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Son HS, Chang DF, Li C, Liu L, Zafar S, Lum F, Woreta FA. Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2024; 131:403-411. [PMID: 37858872 DOI: 10.1016/j.ophtha.2023.10.021] [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: 02/19/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN Retrospective cohort study. PARTICIPANTS Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES Visual outcomes and postoperative complications after lens exchange. RESULTS A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | | | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Schehlein EM, Hovanesian J, Shukla AG, Talley Rostov A, Findl O, Chang DF. Reducing ophthalmic surgical waste through electronic instructions for use: a multisociety position paper. J Cataract Refract Surg 2024; 50:197-200. [PMID: 38141003 PMCID: PMC10878457 DOI: 10.1097/j.jcrs.0000000000001381] [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: 11/28/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Every ophthalmic surgical supply, including intraocular lenses (IOLs), IOL cartridges, and ophthalmic viscosurgical device syringes, is packaged with instructions for use (IFU). These pamphlets are printed in multiple languages and, in the case of an IOL, significantly increase the size and weight of the packaging. To eliminate this significant and unnecessary source of waste, we recommend that manufacturers move to Quick Response codes that link to online electronic IFU (e-IFU) as a sensible alternative. In addition to reducing carbon emissions and manufacturing costs, e-IFU can be updated more easily and accessed by surgeons in the clinic, where IOL models and powers are selected. Varying and inconsistent IFU requirements between different countries are a barrier to wider adoption of e-IFU by the ophthalmic surgical industry. Regulatory agencies in every country should allow and encourage e-IFU. This position paper has been endorsed by the 3 major societies that sponsor EyeSustain, a consortium of global societies dedicated to advancing sustainability in ophthalmology.
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Affiliation(s)
- Emily M. Schehlein
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - John Hovanesian
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Aakriti Garg Shukla
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Audrey Talley Rostov
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Oliver Findl
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - David F. Chang
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
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Awidi AA, Chang DF, Riaz KM, Li X, LaBorwit S, Zebardast N, Srikumaran D, Prescott CR, Daoud YJ, Woreta FA. Anti-inflammatory medication use after cataract surgery: online survey of practice patterns. J Cataract Refract Surg 2024; 50:224-229. [PMID: 38381616 PMCID: PMC10878440 DOI: 10.1097/j.jcrs.0000000000001341] [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: 07/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine current prescribing patterns for topical or intraocular/periocular anti-inflammatory medications (AIMs) after routine cataract surgery. SETTING kera-net online members. DESIGN Cross-sectional survey. METHODS An online survey was distributed to subscribers of kera-net, a global online platform sponsored by the Cornea Society. Questions were asked regarding the use of topical or intraocular/periocular AIM after cataract surgery and types of medications prescribed. RESULTS Of 217 surgeon respondents (23% response rate), 171 (79%) practiced in the United States and 171 (79%) were cornea subspecialists. Most of the respondents (n = 196, 97%) prescribed topical corticosteroids after routine cataract surgery. The most frequently prescribed were prednisolone acetate (n = 162, 83%), followed by dexamethasone (n = 26, 13%), difluprednate (n = 24, 12%), and loteprednol etabonate (n = 13, 7%). Corticosteroids comprised (n = 40, 32%) of total intraocular/periocular injections, with triamcinolone acetonide 10 or 40 mg (n = 19, 47.5%) most commonly used. 23 surgeons (58%) who utilized intraocular/periocular corticosteroids also prescribed topical corticosteroids. Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 148 surgeons (73%). CONCLUSIONS Most surgeons prescribed topical AIM after routine cataract surgery. Many surgeons injected intraocular or periocular AIM while prescribing topical AIM. The diversity of practice patterns may reflect the lack of clear evidence-based guidelines.
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Affiliation(s)
- Abdelhalim A. Awidi
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - David F. Chang
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Kamran M. Riaz
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Ximin Li
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Scott LaBorwit
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Nazlee Zebardast
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Divya Srikumaran
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Christina R. Prescott
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Yassine J. Daoud
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Fasika A. Woreta
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
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Chang DF, Court KA, Holgate R, Davis EA, Bush KA, Quick AP, Spiegel AJ, Rahimi M, Cooke JP, Godin B. Telomerase mRNA Enhances Human Skin Engraftment for Wound Healing. Adv Healthc Mater 2024; 13:e2302029. [PMID: 37619534 PMCID: PMC10840696 DOI: 10.1002/adhm.202302029] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/20/2023] [Indexed: 08/26/2023]
Abstract
Deep skin wounds represent a serious condition and frequently require split-thickness skin grafts (STSG) to heal. The application of autologous human-skin-cell-suspension (hSCS) requires less donor skin than STSG without compromising the healing capacity. Impaired function and replicative ability of senescent cutaneous cells in the aging skin affects healing with autologous hSCS. Major determinants of senescence are telomere erosion and DNA damage. Human telomerase reverse transcriptase (hTERT) adds telomeric repeats to the DNA and can protect against DNA damage. Herein, hTERT mRNA lipid nanoparticles (LNP) are proposed and evaluated for enhancing cellular engraftment and proliferation of hSCS. Transfection with optimized hTERT mRNA LNP system enables delivery and expression of mRNA in vitro in keratinocytes, fibroblasts, and in hSCS prepared from donors' skin. Telomerase activity in hSCS is significantly increased. hTERT mRNA LNP enhance the generation of a partial-thickness human skin equivalent in the mouse model, increasing hSCS engraftment (Lamin) and proliferation (Ki67), while reducing cellular senescence (p21) and DNA damage (53BP1).
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Affiliation(s)
- David F. Chang
- Center for Cardiovascular Regeneration, Institute of Academic Medicine (IAM), Houston Methodist Research Institute (HMRI), Houston, TX, USA
| | | | - Rhonda Holgate
- Center for Cardiovascular Regeneration, Institute of Academic Medicine (IAM), Houston Methodist Research Institute (HMRI), Houston, TX, USA
| | - Elizabeth A. Davis
- Center for Cardiovascular Regeneration, Institute of Academic Medicine (IAM), Houston Methodist Research Institute (HMRI), Houston, TX, USA
| | | | | | - Aldona J. Spiegel
- Center for Breast Restoration, Houston Methodist Institute for Reconstructive Surgery, Houston Methodist Hospital (HMH)
| | - Maham Rahimi
- Center of Cardiovascular Surgery, Institute of Academic Medicine, HMH
| | - John P. Cooke
- Center for Cardiovascular Regeneration, Institute of Academic Medicine (IAM), Houston Methodist Research Institute (HMRI), Houston, TX, USA
- Department of Cardiovascular Sciences, Institute of Academic Medicine, HMH
- Center for RNA Therapeutics, IAM, HMH
| | - Biana Godin
- Department of Nanomedicine, IAM, HMRI, Houston, TX, USA
- Center for RNA Therapeutics, IAM, HMH
- Department of Obstetrics and Gynecology, HMH
- Department of Obstetrics and Gynecology, Weill Cornell Medicine College
- Department of Biomedical Engineering, Texas A&M University
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Myers WG, Chang DF, Shorstein NH, Mah FS, Mamalis N, Miller KM. ASCRS clinical advisory on intracameral moxifloxacin injection for infection prophylaxis. J Cataract Refract Surg 2023; 49:1068-1070. [PMID: 37290753 DOI: 10.1097/j.jcrs.0000000000001237] [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: 03/01/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
Moxifloxacin solution is frequently injected at the conclusion of cataract surgery for endophthalmitis prophylaxis. 2 different concentrations are most commonly available in the United States for intracameral (IC) use: 0.5% (5 mg/mL) and 0.1% (1 mg/mL). The recommended volume to be injected is different for the 2 concentrations, and incorrect dosing can increase the risk of toxic anterior segment syndrome or endophthalmitis. In addition, the U.S. Food and Drug Administration recently published an alert regarding potential adverse events associated with intraocular compounded moxifloxacin. This clinical advisory reviews the optimal dosing of IC moxifloxacin based on current evidence.
