Dean Eliott

Harvard Medical School, Boston, Massachusetts, United States

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Publications (89)265.23 Total impact

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    ABSTRACT: To describe a syndrome of hemorrhagic occlusive retinal vasculitis (HORV) that developed after seemingly uncomplicated cataract surgery. Retrospective case series. Eleven eyes of 6 patients from 6 different institutions. Cases were identified after discussion among retina specialists. The findings on presentation, clinical course, and outcome of a series of 7 eyes of 4 patients were compared with a previous report of 4 eyes of 2 patients, and data from both series were combined for a comprehensive analysis. Historical data, examination findings, imaging results, systemic evaluation findings, treatment regimens, and visual outcomes. Eleven eyes of 6 patients underwent otherwise uncomplicated cataract surgery, receiving viscoelastic and prophylactic intracameral vancomycin during the procedure. Despite good initial vision on postoperative day 1, between 1 to 14 days after surgery, all eyes demonstrated painless vision loss resulting from HORV. Extensive ocular and systemic evaluations were unrevealing in all patients. All patients were treated with aggressive systemic and topical corticosteroids. Additional treatments included systemic antiviral medication in 4 patients, intravitreal antibiotics in 4 eyes, and pars plana vitrectomy in 4 eyes. Skin testing for vancomycin sensitivity showed negative results in 3 patients and was not performed in the others. Neovascular glaucoma developed in 7 eyes, and all eyes received intravitreal anti-vascular endothelial growth factor (VEGF) injection, panretinal photocoagulation, or both for retinal ischemia. Final visual acuity was less than 20/100 in 8 of 11 eyes. Postoperative HORV is an exceedingly rare and potentially devastating condition that can occur after otherwise uncomplicated cataract surgery. Although the precise cause remains unknown, this disease may represent a delayed immune reaction similar to vancomycin-induced leukocytoclastic vasculitis. Despite treatment with high-dose corticosteroids, antiviral medication, and early vitrectomy in many patients, visual outcomes typically were poor in this series. Early intervention with intravitreal anti-VEGF medication and panretinal photocoagulation may help to prevent additional vision loss resulting from neovascular glaucoma. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
    Ophthalmology 04/2015; DOI:10.1016/j.ophtha.2015.03.016 · 6.17 Impact Factor
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    ABSTRACT: To characterize anatomic and visual outcomes in patients with full-thickness macular hole (FTMH) at baseline in ocriplasmin phase 3 clinical trials, focusing on the relationship between resolution of vitreomacular adhesion and FTMH closure. Two multicenter, randomized, double-masked clinical trials. Pharmacologic FTMH closure was one of multiple secondary end points. OCT scans were obtained at baseline and all postinjection visits, and for patients with baseline FTMH, evaluated for FTMH width, vitreomacular adhesion, and epiretinal membrane. FTMH closure was observed in a greater proportion of ocriplasmin- vs vehicle-injected patients with baseline FTMH width ≤250 μm (58.3% vs 16.0%, P<.001) and >250 to ≤400 μm (36.8% vs 5.3%, P=.009). Among FTMH patients in the ocriplasmin group, ≥2-line visual acuity gains at month 6 were achieved by a greater percentage of those who achieved hole closure at day 28 versus those who did not achieve this outcome (72.1% vs 25.4%). Ocriplasmin demonstrated efficacy in closure of small and medium FTMH, and in FTMH without epiretinal membrane at baseline. Visual acuity gains occurred more frequently when hole closure was achieved after ocriplasmin treatment compared to when this outcome did not occur. Ocriplasmin treatment is an additional option for the management of patients with FTMH and vitreomacular adhesion. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 03/2015; 160(1). DOI:10.1016/j.ajo.2015.03.017 · 4.02 Impact Factor
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  • Jama Ophthalmology 01/2015; 133(1):e141812. DOI:10.1001/jamaophthalmol.2014.1812 · 3.83 Impact Factor
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    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.
    Molecular vision 01/2015; 21:673-87. · 2.25 Impact Factor
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    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.
    ARVO 2015; 01/2015
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    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 · 1.20 Impact Factor
  • Bobeck S Modjtahedi, Dean Eliott
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    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 · 1.20 Impact Factor
