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Saraf SS, Leveque TK, Kim JB, Nash RW, Pepple KL, Olmos de Koo LC. IDIOPATHIC PENETRATION OF CILIA INTO THE POSTERIOR SEGMENT PRESENTING AS SECTORAL SCLERITIS WITH PROGRESSIVE INTRAOCULAR INFLAMMATION. Retin Cases Brief Rep 2022; 16:452-456. [PMID: 32459699 PMCID: PMC9213081 DOI: 10.1097/icb.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of idiopathic intraocular cilia presenting as sectoral scleritis with progressive intraocular inflammation. METHODS Both patients were treated with intravitreal antibiotics and underwent pars plana vitrectomy where the cilia were removed and identified on histopathology. RESULTS One patient developed a retinal detachment while being treated for presumed endophthalmitis. The intraocular cilium was discovered during pars plana vitrectomy. In the second case, the cilium was detected on dilated fundus exam and was believed to be the cause of the patient's scleritis and vitritis. Therapeutic vitrectomy was performed. In both cases, the cilia were positively identified on histopathology. CONCLUSION Idiopathic intraocular penetration of cilia should be considered in the differential diagnosis of sectoral scleritis with progressive intraocular inflammation.
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Affiliation(s)
- Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | - Thellea K. Leveque
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | - Joon-Bom Kim
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
| | | | - Kathryn L. Pepple
- Department of Ophthalmology, University of Washington, Seattle, Washington; and
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Breazzano MP, Nair AA, Arevalo JF, Barakat MR, Berrocal AM, Chang JS, Chen A, Eliott D, Garg SJ, Ghadiali Q, Gong D, Grewal DS, Handa JT, Henderson M, Leiderman YI, Leng T, Mannina A, Mendel TA, Mustafi D, de Koo LCO, Patel SN, Patel TP, Prenner J, Richards P, Singh RP, Wykoff CC, Yannuzzi NA, Yu H, Modi YS, Chang S. Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States During the COVID-19 Pandemic. JAMA Ophthalmol 2021; 139:456-463. [PMID: 33662093 DOI: 10.1001/jamaophthalmol.2021.0036] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.
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Affiliation(s)
- Mark P Breazzano
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York.,NYU Langone Eye Center, New York University, New York.,Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine, Madison
| | - Andrew Chen
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dean Eliott
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Sunir J Garg
- Wills Eye Hospital, Mid-Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Quraish Ghadiali
- Department of Surgery, Cook County Health, Chicago, Illinois.,Retina Consultants Ltd, Chicago, Illinois
| | - Dan Gong
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Henderson
- NJRetina, Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Theodore Leng
- Byers Eye Institute of Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Amar Mannina
- Department of Surgery, Cook County Health, Chicago, Illinois
| | | | - Debarshi Mustafi
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Shriji N Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tapan P Patel
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Prenner
- NJRetina, Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paige Richards
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison School of Medicine, Madison
| | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida
| | - Hannah Yu
- Retina Consultants of Houston, Houston, Texas
| | - Yasha S Modi
- NYU Langone Eye Center, New York University, New York
| | - Stanley Chang
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York
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Dai Y, Zhou H, Zhang Q, Chu Z, Olmos de Koo LC, Chao JR, Rezaei KA, Saraf SS, Wang RK. Quantitative assessment of choriocapillaris flow deficits in diabetic retinopathy: A swept-source optical coherence tomography angiography study. PLoS One 2020; 15:e0243830. [PMID: 33306736 PMCID: PMC7732066 DOI: 10.1371/journal.pone.0243830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To quantitatively assess choriocapillaris (CC) flow deficits in eyes with diabetic retinopathy (DR) using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic subjects with different stages of DR and age-matched healthy subjects were recruited and imaged with SS-OCTA. The en face CC blood flow images were generated using previously published and validated algorithms. The percentage of CC flow deficits (FD%) and the mean CC flow deficit size were calculated in a 5-mm-diameter circle centered on the fovea from the 6×6-mm scans. Results Forty-five diabetic subjects and 27 control subjects were included in the study. The CC FD% in diabetic eyes was on average 1.4-fold greater than in control eyes (12.34±4.14% vs 8.82±2.61%, P < 0.001). The mean CC FD size in diabetic eyes was on average 1.4-fold larger than in control eyes (2151.3± 650.8μm2 vs 1574.4±255.0 μm2, P < 0.001). No significant difference in CC FD% or mean CC FD size was observed between eyes with nonproliferative DR and eyes with proliferative DR (P = 1.000 and P = 1.000, respectively). Conclusions CC perfusion in DR can be objectively and quantitatively assessed with FD% and FD size. In the macular region, both CC FD% and CC FD size are increased in eyes with DR. SS-OCTA provides new insights for the investigations of CC perfusion status in diabetes in vivo.
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Affiliation(s)
- Yining Dai
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Lisa C. Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Jennifer R. Chao
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Kasra A. Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Huang LC, Kelly JP, Cabrera MT, Olmos de Koo LC, Weiss AH, Herlihy EP. Optical coherence tomography findings in Cohen syndrome. J AAPOS 2020; 24:306-309. [PMID: 32919079 DOI: 10.1016/j.jaapos.2020.07.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Cohen syndrome is a rare disease that causes myopia and retinal degeneration in the setting of developmental delay and characteristic craniofacial features. We report optical coherence tomography (OCT) abnormalities in 4 patients with Cohen syndrome, 2 of whom have longitudinal follow-up. All subjects had schisis-like changes, with cystoid spaces in the inner retina as well as diffuse outer retinal atrophy sparing the subfoveal region. Ophthalmologic findings in 1 patient led to the work-up that resulted in a diagnosis of Cohen syndrome, suggesting that characteristic retinal abnormalities visualized by fundus examination and OCT may represent distinguishing features of this syndrome.
