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Eng KT, Grewal PS, Hostovsky A, Rai AS, Batawi H, Alali A, Kertes PJ, Rolnitsky A. Survival and characteristics of retinopathy of prematurity in micro-premature infants. Can J Ophthalmol 2023:S0008-4182(23)00381-2. [PMID: 38142714 DOI: 10.1016/j.jcjo.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/23/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To describe the risk and nature of retinopathy of prematurity (ROP) in micro-premature infants (≤26 weeks' gestational age [GA]). METHODS Retrospective analysis of prospectively collected data from infants born at 22-26 weeks' GA over a 5-year period. RESULTS A total of 502 infants were identified, of whom 414 survived to discharge (82.5%). The Vermont Oxford Network database documented clinical follow-up data and ROP outcomes for all 414 patients; complete ROP clinical records were available for 294 of the infants who survived (70.8%). Forty infants were born between 22 and 23 weeks' GA (group A, 13.6%), and 254 were born between 24 and 26 weeks' GA (group B, 86.4%). Survival for group A infants was worse than that of group B infants (66.2% vs 85.4%; p < 0.01). Survival of group A infants improved during the study period (R2 = 0.625). Overall, 59.9% of infants developed any ROP and 8.5% developed type 1 ROP. Group A infants were more likely to develop ROP (90.0% vs 48.6%; p < 0.01) and type 1 ROP (30.0% vs 5.1%; p < 0.01) than group B infants. Group A infants developed ROP at an earlier age (32 + 6 weeks vs 33 + 3 weeks; p = 0.02) and were more likely to have zone I disease on presentation (65.0% vs 20.5%; p < 0.01), but there was no difference in the corrected gestational age of peak severity of ROP (35 + 2 weeks vs 34 + 5 weeks; p = 0.36). CONCLUSION The most premature infants, born at 22-23 weeks' GA, develop ROP at an earlier age, are more likely to present with posterior disease, and have a high risk of disease requiring treatment.
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Affiliation(s)
- Kenneth T Eng
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
| | - Parampal S Grewal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Avner Hostovsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Amrit S Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Hatim Batawi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Alaa Alali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Asaph Rolnitsky
- Neonatal-Perinatal Medicine, Department of Paediatrics, University of Toronto, Toronto, ON
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Jhaveri A, Martins Melo I, Pecaku A, Zajner C, Naidu S, Batawi H, Muni RH. Outer Retinal Hyperreflective Dots: A Potential Imaging Biomarker in Rhegmatogenous Retinal Detachment. Ophthalmol Retina 2023; 7:1087-1096. [PMID: 37481035 DOI: 10.1016/j.oret.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To investigate hyperreflective dots (HRDs) on baseline OCT in rhegmatogenous retinal detachment (RRD). DESIGN Retrospective cohort study. SUBJECTS Consecutive primary fovea-off RRDs presenting between January 2012 and September 2022. METHODS Visual acuity (VA) was obtained at baseline, 3, 6, and 12 months. Baseline foveal OCT scans were graded for the presence of HRDs in the outer retina, morphologic stage of RRD in the parafovea, and foveal photoreceptor integrity (intact, patchy or complete loss of the bacillary layer). Epiretinal membrane (ERM) and cystoid macular edema (CME) were graded after surgery. MAIN OUTCOME MEASURES The primary outcome was the proportion of patients in each morphologic stage with HRDs present on OCT and their association with postoperative VA. Secondary outcomes included association with the height of foveal detachment, duration of central vision loss, RRD extent, and development of ERM/CME. RESULTS A total of 351 patients were included. The presence of HRDs by morphologic stage of RRD was 0% in stage 1, 4.5% (2/42) in stage 2, 13% (7/54) in stage 3a, 16% (20/126) in stage 3b, 48% (40/83) in stage 4, and 85% (35/41) in stage 5. Hyperreflective dots were associated with increasing stage of RRD (P < 0.001), reduced integrity of foveal photoreceptors (P < 0.001), and reduced postoperative VA at 3, 6, and 12 months (P < 0.001), after excluding visually significant cataracts and adjusting for covariates. There was also a significant association between HRDs and height of foveal detachment, duration of central vision loss, and RRD extent (P < 0.001). Hyperreflective dots were neither associated with postoperative ERM formation nor with its severity (P = 0.27). Nevertheless, they were associated with the occurrence of CME at 3 and 6 months after surgery (P = 0.01; P = 0.006). CONCLUSIONS Hyperreflective dots have been hypothesized to consist of intraretinal inflammatory cells. We found that HRDs were significantly associated with the morphologic stage, extent, duration, and height of the RRD before surgery and with reduced VA and CME after surgery. Our results suggest that HRDs are associated with photoreceptor degeneration, as longstanding and extensive RRDs are more likely to present with HRDs. The association of HRDs with CME provides insight into the possible importance of inflammatory processes in RRD before and after surgery. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Aaditeya Jhaveri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aurora Pecaku
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Sumana Naidu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Hatim Batawi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute, Toronto, Ontario, Canada.
