Esen Karamursel Akpek

Johns Hopkins University, Baltimore, Maryland, United States

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Publications (88)282.14 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To study the long-term outcomes of Boston type 1 keratoprosthesis (KPro) surgery.
    Ophthalmology 07/2014; · 5.56 Impact Factor
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    ABSTRACT: The aim of this study was to review the frequency and types of inflammatory systemic diseases in a cohort of patients with dry eye, and identify clinical features suggesting the presence of these.
    Cornea 06/2014; · 1.75 Impact Factor
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    ABSTRACT: Extranodal Rosai-Dorfman disease is a rare benign condition recently reported to sometimes show features of IgG4-related disease. The purpose of this study was to describe the corneal-limbal manifestation of the entity and to investigate whether numerous IgG4-positive plasma cells are associated with the disease at this site. This is an interventional retrospective small case series. Two patients presenting with painless limbal mass lesions underwent total excisional biopsy with anterior lamellar keratoplasty for diagnostic and therapeutic purposes. Histopathologic evaluation of the specimens revealed inflammatory lesions containing atypical S100-immunoreactive histiocytes diagnostic of Rosai-Dorfman disease, but not an increase in the IgG4-positive plasma cells. Point mutations (V600E) in the BRAF oncogene were absent. Rosai-Dorfmann disease should be considered in the differential diagnosis of limbal mass lesions. Involvement at this site was not associated with BRAF mutation or IgG4 abnormalities in the cases examined.
    Cornea 05/2014; · 1.75 Impact Factor
  • Ocular immunology and inflammation 04/2014; · 0.72 Impact Factor
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    ABSTRACT: People with dry eye often complain of difficulty reading, but this perceived deficit has not been appropriately quantified. The purpose of this study is to determine if dry eye is associated with measurable reading deficits. A cross-sectional study of 1981 participants in the Salisbury Eye Evaluation, a population-based study of the elderly. Dry eye symptoms were identified by questionnaire and clinically significant dry eye was defined as the presence of dry eye symptoms and positive Schirmer testing or ocular surface staining in either eye. Spoken reading speed was measured using short text passages. Subjects self-reported if they did not read or had difficulty reading newsprint. 13.8% of subjects (274/1981) had dry eye symptoms and 3.1% (62/1981) had clinically significant dry eye. There was no difference in reading speed between subjects with dry eye symptoms or clinically significant dry eye and their controls (p=0.99 and 0.78, respectively) in multivariable models. Compared with asymptomatic subjects, however, subjects with dry eye symptoms were more likely to report reading difficulty (OR=1.7, 95% CI 1.3 to 2.4, p<0.01) and not reading newsprint (OR=1.9, 95% CI 1.0 to 3.6, p=0.04). Similarly, subjects with clinically significant dry eye were more likely to report difficulty reading newsprint (OR=2.5, 95% CI 1.4 to 4.5, p<0.01) or not reading newsprint at all (OR=4.1, 95% CI 1.6 to 10.7, p<0.01) as compared with subjects without dry eye signs or symptoms. Dry eye did not significantly affect reading speed but was associated with self-reported reading difficulty and avoidance of newspaper reading in this elderly population-based sample.