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Affiliation(s)
- William G Myers
- From the Northwestern University, Chicago, Illinois (Myers); University of California, San Francisco, San Francisco, California (Chang); Kaiser Permanente, Walnut Creek, California (Shorstein); Scripps Clinic Medical Group, La Jolla, California (Mah); Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Mamalis); Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California (Miller)
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Montesano G, Ometto G, Ahmed IIK, Ramulu PY, Chang DF, Crabb DP, Gazzard G. Response to Comment on: Five-year visual field outcomes of the HORIZON trial. Am J Ophthalmol 2023; 253:253-254. [PMID: 37196841 DOI: 10.1016/j.ajo.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Giovanni Montesano
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; City University of London-Optometry and Visual Sciences, London, United Kingdom
| | - Giovanni Ometto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; City University of London-Optometry and Visual Sciences, London, United Kingdom
| | - Iqbal Ike K Ahmed
- John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA; Department of Ophthalmology, University of Toronto, Toronto, Canada
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - David P Crabb
- City University of London-Optometry and Visual Sciences, London, United Kingdom
| | - Gus Gazzard
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Dai X, Chang DF, Chen A, Dun C, Saeed S, Repka MX, Woreta FA. Use and Cost of Sustained-Release Corticosteroids for Cataract Surgery Under the Medicare Pass-Through Program. JAMA Ophthalmol 2023; 141:844-851. [PMID: 37535374 PMCID: PMC10401390 DOI: 10.1001/jamaophthalmol.2023.3389] [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: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Abstract
Importance Sustained-release corticosteroids offer the potential of improved compliance and greater patient convenience for anti-inflammatory treatment after cataract surgery. However, they are substantially more expensive than postoperative corticosteroid eye drops, which have historically been standard care. Objective To examine the use and cost of sustained-release corticosteroids in patients with Medicare who underwent cataract surgery in the US during the temporary pass-through reimbursement program period. Design, Setting, and Participants This cross-sectional study examined Medicare fee-for-service (FFS) claims from beneficiaries with at least 12 continuous months of Medicare enrollment who underwent at least 1 cataract surgery from March 2019 through December 2021. Patients younger than 65 years, those with missing demographic information, those who had more than 1 cataract surgery on each eye, and those who received more than 1 corticosteroid on the day of surgery were excluded. Cataract surgeries with concurrent use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert were identified. Information on surgeon demographic characteristics and costs of surgery and drugs were extracted. Data were analyzed from June 15 to December 4, 2022. Exposure Use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert during cataract surgery. Main Outcome Measures Utilization rate and cost of dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert among Medicare FFS beneficiaries who underwent cataract surgery. Results A total of 4 252 532 cataract surgeries in Medicare FFS beneficiaries (mean [SD] age, 74.8 [5.8] years; 1 730 811 male [40.7%] and 2 521 721 female [59.3%]) were performed by 12 284 ophthalmologists (8876 male [72.3%], 2877 female [23.4%], and 531 sex unknown [4.3%]). In all, 34 627 beneficiaries (0.8%) received dexamethasone intraocular suspension 9% and 73 430 (1.7%) received a dexamethasone ophthalmic insert; the use of both drugs increased over the study period. The mean (SD) Medicare allowed charges for dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert were $531.47 ($141.52) and $538.49 ($63.79), respectively. Conclusions and Relevance Despite offering the potential of improved compliance and greater patient convenience, findings of this study suggest that sustained-release corticosteroid use during cataract surgery was low and associated with cost increases to the health care system vs conventional postoperative eye drops. As these new products must be priced high enough to qualify for the Medicare pass-through program, unreasonable cost may have been a deterrent to their use, suggesting that the current Medicare reimbursement rules may not be appropriate for sustained-release postoperative corticosteroids in cataract surgery.
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Affiliation(s)
- Xi Dai
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David F. Chang
- Department of Ophthalmology, University of California, San Francisco, San Francisco
- Altos Eye Physicians, Los Altos, California
| | - Ariel Chen
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Safa Saeed
- School of Medicine, Aga Khan University, Karachi, Pakistan
| | - Michael X. Repka
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika Ambachew Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Montesano G, Ometto G, Ahmed IIK, Ramulu PY, Chang DF, Crabb DP, Gazzard G. Five-Year Visual Field Outcomes of the HORIZON Trial. Am J Ophthalmol 2023; 251:143-155. [PMID: 36813144 DOI: 10.1016/j.ajo.2023.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS). DESIGN Post hoc analysis of VF data from the HORIZON multicenter randomized controlled trial. METHODS A total of 556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187) and followed up for 5 years. VF was performed at 6 months and then every year after surgery. We analyzed data for all participants with at least 3 reliable VFs (false positives < 15%). Average between-group difference in rate of progression (RoP) was tested using a Bayesian mixed model and a 2-sided Bayesian P value <.05 (main outcome). A multivariable model measured the effect of intraocular pressure (IOP). A survival analysis compared the probability of global VF sensitivity dropping by predefined cutoffs (2.5, 3.5, 4.5, and 5.5 dB) from baseline. RESULTS Data from 352 eyes in the CS-HMS arm and 165 in the CS arm were analyzed (2966 VFs). The mean RoP was -0.26 dB/y (95% credible interval -0.36, -0.16) for CS-HMS and -0.49 dB/y (95% credible interval -0.63, -0.34) for CS. This difference was significant (P = .0138). The difference in IOP only explained 17% of the effect (P < .0001). Five-year survival analysis showed an increased probability of VF worsening by 5.5 dB (P = .0170), indicating a greater proportion of fast progressors in the CS arm. CONCLUSIONS CS-HMS has a significant effect on VF preservation in glaucoma patients compared with CS alone, reducing the proportion of fast progressors.
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Affiliation(s)
- Giovanni Montesano
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom; City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom.
| | - Giovanni Ometto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom; City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom
| | - Iqbal Ike K Ahmed
- John Moran Eye Center, University of Utah (I.I.K.A.), Salt Lake City, Utah; University of Toronto (I.I.K.A.), Toronto, Ontario, Canada
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University (P.Y.R.), Baltimore, Maryland, USA
| | - David F Chang
- Altos Eye Physicians (D.F.C.), Los Altos, California, USA
| | - David P Crabb
- City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom
| | - Gus Gazzard
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom.
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Chang DF, Elferink S, Nuijts RMMA. Survey of ESCRS members' attitudes toward operating room waste. J Cataract Refract Surg 2023; 49:341-347. [PMID: 36975010 DOI: 10.1097/j.jcrs.0000000000001096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 03/29/2023]
Abstract
In a survey of ESCRS member cataract surgeons, 92% felt that operating room waste is excessive and should be reduced; 99% were concerned about global warming and climate change. Most respondents cited restrictions on reuse by manufacturers and regulatory bodies as major drivers of this waste. There was a strong desire to have more reusable options for instruments, devices, and supplies. In comparable percentages with an earlier survey of North American cataract surgeons using the identical questionnaire, there was a strong willingness to reuse many surgical supplies, as well as topical and intraocular medications. This was true even though ESCRS members were much more likely to practice in hospitals (68% vs 35%). The similarities of these results to the North American survey suggest that these attitudes toward sustainability are in fact global and universal. The strong concordance between the 2 surveys suggests that global collaboration is both possible and necessary.
