Esen Karamursel Akpek

Johns Hopkins University, Baltimore, Maryland, United States

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Publications (99)355.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To report the ocular complications of primary Sjögren's Syndrome (SS) in men. Retrospective cohort study. Setting: Tertiary-care SS center. 163 consecutive primary Sjögren's Syndrome patients evaluated between January 2007 and March 2013. Frequency of extraglandular ocular and systemic manifestations and serological results in men compared to women. 14 (9%) of the 163 primary Sjögren's Syndrome patients were men. On initial presentation, men were a decade older (61 vs 50 years, p<0.01) and less likely than women to have a prior diagnosis of SS (43% vs 65%, p=0.09). A majority of men reported dry eye on presentation (92%), albeit less chronic compared to women (5.9 vs 10.8 years, p=0.07). Men were more likely to present with serious ocular complications than women (43% vs 11%, p=0.001). Extraglandular systemic complications of SS (i.e. vasculitis, interstitial nephritis) were also more common in men (64% vs 40%, p=0.07). Further, men were more likely to be negative for anti-SSA/Ro, anti-SSB/La, and antinuclear antibodies than women (36% men vs 11% women, p=0.01). Men with primary SS have a higher frequency of serious ocular and systemic manifestations. Although primary Sjögren's Syndrome is typically considered a disease of middle-aged women, it may be underdiagnosed and consequentially more severe in men. Physicians should have a lower threshold to test for SS in men with dry eye. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 06/2015; 160(3). DOI:10.1016/j.ajo.2015.06.004 · 3.87 Impact Factor
  • Divya Srikumaran · Beatriz Munoz · Esen Karamursel Akpek
    Ophthalmology 05/2015; 122(5):e31-e32. DOI:10.1016/j.ophtha.2014.09.038 · 6.14 Impact Factor
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    ABSTRACT: To identify predictors of visual outcomes following Boston type 1 keratoprosthesis (KPro) implantation. Retrospective chart review. Data regarding pre-operative clinical and demographic characteristics and postoperative course were collected. Patients: Fifty-nine eyes of 59 adult patients who underwent KPro implantation between January 2006 and March 2012 at a single tertiary care center. Main Outcome Measures: Pre-operative factors associated with all-cause and glaucoma-related loss of visual acuity from the best postoperative visual acuity noted. Fifty two of 59 eyes (88%) achieved improved vision post implantation, with 7 eyes failing to gain vision as a result of pre-existing glaucoma (n=4) or retino-choroidal disease (n=3). Twenty one eyes (21/52, 40%) maintained their best ever visual acuity at last visit (mean follow-up period was 37.8 months). The likelihood of maintaining best ever vision was 71% at 1 year, 59% at 2 years and 48% at 3 years. Primary KPro implantation was associated with a higher likelihood of losing best ever vision as compared to KPro implantation as a repeat corneal procedure (Hazard Ratio [HR]=3.06; p=.006). The main reasons for post-implantation vision loss was glaucoma (12/31, 39%), and the risk of glaucomatous visual acuity loss was 15% at 2 years and 27% at 3 years. Prior trabeculectomy was associated with a higher rate of vision loss from glaucoma (HR=3.25, p=.04). Glaucoma is the primary reason for loss of visual acuity after KPro implantation. Conditions necessitating primary KPro surgery are associated with more frequent all-cause vision loss. Prospective trials are necessary to better determine which clinical features best predict KPro success. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 12/2014; 113(4). DOI:10.1016/j.ajo.2014.12.024 · 3.87 Impact Factor
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    ABSTRACT: Purpose To report vision-threatening ocular manifestations of primary Sjögren’s syndrome (SS). Design Retrospective review. Participants Consecutive patients evaluated at an SS center between January 2007 and May 2011. Methods Data collection was completed in March 2013. The 2002 American-European consensus criteria were used for diagnosis of SS. Main Outcome Measures Frequency of extraglandular ocular findings and timing of their diagnosis relative to that of SS and dry eye were assessed. Results One hundred sixty-three patients were included. Almost all patients (98%) had a history of dry eye for an average of 10.4 years (median, 7.9 years) before presentation. One or more extraglandular ocular manifestations were present in 40 patients (25%), and vision-threatening findings were present in 22 patients (13%). Twelve patients (55%) with a vision-threatening ocular finding did not have a diagnosis of SS at presentation. Sixty-eight patients (42%) had extraglandular systemic manifestations of SS. Patients with vision-threatening ocular findings were 3.9 times more likely to have systemic involvement (95% confidence interval, 1.4–11.0; P = 0.010). Peripheral neuropathy, interstitial nephritis, and vasculitis were more common in those with vision-threatening ocular findings compared with patients without (P < 0.05 for all). Conclusions These results from a tertiary referral-based cohort demonstrate that primary SS frequently is associated with ocular and systemic complications. Dry eye precedes these findings on average by 1 decade. Therefore, ophthalmologists should consider assessing for SS in patients with clinically significant dry eye.
