Faculty Bibliography
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department:Ophthalmology
recent-years:2
school:SOM
Total Results:
377
Transmission Rates of UV-A and Green Light in an ex vivo Corneal Cross-linking Model for Infectious Keratitis
PURPOSE/OBJECTIVE:To investigate the light transmission (LT) of UV-A and green light through infected corneas saturated with riboflavin or rose bengal in an ex vivo porcine model for infectious keratitis. SETTING/METHODS:University of Zurich and EMPA. DESIGN/METHODS:Laboratory study. METHODS:Ex vivo porcine eyes (n=162) were divided into three groups: control eyes, eyes infected with Staphylococcus aureus, and eyes infected with Pseudomonas aeruginosa. Corneas remained either uninfected, or were infected with S. aureus, and P. aeruginosa, respectively, and were either left untreated, or were instilled with 0.1% riboflavin or 0.1% rose bengal. Corneal buttons were prepared, and corneal LT was measured at 365 nm and 522 nm using a spectrophotometer. LTs were calculated and compared. Transmission electron microscopy (TEM) was used to visualize structural damage and bacteria within infected corneas. RESULTS:Riboflavin-saturated corneas infected by S. aureus or P. aeruginosa (LT = 0.77% [0.41-1.87] and 0.81% [0.23, 1.46]) exhibited 3.18-fold and 3.02-fold lower LTs than uninfected corneas (LT = 2.45% [2.15, 5.89]) (both p-values < 0.001). No LT difference was found between rose bengal-saturated corneas infected by S. aureus or P. aeruginosa and uninfected corneas (all LTs = 0.01% [0.01-0.01]; both p-values = 0.08). TEM showed bacteria on corneal stroma borders and occasionally inside the stroma. CONCLUSION/CONCLUSIONS:Our results indicate that the amount of light arriving at the corneal endothelium is substantially reduced in infected corneas. The total fluence of clinical PACK-CXL protocols can be safely increased substantially while maintaining a low risk of corneal endothelial damage.
PMID: 39680566
ISSN: 1873-4502
CID: 5764162
Femtosecond Laser-Assisted Graft Preparation and Implantation of Corneal Allogeneic Intrastromal Ring Segments for Corneal Ectasia: 1-Year Results
PURPOSE/OBJECTIVE:To evaluate the outcomes of patients treated with corneal allogeneic intrastromal ring segments cut with femtosecond laser (Femto-CAIRS) without concomitant corneal crosslinking. METHODS:Patients with keratoconus treated with Femto-CAIRS at the American University of Beirut Medical Center were included (May 2022-January 2023). A proprietary software program was developed on the femtosecond laser to cut allogeneic segments. Visual, refractive, tomographic, aberrometric, and epithelial data by anterior segment optical coherence tomography were measured at baseline and 1, 3, 6, and 12 months postoperatively. RESULTS:20 eyes of 15 patients were included and followed up for 12 months. The manifest refraction spherical equivalent and cylinder improved from -6.79 ± 4.9 diopter (D) and -4.25 ± 1.8 D to -1.88 ± 2.9 D (P < 0.001) and -2.64 ± 1.4 D (P = 0.01) 12 months postoperatively, respectively. 75% of eyes gained 3 or more corrected distance visual acuity lines, most of which (65%) gained 4 lines or more 12 months postoperatively. The maximum keratometry and vertical coma decreased by 5.2 D (P < 0.001) and 1 μm (P = 0.001), respectively, 3 months postoperatively and remained stable until 12 months. The largest anterior stromal elevation over the central 5-mm diameter decreased from 36.0 ± 18.2 μm preoperatively to 19.9 ± 9.25 μm at 1 week postoperatively (P < 0.001) and remained relatively stable. Epithelial thickness over the cone increased relative to baseline starting 1 month postoperatively and becoming stable after 6 months while the mean epithelial thickness central to the ring peaked at 1 month after which it decreased to reach a plateau at 6 months. CONCLUSIONS:The Femto-CAIRS procedure improves visual and tomographic parameters and allows repeatable and safe results with the possibility of customization for individualized management.
