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Risk Alleles Associated with Neovascularization in a Pachychoroid Phenotype

Dansingani, Kunal K; Perlee, Lorah T; Hamon, Sara; Lee, May; Shah, Vinnie P; Spaide, Richard F; Sorenson, John; Klancnik, James M Jr; Yannuzzi, Lawrence A; Barbazetto, Irene A; Cooney, Michael J; Engelbert, Michael; Chen, Christine; Hewitt, Alex W; Freund, K Bailey
PMID: 27506487
ISSN: 1549-4713
CID: 2255162

Optical coherence tomographic relationships of neovascular complexes and posterior vitreous spaces in proliferative diabetic retinopathy [Meeting Abstract]

Vaz-Pereira, Sara; Dansingani, Kunal K; Chen, Kevin C; Cooney, Michael Jude; Klancnik, Lames M; Engelbert, Michael
ISSN: 0146-0404
CID: 2492292


McCann, Jesse T; Engelbert, Michael
PURPOSE: To report a giant retinal pigment epithelium rip in a patient with a bullous retinal and choroidal detachment. METHODS: Case report with widefield imaging, fundus autofluorescence, and optical coherence tomography of the retina. RESULTS: This 62-year-old patient had a history of advanced glaucoma, trabeculectomy, blebitis, and endophthalmitis. He had cataract surgery 6 weeks before presentation. He was found to have a large bullous retinal and choroidal detachment with a large retinal pigment epithelium tear at the limit of the choroidal detachment. After vitrectomy for retinal detachment repair, the tear was observed to extend inferiorly at the margins of the choroidal detachment. CONCLUSION: This case report demonstrates that large retinal pigment epithelium rips can be found associated with large bullous choroidal and retinal detachments. These tears seem similar to tears that have been observed after trabeculectomy.
PMID: 27508422
ISSN: 1937-1578
CID: 2274862

Adherence to European Society for Cataract and Refractive Surgery recommendations among Italian cataract surgeons: a survey

Grosso, Andrea; Pertile, Grazia; Marchini, Giorgio; Scarpa, Giuseppe; Ceruti, Piero; Prigione, Guido; Romano, Mario R; Bert, Fabrizio; Gili, Renata; Panico, Claudio; Siliquini, Roberta; Engelbert, Michael
PURPOSE: To survey the surgical routines with regards to prophylactic strategies in a sample of Italian hospitals and compare these with European Society for Cataract and Refractive Surgery (ESCRS) guidelines. METHODS: Six private and 18 public hospitals were included in this clinical-based retrospective study. The overall volume of cataract operations in the 24 centers in 2013 was 43,553. Main outcome measure was incidence of endophthalmitis per 1,000. An incidence of less than 0.13% was considered acceptable. RESULTS: Our study provides the first Italian data on the use of intracameral antibiotics in cataract surgery as recommended by the ESCRS. Thirteen centers (54%) used intracameral cefuroxime at the end of surgery. Of the 13 centers that used cefuroxime, 8 (62%) had an incidence of endophthalmitis less than 0.13%. Of the 7 (29%) centers that did not use intracameral cefuroxime, all had an endophthalmitis rate of greater than 0.13%. This difference was statistically significant (p<0.05). Among the 4 centers not included, 2 used vancomycin in the infusion bottle, 1 a fluoroquinolone, and the last a combination of antibiotics. The majority of surgeons (71%) used preoperative antibiotic eyedrops, but this measure was not shown to be significantly protective. CONCLUSIONS: Slightly more than half of the centers surveyed in this study adhered to the recommendations of the ESCRS and routinely employed prophylactic intracameral cefuroxime. An incidence of endophthalmitis greater than 0.13% was encountered significantly more frequently among centers that did not employ intracameral cefuroxime.
PMID: 26868006
ISSN: 1724-6016
CID: 2044962

Giant premacular bursa: a novel finding of the posterior vitreous in two patients with Stickler syndrome type 1 revealed by swept-source optical coherence tomography

Chen, Kevin C; Jung, Jesse J; Engelbert, Michael
PMID: 26245341
ISSN: 1435-702x
CID: 1709192


Chen, Kevin C; Jung, Jesse J; Engelbert, Michael
BACKGROUND/PURPOSE: To report the swept-source optical coherence tomography (SS-OCT) findings in a case of acute toxoplasmosis chorioretinitis. METHODS: A 35-year-old male presented with acute blurry vision and floaters in his left eye. Ophthalmic examination, color photographs, spectral-domain OCT (SD-OCT), enhanced depth imaging OCT (EDI-OCT), SS-OCT and wide-field fluorescein angiography images were obtained to diagnose and follow the subsequent changes of toxoplasmosis chorioretinitis over a 2-month period. RESULTS: Initial imaging with different modalities of SD- and EDI-OCT including radial vitreous scans and horizontal high-speed B-scan raster lines demonstrated thickening of the posterior hyaloid and acute vitreous cells emanating from the retinal blood vessels, thickening and disorganization of the retinal layers within the chorioretinal lesion, and increased sub-lesional choroidal thickness, respectively. SS-OCT demonstrated all of these same findings in a single 12-mm B-scan. Topical steroids were initiated and imaging over the next 2 months showed separation of the posterior hyaloid, decrease in vitreous cell, and atrophy of the chorioretinal lesion. CONCLUSION: We report the first SS-OCT images of an acute case of toxoplasmosis chorioretinitis. SS-OCT can visualize the choroidal, retinal, and vitreous changes in a single scan, compared with the different imaging algorithms required with SD-OCT.
PMID: 26510002
ISSN: 1937-1578
CID: 1817522