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Affiliation(s)
- Laura C Huang
- Department of Ophthalmology, University of Washington, Seattle, Washington; Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - John P Kelly
- Department of Ophthalmology, University of Washington, Seattle, Washington; Roger H. Johnson Vision Clinic, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle, Washington; Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | | | - Avery H Weiss
- Department of Ophthalmology, University of Washington, Seattle, Washington; Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Erin P Herlihy
- Department of Ophthalmology, University of Washington, Seattle, Washington; Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, Washington.
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Lee CS, Hong B, Kasi SK, Aderman C, Talcott KE, Adam MK, Yue B, Akileswaran L, Nakamichi K, Wu Y, Rezaei KA, Olmos de Koo LC, Chee YE, Lee AY, Garg SJ, Van Gelder RN. Prognostic Utility of Whole-Genome Sequencing and Polymerase Chain Reaction Tests of Ocular Fluids in Postprocedural Endophthalmitis. Am J Ophthalmol 2020; 217:325-334. [PMID: 32217118 DOI: 10.1016/j.ajo.2020.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/12/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To associate detection of potential pathogen DNA in endophthalmitis with clinical outcomes. DESIGN Prospective cohort study. METHODS Patients in whom endophthalmitis was diagnosed following an intraocular procedure were recruited. Clinical outcome data from baseline, week-1, month-1, and month-3 visits were collected. Intraocular biopsy samples were cultured by standard methods. Quantitative polymerase chain reaction (qPCR) was performed for specific pathogens and whole-genome sequencing (WGS). RESULTS A total of 50 patients (mean age 72 years old; 52% male) were enrolled. Twenty-four cases were culture-positive and 26 were culture-negative. WGS identified the cultured organism in 76% of culture-positive cases and identified potential pathogens in 33% of culture-negative cases. Month-1 and -3 visual acuities did not vary by pathogen-positive versus pathogen-negative cases as detected by either culture or WGS. Visual outcomes of Staphylococcus epidermidis endophthalmitis were no different than those of pathogen-negative cases, whereas the patients infected with other pathogens showed worse outcome. Higher baseline bacterial DNA loads of bacteria other than those of S epidermidis detected by WGS were associated with worse month-1 and -3 visual acuity, whereas the S epidermidis loads did not appear to influence outcomes. Torque teno virus (TTV) and Merkel cell polyomavirus (MCV) were detected by qPCR in 49% and 19% of cases, respectively. Presence of TTV at presentation was associated with a higher rate of secondary pars plana vitrectomy (P = .009) and retinal detachment (P = .022). CONCLUSIONS The presence and higher load of bacteria other than S epidermidis detected by WGS or DNA from TTV by qPCR in ocular fluids is associated with worse outcomes in post-procedure endophthalmitis.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
| | - Bryan Hong
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sundeep K Kasi
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher Aderman
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Katherine E Talcott
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murtaza K Adam
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bryan Yue
- University of Washington, Seattle, Washington, USA
| | - Lakshmi Akileswaran
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Kenji Nakamichi
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Yewlin E Chee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Sunir J Garg
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA; Departments of Biological Structure and Pathology, University of Washington, Seattle, Washington, USA
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Abstract
The most common microvascular complication of diabetes is diabetic retinopathy, the leading cause of blindness in adults of working age. Our understanding of the vascular changes in diabetic retinopathy was enhanced by the demonstration of fluorescein angiography (FA) in the human retina for the first time in 1961. It was subsequently integrated with digital fundoscopic imaging to become an invaluable technique in evaluation of the retinal vasculature. The recent development of OCT-angiography (OCT-A) has revolutionized the clinician's ability to examine the retinal vasculature without the need for injection of a contrast dye. By coupling OCT, which can provide noninvasive cross-sectional imaging of the central retina, with angiography in OCT-A, one can reveal retinal perfusion by allowing visualization of the depth-resolved retinal capillary plexus. OCT-A has allowed for more precise delineation of changes in the retinal microvasculature, specifically the alterations of retinal vasculature and loss of capillary perfusion from chronic microvascular occlusion in diabetic retinopathy.
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Affiliation(s)
- Debarshi Mustafi
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Steven S Saraf
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Qing Shang
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA.
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Rizzo S, Barale PO, Ayello-Scheer S, Devenyi RG, Delyfer MN, Korobelnik JF, Rachitskaya A, Yuan A, Jayasundera KT, Zacks DN, Handa JT, Montezuma SR, Koozekanani D, Stanga PE, da Cruz L, Walter P, Augustin AJ, Chizzolini M, Olmos de Koo LC, Ho AC, Kirchhof B, Hahn P, Vajzovic L, Iezzi R, Gaucher D, Arevalo JF, Gregori NZ, Grisanti S, Özmert E, Yoon YH, Kokame GT, Lim JI, Szurman P, de Juan E, Rezende FA, Salzmann J, Richard G, Huang SS, Merlini F, Patel U, Cruz C, Greenberg RJ, Justus S, Cinelli L, Humayun MS. ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS: Incidence, Causes, and Best Practices for Managing and Preventing Conjunctival Erosion. Retina 2020; 40:303-311. [PMID: 31972801 DOI: 10.1097/iae.0000000000002394] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.
