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Achiron A, Trivizki O, Knyazer B, Elbaz U, Hecht I, Jeon S, Kanclerz P, Tuuminen R. The effect of blue-light filtering intraocular lenses on the development and progression of macular atrophy in eyes with nAMD. Am J Ophthalmol 2024:S0002-9394(24)00171-5. [PMID: 38692502 DOI: 10.1016/j.ajo.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD). DESIGN Retrospective clinical cohort study. METHODS nAMD patients with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All OCT scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. Using the Heidelberg software, the area of MA was manually evaluated and calculated (mm2) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event. RESULTS Included were 373 eyes of 373 patients (mean age 78.6±6.7 years at surgery, 67.4% females). 206 eyes were implanted with BLF IOLs and 167 with non-BLF IOLs with comparable follow-up times (3164±1420 days vs. 3180±1403 days, respectively, P=0.908), and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine pre-existing and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P=0.598 and P=0.399, respectively). Both univariate Kaplan-Meier (P=0.366) and multivariate Cox regression analysis adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (HR 1.236, 95% CI 0.784-1.949, P=0.363). Final MA area at the last visit was 5.14±4.71mm2 for BLF IOLs and 8.56±9.17mm2 for non-BLF IOLs (P=0.028), with the mean annual MA area increase of 0.78±0.84mm2 and 1.26±1.32mm2, respectively (P=0.042). CONCLUSIONS BLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of nAMD patients.
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Affiliation(s)
- Asaf Achiron
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Omer Trivizki
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Boris Knyazer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Uri Elbaz
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Tel Aviv, Israel
| | - Idan Hecht
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel; Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sohee Jeon
- Keye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, South Korea
| | - Piotr Kanclerz
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Hygeia Clinic, Gdańsk, Poland
| | - Raimo Tuuminen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.
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Levy-Neuman S, Mendel L, Achiron A, Bukelman A, Weinberg T, Avizemer H, Schlesinger M, Marcovich AL, Kleinmann G. Comparison of flanged polypropylene scleral intraocular lens fixation with scleral sutured fixation. Can J Ophthalmol 2024:S0008-4182(24)00093-0. [PMID: 38636552 DOI: 10.1016/j.jcjo.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To compare the outcome of 2 intraocular lens (IOL) scleral fixation techniques: double-flanged polypropylene and Hoffman scleral pocket. METHODS Retrospective case series of all patients who underwent IOL scleral fixation by either the flange (flange group) or Hoffman scleral pocket (Hoffman group) techniques at the Kaplan Medical Center and the Edith Wolfson Medical Center. RESULTS A total of 140 patients were included (63 flange, 77 Hoffman). The final distance-corrected visual acuity was similar between the flange and Hoffman groups (0.42 ± 0.5 and 0.51 ± 0.5 logMAR, respectively; p = 0.23), but the spherical equivalent was less myopic in the flange group (-0.63 ± 2 and -2.3 ± 1.3 D, respectively; p = 0.003). In the flange group, there were more cases of elevated IOP (17.5% vs 5.2%; p = 0.02), corneal edema (11.1% vs 1.3%; p = 0.02), cystoid macular edema (15.9% vs 2.6%; p = 0.005), and IOL decentration (19% vs 7.8%; p = 0.07). The flange group had a higher rate of combined additional procedures during the fixation surgery (68.3% vs 32%; p < 0.001), but surgery duration was not prolonged (70 vs 77 minutes; p = 0.29). CONCLUSION Comparison of scleral IOL fixations performed with the recently developed flange technique to the conventional Hoffman scleral pocket technique resulted in similar visual outcomes and less myopization. There were more complications in the newly adopted flange technique, which may be related to the higher rate of combined anterior vitrectomy and pars plana vitrectomy. The flange technique is effective, with a shorter learning curve and similar surgical time. Therefore, it can become a viable method for scleral IOL fixation in the absence of zonular support.
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Affiliation(s)
| | - Liat Mendel
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Bukelman
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Tamir Weinberg
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Haggay Avizemer
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel
| | - Mor Schlesinger
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Arie L Marcovich
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Guy Kleinmann
- Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kinori M, Nitzan I, Szyper NS, Achiron A, Spierer O. Correlation of Refractive Error with Anisometropia Development in Early Childhood. Am J Ophthalmol 2024; 264:145-153. [PMID: 38552933 DOI: 10.1016/j.ajo.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE This study aims to investigate the relationship between the type and severity of refractive error and anisometropia development in preschool children. DESIGN Retrospective cohort study. METHODS Data from Maccabi Healthcare Services, Israel's second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1 to 6 years, re-examined for refraction at least 2 years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors. RESULTS Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n = 8944), 4.2% (n = 1397), and 69.1% (n = 23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥3 D). Associations remained consistent in sensitivity and subgroup analyses including across both sexes and when using a stricter anisometropia criterion. CONCLUSIONS Children aged 1 to 6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications.
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Affiliation(s)
- Michael Kinori
- Department of Ophthalmology (M.K.), Assuta Medical Center Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Itay Nitzan
- Department of Ophthalmology (I.N.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Military Medicine, Faculty of Medicine (I.N.), Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Asaf Achiron
- Department of Ophthalmology (A.A.), Tel Aviv Medical Center, Tel Aviv, Israel; Faculty of Medicine (A.A., O.S.), Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Faculty of Medicine (A.A., O.S.), Tel Aviv University, Tel Aviv, Israel; Department of Ophthalmology (O.S.), E. Wolfson Medical Center, Holon, Israel
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Cunha M, Elhaddad O, Yahalomi T, Avadhanam V, Tole D, Darcy K, Levinger E, Tuuminen R, Achiron A. Type 1 and type 2 diabetes predisposed to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases. Can J Ophthalmol 2024:S0008-4182(24)00057-7. [PMID: 38513717 DOI: 10.1016/j.jcjo.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/01/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery. DESIGN A retrospective cohort study. METHODS All patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies. RESULTS Included were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. CONCLUSION In our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.
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Affiliation(s)
- Mariana Cunha
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel.
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Eliya Levinger
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Achiron A, Yahalomi T, Knyazer B, Hecht I, Elbaz U, Spierer O, Livny E, Akowuah PK, Tuuminen R, Avadhanam VS. Efficacy comparison of combining cross-linking and refractive laser ablation in progressive keratoconus: systematic review and meta-analysis. Can J Ophthalmol 2024:S0008-4182(24)00056-5. [PMID: 38513713 DOI: 10.1016/j.jcjo.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/12/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study assessed the effect of combining corneal collagen cross-linking (CXL) with refractive laser ablation techniques for the treatment of keratoconus, a progressive corneal disorder. METHODS We performed a systematic review and meta-analysis to assess the effect of combined CXL and refractive techniques. We included all published clinical trials or observational studies published by September 1, 2023. We calculated and compared the standardized mean difference (SMD) between CXL alone and CXL plus laser ablation for uncorrected distance visual acuity, best-corrected distance visual acuity, spherical equivalent manifest refraction, sphere and cylinder, flat keratometry (K1), steep keratometry (K2), and central corneal thickness. RESULTS We identified 13 studies that fulfilled our inclusion and exclusion criteria. The average follow-up was 21.3 ± 11.8 months. The CXL plus laser ablation group showed improvement in uncorrected distance visual acuity logMAR (SMD, -0.35; 95% CI, -0.67 to -0.04; p = 0.029), best-corrected distance visual acuity logMAR (SMD, -0.17; 95% CI, -0.30 to -0.03; p = 0.014), spherical equivalent manifest refraction (SMD, -0.28; 95% CI, 0.06-0.50; p = 0.013), and change in maximal corneal curvature (Kmax; SMD, -0.41; 95% CI, -0.69 to -0.13; p = 0.004) compared with CXL alone. However, central corneal thickness decreased further among patients who underwent CXL plus laser ablation (SMD, -0.37; 95% CI, -0.66 to -0.07; p = 0.016). No effect was observed in terms of sphere (p = 0.878), cylinder (p = 0.859), K1 (p = 0.907), or K2 (p = 0.169). Ectasia was not observed as an adverse effect resulting from the additional corneal ablation performed during the CXL treatments. CONCLUSIONS This study showed that combining refractive laser ablation techniques with standard or accelerated CXL treatment improved visual and refractive outcomes and anterior corneal curvature values.
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Affiliation(s)
- Asaf Achiron
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center and Petach-Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center and Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland
| | - Venkata S Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Levinger N, Erdinest N, London N, Levinger E, Goldfeather Ben Zaken S, Barequet D, Barequet I, Achiron A, Levinger S. Femtosecond LASER-Assisted Double Intraocular Lens Exchange in Nanophthalmic Eyes. Case Rep Ophthalmol 2024; 15:143-149. [PMID: 38348443 PMCID: PMC10861217 DOI: 10.1159/000536190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Though patients with nanophthalmos frequently endure decreased quality of vision with contact lenses or spectacles, refractive surgery is generally an inadequate alternative due to the associated high refractive error. A refractive lens exchange (RLE) is an alternative option but is technically challenging, requiring accuracy in biometry measurements and procedures. Case Presentation This case discusses a 27-year-old female with nanophthalmos (axial lengths 17.6 mm and 17.4 mm, right and left eyes, respectively) who underwent a femtosecond laser-assisted (FLA) RLE with simultaneous implantation of a monofocal and a Sulcoflex trifocal (Rayner, Britain) lens in each eye. Preoperative cycloplegic refraction was +11.50/-0.75 × 145 and +12.00/-1.00 × 35 in the RE and LE, respectively. Best-corrected visual acuity (BCVA) at distance and near in the RE and LE was 6/7.5 and J1, 6/8.5 and J2, respectively. Uncorrected visual acuity (UCVA) was >6/120 and >J14 for each eye. FLA RLE was performed in the RE, then in the LE 2 weeks later. In each eye, a monofocal (44.0 D, RE, and LE) and a Sulcoflex trifocal lens (both implants, Rayner, Britain) were implanted in one procedure. Distance and near UCVA measured 6 weeks post-op RE and 1-month post-op LE at 6/8.5 and J1 in the RE, 6/10 and J1 in the LE. The RE and LE refraction and BCVA were +0.50/-1.00 × 115, 6/7.5, and plano/-1.00 × 55, 6/8.5, respectively. The post-op outcomes were uneventful. Conclusion A single procedure concurrently implanting a monofocal and Sulcoflex trifocal intraocular lens in nanophthalmic eyes resulted in an excellent UCVA. This procedure can be considered esthetic and reconstructive as it significantly improves patient appearance and function.