PMID: 39499155
ISSN: 1536-4798
CID: 5766762
Distinctive Optical Coherence Tomography Angiography and Indocyanine Green Angiography Imaging Patterns in Topiramate-Induced Choroidal Effusion
PURPOSE/OBJECTIVE:To describe novel findings seen on optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) in a young male patient presenting with bilateral topiramate-induced choroidal effusion. METHODS:Retrospective case report. A comprehensive ophthalmic examination was conducted and multimodal imaging techniques, including B-scan ultrasound, OCT, OCTA, and ICGA were analyzed. RESULTS:A male in his 30s presented with a myopic shift due to bilateral choroidal effusion induced by a medication containing topiramate prescribed for weight loss. ICGA showed multiple hypofluorescent spots within the choroid corresponding to areas of reduced OCTA flow signal in both the inner and deeper en face choroidal slabs. Symptoms and abnormal imaging findings resolved within five days of discontinuing the medication. CONCLUSION/CONCLUSIONS:Findings observed with OCTA and ICGA together suggest multifocal reversible areas of reduced choroidal vascular flow occurring in a topiramate-induced choroidal effusion. We propose that this transient hypoperfusion is due to compression from deeper choroidal vessels with a congested choroid.
PMID: 38109671
ISSN: 1937-1578
CID: 5612492
CASE REPORTS: Unilateral idiopathic spontaneous filtering bleb repaired by donor scleral patch graft [Case Report]
ORIGINAL:0017645
ISSN: 1542-8958
CID: 5818192
Surgeon Adoption of Immediate Sequential Bilateral Cataract Surgery in the United States from 2018 to 2022: Immediate Sequential Bilateral Cataract Surgery
PURPOSE/OBJECTIVE:To assess 5-years trends in the rate of immediate sequential bilateral cataract surgery (ISBCS) and surgeon characteristics associated with performing ISBCS. SETTING/METHODS:100% Medicare Fee-for-service beneficiaries from 2018-2022. DESIGN/METHODS:Cross-sectional study. METHODS:ISBCS cases were identified among patients aged ≥ 65 years undergoing bilaterally performed cataract surgery (BPCS). Cochrane Armitage trend test was used to assess patient and surgeon characteristics over time. Multivariable logistic regression was used to evaluate surgeon characteristics associated with performing ISBCS. RESULTS:Among 1,190,169 BPCS, 3,954 (0.33%) were ISBCS. Quarterly ISBCS rate increased from 2.12 to 5.5 per 1,000 BPCS (p<0.001). Among 10,290 surgeons, 1,119 (10.87%) performed ISBCS on some patients. Proportion of surgeons performing ISBCS per 1,000 cataract surgeons increased from 15.63 during the first quarter of 2018 to 26.55 during the last quarter of 2022 (p<0.001). Among the ISBCS surgeons, the proportion of ISBCS cases per 1,000 BPCS doubled from 17.20 in 2018 to 35.50 in 2022 (p<0.001). On multivariable analysis, surgeons in the highest surgical volume quartile (OR: 1.21; 95% CI: 1.01-1.45; Ref: lowest quartile), recent graduates (0-10 years OR: 2.43, 95% CI: 1.87-3.15; Ref: ≥ 31 years) and surgeons in West (OR: 2.408, 95% CI: 2.052-2.826; Ref: South) had higher odds of performing ISBCS. CONCLUSIONS:There was an increased rate of ISBCS possibly suggesting greater interest among patients and surgeons. Although the overall ISBCS rate remained low, the number of surgeons performing ISBCS increased. Higher volume surgeons, recent graduates, and those practicing in the West were more likely to perform ISBCS.
PMID: 39696765
ISSN: 1873-4502
CID: 5764632
Are Alpha-2 Adrenergic Agonists Being Used in Infants?