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3
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Muni RH, Melo IM, Pecaku A, Mannina A, Batawi H, Bansal A. In-Office Suprachoroidal Viscopexy for Rhegmatogenous Retinal Detachment Repair. JAMA Ophthalmol 2023; 141:933-936. [PMID: 37615957 PMCID: PMC10587788 DOI: 10.1001/jamaophthalmol.2023.3785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023]
Abstract
Importance In-office suprachoroidal viscopexy (SCVEXY) is a minimally invasive technique for rhegmatogenous retinal detachment (RRD) repair that can be performed with no incision, no tamponade agent, and no positioning requirements. This technique has the potential to be a step forward in the armamentarium to treat RRDs. Objective To describe in-office SCVEXY for RRD repair. Design, Setting, and Participant In this single-case report with short follow-up, a man in his 50s with pseudophakia and recent visual loss presented to St Michael's Hospital, Unity Health Toronto, with a fovea-off RRD in the right eye, extending from 6 to 10 o'clock, with no visible causative retinal break. Exposure Injection of suprachoroidal sodium hyaluronate, 1%, in the region of the suspected break, using a 30-gauge needle with a custom-made guard that exposed only 1 mm of the needle. Main Outcome and Measures Ability to perform in-office SCVEXY and to obtain a visible choroidal indentation. Results After the procedure, a dome-shaped choroidal convexity was present in the superior temporal area. The patient achieved macular reattachment in less than 24 hours with no postoperative abnormalities, such as outer retinal folds, residual subfoveal fluid, or retinal displacement, with rapid recovery of the outer retinal bands on optical coherence tomography. The optical coherence tomography scans acquired in the area of the choroidal convexity demonstrated the location of the viscoelastic material in the suprachoroidal space. Laser retinopexy was applied in the suspected region of the retinal tear, and the patient was able to resume normal activity immediately after the procedure with no restrictions. Conclusions and Relevance Suprachoroidal viscopexy is feasible as an in-office technique to create a temporary choroidal buckle for RRD repair. It is a minimally invasive procedure with the potential to maximize anatomical outcomes of integrity and postoperative functional outcomes in RRD because its mechanism of action does not require drainage of subretinal fluid or intraocular gas tamponade. Nevertheless, this was a single-case report with short follow-up, which limits the ability to determine the procedure's benefits, potential adverse events, failure rates, and best-case selection. Further work is required to refine the procedure and assess its efficacy and safety.
