David S Rootman

Toronto Western Hospital, Toronto, Ontario, Canada

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Publications (198)464.64 Total impact

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    ABSTRACT: To describe outcomes of patients with Terrien marginal degeneration. Retrospective case series. Database review of 25 patients (43 eyes) seen over 10 years (2004-2013) at Toronto Western Hospital cornea clinic. Outcome measures included demographics, location of disease, topographical astigmatism, visual acuity, coexisting ocular disease, and surgical management. Mean age at presentation was 44 years (range, 20 to 82 years) and 54% were male. 18 patients (72%) had bilateral disease. Mean follow up was 30.3 months. Mean topographic astigmatism was 4.02 diopters at 5 degrees. Mean change in astigmatism 1 year from baseline was 0.75 D; at 2 years was 1.22 D; and at 3 years was 1.68 D. Mean Best spectacle corrected visual acuity (BSCVA) at presentation was 20/46 and 20/48 at last follow-up. Eyes requiring surgery (23.3%) had mean BSCVA of 20/81 at presentation and 20/106 after surgery. Five eyes perforated; four spontaneously, and one from trauma. Three eyes (6.9%) presented with pseudopterygium. Two eyes (4.7%) had intracorneal cysts. Fourteen patients (56%) presented with ocular surface inflammation. Terrien marginal degeneration is a slow progressing, bilateral but asymmetric, degeneration of the peripheral cornea. Men over 40 are more commonly affected. Stromal thinning, vascularization, lipid deposition, and against-the-rule astigmatism are classic signs. Though typically non-inflammatory, a variant form characterized by prominent inflammation exists. Surgery (lamellar graft) can preserve corneal integrity and is indicated when conventional options fail to maintain vision or if perforation is imminent. Perforations are rare, but can result in significant vision loss. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · American Journal of Ophthalmology
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    ABSTRACT: To evaluate the demographic and clinical characteristics of patients referred to a tertiary care hospital cornea clinic for ocular cicatricial pemphigoid (OCP) assessment. Retrospective, nonrandomized, consecutive case series. Thirty three patients with OCP who were treated at the corneal clinic of Toronto Western Hospital from 2003 to 2012. Database search of patients from 2003 to 2012 with a referral request or diagnosis of OCP was conducted at a tertiary care hospital cornea clinic. Charts of 33 patients (64 eyes) were reviewed. Outcome measures included patient demographics, methods of diagnosis, visual acuity, ocular features, and disease staging using Foster's staging system, systemic modes of treatment, disease progression, and presence of systemic involvement. Mean patient age at presentation was 69.8 years (range 40-91), and 81% (27/33) were female. At presentation, disease staging consisted of stage I (subepithelial fibrosis) 7.8% (5/64), stage II (shortened fornices) 21.8% (14/64), stage III (symblepharon formation) 65.6% (42/64), and stage IV (keratinization with or without globe immobility) 4.6% (3/64). At the final follow-up visit, the proportions of the involved eyes for stages I to IV were 1.5% (1/64), 10.9% (7/64), 76.5% (49/64), and 10.9% (7/64), respectively. Conjunctival biopsies were obtained from 81% (27/33) of patients and reported as positive in 30% (8/27), negative in 63% (17/27), and inconclusive in 7% (2/27) of patients. Mean duration of follow-up was 6.8 ± 5.6 years (range 0.5-22), and 66.6% (22/33) of patients had progressive disease. Systemic mucocutaneous involvement was noted in 36.3% (12/33) of patients. The high rate of disease progression suggests the need for improved therapeutic options. Additional modalities are needed in addition to conjunctival biopsy to confirm a diagnosis of OCP in patients with clinical signs of the disease. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Canadian Journal of Ophthalmology