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Affiliation(s)
- Stanislao Rizzo
- Azienda Ospedaliera Universitaria Careggi, Department of Medicine and Translational Surgery, University of Florence, Florence, Italy
| | - Pierre-Olivier Barale
- Sorbonne University, UPMC Univ Paris 06, INSERM U968, CNRS UMR 7210, Institute of Vision, Paris, France
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Sarah Ayello-Scheer
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Robert G Devenyi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marie-Noëlle Delyfer
- Inserm, Bordeaux Population Health Research Center, Team LEHA, University of Bordeaux, Bordeaux, France
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-François Korobelnik
- Inserm, Bordeaux Population Health Research Center, Team LEHA, University of Bordeaux, Bordeaux, France
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | | | - Alex Yuan
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - David N Zacks
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - James T Handa
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Dara Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Paulo E Stanga
- Manchester Vision Regeneration (MVR) Lab, Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lyndon da Cruz
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Albert J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Marzio Chizzolini
- Unità Operativa Complessa di Oculistica, Camposampiero-Cittadella (Padova), Padua, Italy
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, UW Medicine Eye Institute, University of Washington, Seattle, Washington
| | - Allen C Ho
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, Pennsylvania
| | - Bernd Kirchhof
- Department of Retina and Vitreous Surgery, Center of Ophthalmology, University of Cologne, Cologne, Germany
| | - Paul Hahn
- New Jersey Retina, Teaneck, New Jersey
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, Minnesota
| | - David Gaucher
- Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
- Laboratory of Bacteriology (EA- 7290), The Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
| | - J Fernando Arevalo
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ninel Z Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Luebeck, UKSH Luebeck, Germany
| | - Emin Özmert
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Peter Szurman
- Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | | | - Flavio A Rezende
- Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada
| | - Joël Salzmann
- Department of Ophthalmology, Clinique Générale-Beaulieu, Geneva, Switzerland
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Uday Patel
- Second Sight Medical Products, Inc, Sylmar, California
| | - Cynthia Cruz
- Second Sight Medical Products, Inc, Sylmar, California
| | | | | | - Laura Cinelli
- Azienda Ospedaliera Universitaria Careggi, Department of Medicine and Translational Surgery, University of Florence, Florence, Italy
| | - Mark S Humayun
- USC Institute for Biomedical Therapeutics, USC Roski Eye Institute, University of Southern California, Los Angeles, California; and
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Rizzo S, Barale PO, Ayello-Scheer S, Devenyi RG, Delyfer MN, Korobelnik JF, Rachitskaya A, Yuan A, Jayasundera KT, Zacks DN, Handa JT, Montezuma SR, Koozekanani D, Stanga P, da Cruz L, Walter P, Augustin AJ, Olmos de Koo LC, Ho AC, Kirchhof B, Hahn P, Vajzovic L, Iezzi R, Gaucher D, Arevalo JF, Gregori NZ, Wiedemann P, Özmert E, Lim JI, Rezende FA, Huang SS, Merlini F, Patel U, Greenberg RJ, Justus S, Bacherini D, Cinelli L, Humayun MS. Hypotony and the Argus II retinal prosthesis: causes, prevention and management. Br J Ophthalmol 2019; 104:518-523. [DOI: 10.1136/bjophthalmol-2019-314135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/15/2023]
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9
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Storey PP, Aziz HA, O'Keefe GAD, Borchert M, Lam LA, Puliafito CA, Olmos de Koo LC. Decreased severity of age-related macular degeneration in amblyopic eyes. Br J Ophthalmol 2018; 102:1575-1578. [PMID: 29437581 DOI: 10.1136/bjophthalmol-2017-311671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/04/2022]
Abstract
AIM To evaluate whether people with age-related macular degeneration (AMD) and a history of amblyopia have equal severity of AMD in both eyes. METHODS Billing records were used to locate all people with a history of amblyopia and AMD evaluated between 1 January 2003 and 1 June 2015 at a single ophthalmology institute. Two ophthalmic graders blinded to amblyopia status determined the severity of AMD in each eye using fundus photos and a validated grading scale. RESULTS A total of 14 people were found to have AMD and a documented history of amblyopia. Average patient age was 77.0 years and average best corrected visual acuity was 20/160 in eyes with a history of amblyopia and 20/40 in fellow eyes without amblyopia. Eyes with a history of amblyopia were found to have a lower AMD severity score (mean lower score: -1.38; paired t-test P=0.019). Of the 11 people with asymmetric disease severity, 10 individuals had worse AMD in the non-amblyopic eye while one person had worse AMD in the amblyopic eye (P=0.0067). CONCLUSIONS Our pilot study suggests that eyes with a history of amblyopia may manifest decreased severity of AMD compared with non-ambylopic eyes in the same patient. Further research is warranted to investigate this clinical observation.
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Affiliation(s)
- Philip P Storey
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA
| | - Hassan A Aziz
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA
| | | | - Mark Borchert
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA.,Department of Ophthalmology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Linda A Lam
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA
| | - Carmen A Puliafito
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA
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Do JL, Olmos de Koo LC, Ameri H. Atypical chronic central serous chorioretinopathy with cystoid macular edema: Therapeutic response to medical and laser therapy. J Curr Ophthalmol 2017. [PMID: 28626824 PMCID: PMC5463008 DOI: 10.1016/j.joco.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose To describe an atypical case of chronic central serous chorioretinopathy (CSCR). Methods A 58-year-old man with longstanding, bilateral visual impairment was self-referred for a second opinion. Results Findings by direct ophthalmoscopy, optical coherence tomography, fluorescein angiography, and fundus autofluorescence (FAF) were suggestive of atypical, chronic CSCR. Treatment with oral anti-mineralocorticoids resulted in moderate improvement, and photodynamic therapy (PDT) had minimal effect. Conclusion Chronic CSCR may lack cardinal features of CSCR. Once retinal degenerative changes ensue, current treatments may not be effective in improving anatomical and visual outcomes in patients with chronic CSCR.