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Affiliation(s)
- David F Chang
- From the University of California, San Francisco, San Francisco, California (Chang); Flevoziekenhuis, Almere, the Netherlands (Elferink); Maastricht University Medical Center+, Maastricht, the Netherlands (Nuijts)
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Shukla AG, Robin AL, Chang DF. Comments on: All India Ophthalmological Society (AIOS) Task Force guidelines to prevent intraocular infections and cluster outbreaks after cataract surgery. Indian J Ophthalmol 2022; 70:4456. [PMID: 36453367 PMCID: PMC9940562 DOI: 10.4103/ijo.ijo_1948_22] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Aakriti Garg Shukla
- On Behalf of the Ophthalmic Instrument Cleaning and Sterilization Task Force of the American Academy of Ophthalmology, The American Society of Cataract and Refractive Surgery, The American Glaucoma Society, and The Outpatient Ophthalmic Surgery Society
| | - Alan L Robin
- On Behalf of the Ophthalmic Instrument Cleaning and Sterilization Task Force of the American Academy of Ophthalmology, The American Society of Cataract and Refractive Surgery, The American Glaucoma Society, and The Outpatient Ophthalmic Surgery Society,Correspondence to: Dr. Alan L Robin, Ophthalmology and International Health, Johns Hopkins University, 6520 Abbey View Way, Baltimore, MD, USA. E-mail:
| | - David F Chang
- On Behalf of the Ophthalmic Instrument Cleaning and Sterilization Task Force of the American Academy of Ophthalmology, The American Society of Cataract and Refractive Surgery, The American Glaucoma Society, and The Outpatient Ophthalmic Surgery Society
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Palmer DJ, Robin AL, McCabe CM, Chang DF. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg 2022; 48:1073-1077. [PMID: 35608314 DOI: 10.1097/j.jcrs.0000000000000975] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
This position article on reducing topical drug waste with ophthalmic surgery was written by the Ophthalmic Instrument Cleaning and Sterilization Task Force, comprising representatives of the ASCRS, American Academy of Ophthalmology, American Glaucoma Society, and Outpatient Ophthalmic Surgery Society. Drug waste significantly increases the costs and carbon footprint of ophthalmic surgery. Surgical facilities should be permitted to use topical drugs in multidose containers on multiple patients until the manufacturer's labeled date of expiration, if proper guidelines are followed. Surgical patients requiring a topical medication not used for other patients should be allowed to bring that partially used medication home for postoperative use. These recommendations are based on published evidence and clarification of policies from multiple regulatory and accrediting agencies with jurisdiction over surgical facilities. Surveys suggest that most ambulatory surgery centers and hospitals performing cataract surgery are wasting topical drugs unnecessarily.
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Affiliation(s)
- David J Palmer
- From the Northwestern University Feinberg School of Medicine, Chicago, Illinois (Palmer); University of Michigan, Ann Arbor, Michigan (Robin); The Eye Associates, Bradenton, Florida (McCabe); Altos Eye Physicians, Los Altos, California (Chang)
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Thiel CL, Zhang J, Chang DF. Differences in reuse of cataract surgical supplies and pharmaceuticals based on type of surgical facility. J Cataract Refract Surg 2022; 48:1092-1094. [PMID: 35383659 DOI: 10.1097/j.jcrs.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Cassandra L Thiel
- From the Departments of Population Health and Ophthalmology, NYU Langone Health, New York City, New York (Thiel); Merck Research Laboratories, Merck & Co., Inc., MRL BARDS, Rahway, New Jersey (Zhang); Department of Ophthalmology, University of California, San Francisco, San Francisco, California (Chang)
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Haripriya A, Ravindran RD, Robin AL, Shukla AG, Chang DF. Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery. Br J Ophthalmol 2022; 107:780-785. [PMID: 35017161 DOI: 10.1136/bjophthalmol-2021-320506] [Citation(s) in RCA: 2] [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: 09/23/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine whether four new operating room (OR) protocols instituted because of COVID-19 reduced the cataract surgical postoperative endophthalmitis rate (POE). DESIGN Retrospective, sequential, clinical registry study. METHODS 85 552 sequential patients undergoing cataract surgery at the Aravind Eye Hospitals between 1 January 2020 and 25 March 2020 (56 551 in group 1) and 3 May 2020 and 31 August 2020 (29 011 in group 2). In group 1, patients were not gowned, surgical gloves were disinfected but not changed between cases, OR floors were not cleaned between every case, and multiple patients underwent preparation and surgery in the same OR. In group 2, each patient was gowned, surgical gloves were changed between each case, OR floors and counters were cleaned between patients, and only one patient at a time underwent preparation and surgery in the OR. RESULTS Group 1 was older, had slightly more females, and better preoperative vision. More eyes in group 2 underwent phacoemulsification (p=0.18). Three eyes (0.005%) in group 1 and 2 eyes (0.006%) in group 2 developed POE (p=0.77). Only one eye that underwent phacoemulsification developed POE; this was in group 1. There was no difference in posterior capsule rupture rate between the two groups. CONCLUSIONS Adopting a set of four temporary OR protocols that are often mandatory in the Western world did not reduce the POE rate. Along with previously published studies, these results challenge the necessity of these common practices which may be needlessly costly and wasteful, arguing for the reevaluation of empiric and potentially unnecessary guidelines that govern ophthalmic surgeries.
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Affiliation(s)
- Aravind Haripriya
- Cataract and Intraocular Lens Services, Aravind Eye Care System, Chennai, Tamil Nadu, India
| | - Ravilla D Ravindran
- Chairman & Director - Quality Division, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA
- Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland, USA
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Chang DF, Rhee DJ. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2021 ASCRS member survey. J Cataract Refract Surg 2022; 48:3-7. [PMID: 34282070 DOI: 10.1097/j.jcrs.0000000000000757] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 06/12/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
In an online survey of >1200 global cataract surgeons, 66% were using intracameral (IC) antibiotic prophylaxis. This compared with 50% and 30% in the 2014 and 2007 surveys, respectively. Irrigation bottle infusion and intravitreal injection was each used by only 5% of respondents. For IC antibiotics, vancomycin was used by 6% in the United States (52% in 2014), compared with 83% for moxifloxacin (31% in 2014). Equal numbers used compounded moxifloxacin or the Vigamox bottle as the source. There was a decrease in respondents using preoperative (73% from 85%) and postoperative (86% from 97%) topical antibiotic prophylaxis; the latter was not used by 24% of surgeons injecting IC antibiotics. Reasons cited by those not using IC antibiotics include mixing/compounding risk (66%) and being unconvinced of the need (48%). However, 80% believe having a commercially approved IC antibiotic is important; if reasonably priced, this would increase adoption of IC prophylaxis to 93%.
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Affiliation(s)
- David F Chang
- From the University of California, San Francisco, San Francisco, California (Chang); and the Case Western Reserve University, Cleveland, Ohio (Rhee)
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Malwankar J, Son HS, Chang DF, Dun C, Woreta F, Prescott C, Makary M, Srikumaran D. Trends, Factors, and Outcomes Associated with Immediate Sequential Bilateral Cataract Surgery (ISBCS) Among Medicare Beneficiaries. Ophthalmology 2021; 129:478-487. [PMID: 34971649 DOI: 10.1016/j.ophtha.2021.12.015] [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: 10/15/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the incidence of immediate (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) and identify factors associated with undergoing ISBCS. DESIGN Retrospective cohort study. SUBJECTS Medicare beneficiaries aged ≥65 who underwent ISBCS and DSBCS from 2011 to 2019. METHODS Population-based analysis of the 100% Medicare fee-for-service carrier claims data. Logistic regression models were performed to evaluate factors associated with ISBCS. MAIN OUTCOME MEASURES 1) Incidence of ISBCS and DSBCS, 2) demographic, ocular and medical characteristics associated with receipt of ISBCS, and 3) rates of endophthalmitis and cystoid macular edema (CME) after ISBCS or DSBCS. RESULTS A total of 4,014 (0.2%) ISBCS and 1,944,979 (99.8%) DSBCS patients were identified. Black (OR:2.31, 95%CI: 2.06-2.59), Asian (OR:1.82, 95%CI: 1.51-2.12), or Native American (OR:2.42, 95%CI: 1.81-3.23) patients were more likely to receive ISBCS compared to White patients. Patients residing in rural areas had higher likelihood of ISBCS (OR:1.26, 95%CI: 1.17-1.35) compared to metropolitan areas. Patients operated at a hospital compared to ambulatory setting (OR:2.71, 95%CI: 2.53-2.89) were more likely to receive ISBCS. Patients with bilateral complex vs. non-complex cataract (OR:3.23, 95%CI: 2.95-3.53) were more likely to receive ISBCS. Patients with a Charlson comorbidity index (CCI) of 1-2 (OR:1.45, 95%CI: 1.29-1.62), 3-4 (OR:1.70, 95%CI: 1.47-1.97), 5-6 (OR:1.97, 95%CI: 1.62-2.39), and CCI≥7 (OR:1.97, 95%CI: 1.55-2.50) were all more likely to receive ISBCS compared to those with CCI=0. In contrast, patients with glaucoma (OR:0.82, 95%CI: 0.76-0.89), macular degeneration (OR:0.75, 95%CI: 0.68-0.82), and macular hole/epiretinal membrane (OR:0.55, 95%CI: 0.48-0.65) were less likely to undergo ISBCS compared to those without. Cumulatively, there was no significant difference in endophthalmitis rate within 42 days between ISBCS (1.74 per 1,000 ISBCS) and DSBCS (1.01 per 1,000 DSBCS; p=0.15). Similarly, there was no significant cumulative difference between ISBCS (1.79 per 100 ISBCS) and DSBCS (1.96 per 100 DSBCS) CME rates (p=0.48). CONCLUSION Overall utilization of ISBCS among Medicare beneficiaries remains low over the past decade, though rates of endophthalmitis and CME were comparable to DSBCS. Race, geography, systemic and ocular comorbidities were associated with receiving ISBCS. ISBCS represents a potential opportunity to improve access to cataract surgery.
