Shantan Reddy

Jules Stein Eye Institute, Maryland, United States

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Publications (15)22.62 Total impact

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    ABSTRACT: Intravitreal bevacizumab may result in intraocular inflammation of infectious and non-infectious etiology. Appropriate recognition of a sterile process can circumvent unnecessary treatment for endophthalmitis. Observational case report. A marked web-like inflammatory response within the vitreous following intraoperative intravitreal bevacizumab is described in a patient with pre-proliferative diabetic retinopathy, macular edema, and epiretinal membrane who underwent pars plana vitrectomy, membrane peel, endolaser, and fluid-air exchange. Wide-field fundus photography captured the full extent of this reaction. On post-operative day one, the patient presented with vitreous opacities in the form of a web of multiple white strands inferior to an air bubble, with minimal anterior or vitreous cell. At one week, the inflammatory reaction had completely resolved. Existing reports of intraocular inflammation following intravitreal bevacizumab range from uveitis to infectious endophthalmitis. With wide-field fundus imaging, we report an acute, marked web-like inflammatory response following intraoperative intravitreal bevacizumab that resolved spontaneously.
    Seminars in ophthalmology 01/2011; 26(1):25-7. · 1.09 Impact Factor
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    ABSTRACT: Purpose: To describe a case of choroidal infarction as illustrated by the “triangular sign of Amalric” after cocaine inhalation. Methods: Observational case report. Results: A 52-year-old male presented with an acute loss of vision in his left eye immediately after cocaine inhalation. Color photography and fluorescein angiography revealed triangular areas of choroidal ischemia following the distribution of the posterior ciliary arteries. Conclusion: Cocaine-induced vasospasm, specifically of the distal short posterior ciliary arteries, may explain the triangular wedge-shaped choroidal infarcts in our patient. A thorough drug history may circumvent unnecessary and costly investigations in such cases.
    Retinal Cases & Brief Reports 12/2010; 5(1):91-93.
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    ABSTRACT: Background: Optic disk pits are a congenital optic disk anomaly frequently associated with serous macular detachment. Methods: A case of optic disk pits associated with serous maculopathy in a patient with incontinentia pigmenti is presented. The patient was treated with oral acetazolamide. Results: Over the course of 1 year, treatment with oral acetazolamide resulted in the complete resolution of subretinal fluid and improvement in vision. Conclusion: An association between optic disk pits and incontinentia pigmenti is presented. The case demonstrates the utility of oral acetazolamide in the treatment of serous maculopathy associated with optic disk pits.
    Retinal Cases & Brief Reports 12/2010; 5(3):267-269.
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    ABSTRACT: The purpose of this study was to assess the prognostic value of a new grading system for retinal pigment epithelium (RPE) tears that developed after antivascular endo-thelial growth factor (VEGF) therapy for exudative age-related macular degeneration. The authors performed a retrospective review of consecutive eyes that developed an RPE tear after intravitreal injection of an anti-VEGF agent (pegaptanib, bevacizumab, or ranibizumab) within a 4.5-year period (January 2005 to January 2009) at a single center. Fundus photography, fluorescein angiography, and optical coherence topography were studied for each case of RPE tear, and using fluorescein angiography analysis, a measurement of greatest linear diameter (millimeter) was obtained and a grading scale devised. The grade of RPE tear was correlated with visual and anatomical outcomes and response to continued anti-VEGF therapy. Twenty-one eyes from 20 patients were evaluated in this study. Retinal pigment epithelium tears were graded from one to four based on the greatest length in the vector direction of the tear and involvement of the fovea. Nineteen percent (n = 4) of eyes had Grade 1 tears (diameter smaller than 200 microm), 14% (n = 3) had Grade 2 tears (diameter between 200 microm and 1-disk diameter), 19% (n = 4) had Grade 3 tears (diameter greater than 1-disk diameter), and 48% (n = 10) had Grade 4 tears (Grade 3 tears that involved the foveal center). Lower grade tears were more likely to have better visual acuity and better response to continued anti-VEGF therapy and less likely to develop a disciform scar but were at risk of progressing to a higher grade tear over time. The grading of RPE tears according to greatest linear diameter may have prognostic value in predicting visual acuity and anatomical outcome with or without continued anti-VEGF therapy. Lower grade tears have better visual acuity and response to anti-VEGF therapy. Grade 4 tears have a very poor prognosis with or without anti-VEGF therapy.