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    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. In the USA, two prospective phase 1/2 studies were done to assess the primary endpoints safety and tolerability of subretinal transplantation of hESC-derived retinal pigment epithelium in nine patients with Stargardt's macular dystrophy (age >18 years) and nine with atrophic age-related macular degeneration (age >55 years). Three dose cohorts (50 000, 100 000, and 150 000 cells) were treated for each eye disorder. Transplanted patients were followed up for a median of 22 months by use of serial systemic, ophthalmic, and imaging examinations. The studies are registered with ClinicalTrials.gov, numbers NCT01345006 (Stargardt's macular dystrophy) and NCT01344993 (age-related macular degeneration). There was no evidence of adverse proliferation, rejection, or serious ocular or systemic safety issues related to the transplanted tissue. Adverse events were associated with vitreoretinal surgery and immunosuppression. 13 (72%) of 18 patients had patches of increasing subretinal pigmentation consistent with transplanted retinal pigment epithelium. Best-corrected visual acuity, monitored as part of the safety protocol, improved in ten eyes, improved or remained the same in seven eyes, and decreased by more than ten letters in one eye, whereas the untreated fellow eyes did not show similar improvements in visual acuity. Vision-related quality-of-life measures increased for general and peripheral vision, and near and distance activities, improving by 16-25 points 3-12 months after transplantation in patients with atrophic age-related macular degeneration and 8-20 points in patients with Stargardt's macular dystrophy. The results of this study provide the first evidence of the medium-term to long-term safety, graft survival, and possible biological activity of pluripotent stem cell progeny in individuals with any disease. Our results suggest that hESC-derived cells could provide a potentially safe new source of cells for the treatment of various unmet medical disorders requiring tissue repair or replacement. Advanced Cell Technology. Copyright © 2014 Elsevier Ltd. All rights reserved.
    The Lancet 10/2014; 385(9967). DOI:10.1016/S0140-6736(14)61376-3 · 45.22 Impact Factor
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    ABSTRACT: To design, fabricate, and evaluate novel materials to remove silicone oil (SiO) droplets from intraocular lenses (IOL) during vitreoretinal surgery.
    09/2014; 3(5):4. DOI:10.1167/tvst.3.5.4
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    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.].
    08/2014; 45(5):1-5. DOI:10.3928/23258160-20140806-02
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    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 · 2.49 Impact Factor
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    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.].
    07/2014; 45(4):338-342. DOI:10.3928/23258160-20140605-01
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    ABSTRACT: To review clinical and structural outcomes of ocriplasmin for treatment of stage 2 macular holes.
    07/2014; 45(4):293-7. DOI:10.3928/23258160-20140709-05
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    ABSTRACT: Silicone oil continues to be an important aid in retinal detachment surgery. We report a case in which disparate responses to silicone oil were noted in the conjunctiva and intraocularly. Intraocularly, the oil permeated a fibrous membrane that formed behind a keratoprosthesis, the first example of this phenomenon. We detail the histological response to the oil at this site as well as a distinctly different reaction present to oil in the conjunctiva of the same eye. The divergence of histological responses provides a demonstration of the eye's apparent retained capacity to protect against intraocular inflammation, despite multiple previous surgeries.
    06/2014; 4:15. DOI:10.1186/s12348-014-0015-y
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    ABSTRACT: To report the ocular injuries sustained by survivors of the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas.
    Ophthalmology 05/2014; 121(9). DOI:10.1016/j.ophtha.2014.04.004 · 6.17 Impact Factor
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    ABSTRACT: Adult-onset foveomacular vitelliform dystrophy (AOFVD) is a clinically heterogeneous maculopathy that may mimic other conditions and be difficult to diagnose. It is characterized by late onset, slow progression and high variability in morphologic and functional alterations. Diagnostic evaluation should include careful ophthalmoscopy and imaging studies. The typical ophthalmoscopic findings are bilateral, asymmetric, foveal or perifoveal, yellow, solitary, round to oval elevated subretinal lesions, often with central pigmentation. The lesions characteristically demonstrate increased autofluorescence and hypofluorescent lesions surrounded by irregular annular hyperfluorescence on fluorescein angiography. Optical coherence tomography studies demonstrate homogenous or heterogeneous hyperreflective material between the retinal pigment epithelium and the neurosensory retina. The visual prognosis is generally favorable, but visual loss can occur from chorioretinal atrophy and choroidal neovascularization.