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Affiliation(s)
- Nadav Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Nir Erdinest
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
| | | | - Eliya Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shalhevet Goldfeather Ben Zaken
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
| | - Dana Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irit Barequet
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Asaf Achiron
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Levinger
- Enaim Medical Center Jerusalem and Tel Aviv, Tel Aviv, Israel
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Buhbut O, Achiron A, Knyazer B, Kantor S, Shinar C, Abayev L, Hecht I, Burgansky-Eliash Z, Karmona L, Kleinmann G, Avizemer H. Risk factors for a phacodonesis surprise during cataract surgery in patients with pseudoexfoliation. Int Ophthalmol 2023; 43:4739-4746. [PMID: 37742318 DOI: 10.1007/s10792-023-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the association of different pre-operative parameters with surprise phacodonesis during cataract surgery among patients with pseudoexfoliation (PXF). MATERIALS AND METHODS This is a retrospective charts review of all PXF patients who underwent cataract surgery between the years 2013 and 2018. Pre-operative parameters (demographics, biometry, intraocular pressure (IOP), endothelial cell count, pupil size, cataract density, glaucoma status, cup to disc ratio, number of glaucoma medications, prior intra-vitreous injections, risk for intraoperative floppy iris syndrome) were compared between patients with and without surprise phacodonesis. Binary logistic regression was used to calculate the predictive value of each parameter. RESULTS Out of 396 surgical cases with computerized pre-operative assessment, we included 127 eyes of 120 PXF patients without evidence of phacodonesis preoperatively. The mean age was 77.8 ± 12.0 years, 63 (52.7%) were male, and 106 (84.2%) underwent phacoemulsification surgery. We identified 10 cases of surprise phacodonesis during surgery (8.2%). Compared to PXF cases without intraoperative phacodonesis, they had higher pre-operative IOP (23.0 ± 11.0 mmHg vs. 14.9 ± 3.8 mmHg, p < 0.001) and a higher rate of B scan use due to dense cataract obscuring posterior pole evaluation [4 (40%) vs. 15 (12.8%), p = 0.04]. Multivariant binary logistic regression confirmed that only baseline IOP contributed to the prediction of surprise phacodonesis (OR 1.22 CI 1.04-1.43, p = 0.014). CONCLUSIONS Among patients with PXF undergoing cataract surgery, elevated IOP and poor posterior segment visibility requiring B scan use were associated with zonular instability putting these patients at risk for intra-operative complications.
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Affiliation(s)
- Ortal Buhbut
- Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Yitzhak Rager Boulevard 151, Beer-Sheva, Israel.
| | - Asaf Achiron
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Boris Knyazer
- Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Yitzhak Rager Boulevard 151, Beer-Sheva, Israel
| | - Shiri Kantor
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmel Shinar
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lena Abayev
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Shamir Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lily Karmona
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kleinmann
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggay Avizemer
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Moshkovsky R, Golan N, Aviel Gadot E, Bar A, Achiron A, Fischer N, Spierer O. Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double-blind, randomized controlled trial. Acta Ophthalmol 2023. [PMID: 37853924 DOI: 10.1111/aos.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To evaluate whether cooled anaesthetic eyedrops and antiseptics alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection. METHODS A prospective, double-masked, randomised controlled trial of 100 participants receiving either cooled (n = 50) or room temperature (n = 50) topical anaesthetic eyedrops and antiseptics before receiving an injection of bevacizumab. Baseline tolerability was estimated using a self-reported pain sensitivity questionnaire. RESULTS Overall tolerability was comparable between the study group and the control group (0.75 ± 0.13 vs. 0.74 ± 0.14, respectively, p = 0.99). Subconjunctival haemorrhage incidence was similar in both groups (80% vs. 86%, respectively, p = 0.113), as was subconjunctival haemorrhage size (2.75 ± 5.51 mm2 vs. 5.53 ± 10.72 mm2 , respectively, p = 0.11). Sub-group analysis demonstrated that the participants taking daily ocular eyedrops who received cooled anaesthetic eyedrops and antiseptics reported less pain at 10 min and less burning sensation at 24 h compared with matched controls (0.67 ± 1.50 vs. 2.50 ± 3.03, respectively, p = 0.040 and 0.00 ± 0.00 vs. 1.44 ± 2.96, respectively, p = 0.045). Participants who received cooled eyedrops and did not use antithrombotic therapy had smaller-sized subconjunctival haemorrhages compared with matched controls (1.55 ± 1.87 mm2 vs. 8.29 ± 14.61 mm2 , respectively, p = 0.038). Participants with hypertension who received cooled eyedrops had smaller-sized subconjunctival haemorrhage compared with matched controls (2.33 ± 4.99 mm2 vs. 6.89 ± 12.41 mm2 , respectively, p = 0.045). CONCLUSION The benefit of using cooled anaesthetic eyedrops and antiseptics to alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection was not proven in the general population. It may be beneficial in part for some patients, such as those who regularly use eyedrops, patients with hypertension or those not on antithrombotic therapy.
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Affiliation(s)
- Ran Moshkovsky
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Einat Aviel Gadot
- The Faculty of Exact Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sorkin N, Levinger E, Achiron A, Gomel N, Cohen S, Rabina G, Schwartz S, Barak A, Loewenstein A, Varssano D. Use of a three-dimensional head-mounted digital visualization platform in cataract surgery. Eye (Lond) 2023; 37:2905-2908. [PMID: 36737520 PMCID: PMC10517046 DOI: 10.1038/s41433-023-02427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/15/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To report preliminary experience using the BeyeonicsOne (Beyeonics Vision, Haifa, Israel) digital visualization platform and the utilization of its three-dimensional (3D) head-mounted display (HMD) in cataract surgery. METHODS An interventional case series including patients who underwent cataract surgery using the 3D HMD platform at the Tel Aviv Medical Center. The system uses the HMD unit to display high-resolution real-time 3D surgical field images. Collected data included patient demographics, ocular comorbidities, risk factors for complex cataract surgery, cataract grading, preoperative and postoperative best-corrected visual acuity (BCVA), and intra- and postoperative complications. RESULTS In total, 60 eyes of 60 subjects (mean age 73.1 ± 8.4 years) were included. Mean preoperative BCVA was 0.40 ± 0.30 logMAR (Snellen equivalent ~20/50) and improved to 0.10 ± 0.10 logMAR (Snellen equivalent ~20/25, p < 0.001). None of the patients suffered BCVA loss. All procedures and follow-ups were uneventful except for one case of a posterior capsular tear and one case of post-surgical cystoid macular edema. CONCLUSION The visualization platform and its embedded 3D head-mounted display can be easily used in routine cataract surgery with the added benefits of improved ergonomics, high picture quality and enhanced image control.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eliya Levinger
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Gomel
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Cohen
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Rabina
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shulamit Schwartz
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adiel Barak
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Varssano
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Olshaker H, Achiron A, Chorny A, Hafezi F, Yahalomi T, Kratz A, Tsumi E, Lu NJ, Knyazer B. Accelerated high fluence photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study. Front Pharmacol 2023; 14:1229095. [PMID: 37745064 PMCID: PMC10512457 DOI: 10.3389/fphar.2023.1229095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high fluence PACK-CXL, using 10.0 J/cm2 (30 mW/cm2, 5 min, and 33 s) at the slit lamp. Methods: This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment. Results: The average re-epithelization time was 8.2 ± 2.8 days (range 3-14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm2, respectively (p = 0.96). Conclusion: although it was not a randomized control trial, we conclude that high fluence PACK-CXL as an adjuvant therapy is safe with no complications observed, and efficient as time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.
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Affiliation(s)
- Hagar Olshaker
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Chorny
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Farhad Hafezi
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- ELZA Institute, Dietikon, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Ophthalmology, University of Southern California Roski Eye Institute, University of Southern California, Los Angeles, Los Angeles, CA, United States
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Assaf Kratz
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nan-Ji Lu
- ELZA Institute, Dietikon, Switzerland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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11
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Manns RPC, Achiron A, Knyazer B, Elhaddad O, Darcy K, Yahalomi T, Tole D, Avadhanam VS. Use of corneal cross-linking beyond keratoconus: a systemic literature review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2435-2453. [PMID: 36881260 DOI: 10.1007/s00417-023-05994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/13/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. METHODS A systemic literature review. RESULTS We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. CONCLUSION Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.
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Affiliation(s)
- Richard P C Manns
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK
| | - Venkata S Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St., Bristol, BS1 2LX, UK.
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12
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Karesvuo M, Kanclerz P, Hecht I, Achiron A, Tuuminen R. Association of clear vs blue-light filtering intraocular lenses with mental and behavioral disorders and diseases of the nervous system among patients receiving bilateral cataract surgery. J Cataract Refract Surg 2023; 49:679-685. [PMID: 36940191 PMCID: PMC10284132 DOI: 10.1097/j.jcrs.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To analyze new-onset mental and behavioral disorders and nervous system diseases in patients with cataract implanted with either non-blue-light filtering (BLF) or BLF intraocular lenses (IOLs) in both eyes. SETTING Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. DESIGN A retrospective registry-based cohort study of patients operated between September 2007 and December 2018 who were followed until December 2021. We included 4986 patients who underwent bilateral cataract surgery. METHODS Patients were implanted with either non-BLF IOLs (N = 2609) or BLF IOLs (N = 2377) in both eyes. Follow-up before the first-eye surgery and between the first-eye and the second-eye surgery was performed to acknowledge the preexisting disorders and diseases. After the second-eye surgery, the groups were analyzed for the new-onset mental and behavioral disorders and diseases of the nervous system subcategorized by the International Classification of Diseases codes. RESULTS 1707 male and 3279 female patients, aged 73.2 ± 8.6 years at the first-eye surgery and 74.3 ± 8.8 years at the second-eye surgery, were identified. In univariate log-rank tests, the use of BLF IOLs showed no association in overall new-onset disorders or diseases over non-BLF IOLs, in any subtype diagnosis codes except for sleep disorders, which favored BLF IOLs ( P = .003). A multivariate analysis adjusted for age and sex identified no associations in any new-onset disorders or diseases. Multivariate analysis of sleep disorders showed a nonsignificant advantage for BLF-IOLs (hazard ratio 0.756, 95% CI 0.534-1.070, P = .114). CONCLUSIONS BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.
