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The success rate of TED upper eyelid retraction reoperations

Golan, Shani; Rootman, Dan B; Goldberg, Robert A
Although reoperation rates for upper lid retraction surgery for thyroid eye disease (TED) typically range between 8% and 23%, there is little literature describing the outcomes of these second operations. In this retrospective observational cohort study, all patients that underwent surgery for upper eyelid retraction over a 14-year period at a single institution were included. Cases were included if a second eyelid retraction surgery was performed during the study period. Success of surgery was defined as a marginal reflex distance (MRD1) of 2.5 to 4.5 mm in each eye and less than 1 mm difference in MRD1 between the eyes. Overcorrection and undercorrection were defined as above and below these bounds, respectively. 72 eyes in 49 patients were included in the study. The mean age was 56.6 (±11.5) years. By definition, all patients had at least 1 lid lengthening surgery for upper eyelid retraction, and at least 1 subsequent surgery. For this second surgery, 61 eyes (85%) underwent retraction surgery and 11 eyes (15%) underwent ptosis surgery. After this second operation, 31% were undercorrected and 33% were overcorrected. A third surgery was performed in 19 eyes (25%), 12 had surgery for residual retraction and 7 for ptosis. After the third operation 10% of eyes were under corrected and 11% were over corrected. Four patients underwent a fourth surgery: one for retraction and three for ptosis. Success was noted in 35% after the second surgery and 44% after the third. Surgical success in eyelid retraction surgery increases from a second to a third consecutive surgery, and residual asymmetry was roughly equally distributed between over- and undercorrection.
PMID: 27560939
ISSN: 1744-5108
CID: 3962642

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

Golan, Shani; Rabina, Gilad; Kurtz, Shimon; Leibovitch, Igal
PURPOSE AND DESIGN/OBJECTIVE:The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. PARTICIPANTS/METHODS:All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. METHODS:The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. MAIN OUTCOME MEASURE/METHODS:In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. RESULTS:=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. CONCLUSION/CONCLUSIONS:An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients.
PMID: 27785003
ISSN: 1178-1998
CID: 3962652

Original and generic latanoprost for the treatment of glaucoma and ocular hypertension: are they really the same?

Golan, Shani; Rosenfeld, Eldar; Shemesh, Gabi; Kurtz, Shimon
We compared the intraocular pressure (IOP)-lowering effect and safety profile of latanoprost (Xalatan) with its generic variant, Glautan (Unipharm, Tel Aviv, Israel). After 1 and 4 weeks of treatment, a randomized, prospective, cross-over comparison was carried out that included patients with open-angle glaucoma or ocular hypertension, either naïve or treated and well-controlled, who were attending the Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel, between May 2010 and November 2012. After a 3-week washout period for the medicated subjects, the participants were randomized to 4 weeks of treatment with either Xalatan or Glautan once every evening and then, after a 3-week washout period, crossed-over to the other treatment for an additional 4 weeks. Efficacy was expressed by a change in intraocular pressure at three designated hours of the day after 1 week and 1 month of treatment, and tolerability was determined by ocular side-effects as reported by the patient in a questionnaire. A total of 19 patients (mean age at initial diagnosis 66 ± 9 years, 14 females) were enrolled, of whom 17 had bilateral open-angle glaucoma and two had unilateral disease. Both drugs lowered intraocular pressure after 1 week and 1 month (P = 0.06 and P = 0.04, respectively) of treatment. Xalatan had a tendency of greater efficacy than Glautan both after 1 week and 1 month, but the difference was not statistically significant (P = 0.69 and P = 0.34, respectively). Drug safety was similar for Xalatan or Glautan, but more ocular side-effects were reported after treatment with Glautan (21 vs 12 for Xalatan, P = 0.06).
PMID: 25345750
ISSN: 1440-1681
CID: 3962612

Diode laser cyclophotocoagulation for nanophthalmic chronic angle closure glaucoma

Golan, Shani; Kurtz, Shimon
PURPOSE/OBJECTIVE:To retrospectively evaluate the results of diode laser cyclophotocoagulation (CPC) in patients with nanophthalmos. METHODS:The data on all bilaterally nanophthalmic patients who underwent diode laser CPC in our department between 2004 and 2012 were retrieved and evaluated. RESULTS:Four patients fulfilled study entry criteria. All 4 were females aged 58, 62, 68, and 74 years. The mean preoperative intraocular pressure of 46±5.7 mm Hg dropped to 16.2±1.5 mm Hg at the final follow-up visit (43.5±16 mo). Visual acuity did not change in 2 patients and slightly worsened in the other 2. Choroidal detachment was observed in all patients between 7 and 14 days after the procedure and lasted for 1 to 2 months, resolving spontaneously in 2 patients and following systemic steroid treatment in the other 2. CONCLUSIONS:Diode laser CPC was an effective treatment for patients with glaucoma secondary to nanophthalmos.
PMID: 23807357
ISSN: 1536-481x
CID: 3962542