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    ABSTRACT: To assess changes in macular thickness after Descemet stripping automated endothelial keratoplasty (DSAEK), using Optical coherence tomography DESIGN: Prospective interventional case series METHODS: Setting-Institutional Patients and intervention- 33 eyes of 31 patients who had Fuchs dystrophy or pseudophakic bullus keratopathy (PBK) and underwent DSAEK or combined DSAEK with cataract surgery. Main Outcome Measure- Changes in macular thickness RESULTS: There were 7, 9 eyes with Fuchs endothelial dystrophy and pseudophakic bullous keratopathy (PBK), respectively that underwent DSAEK and 17 eyes with Fuchs endothelial dystrophy and cataract that underwent combined DSAEK with phacuemulsification cataract surgery. For the whole group there was a significant increase of 19.32 micron in macular thickness at 1 month after surgery (P=0.025). At 3 months the increase of 10.33 was not statistically significant (p=0.192). For the Fuchs endothelial dystrophy there was a mean increase of 11.83 and a mean decrease of 9 microns at 1 and 3 months, respectively. For the PBK group there was 12.37 and 2.428 micron at 1 month (P=0.603) and at 3 months after surgery (P=0.883), respectively. These changes were not significant. For the Fuchs endothelial dystrophy and cataract group there was a significant increase of 26.50 micron at 1 month (P=0.012) and 23.15 at 3 months after surgery (P=0.038). Macular thickness significantly increased after DSAEK combined with cataract surgery but didn't change significantly when only DSAEK was performed. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Nov 2014 · American Journal of Ophthalmology
  • Noa Avni-Zauberman · David S Rootman
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    ABSTRACT: Objectives: To review and summarize relevant studies on combined use of corneal crosslinking and intracorneal ring segments (ICRS) for the treatment of corneal ectasia. Methods: A literature search was performed using the key words "corneal collagen cross-linking" and "intra-corneal ring segments." Results: Crosslinking is a well-accepted treatment option for corneal ectasia and can be combined with corneal ICRS insertion as needed. The advent of crosslinking has dramatically reduced the number of corneal transplants performed for patients with keratoconus or postrefractive ectasia. Intracorneal ring segments, although flatten the corneal surface, do not prevent the progression of corneal ectasia. This is why the combination of crosslinking and ICRS is potentially synergistic. Previous studies reported that combining these two complementary interventions has been shown to be safe and effective. Conclusions: The effects of ICRS are enhanced and stabilized by crosslinking, but the ideal combined technique is not known at present.
    No preview · Article · Oct 2014 · Eye & Contact Lens Science & Clinical Practice
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    ABSTRACT: Purpose To compare objective and subjective outcomes after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in the fellow eye of the same patients. Study Design Single-center, retrospective case series. Methods Seventeen patients with bilateral Fuchs endothelial dystrophy who underwent DSAEK earlier in one eye, and later underwent DMEK in the contralateral eye, composed study population. A chart review was completed to obtain follow up data for at least six months after each surgery. Outcome measures included best spectacles-corrected visual acuity (BSCVA) and endothelial cell density (ECD). Subjective questionnaires were used to assess patients’ satisfaction. Results Preoperative BSCVA (logMAR) was similar in both groups, 0.66±0.4 in DMEK and 0.59±0.4 in DSAEK (P=0.6). DMEK group showed better BSCVA than DSAEK group at 6-month time point (0.25±0.1 and 0.39±0.1, for DMEK and DSAEK, respectively, P=0.02). Preoperative ECD (cells/mm2) was similar in both groups (2647±249 and 2768±404, P=0.3) in DMEK and DSAEK, respectively. There was statistically significant difference found in ECD at 6 months (2227±565 for DMEK and 1780±433 for DSAEK, P=0.049). Subjective level of average satisfaction after DMEK was 6 and after DSAEK was 4.87±1.19 (p=0.002). Conclusions DMEK provided better visual outcome and lower endothelial cell loss than DSAEK and higher level of patient satisfaction when assessed at 6 months after surgery. Our results comparing the two procedures in the same patients supports the benefits of DMEK, and suggest the need for long-term studies observing this new surgical procedure.