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Affiliation(s)
- Rajeev H. Muni
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Institute, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aurora Pecaku
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Amar Mannina
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Hatim Batawi
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Bansal
- Department of Ophthalmology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Alshaker S, Mimouni M, Batawi H, Cohen E, Trinh T, Santaella G, Chan CC, Slomovic AR, Rootman DS, Sorkin N. Four-Year Survival Comparison of Endothelial Keratoplasty Techniques in Patients With Previous Glaucoma Surgery. Cornea 2021; 40:1282-1289. [PMID: 33332901 DOI: 10.1097/ico.0000000000002585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare 4-year survival outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma surgery. METHODS This is a retrospective, comparative case series, including patients with previous trabeculectomy or glaucoma drainage device implantation, who later underwent either DMEK (n = 48) or DSAEK (n = 41). Follow-up was limited to 12 to 60 months to prevent bias. Primary outcomes were graft survival and rejection. Secondary outcomes were best spectacle-corrected visual acuity (BSCVA), detachment/rebubble, endothelial cell loss, and intraocular pressure elevations. RESULTS Baseline characteristics, follow-up duration, and preexisting glaucoma parameters did not differ significantly between the groups. Graft survival probability after DMEK and DSAEK was 75% and 75% at 1 year, 63% and 50% at 2 years, 49% and 44% at 3 years, 28% and 33% at 4 years, and 28% and 29% at 5 years, respectively (P = 0.899 between the groups). Graft rejection rates were 20.8% and 19.5%, respectively (P = 1.000). Primary failure, rebubbling, endothelial cell loss, and intraocular pressure elevation did not differ significantly between the groups. Preoperative BSCVA did not differ between the groups (P = 0.821). Postoperative BSCVA was significantly better in the DMEK group at 6, 12, and 24 months (P < 0.001, P = 0.022, and P = 0.047, respectively). In a multivariable model (R2 = 0.576), the type of surgery was the only significant factor affecting postoperative BSCVA, in favor of DMEK (coefficient value -0.518, P = 0.002). CONCLUSIONS In eyes with previous glaucoma surgery, DMEK and DSAEK had comparably low survival and comparably high rejection rates. Postoperative visual acuity might be better after DMEK in this setting.
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Affiliation(s)
| | | | | | - Eyal Cohen
- University of Toronto, Toronto, Canada; and
| | | | | | | | | | | | - Nir Sorkin
- University of Toronto, Toronto, Canada; and
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Felfeli T, Batawi H, Aldrees S, Hatch W, Mandelcorn ED. Utility of patient face masks to limit droplet spread from simulated coughs at the slit lamp. Can J Ophthalmol 2020; 55:e163-e165. [PMID: 32730746 PMCID: PMC7384778 DOI: 10.1016/j.jcjo.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Hatim Batawi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Sultan Aldrees
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont..
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Abstract
A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie's tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.
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Affiliation(s)
- Hatim Batawi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada .,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
The combination of a sixth nerve palsy and ipsilateral Horner's syndrome localises the disease process to the posterior cavernous sinus and can be a result of various pathologies in this region. A 74-year-old Chinese woman presented with a 9-month history of binocular horizontal diplopia worse when looking left. She was found to have a left sixth nerve palsy and Horner's syndrome and MRI revealed an enhancing soft tissue mass in the nasopharynx with involvement of the bones of the skull base and invasion of the left cavernous sinus. Endoscopic biopsy of the mass confirmed the diagnosis of non-keratinising squamous cell carcinoma, which was Epstein-Barr virus positive. She was treated with radiation therapy. Patients with a sixth nerve palsy and ipsilateral Horner's syndrome should have urgent neuroimaging with careful attention to the cavernous sinus since sympathetic fibres join the sixth nerve for a short distance in this location.