PMID: 39172558
ISSN: 1557-7732
CID: 5757752
Atypical Autofluorescence Findings in Geographic Atrophy: The Influence of Age-Related Choroidal Atrophy
PURPOSE/OBJECTIVE:To describe atypical fundus autofluorescence (FAF) patterns in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) with associated age-related choroidal atrophy (ARCA). METHODS:Multimodal imaging of two cases using (pseudo-)color fundus photography, optical coherence tomography (OCT), fluorescein and indocyanine green angiography, and FAF employed with blue- and green excitation wavelengths on several devices (Spectralis, Heidelberg and (ultra-)widefield [UWF] FAF [California, Optos and EIDON, iCare]). RESULTS:Two female patients, with foveal-involving GA secondary to AMD, were assessed. All eyes demonstrated concurrent features indicative of ARCA on multimodal imaging including a paucity of choroidal vasculature, reduced choroidal pigmentation, macular pigmentary changes, peripapillary atrophy, and subretinal drusenoid deposits. Clinically, progression of GA with coalescence of lobular lesions was observed. Notably, UWF FAF with green-(California) and blue excitation wavelengths (California and EIDON) revealed atypical patterns characterized by isofluorescent FAF signals (indistinguishable from surrounding tissue) or hyperautofluorescent GA lesions. In these cases, blue excitation wavelengths were more effective than green light for delineating GA, owing to increased contrast from hypoautofluorescence related to macular pigment surrounding the lesion. CONCLUSION/CONCLUSIONS:In patients with GA and concomitant ARCA, atypical FAF patterns on UWF imaging complicate the accurate delineation and monitoring of GA. Atypical FAF patterns appear due to the properties of the confocal apertures and postprocessing features of UWF imaging that allow for the detection of scleral autofluorescence in patients with reduced choroidal vasculature, pigment and thickness. In patients with concomitant ARCA, multimodal imaging plays a crucial role in precisely identifying and tracking GA progression.
PMID: 39999827
ISSN: 1937-1578
CID: 5800782
Full length title: Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis and Central Anomalous Retinoschisis with mid-PEripheral Traction (CARPET)
PURPOSE/OBJECTIVE:To report the clinical and multimodal imaging (MMI) findings and long-term follow-up of stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) contiguous with midperipheral retinoschisis (MPRS) and to describe a severe SNIFR variant termed CARPET (Central Anomalous Retinoschisis with mid-PEripheral Traction). DESIGN/METHODS:Retrospective case series. SUBJECTS/METHODS:Eleven patients (15 eyes) with SNIFR contiguous with MPRS in at least one eye at baseline or final follow-up. METHODS:MMI features, including cross-sectional and en face macular and peripheral spectral-domain optical coherence tomography (OCT) and OCT angiography, were reviewed in all cases at baseline and at the final follow-up visit. MAIN OUTCOME MEASURES/METHODS:Various courses (including progression, regression, or stability) of MPRS or SNIFR over time were evaluated. RESULTS:MPRS exhibited centripetal progression to SNIFR in 5 eyes of 3 patients with follow up of 67, 60, and 27 months, respectively, with maintenance of excellent visual acuity (range: 20/25-20/20) in 4 of these 5 eyes. In 2 eyes of 2 patients (including 1 eye with initial centripetal progression of MPRS to SNIFR), MPRS contiguous with SNIFR spontaneously resolved with long-term follow-up (77 and 48 months, respectively). SNIFR contiguous with MPRS partially regressed after 48 months in one patient, and was stable after 54 months in another. A distinctive midperipheral microvasculopathy, associated with MPRS that was contiguous with SNIFR, was identified in 7 eyes of 4 patients. Finally, 3 eyes of 3 patients exhibited additional unique features, including central neurosensory detachment and outer lamellar macular hole, which were associated with significant midperipheral traction, representing a severe variant subtype of SNIFR that we refer to as CARPET. Two of these 3 eyes progressed with short-term follow-up of 6 and 2 months, respectively, while the schisis resolved and vision improved after pars plana vitrectomy in the third case. CONCLUSIONS:MPRS can progress to SNIFR over multiple years of follow-up. SNIFR with MPRS can also spontaneously resolve or remain stable. MPRS can additionally be complicated by a midperipheral inner retinal microvasculopathy. Finally, CARPET may represent a unique and severe variant form of SNIFR driven by midperipheral vitreoretinal traction and associated with significant vision loss.
