Sharon Fekrat

Duke University Medical Center, Durham, North Carolina, United States

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Publications (82)204.84 Total impact

  • Paul Hahn, Phoebe Lin, Sharon Fekrat
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    ABSTRACT: Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder whose ophthalmic associations most commonly consist of pigmentary fundus changes and scotopic electroretinogram abnormalities. A 23-year-old man with advanced DMD and associated cardiopulmonary compromise complaining of floaters presented with a striking retinal vasculopathy characterized by vitreous hemorrhage, neovascularization, capillary drop-out, and prominent saccular venular aneurysms diffusely throughout the fundus of both eyes. This vasculopathy was promptly treated with panretinal phocoagulation with marked improvement to at least 1 year. This report suggests that early identification and prompt treatment of DMD may be important in managing this condition.[Ophthalmic Surg Lasers Imaging Retina. 2013;44:293-295.].
    Ophthalmic surgery, lasers & imaging retina. 05/2013; 44(3):293-5.
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    ABSTRACT: PURPOSE:: The authors have recently developed a high-resolution microscope-integrated spectral domain optical coherence tomography (MIOCT) device designed to enable OCT acquisition simultaneous with surgical maneuvers. The purpose of this report is to describe translation of this device from preclinical testing into human intraoperative imaging. METHODS:: Before human imaging, surgical conditions were fully simulated for extensive preclinical MIOCT evaluation in a custom model eye system. Microscope-integrated spectral domain OCT images were then acquired in normal human volunteers and during vitreoretinal surgery in patients who consented to participate in a prospective institutional review board-approved study. Microscope-integrated spectral domain OCT images were obtained before and at pauses in surgical maneuvers and were compared based on predetermined diagnostic criteria to images obtained with a high-resolution spectral domain research handheld OCT system (HHOCT; Bioptigen, Inc) at the same time point. Cohorts of five consecutive patients were imaged. Successful end points were predefined, including ≥80% correlation in identification of pathology between MIOCT and HHOCT in ≥80% of the patients. RESULTS:: Microscope-integrated spectral domain OCT was favorably evaluated by study surgeons and scrub nurses, all of whom responded that they would consider participating in human intraoperative imaging trials. The preclinical evaluation identified significant improvements that were made before MIOCT use during human surgery. The MIOCT transition into clinical human research was smooth. Microscope-integrated spectral domain OCT imaging in normal human volunteers demonstrated high resolution comparable to tabletop scanners. In the operating room, after an initial learning curve, surgeons successfully acquired human macular MIOCT images before and after surgical maneuvers. Microscope-integrated spectral domain OCT imaging confirmed preoperative diagnoses, such as full-thickness macular hole and vitreomacular traction, and demonstrated postsurgical changes in retinal morphology. Two cohorts of five patients were imaged. In the second cohort, the predefined end points were exceeded with ≥80% correlation between microscope-mounted OCT and HHOCT imaging in 100% of the patients. CONCLUSION:: This report describes high-resolution MIOCT imaging using the prototype device in human eyes during vitreoretinal surgery, with successful achievement of predefined end points for imaging. Further refinements and investigations will be directed toward fully integrating MIOCT with vitreoretinal and other ocular surgery to image surgical maneuvers in real time.
    Retina (Philadelphia, Pa.) 03/2013; · 2.93 Impact Factor
  • Paul Hahn, Sharon Fekrat
    American journal of ophthalmology 03/2013; 155(3):415-417.e2. · 3.83 Impact Factor
  • Phoebe Lin, Paul Hahn, Sharon Fekrat
    Retina (Philadelphia, Pa.) 08/2012; 32(8):1689-90. · 2.93 Impact Factor
  • Paul Hahn, Sharon Fekrat
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    ABSTRACT: Retinal vein occlusion (RVO) is a sight-threatening retinal vascular disorder associated with macular edema and neovascularization. Until recently, the standard of care for branch RVO-associated macular edema was grid laser photocoagulation and observation for central RVO-associated macular edema. Neovascularization was treated with scatter laser photocoagulation. The purpose of this article is to review recent findings that have changed our treatments of RVO. The recent development of intravitreal pharmacotherapy has demonstrated benefit with anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of RVO-associated macular edema. The intravitreal use of FDA-approved ranibizumab (Lucentis) and a sustained release dexamethasone implant (Ozurdex), along with off-label bevacizumab (Avastin) and preservative-free triamcinolone, has significantly expanded our treatment options and replaced standard of care for treatment of RVO-associated macular edema. Whereas anti-VEGF agents can also induce rapid regression of neovascularization, scatter laser photocoagulation remains the standard of care to prevent neovascular complications. Intravitreal pharmacotherapy has revolutionized our treatment of retinal vascular diseases, including RVO. Although these intravitreal agents are effective, our understanding of their specific indications and long-term roles is still evolving. Furthermore, until the underlying occlusive pathophysiology of RVO can be addressed, our treatments will be limited to temporizing therapies against a chronic disease.