    The British journal of ophthalmology 10/2013; · 2.92 Impact Factor
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    ABSTRACT: Theoretically, autologous serum tears (AST) have a potential advantage over traditional therapies based on the assumption that AST serve not only as a lacrimal substitute to provide lubrication, but also contain other biochemical components mimicking natural tears more closely. The application of AST in dry eye treatment has gained popularity as an adjunctive treatment for dry eye. However, thus far there has been no systematic review assessing the effectiveness of AST in the treatment for dry eye. To assess the safety and effectiveness of AST eye drops compared to artificial tears for treating dry eye. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to April 2013), EMBASE (January 1980 to April 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to April 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We also searched the Science Citation Index Expanded database and reference lists of included studies. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 April 2013. We included randomized controlled trials (RCTs) in which AST was compared to artificial tears in the treatment of dry eye. Two review authors independently screened all retrieved articles. Methodological quality and study characteristics of the included trials were assessed by two review authors. We contacted investigators for missing data. For both primary and secondary outcomes, we reported mean differences with corresponding 95% confidence intervals (CIs) for continuous outcomes. Four eligible trials randomized individuals (n = 72 participants) with dry eye of various etiologies (Sjögren's syndrome-related dry eye, non-Sjögren's syndrome dry eye and postoperative dry eye induced by laser-assisted in situ keratomileusis (LASIK)) to either AST or artificial tear treatment. The quality of the evidence provided by these trials was variable. Incomplete outcome reporting and heterogeneity in the participant populations prevented the inclusion of these trials in a summary meta-analysis. Based on the results of two trials in 32 participants, 20% AST may provide some improvement in participant-reported symptoms compared to traditional artificial tears after two weeks of treatment. One trial also showed promising results with a mean difference in tear break-up time (TBUT) of 2.00 seconds (95% CI 0.99 to 3.01 seconds) between 20% AST and artificial tears after two weeks. These findings in participant-reported symptom improvement and tear film stability were not consistent in the other trials. Based on additional objective clinical assessments, AST was not associated with improvements in aqueous tear production measured by Schirmer's test (two trials, 33 participants), ocular surface condition with fluorescein (four trials, 72 participants) or Rose Bengal staining (three trials, 60 participants), and epithelial metaplasia by impression cytology compared to artificial tears (one trial, 13 participants). Data on adverse effects were not reported consistently in the included studies; however, there were no reported serious adverse events associated with the collection of and treatment with AST. Although 20% AST may provide some benefit in improving participant-reported symptoms in the short-term (two weeks), there is still a lack of sufficient and strong evidence to determine whether the application of AST offers a significant advantage over artificial tears on dry eye. Well-planned, large, high-quality RCTs are warranted, comparing different concentrations of AST to artificial tears using standardized questionnaires to measure patient-reported outcomes and objective clinical tests as well as objective biomarkers, to provide a robust and reliable clinical evidence base.
    Cochrane database of systematic reviews (Online) 08/2013; 8:CD009327. · 5.70 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. DESIGN: Cross-sectional study. PARTICIPANTS: Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. METHODS: Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. MAIN OUTCOME MEASURES: Tear film breakup time (TBUT), corneal staining score (0-15), and Schirmer's test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vision-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. RESULTS: Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P<0.001), but groups did not differ with regard to TBUT or Schirmer's results (P>0.20 for both). Multivariate regression models showed that topical glaucoma therapy burden was associated with a significantly higher total corneal staining grade (β, +0.9 for each additional glaucoma drop; 95% confidence interval [CI], 0.5-1.3; P<0.001), but not with TBUT or Schirmer's results (P>0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; P<0.001). This largely was the result of higher vision-related subscores in the glaucoma group (11.1 vs. 3.3; P<0.001). Ocular discomfort-related subscores, however, were similar in both groups (5.7 vs. 4.6; P = 0.30). In multivariate analyses, each 5-decibel decrement in better-eye VF mean deviation was associated with a 4.7-point increase in total OSDI score (95% CI, 1.9-7.5; P = 0.001) and a 3.7-point increase in the vision-related subscore (95% CI, 1.7-5.6; P<0.001) but did not predict a higher discomfort-related subscore (β, 1.1 point; P = 0.07). Topical glaucoma therapy burden was not associated with higher total OSDI score or vision- or discomfort-related subscore (P>0.20 for all). CONCLUSIONS: Glaucoma is associated with significant ocular surface disease, and topical glaucoma therapy burden seems predictive of corneal staining severity. However, OSDI is a poor metric for capturing ocular surface disease in glaucoma because symptoms seem to be related largely to VF loss. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
    Ophthalmology 05/2013; · 5.56 Impact Factor
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    ABSTRACT: We report necrotizing scleritis as a serious complication of a cosmetic eye whitening procedure that involves the use of intraoperative and postoperative topical mitomycin C. This is a single case report. A 59-year-old Caucasian male with a history of blepharitis status post uncomplicated LASIK refractive surgery reported chronic conjunctival hyperemia for 15 years prior to undergoing a cosmetic eye whitening procedure. He presented to our clinic 12 months after the cosmetic eye whitening procedure with progressive bilateral necrotizing scleritis and scleral calcification. Chronic conjunctival hyperemia may prompt patients to seek surgical correction with cosmetic eye whitening procedures. However, conjunctival hyperemia secondary to tear deficiency and evaporative dry eye may predispose to poor wound healing. Serious complications including necrotizing scleritis may result from cosmetic eye whitening procedures and the use of topical mitomycin C.