    Ophthalmology 12/2014; 122(1). DOI:10.1016/j.ophtha.2014.07.026 · 6.14 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the clarity of gamma-irradiated sterile corneal donor lenticules. Broadband UV, visible, and near-infrared (200-850 nm) light transmission was measured through gamma-irradiated, sterile partial-thickness, and full-thickness donor lenticules and fresh corneal tissues and compared with standard acrylic intraocular lens (IOL) implants using a conventional spectrophotometer technique. All tissues had high light transmission (≥ 90%) in the visible and near-infrared regions and very low (<2%) transmission below 290 nm. Differences in light transmission between irradiated and fresh cornea types were observed between 300 and 450 nm, which mirrored differences in light transmission through their respective storage solutions. Light transmission through partial-thickness irradiated donor lenticules was greatest across all wavelengths. All corneal tissues exhibited higher transmission than acrylic IOL implant across all wavelengths. Gamma-irradiated donor lenticules are comparable with fresh corneas regarding light transmission, with both partial-thickness and full-thickness lenticules having greater transmission than standard IOL. We would expect the optical performance of gamma-irradiated donor lenticules to be comparable to fresh cornea if used for lamellar corneal procedures that do not require a viable endothelium.
    Cornea 12/2014; 34(2). DOI:10.1097/ICO.0000000000000323 · 2.04 Impact Factor
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    ABSTRACT: Individuals who have failed one or more full thickness penetrating keratoplasties (PKs) may be offered repeat corneal surgery using an artificial or donor cornea. An artificial or prosthetic cornea is known as a keratoprosthesis. Both donor and artificial corneal transplantations involve removal of the diseased and opaque recipient cornea (or the previously failed cornea) and replacement with another donor or prosthetic cornea.
    Cochrane database of systematic reviews (Online) 11/2014; 11(11):CD009561. DOI:10.1002/14651858.CD009561.pub2 · 6.03 Impact Factor
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    ABSTRACT: Purpose: To study the long-term outcomes of Boston type 1 keratoprosthesis (KPro) surgery. Design: Retrospective, multicenter case series. Participants: A total of 158 eyes of 150 patients underwent KPro implantation at 5 participating tertiary centers in the United States between January 2003 and December 2006. Of those, 139 eyes of 133 patients were included in the analyses. Methods: The medical records of consecutive adult patients who received KPro surgery were reviewed. All patients with at least 1 postoperative visit were retained in the outcomes analyses. In eyes in which a repeat KPro procedure was performed, only the outcomes of the initial surgery were analyzed. Main Outcome Measures: Visual acuity (VA) outcomes, postoperative complications, and device retention. Results: The mean follow-up was 46.7 +/- 26 months with all but 4 eyes having at least 6 months of follow-up. Preoperatively, only 10.8% of the eyes had VA of >= 20/200. Postoperatively, the VA in 70% of eyes improved to >= 20/200. The probability of maintaining VA of >= 20/200 at 7 years was 50%. The device retention rate was estimated at 67% at 7 years. The 7-year cumulative incidence of complications was 49.7% for retroprosthetic membrane formation, 21.6% for glaucoma surgery, 18.6% for retinal detachment, and 15.5% for endophthalmitis. Conclusions: Although the risk for complications with longer follow-up seemed to increase, this large multicenter cohort demonstrates favorable outcomes with KPro, with a large number of patients achieving and retaining useful vision over a 7-year period. (C) 2014 by the American Academy of Ophthalmology.
    Ophthalmology 07/2014; 121(11). DOI:10.1016/j.ophtha.2014.05.030 · 6.14 Impact Factor
  • Claudia F Henrich · Pradeep Y Ramulu · Esen K Akpek
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    ABSTRACT: Purpose: 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. Methods: Consecutive new patients with a primary diagnosis of dry eye evaluated at a tertiary dry eye center between January 2010 and December 2011 were reviewed retrospectively. Standardized questionnaires were used to obtain data regarding systemic symptoms, previous medical diagnoses, and family history. Dry eye evaluations included Schirmer testing, tear film break-up time, corneal fluorescein staining, and bulbar conjunctival lissamine green staining. Clinically significant dry eye was defined as having a Schirmer test score without anesthesia of ≤10 mm or conjunctival lissamine green staining of ≥1 using the Oxford scale. Results: A total of 228 new patients were analyzed. Of these, 47.4% (108/228) presented with a known diagnosis of inflammatory disease. Based on a review of systems and ocular examination, 81 patients (81/228) underwent a further work-up that revealed 25 additional diagnoses that were not known on presentation. The most common newly identified conditions included occult thyroid eye disease (n = 20), primary Sjögren Syndrome (4), and Sjögren Syndrome suspect (1). Female gender, family history of autoimmune disease, self-reported joint pain or dry mouth, external signs of orbital inflammation, and conjunctival chemosis were more common in patients with inflammatory systemic disease as compared with that in patients with no identifiable condition (P < 0.05 for all). Conclusions: Systemic inflammatory diseases are frequently associated with dry eye in patients evaluated at a tertiary academic center. Diagnostic evaluations may help uncover previously undiagnosed significant conditions in about one-third of tested patients.