    No preview · Article · Oct 2014 · American Journal of Ophthalmology
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    ABSTRACT: Aim To compare the results of same day transepithelial phototherapeutic keratectomy (t-PTK) and single inferior intracorneal ring segment (ICRS) combined with standard versus accelerated corneal collagen crosslinking (CXL) for keratoconus. Methods All consecutive progressive keratoconus eyes that underwent standard or accelerated CXL treatment preceded by same day t-PTK and placement of a single inferior ICRS and had 6 and 12 months of follow-up were reviewed retrospectively. Eyes were classified into two groups, the ‘standard’ and the ‘accelerated’ group, accordingly. Visual, refractive and topographic data prior to surgery and at 6 and 12 months post-treatment were analysed. Results Sixteen eyes were included in each of the standard and the accelerated groups. Mean patient age was 27.5±8.5 years and 30.5±10.7 years (p=0.38) in the standard and accelerated groups, respectively. There was a significant improvement in uncorrected distance visual acuity, refractive cylinder and all examined corneal parameters in both groups 12 months postsurgery. The corrected distance visual acuity and manifest refraction spherical equivalent showed a significant improvement after 12 months of follow-up only in the accelerated group. However, mean changes in all evaluated parameters did not differ significantly between the two groups. Conclusions A combined treatment of accelerated CXL preceded by same day t-PTK and single ICRS is as effective as the combined treatment using standard CXL for visual rehabilitation in progressive keratoconus.
    No preview · Article · Aug 2014 · British Journal of Ophthalmology
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    ABSTRACT: Purpose: The aim of this study was to assess the efficacy of accelerated crosslinking (irradiance of 9 mW/cm; 10 minutes) in keratoconus-affected eyes through topographical, visual, and refractive end points. Methods: Mild-moderate keratoconus-affected eyes that underwent accelerated corneal collagen crosslinking (CXL) treatment and had 6 and 12 months of follow-up were reviewed retrospectively. Data regarding uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), and computerized corneal topography data before surgery and post-CXL treatment were extracted and analyzed. Results: Sixteen eyes of 14 patients were included in the study. The mean patient age was 24.9 ± 5.8 years (range: 17.1-38.3 years). No statistically significant changes were found in the mean CDVA, mean refractive cylinder, or mean manifest refraction spherical equivalent at either time point. There was a gain of 0.13 logarithm of the minimum angle of resolution lines in the mean UDVA (P = 0.012) at 12 months. All corneal parameters including Ksteep, Kflat, average K (Km), corneal astigmatism (Kcyl), and maximal curvature reading at the corneal apex (Kmax) were stable at 6 and 12 months in all patients. No complications were observed during the follow-up period. Conclusions: Accelerated corneal CXL is effective in stabilizing topographic parameters after 12 months of follow-up in mild-moderate keratoconus-affected corneas. Improvement in the UDVA and stabilization of all tested corneal parameters were noted after the treatment. However, a longer follow-up with larger cohorts is necessary to validate these findings.
    No preview · Article · Jun 2014 · Cornea
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    ABSTRACT: Purpose: To compare 2 lenticule insertion methods currently in use for Descemet stripping automated endothelial keratoplasty (DSAEK). Design: Prospective randomized single-masked study. Patients and methods: Twenty patients with Fuchs endothelial dystrophy and pseudophakic bullous keratopathy undergoing DSAEK surgery were included and randomized to the use of either EndoGlide or EndoSerter as a delivery method for the donor lenticule. Post surgery, patients were monitored for up to 1 year. Evaluation included corrected distance visual acuity (CDVA) and refraction. Specular microscopy images were obtained at the 6- and 12-month visits. Complications, including rebubbling rate, graft dislocation, and graft failure, were recorded. Results: Twenty eyes were randomized to receive the Tan EndoGlide or the EndoSerter injector for lenticule insertion. Mean patient age was 65.9±8.4 years and 70.3±9.8 years in the Tan EndoGlide and EndoSerter groups, respectively (P=.3). Two eyes in each group needed rebubbling. The mean endothelial cell loss, including the rebubbled eyes, at the 12-month visit was 1093±629 cells/mm2 (range: 239-2109 cells/mm2, mean percentage cell loss 41.2%) and 877±566 cells/mm2 (range: 116-1851 cells/mm2, mean percentage cell loss 31.4%) in the Tan EndoGlide and EndoSerter groups, respectively (P=.45). Mean CDVA did not show a statistically significant difference between the 2 groups at the 6- or 12-month visit. Conclusion: The EndoSerter shows comparable results to the Tan EndoGlide. However, further investigation is warranted in order to validate these findings.