    Journal of ophthalmic inflammation and infection. 01/2013; 3(1):39.
  • Divya Srikumaran, Esen K Akpek
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    ABSTRACT: This review article summarizes the recent literature in regards to advancements in the diagnosis and management of mucous membrane pemphigoid (MMP) published in the English literature since May 2011. MMP is an uncommon, subepithelial blistering conjunctivitis that is commonly associated with vision loss. Distinct subgroups of MMP have recently been identified using advanced immunohistochemical techniques. Antiepiligrin MMP has been described as a distinct entity with a relationship to certain solid organ malignancies. There is evidence that conventional immunomodulators such as mycophenolate mofetil and biologics such as rituximab are effective in halting disease progression. Unfortunately, the majority of patients at presentation to tertiary centers already have advanced disease. Novel regenerative techniques such as stem cell therapy as well as traditional surgical approaches such as keratoprosthesis might be required for the restoration of vision in patients with significant corneal scarring. Despite advances in available immunosuppressive treatment regimens, significant ocular morbidity persists possibly secondary to difficulty in diagnosis. Additionally, absence of clinically detectable inflammation in a significant proportion of patients causes delay in the treatment and leads to progressive scarring. Surgical management of the complications of MMP remains challenging, with high failure rates over long-term follow-up.
    Current opinion in ophthalmology 11/2012; 23(6):523-7. · 2.49 Impact Factor
  • Michelle Hessen, Esen K Akpek
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    ABSTRACT: This review was carried out to study the frequency, and severity of ocular surface involvement at the setting of allogeneic hematopoietic stem cell transplantation and subsequent graft-versus-host disease (GVHD) and evaluate the clinical outcomes of newer treatments. Ocular involvement has been reported in 60-90% of patients with chronic GVHD. Although dry eye is the most frequent finding occurring in the great majority of patients (up to 90%), posterior segment complications are also not infrequent, seen in 12.8% of patients after bone marrow transplantation. Anti-inflammatory treatments particularly T-cell suppressants seem to have a beneficial effect in managing GVHD. Corticoteroids, calcineurin inhibitors, such as cyclosporine and tacrolimus, as well as antifibrotic agents such as tranilast are available options for topical application. Cyclosporine ophthalmic drop seems to be a well tolerated and effective treatment modality; favorable results have been demonstrated with increased dosage. GVHD is an increasingly frequent cause of ocular surface morbidity with the potential of visual loss from corneal involvement. Early diagnosis and aggressive local as well as systemic treatment can be vision saving.
    Current Opinion in Allergy and Clinical Immunology 08/2012; 12(5):540-7. · 3.40 Impact Factor
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    ABSTRACT: To report the occurrence of chronic hypotony as a complication following Boston type 1 keratoprosthesis (KPro) implantation and to determine associated risk factors. Retrospective case series. The medical records of all patients undergoing KPro implantation between January 2004 and November 2010 at the Wilmer Eye Institute were reviewed. Patients who developed chronic hypotony following Boston type 1 KPro implantation not attributable to anatomic problems (eg, retinal detachment, overfiltering glaucoma tube shunts, tissue necrosis with aqueous leak) or other causes were identified. Demographics and preoperative, intraoperative, and postoperative clinical findings were analyzed. Light microscopic examination of an enucleated globe as well as fibrous retroprosthetic membranes excised at the time of vitrectomy from another patient was performed. Sixty-eight eyes received KPro implantation over the study period. Six eyes experienced chronic hypotony, with a median time of 18.5 months between KPro implantation and the onset of hypotony. The incidence of chronic hypotony in this series was calculated to be 3.7% at 1 year (95% CI = 0.9%-14.0%) and 13.3% at 2 years (95% CI = 5.5%-30.0%). Of the 6 eyes that developed chronic hypotony, 5 had a previous history of glaucoma or ocular hypertension, but only 3 had a glaucoma drainage implant. All eyes progressing to chronic hypotony were noted to have a retroprosthetic membrane prior to the onset of hypotony. Cox regression modeling demonstrated an increased risk of chronic hypotony in eyes with retroprosthetic membranes (P < .01) but no increase in risk for older patients (P > .1), eyes with glaucoma drainage implants (P > .5), or a previous history of multiple donor corneal transplants (P > .5). Chronic hypotony can be a significant complication of KPro implantation and should be assessed carefully in eyes with retroprosthetic membranes. Further study of an association between hypotony and retroprosthetic membrane formation may be useful to gain insight into the mechanism of this complication and potential prevention or treatment options.