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Affiliation(s)
- Jiun L Do
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Lisa C Olmos de Koo
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Hossein Ameri
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Koulisis N, Kim AY, Chu Z, Shahidzadeh A, Burkemper B, Olmos de Koo LC, Moshfeghi AA, Ameri H, Puliafito CA, Isozaki VL, Wang RK, Kashani AH. Quantitative microvascular analysis of retinal venous occlusions by spectral domain optical coherence tomography angiography. PLoS One 2017; 12:e0176404. [PMID: 28437483 PMCID: PMC5402954 DOI: 10.1371/journal.pone.0176404] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/09/2017] [Indexed: 01/05/2023] Open
Abstract
Purpose To quantitatively evaluate the retinal microvasculature in human subjects with retinal venous occlusions (RVO) using optical coherence tomography angiography (OCTA). Design Retrospective, cross-sectional, observational case series. Participants Sixty subjects (84 eyes) were included (20 BRVO, 14 CRVO, 24 unaffected fellow eyes, and 26 controls). Methods OCTA was performed on a prototype, spectral domain-OCTA system in the 3x3mm central macular region. Custom software was used to quantify morphology and density of retinal capillaries using four quantitative parameters. The vasculature of the segmented retinal layers and nonsegmented whole retina were analyzed. Main outcome measures Fractal dimension (FD), vessel density (VD), skeletal density (SD), and vessel diameter index (VDI) within the segmented retinal layers and nonsegmented whole retina vasculature. Results Nonsegmented analysis of RVO eyes demonstrated significantly lower FD (1.64±0.01 vs 1.715±0.002; p<0.001), VD (0.32±0.01 vs 0.432±0.002; p<0.001), and SD (0.073±0.004 vs 0.099±0.001; p<0.001) compared to controls. Compared to the fellow eye, FD, VD and SD were lower (p<0.001), and VDI was higher (p<0.001). FD, VD, and SD progressively decreased as the extent (or type) of RVO increased (control vs BRVO vs CRVO; p<0.001). In the unaffected fellow eye FD, VD and SD showed significant differences when compared to control eyes or affected RVO eyes (p<0.001). Conclusions Quantitative OCTA of the central 3x3mm macular region demonstrates significant differences in capillary density and morphology among subjects with BRVO and CRVO compared to controls or unaffected fellow eyes in all vascular layers. The unaffected fellow eyes also demonstrate significant differences when compared to controls. OCTA allows for noninvasive, layer-specific, quantitative evaluation of RVO-associated microvascular changes.
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Affiliation(s)
- Nicole Koulisis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alice Y. Kim
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Anoush Shahidzadeh
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lisa C. Olmos de Koo
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Andrew A. Moshfeghi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hossein Ameri
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Carmen A. Puliafito
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Veronica L. Isozaki
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Amir H. Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
- * E-mail:
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Duncan JL, Richards TP, Arditi A, da Cruz L, Dagnelie G, Dorn JD, Ho AC, Olmos de Koo LC, Barale P, Stanga PE, Thumann G, Wang Y, Greenberg RJ. Improvements in vision-related quality of life in blind patients implanted with the Argus II Epiretinal Prosthesis. Clin Exp Optom 2017; 100:144-150. [PMID: 27558213 PMCID: PMC5347867 DOI: 10.1111/cxo.12444] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/19/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The purpose of this analysis is to report the change in quality of life (QoL) after treatment with the Argus II Epiretinal Prosthesis in patients with end-stage retinitis pigmentosa. METHODS The Vision and Quality of Life Index (VisQoL) was used to assess changes in QoL dimensions and overall utility score in a prospective 30-patient single-arm clinical study. VisQoL is a multi-attribute instrument consisting of six dimensions (injury, life, roles, assistance, activity and friendship) that may be affected by visual impairment. Within each dimension, patients were divided into two groups based on how much their QoL was affected by their blindness at baseline (moderate/severe or minimal). Outcomes were compared within each dimension sub-group between baseline and the combined follow-up periods using the Friedman test. In addition, data from the six dimensions were combined into a single utility score, with baseline data compared to the combined follow-up periods. RESULTS Overall, 80 per cent of the patients reported difficulty in one or more dimensions pre-implant. Composite VisQoL utility scores at follow-up showed no statistically significant change from baseline; however, in three of the six VisQoL dimensions (injury, life and roles), patients with baseline deficits showed significant and lasting improvement after implantation with Argus II. In two of the three remaining dimensions (assistance and activity), data trended toward an improvement. In the final VisQoL dimension (friendship), none of the patients reported baseline deficits, suggesting that patients had largely adjusted to this attribute. CONCLUSION Patients whose vision negatively affected them with respect to three VisQoL dimensions (that is, getting injured, coping with the demands of their life and fulfilling their life roles) reported significant improvement in QoL after implantation of the Argus II retinal prosthesis. Furthermore, the benefit did not deteriorate at any point during the 36-month follow-up, suggesting a long-term, durable improvement.
