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Cao JA, Al-Khersan H, Chaudhary V, Wykoff CC. Retinal non-perfusion: recognizing and defining what is important. Eye (Lond) 2024:10.1038/s41433-024-02981-x. [PMID: 38438795 DOI: 10.1038/s41433-024-02981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Affiliation(s)
| | - Hasenin Al-Khersan
- Retina Consultants of Texas, Houston, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX, USA
| | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA.
- Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX, USA.
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Scarboro SD, Harper CA, Karsaliya G, Ghoraba H, Moshfeghi DM, Al-Khersan H, Robles-Holmes HK, Fan KC, Berrocal AM, Hoyek S, Patel NA, Sbrocca R, Capone A, Drenser KA, Wood EH. The Incidence and Timing of Treatment-Requiring Retinopathy of Prematurity in Nanopremature and Micropremature Infants in the United States: A National Multicenter Retrospective Cohort Study. Ophthalmol Retina 2024; 8:279-287. [PMID: 37838276 DOI: 10.1016/j.oret.2023.10.003] [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: 06/14/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
PARTICIPANTS This article includes 7293 infants (14 586 eyes) screened for ROP across 5 centers in the United States (Austin Retina Associates, Austin, TX; Bascom Palmer Eye Institute, Miami, FL; Beaumont Eye Institute, Royal Oak, MI; Massachusetts Eye and Ear, Boston, MA; and Stanford Byers Eye Institute, Stanford, CA). PURPOSE To analyze the incidence and timing of treatment requiring retinopathy of prematurity (ROP) in extremely small premature infants. We hypothesize that the smaller the infant by gestational age and birthweight, the higher their likelihood of requiring treatment for ROP. DESIGN Premature infants screened for Retinopathy of Prematurity from 2002-2022 were divided into cohorts based on the following criteria based on gestational age (GA) and birth weight (BW). "Micropremature infants" are infants born between 24-26 weeks GA and between 600-799 g BW. "Nanopremature infants" are born ≤ 24 weeks GA and ≤ 600 g BW. METHODS Retrospective chart review. MAIN OUTCOME MEASURES The incidence and timing of treatment-requiring ROP. RESULTS We found that infants defined as nanopremature had a ∼63% chance of requiring treatment at an average postmenstrual age (PMA) of 36.6 weeks, whereas those defined as micropremature had a 30% chance of requiring treatment at an average PMA of 36.3 weeks. This significantly contrasts with the risk of all screened babies for ROP where the risk of requiring treatment was 8.5%. CONCLUSION Micropremature and nanopremature infants are significantly more likely to require treatment for ROP. With demographic data matched to all 5 major US regions spanning the last decade, these results have the potential to inform neonatologists, pediatricians, and ophthalmologists of an important shift in the landscape of prematurity in the United States. 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)
| | - Clio Armitage Harper
- Austin Retina Associates, Austin, Texas; Dell Medical School, Department of Ophthalmology, University of Texas Austin, Austin, Texas
| | | | - Hashem Ghoraba
- Byers Eye Institute, Stanford University School of Medicine, Department of Ophthalmology, Stanford, California
| | - Darius M Moshfeghi
- Byers Eye Institute, Stanford University School of Medicine, Department of Ophthalmology, Stanford, California
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami, Department of Ophthalmology, Miami, Florida
| | | | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami, Department of Ophthalmology, Miami, Florida
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami, Department of Ophthalmology, Miami, Florida
| | - Sandra Hoyek
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | - Nimesh A Patel
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | - Rocco Sbrocca
- Associated Retinal Consultants at William Beaumont School of Medicine, Royal Oak, Michigan
| | - Antonio Capone
- Associated Retinal Consultants at William Beaumont School of Medicine, Royal Oak, Michigan
| | - Kimberly A Drenser
- Associated Retinal Consultants at William Beaumont School of Medicine, Royal Oak, Michigan
| | - Edward H Wood
- Austin Retina Associates, Austin, Texas; Dell Medical School, Department of Ophthalmology, University of Texas Austin, Austin, Texas.
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Patel NA, Al-Khersan H, Yannuzzi NA, Lin J, Smiddy WE. Reply. Ophthalmol Retina 2024; 8:e4. [PMID: 37865910 DOI: 10.1016/j.oret.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James Lin
- Vitreoretinal Consultants of New York, Great Neck, New York
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Patel NA, Al-Khersan H, Yannuzzi NA, Lin J, Smiddy WE. A Cost-Effectiveness Analysis of Pegcetacoplan for the Treatment of Geographic Atrophy. Ophthalmol Retina 2024; 8:25-31. [PMID: 37572871 DOI: 10.1016/j.oret.2023.08.003] [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: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of the treatment of geography atrophy (GA) with intravitreal pegcetacoplan and to identify utility-measurement surrogates. DESIGN Cost analysis based on data from a published study. SUBJECTS None; based on data from published sham control compared with 2 treatment groups in the index study. METHODS Costs were based on 2022 Medicare reimbursement data. Specific outcomes were extrapolated from the DERBY and OAKS trials. Assumptions were made for the lifetime analysis based on a theoretical logistic growth model of the atrophy. OUTCOME MEASURES Cost, cost utility, cost per quality-adjusted life-year, and cost per area of GA (in US$). RESULTS The costs to treat GA in every month (EM) and every-other-month (EOM) treatment groups over the 2 years as reported were $70 000 and $34 600, respectively. The costs per area of delaying GA for 2 years in all patients were $87 300/mm2 (EM) and $49 200/mm2 (EOM), and in initially extrafoveal patients, $53 900/mm2 (EM) and $32 100/mm2 (EOM). The costs per day of delaying GA for 2 years were $295 (EM) and $170 (EOM); the marginal cost (EM vs. EOM) per retinal pigment epithelium cell saved was $30. The modeled lifetime costs were $350 000 (EM) and $172 000 (EOM), or $309 000/mm2 (EM) and $180 000 (EOM) /mm2. The modeled time to 95% atrophy at 13 years was delayed by 2.5 years (EM) and 2.1 years (EOM). The costs/quality-adjusted life-year gained based on modeled visual loss with 95% atrophy were $706 000 (EM) and $397 000 (EOM). CONCLUSION Treatment of GA with intravitreal pegcetacoplan EOM was more cost effective than EM. Treatment of extrafoveal lesions yielded greater utility than the treatment of the entire group. As atrophy progression approaches an upper limit, the marginal cost/benefit ratios increase. 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)
- Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James Lin
- Vitreoretinal Consultants of New York, Great Neck, New York
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Hoyek S, Cruz NFSD, Patel NA, Al-Khersan H, Fan KC, Berrocal AM. Identification of novel biomarkers for retinopathy of prematurity in preterm infants by use of innovative technologies and artificial intelligence. Prog Retin Eye Res 2023; 97:101208. [PMID: 37611892 DOI: 10.1016/j.preteyeres.2023.101208] [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: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable vision loss in preterm infants. While appropriate screening is crucial for early identification and treatment of ROP, current screening guidelines remain limited by inter-examiner variability in screening modalities, absence of local protocol for ROP screening in some settings, a paucity of resources and an increased survival of younger and smaller infants. This review summarizes the advancements and challenges of current innovative technologies, artificial intelligence (AI), and predictive biomarkers for the diagnosis and management of ROP. We provide a contemporary overview of AI-based models for detection of ROP, its severity, progression, and response to treatment. To address the transition from experimental settings to real-world clinical practice, challenges to the clinical implementation of AI for ROP are reviewed and potential solutions are proposed. The use of optical coherence tomography (OCT) and OCT angiography (OCTA) technology is also explored, providing evaluation of subclinical ROP characteristics that are often imperceptible on fundus examination. Furthermore, we explore several potential biomarkers to reduce the need for invasive procedures, to enhance diagnostic accuracy and treatment efficacy. Finally, we emphasize the need of a symbiotic integration of biologic and imaging biomarkers and AI in ROP screening, where the robustness of biomarkers in early disease detection is complemented by the predictive precision of AI algorithms.