    American journal of ophthalmology 05/2012; 154(2):266-271.e1. · 3.83 Impact Factor
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    ABSTRACT: To report the use of a sterile, γ-irradiated corneal tissue without viable endothelium (VisionGraft Sterile Cornea; Tissue Banks International) in lieu of fresh donor cornea in Boston type 1 keratoprosthesis (KPro) implantation. Retrospective, interventional small case series. Eleven eyes of 11 patients underwent Boston type 1 keratoprosthesis implantation using VisionGraft Sterile Cornea between April 2009 and October 2010. Precut donut-shaped corneal lenticules, using femtosecond laser, measuring 8.5 mm in diameter with a 3-mm central hole were used. Surgical procedures were uneventful. Complete corneal re-epithelization was noted within 10 days in all cases. No complications related to the donor cornea (eg, stromal necrosis, wound leak, or device extrusion) occurred over an average follow-up of 16.5 months. VisionGraft Sterile Cornea eliminates the need for use of fresh donor corneal tissue for Boston type 1 keratoprosthesis procedures, which makes this procedure a viable sight-restoring option when donor corneal tissues are not readily available.
    American journal of ophthalmology 05/2012; 154(3):495-498.e1. · 3.83 Impact Factor
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    ABSTRACT: To evaluate the long-term effectiveness of the combination of topical cyclosporine drops and tacrolimus ointment in the treatment of steroid-dependent atopic keratoconjunctivitis (AKC). Ten patients with moderate to severe AKC participated in the study. Topical cyclosporine 0.05% was used, as a monotherapy, 6 times daily during the first month of the study, followed by 4 times daily during the second month. The patients were then instructed to self-treat with topical cyclosporine at a dose ranging from 2 to 6 times daily depending on the severity of the disease. Tacrolimus ointment 0.03% was applied on the lid skin. Follow-up examinations were performed approximately every 3 months. Each patient completed a follow-up period of at least 12 months. Symptoms and signs of AKC were assessed on the day of enrollment, on days 28, 56, and 63, and at subsequent follow-up visits. Flare-ups of AKC requiring steroid use and progression of the disease findings were also recorded. All patients experienced significant improvement of their symptoms and signs during the first 2 months of the study. Two patients were lost to follow-up after the initial 2 months. One patient was noncompliant and continued the treatment only for 7 months. During the median treatment period of 21.5 months for the 7 continuing patients, a total of only 2 flare-up episodes were noted requiring topical steroids. Adequate topical immunomodulation using topical calcineurin inhibitors may eliminate the need for steroids and favorably alter the long-term prognosis of patients with AKC.
    Cornea 02/2012; 31(6):649-54. · 1.75 Impact Factor
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    ABSTRACT: Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye condition that affects both children and adults. It is common in all ethnic groups and across all ages. Although infrequent, blepharitis can lead to permanent alterations to the eyelid margin or vision loss from superficial keratopathy (abnormality of the cornea), corneal neovascularization, and ulceration. Most importantly, blepharitis frequently causes significant ocular symptoms such as burning sensation, irritation, tearing, and red eyes as well as visual problems such as photophobia and blurred vision. The exact etiopathogenesis is unknown, but suspected to be multifactorial, including chronic low-grade infections of the ocular surface with bacteria, infestations with certain parasites such as demodex, and inflammatory skin conditions such as atopy and seborrhea. Blepharitis can be categorized in several different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis. Second, categorization is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic blepharitis), and posterior, or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis and stratifies anterior and posterior blepharitis. To examine the effectiveness of interventions in the treatment of chronic blepharitis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Despite identifying 34 trials related to treatments for blepharitis, there is no strong evidence for any of the treatments in terms of curing chronic blepharitis. Commercial products are marketed to consumers and prescribed to patients without substantial evidence of effectiveness. Further research is needed to evaluate the effectiveness of such treatments. Any RCT designed for this purpose should separate participants by type of condition (e.g. staphylococcal blepharitis or MGD) in order to minimize imbalances between groups (type I errors) and to achieve statistical power for analyses (prevent type II errors). Medical interventions and commercial products should be compared with conventional lid hygiene measures, such as warm compresses and eyelid margin washing, to determine effectiveness, as well as head-to-head to show comparative effectiveness between treatments. Outcomes of interest should be patient-centered and measured using validated questionnaires or scales. It is important that participants be followed long-term, at least one year, to assess chronic outcomes properly.