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Affiliation(s)
- Jacque L Duncan
- Department of Ophthalmology, School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Aries Arditi
- Lighthouse Guild InternationalNew YorkNew YorkUSA
| | | | - Gislin Dagnelie
- Lions Vision Research and Rehabilitation CenterJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jessy D Dorn
- Second Sight Medical ProductsSylmarCaliforniaUSA
| | - Allen C Ho
- Department of OphthalmologyWills Eye HospitalPhiladelphiaPennsylvaniaUSA
| | - Lisa C Olmos de Koo
- Roski Eye InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Paulo E Stanga
- Manchester Royal Eye HospitalManchesterUK
- Manchester Vision Regeneration Laboratory at NIHR/Wellcome Trust Manchester CRFManchesterUK
| | | | - Yizhong Wang
- Retina Foundation of the SouthwestDallasTexasUSA
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Dagnelie G, Christopher P, Arditi A, da Cruz L, Duncan JL, Ho AC, Olmos de Koo LC, Sahel J, Stanga PE, Thumann G, Wang Y, Arsiero M, Dorn JD, Greenberg RJ. Performance of real-world functional vision tasks by blind subjects improves after implantation with the Argus® II retinal prosthesis system. Clin Exp Ophthalmol 2017; 45:152-159. [PMID: 27495262 PMCID: PMC5293683 DOI: 10.1111/ceo.12812] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The main objective of this study was to test Argus II subjects on three real-world functional vision tasks. DESIGN The study was designed to be randomized and prospective. Testing was conducted in a hospital/research laboratory setting at the various participating centres. PARTICIPANTS Twenty eight Argus II subjects, all profoundly blind, participated in this study. METHODS Subjects were tested on the three real-world functional vision tasks: Sock Sorting, Sidewalk Tracking and Walking Direction Discrimination task MAIN OUTCOME MEASURES: For the Sock Sorting task, percentage correct was computed based on how accurately subjects sorted the piles on a cloth-covered table and on a bare table. In the Sidewalk Tracking task, an 'out of bounds' count was recorded, signifying how often the subject veered away from the test course. During the Walking Direction Discrimination task, subjects were tested on the number of times they correctly identified the direction of testers walking across their field of view. RESULTS The mean percentage correct OFF versus ON for the Sock Sorting task was found to be significantly different for both testing conditions (t-test, P < 0.01). On the Sidewalk Tracking task, subjects performed significantly better with the system ON than they did with the system OFF (t-test, P < 0.05). Eighteen (18) of 27 subjects (67%) performed above chance with the system ON, and 6 (22%) did so with system OFF on the Walking Direction Discrimination task. CONCLUSIONS Argus II subjects performed better on all three tasks with their systems ON than they did with their systems OFF.
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Affiliation(s)
- Gislin Dagnelie
- Lions Vision Research and Rehab CenterJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | | | | | - Allen C Ho
- Wills Eye HospitalPhiladelphiaPennsylvaniaUSA
| | - Lisa C Olmos de Koo
- Department of OphthalmologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | | | | | - Yizhong Wang
- Retina Foundation of the SouthwestDallasTexasUSA
| | - Maura Arsiero
- Second Sight Medical Products IncSylmarCaliforniaUSA
| | - Jessy D Dorn
- Second Sight Medical Products IncSylmarCaliforniaUSA
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Moysidis SN, Koulisis N, Olmos de Koo LC. Reply. Retin Cases Brief Rep 2017; 11:e3-e4. [PMID: 27490975 DOI: 10.1097/icb.0000000000000366] [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: 06/06/2023]
Affiliation(s)
- Stavros N Moysidis
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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da Cruz L, Dorn JD, Humayun MS, Dagnelie G, Handa J, Barale PO, Sahel JA, Stanga PE, Hafezi F, Safran AB, Salzmann J, Santos A, Birch D, Spencer R, Cideciyan AV, de Juan E, Duncan JL, Eliott D, Fawzi A, Olmos de Koo LC, Ho AC, Brown G, Haller J, Regillo C, Del Priore LV, Arditi A, Greenberg RJ. Five-Year Safety and Performance Results from the Argus II Retinal Prosthesis System Clinical Trial. Ophthalmology 2016; 123:2248-54. [PMID: 27453256 DOI: 10.1016/j.ophtha.2016.06.049] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/04/2016] [Accepted: 06/17/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The Argus II Retinal Prosthesis System (Second Sight Medical Products, Inc, Sylmar, CA) was developed to restore some vision to patients blind as a result of retinitis pigmentosa (RP) or outer retinal degeneration. A clinical trial was initiated in 2006 to study the long-term safety and efficacy of the Argus II System in patients with bare or no light perception resulting from end-stage RP. DESIGN Prospective, multicenter, single-arm clinical trial. Within-patient controls included the nonimplanted fellow eye and patients' native residual vision compared with their vision with the Argus II. PARTICIPANTS Thirty participants in 10 centers in the United States and Europe. METHODS The worse-seeing eye of blind patients was implanted with the Argus II. Patients wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina. MAIN OUTCOME MEASURES The primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by 3 computer-based, objective tests. Secondary measures included functional vision performance on objectively scored real-world tasks. RESULTS Twenty-four of 30 patients remained implanted with functioning Argus II Systems at 5 years after implantation. Only 1 additional serious adverse event was experienced after the 3-year time point. Patients performed significantly better with the Argus II on than off on all visual function tests and functional vision tasks. CONCLUSIONS The 5-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind as a result of RP. The Argus II is the first and only retinal implant to have market approval in the European Economic Area, the United States, and Canada.