    Retina (Philadelphia, Pa.) 05/2010; 30(7):1039-45. · 2.93 Impact Factor
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    ABSTRACT: Retinal cavernous hemangiomas are rare vascular anomalies, and can be associated with cerebral cavernous malformations (CCM). Distinct mutations have been reported in patients who have both CCMs and retinal cavernous hemangiomas. Fluorescein angiography, spectral domain optical coherence tomography, and genetic testing were performed on a patient with a retinal cavernous hemangioma and a CCM. Our patient was heterozygous in the KRIT1/CCM1 gene for a frameshift mutation, c.1088delC. This would be predicted to result in premature protein termination. We have identified a novel mutation in the KRIT1/CCM1 gene in a patient with both CCM and retinal cavernous hemangioma. We hypothesize that the occurrence of retinal cavernous hemangiomas and CCMs is underlaid by a common mechanism present in the KRIT1/CCM1 gene.
    Albrecht von Graæes Archiv für Ophthalmologie 03/2010; 248(9):1359-61. · 1.93 Impact Factor
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    ABSTRACT: The authors describe a case of nasal and macular retinoschisis in a patient with open angle glaucoma. A 75 year-old female with optic nerve head damage secondary to chronic open angle glaucoma developed macular schisis and a separate area of retinoschisis nasal to her optic disk. There were no other identifiable causes for her retinoschisis. Glaucoma related structural defects offer a plausible explanation for multiple cavities of retinoschisis in favor of multiple occult congenital pits of the optic nerve head.
    Ophthalmic Surgery Lasers and Imaging 03/2010; · 1.46 Impact Factor
  • Retina (Philadelphia, Pa.) 02/2010; 30(3):524-6. · 2.93 Impact Factor
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    ABSTRACT: The authors retrospectively identified 2 cases of gyrate atrophy, 3 cases of choroideremia, and 1 case of the carrier state of choroideremia who underwent ultra-wide-field fundus photography and fluorescein angiography. The findings were studied and compared to standard fundus photography and fluorescein angiography. Gyrate atrophy demonstrated a diffuse confluent extent of chorioretinal atrophy extending from the anterior to the posterior pole to the periphery. Choroideremia demonstrated a patchy irregular pattern of chorioretinal atrophy extending from the posterior pole to the periphery. Peripheral reticular degeneration without chorioretinal atrophy was appreciated in the carrier state. Ultra-wide-field imaging of these choroidal dystrophies demonstrated distinctive patterns that may aid in their identification and diagnosis.
    Ophthalmic Surgery Lasers and Imaging 01/2010; 41 Online:e1-5. · 1.46 Impact Factor
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    ABSTRACT: To evaluate the positive dual-modality positron emission tomography/computed tomography (PET/CT) of choroidal melanoma with chromosome 3 loss and tumor size. Thirty-seven consecutive patients with choroidal melanoma with known chromosome 3 status who underwent whole-body PET/CT imaging were retrospectively reviewed. Cytology and chromosome 3 loss were identified by fine-needle aspiration biopsy. Fluorescent in situ hybridization and whole genome microarray by single-nucleotide polymorphism were used to evaluate the chromosome 3 status. Metabolic activity of primary choroidal melanoma by PET/CT imaging was evaluated. Thirteen of 37 (35%) primary choroidal melanomas had loss of chromosome 3; 7 of the 13 (54%) melanomas were positive for metabolic activity identified by PET/CT imaging. All 24 of 37 melanomas without chromosome 3 loss were inactive for metabolic activity. There was a statistically significant association between positive metabolic activity and chromosome 3 loss (P = 0.00017 Fisher exact test); positive PET/CT imaging was 54% sensitive and 100% specific for loss of chromosome 3. Seven of 37 (19%) choroidal melanomas with positive metabolic activity by PET/CT were statistically significantly larger in size than the 30 metabolically inactive melanomas (P < 0.001, Kruskal-Wallis test). Positive metabolic activity of choroidal melanoma identified by PET/CT imaging was statistically significantly associated with chromosome 3 loss and larger tumor size.