    No preview · Article · May 2014 · American Journal of Ophthalmology
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    ABSTRACT: To compare posterior corneal curvature in the fellow eye of the same patients after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK). This retrospective, case series comparative study included consecutive patients who underwent DSAEK in one eye and DMEK in the fellow eye. Each eye underwent corneal evaluation with Pentacam HR (Oculus, Wetzlar, Germany). Postoperative corneal curvature, corneal thickness, and visual acuity were assessed. Twenty eyes of 10 patients (5 women and 5 men) aged 72.5 ± 13.5 (range, 42-87) years were included. No significant differences were observed between front flat K's (43.01 ± 1.6 vs. 43.5 ± 0.9, P = 0.27) and front steep K's (44.17 ± 1.5 vs. 44.52 ± 0.7, P = 0.39) in DMEK vs. DSAEK eyes, accordingly. Posterior curvature was statistically significantly flatter in DMEK compared with DSAEK eyes; back flat K's (-6.30 ± 0.2 vs. -6.84 ± 0.6, P = 0.012), back steep K's (-6.64 ± 0.1 vs. -7.2 ± 0.3, P = 0.03), and back Km (-6.45 ± 0.1 vs. -6.99 ± 0.4, P = 0.005), accordingly. Corneas in DMEK eyes were significantly thinner than in DSAEK eyes (541.0 ± 61 vs. 627.9 ± 70 μm, P = 0.007). Eyes that underwent DSAEK surgery have thicker corneas with steeper posterior corneal curvature than fellow eyes that underwent DMEK. This difference may explain the hyperopic shift commonly observed after DSAEK and should be considered when choosing an intraocular lens for cataract surgery.
    No preview · Article · Apr 2014 · Cornea
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    ABSTRACT: To evaluate the clinical features and outcomes of patients with recurrent corneal erosion syndrome who underwent anterior stromal puncture. Retrospective, nonrandomized, consecutive case series. Database search of patients from 2003-2013 who underwent anterior stromal puncture was conducted at a tertiary care hospital cornea clinic. Charts of 30 patients (35 eyes) were reviewed. Outcome measures included demographics, laterality, history of corneal trauma, prior ocular history, frequency and duration of symptoms, failed treatments, signs on examination, degree of symptom resolution, additional treatments needed, and complications. Mean patient age at presentation was 37 (± 11.5 SD) years, 60% were male. A total of 83.3% of patients had unilateral and 16.7% had bilateral involvement. In all, 62.9% of eyes had prior history of corneal trauma and 2.9% had prior laser-assisted in situ keratomileusis. Ninety-seven percent of eyes had symptoms of pain upon awakening refractory to conservative treatment. In 97% of eyes, there were findings of microcysts, fingerprint lines, loose epithelium, and/or faint scars. Mean follow-up was 14 months (range: 3-120 months). At final follow-up, 62.9% of eyes were symptom free and 37.1% experienced milder episodes. Seventeen percent required additional treatment: 16.6% superficial keratectomy, 66% repeat anterior stromal puncture, and 16.7% phototherapeutic keratectomy. No complications were observed. Anterior stromal puncture using a short (5/8 inch) 25 gauge bent needle is a simple, safe, and cost-effective procedure for symptomatic relief in patients with recurrent corneal erosion syndrome refractive to conservative measures. Repeat treatment may be performed prior to additional surgical intervention.
    No preview · Article · Feb 2014 · American Journal of Ophthalmology
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    ABSTRACT: The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations. The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure. Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively. CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.