    Current opinion in ophthalmology 03/2012; 23(3):175-81. · 2.49 Impact Factor
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    ABSTRACT: PURPOSE/AIMS: This study investigates the efficacy of intravitreal bevacizumab (IVB) for cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). Subgroup analysis was performed comparing early (within 90 days of CRVO onset) and late treatment (after 90 days) as well as perfused and ischemic subgroups. Retrospective review of 48 consecutive eyes with CRVO treated with IVB was performed. Data collected at various time points included best corrected visual acuity (BCVA), central foveal thickness (FT) on optical coherence tomography (OCT), perfusion status on fluorescein angiography (FA), and complications. Mean initial BCVA was 20/288 compared to 20/214 at 12 months (p=0.07) and 20/204 (p=0.03) at final follow-up. Initial mean central FT was 591 micrometers compared to 339 micrometers at 12 months (p=0.003). Mean follow-up was 10.5 months, and mean number of injections was 3.7. After IVB, no significant difference in BCVA gain or edema resolution on OCT was noted between the early and late treatment groups or between the perfused and ischemic subgroups. IVB improves foveal thickness in eyes with CRVO, but this does not always correlate with visual recovery. No difference in efficacy was observed for IVB treatment of perfused versus ischemic CRVO or when used for early versus late treatment.
    Current eye research 12/2011; 36(12):1164-70. · 1.51 Impact Factor
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    ABSTRACT: To evaluate the effect of intravitreal bevacizumab on the visual and anatomical outcome in eyes with macular edema secondary to branch retinal vein occlusion. A retrospective, consecutive case series identified 53 consecutive patients with a branch retinal vein occlusion treated with intravitreal bevacizumab. Clinical variables were analyzed, including best-corrected visual acuity, angiographic characteristics, central foveal thickness, and complications. Fifty-three eyes were identified with a mean initial best-corrected visual acuity of 20/137 and final best-corrected visual acuity of 20/96 (P = 0.05). The mean final line change was +1.6 lines (95% confidence interval, +0.7 to +2.3; +8 letters [95% confidence interval, +3.5 to 11.5]). At final follow-up, 28% gained ≥ 3 lines, whereas a loss of >3 lines was seen in 6% of eyes. The mean initial central foveal thickness of 425 μm decreased to 289 μm (P < 0.001). Mean number of injections was 2.5, and mean follow-up was 9 months. Eyes treated for ≤ 6 months after the onset of branch retinal vein occlusion showed improved functional outcomes (e.g., final best-corrected visual acuity, mean line change) as compared with those treated with >6 months of symptoms (P < 0.01). Intravitreal bevacizumab appears to be an effective treatment for macular edema secondary to branch retinal vein occlusion in many subjects. Eyes treated with intravitreal bevacizumab showed a significant reduction in central foveal thickness and improvement in visual acuity. Early treatment with intravitreal bevacizumab resulted in a greater improvement in visual acuity compared with delayed treatment.
    Retina (Philadelphia, Pa.) 06/2011; 31(9):1856-62. · 2.93 Impact Factor
  • Francis Char Decroos, Sharon Fekrat
    American journal of ophthalmology 05/2011; 151(5):739-741.e2. · 3.83 Impact Factor
  • Justis P Ehlers, Sharon Fekrat
    Canadian Journal of Ophthalmology 02/2011; 46(1):88-9. · 1.15 Impact Factor
  • Justis P Ehlers, Sharon Fekrat
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    ABSTRACT: Retinal vein occlusion is a major cause of vision loss. We provide an overview of the clinical features, pathogenesis, natural history, and management of both branch retinal vein occlusion and central retinal vein occlusion. Several recent multicenter randomized clinical trials have been completed which have changed the approach to this disorder. Management of retinal vein occlusions can be directed at the underlying etiology or the resulting sequelae. Options include surgical intervention, laser photocoagulation, intravitreal pharmacotherapy, and sustained drug delivery devices.