Third time spontaneous closure of myopic macular hole [Case Report]

Golan, Shani; Barak, Adiel
PURPOSE/OBJECTIVE:To describe the spontaneous closure of a myopic macular hole occurring three times. METHODS:A 75-year-old high myopic woman presented with decreased visual acuity and a deep small full-thickness macular hole in the left eye. The hole spontaneously resolved within 2 months. One year later, the patient returned with decreased visual acuity and severe metamorphopsia. A full-thickness macular hole was observed again. The hole spontaneously resolved 1 month later. Six months later, the patient presented again with decreased visual acuity and macular hole, the hole spontaneously resolved within 2 months. Optical coherence tomography was obtained during all visits. RESULTS:Initial optical coherence tomography revealed a small macular hole with bridging elements. At subsequent visits, optical coherence tomography showed resolution and recurrence of the hole twice. CONCLUSION/CONCLUSIONS:Dynamic interaction between tensile and degenerative forces, and proliferative and reparative glial elements, may lead to hole remodeling.
PMID: 25383861
ISSN: 1937-1578
CID: 3962622

Changes in the etiology of endophthalmitis from 2003 to 2010 in a large tertiary medical center

Kessner, Rivka; Golan, Shani; Barak, Adiel
PURPOSE/OBJECTIVE:To ascertain the leading causes of endophthalmitis at the Tel Aviv Medical Center between 2003 and 2010. METHODS:The design of the study is retrospective chart review. The medical records of all patients diagnosed with endophthalmitis in our center between 2003 and 2010 were reviewed for visual acuity and results of ophthalmologic examination at admission, treatment, complications, laboratory investigations, and final visual results. The etiologies of endophthalmitis after cataract surgery were compared for each year from 2003 to 2010, and after intravitreal (IVT) injection from 2006 to 2010. RESULTS:Eighty patients were diagnosed with endophthalmitis between 2003 and 2010: 46 male and 34 female, average age 70.7 years. A total of 27.5% were treated with IVT antibiotic injection only and 68.8% needed pars plana vitrectomy. Final visual acuity was better than counting fingers in 56.3% of cases. Surgery was almost the sole cause of endophthalmitis until 2005, when IVT injection became an important etiology. The incidence of postcataract endophthalmitis decreased significantly after 2007 and that following IVT injection decreased significantly after 2008. CONCLUSIONS:The leading etiology of endophthalmitis changed from postoperative endophthalmitis to endophthalmitis after IVT injection from 2003 to 2010, and the incidence of the infection as a complication of those procedures decreased.
PMID: 24803157
ISSN: 1724-6016
CID: 3962582

Unexpected pathologies in patients referred for endoscopic DCR

Golan, Shani; Leibovitch, Igal; Landsberg, Roee
The objective of this study is to describe a series of patients with different pathologies mimicking nasolacrimal duct obstruction (NLDO), diagnosed with the use of a computed tomography (CT) scan prior to a scheduled endoscopic dacryocystorhinostomy (DCR). This study is a retrospective report. We reviewed the medical records of 47 consecutive patients (57 sides) with long-standing epiphora between 2007 and 2012. All patients were referred to our tertiary Medical Center with a diagnosis of NLDO and were expected to undergo endoscopic dacryocystorhinostomy (DCR). They all underwent routine sinus CT scan prior to surgery. All scans, as well as the demographic and medical characteristics of these patients were reviewed. Of all 47 patients enrolled, in 4 patients (7 % of all sides), unexpected pathologies, other than nasolacrimal system distention, inflammation or infection were identified preoperatively. These included squamous cell carcinoma of the lacrimal sac and nasolacrimal duct, rhinoscleroma at Hasner's valve region, a compressing ethmoidal mucocele and a case of dacryocystocele. These unusual pathologies mandated a different management and surgical approach. In all four cases, a preoperative CT scan helped in identifying the pathology and in localizing the lacrimal apparatus in relation to the paranasal sinuses. Different nasal, paranasal and lacrimal pathologies may mimic primary acquired NLDO. A high index of suspicion, a thorough clinical evaluation and utilizing preoperative imaging may lead to an alteration of patient management and to a completely different surgical approach.
PMID: 24477341
ISSN: 1434-4726
CID: 3962572

Gene profiling of human VEGF signaling pathways in human endothelial and retinal pigment epithelial cells after anti VEGF treatment

