The effective relief of pain with lidocaine for intravitreous injection is independent of its mode of application (gel vs subconjunctival injection).

Anesthetics, Local↗
PubMed2005

Xanthoma disseminatum with bilateral epibulbar involvement.

PURPOSE: To describe the ocular involvement in xanthoma disseminatum. DESIGN: Case report and literature review. METHODS: Histopathologic study of excised conjunctival tumor and clinical follow-up. RESULTS: A 29-year-old woman with normal serum lipoproteins developed widespread xanthomas of the skin, throat, and episclera. There were no signs of recurrence 12 months after removal of the conjunctival xanthomas. CONCLUSIONS: Xanthoma disseminatum is a rare condition for which there is no medical treatment. The distinction between the normolipemic xanthomatoses awaits a better understanding of their pathogenesis. Surgical removal of episcleral xanthomas can be successful, but long-term follow-up of such patients has been limited.

Adult↗
PubMed2005

Posterior vitreous detachment. How to approach sudden-onset floaters and flashing lights.

Symptomatic PVD is a common age-related problem that in some patients is associated with retinal tear and retinal detachment. Thorough ocular examination of patients with unilateral floaters and photopsias is needed to identify those at greatest risk for vision loss. Patients without retinal pathologic findings on initial examination need to be given careful instructions on what to expect and do should symptoms of retinal tear or detachment occur.

Acute Disease↗
PubMed2004

Hospitalization for nontraumatic disorders of the eye and ocular adnexa: analysis of the Florida agency for health care administration data set.

OBJECTIVE: To study the demographic features and patterns of hospital admission in Florida for nontraumatic disorders of the eye and ocular adnexa. METHODS: The public data set from the Florida Agency for Health Care Administration for 2001 was used to identify persons hospitalized for 24 hours or longer for nontraumatic disorders of the eye and ocular adnexa by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS: In 2001, there were 2137 hospital admissions for nontraumatic disorders of the eye and ocular adnexa, most of which were for infections or neuro-ophthalmologic disorders. The median length of stay was 3.0 days (mean +/- SD, 3.4 +/- 3.8 days). On average, 1 patient was admitted per month to 180 Florida hospitals. Eighty-three patients (3.9% of eye admissions) were hospitalized for 10 days or longer and accounted for 18.1% of total hospital-patient days. Prolonged hospital stay was positively associated with hospital transfer (P <.001) and facial cellulitis (P =.04). A trend for positive association with Medicaid coverage was also observed (P =.07). CONCLUSIONS: Nontraumatic eye care composes a small proportion of all inpatient care (< 0.1%) in Florida. Few of these patients require prolonged hospitalization but use a large proportion of inpatient care on the basis of the percentage of gross charges. An opportunity exists to improve hospital efficiency and improve eye care by targeting the patients at highest risk for prolonged hospital stay.

Databases, Factual↗
PubMed2004

Periocular cutaneous melanoma arising in a radiotherapy field.

A 78-year-old woman had a periocular cutaneous melanoma in the radiation field of a meningioma. A medial canthal melanoma arose 32 years after primary radiation for a sphenoid wing meningioma and 22 years after supplemental radiation for meningioma recurrence. Histologic sections taken from skin surrounding the melanoma showed widespread melanocytic atypia and 2 separate foci of melanoma in situ. Cutaneous melanoma can arise in a radiation field after a long latency period and should be considered an uncommon form of secondary malignancy.

Aged↗
PubMed2003

Episcleral pseudomelanoma: late complication of scleral tunnel incision.

PURPOSE: To describe two patients who developed scleral thinning as a late complication of scleral tunnel incision for cataract extraction. DESIGN: Observational case report and interventional case report. METHODS: A 75-year-old man had an asymptomatic gray-brown subconjunctival nodule in the location of the healed scleral tunnel incision for cataract surgery. A 62-year-old man had a biopsy of a brown conjunctival nodule at the site of a scleral tunnel incision for cataract surgery. RESULTS: The 75-year-old patient with prolapsed uveal tissue was followed up for 4 years without change in the wound defect. The 62-year-old patient had a biopsy because the exposed ciliary body mimicked a melanoma. CONCLUSIONS: Scleral defects with herniated uveal tissue as a late sequela of scleral tunnel incision for cataract surgery should be differentiated from melanoma and can be safely observed for years when covered by conjunctiva.

Aged↗
PubMed2002

Tourette syndrome and iatrogenic eye injury.