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Affiliation(s)
- Minna Karesvuo
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Piotr Kanclerz
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Idan Hecht
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Asaf Achiron
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
| | - Raimo Tuuminen
- From the Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Karesvuo, Kanclerz, Hecht, Tuuminen); Health Services Dental Care, City of Helsinki, Helsinki, Finland (Karesvuo); Hygeia Clinic, Gdańsk, Poland (Kanclerz); Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel (Hecht); Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Hecht, Achiron); Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Achiron); Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland (Tuuminen)
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13
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Hecht I, Kanclerz P, Achiron A, Elbaz U, Tuuminen R. The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Glaucoma. J Glaucoma 2023; 32:451-457. [PMID: 37054398 DOI: 10.1097/ijg.0000000000002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Among patients who underwent uneventful cataract surgery, an advantage was seen to blue-light filtering (BLF) intraocular lenses (IOLs) in terms of glaucoma-free survival and glaucoma procedure-free survival. Among patients with preexisting glaucoma, no advantage was seen. PURPOSE To assess the effect of BLF IOLs on the development and progression of glaucoma after cataract surgery. PATIENTS AND METHODS A retrospective cohort study of patients who underwent uneventful cataract surgery between 2007 and 2018 at Kymenlaakso Central Hospital, Finland. Survival analyses for the overall risk of developing glaucoma or undergoing glaucoma procedures were assessed between patients who received a BLF IOL (SN60WF) and a non-BLF IOL (ZA9003 and ZCB00). A separate analysis was performed on patients with preexisting glaucoma. RESULTS Included 11,028 eyes of 11,028 patients with a mean age of 75 ± 9 years (62% females). The BLF IOL was used in 5188 eyes (47%) and the non-BLF IOL in 5840 eyes (53%). During the follow-up (mean: 55 ± 34 mo), 316 cases of glaucoma were diagnosed. Glaucoma-free survival rates showed an advantage to the BLF IOL ( P = 0.036). In a Cox regression analysis controlling for age and sex the use of a BLF IOL was again associated with a lower ratio of glaucoma development (hazard ratio:0.778; 95% CI: 0.621-0.975). Furthermore, glaucoma procedure-free survival analysis revealed an advantage to the BLF IOL (hazard ratio:0.616; 95% CI: 0.406-0.935). Among 662 cases, which already had glaucoma at the time of surgery, no significant differences were seen in any outcome. CONCLUSIONS Among a large cohort of patients who underwent cataract surgery, the use of BLF IOLs was associated with favorable glaucoma outcomes compared with the use of non-BLF IOLs. Among patients with preexisting glaucoma, no significant advantage was seen.
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Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Shamir Medical Center
| | - Piotr Kanclerz
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Hygeia Clinic, Gdańsk, Poland
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University
- Tel Aviv Sourasky Medical Center, Tel Aviv
| | - Uri Elbaz
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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14
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Achiron A, Yavnieli R, Tiosano A, Elbaz U, Nahum Y, Livny E, Bahar I. ABCD progression display for keratoconus progression: a sensitivity-specificity study. Eye (Lond) 2023; 37:1566-1570. [PMID: 35869390 PMCID: PMC10220054 DOI: 10.1038/s41433-022-02183-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of the ABCD progression display for keratoconus progression. METHODS Data was collected from patients that underwent at least two Pentacam assessments 6 months apart. Sensitivity and specificity were calculated for the ABCD progression display. Progression was defined by criterion 1: change in two ABCD parameters above 80% confidence interval (CI) or criterion 2: change in one ABCD parameter above 95%CI. Receiver operating characteristic analysis compared the area under the curve (AUC) of all ABCD parameter combinations. RESULTS Thirty eyes were evaluated over a median time of 10.3 months. Progression by criterion 1 resulted in a sensitivity of 61.9% and specificity of 88.9%. Progression by criterion 2 resulted in higher sensitivity (80.9%) and specificity (100%). Pairwise comparisons of the ROC curves show that the AUC achieved by criterion 2 was significantly higher than criterion 1 (0.905 vs. 0.754, p = 0.0332). Evaluation of all ABCD combinations with a significant change of 80% or 95% CI did not show superiority over criterion 1 or 2 regarding progression detection. The D parameter had a very low AUC (0.5-0.556). CONCLUSIONS The ABCD progression display can assess keratoconus progression with high sensitivity and specificity, thus assisting the patients' decision-making process. The D parameter did not contribute to the sensitivity or specificity of this classification.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roy Yavnieli
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Yahalomi T, Achiron A, Arnon R, Stanescu N, Pikkel J. Dry Eye Disease following LASIK, PRK, and LASEK: An Observational Cross-Sectional Study. J Clin Med 2023; 12:jcm12113761. [PMID: 37297956 DOI: 10.3390/jcm12113761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Dry eye disease is the most frequent non-refractive postoperative complication following refractive surgery. This prospective study investigated the development of dry eye disease after three common refractive laser surgeries: laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and laser-assisted sub-epithelial keratectomy (LASEK). Patients who underwent uneventful refractive surgery in a single private medical center between May 2017 and September 2020 were included. Ocular surface disease was graded according to the Dry Eye Workshop severity (DEWS) classification. Patients were examined 6 months following refractive surgery. The analysis included 251 eyes of 137 patients: 64 eyes (36 patients) after LASEK, 90 eyes (48 patients) after PRK, and 97 eyes (53 patients) after LASIK. At 6 months post-surgery, the DEWS score was higher for the LASIK than the PRK and LASEK groups (p = 0.01). For the total cohort, severe DEWS score (grades 3 and 4) at 6 months post-surgery was correlated with female gender (p = 0.01) and to the amount of refractive correction (p < 0.001), but not to age (p = 0.87). In conclusion, LASIK surgery and female gender were associated with dry eye. Patients, particularly those with high myopia, should be counseled about the risk of developing dry eye after refractive surgeries.
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Affiliation(s)
- Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashdod 7747629, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Roee Arnon
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashdod 7747629, Israel
| | - Nir Stanescu
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashdod 7747629, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashdod 7747629, Israel
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16
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Einan-Lifshitz A, Achiron A, Hed S, Hecht I, Dubinsky-Pertzov B, Knyazer B. Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus. Eye (Lond) 2023; 37:1219-1224. [PMID: 35590103 PMCID: PMC10102302 DOI: 10.1038/s41433-022-02093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/19/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Standard corneal collagen cross-linking (S-CXL) is an effective treatment to arrest Keratoconus (KC) progression in children. Less is known on the long-term efficacy of accelerated CXL (A-CXL) in paediatric populations. METHODS A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres in Israel between 2010-2017. Preoperative and 3-year postoperative evaluation included changes in visual acuity (best spectacle corrected [BSCVA]) and uncorrected [UCVA]), refractive errors, and keratometric data. RESULTS Ninety-three eyes of 93 patients were analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 LogMAR UCVA, p < 0.05 for both). Improvement in BSCVA and UCVA following A-CXL was non-inferior to S-CXL (< ± 0.2 LogMAR). Kmax decreased by a mean of 0.98 ± 5.56 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres following A-CXL (p = 0.015). Thinnest pachymetry decreased following both treatments (S-CXL: by 26.8 ± 40.7 µm, p = 0.001, A-CXL: by 10.2 ± 13.4 µm, p = 0.028), the difference between groups was within the non-inferiority margin (< ± 10 µm). CONCLUSIONS Paediatric patients followed for three years after A-CXL showed improved visual function, reduced corneal astigmatism and Kmax, and decreased thinnest corneal thickness. A-CXL was non-inferior to S-CXL at three years in terms of best-corrected and uncorrected visual acuity, thinnest pachymetry, and astigmatism. For Kmax, non-inferiority could not be concluded.
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Affiliation(s)
- Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Hed
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Hagay H, Achiron A, Maswuara D, Goldberg M. [ROCK (RHO-KINASE INHIBITORS) FOR THE TREATMENT OF OPEN-ANGLE GLAUCOMA AND OCULAR HYPERTENSION]. Harefuah 2023; 162:160-164. [PMID: 36966373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Netarsudil ophthalmic solution 0.02% is a new treatment for open-angle glaucoma and ocular hypertension, which was approved for treatment in the United States and in the European Commission. The drug is a rho- kinase inhibitor (ROCK) that lowers intraocular pressure by enhancing the outflow at the trabecular meshwork and decreasing both aqueous humor production and episcleral venous pressure. This literature review aims to present this new treatment, characterize its specific mechanism of action, and discuss its effect and adverse events profile. The efficacy and safety of the drug were studied in the ROCKET and MERCURY clinical trials, in which Netarsudil was compared to other common drugs, including Timolol (Beta-blocker), Latanoprost (Prostaglandin analog), and a combination drop containing Netarsudil and Latanoprost. These trials showed a reduction of 16%-21% in the intraocular pressure (IOP) when using Netarsudil. Moreover, it was found that when using a combination of Netarsudil and Latanoprost, 64.5% of these patients achieved ≥30% reduction in mean diurnal IOP versus 28.8% of patients treated only with Netarsudil and 37.2% of patients treated only with Latanoprost (P<0.0001). The most common adverse event reported was conjunctival hyperemia, which was more frequent in patients using Netarsudil. However, this did not significantly affect the drug tolerance.