    Survey of Ophthalmology 01/2011; 56(4):281-99. · 2.86 Impact Factor
  • Justis P Ehlers, Sharon Fekrat
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    ABSTRACT: Purpose: The purpose of this study is to report a case of diabetic macular edema that resolved after systemic bevacizumab. Methods: This is an observational case report of a patient with diabetic macular edema. Results: After initiation of systemic bevacizumab for a central nervous system glioblastoma, the diabetic macular edema resolved. Conclusion: Systemic bevacizumab may result in the resolution of macular edema secondary to diabetes.
    Retinal Cases & Brief Reports 12/2009; 4(4):297-299.
  • Rajeev S. Ramchandran, Sharon Fekrat
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    ABSTRACT: Purpose: To report one surgeon's experience in treating a case of branch retinal artery occlusion with pars plana vitrectomy and surgical removal of the etiologic retinal arterial embolus. Methods: Single case presentation of pre- and postoperative visual acuity data, fluorescein angiography, and optical coherence tomography studies of one eye undergoing pars plana vitrectomy and retinal arterial embolectomy. Results: Attempted embolectomy was unsuccessful in removing the retinal arterial embolus. Intraoperatively, the embolus traveled retrograde back into the central retinal artery when the infusion bottle was raised to maximum height. On postoperative Day 1, the embolus had returned to its preoperative position. However, postoperative arterial perfusion improved, as evidenced by fluorescein angiography, and macular edema was improved on the first postoperative day, as documented on optical coherence tomography. Visual acuity improved from 20/80 preoperatively to 20/32 at 1 month and to 20/20 at 9 months postoperatively, even though the affected retinal tissue had markedly thinned. Conclusion: This single case illustrates our experience with the vitreous surgical techniques of embolus extraction in an eye with a branch retinal artery occlusion and an ophthalmoscopically visible embolus.
    Retinal Cases & Brief Reports 12/2009; 4(2):116-119.
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    ABSTRACT: Objective: To examine the incidence, prevalence, resource use, and costs associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in elderly patients.
    12/2009; 26(1):223-230.
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    ABSTRACT: To examine the incidence, prevalence, resource use, and costs associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in elderly patients. In a retrospective cohort study of a nationally representative sample of Medicare beneficiaries from 2001 through 2006, the authors identified patients with BRVO (n = 10,682) and CRVO (n = 6236) and controls with hypertension (n = 49,524) and glaucoma (n = 49,569) but no retinal vein occlusion. Incident cases were those with no claims listing a diagnosis for the same type of retinal vein occlusion in the previous 12 months. Prevalence was defined as the number of beneficiaries with a diagnosis of BRVO or CRVO. The authors summed Medicare reimbursements for all claims and used generalized linear models to estimate the effects of BRVO and CRVO on 1-year and 3-year costs compared with hypertension and glaucoma control groups. The authors also examined trends in the use of diagnostic and treatment modalities. Resource use (fluorescein angiography, optical coherence tomography, intravitreal injection, laser photocoagulation, and vitrectomy) and direct medical costs (total Medicare reimbursement amounts as recorded on each inpatient, outpatient, home health, skilled nursing, hospice, durable medical equipment, and professional service claim) at 1 year and 3 years. After adjustment for baseline characteristics, BRVO was associated with 16% higher 1-year costs and 12% higher 3-year costs compared with hypertension and 18% higher 1-year costs and 13% higher 3-year costs compared with glaucoma. CRVO was associated with 22% higher 1-year costs and 15% higher 3-year costs compared with hypertension and 24% higher 1-year costs and 16% higher 3-year costs compared with glaucoma. Use of fluorescein angiography and optical coherence tomography increased during the study. Use of intravitreal injections increased from less than 1% of patients overall to greater than 13% for BRVO and 16% for CRVO. The incidence of BRVO declined slightly during the study period, whereas the incidence of CRVO remained relatively flat. Prevalence increased in both groups. The results may not be generalizable to younger patients or managed-care beneficiaries. The study included only direct costs to Medicare, not nonmedical expenditures or outpatient prescription medications. Diagnosis and procedure codes may not have been complete. The study could not account for clinical variables, such as the amount of vision loss. It was not feasible to adjust for whether one or both eyes were affected or treated. Although not common in the Medicare population, BRVO and CRVO are important independent predictors of total medical costs. Diagnostic and treatment modalities have changed over time.