    No preview · Article · Dec 2013 · Cornea
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    ABSTRACT: To compare outcomes and complications of femtosecond laser (FSL) mushroom configuration and manual trephine (MT) straight-edge configuration deep anterior lamellar keratoplasty (DALK). A cohort of 19 consecutive eyes that underwent FSL DALK was compared with 19 consecutive eyes that underwent MT DALK. Surgery was performed for eyes with keratoconus, corneal ectasia and scarring. Patient demographics, best-corrected visual acuities (BCVAs), refraction and complications were compared. Groups were comparable for age, gender and preoperative BCVA. Rates of intraoperative and postoperative complications were low and comparable between the groups. These included intraoperative Descemet's membrane (DM) perforation which did not require conversion to penetrating keratoplasty; stromal rejection successfully treated with topical steroids; postoperative DM detachment; delayed epithelial healing and increased intraocular pressure which resolved with topical anti-glaucoma drops. At 3 months, the mean BCVA was significantly better in the FSL group compared with the MT group (p=0.00002). At 6 months and 1 year, there was no significant difference between mean BCVA between the two groups. Mean spherical equivalent, cylindrical astigmatism and keratometric cylinder preoperatively and at 3, 6 and 12 months postoperatively were similar between the two groups. FSL or trephine DALK are viable options for keratoconus, ectasia and corneal scars. Earlier visual recovery occurs with FSL mushroom configuration compared with MT straight-edge DALK.
    No preview · Article · Oct 2013 · The British journal of ophthalmology
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    ABSTRACT: To compare the outcomes with IntraLase-enabled keratoplasty using (IEK) Top Hat (TH) versus Zig Zag (ZZ) configuration. Retrospective comparative series of 24 eyes that underwent TH and 10 eyes that underwent ZZ IEK. There were no significant differences in LogMar Best-spectacle corrected visual acuity (TH- IEK=0.3; ZZ-IEK=0.18, p=0.18), spherical equivalent (TH-IEK=-3.55±3.7 dioptres (D); ZZ-IEK=-2.69±4.85 D, p=0.60), manifest cylinder (TH- IEK=3.79±2.43 D; ZZ- IEK=4.61±3.29 D, p=0.45), topographic astigmatism (TH-IEK=3.67±2.34 D; ZZ-IEK=4.26±1.1 D, p=0.63), total higher-order aberrations (TH- IEK=8.26±3.53; ZZ-IEK=8.1±4.71, P=0.92), endothelial cell density change from baseline (TH- IEK= -41.55%±15.86; ZZ-IEK=-25.45%±30.66, p=0.22) or time to suture removal in months (TH- IEK=7.48±4.07; ZZ- IEK=6.93±2.71, p=0.75). There was no difference in requirements for astigmatic keratectomy (TH-IEK=54.2%±13; ZZ-IEK=50%±5, OR=1.18) or complications (TH-IEK=25%±6; ZZ-IEK=30%±3, OR=0.78). TH-IEK and ZZ-IEK have comparable visual and refractive outcomes, wound healing and endothelial cell counts at 1-year.
    No preview · Article · Sep 2013 · The British journal of ophthalmology
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    ABSTRACT: To report the outcome and the reversibility of refractive outcomes after intrastromal corneal ring segment (ICRS) explantation in patients with keratoconus treated with ICRS implantation and same-day collagen crosslinking (CXL). This is a retrospective review of ICRS explantation in 3 eyes of 3 patients with keratoconus that had undergone femtosecond laser-enabled placement of paired ICRS (Intacs) with same-day CXL by a single surgeon between 2008 and 2011. The main outcome measures included baseline/preexplantation/postexplantation visual acuity, refractive error, keratometry, and higher order aberrations. None of the patients lost best-corrected distance visual acuity lines. ICRS can be safely and easily explanted from keratoconic eyes with previous CXL. Some of the topographic benefits gained from ICRS implantation may persist after explantation. Despite the reversal of refractive outcomes, the preservation of topographic changes may occur in some cases after the explantation of 1 or both the segments in patients with keratoconus treated with ICRS implantation with same-day CXL.