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Affiliation(s)
- Jui Malwankar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hyeck-Soo Son
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Prescott
- Department of Ophthalmology, New York University Langone Health, New York, NY
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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Chang DF, Gilliam EA, Nucho LMA, Garcia J, Shevchenko Y, Zuber SM, Squillaro AI, Maselli KM, Huang S, Spence JR, Grikscheit TC. NH 2-terminal deletion of specific phosphorylation sites on PHOX2B disrupts the formation of enteric neurons in vivo. Am J Physiol Gastrointest Liver Physiol 2021; 320:G1054-G1066. [PMID: 33881351 DOI: 10.1152/ajpgi.00073.2021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mutations in the paired-like homeobox 2 b (PHOX2B) gene are associated with congenital central hypoventilation syndrome (CCHS), which is a rare condition in which both autonomic dysregulation with hypoventilation and an enteric neuropathy may occur. The majority of patients with CCHS have a polyalanine repeat mutation (PARM) in PHOX2B, but a minority of patients have nonpolyalanine repeat mutations (NPARMs), some of which have been localized to exon 1. A PHOX2B-Y14X nonsense mutation previously generated in a human pluripotent stem cell (hPSC) line results in an NH2-terminus truncated product missing the first 17 or 20 amino acids, possibly due to translational reinitiation at an alternate ATG start site. This NH2-terminal truncation in the PHOX2B protein results in the loss of two key phosphorylation residues. Though the deletion does not affect the potential for PHOX2BY14X/Y14X mutant hPSC to differentiate into enteric neural crest cells (ENCCs) in culture, it impedes in vivo development of neurons in an in vivo model of human aganglionic small intestine.NEW & NOTEWORTHY A mutation that affects only 17-20 NH2-terminal amino acids in the paired-like homeobox 2 b (PHOX2B) gene hinders the subsequent in vivo establishment of intestinal neuronal cells, but not the in vitro differentiation of these cells.
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Affiliation(s)
- David F Chang
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Elizabeth A Gilliam
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Laura-Marie A Nucho
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Jazmin Garcia
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Yevheniya Shevchenko
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Samuel M Zuber
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Anthony I Squillaro
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Kathryn M Maselli
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Sha Huang
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason R Spence
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan.,Program of Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California.,Keck Medical School, University of Southern California, Los Angeles, California
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Haripriya A, Gk S, Mani I, Chang DF. Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs. J Cataract Refract Surg 2021; 47:178-183. [PMID: 32925653 DOI: 10.1097/j.jcrs.0000000000000415] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the comparative rotational stability and the repositioning rates and outcomes of a hydrophilic and hydrophobic acrylic monofocal toric intraocular lens (IOLs). SETTING Single center, Aravind Eye Hospital in Madurai, India. DESIGN Retrospective cohort study. METHODS All patients had either an Auroflex hydrophilic acrylic toric IOL (n = 4603) or AcrySof hydrophobic acrylic toric IOL (n = 926) implanted between January 2015 and April 2019. Surgical repositioning was offered if the toric IOL was 15 degrees or greater misaligned or there was a 2-line or greater improvement in uncorrected distance visual acuity (UDVA) predicted with repositioning. RESULTS A total of 5529 single-piece toric IOLs were implanted during the study period. There was no statistically significant difference between the hydrophilic and hydrophobic acrylic toric IOL groups in need for surgical repositioning (2.5% vs 1.9%; P = .34) or actual surgical repositioning rate (1.8% vs 1.5%; P = .59). A higher rate of surgical toric IOL repositioning was associated with younger age (62.7 vs 67.2 years; P < .0001), higher presurgical astigmatism (2.32 vs 1.99 diopters [D]; P < .0001), and with-the-rule astigmatism (4.7% vs 2.1% against-the-rule astigmatism; P = .002). In 95 eyes that underwent toric IOL repositioning, there was significant preoperative to postoperative improvement in UDVA (0.48 vs 0.12 logarithm of the minimum angle of resolution; P < .001), mean residual cylinder (1.79 vs 0.7 D; P < .001), and mean toric IOL misalignment (49.7 vs 5.4 degrees; P < .001). The repositioning outcomes were statistically similar with both toric IOL models. There were no major complications or recurrent toric IOL rotation after surgical repositioning. CONCLUSIONS The hydrophilic acrylic toric IOL had comparable rates of postoperative misalignment and surgical repositioning with the hydrophobic acrylic toric IOL. Early postoperative surgical repositioning was both safe and effective with both toric IOLs.