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Affiliation(s)
- Hatim Batawi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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8
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Karanam VC, Tamariz L, Batawi H, Wang J, Galor A. Functional slit lamp biomicroscopy metrics correlate with cardiovascular risk. Ocul Surf 2018; 17:64-69. [PMID: 30253248 DOI: 10.1016/j.jtos.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Our aim was to correlate cardiovascular risk factor estimation with bulbar conjunctival blood flow metrics as measured through Functional Slit Lamp Biomicroscopy (FSLB). METHODS Cross-sectional study of individuals with otherwise healthy eyelid and corneal anatomy recruited from the Miami Veterans Affairs (VA) Healthcare System eye clinic. We measured conjunctival microvascular hemodynamics by mounting a camera on a slit lamp and cardiovascular risk using the Framingham risk score. Our main outcome measures were correlations between conjunctival vessel parameters (axial and cross-sectional blood flow velocity, blood flow rate) and Framingham score. RESULTS We included 84 patients who underwent FSLB. The mean age was 60 years, the majority were male (88%) and approximately half the patients were black (54%). Mean vessel diameter was similar between all Framingham score categories. Axial and cross-sectional blood flow velocities and blood flow rate were lower in individuals with higher Framingham risk score. Specifically, mean cross-sectional blood flow velocity in individuals with a low Framingham risk score was 0.37 ± 0.0.9 mm/s, with an intermediate score was 0.30 ± 0.09 mm/s, and with a high score was 0.29 ± 0.10 mm/s, p = 0.04. Mean blood flow rate in individuals with a low Framingham risk score was 133.4 ± 59.6 pl/s, with an intermediate score was 123.6 ± 39.3 pl/s, and with a high score was 121.9 ± 52.6 pl/s, p = 0.04. The beta coefficient of the blood flow rate for change in Framingham score was -0.73; 95% CI-1.34-0.13, p = 0.02, adjusted for race. CONCLUSION FSLB correlates with cardiovascular risk estimation. Future studies should evaluate if FSLB can predict cardiovascular outcomes.
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Affiliation(s)
| | - Leonardo Tamariz
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Division of Population Health and Computational Medicine, USA
| | - Hatim Batawi
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Anat Galor
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA.
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9
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Shaikhomer M, Gelaidan A, Batawi H, Snow K, Payson A, Chin-Beckford N, Espinoza L. Prevalence and Reasons of Antiretroviral Therapy Switch Among HIV Patients in a large Urban Center. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1217] [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: 11/13/2022] Open
Affiliation(s)
- Mohammed Shaikhomer
- Infectious Disease, University of Miami-Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
- Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhadi Gelaidan
- Public Health, Miller School of Medicine, University of Miami, Miami, FL
- Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | | | | | | | - Luis Espinoza
- Medicine, University of Miami School of Medicine, Miami, FL
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10
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Lanza NL, McClellan AL, Batawi H, Felix ER, Sarantopoulos KD, Levitt RC, Galor A. Dry Eye Profiles in Patients with a Positive Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test Versus Negative Patients. Ocul Surf 2016; 14:216-23. [PMID: 26807724 DOI: 10.1016/j.jtos.2015.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 09/27/2015] [Revised: 12/26/2015] [Accepted: 12/27/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare dry eye (DE) symptoms and signs in subjects who tested positive versus those who tested negative for ocular surface matrix metalloproteinase 9 (MMP-9) using the InflammaDry point-of-care test (RPS, Sarasota, FL). METHODS In this cross-sectional study, individuals seen in the Miami Veterans Affairs eye clinic with DE symptoms, as evidenced by DE questionnaire 5 (DEQ5) ≥6, were given standardized questionnaires to assess DE symptoms and ocular and non-ocular pain complaints. Also, a complete evaluation was conducted to measure ocular surface signs of DE. MMP-9 testing was performed using the InflammaDry once in each eye, per the manufacturer's instructions. The main outcome measure was a comparison of DE symptoms and signs in MMP-9 positive versus negative subjects. RESULTS Of 128 subjects, 50 (39%) were positive for MMP-9 for InflammaDry testing in either eye. No statistically significant differences in mental health indices, DE symptoms, or ocular surface signs were seen in subjects based on MMP-9 status. CONCLUSION In our population, there was no difference in the DE profile by both symptoms and signs between those testing positive versus negative for MMP-9 on the ocular surface. This suggests that clinical exam alone cannot predict patients with clinically significant inflammation.