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Affiliation(s)
- Lyndon da Cruz
- Department of Vitreoretinal Surgery, Moorfields Eye Hospital, NHS Foundation Trust, NIHR Moorfields Biomedical Research Centre, London, United Kingdom and Department of Brain Science, University College London (UCL)
| | - Jessy D Dorn
- Second Sight Medical Products, Inc, Sylmar, California.
| | - Mark S Humayun
- University of Southern California, Los Angeles, California
| | - Gislin Dagnelie
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - James Handa
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - José-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Sorbonne Universities-UPMC Paris-6, and Institut de la Vision, Paris, France; Rothschild Ophthalmology Foundation, Paris, France
| | - Paulo E Stanga
- Manchester Royal Eye Hospital, Manchester Vision Regeneration (MVR) Laboratory at NIHR/Wellcome Trust Manchester CRF, and Manchester Academic Health Science Centre and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, Manchester, United Kingdom
| | - Farhad Hafezi
- University of Southern California, Los Angeles, California; ELZA Institute, Zurich, Switzerland; Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Avinoam B Safran
- Sorbonne Universities-UPMC Paris-6, and Institut de la Vision, Paris, France; Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Joel Salzmann
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Arturo Santos
- Centro de Retina Medica y Quirúrgica, SC, and Tecnologico de Monterrey, Guadalajara, Mexico
| | - David Birch
- Retina Foundation of the Southwest, Dallas, Texas
| | | | - Artur V Cideciyan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eugene de Juan
- University of California, San Francisco, San Francisco, California
| | - Jacque L Duncan
- University of California, San Francisco, San Francisco, California
| | - Dean Eliott
- University of Southern California, Los Angeles, California; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Amani Fawzi
- University of Southern California, Los Angeles, California; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Allen C Ho
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Gary Brown
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Julia Haller
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Lucian V Del Priore
- Columbia University, New York, and Storm Eye Institute, Charleston, South Carolina
| | - Aries Arditi
- Lighthouse Guild, New York, and Visibility Metrics, LLC, Chappaqua, New York
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Koulisis N, Moysidis SN, Olmos de Koo LC, Russell CA, Kashani AH. The tipping point: Tamoxifen toxicity, central serous chorioretinopathy, and the role of estrogen and its receptors. Am J Ophthalmol Case Rep 2016; 3:8-13. [PMID: 29503899 PMCID: PMC5757395 DOI: 10.1016/j.ajoc.2016.05.004] [Citation(s) in RCA: 6] [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: 01/14/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 01/31/2023] Open
Abstract
Purpose To describe a case of tamoxifen toxicity superimposed on central serous chorioretinopathy (CSCR). We review the role of estrogen and the effect of tamoxifen on ocular tissues. Observations A 32-year-old Hispanic female with infiltrating ductal carcinoma of the left breast (T2N1M0, triple-positive), status post chemotherapy and bilateral mastectomy, presented with complaint of a floater and decreased central vision of the right eye (OD). Symptoms began three weeks after initiating tamoxifen and five months after the last cycle of chemotherapy and dexamethasone. Visual acuity (VA) was 20/30 OD at presentation. Clinical examination and multimodal imaging revealed subretinal fluid (SRF) and pigment epithelial detachment (PED) suggestive of CSCR. After one month of monitoring, VA improved to 20/20; there was SRF resolution, small PED, and focal ellipsoid zone (EZ) band loss. Two weeks later, after undergoing surgery and starting a topical steroid, she returned with count fingers (CF) VA and large SRF OD. Steroid cessation improved SRF after one month, but VA was unchanged. Tamoxifen was discontinued, and VA improved to 20/100 with near-complete resolution of SRF at three weeks, and significant reduction in choroidal thickness at two months. At final follow-up, VA was 20/200, and there was focal EZ band loss sub-foveally, minimal SRF, and small PED. Conclusions and Importance Treatment with tamoxifen may lead to ocular toxicity and can complicate the recovery course of patients affected with CSCR. Variations in levels of the estrogen receptor-alpha (ER-α) and treatment with tamoxifen (ER-α partial agonist) may lead to loss of the protective effect of estrogen in the retinal pigment epithelial cells in premenopausal women. Furthermore, tamoxifen toxicity can lead to focal photoreceptor loss. Treatment in these cases should be coordinated together with the oncologist.
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Affiliation(s)
- Nicole Koulisis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Stavros N Moysidis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lisa C Olmos de Koo
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Christy A Russell
- Department of Medicine-Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Amir H Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Olmos de Koo LC, Puliafito CA. 8 Questions with Dr. Puliafito. Ophthalmic Surg Lasers Imaging Retina 2016; 47:194-6. [DOI: 10.3928/23258160-20160126-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Geruschat DR, Richards TP, Arditi A, da Cruz L, Dagnelie G, Dorn JD, Duncan JL, Ho AC, Olmos de Koo LC, Sahel JA, Stanga PE, Thumann G, Wang V, Greenberg RJ. An analysis of observer-rated functional vision in patients implanted with the Argus II Retinal Prosthesis System at three years. Clin Exp Optom 2016; 99:227-32. [PMID: 26804484 PMCID: PMC5066820 DOI: 10.1111/cxo.12359] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/13/2015] [Accepted: 10/23/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this analysis was to compare observer‐rated tasks in patients implanted with the Argus II Retinal Prosthesis System, when the device is ON versus OFF. Methods The Functional Low‐Vision Observer Rated Assessment (FLORA) instrument was administered to 26 blind patients implanted with the Argus II Retinal Prosthesis System at a mean follow‐up of 36 months. FLORA is a multi‐component instrument that consists in part of observer‐rated assessment of 35 tasks completed with the device ON versus OFF. The ease with which a patient completes a task is scored using a four‐point scale, ranging from easy (score of 1) to impossible (score of 4). The tasks are evaluated individually and organised into four discrete domains, including ‘Visual orientation’, ‘Visual mobility’, ‘Daily life and ‘Interaction with others’. Results Twenty‐six patients completed each of the 35 tasks. Overall, 24 out of 35 tasks (69 per cent) were statistically significantly easier to achieve with the device ON versus OFF. In each of the four domains, patients’ performances were significantly better (p < 0.05) with the device ON versus OFF, ranging from 19 to 38 per cent improvement. Conclusion Patients with an Argus II Retinal Prosthesis implanted for 18 to 44 months (mean 36 months), demonstrated significantly improved completion of vision‐related tasks with the device ON versus OFF.