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Affiliation(s)
- Aravind Haripriya
- From the Aravind Eye Hospital (Haripriya, GK), Chennai, and Lions Aravind Institute of Community Ophthalmology (Mani), Madurai, India ; University of California, San Francisco (Chang), San Francisco; Altos Eye Physicians (Chang), Los Altos, California, USA
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Affiliation(s)
- David F Chang
- University of California, San Francisco, San Francisco, California
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Gilliam EA, Chang DF, Garcia J, Wang F, Nucho LMA, Grikscheit TC. Systematic Tracking of the Biodistribution of Enteric Neural Crest Cells Differentiated from Human-Derived Pluripotent Stem Cells in an in Vivo Mouse Model. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang XJ, Li EY, Leung CKS, Musch DC, Zheng CR, He MG, Chang DF, Lam DSC. Willingness to pay for cataract surgery in baiyin district, northwestern China. Ophthalmic Epidemiol 2020; 28:205-212. [PMID: 32822250 DOI: 10.1080/09286586.2020.1812089] [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: 10/23/2022]
Abstract
PURPOSE To investigate willingness to pay for cataract surgery, and its associations, in Northwestern China. METHODS Four hundred thirty-eight persons aged 50 years and above, diagnosed with cataract indicated for surgery, identified in an outreach screening program were included. Subjects were offered a willingness-to-pay interview for the maximal amount that the subjects would be willing to pay for a cataract surgery. Age, gender, literacy, education level, occupation, and annual household income were recorded. RESULTS Among 328 (74.9%) subjects who completed the interview, 197 (60.1%) participants were willing to pay something for the cataract surgery (mean, 902.9 ± 856.7 renminbi[RMB], [US$ 145 ± 137]; median, 500RMB, US$ 78). Individuals with presenting visual acuity (PVA) in the worse eye ≤6/60 (OR: 2.1, 95% CI: 1.3-3.2) and a high annual household incomes (OR: 2.0, 95% CI: 0.9-4.6) were likely to be willing to pay for the surgery, as revealed in the regression models. Willingness to pay any amount for cataract surgery was more likely among literate persons (OR: 1.5, 95% CI: 1.0-2.4) and persons with non-agricultural occupation (OR: 1.8, 95% CI: 1.0-3.2). CONCLUSIONS The amount that subjects were willing to pay is significantly less than the current cost of cataract surgery (5000 RMB, US$320) in the area. Providing low-cost cataract surgery to patients in a financially sustainable manner is important to increase uptake of cataract surgery among rural residents in Northwest China.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Emmy Y Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Project Vision Charitable Foundation, Hong Kong, China
| | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Ming Guang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - David F Chang
- The University of California, San Francisco, Los Altos, California, USA
| | - Dennis Shun-Chiu Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Project Vision Charitable Foundation, Hong Kong, China.,C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong.,International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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Kane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology 2020; 128:e94-e114. [PMID: 32798526 DOI: 10.1016/j.ophtha.2020.08.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022] Open
Abstract
The refractive outcome of cataract surgery is influenced by the choice of intraocular lens (IOL) power formula and the accuracy of the various devices used to measure the eye (including intraoperative aberrometry [IA]). This review aimed to cover the breadth of literature over the previous 10 years, focusing on 3 main questions: (1) What IOL power formulas currently are available and which is the most accurate? (2) What biometry devices are available, do the measurements they obtain differ from one another, and will this cause a clinically significant change in IOL power selection? and (3) Does IA improve refractive outcomes? A literature review was performed by searching the PubMed database for articles on each of these topics that identified 1313 articles, of which 166 were included in the review. For IOL power formulas, the Kane formula was the most accurate formula over the entire axial length (AL) spectrum and in both the short eye (AL, ≤22.0 mm) and long eye (AL, ≥26.0 mm) subgroups. Other formulas that performed well in the short-eye subgroup were the Olsen (4-factor), Haigis, and Hill-radial basis function (RBF) 1.0. In the long-eye group, the other formulas that performed well included the Barrett Universal II (BUII), Olsen (4-factor), or Holladay 1 with Wang-Koch adjustment. All biometry devices delivered highly reproducible measurements, and most comparative studies showed little difference in the average measures for all the biometric variables between devices. The differences seen resulted in minimal clinically significant effects on IOL power selection. The main difference found between devices was the ability to measure successfully through dense cataracts, with swept-source OCT-based machines performing better than partial coherence interferometry and optical low-coherence reflectometry devices. Intraoperative aberrometry generally improved outcomes for spherical and toric IOLs in eyes both with and without prior refractive surgery when the BUII and Hill-RBF, Barrett toric calculator, or Barrett True-K formulas were not used. When they were used, IA did not result in better outcomes.
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Affiliation(s)
- Jack X Kane
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - David F Chang
- University of California, San Francisco, San Francisco, California
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Saheb H, Donnenfeld ED, Solomon KD, Voskanyan L, Chang DF, Samuelson TW, Ahmed IIK, Katz LJ. Five-Year Outcomes Prospective Study of Two First-Generation Trabecular Micro-Bypass Stents (iStent®) in Open-Angle Glaucoma. Curr Eye Res 2020; 46:224-231. [PMID: 32715828 DOI: 10.1080/02713683.2020.1795881] [Citation(s) in RCA: 8] [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: 10/23/2022]
Abstract
PURPOSE To assess 5-year effectiveness and safety of 2 iStent® trabecular micro-bypass stents in eyes with open-angle glaucoma (OAG) not controlled on 1 medication. MATERIALS AND METHODS This prospective, interventional, single-arm, multi-surgeon study (NCT #1252862, clinicaltrials.gov) enrolled eyes with OAG, preoperative intraocular pressure (IOP) of 18-30 mmHg on 1 ocular hypotensive medication, and 22-38 mmHg after medication washout. Eyes underwent standalone implantation of 2 iStent devices and were followed through 60 months postoperatively. Efficacy was quantified by mean diurnal IOP and medication usage. Efficacy endpoints included the proportion of eyes with ≥20% IOP reduction versus baseline unmedicated IOP (primary efficacy), and the proportion of eyes with IOP ≤18 mmHg (secondary efficacy) without medication or secondary glaucoma surgery. Safety parameters included visual acuity, cup-to-disc ratio, visual field, and complications and adverse events. RESULTS Preoperative mean IOP on 1 medication was 20.6 ± 2.0 mmHg and post-washout unmedicated IOP was 24.1 ± 1.4 mmHg (n = 39). At 5 years postoperative, medication-free mean diurnal IOP reduced to 14.5 ± 2.2 mmHg, constituting a 40% decrease versus preoperative washed-out IOP (p < .0001). In addition, this 5-year medication-free IOP constituted a 30% decrease versus preoperative IOP on 1 medication (p < .0001). At Month 60, 89.7% (26/29) of eyes achieved the primary efficacy endpoint of ≥20% IOP reduction versus baseline unmedicated IOP, and 86.2% (25/29) of eyes achieved the secondary efficacy endpoint of IOP ≤18 mmHg, without medication or secondary glaucoma surgery. Throughout follow-up, 89.7-91.3% of eyes were on no medications. Favorable safety included no secondary glaucoma surgeries, minimal adverse events, and stable visual acuity, cup-to-disc ratio, and visual fields through 5 years postoperative. CONCLUSIONS This prospective interventional study demonstrates persistent 5-year reductions in IOP and freedom from medications, together with favorable safety, following implantation of 2 first-generation trabecular micro-bypass stents in eyes with OAG on 1 preoperative medication.
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Affiliation(s)
- Hady Saheb
- Department of Ophthalmology, McGill University , Montreal, Quebec, Canada
| | - Eric D Donnenfeld
- Ophthalmic Consultants of Long Island , Rockville Centre, New York, USA
| | - Kerry D Solomon
- Carolina Eyecare Physicians , Mt Pleasant, South Carolina, USA
| | | | | | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology, University of Toronto , Toronto, Ontario, Canada
| | - L Jay Katz
- Department of Ophthalmology, Wills Eye Hospital, Jefferson Medical College , Philadelphia, Pennsylvania, USA
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Zhang XJ, Leung CK, Li EY, Musch DC, Zheng CR, He MG, Chang DF, Lam DS. Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment. Am J Ophthalmol 2020; 213:235-243. [PMID: 31846622 DOI: 10.1016/j.ajo.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB). DESIGN Population-based diagnostic accuracy study. METHODS A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye. MAIN OUTCOME MEASURES The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI. RESULTS A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively. CONCLUSION The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.
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Chang DF, Zuber SM, Gilliam EA, Nucho LMA, Levin G, Wang F, Squillaro AI, Huang S, Spence JR, Grikscheit TC. Induced pluripotent stem cell-derived enteric neural crest cells repopulate human aganglionic tissue-engineered intestine to form key components of the enteric nervous system. J Tissue Eng 2020; 11:2041731420905701. [PMID: 32435442 PMCID: PMC7225796 DOI: 10.1177/2041731420905701] [Citation(s) in RCA: 8] [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: 08/28/2019] [Accepted: 01/18/2020] [Indexed: 12/31/2022] Open
Abstract
Models for enteric neuropathies, in which intestinal nerves are absent or
injured, are required to evaluate possible cell therapies. However, existing
options, including transgenic mice, are variable and fragile. Here
immunocompromised mice were implanted with human pluripotent stem cell–derived
tissue-engineered small intestine 10 weeks prior to a second survival surgery in
which enteric nervous system precursor cells, or saline controls, were injected
into the human intestinal organoid–derived tissue-engineered small intestine and
analyzed 4 weeks later. Human intestinal organoid–derived tissue-engineered
small intestine implants injected with saline as controls illustrated formation
of intestinal epithelium and mesenchyme without an enteric nervous system.