PURPOSE: To describe the circumstances associated with eye injury from an ocular examination of two patients with Tourette syndrome. DESIGN: Case reports. METHODS: A 21-year-old man and a 24-year-old man had sudden and unpredictable movement during an eye examination, causing conjunctival laceration and hemorrhage abrasion in the first patient and a corneal abrasion in the second patient. RESULTS: With topical antibiotics for both patients and patching of the eye for the 24-year-old patient, healing was uncomplicated. CONCLUSIONS: Patients with Tourette syndrome are at risk of eye injury when an unanticipated tic movement occurs during eye examination. Physician precautions, particularly mental preparedness for sudden jerking movement, should be taken when examining patients with Tourette syndrome.

Adult↗
PubMed2002

Peer and expert opinion and the reliability of implicit case review.

OBJECTIVE: To compare the interrater and intergroup agreement in judging physician maloccurrence and compliance with standards of care using the implicit case review process. DESIGN: Mail survey with questionnaire. PARTICIPANTS: Case reviews and questionnaires were mailed to 140 board-certified ophthalmologists and 140 board-certified ophthalmologists with fellowship training. MAIN OUTCOME MEASURE: Agreement judging maloccurrence and compliance with standard of care within each group and between general ophthalmologists and specialists. RESULTS: Ninety-seven (35%) questionnaires were returned. Overall, 35% of respondents believed that ophthalmologists in the case reviews committed an error of either commission or omission. Forty-five percent of reviewers believed that physicians did not meet the standard of care. There was good within-group agreement for finding clinical error in management and not meeting the standard of care for all groups (kappa coefficient range: 0.55-0.83; P = < 0.004) except retina specialists (kappa coefficient = 0.12; P = 0.2). CONCLUSIONS: Unstructured implicit case review is not a reliable method for determining physician error or for measuring compliance with standards of care. The process is susceptible to bias, and results may vary with reviewer background or training. Unstructured implicit case review needs to be regarded as a rough screening tool and used accordingly.

Clinical Competence↗
PubMedDate not supplied

Quality care and practice variation: the roles of practice guidelines and public profiles.

Goals of the quality-of-care initiative are to improve the structure, process, and outcome of health care. The effectiveness of methods to improve quality have been largely unverified. Most methods are costly to implement and time-consuming to perform; some threaten professional autonomy. The characteristic feature of modern medicine that fuels the debate over quality is the variation in the delivery of health care. This review examines the "variation phenomenon" in medicine and the roles that practice guidelines and physician profiling have in improving health care, in general, and for adult cataract, in particular.

Cataract Extraction↗
PubMedDate not supplied

The reliability of clinical methods in ophthalmology.

The reliability of clinical methods is often taken for granted. There is considerable evidence, however, that variability of clinical measurements, interpretations, and judgements are greater than commonly thought. Inconsistency of clinical methods has profound and widespread implications in clinical practice. The inferential capacity of measurements depends on accuracy and reproducibility. Appropriate medical decisions cannot be reached without accurate and reliable data. This review will examine the conceptual relationship of reliability, accuracy, and validity. The role of observer reliability in ophthalmic test measurements and interpretations will be addressed in the context of three case reports.

Adult↗
PubMedDate not supplied

The Collaborative Ocular Melanoma Study: an overview.

BACKGROUND: The Collaborative Ocular Melanoma Study (COMS) is a 3-arm study that includes two multicenter randomized clinical trials designed to compare the effectiveness of brachytherapy to enucleation for treatment of medium-size choroidal melanomas, and the effectiveness of enucleation with and without preoperative external-beam radiotherapy for large choroidal melanomas. The third arm is an observational study of small choroidal melanomas. Patient accrual ran from 1987 to 1998. METHODS: A review of COMS published reports was conducted. RESULTS: There is no difference in 5-year all-cause mortality for large- and medium-size choroidal melanomas with COMS-designated treatments. Preoperative radiation for large choroidal melanomas does not improve survival. The accuracy of the clinical diagnosis of choroidal melanoma is excellent. CONCLUSIONS: Data from the trials are still being collected and analyzed, but primary outcomes will unlikely change significantly in the future. Similar rates of mortality after treatment with enucleation and brachytherapy shift the emphasis of selection of therapy to secondary outcomes such as preservation of vision. The findings highlight the need to better understand the biological mechanisms and timing of hematogenous dissemination to achieve an appreciable impact on choroidal melanoma survival.

Brachytherapy↗