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In Brief Insulin therapies using a wide variety of delivery devices are available to accommodate individual patients' needs. In this study of veterans with diabetes, converting from insulin aspart delivered with vials and syringes to insulin aspart delivered via a pen device resulted in no significant change in A1C. Although insulin pen delivery devices offer benefits, providers should thoroughly consider all potential reasons for uncontrolled diabetes before modifying a patient's insulin delivery method.

Objective: This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis., Design: The study design was a multicenter retrospective chart review., Participants: Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied., Intervention: Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed., Main Outcome Measures: Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured., Results: All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated., Conclusions: Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

We have presented mortality, clinical, and histopathologic data on a consecutive group of patients with malignant choroidal melanoma studied by a radioactive phosphorus uptake test. The mortality of 14% is the lowest reported in the literature (Table 11) and suggests that early diagnosis followed by prompt enucleation affords the patient a favorable prognosis. There is no evidence to suggest that the surgical manipulations involved expose the patient to added risks. Factors of importance regarding prognosis of malignant melanoma include tumor size, cell type, and presence or absence of extrascleral extension. Of these, we believe that cell type is the most important factor. Our data to date do not permit us to predict from the 32P tests the prognosis for patient survival.