    Saudi Journal of Ophthalmology 04/2014; 28(2). DOI:10.1016/j.sjopt.2014.02.001
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    ABSTRACT: Proliferative vitreoretinopathy (PVR) is a blinding disorder that occurs in eyes with rhegmatogenous retinal detachment and in eyes that have recently undergone retinal detachment surgery. There are presently no treatment strategies to reduce the risk of developing PVR in eyes with retinal detachment, and surgical intervention is the only option for eyes with retinal detachment and established PVR. Given the poor visual outcome associated with the surgical treatment of PVR, considerable work has been done to identify pharmacologic agents that could antagonize the PVR process. Intensive efforts to identify molecular determinants of PVR implicate vitreal growth factors. A surprise that emerged in the course of testing the 'growth factor hypothesis' of PVR was the existence of a functional relationship amongst growth factors that engage platelet-derived growth factor (PDGF) receptor α (PDGFRα), a receptor tyrosine kinase that is key to pathogenesis of experimental PVR. Vascular endothelial cell growth factor A (VEGF), which is best known for its ability to activate VEGF receptors (VEGFRs) and induce permeability and/or angiogenesis, enables activation of PDGFRα by a wide spectrum of vitreal growth factors outside of the PDGF family (non-PDGFs) in a way that triggers signaling events that potently enhance the viability of cells displaced into vitreous. Targeting these growth factors or signaling events effectively neutralizes the bioactivity of PVR vitreous and prevents PVR in a number of preclinical models. In this review, we discuss recent conceptual advances in understanding the role of growth factors in PVR, and consider the tangible treatment strategies for clinical application.
    Progress in Retinal and Eye Research 01/2014; DOI:10.1016/j.preteyeres.2013.12.006 · 9.90 Impact Factor
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    ABSTRACT: To describe a favorable outcome after the surgical repair of a very large macular hole with a neurosensory operculum.
    Retinal Cases & Brief Reports 01/2014; 8(2):138-40. DOI:10.1097/ICB.0000000000000025
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    ABSTRACT: PurposeTo identify factors associated with visual outcomes in patients with diabetic macular edema (DME) treated with ranibizumab (RBZ) in the Ranibizumab for Edema of the mAcula in Diabetes-Protocol 2 (READ-2) Study.Patients and methodsOptical coherence tomography scans, fundus photographs, and fluorescein angiograms (FAs) were graded and along with baseline characteristics were correlated with month (M) 24 visual outcome of best-corrected visual acuity (BCVA) ≤20/100 (poor outcome) vs >20/100 (better outcome).ResultsOf 101 patients with a M20 visit or beyond, 27 (27%) had BCVA ≤20/100. Comparison of patients with or without poor outcome showed mean baseline BCVA of 16.8 letters (20/125) in the former compared with 30.4 letters (20/63; P<0.001). Mean change in BCVA between baseline and M24 was -2.6 letters in the poor outcome group compared with +9.8 letters (P<0.001). Foveal thickness (FTH) at M24 was 374.1 μm in the poor outcome group compared with 268.8 μm (P<0.01), a difference driven by 14 patients with mean FTH of 450.3 μm. Foveal atrophy occurred in 65% (11/17) in the poor outcome group compared with 17%(12/71, P=0.001). Persistent edema was noted in 52% (14/27) of patients with poor outcome. Laser scars near foveal center were significantly more common in patients with poor outcome who did not have edema vs those who did (78% (7/9) vs 23% (3/13) P=0.03).Conclusion Poor baseline BCVA (≤20/125) in DME patients predicts poor visual outcome (≤20/100) after 2 years of treatment with RBZ and/or focal/grid laser, often due to foveal atrophy and/or persistent edema.Eye advance online publication, 22 November 2013; doi:10.1038/eye.2013.245.
    Eye (London, England) 11/2013; DOI:10.1038/eye.2013.245 · 1.90 Impact Factor

Publication Stats

1k Citations
265.23 Total Impact Points

Institutions

  • 2013–2015
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2014
    • Schepens Eye Research Institute
      Boston, Massachusetts, United States
  • 2011–2014
    • Massachusetts Eye and Ear Infirmary
      Boston, Massachusetts, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2010–2011
    • University of Southern California
      • • Doheny Eye Institute
      • • Department of Ophthalmology
      Los Angeles, CA, United States
  • 2009–2011
    • Doheny Eye Institute
      Los Ángeles, California, United States
    • Keck School of Medicine USC
      Los Ángeles, California, United States
  • 2008–2010
    • University of California, Los Angeles
      • Department of Ophthalmology
      Los Ángeles, California, United States
  • 1996–2008
    • Kresge Eye Institute
      Detroit, Michigan, United States
  • 2007
    • Henry Ford Hospital
      Detroit, Michigan, United States
  • 2002–2003
    • Wayne State University
      Detroit, Michigan, United States