    Current Medical Research and Opinion 11/2009; 26(1):223-30. · 2.26 Impact Factor
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    ABSTRACT: To evaluate vision-related quality of life in persons with branch retinal vein occlusion (BRVO) using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Observational, cross-sectional, interviewer-administered study. 46 patients with unilateral BRVO were included in this study. Scores on the VFQ-25 were analysed and converted to scaled scores per NEI VFQ-25 algorithms. Clinical data including age, gender, employment status, living arrangements, visual acuity, number of systemic diseases and duration of BRVO were also recorded. Subscale results were compared with previously published data, and subgroup analyses were performed. Mean adjusted subscale responses among BRVO patients were higher (except for ocular pain) than known averages in patients with diabetic retinopathy, central retinal vein occlusion, age-related macular degeneration and low vision, but lower than known averages in a reference group of people without ocular disease. Subscale responses correlated significantly with visual acuity in the involved eye. This observation held true in eight of 12 subscales, even in patients who maintained vision of 20/25 or better in the uninvolved eye. The General Health subscale and number of systemic diseases correlated significantly with both the General Vision and Peripheral Vision subscale scores. There was no correlation between subscale responses and age. BRVO is a retinal vascular disease that is associated with a decrease in vision-related quality of life as determined by the VFQ-25. A decrease in VFQ-25 score is correlated with involved eye visual acuity, even when good visual acuity is maintained in the uninvolved eye.
    The British journal of ophthalmology 10/2009; 94(3):319-23. · 2.92 Impact Factor
  • Source
    Srilaxmi Bearelly, Supriya Rao, Sharon Fekrat
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    ABSTRACT: To assess the incidence of anaphylaxis following intravenous fluorescein angiography (IVFA) at 1 satellite clinic. Observational case series. Records from 1400 patients were reviewed. Consecutive vitreoretinal patients who underwent IVFA between 1998 and 2005 at 1 satellite office were included for retrospective analysis. Anaphylaxis developed in 4 of 1400 (0.3%) patients within minutes after they had received intravenous fluorescein. In each case, the reaction was recognized promptly and treated with injectable epinephrine by the physician, and symptoms resolved quickly. The ambulance was called in all 4 cases. In the literature, reports of 21 cases of anaphylaxis and 7 deaths have been published in the past 55 years. Although uncommon, anaphylaxis as a reaction to intravenous fluorescein does occur. As this is potentially life-threatening, prompt diagnosis and treatment are crucial. An emergency care plan should be available.
    Canadian Journal of Ophthalmology 09/2009; 44(4):444-5. · 1.15 Impact Factor
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    ABSTRACT: To investigate the visual and anatomic outcomes in eyes with cystoid macular edema (CME) resulting from central retinal vein occlusion (CRVO) that underwent pars plana vitrectomy, internal limiting membrane peeling, and panretinal endolaser photocoagulation (PPV/MP/EL). Retrospective, observational case series. Consecutive, nonrandomized patients at the Duke Eye Center who underwent PPV/MP/EL for treatment of CME secondary to CRVO by a single surgeon (S.F.) over the last 5 years were identified and reviewed. Outcome measures include best-corrected visual acuity (BCVA), foveal thickness, and total macular volume (TMV). Twelve patients were identified. Duration of CRVO before surgery ranged from 3 to 19 months (mean, 12.3 months). Preoperative perfusion status was not ischemic in 6 eyes, ischemic in 5 eyes, and indeterminate in 1 eye. Intravitreal triamcinolone had been administered in 66% and was given at least 4 months before surgical intervention. After surgery, foveal thickness and TMV improved, but BCVA demonstrated only a modest improvement that did not reach statistical significance. At the time of surgery, 50% of eyes were pseudophakic. Of the remaining eyes, visually significant cataracts developed in all 6 (100%) within 1 year after surgery, with 67% of those undergoing cataract extraction within 15 months after PPV/MP/EL. PPV/MP/EL performed for CME secondary to CRVO reduced foveal thickness and TMV at final follow-up; however, anatomic improvement did not correlate with a statistically significant improvement in BCVA.