Golan, Shani; Entin-Meer, Michal; Semo, Yonathan; Maysel-Auslender, Sofia; Mezad-Koursh, Daphna; Keren, Gad; Loewenstein, Anat; Barak, Adiel
BACKGROUND:Ranibizumab (Lucentis®) is a Fab-antibody fragment developed from Bevacizumab, a full-length anti-VEGF antibody. Both compounds are used for treating age-related macular degeneration (AMD). The influence of bevacizumab and ranibizumab on genes involved in signal transduction and cell signaling downstream of VEGF were compared in order to detect possible differences in their mode of action, which are not related to their Fab-antibody fragments. METHODS:Human umbilical vein cell lines (EA.hy926) and retinal pigment epithelial cells (ARP-19) were exposed to oxidative stress. The cells were treated with therapeutic concentrations of bevacizumab (0.25 mg/mL) and ranibizumab (125 mg/mL) for 24 hours prior to all experiments, and their effects on gene expressions were determined by RT- PCR. RESULTS:After exposure to bevacizumab, more genes in the endothelial cells were up-regulated (KDR, NFATc2) and down-regulated (Pla2g12a, Rac2, HgdC, PRKCG) compared to non-treated controls. After exposure to ranibizumab, fewer genes were up-regulated (PTGS2) and down-regulated (NOS3) compared to controls. In comparison between drugs, more genes were up-regulated (NFATc2 and KDR) and more were down-regulated (Pla2g12a, Pla2g1b, Ppp3r2, Rac2) by bevacizumab than by ranibizumab. In RPE cells, NOS3 and PGF were up-regulated and Pla2g12b was down-regulated after exposure to ranibizumab, while PIK3CG was up-regulated and FIGF was down-regulated after exposure to bevacizumab, but the differences in gene expression were minor between drugs (PIK3CGand PGF were down-regulated more by ranibizumab than by bevacizumab). CONCLUSIONS:The different gene expressions after exposure to ranibizumab and bevacizumab in endothelial and RPE cells may indicate a somewhat different biological activity of the two compounds.
PMID: 25201034
ISSN: 1756-0500
CID: 3962592

Surgical treatment for macular edema

Golan, Shani; Loewenstein, Anat
UNLABELLED:OBJECTIVE OR PURPOSE: Macular edema (ME) is secondary to various disease processes. It is most commonly seen following venous occlusive disease, diabetic retinopathy, posterior segment inflammatory disease, and vitreomacular traction syndromes. Treatment varies, depending upon the underlying etiology, and has led to varying degrees of success. Advances in vitreoretinal surgical techniques over the years have expanded the list of indications for vitreoretinal surgical treatment. The purpose of this review is to outline the current use of vitreoretinal surgery and highlight the ever-growing indications for surgery in macular edema. DESIGN/METHODS:This is a comprehensive review, using Medline, of all literature published on vitreoretinal surgery for macular edema secondary to various conditions. RESULTS:Over 450 abstracts were reviewed, and the articles pertinent to our discussion were selected. The search words were "macular edema" and "pars plana vitrectomy" or "surgery." CONCLUSIONS:The pathology of the vitreous body is associated with ME in several different conditions, and vitreoretinal surgical techniques can be effective in the management of ME in the majority of them. The ever-expanding new surgical techniques, as well as the new pharmacologic agents used during surgery, show great promise for the future.
PMID: 24409947
ISSN: 1744-5205
CID: 3962552

The effects of vital dyes on retinal pigment epithelium cells in oxidative stress

Golan, Shani; Levi, Ran; Entin-Meer, Michal; Barak, Adiel
PURPOSE/OBJECTIVE:To determine the effect of the most commonly used vital dyes in vitrectomy [trypan blue at 0.15% concentration and indocyanine green (ICG) at 0.5% concentration] on the viability of human retinal pigment epithelium (RPE) cell lines (ARPE-19) exposed to oxidative stress. METHODS:ARPE-19 cells unexposed or exposed to oxidative stress (hypoxic chamber) were treated for 1 min with one of the dyes. RPE proliferation was measured by (3)H-thymidine incorporation, adhesion by ability to adhere to fibronectin, and safety by annexin V staining. RESULTS:Proliferation: The dyes affected the proliferation of RPE cells differently under non-hypoxic and hypoxic conditions (p = 0.001). In non-hypoxic conditions, there was no statistically significant difference between the proliferation of the treated (both dyes) and untreated RPE cells (p = 0.279). Under hypoxia, both dyes significantly suppressed proliferation, more so with ICG (p = 0.001). Adhesion: The dyes affected adhesion differently under non-hypoxic and hypoxic conditions (p = 0.04). In non-hypoxic conditions, both increased the adhesive properties of RPE cells to fibronectin, ICG more than trypan blue (p = 0.001). Under hypoxia, both dyes suppressed adhesion, with no statistically significant difference between treated and non-treated RPE cells. Apoptosis: Both dyes increased early apoptosis of RPE cells compared with no treatment (p = 0.001), ICG more than trypan blue. Hypoxia increased the apoptosis of both dyes compared to non-hypoxic conditions (p = 0.02). CONCLUSIONS:In hypoxic conditions, both dyes showed an inhibition of RPE adhesion to fibronectin and proliferation capacity and an increase in early apoptosis compared with non-hypoxic conditions. Apoptosis was greater in ICG-treated RPE cells than in trypan blue-treated cells.
PMID: 25300946
ISSN: 1423-0259
CID: 3962602