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Affiliation(s)
- Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Natasha F S da Cruz
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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Eatz TA, Kalavar M, Birnhak M, Al-Khersan H, Sridhar J, Cavuoto KM. The Role of Social Media in Strabismus Surgical Experience. J Pediatr Ophthalmol Strabismus 2023; 60:402-405. [PMID: 37092665 DOI: 10.3928/01913913-20230323-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE To understand patients' strabismus surgery experience, including its impact on patients' appearance and psychosocial factors such as anxiety and depression, via trends on popular social media platforms. METHODS TikTok and Instagram were searched for the following post hashtags: "#strabismus," "#strabismussurgery," "#crosseyed," and "#lazyeye." Data regarding date of post, username, gender, city, state, United States or international location, surgical status (preoperative, perioperative, or postoperative), tone (positive or negative), place of treatment, type of post (photo or video), number of likes/views, and number of followers were recorded for statistical analysis. RESULTS A total of 790 posts (400 TikTok, 390 Instagram) were included. The majority (87.8%) had a positive tone, particularly for Instagram (Instagram = 97.7%, TikTok = 78.3%, P < .01). TikTok had significantly more likes/follower (P < .01), as did negative posts (P < .01). #Lazyeye gained significantly more traction than other hashtags (range: P < .001 to .006). There were no differences in likes/follower for treatment phase (preoperative/perioperative/postoperative), gender, or relative age of poster (adult/parent/child). CONCLUSIONS These findings demonstrated that TikTok and Instagram users tend to share positive strabismus surgical experiences; however, negative posts were associated with more interactive responses from viewers. Colloquial hashtags (eg, #lazyeye) were more likely to gain traction than medical terms. TikTok posts were associated with more engagement than Instagram, which suggests TikTok may be a better platform going forward for patient outreach. [J Pediatr Ophthalmol Strabismus. 2023;60(6):402-405.].
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Sengillo JD, Al-Khersan H, Rohowetz L, Shoji MK, Robles-Holmes H, Cruz NFSD, Negron CI, Yannuzzi NA, Patel NA, Berrocal AM. Retinal Detachments in Pediatric Patients With X-Linked Retinoschisis: Characteristics and Surgical Outcomes. Ophthalmic Surg Lasers Imaging Retina 2023; 54:574-579. [PMID: 37847161 DOI: 10.3928/23258160-20230920-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Retinal detachments (RDs) are a complication of X-linked retinoschisis (XLRS) with a poor prognosis. This study aims to report outcomes of XLRS-RD repair in pediatric patients. MATERIALS AND METHODS The study is a retrospective analysis of pediatric patients undergoing vitreoretinal surgery for XLRS-RDs from 2000 to 2022. RESULTS Nine patients (11 eyes) met inclusion criteria. All patients were boys, with a mean age of 8 years. Most RDs arose inferiorly (64%). Seven (64%) detachments were macula-involving. Seven (64%) detachments were repaired with combined scleral buckling and vitrectomy, two (18%) detachments were repaired with vitrectomy alone, one (9%) detachment underwent a primary scleral buckling procedure, and one (9%) asymptomatic detachment with a pigment demarcation line was observed. Silicone oil was used in eight of nine (89%) eyes undergoing vitrectomy. Final visual acuity was 20/200 or better in eight (73%) eyes. One eye that underwent surgical intervention remained unattached at follow-up. CONCLUSION Surgical repair in patients with XLRSRDs was associated with successful reattachment, although visual prognosis varied. [Ophthalmic Surg Lasers Imaging Retina 2023;54:574-579.].
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Lin BR, Al-Khersan H, Rowsey T, West M, Lin A, Qu P, Bitrian E, Hudson J, Venincasa M, Fan J, Gutkind N, Diaz JD, Parekh P, Sultan H, Yannuzzi NA. Reply. Ophthalmology 2023; 130:e35-e36. [PMID: 37437782 DOI: 10.1016/j.ophtha.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Benjamin R Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Tyler Rowsey
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew West
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Albert Lin
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Phillip Qu
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Elena Bitrian
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Julia Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Michael Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Naomi Gutkind
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | | | | | | | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida.
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Lin BR, Al-Khersan H, Bitrian E, Flynn HW. Endophthalmitis Associated With XEN Stent Implantation. Am J Ophthalmol 2023; 253:37-43. [PMID: 37059319 PMCID: PMC10524262 DOI: 10.1016/j.ajo.2023.04.006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants. DESIGN Retrospective, noncomparative consecutive case series. METHODS Clinical and microbiologic review was performed for 8 patients presenting to the Bascom Palmer Eye Institute Emergency Room between 2021 and 2022 with XEN stent-related endophthalmitis. Data collected included clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow-up. RESULTS The current study included 8 eyes from 8 patients. All cases of endophthalmitis occurred >30 days after implantation of the XEN stent. At the time of presentation, there were external exposures of the XEN stent in 4 of 8 patients. Five of the 8 patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in 5 patients (62.5%), and pars plana vitrectomy in 6 patients (75%). At last follow-up, 6 of the 8 patients (75%) had a visual acuity of hand motion or worse. CONCLUSIONS Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad-spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy.
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Affiliation(s)
- Benjamin R Lin
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Hasenin Al-Khersan
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Elena Bitrian
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Harry W Flynn
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA..
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da Cruz NFS, Sengillo JD, Al-Khersan H, Negron CI, Felder MB, Patel NA, Berrocal AM. Vitreous Hemorrhage in Pediatric Patients With X-Linked Retinoschisis: Characteristics and Outcomes. Ophthalmic Surg Lasers Imaging Retina 2023; 54:513-518. [PMID: 37642422 DOI: 10.3928/23258160-20230803-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To report the management and outcomes of vitreous hemorrhage in pediatric patients with X-linked retinoschisis (XLRS). MATERIALS AND METHODS Retrospective case series of pediatric patients with XLRS with vitreous hemorrhage between January 2000 and January 2022 at the Bascom Palmer Eye Institute. RESULTS Nine patients (12 eyes) met inclusion criteria. The average age at presentation was 5.75 years and mean follow-up time was 6 years. All eyes (58.3%) that underwent fluorescein angiography exhibited peripheral capillary dropout. Six of 12 eyes (50%) were observed without intervention. Four of 12 eyes (33.3%) underwent intravitreal injection of bevacizumab and 2 (16.6%) underwent vitreoretinal surgery. Seven of 12 eyes (58.3%) had documented recurrence of vitreous hemorrhage during follow-up. All retinas were attached and had clear media at final follow-up. CONCLUSION Fluorescein angiography is a helpful tool to evaluate the vascular phenotype in XLRS. Favorable anatomic outcomes were noted in this cohort, but recurrence of vitreous hemorrhage was common. [Ophthalmic Surg Lasers Imaging Retina 2023;54:513-518.].
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Patel NA, Hoyek S, Al-Khersan H, Fan KC, Yannuzzi NA, Davila J, Berrocal AM. Retinopathy of Prematurity Outcomes of Neonates Meeting Only a Single Screening Criterion: Proposal of the TWO-ROP Algorithm. Am J Ophthalmol 2023; 252:147-152. [PMID: 36933856 DOI: 10.1016/j.ajo.2023.03.007] [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: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To assess the rates of retinopathy of prematurity (ROP) and treatment-warranted ROP in a modern set of patients meeting 0 or 1 of the current ROP screening criteria. DESIGN Retrospective cohort study. METHODS Single-center study of 9350 infants screened for ROP from 2009 to 2019. Rates of ROP and treatment-warranted ROP were evaluated in group 1 (birth weight [BW] <1500 g and gestational age [GA] ≥30 weeks), group 2 (BW ≥1500 g and GA <30 weeks), and group 3 (BW ≥1500 g and GA ≥30 weeks). RESULTS Of 7520 patients with reported BW and GA, 1612 (21.4%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 was 466 (6.19%), 23 (0.31%), and 1123 (14.93%), respectively. The number of patients diagnosed with ROP was 20 (4.29%) in group 1, 1 (4.35%) in group 2, and 12 (1.07%) in group 3 (P < .001). The mean interval between birth and ROP diagnosis was 36.25 days (range 12-75 days) in group 1, 47 days in group 2, and 23.33 days (range 10-39 days) in group 3 (P = .05). No cases of stage 3, zone 1, or plus disease were recorded. No patients met the treatment criteria. CONCLUSIONS Patients meeting 1 screening criterion had a low rate of ROP (<5%), with no stage 3, zone 1, or plus disease. No patients required treatment. We propose a possible algorithm (TWO-ROP) in appropriate neonatal intensive care units, with an amendment in screening protocol for this low-risk population to include only an outpatient screening examination within 1 week of discharge, or at 40 weeks if inpatient, to decrease the inpatient ROP screening burden while maintaining safety. Further external validation of this protocol would be required.