Second surgical introduction of human pluripotent stem cell–generated enteric
nervous system precursors into developing human intestinal organoid–derived
tissue-engineered small intestine implants resulted in proliferative migratory
neuronal and glial cells, including multiple neuronal subtypes, and demonstrated
function in contractility assays.
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Affiliation(s)
- David F Chang
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Samuel M Zuber
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Elizabeth A Gilliam
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Laura-Marie A Nucho
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Gabriel Levin
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Fengnan Wang
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Anthony I Squillaro
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sha Huang
- Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA.,Department of Cell & Developmental Biology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Jason R Spence
- Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA.,Department of Cell & Developmental Biology, Medical School, University of Michigan, Ann Arbor, MI, USA.,Program of Cellular & Molecular Biology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Surgery, Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck Medical School, University of Southern California, Los Angeles, CA, USA
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Abstract
The light-adjustable lens is the first Food and Drug Administration (FDA)-approved product from an entirely new category of intraocular lenses (IOLs). The 3-piece foldable silicone light-adjustable lens is implanted through a small incision after phacoemulsification. A slit-lamp-based digital light delivery device is used to adjust and then lock-in the IOL power during the first postoperative month. Up to 4.5 diopters (D) of cylindrical or spherical adjustment can be achieved. This should offer significant advantages in difficult IOL power calculation cases, such as postrefractive eyes. In addition to achieving better refractive accuracy, an adjustable IOL will now allow patients to test and elect a different refractive target postoperatively. This paradigm shift will change how cataract patients choose their refractive objectives, and how ophthalmologists will be able to achieve them. For example, adjustable IOLs may increase the popularity of pseudophakic monovision and bilateral same-day sequential surgery. For those electing adjustable IOL, preoperative patient counseling will change and certain pre- and intraoperative technologies, such as intraoperative aberrometry and digital astigmatic axis marking, would become superfluous.
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Affiliation(s)
- David F Chang
- University of California, San Francisco, and private practice Los Altos, CA
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Haripriya A, Chang DF, Ravindran RD. Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries. J Cataract Refract Surg 2019; 45:1226-1233. [DOI: 10.1016/j.jcrs.2019.04.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/21/2023]
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Chang DF. Consultation Section: Cataract. May consultation #3. J Cataract Refract Surg 2019; 45:699. [PMID: 31030786 DOI: 10.1016/j.jcrs.2019.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ahmed IIK, Fea A, Au L, Ang RE, Harasymowycz P, Jampel HD, Samuelson TW, Chang DF, Rhee DJ. A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma: The COMPARE Study. Ophthalmology 2019; 127:52-61. [PMID: 31034856 DOI: 10.1016/j.ophtha.2019.04.034] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 04/04/2019] [Accepted: 04/19/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To compare the efficacy of different microinvasive glaucoma surgery (MIGS) devices for reducing intraocular pressure (IOP) and medications in open-angle glaucoma (OAG). DESIGN Prospective, multicenter, randomized clinical trial. PARTICIPANTS One hundred fifty-two eyes from 152 patients aged 45 to 84 years with OAG, Shaffer angle grade III-IV, best-corrected visual acuity (BCVA) 20/30 or better, and IOP 23 to 39 mmHg after washout of all hypotensive medications. Eyes with secondary glaucoma other than pseudoexfoliative or pigmentary glaucoma, angle closure, previous incisional glaucoma surgery, or any significant ocular pathology other than glaucoma were excluded. INTERVENTION Study eyes were randomized 1:1 to standalone MIGS consisting of either 1 Hydrus Microstent (Ivantis, Inc, Irvine, CA) or 2 iStent Trabecular Micro Bypass devices (Glaukos Inc, San Clemente, CA). Follow-up was performed 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. MAIN OUTCOME MEASURES Within-group and between-group differences in IOP and medications at 12 months and complete surgical success defined as freedom from repeat glaucoma surgery, IOP 18 mmHg or less, and no glaucoma medications. Safety measures included the frequency of surgical complications, changes in visual acuity, slit-lamp findings, and adverse events. RESULTS Study groups were well matched for baseline demographics, glaucoma status, medication use, and baseline IOP. Twelve-month follow-up was completed in 148 of 152 randomized subjects (97.3%). At 12 months, the Hydrus had a greater rate of complete surgical success (P < 0.001) and reduced medication use (difference = -0.6 medications, P = 0.004). More Hydrus subjects were medication free at 12 months (difference = 22.6% P = 0.0057). Secondary glaucoma surgery was performed in 2 eyes in the 2-iStent group (3.9%) and in none of the Hydrus eyes. Two eyes in the Hydrus group and 1 in the 2-iStent group had BCVA loss of ≥2 lines. CONCLUSION Standalone MIGS in OAG with the Hydrus resulted in a higher surgical success rate and fewer medications compared with the 2-iStent procedure. The 2 MIGS devices have similar safety profiles.
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Affiliation(s)
| | - Antonio Fea
- Dipartimento di Scienze Chirurgiche, Universita' di Torino, Torino, Italy
| | - Leon Au
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | | | - Paul Harasymowycz
- University of Montreal, Bellevue Ophthalmology Clinic, Montreal, Canada
| | - Henry D Jampel
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio.
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Lee BS, Chang DF. Femtosecond Laser-Assisted Cataract Surgery vs. Phacoemulsification: Overall Safety and the Effect on the Corneal Endothelium. Curr Ophthalmol Rep 2018. [DOI: 10.1007/s40135-018-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hou X, Chang DF, Trecartin A, Barthel ER, Schlieve CR, Frey MR, Fowler KL, Grikscheit TC. Short-term and long-term human or mouse organoid units generate tissue-engineered small intestine without added signalling molecules. Exp Physiol 2018; 103:1633-1644. [PMID: 30232817 DOI: 10.1113/ep086990] [Citation(s) in RCA: 6] [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: 02/27/2018] [Accepted: 08/30/2018] [Indexed: 01/08/2023]
Abstract
NEW FINDINGS What is the central question of this study? Tissue-engineered small intestine was previously generated in vivo by immediate implantation of organoid units derived from both mouse and human donor intestine. Although immediate transplantation of organoid units into patients shows promise as a potential future therapy, some critically ill patients might require delayed transplantation. What is the main finding and its importance? Unlike enteroids, which consist of isolated intestinal crypts, short- and long-term cultured organoid units are composed of epithelial and mesenchymal cells derived from mouse or human intestine. Organoid units do not require added signalling molecules and can generate tissue-engineered intestine in vivo. ABSTRACT Mouse and human postnatal and fetal organoid units (OUs) maintained in either short-term culture (2 weeks) or long-term culture (from 4 weeks up to 3 months) without adding exogenous growth factors were implanted in immunocompromised mice to form tissue-engineered small intestine (TESI) in vivo. Intestinal epithelial stem and neuronal progenitor cells were maintained in long-term OU cultures from both humans and mice without exogenous growth factors, and these cultures were successfully used to form TESI. This was enhanced with OUs derived from human fetal tissues. Organoid unit culture is different from enteroid culture, which is limited to epithelial cell growth and requires supplementation with R-Spondin, noggin and epidermal growth factor. Organoid units contain multiple cell types, including epithelial, mesenchymal and enteric nervous system cells. Short- and long-term cultured OUs derived from mouse and human intestine develop into TESI in vivo, which contains key components of the small intestine similar to native intestine.
