[Show abstract][Hide abstract] ABSTRACT: Purpose:
To review presenting characteristics, clinical course, and long-term visual and anatomic outcomes of patients with traumatic macular holes at a tertiary referral center.
Retrospective case series.
28 consecutive patients with traumatic macular holes at a single tertiary referral center were reviewed. In addition to visual acuities and treatments throughout the clinical course, specific dimensions of the macular hole, including diameters, height, configuration, shape, and the presence of a cuff of fluid were examined using spectral-domain optical coherence tomography (OCT).
Twenty-eight patients were identified with a mean initial visual acuity (VA) of logMAR 1.3 (20/400) and a mean follow-up of 2.2 years. Eleven holes (39.3%) closed spontaneously in median 5.7 weeks. Eleven underwent vitrectomy with a median time to intervention of 35.1 weeks. Median time to surgery for the 5 eyes with successful hole closure was 11.0 weeks vs. 56.3 weeks for the 6 eyes that failed to close (P=.02). VA improved in closed holes (P<.01), whether spontaneously (P<.01) or via vitrectomy (P=.04), but VA did not improve in holes that did not close (P=.22). There was no relation between initial OCT dimensions and final hole closure status, although there was a trend that did not reach statistical significance towards small dimensions for those that closed spontaneously.
A fairly high spontaneous closure rate was observed, with a trend towards smaller OCT dimensions. We found no relationship between hole closure and the OCT characteristics of the hole. Surgical intervention was less successful at hole closure when elected after 3 months.
American Journal of Ophthalmology 09/2015; DOI:10.1016/j.ajo.2015.09.004 · 3.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Figure 1. A, The implanted portions of the Argus II System (Second Sight Medical Products, Inc., Sylmar, CA). B, The external components of the Argus II System. Images in real time are captured by the camera mounted on the glasses. The video processing unit down-samples and processes the image, converting it to stimulation patterns. Data and power are sent via radiofrequency link from the transmitter antenna on the glasses to the receiver antenna around the eye. A removable, rechargeable battery powers the system.
[Show abstract][Hide abstract] ABSTRACT: Retinal venous occlusive events are a rare complication of arteriovenous malformations of the retina found in Wyburn-Mason syndrome. The authors present a case of a 28-year-old man diagnosed with Wyburn-Mason syndrome and cutaneous reactive angiomatosis, a reactive angioproliferative disorder induced by vascular occlusion. He developed a central retinal vein occlusion complicated by macular edema and received treatment with intravitreal bevacizumab, which led to resolution of the edema. To the best of the authors' knowledge, this is the first report of an anti- vascular endothelial growth factor agent employed as an effective treatment for macular edema in the setting of Wyburn-Mason syndrome. The association between Wyburn-Mason syndrome and cutaneous reactive angiomatosis is also a novel finding. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:760-762.].
Copyright 2015, SLACK Incorporated.
Ophthalmic Surgery Lasers and Imaging Retina 07/2015; 46(7):760-2. DOI:10.3928/23258160-20150730-12 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors report a new clinical manifestation of chronic myeloid leukemia. A 41-year-old man presented with significant visual loss, leading to a diagnosis of chronic myeloid leukemia. His white blood count exceeded that of any previously reported case of the disease with documented retinal findings (562,000/mm(3)), and clinical evaluation revealed the blockage of temporal retinal vessels by white blood cells. Hematologic findings resolved within 1 month of chemotherapy with dasatinib, and further treatment with intravitreal anti-VEGF agents resulted in the complete resolution of fundus findings. The authors propose that leukostasis retinopathy be recognized as a clinical manifestation of this life-threatening disease. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:768-770.].
Copyright 2015, SLACK Incorporated.
Ophthalmic Surgery Lasers and Imaging Retina 07/2015; 46(7):768-70. DOI:10.3928/23258160-20150730-14 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epiretinal fibrovascular membranes (FVMs) are a hallmark of proliferative diabetic retinopathy (PDR). Surgical removal of FVMs is often indicated to treat tractional retinal detachment. This potentially informative pathological tissue is usually disposed of after surgery without further examination. We developed a method for isolating and characterizing cells derived from FVMs and correlated their expression of specific markers in culture with that in tissue.
FVMs were obtained from 11 patients with PDR during diabetic vitrectomy surgery and were analyzed with electron microscopy (EM), comparative genomic hybridization (CGH), immunohistochemistry, and/or digested with collagenase II for cell isolation and culture. Antibody arrays and enzyme-linked immunosorbent assay (ELISA) were used to profile secreted angiogenesis-related proteins in cell culture supernatants.
EM analysis of the FVMs showed abnormal vessels composed of endothelial cells with large nuclei and plasma membrane infoldings, loosely attached perivascular cells, and stromal cells. The cellular constituents of the FVMs lacked major chromosomal aberrations as shown with CGH. Cells derived from FVMs (C-FVMs) could be isolated and maintained in culture. The C-FVMs retained the expression of markers of cell identity in primary culture, which define specific cell populations including CD31-positive, alpha-smooth muscle actin-positive (SMA), and glial fibrillary acidic protein-positive (GFAP) cells. In primary culture, secretion of angiopoietin-1 and thrombospondin-1 was significantly decreased in culture conditions that resemble a diabetic environment in SMA-positive C-FVMs compared to human retinal pericytes derived from a non-diabetic donor.