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Affiliation(s)
- Nimesh A Patel
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Department of Ophthalmology (N.A.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Sandra Hoyek
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Kenneth C Fan
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jose Davila
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Audina M Berrocal
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Markatia Z, Al-Khersan H, Kalavar M, Watane A, Yannuzzi N, Sridhar J. Ergonomics of Ophthalmic Surgery: Evaluating the Effect of a Posture Trainer on Trainee Intraoperative Back Posture. J Acad Ophthalmol (2017) 2023; 15:e276-e279. [PMID: 38059191 PMCID: PMC10697791 DOI: 10.1055/s-0043-1777411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
Purpose Ophthalmic surgeons are at an increased risk for musculoskeletal disorders resulting from ophthalmology-specific routines and equipment, which have become widely associated with poor posture. The purpose of this study was to observe the effect that a commercially available posture trainer, Upright Go, can have on the improvement of posture of ophthalmic surgeons. Methods Eight ophthalmologists-in-training were studied over a period of 4 weeks during their surgical rotations between September 2020 and June 2021. Participants underwent an "observation" period, followed by a 2-week "training" period, then a final "testing" period. The percentage of time users spent upright intraoperatively pre- and posttraining was evaluated. Pre- and poststudy surveys were also administered to help measure participant satisfaction and self-reported changes in posture. Results All eight participants demonstrated an increase in the percentage of time spent upright after the training period. Across all participants, the total average percentage spent upright in the observation period was 59.8%, while in the testing period was 87.1%, resulting in an average improvement of 27.3% of time spent in an upright position after the completion of the training period ( p < 0.0001). The range of improvement of time spent upright was 16.0 to 46.5%. Conclusion This cohort study utilized the Upright Go device to help determine the effect that its training could have on the improvement of posture in ophthalmic surgeons. The results indicated a significant increase in the average proportion of time spent with upright posture compared after the training period.
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Affiliation(s)
- Zahra Markatia
- Department of Ophthalmology, Baylor College of Medicine Cullen Eye Institute, Houston, Texas
| | | | - Meghana Kalavar
- Department of Ophthalmology, Ohio State University Ophthalmology, Columbus, Ohio
| | - Arjun Watane
- Department of Ophthalmology, Yale Eye Center, New Haven, Connecticut
| | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, University of California Los Angeles Stein Eye Institute, Los Angeles, California
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Patel NA, Al-Khersan H, Yannuzzi NA, Lin J, Smiddy WE. Aflibercept Monotherapy versus Bevacizumab-First for Diabetic Macular Edema: A Cost Analysis Based on Diabetic Retinopathy Clinical Research Network Protocol AC Results. Ophthalmol Retina 2023; 7:413-419. [PMID: 36423893 DOI: 10.1016/j.oret.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 05/07/2023]
Abstract
PURPOSE To calculate the costs of treatment for diabetic macular edema with bevacizumab-first (step therapy) compared with aflibercept monotherapy. DESIGN Cost analysis of the treatment arms based on a published study. SUBJECTS None. METHODS Published results from the Diabetic Retinopathy Clinical Research Network protocol AC were used to assess costs. Data incorporated in the usage and outcome model included the frequency of injections, medication type, visits, and imaging. Costs were modeled based on the 2022 Medicare reimbursement data for both facility (hospital-based) and nonfacility settings in Miami. Outcomes were similar in protocol AC so were not differentially studied. Results were extrapolated so as to estimate lifetime (17 years for the age of the cohort). MAIN OUTCOME MEASURES Cost of treatment options. RESULTS Over the 2 years reported in the protocol AC, the cost required to treat in the facility (nonfacility setting) was $42 000 ($32 000) in the aflibercept monotherapy group and $29 000 ($22 000) in the bevacizumab-first group. Extrapolated modeled lifetime costs were $158 000 ($136 000) and $125 000 ($103 000), respectively. The total cost with bevacizumab-first was 33% lower at year 2 and 21% lower at year 17 compared with aflibercept monotherapy. Savings per year for the 2 years results were $6500 ($5000) in the facility (nonfacility) setting. For the extrapolated 17 years model, annual savings were $1900 ($1900) in the facility (nonfacility) setting. The professional fees accounted for a minority of overall costs; in contrast, medication costs accounted for 82% of the total costs for the aflibercept monotherapy and 73% in the bevacizumab-first group at 2 years. Our model predicted an additional 15% lifetime cumulative savings if patients still not meeting the threshold criteria after switching to aflibercept were placed back on bevacizumab, and a similar degree of improvement if those on not meeting threshold criteria on aflibercept monotherapy were switched to bevacizumab. CONCLUSIONS Medication is the dominant driver of the total expenses associated with the treatment of diabetic macular edema. Although cost savings are realized with bevacizumab-first step therapy, the magnitude was not as much as might be intuited, probably because of the high (70%) incidence of patients switching to aflibercept within protocol AC. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James Lin
- Retinal Consultants of Long Island, Great Neck, New York
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Lin BR, Al-Khersan H, Rowsey T, West M, Lin A, Qu P, Bitrian E, Hudson J, Venincasa M, Fan J, Gutkind N, Diaz JD, Parekh P, Sultan H, Yannuzzi NA. Clinical Outcomes after Ocular Trauma with Orbeez Gel Pellet Projectiles. Ophthalmology 2023; 130:553-555. [PMID: 36717000 DOI: 10.1016/j.ophtha.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/30/2023] Open
Affiliation(s)
- Benjamin R Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Tyler Rowsey
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew West
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Albert Lin
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Phillip Qu
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Elena Bitrian
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Julia Hudson
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Michael Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Jason Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Naomi Gutkind
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | | | | | | | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
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Pakravan P, Patel V, Chau V, Rohowetz L, Lai J, Fan KC, Al-Khersan H, Melo IM, Muni RH, Tsao SW, Kaplan R, Jung JJ, Hoyek S, Patel NA, Kuriyan AE, Laura DM, Mantopoulos D, Syed ZA, Yannuzzi NA. Haptic Erosion Following Sutureless Scleral-fixated Intraocular Lens Placement. Ophthalmol Retina 2023; 7:333-337. [PMID: 36441084 DOI: 10.1016/j.oret.2022.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/11/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To describe the clinical features and visual outcomes of eyes with conjunctival haptic erosion after sutureless intrascleral (SIS) fixated intraocular lens (IOL) placement. DESIGN Retrospective case series. SUBJECTS Patients experiencing haptic erosion after SIS fixation between January 1, 2013, and March 1, 2022. METHODS A multicenter, multisurgeon, retrospective review. MAIN OUTCOME MEASURES Clinical features, visual outcomes, and treatment options following haptic erosions after SIS fixation. RESULTS Nineteen eyes with haptic erosion were identified. The mean age at initial SIS fixation was 64 ± 12 years (range, 38-81 years). There were 5 (26%) eyes with a history of conjunctiva involving ocular surgery, including scleral buckle surgery and tube shunt surgery. Trocar-assisted fixation was performed in 15 (79%) eyes, whereas needle fixation was used in 4 (21%) eyes. Eighteen (95%) sets of haptics were flanged with a low temperature cautery. Seventeen (90%) sets of haptics were externalized superiorly and inferiorly, and 2 (10%) sets of haptics were externalized nasally and temporally. Haptics were covered by conjunctiva in 14 (74%) eyes and by scleral flap in 5 (26%) eyes. All patients experienced a single haptic erosion, of which 8 (43%) were located superiorly, 9 (47%) inferiorly, and 2 (10%) temporally. The mean interval between the initial SIS fixation and haptic erosion was 278 ± 437 days. After correction of the erosion, 18 (95%) eyes had a stable IOL at the last follow-up, with no recurrence of haptic erosion. In this series, there were no cases of endophthalmitis. CONCLUSIONS Haptic erosion is a notable complication after SIS fixated IOL surgery but may be repaired with favorable visual outcomes. Careful evaluation of the conjunctiva should be considered before the surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Parastou Pakravan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Veshesh Patel
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Viet Chau
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Landon Rohowetz
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - James Lai
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Sean W Tsao
- Department of Ophthalmology, Southern California Permanente Medical Group, Santa Ana, California
| | | | - Jesse J Jung
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; East Bay Retina Consultants, Inc., Oakland, California
| | - Sandra Hoyek
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nimesh A Patel
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Ajay E Kuriyan
- Wills Eye Hospital, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Diana M Laura
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Zeba A Syed
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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Al-Khersan H, Nuesi R. Subretinal and Liver Abscesses in Klebsiella Endophthalmitis. Am J Ophthalmol 2023; 248:e1. [PMID: 36709020 DOI: 10.1016/j.ajo.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/27/2023]
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Anibire O, Al-Khersan H, Williams BK. A Case of Acute Chest Pain After Acetazolamide to Treat Uncontrolled Increased Intraocular Pressure. JAMA Ophthalmol 2023; 141:398-399. [PMID: 36929414 DOI: 10.1001/jamaophthalmol.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
A 61-year-old man with uncontrolled increased intraocular pressure after cataract surgery was treated with acetazolamide. Three days later, he developed acute chest pain requiring emergency treatment. What would you do next?