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Affiliation(s)
- Duane R Geruschat
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Aries Arditi
- Lighthouse Guild International, New York, New York, USA
| | | | - Gislin Dagnelie
- Lions Vision Research and Rehab Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jessy D Dorn
- Second Sight Medical Products, Sylmar, California, USA
| | - Jacque L Duncan
- University of California San Francisco, San Francisco, California, USA
| | - Allen C Ho
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - José-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Paulo E Stanga
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | | | - Vizhong Wang
- Retina Foundation of the Southwest, Dallas, Texas, USA
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Cunningham SI, Shi Y, Weiland JD, Falabella P, Olmos de Koo LC, Zacks DN, Tjan BS. Feasibility of Structural and Functional MRI Acquisition with Unpowered Implants in Argus II Retinal Prosthesis Patients: A Case Study. Transl Vis Sci Technol 2015; 4:6. [PMID: 26693097 DOI: 10.1167/tvst.4.6.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 06/03/2015] [Accepted: 09/27/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) can measure the effects of vision loss and recovery on brain function and structure. In this case study, we sought to determine the feasibility of acquiring anatomical and functional MRI data in recipients of the Argus II epiretinal prosthesis system. METHODS Following successful implantation with the Argus II device, two retinitis pigmentosa (RP) patients completed MRI scans with their implant unpowered to measure primary visual cortex (V1) functional responses to a tactile task, whole-brain morphometry, V1 cortical thickness, and diffusion properties of the optic tract and optic radiation. Measurements in the subjects with the Argus II implant were compared to measurements obtained previously from RP patients and sighted individuals. RESULTS The presence of the Argus II implant resulted in artifacts that were localized around the patient's implanted eye and did not extend into cortical regions or white matter tracts associated with the visual system. Structural data on V1 cortical thickness and the retinofugal tract obtained from the two Argus II subjects fell within the ranges of sighted and RP groups. When compared to the RP and sighted subjects, Argus II patients' tactile-evoked cross-modal functional MRI (fMRI) blood oxygen level-dependent (BOLD) responses in V1 also fell within the range of either sighted or RP groups, apparently depending on time since implantation. CONCLUSIONS This study demonstrates that successful acquisition and quantification of structural and functional MR images are feasible in the presence of the inactive implant and provides preliminary information on functional changes in the brain that may follow sight restoration treatments. TRANSITIONAL RELEVANCE Successful MRI and fMRI acquisition in Argus II recipients demonstrates feasibility of using MRI to study the effect of retinal prosthesis use on brain structure and function.
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Affiliation(s)
- Samantha I Cunningham
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yonggang Shi
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - James D Weiland
- USC Eye Institute, University of Southern California, Los Angeles, CA, USA
| | - Paulo Falabella
- USC Eye Institute, University of Southern California, Los Angeles, CA, USA ; Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - David N Zacks
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Bosco S Tjan
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA ; Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Ho AC, Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Handa J, Barale PO, Sahel JA, Stanga PE, Hafezi F, Safran AB, Salzmann J, Santos A, Birch D, Spencer R, Cideciyan AV, de Juan E, Duncan JL, Eliott D, Fawzi A, Olmos de Koo LC, Brown GC, Haller JA, Regillo CD, Del Priore LV, Arditi A, Geruschat DR, Greenberg RJ. Long-Term Results from an Epiretinal Prosthesis to Restore Sight to the Blind. Ophthalmology 2015; 122:1547-54. [PMID: 26162233 DOI: 10.1016/j.ophtha.2015.04.032] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Retinitis pigmentosa (RP) is a group of inherited retinal degenerations leading to blindness due to photoreceptor loss. Retinitis pigmentosa is a rare disease, affecting only approximately 100 000 people in the United States. There is no cure and no approved medical therapy to slow or reverse RP. The purpose of this clinical trial was to evaluate the safety, reliability, and benefit of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Inc, Sylmar, CA) in restoring some visual function to subjects completely blind from RP. We report clinical trial results at 1 and 3 years after implantation. DESIGN The study is a multicenter, single-arm, prospective clinical trial. PARTICIPANTS There were 30 subjects in 10 centers in the United States and Europe. Subjects served as their own controls, that is, implanted eye versus fellow eye, and system on versus system off (native residual vision). METHODS The Argus II System was implanted on and in a single eye (typically the worse-seeing eye) of blind subjects. Subjects wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina. MAIN OUTCOME MEASURES The primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by 3 computer-based, objective tests. RESULTS A total of 29 of 30 subjects had functioning Argus II Systems implants 3 years after implantation. Eleven subjects experienced a total of 23 serious device- or surgery-related adverse events. All were treated with standard ophthalmic care. As a group, subjects performed significantly better with the system on than off on all visual function tests and functional vision assessments. CONCLUSIONS The 3-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind from RP. Earlier results from this trial were used to gain approval of the Argus II by the Food and Drug Administration and a CE mark in Europe. The Argus II System is the first and only retinal implant to have both approvals.