PMID: 39922381
ISSN: 2468-6530
CID: 5793032
Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies
BACKGROUND AND AIMS/OBJECTIVE:The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of the hepatitis C virus (HCV). HCV treatment trends by country, region, and globally are important to monitor progress toward the World Health Organization's 2030 elimination targets. Additionally, the historical patterns can help predict the treatment uptake for future therapies for other liver diseases. METHODS:The number of people living with HCV (PLHCV) treated between 2014-2023 across 119 countries was estimated using national HCV registries, reported DAA sales data, pharmaceutical companies' reports, and estimates provided by national experts. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used. RESULTS:An estimated 13,816,000 (95% uncertainty intervals (UI): 13,221,000-16,415,000) PLHCV were treated, of whom 12,748,000 (12,226,000-15,231,000) were treated with DAAs, of which 11,081,000 (10,542,000-13,338,000) were sofosbuvir-based DAA regimens. Country-level data accounted for 97% of these estimates. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was a large predictor of treatment. In low- and middle-income countries, price played an important role in expanding treatment access through the public and private markets, and treatment continues to increase slowly after a sharp drop at the end of the Egyptian national program. CONCLUSIONS:In the last 10 years, 21% of all HCV infections were treated with DAAs. Regional and temporal variations highlight the importance of active screening strategies. Without program enhancements, the number of treated PLHCV stalled in every country/region which may not reflect a lower prevalence but may instead reflect the diminishing returns of the existing strategies. IMPACT AND IMPLICATIONS/UNASSIGNED:Long-term hepatitis C virus (HCV) infection can lead to cirrhosis and liver cancer. Since 2014, these infections can be effectively treated with 8-12 weeks of oral therapies. In 2015, the World Health Organization (WHO) established targets to eliminate HCV by 2030, which included treatment targets for member countries. The current study examines HCV treatment patterns across 119 countries and regions from 2014 to 2023 to assess the impact of national programs. This study can assist physicians and policymakers in understanding treatment patterns within similar regions or income groups and in utilizing historical data to refine their strategies in the future.
PMID: 39914746
ISSN: 1600-0641
CID: 5784292
Functional Deficits Associated with Dark Without Pressure
PURPOSE/OBJECTIVE:To describe a patient with progressive visual symptoms and reduced retinal sensitivity corresponding to dark without pressure (DWP). METHODS:Retrospective chart review of a single patient. Comprehensive ophthalmic examinations and multimodal imaging techniques, including optical coherence tomography (OCT), OCT-angiography, and microperimetry, were analyzed. RESULTS:A 23-year-old male presented with progressive peripheral areas of blurred vision superiorly in his right eye and temporally in his left eye. These disturbances corresponded with dark areas of retina inferiorly in his right eye and nasally in his left eye having characteristic features of DWP on multimodal imaging. Although Humphrey visual field (HVF) 24-2 testing was normal, microperimetry showed decreased retinal sensitivity in areas of DWP relative to adjacent areas without DWP. CONCLUSION/CONCLUSIONS:Prior descriptions of DWP have described it as a benign retinal finding showing no functional deficits. We demonstrate that DWP can be associated with progressive visual complaints showing decreased retinal sensitivity on microperimetry and undetected with HVF 24-2 testing.
PMID: 39903922
ISSN: 1937-1578
CID: 5783882