    Cochrane database of systematic reviews (Online) 01/2012; 5:CD005556. · 5.70 Impact Factor
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    ABSTRACT: To describe the clinical features and outcomes of corneal melt associated with Boston type I keratoprosthesis (KPro) implantation. Medical records of patients who experienced corneal melt following KPro implantation were reviewed retrospectively. Sixty-six adult patients had KPro implantation from January 2004 to November 2010. Six patients had an underlying inflammatory ocular surface disorder. Four experienced corneal melt (6.1%) 5-42 months after the initial surgery. One patient was diagnosed with Sjögren's syndrome as a result of diagnostic workup following melt. Three patients were treated with systemic immunomodulatory therapy; two experienced fungal keratitis and subsequent endophthalmitis. KPro had to be explanted and replaced with donor cornea in all cases. KPro-associated corneal melt is uncommon and appears to occur in patients with preexisting inflammatory disorders, which might not have been previously diagnosed. Timely explantation of KPro and replacement with donor cornea may prevent a poor outcome.
    Ocular immunology and inflammation 12/2011; 19(6):413-8. · 0.72 Impact Factor
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    ABSTRACT: To report the short-term outcome of gamma-irradiated sterile cornea in corneal and glaucoma patch graft surgeries when viable endothelium is not necessary. Surgeons who have used the irradiated corneas were asked to rate their impression from 1 (fair) to 4 (very good). Specific intraoperative questions included availability, ease of use, clarity, thickness, tensile strength, and suturing. Postoperative outcomes included epithelialization, biological incorporation, and clarity of tissue, as well as any adverse outcomes. Irradiated sterile cornea has been used in more than 150 surgeries so far. The major uses for irradiated cornea were as glaucoma patch graft (65.3%), as corneal patch graft (14%), in anterior lamellar keratoplasty (10.7%), and in keratoprosthesis (10%). The mean score for packaging of tissue was 3.75 (SD, 0.45), ease of use 3.83 (SD, 0.39), clarity 3.62 (SD, 0.51), thickness 3.67 (SD, 0.49), tensile strength 3.64 (SD, 0.50), and suturing 3.62 (SD, 0.65). Postoperative outcomes were also favorable, including epithelialization (mean ± SD, 3.46 ± 0.69), biological incorporation (mean ± SD, 3.46 ± 0.69), and clarity (mean ± SD, 3.43 ± 0.85). There were 4 episodes of corneal melt (all occurred in patients with previous corneal melt). There were no reported cases of tissue rejection or infection. Gamma-irradiated sterile cornea is a promising new development that may help increase the supply of donor cornea tissue. It virtually eliminates the risk of infection while providing a long shelf life. It is particularly helpful in emergency situations or in remote areas. However, longer follow-up and a prospective study comparing the outcomes of the irradiated corneas with those of the optisol-stored corneas are needed.
    Cornea 12/2011; 30(12):1387-91. · 1.75 Impact Factor
  • Canan Asli Utine, Jonathan Tzu, Karen Dunlap, Esen Karamursel Akpek
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    ABSTRACT: To compare the short-term visual and clinical outcomes of explantation versus preservation of a posterior chamber intraocular lens (PC IOL) during keratoprosthesis implantation. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. Comparative case series. This study comprised patients who had implantation of an aphakic or a pseudophakic Boston type I keratoprosthesis based on their lenticular status. Only adult patients who were pseudophakic with a PC IOL at the time of surgery and who had at least 1 year of follow-up were included. The postoperative refractive error, uncorrected and corrected visual acuities, and intraoperative and postoperative complications were analyzed. Fifteen patients with an unstable PC IOL had aphakic keratoprosthesis implantation with IOL explantation, and 10 patients had implantation of a pseudophakic keratoprosthesis. The postoperative best-ever visual acuity and magnitude of visual acuity improvement were comparable in the 2 groups. The mean postoperative spherical equivalent refractive error was significantly better in the aphakic group (-0.66 diopter [D] ± 1.59 [SD]) than in the pseudophakic group (-3.25 ± 3.20 D) (P=.04). The rate of postoperative complications in the 2 groups was low (P>.05). In this small short-term study, refractive outcomes were better in aphakic patients than in patients who were left pseudophakic. Although not frequent, posterior segment complications after IOL explantation might necessitate further surgeries and cause decreased visual acuity during long-term follow-up in the aphakic group.