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Affiliation(s)
- Hagay Hagay
- Ophthalmology Department, Barzilai Medical Center, Ashkelon Israel, Israel
| | - Asaf Achiron
- Sourasky Tel Aviv Hospital, Sackler Faculty of Medicine, Israel
| | - Dua Maswuara
- Ophthalmology Department, Barzilai Medical Center, Ashkelon Israel, Israel
| | - Mordechai Goldberg
- Glaucoma Service, Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem Israel
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Lu NJ, Koliwer-Brandl H, Gilardoni F, Hafezi N, Knyazer B, Achiron A, Zbinden R, Egli A, Hafezi F. The Antibacterial Efficacy of High-Fluence PACK Cross-Linking Can Be Accelerated. Transl Vis Sci Technol 2023; 12:12. [PMID: 36757342 PMCID: PMC9924428 DOI: 10.1167/tvst.12.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Purpose To determine whether high-fluence photoactivated chromophore for keratitis cross-linking (PACK-CXL) can be accelerated. Methods Solutions of Staphylococcus aureus and Pseudomonas aeruginosa with 0.1% riboflavin were prepared and exposed to 365 nm ultraviolet (UV)-A irradiation of intensities and fluences from 9 to 30 mW/cm2 and from 5.4 to 15.0 J/cm2, respectively, representing nine different accelerated PACK-CXL protocols. Irradiated solutions and unirradiated controls were diluted, plated, and inoculated on agar plates so that the bacterial killing ratios (BKR) could be calculated. Additionally, strains of Achromobacter xylosoxidans, Staphylococcus epidermidis, and Stenotrophomonas maltophilia were exposed to a single accelerated PACK-CXL protocol (intensity: 30 mW/cm2, total fluence: 15.0 J/cm2). Results With total fluences of 5.4, 10.0, and 15.0 J/cm2, the range of mean BKR for S. aureus was 45.78% to 50.91%, 84.13% to 88.16%, and 97.50% to 99.90%, respectively; the mean BKR for P. aeruginosa was 69.09% to 70.86%, 75.37% to 77.93%, and 82.27% to 91.44%, respectively. The mean BKR was 41.97% for A. xylosoxidans, 65.38% for S. epidermidis, and 78.04% for S. maltophilia for the accelerated PACK-CXL protocol (30 mW/cm2, 15 J/cm2). Conclusions The BKR of high-fluence PACK-CXL protocols can be accelerated while maintaining a high, but species-dependent, BKR. The Bunsen to Roscoe law is respected in fluences up to 10 J/cm2 in S. aureus and P. aeruginosa, whereas fluences above 10 J/cm2 show strain dependence. Translational Relevance The high-fluence PACK-CXL protocols can be accelerated in clinical practice while maintaining high levels of BKR.
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Affiliation(s)
- Nan-Ji Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,ELZA Institute, Dietikon, Zurich, Switzerland
| | | | | | - Nikki Hafezi
- School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,ELZA Institute, Dietikon, Zurich, Switzerland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Adrian Egli
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Farhad Hafezi
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China,ELZA Institute, Dietikon, Zurich, Switzerland,Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland,USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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19
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Malyugin BE, Belodedova A, Antonova O, Gelyastanov A, Tuuminen R, Levinger E, Achiron A, Knyazer B. Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK). Graefes Arch Clin Exp Ophthalmol 2023; 261:185-191. [PMID: 35896678 DOI: 10.1007/s00417-022-05765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet's membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography. MATERIALS AND METHODS A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group). RESULTS In the full FS-DALK group, the BB's formation was significantly higher (64.3% vs. 36.4%, p = 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8 min, p = 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%, p = 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18 months was lower in the full compared with the partial FS-DALK group (12 months:10.0% vs. 16; 18 months: 10.7 vs. 16.5%, p < 0.001 for both comparisons). CONCLUSIONS Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.
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Affiliation(s)
- Boris E Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59a, 127486, Moscow, Russian Federation. .,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation. .,Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Alexandra Belodedova
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59a, 127486, Moscow, Russian Federation
| | - Olga Antonova
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59a, 127486, Moscow, Russian Federation
| | - Aslan Gelyastanov
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59a, 127486, Moscow, Russian Federation
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Eliya Levinger
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Asaf Achiron
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Dafna St 5, Tel Aviv-Yafo, Israel.
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Haddad F, Mimouni M, Nemet A, Safuri S, Achiron A, Shapira Y, Mtanis K, Duvdevan-Strier N, Ben-Ner D, Zayit-Soudry S. Changes in chorioretinal flow index after cataract surgery: an optical coherence tomography angiography study. Int Ophthalmol 2023; 43:35-41. [PMID: 35810396 DOI: 10.1007/s10792-022-02385-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Pseudophakic cystoid macular edema (CME) occurs in up to 2% of uneventful cataract surgeries. This study evaluates changes in macular blood flow succeeding uneventful phacoemulsification cataract extraction among otherwise visually healthy subjects. METHODS This prospective study included 18 eyes of 18 patients undergoing routine phacoemulsification. Optical coherence tomography angiography (OCT-A) was performed using the Angio-Retina 6 × 6 mm protocol with the XR Avanti Angio-Vue system (Optovue Inc., Fremont, California) prior to the surgery and 4-8 weeks thereafter. Exclusion criteria included motion artifacts, segmentation errors and signal strength index (SSI) < 40. The main outcome measure was change in flow index (FI) measured in all 4 retinal segmentation layers within an area of 1 mm diameter around the foveal center. RESULTS Following surgery, a significant increase in SSI (46.65 ± 8.62 versus 53.12 ± 8.07, p = 0.01), superficial plexus FI (0.98 ± 0.23 versus 1.16 ± 0.16, p = 0.02) and deep plexus FI (0.54 ± 0.46 versus 0.93 ± 0.39, p = 0.01) was found. No significant changes were noted in the outer retina or the choriocapillaris. CONCLUSION The study demonstrates a significant increase in FI in the superficial and deep retinal plexus following uneventful cataract surgery, with the greatest changes occurring in the latter. These findings corroborate evidence from structural imaging and support the vascular etiology of pseudophakic CME.
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Affiliation(s)
- Fadi Haddad
- Department of Ophthalmology, The Baruch Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Achia Nemet
- Department of Ophthalmology, Assuta Ashdod University Medical Center, Ashdod, Israel.
| | - Shadi Safuri
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Asaf Achiron
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel.,Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yinon Shapira
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kamal Mtanis
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Nitzan Duvdevan-Strier
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Ben-Ner
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Elhaddad O, Achiron A, Yahalomi T, Avadhanam V, Tole D, Darcy K. Modified "Top-up sandwich" technique for the management of corneal perforations: A case report and a literature review. Am J Ophthalmol Case Rep 2022; 29:101765. [PMID: 36582846 PMCID: PMC9792391 DOI: 10.1016/j.ajoc.2022.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose We describe a modified technique for managing a peripheral, non-infected, corneal perforation using a "Sandwich" technique that combines posterior lamellar keratoplasty, an amniotic membrane patch and a Gundersen conjunctival flap. Observations A 75-year-old female patient presented with Sjogren's syndrome-related corneal perforation. A mini-Descemet stripping automated endothelial keratoplasty (DSAEK) graft (5 mm) was introduced into the anterior chamber and was mobilized to plug the perforation. Then, two amniotic membrane patches were stacked over the perforation and glued. Finally, the whole area was covered with a Gundersen conjunctival flap, mobilized from the inferior conjunctiva and secured in place using interrupted 10-0 nylon sutures. A step-by-step guide is also described. At three months, the final visual acuity was 6/9. A literature review revealed ten cases in which a posterior lamellar graft was effectively employed to treat corneal perforations. Conclusions and Importance We described a modified approach for treating peripheral corneal perforation surgically. This "sandwich" approach is simple to replicate and can give quick healing with few visual repercussions. Our detailed guide may be utilized to obtain similar results and may be added to the array of treatment options for peripheral corneal perforation.
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Affiliation(s)
- Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom,Faculty of Medicine, Alexandria University, Egypt,Corresponding author. Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. Lower Maudlin St, Bristol, BS1 2LX, UK.
| | - Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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22
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Achiron A, Elhaddad O, Regev T, Krakauer Y, Tsumi E, Hafezi F, Knyazer B. PACK Cross-Linking as Adjuvant Therapy Improves Clinical Outcomes in Culture-Confirmed Bacterial Keratitis. Cornea 2022; 41:1069-1073. [PMID: 34743099 DOI: 10.1097/ico.0000000000002905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We recently showed the positive clinical effects of combining accelerated corneal cross-linking (PACK-CXL) with antibiotic treatment in patients with presumed bacterial keratitis. In this study, we compare the impacts of a combined PACK-CXL/standard antibiotic treatment (PACK-ABX group) with standard antibiotic treatment alone (ABX group) in patients with culture-confirmed bacterial keratitis. METHODS We reviewed patients with moderate and severe bacterial keratitis and confirmed bacterial cultures. Clinical outcomes were compared for standard antibiotic treatment alone, before the initiation of PACK-CXL, and after adjuvant use of PACK-CXL. RESULTS A total of 47 eyes of 47 patients were included: 26 eyes in the PACK-ABX group and 21 eyes in the ABX group. Pathogens, baseline demographics (besides age), and clinical parameters were similar between the 2 groups. The PACK-ABX patients had better final uncorrected visual acuity [mean difference 0.57 Logarithm of the Minimum Angle of Resolution, 95% Confidence Interval (CI): 0.16-0.99, P = 0.07] and best-corrected visual acuity (mean difference 0.70 Logarithm of the Minimum Angle of Resolution, 95% CI: 0.23-1.16, P = 0.04), shorter reepithelialization time (mean difference 9.63 days, 95% CI: 3.14-16.12, P = 0.004), and reduced number of clinic visits (mean difference 4.8 meetings, 95% CI: 1.4-8.2, P = 0.007) and need for tectonic grafts (0 vs. 33.3%, P = 0.002). A multivariate analysis controlling for age, sex, ulcer size, and Gram stain showed that PACK-ABX treatment remained significantly associated with reepithelialization time (β = 14.5, P = 0.001). CONCLUSIONS In our study, PACK-CXLs addition to the standard of care in cases of culture-proven bacterial keratitis had a positive effect on the final visual acuity and time to resolution, compared with the standard-of-care treatment.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom and Faculty of Medicine, Alexandria University, Egypt
| | - Tamir Regev
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yonit Krakauer
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Tsumi
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Farhad Hafezi
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
- ELZA Institute, Dietikon/Zurich, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Ophthalmology, USC Roski Eye Institute, USC Los Angeles, Los Angeles
| | - Boris Knyazer
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Achiron A, Elhaddad O, Leadbetter D, Levinger E, Voytsekhivskyy O, Smith K, Avadhanam V, Darcy K, Tole D. Intraocular lens power calculation in patients with irregular astigmatism. Graefes Arch Clin Exp Ophthalmol 2022; 260:3889-3895. [PMID: 35776172 DOI: 10.1007/s00417-022-05729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/07/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Accurate intraocular lens (IOL) calculation in subjects with irregular astigmatism is challenging. This study evaluated the accuracy of using Scheimpflug-derived central 2-mm equivalent keratometry reading (EKR) values for IOL calculation in irregular astigmatism. METHODS This retrospective study included subjects (31 eyes of 30 patients) who underwent cataract surgery and IOL calculation using the 2-mm central EKR methods. We compared prediction error (PE) and absolute PE (APE) outcomes using SRK/T and Barrett Universal II formulas for keratometry data obtained from the IOLMaster 500 and Pentacam (anterior corneal sim k) devices. RESULTS Cataract surgery and IOL calculation using the 2-mm central EKR methods resulted in improved visual acuity (uncorrected: from 1.13 ± 0.38 to 0.65 ± 0.46 logMar, p < 0.01; best-corrected: from 0.45 ± 0.24 to 0.26 ± 0.20 logMar, p < 0.01) after surgery. The percentage of subjects with best-corrected visual acuity of 6/6 was 22%, < 6/9 was 58%, and < 6/12 was 71%. For both the SRK/T and the Barrett formulas, the PE was similar to those obtained by IOLMaster (> 0.14) but lower than those obtained by the anterior corneal sim k (p < 0.02). IOLMaster provided keratometry reading in only 23/31 (74.1%) of cases. CONCLUSIONS The use of Scheimpflug central 2-mm EKR for IOL calculation in irregular astigmatism was beneficial in terms of visual acuity improvement. It had comparable refractive prediction performance to the IOLMaster 500 and better than the anterior corneal sim K. The 2-mm EKR method can be used when IOLMaster cannot provide a reliable reading in abnormal corneas.