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Affiliation(s)
- Xiaogang Hou
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David F Chang
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Andrew Trecartin
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Erik R Barthel
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christopher R Schlieve
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark R Frey
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kathryn L Fowler
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Squillaro AI, Nucho LMA, Schlieve CR, Chang DF, Zuber SM, Fode AM, Grikscheit TC. Human Hepatoblasts Can Be Generated from a Pluripotent Universal Donor Cell Stem Cell Line that Escapes Allogenic Response and Natural Killer Cell Lysis. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chang DF, Hurley N, Mamalis N, Whitman J. Evaluation of Ophthalmic Surgical Instrument Sterility Using Short-Cycle Sterilization for Sequential Same-Day Use. Ophthalmology 2018; 125:1320-1324. [DOI: 10.1016/j.ophtha.2018.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022] Open
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Ianchulev T, Chang DF, Koo E, MacDonald S. Microinterventional endocapsular nucleus disassembly for phacoemulsification-free full-thickness fragmentation. J Cataract Refract Surg 2018; 44:932-934. [DOI: 10.1016/j.jcrs.2018.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/01/2018] [Accepted: 05/19/2018] [Indexed: 10/28/2022]
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Ianchulev T, Chang DF, Koo E, MacDonald S, Calvo E, Tyson FT, Vasquez A, Ahmed IIK. Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study. Br J Ophthalmol 2018; 103:176-180. [PMID: 29669780 PMCID: PMC6362801 DOI: 10.1136/bjophthalmol-2017-311766] [Citation(s) in RCA: 12] [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: 12/18/2017] [Revised: 02/23/2018] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
Abstract
Aim To assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts. Methods This was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications. Results Only high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure. Conclusions Microinterventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts. Trial registration number NCT02843594
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Affiliation(s)
- Tsontcho Ianchulev
- New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York, NY 1183, USA
| | - David F Chang
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California, USA
| | - Edward Koo
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, California, USA
| | - Susan MacDonald
- Department of Ophthalmology, Tufts School of Medicine, Boston, Massachusetts, USA
| | | | | | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada.,Trillium Health Partners and Credit Valley Eye Care, Mississauga, Ontario, Canada
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Lee BS, Chang DF. Comparison of the Rotational Stability of Two Toric Intraocular Lenses in 1273 Consecutive Eyes. Ophthalmology 2018; 125:1325-1331. [PMID: 29544960 DOI: 10.1016/j.ophtha.2018.02.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the rotational stability of the 2 most commonly used toric intraocular lenses (TIOLs). DESIGN Retrospective cohort study in a single private practice. SUBJECTS The study included all patients receiving an Acrysof (n = 626) or Tecnis TIOL (n = 647) over an 18-month period from April 2015 to September 2016. Patients were only excluded if their surgery could not be performed using a digital marking system. METHODS All patients had cataract surgery performed in the same surgical center with a similar technique. A digital marking system with limbal vessel registration was used to record the axis of the TIOL at the conclusion of surgery. A dilated examination was performed either later on the day of surgery or the next morning, and the postoperative rotation of the 2 TIOL models was compared. Patients who required a return to the operating room for TIOL repositioning were examined to determine risk factors for reoperation and subsequent outcomes. MAIN OUTCOME MEASURES The primary outcome measure was the percentage of eyes with TIOL rotation >5 and >10 degrees. The second main outcome was likelihood of requiring return to the operating room to reposition a rotated TIOL. RESULTS The Acrysof TIOL was less likely to rotate postoperatively, with 91.9% of eyes rotated ≤5 degrees at the first postoperative check compared with 81.8% of Tecnis TIOL eyes (P < 0.0001). This difference persisted for rotation ≤10 degrees (97.8% Acrysof vs. 93.2% Tecnis, P = 0.0002) and ≤15 degrees (98.6% Acrysof vs. 96.4% Tecnis, P = 0.02). The mean rotation was 2.72 degrees (95% confidence interval 2.35-3.08 degrees) for Acrysof and 3.79 degrees (95% confidence interval 3.36-4.22 degrees) for Tecnis TIOLs (P < 0.05). The Tecnis TIOL showed a strong predisposition to rotate counterclockwise, unlike the Acrysof. More Tecnis TIOL patients required repositioning (3.1% vs. 1.6%), but this did not reach statistical significance (P = 0.10). Refractive outcomes were similar between the 2 groups. CONCLUSIONS The Acrysof TIOL showed significantly greater rotational stability than the Tecnis TIOL.
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Affiliation(s)
- Bryan S Lee
- Altos Eye Physicians, Los Altos, California.
| | - David F Chang
- Altos Eye Physicians, Los Altos, California; University of California San Francisco, San Francisco, California
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Tsaousis KT, Chang DF, Werner L, Perez JP, Guan JJ, Reiter N, Li HJ, Mamalis N. Comparison of different types of phacoemulsification tips. III. Morphological changes induced after multiple uses in an ex vivo model. J Cataract Refract Surg 2018; 44:91-97. [DOI: 10.1016/j.jcrs.2017.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 10/17/2022]
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Kelkar AS, Chang DF, Kelkar JA, Mehta HM, Lahane T, Parekh R. Antibiotic prophylaxis practice patterns for cataract surgery in India - Results from an online survey. Indian J Ophthalmol 2017; 65:1470-1474. [PMID: 29208837 PMCID: PMC5742985 DOI: 10.4103/ijo.ijo_842_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India. Methods: This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented. Results: Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P < 0.001) and more than 500 cataract surgeries annually (45% vs. 33%, P < 0.001) reported greater use of IC moxifloxacin. Self-reported endophthalmitis rates were statistically significantly greater in those not using IC antibiotics (0.045% vs. 0.036, P = 0.04). Although a majority of respondents believe that IC antibiotics are an important option (54%) and that it is important to have a commercially available solution (68%), many believe that other antibiotic prophylaxis methods are sufficient (31%). Conclusion: IC antibiotic prophylaxis for cataract surgery has sharply increased in India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.
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Affiliation(s)
- Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - David F Chang
- Department of Ophthalmology, Altos Eye Physicians, Los Altos, California, USA
| | - Jai A Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal M Mehta
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Tatyarao Lahane
- Department of Ophthalmology, Grand Medical College and JJ group of Hospitals, Mumbai, Maharashtra, India
| | - Ragini Parekh
- Department of Ophthalmology, Grand Medical College and JJ group of Hospitals, Mumbai, Maharashtra, India
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Abstract
Despite the appeal of an automated method of creating a perfectly circular anterior capsulotomy, global adoption of femtosecond laser capsulotomy (FSLC) has been limited by its high acquisition and per case cost. In addition, the femtosecond laser's large size and the need for eye docking create surgical efficiency and workflow challenges. The Zepto precision pulse capsulotomy (PPC) technology creates a circular anterior capsulotomy of a precise diameter using a disposable handpiece and tip that are used in the normal surgical sequence. Extensive preclinical and clinical testing has resulted in the US Food and Drug Administration (FDA) approval of the technology. Zepto PPC holds promise for complicated eyes such as those with intumescent or brunescent lenses, zonulopathy, or small pupils. This paper and the accompanying videos describe and demonstrate the technique and review the published studies.
