1
|
Suarez MK, Wang SK, Hayes B, Greven MA, Shah RE, Greven C, Russell G, Ong SS. Visual Outcomes after Internal Limiting Membrane Peeling vs. Flap in the Closure of Full Thickness Macular Holes. Retina 2024:00006982-990000000-00609. [PMID: 38437847 DOI: 10.1097/iae.0000000000004084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full thickness macular holes (FTMH). METHODS Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close FTMH at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow up. Main outcome measures were type 1 primary FTMH closure and postoperative best corrected visual acuity (BCVA) in mean logMAR. RESULTS 130 and 30 eyes underwent ILMP and ILMF respectively. There were no significant differences in baseline characteristics between the groups. 96% of ILMP eyes and 90% of ILMF eyes achieved primary hole closure (p=0.29). Among all eyes with primary hole closure, BCVA at 1 year was not different between the groups but when stratified by lens status, was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean BCVA (Snellen equivalent) [95% confidence interval] was 0.42 (20/50) [0.34, 0.49] in the ILMP group and 0.71 (20/100) [0.50, 0.92] in the ILMF group. CONCLUSIONS ILMP and ILMF techniques yielded similarly high FTMH closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse BCVA at 1 year.
Collapse
Affiliation(s)
- Mallory K Suarez
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Sean K Wang
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Bartlett Hayes
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Rajiv E Shah
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Craig Greven
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Greg Russell
- Department of Biostatistics and Data Science, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157
| | - Sally S Ong
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| |
Collapse
|
2
|
Abstract
PURPOSE The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. METHODS This is a case series. RESULTS A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. CONCLUSION We recommend increased use of eye protection in pickleball.
Collapse
Affiliation(s)
- Harrison Huang
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | |
Collapse
|
3
|
Ciociola EC, Powell JC, Barnwell E, Zehden JA, Robbins CB, Soundararajan S, Singh P, Zhang AY, Fekrat S, Greven MA. ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INJECTION DRUG USE COMPARED WITH OTHER ETIOLOGIES. Retina 2023; 43:1996-2002. [PMID: 37490751 DOI: 10.1097/iae.0000000000003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare features of endogenous endophthalmitis associated with injection drug use (IDU) to endogenous endophthalmitis from other etiologies. METHODS The authors retrospectively collected data on patients with endogenous endophthalmitis due to IDU or other causes from three academic tertiary care centers over a six-year period. Differences in presenting characteristics, culture results, treatment, and visual acuity were compared between groups. RESULTS Thirty-eight patients (34%) had IDU-associated endogenous endophthalmitis while 75 patients (67%) had endogenous endophthalmitis from other causes. Compared with patients in the non-IDU group, IDU patients were significantly younger, more frequently male, had longer duration of symptoms at diagnosis, and were less likely to have bilateral disease ( P < 0.05 for all). Injection drug use patients were less likely to have a systemic infection source identified (29% vs. 71%, P < 0.001) or have positive cultures (47% vs. 80%, P < 0.001). The IDU group was less likely to be admitted to the hospital (71% vs. 92%, P = 0.005) and less likely to receive treatment with intravenous antimicrobials (55% vs. 83%, P = 0.003). Visual acuity did not significantly differ between groups. CONCLUSION Endophthalmitis related to IDU presents in younger patients with less comorbidities and frequently without positive cultures or an identifiable systemic source; therefore, a high index of suspicion is needed to identify this disease.
Collapse
Affiliation(s)
- Elizabeth C Ciociola
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jeffrey C Powell
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eliza Barnwell
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jason A Zehden
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cason B Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Srinath Soundararajan
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Pali Singh
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
4
|
Weinstein JE, Greven MA. PARACENTRAL ACUTE MIDDLE MACULOPATHY AND OCULAR ISCHEMIC SYNDROME AFTER INTRANASAL STEROID INJECTION: A CASE REPORT AND REVIEW OF THE LITERATURE. Retin Cases Brief Rep 2023; 17:644-647. [PMID: 35199649 PMCID: PMC10448800 DOI: 10.1097/icb.0000000000001262] [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] [Indexed: 06/14/2023]
Abstract
PURPOSE To describe a case of paracentral acute middle maculopathy and ocular ischemic syndrome after intranasal steroid injection. METHODS Case report. RESULTS Following an intranasal steroid injection, the patient experienced an episode of amaurosis fugax in her right eye lasting several minutes. Afterward, her visual acuity returned to baseline, but she noted a persistent central scotoma. Optical coherence tomography demonstrated paracentral acute middle maculopathy and fluorescein angiography showed staining and leakage to peripheral vessels concerning for diffuse ischemia. CONCLUSION Steroid injections to the face and nasopharynx may result in ischemic and vaso-occlusive events in the retina. Ophthalmologists and other physicians performing these procedures need to be aware of this potential adverse outcome.