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Affiliation(s)
- Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK.
- Sourasky Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Duncan Leadbetter
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
| | - Eliya Levinger
- Sourasky Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Katy Smith
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
| | - Kieren Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin St, Bristol, BS1 2LX, UK
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Achiron A, El-Hadad O, Leadbetter D, Hecht I, Hamiel U, Avadhanam V, Tole D, Darcy K. Progression of Pediatric Keratoconus After Corneal Cross-Linking: A Systematic Review and Pooled Analysis. Cornea 2022; 41:874-878. [PMID: 34294638 DOI: 10.1097/ico.0000000000002808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Corneal collagen cross-linking (CXL) is an effective treatment to slow down keratoconus (KC) progression in adults. Several studies have also shown efficacious outcomes in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. This study aimed to establish the most commonly used criteria for progression and to conduct a systematic review of the literature with pooled analysis to assess children's keratoconus progression after CXL. METHODS A systemic literature review combined with pooled analysis was performed on full-length studies of KC after CXL treatment in a pediatric population and the methods used to report progression were analyzed. RESULTS Thirty-seven studies (2078 eyes) were identified on the rates of KC progression after CXL. The most common method to report progression was increased Kmax, Kmean, or Ksteep by ≥1.0 diopter (78.3% of studies). Using these criteria, the mean pooled progression rate after epithelium-off CXL was 9.9% (95% confidence interval: 6.1% -14.6%, total pooled sample size: 1508 eyes) with high heterogeneity between studies [I 2 = 86.48% (95% confidence interval: 80.98 - 90.39), P < 0.0001]. CONCLUSIONS When considering KC progression after CXL in children, with an increase in Kmax, Kmean, or Ksteep ≥ 1.0 diopter, the progression risk was roughly 10%. We encourage clear quantitative reporting of KC progression in future studies evaluating CXL efficacy in pediatric populations.
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Affiliation(s)
- Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar El-Hadad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Faculty of Medicine, Alexandria University, Egypt
| | - Duncan Leadbetter
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Uri Hamiel
- Genetics Institute, Tel Aviv Sourasky Medical Center & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieren Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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25
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Yahalomi T, Achiron A, Hecht I, Arnon R, Levinger E, Pikkel J, Tuuminen R. Refractive Outcomes of Non-Toric and Toric Intraocular Lenses in Mild, Moderate and Advanced Keratoconus: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092456. [PMID: 35566583 PMCID: PMC9101494 DOI: 10.3390/jcm11092456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background: To perform a systematic review and meta-analysis of the refractive outcomes of non-toric and toric intraocular lenses (IOLs) in keratoconus (KC) using different IOL power calculation formulas. Methods: A systematic search was conducted to identify studies that report on refractive outcomes of different IOL power calculation formulas in KC patients undergoing cataract surgery. Inclusion criteria were primary posterior chamber non-toric and toric monofocal intraocular lens implantation, data on the degree of KC, explicit mention of the formula used for each stage of KC, and the number of eyes in each category. We calculated and compared the absolute and mean prediction errors, percentage of eyes within 0.5 D and 1 D from target, and the weighted absolute prediction errors of IOL formulas, all were given for KC degrees I–III. Results: The bibliographic search yielded 582 studies published between 1996 and 2020, 14 of which (in total 456 eyes) met the criteria: three studies on non-toric IOL (98 eyes), eight studies on toric IOLs (98 eyes) and three studies of unknown separation between non-toric and toric IOLs (260 eyes). The lowest absolute prediction error (APE) for mild, moderate, and advanced KC was seen with Kane’s IOL power formula with keratoconus adjustment. The APE for the top five IOL power formulas ranged 0.49–0.73 diopters (D) for mild (83–94%) of eyes within 1 D from the target), 1.08–1.21 D for moderate (51–57% within 1 D), and 1.44–2.86 D for advanced KC (12–48% within 1 D). Conclusions: Cataract surgery in eyes with mild-to-moderate KC generally achieves satisfactory postoperative refractive results. In patients with advanced KC, a minority of the eyes achieved spherical equivalent refraction within 1 D from the target. The Kane’s formula with keratoconus adjustment showed the best results in all KC stages.
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Affiliation(s)
- Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel; (T.Y.); (R.A.); (J.P.)
| | - Asaf Achiron
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel; (A.A.); (E.L.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Department of Ophthalmology, Shamir Medical, Zerifin 7033001, Israel
| | - Roee Arnon
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel; (T.Y.); (R.A.); (J.P.)
| | - Eliya Levinger
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel; (A.A.); (E.L.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
| | - Joseph Pikkel
- Department of Ophthalmology, Samson Assuta Ashdod Hospital, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel; (T.Y.); (R.A.); (J.P.)
| | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Achiron A, Yavnieli R, Olshaker H, Levinger E, Tuuminen R, Livny E, Elbaz U, Bahar I, Nahum Y. Validation of the multi-metric D-index change in the assessment of keratoconus progression. Int Ophthalmol 2022; 42:2665-2671. [PMID: 35381894 DOI: 10.1007/s10792-022-02255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To validate the effectiveness of the multi-metric D-index by Pentacam in detecting keratoconus (KC) progression. MATERIALS AND METHODS This was a retrospective study of KC patients at the Rabin Medical Center, Petah Tikva, Israel, during 2016-2018 with at least two corneal tomography examinations six months apart. Agreement between clinical diagnosis of progression (1.5D increase in mean keratometric value, 1D increase in Kmax, a 5% decrease in central corneal thickness (CCT), worsening of visual acuity by more than one line, or deterioration of manifest corneal astigmatism > 1.5D) and the D-index was evaluated. Receiver operating characteristic (ROC) analysis was used to find the D-index's optimal cutoff value to show progression. RESULTS We included KC eyes in the stable group (N = 7) and the progression group (N = 54). Patient demographics and tomographic parameters at baseline were similar between the groups. The D-index change was significantly higher in the progression group than in the stable group (median + 1 and 0.0, respectively, p = 0.024). Based on the ROC analysis, the optimal D-index cutoff change within at least six months was 0.32 (59.3% sensitivity and 100% specificity (area under the curve [AUC] = 0.771, Youden = 0.592). Subjects with a D-index change above this value had a 21.1-fold increase in odds for corneal ectasia progression requiring CXL (OR: 21.1, 95%CI 1.17-398.8, p = 0.038). CONCLUSION The multi-metric D-index can serve as a clinically feasible parameter to detect KC progression and guide patients' referral for further interventions.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roy Yavnieli
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Olshaker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliya Levinger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, 39 Ze'ev Jabotinsky St., 4941492, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Achiron A. [REDUCTION OF MORBIDITY RATE IN THYROID EYE DISEASE PATIENTS]. Harefuah 2022; 161:221-222. [PMID: 35466605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In their review, Vashdi and Gur present the clinical effect of lifestyle modification in patients with Thyroid Eye Disease )TED(. Smoking cessation, controlled levels of lipids and supplemental dietary selenium improved patients' quality of life and slowed TED progression.
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Affiliation(s)
- Asaf Achiron
- Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University
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Spierer R, Achiron A, Qassoom A, Bachar Zipori A, Spierer O. Surgical outcomes of medial Rectus advancement for consecutive exotropia. Eur J Ophthalmol 2022; 32:3244-3249. [PMID: 35285340 DOI: 10.1177/11206721221085850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the surgical results of medial rectus muscle advancement for consecutive exotropia. METHODS The medical data of patients that underwent reoperation between the years 2000-2020 were collected and reviewed retrospectively. Patients who underwent medial rectus advancement for consecutive exotropia were included. The exclusion criteria were follow-up period shorter than 6 months, past reoperations and restrictive or paralytic strabismus. Success was defined as alignment within 10 PD of orthophoria at last follow-up. The success group of patients was compared with the failure group. RESULTS Twenty patients with mean postoperative follow-up from the second surgery of 34.7 ± 29.2 months were included. On last follow-up examination, 9 (45.0%) patients had a successful result. Nine patients had undercorrection and 2 had overcorrection. The two groups were similar in the preoperative amount of mean exotropia, 23.3 ± 9.9 PD in the success group and 29.8 ± 14.0 PD in the failure group. On last follow-up examination, the amount of mean deviation was 2.7 ± 2.6 PD exotropia in the success group and 13.4 ± 23.6 PD exotropia in the failure group. CONCLUSION Medial rectus advancement for the correction of consecutive exotropia was successful in almost half of the cases. Failure was usually due to undercorrection.
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Affiliation(s)
- Ronen Spierer
- Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Asaf Achiron
- Department of Ophthalmology, 26738Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayat Qassoom
- Department of Ophthalmology, E. Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Department of Ophthalmology, 26738Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, E. Wolfson Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Achiron A, Tuuminen R. Severe panuveitis with iridis rubeosis activation and cystoid macular edema after BioNTech-Pfizer COVID-19 vaccination in a 17-year-old. Am J Ophthalmol Case Rep 2022; 25:101380. [PMID: 35198809 PMCID: PMC8844771 DOI: 10.1016/j.ajoc.2022.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
We report a case of severe uveitis flare-up with iridis rubeosis recurrence and cystoid macular edema early after the first BioNTech-Pfizer COVID-19 vaccination in a 17-year-old boy. We also performed a systematic literature review on ocular inflammation after COVID-19 vaccinations.