Suhr, Kristin S; Chiang, Michael F; Flynn, John T; Engelbert, Michael
PURPOSE: Hemophagocytic syndrome (HS) is a rare disease with a spectrum of ocular findings. The authors report a unique funduscopic presentation of HS in a neonate and a discussion of diagnosis, typical features, management, and outcome. METHODS: Single case report with retrospective analysis of the published literature of patients with HS and ocular findings from 1950 to present using the key terms hemophagocytic, lymphohistiocytosis, ocular, and ophthalmic. Literature search from 1950 to the present was performed through PubMed/MEDLINE and the Cochrane database. Requirement for inclusion was that the article or abstract was written in English. RESULTS: A 4-week-old neonate with HS demonstrated bilateral discrete white dots within the retina, which resolved incompletely over the course of the next months but showed increased pigmentation. CONCLUSION: With so few documented ophthalmic cases of HS in existence, the ocular findings at this point can be seen as diverse and variable. However as more cases are reported, hopefully this will allow for increased recognition of the ophthalmic manifestations and sequelae and in turn lead to improved treatment of this disease.
PMID: 26807497
ISSN: 1937-1578
CID: 1929572

Optical coherence tomographic angiography shows reduced deep capillary flow in paracentral acute middle maculopathy

Dansingani, K K; Inoue, M; Engelbert, M; Freund, K B
IntroductionParacentral acute middle maculopathy (PAMM) has been described as an ischemic lesion of the middle retinal layers with a characteristic lamellar hyper-reflective placoid appearance in the acute phase and thinning of the involved retinal layers in the chronic phase. Optical coherence tomographic angiography (OCTA) is a novel and non-invasive technique for imaging retinal capillary vasculature with en face segmentation capabilities.MethodCase series. We describe two patients with PAMM who underwent clinical examination and multimodal imaging including OCTA.ResultsIn the first patient, who presented with PAMM secondary to acute cilioretinal artery occlusion, OCTA demonstrated reduction in flow in the deep capillary plexus (DCP). One month later, OCTA revealed a flow void due to thinning of the GCL, INL, and OPL and paradoxical apparent ONL thickening. Similar findings of focal retinal lamellar ectopia were seen in the second patient, who had an incidentally detected chronic PAMM lesion.ConclusionsOCTA images the superficial and deep capillary plexi independently. PAMM is characterized by acute and chronic attenuation of the DCP flow signature. Focal lamellar ectopia in PAMM is discussed.Eye advance online publication, 18 September 2015; doi:10.1038/eye.2015.180.
PMID: 26381094
ISSN: 1476-5454
CID: 1779362

The Spatial Profile of Macular Pigments Is Related to the Topological Characteristics of the Foveal Avascular Zone

Balaratnasingam, Chandrakumar; Chae, Bora; Remmer, Meredith H; Gomez, Erasmo; Suzuki, Mihoko; Engelbert, Michael; Spaide, Richard F
PURPOSE: Macular pigments are preferentially concentrated in the central fovea, an area devoid of vasculature. We hypothesized that there may be a link between the macular pigment profile and the size and structural characteristics of the foveal avascular zone (FAZ). METHODS: Two-wavelength autofluorescence method was used to quantify macular pigment optical density (MPOD) and the radius at half peak of MPOD, which was defined as the retinal eccentricity where the MPOD value was 50% of the peak value. Volumetric spectral-domain optical coherence tomography (OCT) images of the macula were obtained from 32 subjects. The equivalent radius of the FAZ was determined using data generated from OCT angiography. Generalized estimating equations were used to test the hypothesis that there are interrelationships among the central foveal thickness, peak MPOD, the radius at half peak of MPOD and the equivalent radius of the FAZ. RESULTS: The equivalent radius of the FAZ was highly correlated with the radius at half peak of MPOD (P < .001). The equivalent radius of the FAZ was a significant predictor for central foveal thickness (P < .001). The significant predictor for peak MPOD was central foveal thickness (P = .004). Eyes with larger FAZs were more likely to have a secondary peak in their MPOD spatial profile in a zone ranging from 0.5 to 1.0 degrees from the foveal center. CONCLUSIONS: The spatial distribution of macular pigment is related to the size of the FAZ, in addition to the central foveal thickness. It is possible that xanthophyll pigment accumulation in the macula serves functions, such as attenuation of shorter wavelengths of light, that would have been provided by the light-filtering characteristics of blood vessels.
PMID: 26658507
ISSN: 0146-0404
CID: 1877742

Swept source optical coherence tomography of the posterior vitreous after pars plana vitrectomy

Chen, Kevin C; Jung, Jesse J; Engelbert, Michael
PMID: 25904299
ISSN: 1435-702x
CID: 1543542