    No preview · Article · Sep 2013 · Cornea
  • Setareh Ziai · David S Rootman · Allan R Slomovic · Clara C Chan
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    ABSTRACT: To describe a surgical technique to repair Boston type 1 keratoprosthesis (KPro)-related corneal melts. Technique description and review of 3 representative cases. After harvesting the buccal mucosa from the patient's inner lower lip, the exposed area of the KPro back plate is prepared for repair by adequate exposure and removal of necrotic tissue. The area is then covered with a lamellar patch of cornea secured in place with interrupted 10-0 nylon sutures, followed by a thin layer of buccal mucosa secured in place with interrupted 8-0 vicryl sutures. This technique provides surgeons with a method to repair KPro-related corneal melts when there is a conjunctival deficiency.
    No preview · Article · Sep 2013 · Cornea
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    ABSTRACT: To analyze the outcomes of cataract surgery with high-power toric intraocular lens (IOL) implantation in patients with high corneal astigmatism. Retrospective case series. Twelve eyes of 9 patients. Patients with idiopathic, pathologic, or postsurgical corneal astigmatism and a visually significant cataract were included in the study. Cataract extraction with implantation of a custom-made high-power toric IOL was performed on all patients. Outcomes included uncorrected and best corrected distance visual acuity (UDVA and BCDVA), manifest refraction, and mean and steepest keratometry. Analysis of astigmatic vectors was also performed. The mean follow-up time was 3.75 months. At the last follow-up visit, there was a significant improvement of UDVA (1 ± 0.64 vs 0.39 ± 0.21 logMAR; p < 0.05), cylindrical refraction (-4.72 ± 1.13 vs -1.81 ± 1.10 D; p < 0.01), and refractive spherical equivalent (-4.56 ± 5.58 vs -0.36 ± 1.19 D; p < 0.05). The BCDVA improvement did not reach statistical significance. Astigmatism on the target axis was reduced by an average of 5 D (p < 0.01). Cataract surgery with implantation of a high-power toric IOL was safe and effective in correcting high values of corneal astigmatism.
    No preview · Article · Aug 2013 · Canadian Journal of Ophthalmology
  • Kay Lam · Dan B Rootman · Alejandro Lichtinger · David S Rootman
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    ABSTRACT: Corneal ectasia is a serious complication of laser in situ keratomileusis (LASIK). We report the case of a 29-year-old man who underwent LASIK in both eyes and in whom corneal ectasia developed in the left eye 3 years after surgery. He was treated sequentially with intraocular pressure-lowering medication, intrastromal corneal ring segment (ICRS) implants, and collagen cross-linking. Vision improved and the ectasia stabilized following treatment. Combined ICRS implantation and collagen cross-linking should be considered early in the management of post-LASIK ectasia.
    No preview · Article · Jun 2013 · Digital journal of ophthalmology : DJO / sponsored by Massachusetts Eye and Ear Infirmary
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    ABSTRACT: To evaluate the efficacy of single or paired intrastromal corneal ring segments (ICRS) combined with ultraviolet-A and riboflavin collagen crosslinking (CXL) in patients with keratoconus. Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada. Retrospective comparative case series. Consecutive patients with keratoconus had femtosecond laser-assisted ICRS implantation combined with same-day CXL between 2008 and 2011. The main outcome measures included improvement in visual acuity, subjective refractive error, keratometry values, and total higher-order aberration (HOA). Eighty-five eyes of 74 patients with keratoconus (paired ICRS: 47 eyes of 40 patients; single ICRS: 38 eyes of 34 patients) were included in the study. The uncorrected distance visual acuity was significantly improved after single ICRS (3.4 lines; P=.04) and paired ICRS (2.7 lines; P=.01) implantation combined with CXL, while corrected distance visual acuity (CDVA) remained stable. The single and paired ICRS groups had a significant reduction in mean cylinder at 1 year (single ICRS: -3.84 diopters [D] ± 1.72 [SD] versus -2.19 ± 1.54 D, P=.02; paired ICRS: -3.91 ± 1.45 D versus -2.96 ± 1.92 D) (P=.02). There was no significant difference in total HOAs. Single ICRS implantation and paired ICRS implantation with CXL were equivalent in all refractive parameters. No patient lost lines of CDVA. As determined by corneal topography, implantation of single or paired ICRS combined with same-day CXL was safe and effective in patients with keratoconus. No author has a financial or proprietary interest in any material or method mentioned.