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Karesvuo P, Elbaz U, Achiron A, Hecht I, Kaarniranta K, Tuuminen R. Effect of cataract surgery on wet age-related macular degeneration activity. Acta Ophthalmol 2022; 100:e262-e269. [PMID: 33838002 DOI: 10.1111/aos.14864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Wet age-related macular degeneration (AMD) and age-related cataract are often coexisting causes of visual impairment. Yet, the timing of cataract surgery in wet AMD patients is controversial. METHODS One hundred and eleven eyes of 111 patients with wet AMD underwent cataract surgery at Helsinki University Hospital in Finland during 2014-2018. Best-corrected visual acuity and central subfield macular thickness (CSMT) were analysed at the time of wet AMD diagnosis, at the last recording prior to cataract surgery and at the first recording and at 1 year after surgery. The cumulative number of antivascular endothelial growth factor (anti-VEGF) injections at surgery, systemic and topical medication and postoperative anti-VEGF burden were recorded. RESULTS Mean age was 78.9 ± 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 ± 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 ± 0.46 logMAR units preoperatively to 0.39 ± 0.40 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, p < 0.001 for both) and anti-VEGF treatment intervals lengthened despite the surgery (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, p = 0.246, and to 7.05 ± 2.57 weeks at the last documented visit, p = 0.035). A CSMT increase of over 30% from the preoperative values was seen in only one case (1 out of 111 eyes, 0.9%). Macular status at surgery, wet AMD subtype, comorbidity of type II diabetes, systemic drugs and topical anti-inflammatory medication were not associated with macular changes nor with treatment intervals after surgery. The cumulative number of anti-VEGF injections correlated neither with CSMT change postoperatively (r = -0.051, p = 0.619) nor with CSMT change at 1 year (r = 0.091, p = 0.426). CONCLUSION Satisfactory visual outcomes and controlled disease activity were seen in patients with wet AMD undergoing cataract surgery. We found no evidence to support delaying surgery in patients who require it.
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Affiliation(s)
- Petteri Karesvuo
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Uri Elbaz
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Rabin Medical Center Petach‐Tikva, Tel Aviv Israel
| | - Asaf Achiron
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Wolfson Medical Center Holon Israel
- Bristol Eye Hospital Bristol UK
| | - Idan Hecht
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Shamir Medical Center Tel Aviv Israel
| | - Kai Kaarniranta
- Department of Ophthalmology University of Eastern Finland Kuopio Finland
- Department of Ophthalmology Kuopio University Hospital Kuopio Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Elbaz U, Khalili S, Sella R, Reitblat O, Vega Y, Achiron A, Tuuminen R, Ali A, Mireskandari K. Comparison of the Barrett Universal II formula to previous generation formulae for paediatric cataract surgery. Acta Ophthalmol 2021; 100:682-689. [PMID: 34766439 DOI: 10.1111/aos.15062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. METHODS Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. RESULTS Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). CONCLUSION The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.
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Affiliation(s)
- Uri Elbaz
- Department of Ophthalmology Rabin Medical Center Schneider Hospital Petah Tikva Israel
- Department of Ophthalmology Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Sina Khalili
- Department of Ophthalmology and Vision Sciences The Hospital for Sick Children Toronto Ontario Canada
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto Ontario Canada
| | - Ruti Sella
- Department of Ophthalmology Rabin Medical Center Schneider Hospital Petah Tikva Israel
- Department of Ophthalmology Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Olga Reitblat
- Department of Ophthalmology Rabin Medical Center Schneider Hospital Petah Tikva Israel
- Department of Ophthalmology Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yakov Vega
- Department of Ophthalmology Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Goldschleger Eye Institute, Sheba Medical Center Tel‐Hashomer Israel
| | - Asaf Achiron
- Department of Ophthalmology Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology, Sourasky Medical Center Tel‐Aviv Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group Faculty of Medicine, University of Helsinki Helsinki Finland
- Department of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences The Hospital for Sick Children Toronto Ontario Canada
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto Ontario Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences The Hospital for Sick Children Toronto Ontario Canada
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto Ontario Canada
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Elbaz U, Hakkala L, Hecht I, Achiron A, Gershoni A, Tuuminen R. Nd:YAG capsulotomy is not a risk factor for retinal detachment after phacoemulsification cataract surgery. Acta Ophthalmol 2021; 99:e1018-e1026. [PMID: 33423371 DOI: 10.1111/aos.14757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the cumulative incidence and risk factors of pseudophakic retinal detachment (PRD) following phacoemulsification cataract surgery. METHODS Cataract surgeries performed between the years 2007 and 2016 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, were included. The cumulative incidence of PRD was estimated through Kaplan-Meier analysis. Patient mortality was incorporated as one of the censoring events. Cox regression analyses were used to evaluate potential risk factors, including age, gender, intraocular lens (IOL) power and previous neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy. RESULTS A total of 17 688 eyes of 12 003 patients were included. The mean patient age at surgery was 75.2 ± 9.1 years with 63.5% females (n = 11 228). During the mean follow-up time of 4.3 ± 2.7 years, 83 laterality-matched PRDs were registered (incidence 0.11% per year). Univariate analyses showed that age (HR 0.93; 95% CI 0.92-0.95), male gender (HR 3.99; 95% CI 2.52-6.33) and IOL power (HR 0.86; 95% CI 0.83-0.90) were significantly associated with PRD (p < 0.001 for all) and remained significant in a multivariate analysis. Neither univariate (HR 1.45; 95% CI 0.82-2.54, p = 0.201) nor multivariate (HR 1.03; 95%CI 0.57-1.88, p = 0.919) analyses showed any association between Nd:YAG capsulotomy and PRD. CONCLUSIONS Male gender, low IOL power and younger age were confirmed as risk factors for PRD after phacoemulsification surgery. Real-world evidence suggests that Nd:YAG capsulotomy does not increase the risk for PRD.
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Affiliation(s)
- Uri Elbaz
- Department of Ophthalmology Rabin Medical Center Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Laura Hakkala
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
| | - Idan Hecht
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Shamir Medical Center Tel Aviv Israel
| | - Asaf Achiron
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Cornea Unit Bristol Eye Hospital Bristol UK
| | - Assaf Gershoni
- Department of Ophthalmology Rabin Medical Center Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Nussinovitch H, Tsumi E, Tuuminen R, Malyugin B, Lior Y, Naidorf Rosenblatt H, Boyko M, Achiron A, Knyazer B. Cataract Surgery in Very Old Patients: A Case-Control Study. J Clin Med 2021; 10:jcm10204658. [PMID: 34682778 PMCID: PMC8537740 DOI: 10.3390/jcm10204658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.
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Affiliation(s)
- Hanan Nussinovitch
- Department of Ophthalmology, Shaarei Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland;
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Boris Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, 127486 Moscow, Russia;
- Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Yotam Lior
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel; (Y.L.); (M.B.)
| | | | - Matthew Boyko
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel; (Y.L.); (M.B.)
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (A.A.); (B.K.)
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
- Correspondence: (A.A.); (B.K.)
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Achiron RN, Achiron A, Tuuminen R. Correspondence. Retina 2021; 41:e55-e56. [PMID: 33840787 DOI: 10.1097/iae.0000000000003184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Romi Noy Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Tuuminen R, Achiron A, Kanclerz P. Controversies on the Recommended Treatment for Central Retinal Artery Occlusion. J Stroke Cerebrovasc Dis 2021; 30:105970. [PMID: 34274179 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- University Hospitals Bristol NHS Foundation Trust UK
| | - Piotr Kanclerz
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Hygeia Clinic, Gdańsk, Poland.
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Aaronson A, Taipale C, Achiron A, Aaltonen V, Grzybowski A, Tuuminen R. Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery. Transl Vis Sci Technol 2021; 10:15. [PMID: 34125145 PMCID: PMC8212433 DOI: 10.1167/tvst.10.7.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose To assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients. Methods A post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery. Results Aqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT (P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare (P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups. Conclusions At 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy. Translational Relevance A 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Israel.,Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Vesa Aaltonen
- Department of Ophthalmology, Turku University Hospital, Turku, Finland.,Department of Ophthalmology, University of Turku, Turku, Finland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Yehezkeli V, Rotenstreich Y, Haim LNB, Sher I, Achiron A, Belkin A. Ophthalmic emergency-room visits during the Covid-19 pandemic - a comparative study. BMC Ophthalmol 2021; 21:210. [PMID: 33980214 PMCID: PMC8114655 DOI: 10.1186/s12886-021-01976-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background The goal of this study is to compare ophthalmic emergency room (OER) visits during the Coronavirus disease-19 (Covid-19) pandemic to those during a control period. Methods We compared all visits to the OER to Meir Medical Center in Israel, from March 15th to April 15th, 2020, during the Covid-19 pandemic and government mandated quarantine, to the same period in 2019. Factors analyzed were patient demographics, chief complaints, referral patterns, exam findings, treatments given, hospitalizations and surgical interventions. Results We included in this study 1311 visits of 1158 patients, 477 during the 2020 Covid-19 pandemic and 834 during the same period in 2019. The demographic distribution (age, gender, and ethnicity) was similar between the two periods. LogMAR visual acuity at presentation was worse during the Covid-19 pandemic (0.42 ± 0.6 and 0.34 ± 0.5 in 2020 and 2019 respectively; p = 0.025) and the number of emergent surgeries was higher (3.7% in 2020 vs 1.8% in 2019, p = 0.026). In 2019 there was a higher likelihood of involvement of both segments of the eye (4.82% versus 1.2%, p < 0.01) and more diagnoses were given to each patient (1 ± 0.5 versus 0.93 ± 0.35, p = 0.001; During the Covid − 19 pandemic medications (both topical and systemic) were prescribed more often (1.22 ± 0.95 in 2020 and 0.84 ± 0.67 in 2019, p < 0.001). Conclusions OER visits were less frequent during the Covid − 19 pandemic as compared to 2019, though the demographics of the patients remained unchanged. Visits during the pandemic tended to be for more severe ocular conditions, with worse visual acuity at presentation and required more medical and surgical treatment which imply higher necessity of ocular evaluation. This analysis can aid healthcare resource management in similar scenarios in the future.
