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author:("moradi, Jiten")
1.  Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report 
Background
The dramatic increase in need for anti-vascular endothelial growth factor (anti-VEGF) intravitreal therapy in the treatment of retinal disease and the absence of an equivalent increase in ophthalmologists to undertake such intravitreal injections created a patient-safety risk. Timing of intravitreal therapy (IVT) is critical to prevent vision loss and local clinics lacked capacity to treat patients appropriately. We aimed to improve capacity for IVT by nurse injections.
Materials and methods
A multidisciplinary prospective service-improvement process was undertaken at two adjacent general hospitals in the northwest of England. IVT injections by nurses were a principal component of solution development. After we had obtained appropriate institutional approval, experienced ophthalmic nurses were trained, supervised, and assessed to undertake IVT. Ophthalmologists directly supervised the first 200 injections, and a retina specialist was always on site.
Results
Nurses undertook 3,355 intravitreal injections between June 2012 and November 2013, with minor adverse events (0.3% subconjunctival hemorrhage and corneal abrasion). There were no patient complaints at either hospital.
Conclusion
Experienced ophthalmic nurses quickly learned how to perform such injections safely. IVT by nurses was well accepted by patients and staff. Hospital A trained three nurses sequentially for improved flexibility in scheduling. Novel use of appropriately trained non-medical staff can improve efficiency and access in an overburdened service with time-sensitive disease. Retinal assessment was undertaken by ophthalmologists only. Improved access to IVT is important, as treatment with anti-VEGF therapy reduces blindness at population levels.
doi:10.2147/OPTH.S59982
PMCID: PMC3998867  PMID: 24790403
ophthalmology; retina; age-related macular degeneration; nurse; transformation; extended roles
2.  Combined Infliximab and Rituximab in Necrotising Scleritis 
Case Reports in Ophthalmology  2012;3(3):286-290.
We report a patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect. This enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
doi:10.1159/000342842
PMCID: PMC3530152  PMID: 23275790
Infliximab; Rituximab; Granulomatosis with polyangiitis; Scleritis
3.  Valacyclovir in the treatment of acute retinal necrosis 
BMC Ophthalmology  2012;12:48.
Background
To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal necrosis (ARN).
Methods
This study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 2 g tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease.
Results
Retinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10 (60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks).
Conclusions
Treatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis. Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir.
doi:10.1186/1471-2415-12-48
PMCID: PMC3487766  PMID: 22947428
Acute retinal necrosis; Herpetic retinitis; Acyclovir; Valacyclovir
4.  Rhizobium radiobacter Endophthalmitis following Intravitreal Ranibizumab Injection 
Case Reports in Ophthalmology  2012;3(3):283-285.
We present the first reported case of acute endophthalmitis due to Rhizobium radiobacter after an intravitreal injection of ranibizumab for neovascular age-related macular degeneration.
doi:10.1159/000342693
PMCID: PMC3530142  PMID: 23275789
Rhizobium radiobacter; Gram-negative organism; Intravitreal injection; Endophthalmitis

Results 1-5 (5)