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Affiliation(s)
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Basil K Williams
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.,Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Özdek Ş, Özdemir Zeydanlı E, Baumal C, Hoyek S, Patel N, Berrocal A, Lopez-Cañizares A, Al-Khersan H, Kusaka S, Mano F, Jalali S, Lepore D, Akar S. Avascular Peripheral Retina in Infants. Turk J Ophthalmol 2023; 53:44-57. [PMID: 36847634 PMCID: PMC9973209 DOI: 10.4274/tjo.galenos.2022.76436] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Avascular peripheral retina in an infant is a common characteristic of numerous pediatric retinal vascular disorders and often presents a diagnostic challenge to the clinician. In this review, key features of each disease in the differential diagnosis, from retinopathy of prematurity, familial exudative vitreoretinopathy, Coats disease, incontinentia pigmenti, Norrie disease, and persistent fetal vasculature, to other rare hematologic conditions and telomere disorders, will be discussed by expert ophthalmologists in the field.
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Affiliation(s)
- Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Türkiye
| | | | - Caroline Baumal
- Tufts University Faculty of Medicine, Department of Ophthalmology, Tufts Medical Center, Boston, United States of America
| | - Sandra Hoyek
- Harvard Medical School, Massachusetts Eye and Ear, Department of Ophthalmology, Boston, United States of America
| | - Nimesh Patel
- Harvard Medical School, Massachusetts Eye and Ear, Department of Ophthalmology, Boston, United States of America
| | - Audina Berrocal
- University of Miami Miller Faculty of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, United States of America
| | - Ashley Lopez-Cañizares
- University of Miami Miller Faculty of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, United States of America
| | - Hasenin Al-Khersan
- University of Miami Miller Faculty of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, United States of America
| | - Shunji Kusaka
- Kindai University Faculty of Medicine, Department of Ophthalmology, Osaka, Japan
| | - Fukutaro Mano
- Kindai University Faculty of Medicine, Department of Ophthalmology, Osaka, Japan
| | - Subhadra Jalali
- L V Prasad Eye Institute, Anant Bajaj Retina Institute and Child Sight Institute, Hyderabad, India
| | - Domenico Lepore
- Catholic University of the Sacred Heart, Department of Geriatrics and Neuroscience, A. Gemelli Foundation IRCSS, Rome, Italy
| | - Solmaz Akar
- Acıbadem Bakırkoy Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
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Al-Khersan H, Sengillo J, Fan KC, López-Cañizares A, da Cruz NFS, Patel NA, Berrocal AM. Widefield Fluorescein Angiography Findings in Pediatric Patients with X-Linked Retinoschisis. Ophthalmol Retina 2023:S2468-6530(23)00058-1. [PMID: 36805350 DOI: 10.1016/j.oret.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To evaluate the retinal vasculature in pediatric patients with X-linked retinoschisis (XLRS). DESIGN Retrospective consecutive case series. SUBJECTS Pediatric patients with a diagnosis of XLRS who had undergone widefield fluorescein angiography (FA). METHODS The electronic medical records of pediatric patients with XLRS at a tertiary referral eye center were reviewed from January 2015 to December 2021. Fluorescein angiography images were reviewed for anomalies of the retinal vasculature. MAIN OUTCOMES MEASURES Vascular anomalies on FA were recorded, including capillary dropout/ischemia, terminal supernumerary vessels, vascular leakage, abnormal vascular loops, straightening of vessels, aberrant circumferential vessels, and neovascularization. RESULTS In total, 29 eyes of 15 patients were included in the study (1 patient had a phthisical eye). On FA, the most common findings were capillary dropout/ischemia (21 of 29 eyes, 72.4%), terminal supernumerary vessels (21 eyes, 72.4%), abnormal vascular loops (20 eyes, 69%), and vascular leakage (17 eyes, 58.6%). Of the 17 eyes with leakage, the most posterior zone of involvement was zone 1 in 11 eyes (64.7%) and zone 2 in 6 eyes (35.3%). All eyes demonstrated ≥ 1 vascular anomaly on FA. Among the 29 eyes, 23 (79.3%) demonstrated peripheral bullous schisis or retinal detachment (RD) with a mean of 5.6 clock hours of involvement. The presence of either RD or bullous retinal schisis was associated with the incidence of capillary dropout (91.3% in schisis/RD eyes vs. 0% in nonschisis/RD eyes, P < 0.001). Among those with RD or bullous schisis, a higher degree of involvement correlated with more severe capillary dropout (Pearson 0.49, P = 0.025). CONCLUSION The present study demonstrates consistent vascular changes in pediatric patients with XLRS using widefield FA. Although the presence of capillary ischemia was associated with the severity of bullous schisis or RD, other vascular anomalies were observed in patients both with and without peripheral schisis. Although further research is needed to understand the etiology of these vascular anomalies, FA should be considered in the evaluation of these patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | | | | | | | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
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López-Cañizares A, Al-Khersan H, Fernandez MP, Lin BR, Goduni L, Berrocal AM. Smith-Lemli-Optiz syndrome: importance of ophthalmology referral and follow-up. J AAPOS 2022; 27:100-102. [PMID: 36563894 DOI: 10.1016/j.jaapos.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive disorder caused by mutations in the 7-dehydrocholesterol reductase (DHCR7) gene, located on chromosomal region 11q13. This results in reduced cholesterol and increased 7-dehydrocholesterol (7DHC) levels. Accumulation of 7DHC in patients with SLOS can affect multiple organs and display a broad phenotypic expression. Ophthalmic abnormalities related to SLOS are variable but the most common is blepharoptosis. Over 50% of these patients present with self-injurious behavior, such as head banging, which can result in ocular complications and blindness. We report the first case of peripheral avascularity of the retina in a patient with SLOS. Physicians should be aware of the potential ocular complications associated with SLOS and confounding factors, such as prematurity, given that referral is usually delayed due to the lack of awareness of these potentially blinding associations. This case highlights the importance of early referral and continuous ophthalmologic follow-up in preventing further deterioration of visual development and complications that can lead to blindness.