    Cornea 06/2014; 33(8). DOI:10.1097/ICO.0000000000000173 · 2.04 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; 33(8). DOI:10.1097/ICO.0000000000000141 · 2.04 Impact Factor
  • Ocular immunology and inflammation 04/2014; 22(4). DOI:10.3109/09273948.2013.805786 · 1.97 Impact Factor
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    Michelle Hessen · Esen Karamursel Akpek
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    ABSTRACT: Keratoconjunctivitis sicca, or dry eye, is a common ocular disease prompting millions of individuals to seek ophthalmological care. Regardless of the underlying etiology, dry eye has been shown to be associated with abnormalities in the pre-corneal tear film and subsequent inflammatory changes in the entire ocular surface including the adnexa, conjunctiva and cornea. Since the recognition of the role of inflammation in dry eye, a number of novel treatments have been investigated designed to inhibit various inflammatory pathways. Current medications that are used, including cyclosporine A, corticosteroids, tacrolimus, tetracycline derivatives and autologous serum, have been effective for management of dry eye and lead to measurable clinical improvement.
    Journal of Ophthalmic & Vision Research 04/2014; 9(2):240-50.
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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; 98(5). DOI:10.1136/bjophthalmol-2013-303518 · 2.98 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) (, ( and the WHO International Clinical Trials Registry Platform (ICTRP) ( 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(8):CD009327. DOI:10.1002/14651858.CD009327.pub2 · 6.03 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; 120(11). DOI:10.1016/j.ophtha.2013.03.045 · 6.14 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 02/2013; 3(1):39. DOI:10.1186/1869-5760-3-39
  • M. Liew · Min Zhang · Elizabeth Kim · Esen K. Akpek
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    ABSTRACT: Aims: To assess the prevalence and determine predictors of Sjögren's syndrome (SS) in patients with clinically significant aqueous-deficient dry eye. Methods: Patients enrolled in an industry-sponsored, multicentre clinical trial (NCT00784719) were assessed prospectively for the presence of SS. Ocular testing included Schirmer test, corneal fluorescein staining, conjunctival lissamine green staining, and tear-film breakup time. Review of systems questionnaire, medical history, dry eye questionnaire and laboratory work-up (Sjögren-specific antibody A (SSA), Sjögren-specific antibody B (SSB), rheumatoid factor (RF) and antinuclear antibody (ANA)) were obtained. Results: Of 327 patients, 38 (11.6%) had SS: 21 (6.4%) with primary SS (pSS), and 17 (5.2%) with secondary SS. Nine patients (3%) were newly diagnosed using the applied diagnostic criteria based on American-European consensus criteria. Patients with SS had significantly worse conjunctival and corneal staining, Schirmer test (with and without anaesthesia), and symptoms compared with patients without SS. pSS Was significantly more likely to occur in patients with positive ANA (OR: 13.9) and RF (OR: 4.8). Conclusions: Ophthalmologists caring for patients with clinically significant dry eye should have a high index of suspicion for underlying SS and low threshold for serological work-up. RF and ANA are recommended as useful tests in SSA/SSB-negative patients for further diagnostic referral.
    British Journal of Ophthalmology 11/2012; 96(12):1498-1503. DOI:10.1136/bjophthalmol-2012-301767 · 2.98 Impact Factor
  • 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. DOI:10.1097/ICU.0b013e328358bafd · 2.50 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. DOI:10.1097/ACI.0b013e328357b4b9 · 3.57 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. DOI:10.1016/j.ajo.2012.03.001 · 3.87 Impact Factor
  • Esen K Akpek · Anthony J Aldave · James V Aquavella
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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. DOI:10.1016/j.ajo.2012.03.022 · 3.87 Impact Factor

Publication Stats

2k Citations
355.91 Total Impact Points


  • 2000–2015
    • Johns Hopkins University
      • Wilmer Eye Institute
      Baltimore, Maryland, United States
  • 2000–2014
    • Johns Hopkins Medicine
      • Wilmer Eye Institute
      Baltimore, Maryland, United States
  • 2007
    • University of Rochester
      • Flaum Eye Institute
      Rochester, New York, United States
  • 2001
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 1999–2001
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1999–2000
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 1997–1999
    • Massachusetts Eye and Ear Infirmary
      • • Ocular Immunology and Uveitis Service
      • • Department of Ophthalmology
      Boston, Massachusetts, United States