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Affiliation(s)
- Veronika Yehezkeli
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ygal Rotenstreich
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sher
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Asaf Achiron
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Achiron A, Nahum Y, Tiosano A, Shehadeh Mashor R, Tuuminen R, Elbaz U, Bahar I, Livny E. Descemet Membrane Endothelial Keratoplasty Outcomes between Young and Old Graft Recipients. Curr Eye Res 2021; 46:1460-1466. [PMID: 33840319 DOI: 10.1080/02713683.2021.1899245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluated Descemet's membrane endothelial keratoplasty (DMEK) outcomes in young and old graft recipients.Materials and Methods: Data of 164 surgeries with a median age of 76 years (interquartile range 14 years) undergoing DMEK surgery between 2016 and 2018 was reviewed. Complications, graft survival, and visual acuity gain were compared between subjects in the 25th percentile (young recipients; aged 70 years and less, n = 21) and 75th percentile (old recipients; aged 85 years and over, n = 27) over the 2-year follow-up.Results: Young recipients had a lower rate of pre-operative glaucoma (14.3% vs. 51.9%, p = .014) and pseudophakic bullous keratopathy (9.5% vs. 59.3%, p < .001), and a higher rate of Fuchs endothelial dystrophy (57.1% vs. 14.8%, p = .002) and combined cataract extraction at the time of DMEK surgery (52.4% vs. 7.4%, p = .001) when compared to old recipients. Complications (primary graft failure, pupillary block, cystoid macular edema or infectious keratitis) were independent of graft recipient age. Descemet's membrane detachment requiring re-bubbling was observed more often in young compared to the old recipients (42.9% vs. 14.8%, p = .049). Visual acuity gain between the groups remained comparable up to 1-year, whereas at 2-years old recipients showed significantly declined visual acuity gains compared to the young recipients (0.14 ± 0.68 vs. 0.74 ± 0.49, p = .012). Graft recipients aged over 85 years had a considerably higher graft failure rate over the 24-months (40.7% vs. 4.8%, p = .006) and shorter graft survival time (p = .002; log-rank) when compared to the recipients aged under 70 years. After adjusting for potential confounders such as Fuchs endothelial dystrophy, pseudophakic bullous keratopathy and glaucoma, the recipients aged over 85 remained at higher risk for graft failure (HR = 17.278, 95% CI = 1.787-167.1, p = .014).Conclusions: In aged DMEK recipients, regardless of the low incidence of early postoperative complications, the rate of postoperative graft failure was significantly higher and graft survival shorter than in younger recipients.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | | | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jbara D, Achiron A, Antman G, Buhbut O, Hecht I, Tuuminen R, Bahar I, Elbaz U. Agreement of Corneal Endothelial Cell Analysis Between Konan-Noncon Robo SP-6000 and Tomey EM-3000 Specular Microscopes in Healthy Subjects. Eye Contact Lens 2021; 47:191-195. [PMID: 32443012 DOI: 10.1097/icl.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare corneal endothelium parameters taken by two common noncontact specular microscopes in healthy subjects. METHODS Healthy participants visiting the outpatient eye clinic at the Rabin Medical Center, Petah Tikva, Israel, were recruited prospectively. All participants underwent three consecutive corneal endothelial cell photographs with both the Konan-Noncon Robo SP-6000 and the Tomey EM-3000 specular microscopes. Endothelial cell density (ECD) was evaluated using the manual center technique in both machines. Bland-Altman graphs were used to assess the agreement between the devices, and intraclass correlation coefficient (ICC) served to assess intraobserver variability for each device. RESULTS Recruited were 49 healthy subjects with a mean age of 48.9±15.6 years, 49 right eyes were included. The mean ECD was comparable between the Tomey EM-3000 and the Konan-Noncon Robo SP-6000 (2,713.2±242.4 vs. 2,700.8±300.5 cells/mm2, respectively, P=0.47) with a mean difference of 12.4 cells/mm2 (0.67%), a mean ECD absolute difference of 93.3 cells/mm2, and low 95% limits of agreement of -222.0 to +246.9 cells/mm2. A folded empirical distribution function curve showed that all differences fell within 525.4 cells/mm2, centered around a median of 13.3 cells/mm2. Intraclass correlation coefficient was high for both the Konan-Noncon Robo SP-6000 (0.93, 95% confidence interval [CI]: 0.89-0.95) and the Tomey EM-3000 (0.88, 95% CI: 0.82-0.93). CONCLUSIONS The difference in endothelial cell measurements between the Konan SP-6000 and the Tomey EM-3000 specular microscopes through the center and the L-count analyzing techniques, respectively, is clinically small and not statistically significant. Nevertheless, caution should be taken when used interchangeably because ECD difference between the two machines can be as high as 525.4 cells/mm2.
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Affiliation(s)
- Doha Jbara
- Department of Ophthalmology (D.J., G.A., I.B., U.E.), Rabin Medical Center, Petah-Tikva, Israel; Department of Ophthalmology, (D.J., A.A., G.A., I.H., I.B., U.E.), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Department of Ophthalmology (A.A.), Edith Wolfson Medical Center, Holon, Israel ; Department of Ophthalmology (O.B.), Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Ophthalmology (I.H.), Shamir Medical Center, Be'er Ya'akov, Israel ; Department of Ophthalmology (R.T.), Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland ; and Eye Centre (R.T.), Kymenlaakso Central Hospital, Kotka, Finland
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Osaadon P, Belfair N, Lavy I, Walter E, Levy J, Tuuminen R, Achiron A, Knyazer B. Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery. Eur J Ophthalmol 2021; 32:200-204. [PMID: 33719630 DOI: 10.1177/11206721211002064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery. METHODS A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications. RESULTS Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection (p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month (p < 0.001). CONCLUSIONS The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.
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Affiliation(s)
- Perach Osaadon
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Belfair
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itay Lavy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Eyal Walter
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Jaime Levy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Eye Centre, Kymenlaakso Central Hospital, Kotka, Kymenlaakso, Finland
| | - Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Knyazer B, Krakauer Y, Tailakh MA, Achiron A, Hecht I, Lifshitz T, Torres-Netto EA, Hafezi NL, Hafezi F. Accelerated Corneal Cross-linking as an Adjunct Therapy in the Management of Presumed Bacterial Keratitis: A Cohort Study. J Refract Surg 2021; 36:258-264. [PMID: 32267957 DOI: 10.3928/1081597x-20200226-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the outcomes of accelerated photoactivated chromophore for keratitis corneal cross-linking (PACK-CXL) as an adjunct treatment for bacterial keratitis (PACK-CXL plus standard antibiotic therapy) for patients receiving only standard antibiotic therapy. METHODS Retrospective cohort study of outcomes of patients with moderate infectious presumed bacterial keratitis (ulcer diameter 2 to 7 mm and stromal depth < 300 µm) were compared before and after initiation of a new treatment protocol of PACK-CXL in addition to standard antibiotic treatment. RESULTS A total of 70 eyes of 70 patients were included: 39 eyes in the PACK-CXL plus antibiotic (PACK-ABX) group and 31 eyes in the antibiotic only (ABX) control group. The PACK-ABX group showed shorter times to complete reepithelialization (9.3 ± 6.0 vs 16.0 ± 12.7 days, P = .01) and did not require tectonic emergency keratoplasty (0% versus 19.4%, P = .006). The PACK-ABX group also showed a higher percentage of eyes with complete reepithelialization in 6 days or less (46.2% vs 6.5%, P < .001) and a trend for shorter hospitalizations (6.3 ± 5.0 vs 8.5 ± 4.5 days, P = .06). A multivariate analysis controlling for age showed that PACK-ABX treatment remained significantly associated with early ulcer reepithelialization (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.48, P = .005). CONCLUSIONS This study validates previous findings regarding the use of accelerated PACK-CXL in the treatment of bacterial keratitis. Adding PACK-CXL improved clinical outcomes (reducing healing time) when compared to antibiotics alone. [J Refract Surg. 2020;36(4):258-264.].
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Vega Y, Gershoni A, Achiron A, Tuuminen R, Weinberger Y, Livny E, Nahum Y, Bahar I, Elbaz U. High Agreement between Barrett Universal II Calculations with and without Utilization of Optional Biometry Parameters. J Clin Med 2021; 10:jcm10030542. [PMID: 33540639 PMCID: PMC7867297 DOI: 10.3390/jcm10030542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose: To examine the contribution of anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW) measurements to intraocular lens (IOL) power calculations using the Barrett Universal II (BUII) formula. Methods: Measurements taken with the IOLMaster 700 (Carl Zeiss, Meditec AG, Jena, Germany) swept-source biometry of 501 right eyes of 501 consecutive patients undergoing cataract extraction surgery between January 2019 and March 2020 were reviewed. IOL power was calculated using the BUII formula, first through the inclusion of all measured variables and then by using partial biometry data. For each calculation method, the IOL power targeting emmetropia was recorded and compared for the whole cohort and stratified by axial length (AL) of the measured eye. Results: The mean IOL power calculated for the entire cohort using all available parameters was 19.50 ± 5.11 diopters (D). When comparing it to the results obtained by partial biometry data, the mean absolute difference ranged from 0.05 to 0.14 D; p < 0.001. The optional variables (ACD, LT, WTW) had the least effect in long eyes (AL ≥ 26 mm; mean absolute difference ranging from 0.02 to 0.07 D; p < 0.001), while the greatest effect in short eyes (AL ≤ 22 mm; mean absolute difference from 0.10 to 0.21 D; p < 0.001). The percentage of eyes with a mean absolute IOL dioptric power difference more than 0.25 D was the highest (32.0%) among the short AL group when using AL and keratometry values only. Conclusions: Using partial biometry data, the BUII formula in small eyes (AL ≤ 22 mm) resulted in a clinically significant difference in the calculated IOL power compared to the full biometry data. In contrast, the contribution of the optional parameters to the calculated IOL power was of little clinical importance in eyes with AL longer than 22 mm.
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Affiliation(s)
- Yakov Vega
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
| | - Assaf Gershoni
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, 00100 Helsinki, Finland;
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Yehonatan Weinberger
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eitan Livny
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva 49100, Israel; (Y.V.); (A.G.); (A.A.); (Y.W.); (E.L.); (Y.N.); (I.B.)
- Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-9376666
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Maharshak I, Hecht I, Mankuta L, Achiron A, Spierer O, Burgansky Z, Bar A, Grossbard A, Katkov A, Cernes R, Feldman L. The effect of hemodialysis on individual retinal layer thickness. Int Ophthalmol 2021; 41:1233-1240. [PMID: 33389423 DOI: 10.1007/s10792-020-01677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to employ newly developed advanced image analysis software to evaluate changes in retinal layer thickness following hemodialysis. METHODS A non-randomized prospective study of patients with end-stage renal disease assessed on the same day before and after hemodialysis. Intraocular pressure and central corneal thickness were analyzed, and spectral domain optical coherence tomography results were automatically segmented using the Orion software and then compared. All patients had normal retinal optical coherence tomography findings before hemodialysis. RESULTS Of the 31 suitable end-stage renal disease patients treated with hemodialysis who provided consent to participate, seven were unable to complete all evaluations, leaving 24 patients for analysis in the final study group. Their mean age was 66.67±14.3 years (range: 35-88), and 62.5% were males. Mean central corneal thickness did not change following hemodialysis (563.4±30.2 µm to 553.1±47.2 µm, p=.247), while mean intraocular pressure decreased (14.48±2.5 mmHg to 13.16±2.28 mmHg, p=.028). Individual mean retinal layer thickness showed no significant change, including the retinal nerve fiber layer (40.9±6.8 µm to 40.1±5.2 µm, p=.412), the ganglion cell and the inner plexiform layer (68.66±8 µm to 69.03±7.6 µm, p=.639), and the photoreceptor layer (50.26±2.8 µm to 50.32±3.1 µm, p=.869). Total retinal thickness similarly remained constant, with a mean of 303.7±17.3 µm before and 304.33±18.4 µm after hemodialysis (p=.571). CONCLUSIONS Thickness of retinal layers, as assessed by individual segmentation, and central corneal thickness were not affected by hemodialysis treatment, while intraocular pressure was significantly reduced among patients with end-stage renal disease without pre-existing ocular pathology who were undergoing hemodialysis. These results support the view that hemodialysis does not have a negative impact on the retinal morphology of end-stage renal disease patients, who comprise a population with high rates of diabetic and/or hypertensive retinopathy as well as vision-threatening complications.
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Affiliation(s)
- Idit Maharshak
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Beer Yaakov, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mankuta
- Department of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvia Burgansky
- Department of Ophthalmology, Meir medical center, Kefar Sava, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Bar
- Department of Ophthalmology, Edith Wolfson Medical Center, 62 Halochamim St, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aliza Grossbard
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anna Katkov
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Relu Cernes
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leonid Feldman
- Department of Nephrology and Hypertension, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Sharef N, Kassem R, Hecht I, Bar A, Maharshak I, Burgansky-Eliash Z, Weinberger Y, Tuuminen R, Achiron A. Interdigitation and Ellipsoid Zones Disruption Correlate with Visual Outcomes among Treatment-Naive Patients with Diabetic Macular Edema. Ophthalmic Res 2020; 64:476-482. [PMID: 33221809 DOI: 10.1159/000513204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. METHODS Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS The mean patients' age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 (p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 µm (p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 µm to 65.34 ± 143.97 µm (p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction (r = 0.41, p = 0.02) but not with improvement in CMT (r = 0.28, p = 0.121). CONCLUSIONS IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.
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Affiliation(s)
- Nardine Sharef
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rabea Kassem
- Department of Ophthalmology, Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem-Hadassah Medical School, Jerusalem, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Bar
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Maharshak
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Weinberger
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland and Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom,
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Mandelblum J, Fischer N, Achiron A, Goldberg M, Tuuminen R, Zunz E, Spierer O. A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies. J Clin Med 2020; 9:jcm9113503. [PMID: 33138221 PMCID: PMC7694099 DOI: 10.3390/jcm9113503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023] Open
Abstract
Background: The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. Methods: Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild “green nucleus” with plus sign for yellow reflection of the posterior cortex), 3 (medium “yellow nucleus” with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being “red/brown nucleus” and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. Results: Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman′s rho = 0.8, p < 0.001). Conclusion: This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.
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Affiliation(s)
- Jorge Mandelblum
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6243906, Israel; (J.M.); (N.F.); (E.Z.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Naomi Fischer
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6243906, Israel; (J.M.); (N.F.); (E.Z.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Asaf Achiron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2LX, UK
| | | | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, 00100 Helsinki, Finland;
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Eran Zunz
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6243906, Israel; (J.M.); (N.F.); (E.Z.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Oriel Spierer
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 6243906, Israel; (J.M.); (N.F.); (E.Z.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Ophthalmology, Wolfson Medical Center, Holon 5822012, Israel
- Correspondence:
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Hecht I, Dubinsky‐Pertzov B, Karesvuo P, Achiron A, Tuuminen R. Association between intraocular lens diopter and posterior capsular opacification. Clin Exp Ophthalmol 2020; 48:889-894. [DOI: 10.1111/ceo.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/04/2020] [Accepted: 07/04/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Biana Dubinsky‐Pertzov
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Petteri Karesvuo
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Asaf Achiron
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Eye Centre Kymenlaakso Central Hospital Kotka Finland
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Achiron A, Elbaz U, Hecht I, Spierer O, Einan-Lifshitz A, Karesvuo P, Laine I, Tuuminen R. The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 128:410-416. [PMID: 32717342 DOI: 10.1016/j.ophtha.2020.07.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery. DESIGN Cohort study. PARTICIPANTS Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. METHODS Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included. MAIN OUTCOME MEASURE Neovascular age-related macular degeneration-free survival. RESULTS Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n = 88; non-BLF group, n = 76). The nAMD-free survival was similar between the groups (P = 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79-1.47; P = 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P = 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P = 0.527), number of anti-vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P = 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P = 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n = 71; non-BLF, n = 74), the clinical outcomes again were comparable (all P > 0.05). CONCLUSIONS In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Bristol Eye Hospital, Bristol, United Kingdom
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Bristol Eye Hospital, Bristol, United Kingdom
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petteri Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Laine
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Automation and Electrical Engineering, Aalto University, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland.
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Smadar L, Dotan G, Abumanhal M, Achiron A, Spierer O. Demographic, clinical features, and outcomes of pediatric non-penetrating ocular foreign bodies. Graefes Arch Clin Exp Ophthalmol 2020; 258:1469-1474. [PMID: 32296989 DOI: 10.1007/s00417-020-04688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Data regarding ocular foreign body (FB) in the pediatric population is sparse. The purpose of this study is to describe the demographic features and the outcomes of pediatric non-penetrating ocular FB. METHODS The charts of all children with non-penetrating ocular FB who presented at a tertiary medical center between 2011 and 2018 were retrospectively reviewed. Data analyzed included demographics, ocular FB site, the need for general anesthesia, or sedation for FB removal and clinical outcomes. RESULTS Three hundred and fifty-two children (58.8% boys) with a mean age of 7.7 ± 3.7 years were included. Two hundred and fifty-one (71.3%) children presented on the same day of injury. Patients with developmental delay presented more often with restlessness than patients without developmental delay (p < 0.0001). One hundred and forty-six (41.5%) of FBs were found on the conjunctiva, 128 (36.4%) under the eyelid, and 62 (17.6%) on the cornea. In 19 (4.5%) cases, general anesthesia or sedation was required for FB removal. A multivariate analysis identified young age (OR 0.976, 95% CI 0.961-0.992, p = 0.003), corneal FB (OR 50.84, 95% CI 10.08-256.37, p < 0.0001), and developmental delay (OR 18.56, 95% CI 1.22-283.45, p = 0.036), as significant predictors for the need of general anesthesia or sedation. Among patients with corneal FB, in two (3.2%) cases, the corneal FB was complicated by infectious keratitis, resulting in mild corneal scar. CONCLUSION The rate of general anesthesia for non-penetrating ocular FB removal in children is low. Children presenting with non-penetrating ocular FB have good prognosis without long-term complications.
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Affiliation(s)
- Lital Smadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Muhammad Abumanhal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Asaf Achiron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Ophthalmology and Adult Strabismus Unit, E. Wolfson Medical Center, Holon, Israel
| | - Oriel Spierer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Pediatric Ophthalmology and Adult Strabismus Unit, E. Wolfson Medical Center, Holon, Israel.
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Vishnevskia-Dai V, Achiron A, Buhbut O, Berar OV, Musika AA, Elyashiv SM, Hecht I. Chorio-retinal toxoplasmosis: treatment outcomes, lesion evolution and long-term follow-up in a single tertiary center. Int Ophthalmol 2019; 40:811-821. [PMID: 31792847 DOI: 10.1007/s10792-019-01242-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ocular toxoplasmosis is a common cause of ocular inflammation worldwide. The aim of this study is to characterize the clinical outcomes and lesion evolution of patients with ocular toxoplasmosis and to compare the primary and reactivation subgroups. METHODS A retrospective population-based cohort study at one uveitis-specialized tertiary referral center. Patients presenting with active ocular toxoplasmosis between the years 2007-2016 were included. Primary ocular toxoplasmosis and reactivations were compared. RESULTS Included were 22 patients, 64% female with a mean age of 29 ± 18 years, 59% (n = 13) were primary, 9% (n = 2) congenital and 32% (n = 7) reactivations. Visual acuity improved from 0.38 ± 0.44 to 0.20 ± 0.27 LogMAR (P = 0.026) after a mean of 37 ± 33 months. Initial lesion size was 2.38 ± 1.1 optic disc areas, reducing to 1.56 ± 1.24 following 2 months (34% reduction, P = 0.028) and to 1.17 ± 0.87 disc areas following one year (51% reduction, P = 0.012). Patients with macula-threatening lesions had worse visual acuity (0.50 ± 0.46 vs. 0.05 ± 0.07 LogMAR, P = 0.047). Primary and reactivation subgroups had similar presentations, visual outcomes and recurrence rates (all P > 0.05). CONCLUSIONS In this population, primary ocular toxoplasmosis was the most common presentation. Lesion size reduced during the initial months with limited change thereafter and a third of cases recurred. Macula-threatening lesions were associated with worse visual acuity, and no significant differences were seen between the primary and reactivation subgroups.
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Affiliation(s)
- Vicktoria Vishnevskia-Dai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
| | - Asaf Achiron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
| | - Ortal Buhbut
- Department of Ophthalmology, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ofri Vorobichik Berar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Anne Ampaire Musika
- The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Ophthalmology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sivan M Elyashiv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel
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