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21
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Lin BR, Russell JF, Al-Khersan H, Goldhardt R. A systematic review of acute zonal occult outer retinopathy with a focus on attempted treatment modalities. Curr Ophthalmol Rep 2022; 10:168-178. [PMID: 36742288 PMCID: PMC9894323 DOI: 10.1007/s40135-022-00305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Benjamin R. Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Jonathan F. Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa; Iowa City, Iowa
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Raquel Goldhardt
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
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Al-Khersan H, Shaheen AR, Flynn HW, Smiddy WE. Natural History and Surgical Timing for Idiopathic Epiretinal Membrane. Ophthalmol Retina 2022; 6:978-984. [PMID: 35272083 DOI: 10.1016/j.oret.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE This study assessed the prevalence of progression to surgery on idiopathic epiretinal membrane (iERM) and compared the results with those of immediate surgery. DESIGN Retrospective study with nested case-control comparison. SUBJECTS Patients with mild iERM at initial presentation METHODS: A retrospective study with a nested case-control study was conducted to compare the outcomes of those who later progressed to surgery ("deferred surgery") with those of a control group that underwent surgery within 6 months of initial presentation ("immediate surgery"). MAIN OUTCOME MEASURES The prevalence of performing vitrectomy with membrane peeling after initial deferral, features associated with deferred surgery, and the visual acuity (VA) outcomes of surgery compared with those with immediate surgery. RESULTS A total of 413 patients were included in the base study cohort: 369 did not undergo iERM peeling, whereas 44 (10.7%) underwent deferred surgery at a mean duration of 18.1 months after initial presentation. The factor most associated with later progression to surgery, determined using a multivariate analysis, was symptoms at initial presentation (odds ratio [95% confidence interval], 8.75 [3.80-20.15]; P < 0.0001). The immediate surgical group (controls) had a poorer logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at presentation compared with the deferred surgery group (cases), but this decreased in the latter group to about the same preoperative level immediately before the deferred surgery (typically why they underwent surgery). The final logMAR BCVA was similar in the deferred and immediate surgical groups when only pseudophakic cases were analyzed. An analysis of the change from preoperative BCVA (instead of initial) to final BCVA showed no difference in the magnitude of change between the pseudophakic subgroups of the deferred and immediate surgery groups (median [interquartile range] preoperative VA of 0.52 [0.40-0.60] in the deferred surgery group and 0.44 [0.39-0.60] in the immediate surgery group [P = 0.7256]). Within the deferred and immediate surgery groups, the median change from preoperative BCVA to final BCVA in the pseudophakic subgroups was 0.22 (P = 0.0082) in the former and 0.21 (P = 0.0001) in the latter. CONCLUSIONS The vast majority of eyes with iERM remain stable after initial presentation. The deferral of surgery in the minority of patients who progress does not have a disadvantageous final outcome compared with immediate surgery.
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Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Abdulla R Shaheen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Kunkler AL, Sengillo JD, Al-Khersan H, Fan KC, Laura DM, Miller D, Donaldson KE, Yoo SH, Yannuzzi NA, Sridhar J, Gedde SJ, Smiddy WE, Flynn HW. Acute-onset postoperative endophthalmitis after cataract surgery performed by resident and attending physicians at a university teaching hospital. J Cataract Refract Surg 2022; 48:1312-1317. [PMID: 35786812 DOI: 10.1097/j.jcrs.0000000000000989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate acute-onset postoperative endophthalmitis following cataract surgery and to compare rates between resident and attending physician-performed cohorts. SETTING Bascom Palmer Eye Institute, Miami, Florida. DESIGN Retrospective chart review. METHODS Records of patients diagnosed with endophthalmitis within 6 weeks of surgery performed by attending and resident physicians between January 1, 2015, and December 31, 2020, were reviewed. Total cataract volume was obtained from institutional records, and resident case totals were obtained from case logs. Endophthalmitis cases were obtained from billing records and confirmed with chart review. RESULTS There were 22 cases of endophthalmitis among 32 505 cases (0.068%). Endophthalmitis occurred in 6 of 6447 (0.093%) resident cases and 16 of 26 058 (0.061%) attending cases ( P = .55). The most common bacterial isolates were coagulase-negative Staphylococcus (8/22, 36.3%) and Streptococcus species (3/22, 13.6%), with negative cultures in 10 (10/22, 45.5%). Initial treatment with vitreous tap and injection of intravitreal antibiotics was performed in 21 eyes (21/22, 95.4%) and vitrectomy with intravitreal antibiotic injection in one (1/22, 4.5%). Vitrectomy was performed secondarily in 9 patients (9/22, 40.9%). Corrected distance visual acuity (CDVA) at last follow-up was ≥20/40 in 13 eyes (13/22, 59%) and ≤hand motions in 3 eyes (3/22, 13.6%). CDVA (logMAR mean ± SD) was 1.22 ± 1.16 in resident and 0.49 ± 0.79 in attending cases ( P = .11). CONCLUSIONS In the current study, acute-onset postoperative endophthalmitis developed infrequently following cataract surgery. The rates and visual outcomes of endophthalmitis were similar in resident and attending cases.
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Affiliation(s)
- Anne L Kunkler
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Al-Khersan H, Patel NA, Yannuzzi NA, Lin J, Smiddy WE. Cost Analysis: Port Delivery System versus Monthly Ranibizumab for Wet Age-Related Macular Degeneration Treatment. Ophthalmol Retina 2022; 6:1105-1106. [PMID: 35636743 DOI: 10.1016/j.oret.2022.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James Lin
- Department of Ophthalmology, Vitreoretinal Consultants of New York, Great Neck, New York
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Hoyek S, Peacker BL, Acaba-Berrocal LA, Al-Khersan H, Zhao Y, Hartnett ME, Berrocal AM, Patel NA. The Male to Female Ratio in Treatment-Warranted Retinopathy of Prematurity: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2022; 140:1110-1120. [PMID: 36201195 PMCID: PMC9539737 DOI: 10.1001/jamaophthalmol.2022.3988] [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: 06/14/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022]
Abstract
Importance Literature and anecdotal evidence suggest a relationship between male sex and retinopathy of prematurity (ROP). It is not known whether a difference, if present, is sex-related pathophysiologic predisposition or sex difference in meeting ROP screening criteria. Objective To evaluate the association of sex with the development of treatment-warranted ROP. Data Sources PubMed, Embase, and Web of Science databases were searched from 2000 to 2022. The search strategy used keywords including retinopathy of prematurity or ROP or retrolental fibroplasia and treatment or anti-VEGF or bevacizumab or ranibizumab or aflibercept or conbercept or laser or cryotherapy and gender or sex or male or female and medical subject headings terms. Study Selection All studies reporting on treatment with anti-vascular endothelial growth factor, laser photocoagulation, and/or cryotherapy for ROP were identified. Studies reporting sex distribution in the treatment group were included in the meta-analysis. Exclusion criteria included case reports, case series of fewer than 10 treated patients, systematic reviews, conference abstracts, letters to the editor, animal studies, and non-English records. Data Extraction and Synthesis Two reviewers independently screened and extracted the data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The proportions of treated male and female infants were combined using random-effects meta-analysis. Main Outcomes and Measures Numbers and percentages of male and female infants treated for ROP. Results Of 11 368 identified studies, 316 met inclusion criteria, yielding a total of 31 026 treated patients. A higher percentage of male infants were treated for ROP (55% [95% CI, 0.54%-0.55%]), with low heterogeneity between studies (I2 = 34%; P < .001). Thirty-eight studies reported sex distribution in the screened population (170 053 patients; 92 612 [53%] male vs 77 441 [47%] female). There was no significant difference in the odds of receiving treatment between screened male and female infants (pooled odds ratio, 1.04 [95% CI, 0.91-1.18]; P = .67). Conclusions and Relevance More male infants are treated for ROP than female infants. This could be due to a known relative pathophysiological fragility of preterm male infants in addition to a difference in ROP screening rates, with more male infants meeting the criteria than female infants. These findings have implications for future studies and may prompt more careful clinical monitoring of male neonates.
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Affiliation(s)
- Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Bryan L. Peacker
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Luis A. Acaba-Berrocal
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | | | - Audina M. Berrocal
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Nimesh A. Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
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Lopez-Cañizares A, Al-Khersan H, Carletti P, Shields CL, Berrocal AM. Gorlin Syndrome Associated With a Solitary Circumscribed Retinal Astrocytic Proliferation in a Pediatric Patient. Ophthalmic Surg Lasers Imaging Retina 2022; 53:514-516. [PMID: 36107625 DOI: 10.3928/23258160-20220811-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gorlin syndrome is a rare autosomal dominant disorder with near complete penetrance. The underlying genetic mechanism is a mutation in a tumor suppressor gene. Thus far, mutations in patched homolog 1 and 2 genes (PTCH1 and PTCH2) and the suppressor of fused gene (SUFU) have been identified. The syndrome is characterized by neoplasms arising early in childhood as well as developmental abnormalities, including ophthalmic anomalies. We present the first case associating Gorlin syndrome with a rare retinal lesion known as solitary circumscribed retinal astrocytic proliferation (SCRAP). SCRAP is a benign, stable retinal tumor. For this reason, it is essential to differentiate it from similar retinal lesions that are associated with poor prognosis. [Ophthalmic Surg Lasers Imaging Retina 2022;53:514-516.].