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Affiliation(s)
- David F Chang
- Altos Eye Physicians, Los Altos, California, United States of America
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Ianchulev T, Ahmed IIK, Stamper RL, Chang DF, Samuelson TW, Lindstrom RL. Innovative alternatives in the surgical management of glaucoma with cataract surgery. Expert Review of Ophthalmology 2017. [DOI: 10.1080/17469899.2017.1362335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tsontcho Ianchulev
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, U.S.A
| | - Iqbal I. K. Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Robert L. Stamper
- Department of Ophthalmology, UC San Francisco, San Francisco, CA, U.S.A
| | - David F. Chang
- Department of Ophthalmology, UC San Francisco, San Francisco, CA, U.S.A
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Zhang X, Li EY, Leung CKS, Musch DC, Tang X, Zheng C, He M, Chang DF, Lam DSC. Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PLoS One 2017; 12:e0180769. [PMID: 28797099 PMCID: PMC5552304 DOI: 10.1371/journal.pone.0180769] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/21/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To estimate the prevalence and causes of blindness and visual impairment (VI), and report the outcomes of cataract surgery in Chaonan Region, Guangdong Province, southern China Design Cross-sectional population-based survey Participants A total of 3484 participants including 1397 men (40.1%) and 2087 women (59.9%) aged ≥50 years were examined (94.2% response rate). Method A two-stage cluster sampling procedure was used to select 3700 participants aged ≥50 years from 74 clusters of Chaonan Region. Participants were examined according to the Rapid Assessment of Avoidable Blindness (RAAB) method. Blindness and visual impairment (VI) were defined by the World Health Organization criteria. Participants with visual acuity (VA) < 6/18 in either eye were examined by ophthalmologists. The primary causes of blindness and VI were reported with reference to the participant’s better eye. Main outcome measures Prevalence and main causes of blindness, severe visual impairment (SVI), VI and the outcomes of cataract surgery Results The standardized prevalence rates of blindness, SVI, and VI were 2.4% (95% confidence interval [CI], 1.9–2.9%), 1.0% (95% CI, 0.7–1.4%), and 6.4% (95% CI, 5.6%– 7.1%), respectively. The principal cause of blindness and SVI was cataract, accounting for 67.1% and 67.6% respectively, and the principal cause of VI was refractive error (46.9%). One hundred and fifty five out of 3484 (4.4%) people (211 eyes) had cataract surgery. Of the 211 eyes that had cataract surgery, 96.7% were pseudophakic. 67.2% of the 211 operated eyes had a presenting visual acuity (PVA) of 6/18 or better. Conclusions The prevalence of blindness, SVI, and VI was high among rural residents in Chaonan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in rural private clinics were suboptimal. Quality-control initiatives such as hands-on training program should be introduced to improve cataract surgery outcomes.
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Affiliation(s)
- Xiujuan Zhang
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Tianjin Eye Hospital, Tianjin, China
| | - Emmy Y. Li
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Project Vision Charitable Foundation, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | | | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Xin Tang
- Tianjin Eye Hospital, Tianjin, China
| | | | - Mingguang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - David F. Chang
- The University of California, San Francisco, California, United States of America
| | - Dennis Shun-Chiu Lam
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
- Project Vision Charitable Foundation, Hong Kong, China
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- * E-mail:
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Abstract
Endophthalmitis after cataract surgery is a rare but potentially devastating complication. There is great variability in endophthalmitis prophylaxis practice patterns worldwide. Treatment varies globally and is based on the microbiological profile and availability of formulations. Periocular povidone-iodine antisepsis is universally adopted and considered the standard of care in most practices. Perioperative topical antibiotics are also very popular despite the lack of level 1 evidence confirming efficacy. Based on growing observational evidence, routine intracameral antibiotic prophylaxis is increasing, especially where approved commercial intraocular preparations are available. This review updates recent trends and evidence regarding endophthalmitis prophylaxis and the preferred choice of intracameral antibiotics.
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Chang DF, Donnenfeld ED, Katz LJ, Voskanyan L, Ahmed IIK, Samuelson TW, Giamporcaro JE, Hornbeak DM, Solomon KD. Efficacy of two trabecular micro-bypass stents combined with topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 3-year follow-up. Clin Ophthalmol 2017; 11:523-528. [PMID: 28352151 PMCID: PMC5359133 DOI: 10.2147/opth.s121041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the long-term intraocular pressure (IOP)-lowering effect and safety parameters following treatment with two trabecular micro-bypass stents and topical prostaglandin in phakic eyes with open-angle glaucoma (OAG) not controlled on two preoperative medications. Methods This prospective, single-arm, unmasked study enrolled 39 qualified phakic eyes with OAG not controlled on 2 medications, preoperative medicated IOP of 18–30 mmHg, and IOP following medication washout of 22–38 mmHg. Two trabecular micro-bypass stents were implanted as a standalone procedure, and travoprost was started on postoperative day 1. Evaluations included IOP, best-corrected visual acuity, medication use, fundus and slit-lamp examinations, visual field, cup:disc ratio, central corneal thickness, and ocular complications. Data through 18 months were summarized previously. Thirty-seven of the original 39 subjects have been followed for 3 years postoperatively; follow-up is continuing for 5 years. Results At 3 years postoperative, 97% of eyes had achieved an IOP reduction of ≥20% from baseline with a reduction of 1 medication. Eighty-six percent of eyes had IOP of ≤18 mmHg with a reduction of 1 medication. Mean medicated IOP decreased to 14.0±2.6 mmHg on 1 medication versus 22.4±2.3 mmHg on 2 medications preoperatively. The mean unmedicated IOP decreased to 17.7±1.7 mmHg at 37 months from 25.3±1.9 mmHg preoperatively. Long-term postoperative adverse events included cataract surgery in 3 eyes due to cataract progression, and trabeculectomy in 1 eye due to uncontrolled IOP of 23 mmHg. No intraoperative or device-related adverse events occurred. Conclusion Significant and sustained reduction in IOP and medications with a favorable safety profile was shown through 3 years after implantation of 2 trabecular micro-bypass stents combined with postoperative travoprost in phakic OAG eyes uncontrolled on 2 preoperative medications. These findings demonstrate the long-term performance and safety of trabecular bypass stents in combination with topical prostaglandin for OAG patients.
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Affiliation(s)
| | | | - L Jay Katz
- Department of Ophthalmology, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA, USA
| | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Haripriya A, Chang DF, Ravindran RD. Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries. Ophthalmology 2017; 124:768-775. [PMID: 28214101 DOI: 10.1016/j.ophtha.2017.01.026] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the postoperative endophthalmitis rate before and after initiation of intracameral (IC) moxifloxacin prophylaxis for both phacoemulsification and sutureless, manual small-incision cataract surgery (M-SICS), as well as in patients with posterior capsular rupture (PCR). DESIGN Retrospective, clinical registry. PARTICIPANTS All cataract surgeries (617 453) performed during the 29-month period from January 2014 to May 2016 at the 10 regional Aravind eye hospitals were included. METHODS The electronic health record data for all study eyes were analyzed. Endophthalmitis rates before and after moxifloxaxin were statistically compared for all eyes and separately for both phacoemulsification and M-SICS, and for the eyes complicated by PCR. MAIN OUTCOME MEASURES The postoperative endophthalmitis rates before and after initiation of IC moxifloxacin prophylaxis. RESULTS Overall, 302 815 eyes did not receive IC moxifloxacin and 314 638 eyes did, and there was a significant decline in the endophthalmitis rate, from 0.07% (214/302 815) to 0.02% (64/314 638) (P < 0.001), with moxifloxacin. For the 194 252 phacoemulsification eyes, the endophthalmitis rate was 0.07% (75/104 894) without IC moxifloxacin prophylaxis, compared with 0.01% (11/89 358) with moxifloxacin (P < 0.001). For the 414 657 M-SICS eyes, the endophthalmitis rate was 0.07% (135/192 149) without IC moxifloxacin prophylaxis, compared with 0.02% (52/222 508) with moxifloxacin (P < 0.001). Approximately half of the 8479 eyes that had PCR received IC moxifloxacin, and half did not. Without IC moxifloxacin, PCR increased the endophthalmitis rate nearly 7-fold to 0.48% (20/4186); IC moxifloxacin reduced the endophthalmitis rate with PCR to 0.21% (9/4293) (P = 0.034). No adverse events were due to IC moxifloxacin. CONCLUSIONS Routine IC moxifloxacin prophylaxis reduced the overall endophthalmitis rate by 3.5-fold (3-fold for M-SICS and nearly 6-fold for phacoemulsification). There was also a statistical benefit for eyes complicated by PCR, and IC antibiotic prophylaxis should be strongly considered for this high-risk population. These conclusions are strengthened by the high volume of cases analyzed at a single hospital network over a comparatively short time frame. Considering the association of hemorrhagic occlusive retinal vasculitis with vancomycin and the commercial unavailability of IC cefuroxime in many countries, moxifloxacin appears to be an effective option for surgeons electing IC antibiotic prophylaxis.
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