    Retina (Philadelphia, Pa.) 12/2009; 30(1):146-51. · 2.93 Impact Factor
  • Archives of ophthalmology 11/2009; 127(11):1550-1. · 3.86 Impact Factor
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    ABSTRACT: Vitrectomy systems are now available with 20-, 23-, and 25-gauge vitreous cutters and are designed to be used with conventional or new generation pneumatic actuation technology. Five vitreous cutters using pneumatic actuation technology were studied. Flow rates were evaluated using porcine vitreous. A high-speed camera timed the cutting phases (open, closing, closed, and opening), and duty cycle was calculated. The cutting port surface area and internal shaft surface areas were calculated. Increasing cut rate decreased the average open phase duration without affecting other cutting phases. The opening and closing phases of vitreous cutters using new generation pneumatic actuation technology were longer than those for other vitreous cutters. Flow rate was correlated to internal shaft surface area. In addition to confirming the importance of duty cycle at high cut rates, this study demonstrated that the transition phases should also be considered when one is evaluating the efficiency of a vitreous cutter.
    Retina (Philadelphia, Pa.) 10/2009; 29(9):1289-93. · 2.93 Impact Factor
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    ABSTRACT: This essay reviews the experimental treatments and new imaging modalities that are currently being explored by investigators to help treat patients with age-related macular degeneration (AMD). Interpretative essay. Literature review and interpretation. Experimental treatments to preserve vision in patients with exudative AMD include blocking vascular endothelial growth factor (VEGF), binding VEGF, and modulating the VEGF receptors. Investigators are also attempting to block signal transduction with receptor tyrosine kinase inhibitors. Experimental treatments for non-exudative AMD include agents that target inflammation, oxidative stress, and implement immune-modulation. The effectiveness of these newer pharmacologic agents has the potential to grow exponentially when used in combination with new and improved imaging modalities that can help identify disease earlier and follow treatment response more precisely. With a better understanding, at the genetic and molecular level, of AMD and the development of superior imaging modalities, investigators are able to offer treatment options that may offer unprecedented visual gains while reducing the need for repetitive treatments.
    Clinical ophthalmology (Auckland, N.Z.) 02/2009; 3:167-74.
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    ABSTRACT: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options. Interpretative essay. Literature review and interpretation. Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intravitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system. By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity.
    Clinical ophthalmology (Auckland, N.Z.) 02/2009; 3:155-66.
  • International ophthalmology clinics 02/2009; 49(2):53-9.
  • Shantan Reddy, Allen Hu, Steven D Schwartz
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    ABSTRACT: We report two cases in which ultra wide field fluorescein angiography was used to direct targeted retinal photocoagulation (TRP) to areas of retinal capillary non-perfusion in an attempt to cause regression of diabetic neovascularization. By providing up to a 200 degree field of view, accurate delineation of retinal capillary non-perfusion and precise application of photocoagulation was possible. The application of TRP successfully led to the regression of the retinal neovascularization in our patients. Complications of conventional panretinal photocoagulation (PRP) such as visual field loss and macular edema may have been avoided. When TRP is used in conjunction with ultra wide field fluorescein angiography, preservation of functional retina may be possible while minimizing the amount of laser treatment that is applied to the retina.
    Seminars in ophthalmology 01/2009; 24(1):9-14. · 1.09 Impact Factor