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Affiliation(s)
- Allen C Ho
- Wills Eye Hospital, Philadelphia, Pennsylvania.
| | - Mark S Humayun
- University of Southern California, Los Angeles, California
| | - Jessy D Dorn
- Second Sight Medical Products, Sylmar, California
| | - Lyndon da Cruz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; NHIR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Gislin Dagnelie
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - James Handa
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - José-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; ELZA Institute, Zurich, Switzerland
| | - Paulo E Stanga
- Manchester Royal Eye Hospital, Manchester, United Kingdom; Manchester Vision Regeneration Lab at National Institute for Health Research/Wellcome Trust Manchester CRF, Manchester, United Kingdom; Manchester Academic Health Science Centre and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, Manchester, United Kingdom
| | - Farhad Hafezi
- University of Southern California, Los Angeles, California; Hôpitaux Universitaires de Genève, Geneva, Switzerland; ELZA Institute, Zurich, Switzerland
| | - Avinoam B Safran
- Hôpitaux Universitaires de Genève, Geneva, Switzerland; Sorbonne Universities - UPMC Paris-6, and Institut de la Vision, Paris, France
| | - Joel Salzmann
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Arturo Santos
- Centro de Retina Medica y Quirúrgica, SC, Guadalajara, Mexico; Tecnologico de Monterrey, Guadalajara, Mexico
| | - David Birch
- Retina Foundation of the Southwest, Dallas, Texas
| | | | - Artur V Cideciyan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eugene de Juan
- University of California, San Francisco, San Francisco, California
| | - Jacque L Duncan
- University of California, San Francisco, San Francisco, California
| | - Dean Eliott
- University of Southern California, Los Angeles, California; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Amani Fawzi
- University of Southern California, Los Angeles, California; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Julia A Haller
- Wills Eye Hospital, Philadelphia, Pennsylvania; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Lucian V Del Priore
- Columbia University, New York, New York; Storm Eye Institute, Charleston, South Carolina
| | - Aries Arditi
- Lighthouse Guild, New York, New York; Visibility Metrics, LLC, Chappaqua, New York
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Sagong M, van Hemert J, Olmos de Koo LC, Barnett C, Sadda SR. Assessment of Accuracy and Precision of Quantification of Ultra-Widefield Images. Ophthalmology 2015; 122:864-6. [DOI: 10.1016/j.ophtha.2014.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/28/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022] Open
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Pouw AE, Olmos de Koo LC. Oral rifampin for central serous retinopathy: a strategic approach in three patients. Ophthalmic Surg Lasers Imaging Retina 2015; 46:98-102. [PMID: 25559520 DOI: 10.3928/23258160-20150101-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
Abstract
The authors present three cases of chronic central serous retinopathy in which rifampin was used for the utility of its oral delivery in remote care and as an alternative to photodynamic therapy when intravenous access was not possible. In each of these cases, a reduction of subfoveal fluid and improvement of visual acuity were achieved.
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Moysidis SN, Koulisis N, Ameri H, Matsunaga D, Yi J, Isozaki VL, Kashani AH, Olmos de Koo LC. MULTIMODAL IMAGING OF GEOGRAPHIC AREAS OF RETINAL DARKENING. Retin Cases Brief Rep 2015; 9:347-351. [PMID: 26421892 DOI: 10.1097/icb.0000000000000231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/05/2023]
Abstract
PURPOSE To describe the clinical and multimodal imaging characteristics of a patient with unilateral asymptomatic dark retinal lesions corresponding to ellipsoid zone hyporeflectivity on optical coherence tomography (OCT). METHODS The authors report a case of a 35-year-old man with HIV who presents with asymptomatic dark geographic retinal lesions corresponding to ellipsoid zone hyporeflectivity on OCT. Multimodal imaging techniques, including fundus color and widefield photographs, autofluorescence, spectral domain OCT (Spectralis, Heidelberg, Germany), prototype spectral domain OCT (Carl Zeiss Meditec, Dublin, CA) with OCT angiography, and en face images, were performed to evaluate and characterize the morphology of these lesions. RESULTS Clinical examination and multimodal imaging reveal geographic darkening of the retina. Optical coherence tomography conveys hyporeflectivity of the ellipsoid zone band, which occurs abruptly and is present only in the areas of geographic retinal darkening. Optical coherence tomographic angiography shows a qualitatively similar appearance of the vasculature from the superficial retina through the avascular retina and the choriocapillaris, on both sides of the demarcation of retinal darkening, and also as compared to the unaffected eye. En face images from spectral domain OCT reveal an abrupt darkening of the tissue that localizes and is limited to the ellipsoid zone, with similar topographic appearance across the demarcation line. CONCLUSION Geographic areas of darkening with photoreceptor hyporeflectivity have been described previously as "dark without pressure." In this case, the authors demonstrate photoreceptor hyporeflectivity that localizes to the clinically darkened areas, without topographic qualitative differences on en face spectral domain OCT images. The authors term these dark areas as geographic areas of retinal darkening because of ellipsoid nonreflectivity (GARDEN) spots.
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Affiliation(s)
- Stavros N Moysidis
- *Department of Ophthalmology, USC Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California; and †University of Massachusetts Medical School, Worcester, Massachusetts
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Abdallah WF, Olmos de Koo LC, Abdulkader MM, Barnett C, Chader GJ, Humayun MS. High-Resolution OCT: An Innovative Tool for Posterior Segment Imaging. Ophthalmic Surg Lasers Imaging Retina 2012; 43:S123-34. [DOI: 10.3928/15428877-20121003-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/03/2012] [Indexed: 11/20/2022]
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