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Affiliation(s)
- Nicole L Lanza
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | | | - Hatim Batawi
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, Miami, FL, USA; Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Konstantinos D Sarantopoulos
- Miami Veterans Administration Medical Center, Miami, FL, USA; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roy C Levitt
- Miami Veterans Administration Medical Center, Miami, FL, USA; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
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Abstract
<b><i>Purpose:</i></b> We report the case of a 77-year-old man with no history of keratoconus or other ectatic disorders who presented with corneal hydrops in the setting of a corneal ulcer. The risk factors, pathogenesis and treatment options of corneal hydrops are discussed. <b><i>Method:</i></b> This is an observational case report study. <b><i>Results:</i></b> A 77-year-old man presented with a 1-day history of severe pain, redness, mucous discharge and photophobia in the right eye. A slit-lamp examination of the right eye showed an area of focal corneal edema and protrusion. Within the area of edema and protrusion, there was an infiltrate with an overlying epithelial defect consistent with an infectious corneal ulcer. The Seidel test showed no leakage, so a clinical diagnosis of corneal hydrops associated with nonperforated corneal ulcer was made. With appropriate antibiotic treatment, the corneal ulcer and hydrops both resolved over a 1-month period. <b><i>Conclusion:</i></b> Corneal hydrops can occur in the setting of corneal infections.
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Affiliation(s)
- Hatim Batawi
- Miami Veterans Administration Medical Center, Miami, Fla., USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
- King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Nikisha Kothari
- Miami Veterans Administration Medical Center, Miami, Fla., USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Andrew Camp
- Miami Veterans Administration Medical Center, Miami, Fla., USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Luis Bernhard
- Miami Veterans Administration Medical Center, Miami, Fla., USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, Fla., USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Fla., USA
- *Anat Galor, MD, MSPH, 1201 NW 16th Street, Miami, FL 33125 (USA), E-Mail
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12
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Galor A, Batawi H, Felix ER, Margolis TP, Sarantopoulos KD, Martin ER, Levitt RC. Incomplete response to artificial tears is associated with features of neuropathic ocular pain. Br J Ophthalmol 2015; 100:745-9. [PMID: 26377416 DOI: 10.1136/bjophthalmol-2015-307094] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/30/2015] [Indexed: 11/04/2022]
Abstract
AIMS Artificial tears are first-line therapy for patients with dry eye symptoms. It is not known, however, which patient factors associate with a positive response to therapy. The purpose of this study was to evaluate whether certain ocular and systemic findings are associated with a differential subjective response to artificial tears. METHODS Cross-sectional study of 118 individuals reporting artificial tears use (hypromellose 0.4%) to treat dry eye-associated ocular pain. An evaluation was performed to assess dry eye symptoms (via the dry eye questionnaire 5 and ocular surface disease index), ocular and systemic (non-ocular) pain complaints and ocular signs (tear osmolarity, tear breakup time, corneal staining, Schirmer testing with anaesthesia, and eyelid and meibomian gland assessment). The main outcome measures were factors associated with differential subjective response to artificial tears. RESULTS By self-report, 23 patients reported no improvement, 73 partial improvement and 22 complete improvement in ocular pain with artificial tears. Patients who reported no or partial improvement in pain with artificial tears reported higher levels of hot-burning ocular pain and sensitivity to wind compared with those with complete improvement. Patients were also asked to rate the intensity of systemic pain elsewhere in the body (other than the eye). Patients who reported no or incomplete improvement with artificial tears had higher systemic pain scores compared with those with complete improvement. CONCLUSIONS Both ocular and systemic (non-ocular) pain complaints are associated with a differential subjective response to artificial tears.
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Affiliation(s)
- Anat Galor
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Hatim Batawi
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Elizabeth R Felix
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Todd P Margolis
- Departement of Ophthalmology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Konstantinos D Sarantopoulos
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eden R Martin
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roy C Levitt
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
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