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Venincasa MJ, Shoji MK, Al-Khersan H, Maeng MM, Johnson TE, Flynn HW. Acute Onset Endophthalmitis Following Bilateral Upper and Lower Eyelid Blepharoplasty. Ophthalmic Plast Reconstr Surg 2022; 38:e131-e133. [PMID: 35470337 DOI: 10.1097/iop.0000000000002176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 59-year-old woman presented with iritis and uveitis in the OD approximately 3 weeks after she underwent a bilateral upper and lower blepharoplasty by an outside oculoplastic specialist. Examination revealed a visual acuity of hand motion in the OD, scleral ulceration suspicious for prior globe perforation, dense vitritis, and loculations and membranes on echography. The patient was diagnosed with acute onset exogenous endophthalmitis. Vitreous aspiration and intravitreal injection of vancomycin and ceftazidime were performed. The patient underwent a pars plana vitrectomy, and vitreous culture demonstrated Streptococcus pseudoporcinus . Postoperative vision improved to 4/200 but was limited by a full-thickness macular hole. Despite silicone oil removal and macular hole repair, the macular hole remained open at month 7 and limited vision to 5/200. During eyelid surgery, surgeons should take precautions against intraoperative needle perforation including possible use of protective shield. Postoperative vision loss after eyelid surgery requires further evaluation.
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Affiliation(s)
- Michael J Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Hucko L, Al-Khersan H, Lopez Dominguez J, Cavuoto KM, Scott NL, Williams BK, Fountain T, Sridhar J. Racial and Ethnic Diversity of U.S. Residency Programs, 2011-2019. N Engl J Med 2022; 386:2152-2153. [PMID: 35648712 DOI: 10.1056/nejmc2200107] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Djulbegovic M, Kalahasty K, Watane A, Jabori SK, Al-Khersan H, Sridhar J. Correlation Between Altmetric Attention Scores and Citations for Articles Published in High-Impact Factor Ophthalmology Journals From 2018 to 2019. JAMA Ophthalmol 2022; 140:623-627. [PMID: 35446355 PMCID: PMC9026226 DOI: 10.1001/jamaophthalmol.2022.0858] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Altmetric attention score (AAS) provides new information to gauge the impact of a research article not found through typical metrics, such as impact factor or citation counts. Objective To explore the association between AAS and common impact markers among high-impact ophthalmology journals from 2018 to 2019. Design, Setting, and Participants All articles published in the American Journal of Ophthalmology (AJO), JAMA Ophthalmology (JAMAO), and Ophthalmology (OPH) from January 1, 2018, to December 31, 2019, were collected for this cross-sectional study. Excluded articles were those missing Altmetric data at the time of data collection. The AAS and associated social media impact for each article were collected with the AAS calculator bookmarklet. Spearman rank correlation analyses and analysis of variance tests were conducted to assess differences in various metrics between AJO, JAMAO, and OPH. The study included articles published of all document types (article, conference paper, editorial, erratum, letter, note, retracted, review, and short survey) and access status (open access and not open access). Main Outcomes and Measures The correlation between citation counts and Altmetric variables including AAS. Results A total of 2467 articles were published in the study period. There were 351 articles excluded owing to missing Altmetric data. Of the 2116 articles included in the analysis, 1039 (49.1%) were published in 2018, and 1077 (50.9%) were published in 2019; the mean number of citations was 8.8 (95% CI, 7.9-9.6) for AJO, 6.2 (95% CI, 5.3-7.1) for JAMAO, and 15.1 (95% CI, 13.3-17.0) for OPH. The mean AAS was 4.5 (95% CI, 3.3-5.6) for AJO (723 publications), 27.4 (95% CI, 22.1-32.8) for JAMAO (758 publications), and 15.1 (95% CI, 10.9-19.3) for OPH (635 publications). Citation rate was moderately correlated with AAS across the 3 journals (AJO, ρ = 0.39; P < .001; JAMAO, ρ = 0.41; P < .001; OPH, ρ = 0.40; P < .001), as well as minimally or moderately correlated with engagement or mention by Facebook posts (AJO, ρ = 0.38; P < .001; JAMAO, ρ = 0.24; P < .001; OPH, ρ = 0.20; P < .001), news outlet reporting (AJO, ρ = 0.12; P < .001; JAMAO, ρ = 0.38; P < .001; OPH, ρ = 0.19; P < .001), and Twitter posts (AJO, ρ = 0.40; P < .001; JAMAO, ρ = 0.38; P < .001; OPH, ρ = 0.42; P < .001). Conclusions and Relevance Results of this cross-sectional study suggest that citation rate has a moderate positive correlation with online and social media sharing of research in ophthalmology literature. Peer-reviewed journals may increase their reach and impact by sharing their literature through social media and online platforms.
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Affiliation(s)
- Mak Djulbegovic
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Karthik Kalahasty
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Arjun Watane
- Ophthalmology & Visual Science, Yale University, New Haven, Connecticut
| | - Sinan K Jabori
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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López-Cañizares A, Fernandez MP, Al-Khersan H, Carletti P, Arroyo MS, Fernandez-Ruiz MC, Berrocal AM. Coats plus in prematurity. Ophthalmic Genet 2022; 43:543-549. [PMID: 35416114 DOI: 10.1080/13816810.2022.2051193] [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: 10/18/2022]
Abstract
BACKGROUND Coats plus syndrome or cerebroretinal microangiopathy with calcifications and cysts (CMCC) is an exceedingly rare autosomal recessive disorder that predominantly affects the microvasculature in the retina, brain, bones, and gastrointestinal system. Unlike Coats disease, CMCC is bilateral and affects multiple organ systems. MATERIALS AND METHODS Case report. RESULTS We report the case of two brothers with Coats Plus syndrome who presented with variable phenotypic expression. One sibling (Patient 1) was thought to have atypical retinopathy of prematurity and was only diagnosed with Coats plus after his older brother (Patient 2) presented with a seizure and a left upper extremity tremor at 4 years of age. The CTC1 mutation was confirmed in both patients. Aggressive treatment with laser photocoagulation and intravitreal bevacizumab dramatically improved the retinal vascular and exudative changes. CONCLUSION Coats Plus syndrome can have a variable phenotypic presentation, including retinal vascular findings. This rare genetic disease should be in the differential diagnosis in patients who present with atypical retinal pathology, including Retinopathy of Prematurity, Familial Exudative Vitreoretinopathy, or Coats disease associated with non-specific multiorgan abnormalities.
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Kunkler AL, Patel NA, Russell JF, Fan KC, Al-Khersan H, Iyer PG, Acon D, Negron CI, Yannuzzi NA, Berrocal AM. Intraoperative Optical Coherence Tomography Angiography in Children with Incontinentia Pigmenti. Ophthalmol Retina 2022; 6:330-332. [PMID: 34999278 DOI: 10.1016/j.oret.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
OCT angiography detects vascular abnormalities in incontinentia pigmenti not apparent on fluorescein angiography, and therefore may serve as helpful tool to detect early macular ischemia in children during examination under anesthesia.