C-FVMs obtained from individuals with PDR can be isolated, cultured, and profiled in vitro and may constitute a unique resource for the discovery of cell signaling mechanisms underlying PDR that extends beyond current animal and cell culture models.
[Show abstract][Hide abstract] ABSTRACT: Purpose: The RD-OGI Score is a clinical prediction model that was derived based on 893 open globe patients for predicting the risk of retinal detachment after open globe trauma. This study sought to validate the RD-OGI Score in an independent patient cohort to improve clinical decision-making.
Methods: A validation cohort was established by retrospectively reviewing the outcomes of 231 open globe injuries who presented to Eye Trauma Service of the Massachusetts Eye and Ear Infirmary (MEEI) from 1 January 2012 to 31 January 2014 with open globe injury. Logistic regression was undertaken to evaluate optimal predictive value of RD-OGI Score. The sensitivity, the specificity, positive predictive value (PPV), negative predictive value (NPV) and probability of RD development were assessed for each RD-OGI Score cutpoint. RD-OGI Scores were stratified into three risk classes: Low Risk, Moderate Risk, and High Risk of RD development. Kaplan-Meier survival analysis for time to RD was plotted. A log- rank test was used to test differences in survival experience between risk classes.
Results: A total of 66 eyes were ultimately diagnosed with RD after open globe trauma in the validation cohort at 365 days. Regression modeling indicated that RD-OGI Score performs the best in predicting RD for the 30-day follow-up time point (AUC=0.939, AIC=108.8). However, this Score also performed extremely well at every other time point. The Low Risk Class was designated to be RD- OGI Scores of 0-1.5 and none of the patients developed RD in Low Risk Class over 365 days. Moderate Risk Class was designated as RD-OGI Scores 2.0 through 4.0 with a probability of RD of 11-20% at all time points, and High Risk Class at scores 4.5 through 7.5 with probability 66-78% at all time points.
Conclusions: The RD-OGI score can reliably predict the future development of detachment based on clinical variables that are seen at the time of initial presentation after traumatic injury.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To describe a favorable outcome after the surgical repair of a very large macular hole with a neurosensory operculum.
Case report. A 42-year-old man with a history of decreased vision for 3 months was found to have vision of 20/400, a very large macular hole (1159 μm in diameter), and an operculum suspended on the posterior hyaloid above the hole.
Vitrectomy and internal limiting membrane peel were performed. The operculum was processed for histology and found to contain neurons and glial cells. Fourteen months later, the patient's vision improved to 20/60.
Very large macular holes have traditionally been considered to have a poor prognosis. Here, we demonstrate that such large holes can be repaired with good visual outcome, even in the setting of an operculum consisting of avulsed neural retina.
[Show abstract][Hide abstract] ABSTRACT: Abstract The Boston Keratoprosthesis has allowed for visual restoration in patients with corneal blindness; however, vitreoretinal complications remain a significant cause of ocular morbidity. Retroprosthetic membranes, infectious endophthalmitis, sterile vitritis, vitreous hemorrhage, vitreous opacities, retinal detachment, cystoid macular edema, choroidal detachments, retinal vascular occlusion, and epiretinal membrane have all been described, may require the intervention of a vitreoretinal specialist, and are reviewed herein. A strong familiarity with associated posterior segment complications is important to maximizing patient outcomes.
Seminars in Ophthalmology 11/2014; 29(5-6):338-48. DOI:10.3109/08820538.2014.959204 · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract The treatment of neovascular age-related macular degeneration (AMD) and other pathologic ocular conditions that overexpress the vascular endothelial growth factor (VEGF) has been revolutionized in the last decade by the introduction of intravitreal agents that target the VEGF pathway. Since treatment trials are designed primarily to assess the prevention of vision loss caused by ocular conditions, they are inadequate for detecting rare, but potentially serious, systemic side effects. The aim of this article is to present what the ophthalmologist needs to know about systemic complications from anti-VEGF therapy and review the likelihood that these side effects occur in the context of small, but often-repeated, intravitreal doses of these potent biological medications. Preferred practice patterns need to be developed that weigh the ability of these medications to mitigate potentially blinding conditions, while at the same time minimizing the risk of adverse outcomes in specific patient populations that possess multiple and often interrelated medical comorbidities.
Seminars in Ophthalmology 11/2014; 29(5-6):263-75. DOI:10.3109/08820538.2014.959195 · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Since they were first derived more than three decades ago, embryonic stem cells have been proposed as a source of replacement cells in regenerative medicine, but their plasticity and unlimited capacity for self-renewal raises concerns about their safety, including tumour formation ability, potential immune rejection, and the risk of differentiating into unwanted cell types. We report the medium-term to long-term safety of cells derived from human embryonic stem cells (hESC) transplanted into patients.