    Journal of Cataract and Refractive Surgery 09/2011; 37(9):1615-22. · 2.75 Impact Factor
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    ABSTRACT: Outcomes-based review of reported treatment options for patients with dry eye secondary to Sjögren's syndrome (SS). Dry eye affects many individuals worldwide. Significant proportion of patients with dry eye has underlying SS, a progressive autoimmune condition. The few suggested guidelines for the treatment of dry eye are mostly based on severity of symptoms and/or clinical findings rather than on outcomes analysis, and do not differentiate SS from other causes of dry eye. METHODS AND LITERATURE REVIEW: A search strategy was developed to identify prospective, interventional studies of treatments for SS-associated dry eye from electronic databases. Eligible references were restricted to English-language articles published after 1975. These sources were augmented by hand searches of reference lists from accessed articles. Study selection, data extraction, and grading of evidence were completed independently by ≥4 review authors. The searches identified 3559 references as of August 10, 2010. After duplicate review of the titles and abstracts, 245 full-text papers were assessed, 62 of which were relevant for inclusion in the review. In the current literature on SS-associated dry eye, there is a paucity of rigorous clinical trials to support therapy recommendations. Nonetheless, the recommended treatments include topical lubricants, topical anti-inflammatory therapy, and tear-conserving strategies. The efficacy of oral secretagogues seems greater in the treatment of oral dryness than ocular dryness. Although oral hydroxychloroquine is commonly prescribed to patients with SS to alleviate fatigue and arthralgias, the literature lacks strong evidence for the efficacy of this treatment for dry eye.
    Ophthalmology 04/2011; 118(7):1242-52. · 5.56 Impact Factor
  • Canan Asli Utine, Jonathan Heng Tzu, Esen Karamursel Akpek
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    ABSTRACT: To report the clinical outcomes of lamellar keratoplasty using sterile, gamma-irradiated corneal tissues (VisionGraft) for partial-thickness corneal defects. Interventional case series. The medical records of 10 patients with partial-thickness corneal defects who were operated at The Wilmer Eye Institute between April 2009 and December 2009 were retrospectively reviewed. Indications for surgery included corneal melt with microperforation (n = 6), keratoprosthesis-associated corneal melt (n = 2), and noninflammatory limbal lesions (n = 2). The grafts were fashioned from full- or partial-thickness tissues using disposable trephines, based on the depth, shape, and size of the defect in the recipient bed, and were secured with multiple interrupted 10/0 nylon sutures. Rate of epithelialization and clarity of the grafts at the last visit were assessed retrospectively. All but 1 graft became epithelialized between postoperative 1st and 13th days. Corneal inflammation progressed in the 1 patient with Boston type 1 keratoprosthesis-associated corneal melt, probably attributable to the progression of underlying Sjögren syndrome, despite initiation of systemic immunomodulatory treatment, and required replacement of the device. The donor tissues remained clear in all the other cases over a period of 7 to 15 months. No immune rejection, infection, significant opacification, or neovascularization of the donor tissues were noted during a follow-up period. VisionGraft may be considered in lieu of fresh donor corneas for lamellar corneal patch grafts because of its availability, easy handling, and lack of immunogenicity.
    American journal of ophthalmology 01/2011; 151(1):170-174.e1. · 3.83 Impact Factor
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    Investigative ophthalmology & visual science 01/2011; 52(4):2065-85. · 3.43 Impact Factor

Publication Stats

1k Citations
282.14 Total Impact Points

Institutions

  • 2000–2014
    • Johns Hopkins University
      • Wilmer Eye Institute
      Baltimore, Maryland, United States
  • 2012
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, MD, United States
  • 1999–2012
    • Johns Hopkins Medicine
      • Wilmer Eye Institute
      Baltimore, Maryland, United States
  • 2008
    • Ramathibodi Hospital
      Krung Thep, Bangkok, Thailand
  • 2001
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1999–2001
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 1997–2000
    • Massachusetts Eye and Ear Infirmary
      • Department of Ophthalmology
      Boston, MA, United States