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Affiliation(s)
- Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Jonathan F Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Prashanth G Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dhariana Acon
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Catherin I Negron
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Berrocal AM, Fan KC, Al-Khersan H, Negron CI, Murray T. Retinopathy of Prematurity: Advances in the Screening and Treatment of Retinopathy of Prematurity Using a Single Center Approach. Am J Ophthalmol 2022; 233:189-215. [PMID: 34298009 PMCID: PMC8697761 DOI: 10.1016/j.ajo.2021.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To focus on the longitudinal evaluation of high-risk infants for the development of retinopathy of prematurity (ROP) at a single tertiary neonatal intensive care unit (NICU), and to evaluate evolving demographics of ROP and the transition of treatment-warranted disease. DESIGN Retrospective cohort study. METHODS A consecutive retrospective review was performed of all infants screened for ROP between 1990 and 2019 at the Jackson Memorial Hospital neonatal intensive care unit. All inborn infants meeting a birth criteria of <32 weeks' gestational age (GA) or a birthweight (BW) of 1500 g were included. Longitudinal demographic, diagnostic, and treatment data were reported. RESULTS Between January 1, 1990, and June 20, 2019, a total of 25,567 examinations were performed and 7436 patients were included. Longitudinal trends over 3 decades demonstrated a decreasing incidence of ROP (P < .05). Although the mean BW and GA increased over 3 decades, patients with ROP demonstrated lower BW and GA over time (P < .05). The prevalence of micro-premature infants (as defined by BW <750 g) continues to rise over time. Micro-preemies demonstrated increasing severity of zone and stage grading, plus disease, and propensity to require treatment (P < .05). The rate of progression of ROP to stage 4 and 5 disease has decreased over time, and there has been an associated increased adoption of intravitreal bevacizumab as primary and salvage therapy. CONCLUSIONS Understanding the evolution of ROP infants and treatment over time is critical in identifying high-risk infants and in reducing the incidence of severe-stage ROP. Micro-prematurity is one of the significant risk factors for treatment-warranted ROP that continues to increase as neonatal care improves. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Audina M Berrocal
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | - Kenneth C Fan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Catherin I Negron
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Timothy Murray
- Murray Oncology and Retina (T.M.), South Miami, Florida, USA
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Fan KC, Patel NA, Al-Khersan H, Townsend JH. Outcomes of Flanged Intrascleral Haptic Fixation with CT Lucia Three-Piece Intraocular Lens. Ophthalmic Surg Lasers Imaging Retina 2021; 52:658-662. [PMID: 34908480 DOI: 10.3928/23258160-20211127-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the clinical outcomes of the flanged intrascleral haptic fixation technique (FIHFT) with the Zeiss CT Lucia 602 three-piece intraocular lens (IOL). PATIENTS AND METHODS This was a retrospective case series of patients who received FIHFT secondary implantation of the Zeiss CT Lucia 602 IOL from January 2018 to August 2020. Clinical and refractive outcomes were assessed including best-corrected visual acuity (BCVA), refractive prediction error, and complications. RESULTS Of the 22 patients in the series, 19 were included in the study. Mean vision improved from logarithm of the minimum angle of resolution (log-MAR) 1.14 to 0.54 (P = .03). BCVA of those without preoperative trauma improved from logMAR 0.68 to logMAR 0.25 (P = .02). Refractive spherical equivalent improved from 2.46 diopters (D) to 0.50 D (P = .07), but astigmatism increased from 1.09 D to 1.31 D (P = .67). CONCLUSIONS FIHFT with the Zeiss CT Lucia 602 three-piece lens is a safe and effective option for secondary IOL placement. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:658-662.].
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Eatz T, Al-Khersan H, Tanenbaum R, Sridhar J. Does social media have a place in ophthalmology practice? Expert Rev Ophthalmol 2021; 16:329-331. [PMID: 34899961 DOI: 10.1080/17469899.2021.1941877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tiffany Eatz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 7 Street Miami, FL 33136, United States of America
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 7 Street Miami, FL 33136, United States of America
| | - Rebecca Tanenbaum
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 7 Street Miami, FL 33136, United States of America
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 7 Street Miami, FL 33136, United States of America
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Affiliation(s)
| | - Ann Q Tran
- Manhattan Eye, Ear & Throat Hospital, Northwell University, New York, New York
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Robles-Holmes H, Sridhar J, Al-Khersan H, Patel M, Hwang J, Hucko L, Cavuoto KM. Trends in emergency ophthalmic care during COVID-19: A comparative analysis. Am J Emerg Med 2021; 53:276-278. [PMID: 33985829 PMCID: PMC8110036 DOI: 10.1016/j.ajem.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hailey Robles-Holmes
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Marissa Patel
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jodi Hwang
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Lauren Hucko
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Kara M Cavuoto
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America.
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Al-Khersan H, Amescua G, Davis JL. Progressive Scleral Thinning in a Middle-aged Woman. JAMA Ophthalmol 2021; 139:800-801. [PMID: 33885742 DOI: 10.1001/jamaophthalmol.2020.5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Al-Khersan H. Take a Moment: Reflections on a Pandemic, Suffering, and Humanity. Am J Ophthalmol 2021; 227:S0002-9394(21)00029-5. [PMID: 33497674 PMCID: PMC9745899 DOI: 10.1016/j.ajo.2021.01.009] [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] [Received: 12/16/2020] [Revised: 12/23/2020] [Accepted: 01/09/2021] [Indexed: 12/16/2022]
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Al-Khersan H, Patel NA, Albini TA. Rapidly Progressive Bilateral Visual Acuity Loss in a Middle-Aged Woman. JAMA Ophthalmol 2021; 138:706-707. [PMID: 32352496 DOI: 10.1001/jamaophthalmol.2020.0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Fan KC, Read SP, Patel NA, Vanner EA, Al-Khersan H, Laura DM, Pakravan P, Negron CI, Berrocal AM. Fundus Pigmentation in the Diagnosis and Treatment of Retinopathy of Prematurity. Ophthalmology 2020; 128:1242-1244. [PMID: 33383092 DOI: 10.1016/j.ophtha.2020.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sarah P Read
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Retinal Consultants of Hawaii, Honolulu, Hawaii
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Diana M Laura
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Parastou Pakravan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Catherin I Negron
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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Al-Khersan H, Lazzarini TA, Kunkler AL, Laura DM, Fan KC, Zhang L, Redick DW, Salazar H, Medert CM, Patel NA. Ocular trauma secondary to exercise resistance bands during the COVID-19 pandemic. Am J Emerg Med 2020; 42:217-220. [PMID: 33317864 PMCID: PMC7716731 DOI: 10.1016/j.ajem.2020.11.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 01/06/2023] Open
Abstract
Objective To characterize injuries caused by exercise resistance bands. Method Single-site retrospective case series of patients presenting to the Bascom Palmer Eye Institute emergency room with ocular injuries secondary to exercise resistance bands from March through September 2020. Results Eleven patients (9 males, 2 females, 14 eyes) were reviewed. Eight patients had a unilateral injury (3 right eyes, 5 left eyes) while 3 had bilateral injuries. Iritis was the most common presentation, seen in all 11 patients, followed by hyphema (9 patients, 82%), and vitreous hemorrhage (4 patients, 36%). Among affected eyes, the mean presenting visual acuity was approximately 20/100, improving to 20/40 on the last follow up (p = 0.06). However, 4 eyes (33%) had vision ≤20/60 at last follow up. Conclusions Exercise resistance bands can cause a wide spectrum of ocular injuries, some leading to long-term vision loss. As such, we recommend that patients strongly consider using eye protection goggles or glasses while using resistance bands for exercise.
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Affiliation(s)
- Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America.
| | - Thomas A Lazzarini
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Anne L Kunkler
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Diana M Laura
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Kenneth C Fan
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Lily Zhang
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - David W Redick
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Humberto Salazar
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Charles M Medert
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Nimesh A Patel
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
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Lazzarini TA, Al-Khersan H, Patel NA, Russell JF, Fan KC, De Oliveira G, Negron CI, Mavrofrides E, Berrocal AM. Peripheral combined hamartoma of the retina and retinal pigment epithelium with remote peripapillary choroidal neovascular membrane. Am J Ophthalmol Case Rep 2020; 20:100954. [PMID: 33083636 PMCID: PMC7551977 DOI: 10.1016/j.ajoc.2020.100954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe the first reported case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with a remote choroidal neovascular membrane (CNVM). Observations A 19-month-old girl with a normal prenatal and infantile history presented with esotropia of the left eye. Fundus examination demonstrated a large, elevated, charcoal-colored lesion in the nasal equatorial retina. There was dragging of the nasal retinal vessels and a retinal fold, presumed to have resulted from nasal traction from the lesion. There was also subretinal hemorrhage in the peripapillary macula. Multimodal imaging demonstrated a peripapillary choroidal neovascular membrane (CNVM) underlying the retinal fold. There was no leakage within the tumor or secondary retinal neovascularization. Examination of the fellow eye was unremarkable. The patient was diagnosed with peripheral CHRRPE with associated peripapillary CNVM. She was treated with serial intravitreal bevacizumab to the affected eye which resulted in a reduction in leakage from the CNVM and resolution of the subretinal hemorrhage. The CHRRPE remained stable on follow-up. Conclusions Peripheral CHRRPE can rarely be associated with a remote CNVM.