The Lancet 10/2014; 385(9967). DOI:10.1016/S0140-6736(14)61376-3 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
To design, fabricate, and evaluate novel materials to remove silicone oil (SiO) droplets from intraocular lenses (IOL) during vitreoretinal surgery.
Three different designs were fabricated using soft lithography of polydimethylsiloxane (PDMS), three-dimensional (3D) inverse PDMS fabrication using water dissolvable particles, and atomic layer deposition (ALD) of alumina (Al2O3) on surgical cellulose fibers. Laboratory tests included static and dynamic contact angle (CA) measurements with water and SiO, nondestructive x-ray microcomputer tomography (micro-CT), and microscopy. SiO removal was performed in vitro and ex vivo using implantable IOLs and explanted porcine eyes.
All designs exhibited enhanced hydrophobicity and oleophilicity. Static CA measurements with water ranged from 131° to 160° and with SiO CA approximately 0° in 120 seconds following exposure. Nondestructive x-ray analysis of the 3D PDMS showed presence of interconnected polydispersed porosity of 100 to 300 μm in diameter. SiO removal from IOLs was achieved in vitro and ex vivo using standard 20-G vitrectomy instrumentation.
Removal of SiO from IOLs can be achieved using materials with lower surface energy than that of the IOLs. This can be achieved using appropriate surface chemistry and surface topography. Three designs, with enhanced hydrophobic properties, were fabricated and tested in vitro and ex vivo. All materials remove SiO within an aqueous environment. Preliminary ex vivo results were very promising, opening new possibilities for SiO removal in vitreoretinal surgeries.
This is the first report of an instrument that can lead to successful removal of SiO from the surface of IOL. In addition to the use of this instrument/material in medicine it can also be used in the industry, for example, retrieval of oil spills from bodies of water.
[Show abstract][Hide abstract] ABSTRACT: Traumatic chorioretinal rupture, also known as sclopetaria, is a full-thickness break of the choroid and retina caused by a high-velocity projectile striking or passing adjacent to, but not penetrating, the globe. Previous reports have emphasized that retinal detachment seldom occurs, and observation alone has been the recommended management strategy. However, the authors present herein a series of consecutive patients with retinal detachment associated with sclopetaria and provide a literature review of the topic. They recommend that patients with traumatic chorioretinal rupture be monitored closely for the development of retinal detachment during the first few weeks after the injury. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:xxx-xxx.].
Ophthalmic Surgery Lasers and Imaging Retina 08/2014; 45(5):1-5. DOI:10.3928/23258160-20140806-02 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This report describes two cases of severe, bilateral ischemic retinal vasculitis following cataract surgeries at different surgical centers. In both cases, the patient underwent bilateral cataract surgeries, performed 1 week apart for each eye. In the perioperative period following the second of the two surgeries, both patients developed severe, bilateral intraocular inflammation and profound vision loss. The underlying cause of this adverse response remains unknown. The authors suggest that the severe inflammatory reaction could be related to an intraoperative intracameral vancomycin injection. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:338-342.].
Ophthalmic Surgery Lasers and Imaging Retina 07/2014; 45(4):338-342. DOI:10.3928/23258160-20140605-01 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To determine whether Massachusetts Health Reform improved health outcomes in uninsured patients with hyperlipidemia, diabetes, or hypertension.Data SourcePartners HealthCare Research Patient Data Registry (RPDR).Study DesignWe examined 1,463 patients with hyperlipidemia, diabetes, or hypertension who were uninsured in the 3 years before the 2006 Massachusetts Health Reform implementation. We assessed mean quarterly total cholesterol, glycosylated hemoglobin, and systolic blood pressure in the respective cohorts for five follow-up years compared with 3,448 propensity score-matched controls who remained insured for the full 8-year study period. We used person-level interrupted time series analysis to estimate changes in outcomes adjusting for sex, age, race, estimated household income, and comorbidity. We also analyzed the subgroups of uninsured patients with poorly controlled disease at baseline, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year.Principal FindingsIn 5 years after Massachusetts Health Reform, patients who were uninsured at baseline did not experience detectable trend changes in total cholesterol (−0.39 mg/dl per quarter, 95 percent confidence interval [−1.11 to 0.33]), glycosylated hemoglobin (−0.02 percent per quarter [−0.06 to 0.03]), or systolic blood pressure (−0.06 mmHg per quarter [−0.29 to 0.18]). Analyses of uninsured patients with poorly controlled disease, no evidence of established primary care in the baseline period, and those who received insurance in the first follow-up year yielded similar findings.Conclusions
Massachusetts Health Reform was not associated with improvements in hyperlipidemia, diabetes, or hypertension control after 5 years. Interventions beyond insurance coverage might be needed to improve the health of chronically ill uninsured persons.
Health Services Research 07/2014; 49(S2). DOI:10.1111/1475-6773.12196 · 2.78 Impact Factor