    American journal of ophthalmology 03/2009; 147(4):627-633.e1. · 3.83 Impact Factor
  • Alex Melamud, Sandra Stinnett, Sharon Fekrat
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    ABSTRACT: To report the efficacy of treatment of neovascular age-related macular degeneration (AMD) with intravitreal bevacizumab (Avastin; Genentech, Inc, South San Francisco, California, USA) when administered in a series of three monthly injections followed by a period of observation. Retrospective case series. Retrospective review of consecutive eyes with all choroidal neovascular lesion subtypes resulting from neovascular AMD treated with intravitreal bevacizumab. Treatment consisted of a pars plana injection of 1.25 mg Avastin (0.05 ml bevacizumab at a concentration of 25 mg/ml). Evaluation consisted of a complete ophthalmologic examination, including best-corrected visual acuity (VA) measurement, ophthalmoscopy, and optical coherence tomography. Eyes received a series of three monthly injections followed by a three-month period of observation. A total of 36 patients (37 eyes) received a series of three consecutive monthly intravitreal injections of bevacizumab. Twenty (54%) of 37 eyes had no previous treatments for neovascular AMD in the eye that received bevacizumab. Seventeen (46%) of 37 eyes had received some previous treatment before initiation of bevacizumab therapy. Intravitreal Avastin therapy produced an improvement in foveal thickness over time in eyes with neovascular AMD. This improvement was sustained during the series of three monthly injections. All eyes experienced worsening after three months without treatment. No statistically significant effect on VA was demonstrated in this series. Intravitreal bevacizumab therapy produced an improvement in foveal thickness over time in eyes with neovascular AMD when one injection was given each month for three consecutive months. All eyes experienced increased foveal thickening during the subsequent three months without treatment.
    American Journal of Ophthalmology 08/2008; 146(1):91-5. · 3.63 Impact Factor
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    ABSTRACT: To determine treatment outcomes of a long-acting intravitreal fluocinolone acetonide sustained drug delivery implant in eyes with central retinal vein occlusion (CRVO) and chronic refractory macular edema. Prospective, noncomparative, interventional case series. Fourteen eyes of 14 patients with chronically persistent macular edema associated with CRVO underwent intraocular implantation of a three-year fluocinolone acetonide sustained drug delivery system. Best-corrected Early Treatment of Diabetic Retinopathy visual acuity (VA), central foveal thickness determined by optical coherence tomography, and intraocular pressure (IOP) were recorded after the first 12 months after implant insertion. The median (range) vein occlusion and macular edema duration were 12.5 months (range, seven to 49). No eye experienced intraoperative complications. At baseline, median VA was 20/126, improved to 20/60 by two months, and was 20/80 by 12 months. A significant proportion of eyes had gained lines of VA at 12 months compared with baseline (P = .002). At 12 months, the mean and median central retinal thickness decreased from 622 and 600 microm before surgery, respectively, to 307 and 199 microm after surgery, respectively (P = .008). By month 12, cataract had developed in all five phakic patients, and 13 of 14 eyes required medical or surgical IOP-lowering interventions. VA improved and macular edema decreased in a significant proportion of implanted eyes with chronic, CRVO-associated macular edema. Cataract formation and elevated IOP, the main side effects, were managed, respectively, with cataract extraction and medical or surgical IOP control, or both. This system is a promising novel alternative to currently available treatments for this challenging patient population.
    American Journal of Ophthalmology 07/2008; 146(2):285-291. · 3.63 Impact Factor
  • Jonathan Etter, Sharon Fekrat
    Canadian Journal of Ophthalmology 07/2008; 43(3):373-4. · 1.15 Impact Factor

Publication Stats

977 Citations
13 Downloads
204.84 Total Impact Points

Institutions

  • 2000–2013
    • Duke University Medical Center
      • Department of Ophthalmology
      Durham, North Carolina, United States
  • 2009
    • Duke University
      Durham, North Carolina, United States
  • 2008
    • University of Maryland, Baltimore
      • Department of Ophthalmology and Visual Sciences
      Baltimore, MD, United States
  • 2007
    • Wills Eye Institute
      Philadelphia, Pennsylvania, United States
  • 1995–1999
    • Johns Hopkins Medicine
      • Wilmer Eye Institute
      Baltimore, MD, United States