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Al-Khersan H, Rong AJ. Acute Ptosis in a Middle-aged Man With Hypertension. JAMA Ophthalmol 2020; 138:996-997. [PMID: 32672796 DOI: 10.1001/jamaophthalmol.2020.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Patel NA, Fan KC, Al-Khersan H, Yannuzzi NA, Acon D, Rodriguez AJ, Negron CI, Berrocal AM. Persistent Tunica Vasculosa Lentis as an Independent Risk Factor for Treatment in Retinopathy of Prematurity. Ophthalmol Retina 2020; 5:217-219. [PMID: 32781054 DOI: 10.1016/j.oret.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Dhariana Acon
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ana J Rodriguez
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Catherin I Negron
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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Al-Khersan H, Venincasa MJ, Kloosterboer A, Sridhar J, Smiddy WE, Townsend JH, Flynn HW. Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy. Clin Ophthalmol 2020; 14:1559-1563. [PMID: 32606570 PMCID: PMC7293964 DOI: 10.2147/opth.s252285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report visual acuity in patients undergoing pars plana vitrectomy (PPV) reoperations for complications of proliferative diabetic retinopathy (PDR). Design Retrospective case series. Subjects Diabetic patients undergoing reoperation with PPV between 2015 and 2018 at a university referral center. Methods Patient charts were reviewed for indication for initial and repeat PPV, baseline clinical characteristics including gender, age, and lens status, and pre- and post-operative best-corrected visual acuity. Main Outcome Measures Best-corrected visual acuity at last follow-up. Results Of 538 eyes (409 patients) undergoing a PPV for diabetic retinopathy, 153 (28.4%) eyes had reoperation. Among the 130 eyes (119 patients) that met the inclusion criteria, 55 eyes (50 patients) underwent reoperation for complications of PDR, defined as non-clearing vitreous hemorrhage (NCVH) and/or tractional retinal detachment (TRD). Within this subgroup of 55 eyes, 19 (34.5%) eyes had an indication for the first surgery of NCVH. Fourteen (73.7%) of these NCVH eyes achieved a visual acuity of 20/80 or better. When the indication for the first surgery was TRD (33 eyes, 60%), 8 (24.2%) eyes achieved this same outcome (p=0.0011). Conclusion Approximately one of every four eyes treated with PPV for PDR will undergo repeat PPV during follow-up. VA outcomes after the repeat PPV were variable, with NCVH cases achieving better outcomes compared to TRD.
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Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amy Kloosterboer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Al-Khersan H, Patel NA, Fan KC, Lazzarini TA, Yannuzzi NA, Fallas B, Negron C, Berrocal AM. Asymmetric retinopathy of prematurity in presumed fungal endophthalmitis. Am J Ophthalmol Case Rep 2020; 18:100722. [PMID: 32382688 PMCID: PMC7200213 DOI: 10.1016/j.ajoc.2020.100722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 10/27/2022] Open
Abstract
Purpose To report a case of asymmetric retinopathy of prematurity (ROP) in a neonate with endophthalmitis. Observations A 25-week old female was born by caesarean section due to preeclampsia. The patient required supplemental oxygen after birth. The neonatal period was complicated by sepsis secondary to necrotizing enterocolitis with intestinal perforation. The patient subsequently developed endophthalmitis in the right eye. A fungal ball was seen overlying the termination of a persistent hyaloid artery. The patient also had ROP, identified at 31 weeks postconceptional age, which progressed asymmetrically and demonstrated greater severity in the eye affected by endophthalmitis. The endophthalmitis resolved with intravitreal antifungal treatment and systemic therapy. The right eye was also treated with intravitreal bevacizumab, demonstrating regression of ROP severity on follow up. Conclusions and Importance The present case describes the first reported case of asymmetric ROP associated with endophthalmitis. The more severe ROP occurred in the eye with endophthalmitis suggesting that, outside of systemic factors, the local ocular inflammatory environment is important in determining the progression of ROP. Additionally, the fungal ball present in the eye affected by endophthalmitis was seen at the termination of the hyaloid artery, suggesting the hyaloid artery as the route of entry of the fungus into the vitreous.
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Al-Khersan H, Russell JF, Shi Y, Sridhar J, Gregori G, Flynn HW, Rosenfeld PJ. Wide field swept source OCT angiography of multifocal retinal and choroidal occlusions from embolic triamcinolone acetonide. Am J Ophthalmol Case Rep 2020; 18:100704. [PMID: 32322753 PMCID: PMC7170946 DOI: 10.1016/j.ajoc.2020.100704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/29/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose Multifocal retinal arterial occlusions and choroidal infarctions due to embolic triamcinolone acetonide (TA) administered during a septoplasty were imaged using swept source OCT angiography (SS-OCTA) to demonstrate the utility of this imaging modality for the diagnosis and longitudinal follow-up of retinal and choroidal vascular diseases. Observations A 37-year-old man presented with vision loss in his left eye upon awakening from a left-sided septoplasty during which TA was injected. Examination of the left eye demonstrated retinal whitening in the macula, white material in the distal lumen of retinal arterioles, and multifocal hypopigmented choroidal lesions. SS-OCTA imaging showed the absence of detectable flow in areas of retinal and choroidal whitening. Corresponding B-scans demonstrated hyperreflective material, thought to be embolic TA, within the retinal vessels and inner choroid. Conclusions Wide field SS-OCTA was sufficient for the diagnosis and longitudinal evaluation of retinal and choroidal occlusions without the need for dye-based angiography.
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Fan KC, Lin J, Yannuzzi NA, Al-Khersan H, Patel NA, Maestre-Mesa J, Zaidi M, Miller D, Flynn HW. In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone. J Ophthalmic Inflamm Infect 2020; 10:9. [PMID: 32103368 PMCID: PMC7044395 DOI: 10.1186/s12348-020-0200-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues. Methods Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin). Results Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL. Conclusion Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.
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Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - James Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jorge Maestre-Mesa
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mustafa Zaidi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Kalavar M, Al-Khersan H, Sridhar J, Gorniak RJ, Lakhani PC, Flanders AE, Kuriyan AE. Applications of Artificial Intelligence for the Detection, Management, and Treatment of Diabetic Retinopathy. Int Ophthalmol Clin 2020; 60:127-145. [PMID: 33093322 PMCID: PMC8514105 DOI: 10.1097/iio.0000000000000333] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rates of diabetic retinopathy (DR) and diabetic macular edema (DME), a common ocular complication of diabetes mellitus, are increasing worldwide. There is a substantial burden concerning the detection and management of this condition, particularly in low-resource settings, due to limitations such as the time, cost, and labor associated with current screening and treatment methods. Artificial intelligence (AI) is a modality of pattern recognition that has the potential to combat these limitations in a reliable and cost-effective way. This review explores the various applications of AI on the screening, management, and treatment of DR and DME. AI applications for detecting referable DR and DME have been the most thoroughly researched applications for this condition. While some studies exist using AI to stratify DR patients based on the risk of progression, predict treatment outcomes to anti-VEGF therapy, and explore the utilization of AI for clinical trials to develop new treatments for DR, further validation studies on larger datasets are warranted.
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Affiliation(s)
- Meghana Kalavar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | - Paras C. Lakhani
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Adam E. Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Ajay E. Kuriyan
- Mid Atlantic Retina, Philadelphia, PA
- The Retina Service, Wills Eye Hospital, Philadelphia, PA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Bae JH, Al-Khersan H, Yannuzzi NA, Hasanreisoglu M, Androudi S, Albini TA, Nguyen QD. Surgical Therapy for Macular Edema: What We Have Learned through the Decades. Ocul Immunol Inflamm 2019; 27:1242-1250. [PMID: 31647684 DOI: 10.1080/09273948.2019.1672194] [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: 10/25/2022]
Abstract
Macular edema is a leading cause of functional visual loss in retinal vascular or ocular inflammatory diseases. Because persistent macular edema can lead to irreversible retinal damage, multi-approached treatment should be considered to achieve complete resolution of macular edema. With an enhanced understanding of its pathophysiology, numerous therapeutic options have been developed for the management of macular edema over the decades. Although medical therapies account for the mainstay of treatment, surgical approaches with vitrectomy can play an important role in the management of macular edema, depending on its mechanism of fluid accumulation. The index review focuses on the efficacy of surgical therapy for macular edema secondary to various ocular diseases including diabetic retinopathy, uveitis, and retinal vein occlusion, and consequently provides the evidences that may expand the knowledge and support the employment of surgical options.
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Affiliation(s)
- Jeong Hun Bae
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Murat Hasanreisoglu
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Volos, Greece
| | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
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