    No preview · Article · Jun 2013 · Journal of Cataract and Refractive Surgery
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    ABSTRACT: To compare combined intrastromal corneal ring segment implantation with same-day ultraviolet-A/riboflavin corneal collagen cross-linking (ICRS-CXL) versus ICRS implantation alone in patients with corneal ectasia. Retrospective comparative study. Sixty-six eyes from 54 patients with corneal ectasia were included in the study. The groups were composed of 32 eyes from 27 patients and 34 eyes from 27 patients for the ICRS-CXL and ICRS groups, respectively. We reviewed the charts of all patients who underwent these procedures from November 2008 to February 2011 for preoperative and for up to 1 year postoperative uncorrected (UDVA) and best corrected distance visual acuity (BDVA), refraction, topographical analysis (mean and steepest keratometry [K]), as well as root mean-square (RMS) of higher-order aberrations (HOAs). Overall, a significant improvement was seen in both groups for UDVA, BDVA, sphere, cylinder, mean refractive spherical equivalent (MRSE), mean and steepest K, coma, spherical and total HOA at 12 months. Trefoil did not improve, and higher-order astigmatism worsened in the ICRS group (p = 0.0466). There was no statistically significant difference between the 2 groups for visual acuity, sphere, cylinder, coma, trefoil, and spherical HOA. Outcomes were significantly more improved in the ICRS group for MRSE (p = 0.0082), mean K (p = 0.0021), steepest K (p = 0.0152), and total HOAs (p = 0.0208). No complications were observed. ICRS-CXL and ICRS alone were both safe and effective in treating corneal ectasia. The ICRS alone group demonstrated better outcomes of MRSE, mean and steepest K, as well as total HOA.
    No preview · Article · Jun 2013 · Canadian Journal of Ophthalmology
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    ABSTRACT: PURPOSE: To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with implantation of a single inferior intrastromal corneal ring segment (ICRS) and riboflavin with ultraviolet-A collagen crosslinking (CXL) performed sequentially on the same day in the management of keratoconus. SETTING: Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada. DESIGN: Case series. METHODS: This retrospective review comprised consecutive patients with progressive keratoconus having transepithelial PTK followed by femtosecond laser-enabled placement of a single inferior ICRS and CXL on the same day by the same surgeon between December 2010 and August 2011. The main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refraction spherical equivalent, keratometry (K), and total higher-order aberrations. RESULTS: Sixteen eyes of 13 patients were included in the study. Six months after same-day PTK combined with implantation of a single inferior ICRS and CXL, there was a significant improvement in UDVA, CDVA, and the mean and steep K values. No patient lost CDVA lines. CONCLUSION: Phototherapeutic keratectomy combined with implantation of a single inferior ICRS and CXL on the same day was a safe, effective treatment for improving visual acuity in select patients with progressive keratoconus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
    No preview · Article · May 2013 · Journal of Cataract and Refractive Surgery

Publication Stats

3k Citations
464.64 Total Impact Points

Institutions

  • 1993-2015
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1990-2015
    • University of Toronto
      • • Department of Ophthalmology and Vision Sciences
      • • Department of Chemical Engineering and Applied Chemistry
      Toronto, Ontario, Canada
  • 2011-2013
    • University Health Network
      • Department of Ophthalmology
      Toronto, Ontario, Canada
  • 1992-2006
    • SickKids
      • Department of Ophthalmology and Vision Sciences
      Toronto, Ontario, Canada
  • 2002
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      Londinium, England, United Kingdom
  • 1991
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 1987-1989
    • Louisiana State University
      Baton Rouge, Louisiana, United States
  • 1988
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Medicine
      New Orleans, Louisiana, United States