Collapse
Affiliation(s)
- Jessica E. Weinstein
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, Kentucky; and
| | - Margaret A. Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Woldetensaye AG, Selander JM, Huang H, Patel PV, Villarreal A, Hesse RA, Greven MA. The Impact of Social Determinants of Health on Presentation, Treatment, and Outcomes in Branch Retinal Vein Occlusion With Cystoid Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2023:1-6. [PMID: 37418672 DOI: 10.3928/23258160-20230616-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND AND OBJECTIVE To investigate the impact of social determinants of health on the presentation, treatment, and outcomes of branch retinal vein occlusion (BRVO) with cystoid macular edema (CME). PATIENTS AND METHODS A retrospective chart review was conducted of patients with BRVO and CME treated with anti-vascular endothelial growth factor (anti-VEGF) injections at Atrium Health Wake Forest Baptist from 2013 to 2021. Patients' baseline characteristics including visual acuity (VA), age, sex, race, Area Deprivation Index (ADI), insurance status, baseline central macular thickness (CMT), treatment details, final VA, and final CMT were recorded. The primary outcome measure was final VA comparing more and less deprived groups, and White and non-White groups. RESULTS Two hundred forty-four eyes of 240 patients were included. Patients with higher socioeconomic deprivation scores had thicker final CMT (P = 0.05). Non-White patients had worse presenting (P = 0.01) and final VA (P = 0.02). CONCLUSION This study demonstrated disparities in presentation and outcomes based on socioeconomic status and race in patients with BRVO and CME treated with anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].
Collapse
|
6
|
Marshall AJ, Barnwell EL, Greven MA. Bilateral Proliferative Retinopathy as the Initial Presentation of Atypical Hemolytic Uremic Syndrome: A Case Report. Ophthalmic Surg Lasers Imaging Retina 2023; 54:297-300. [PMID: 37022313 DOI: 10.3928/23258160-20230331-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
In this case report, we describe a 34-year-old male patient who presented with vision loss and was found to have profound occlusive retinal vasculopathy. His initial laboratory studies were unremarkable, but five weeks after his ocular symptoms began, he developed acute multi-organ failure and was ultimately diagnosed with atypical hemolytic uremic syndrome (aHUS). His course was complicated by a stroke, respiratory distress requiring intubation, long-term hemodialysis, and eventually death. Occlusive retinal vasculopathy may be the presenting finding in aHUS, although thrombotic microangiopathy syndromes typically present with acute kidney injury and or failure, hemolytic anemia, and thrombocytopenia. [Ophthalmic Surg Lasers Imaging Retina 2023;54:XX-XX.].
Collapse
|
7
|
Abstract
PURPOSE We describe a case of endophthalmitis caused by Streptococcus salivarius presenting as a retinal vasculitis less than 24 hours after intravitreal injection. METHODS A case report. RESULTS The patient progressed from a hemorrhagic retinal vasculitis to severe endophthalmitis with no view to the posterior segment within 24 hours. The visual acuity progressed from 20 of 20 preinjection to light perception within less than 48 after injection. Vitreous tap and injection was performed within 24 hours of intravitreal aflibercept injection, followed by pars plana vitrectomy the next day. The final visual acuity was hand motions. CONCLUSION Streptococcus salivarius is a virulent organism that may cause an endophthalmitis early after intravitreal injection with an unusual presentation of hemorrhagic retinal vasculitis. A high index of suspicion for infectious endophthalmitis should be maintained for all patients presenting with ocular inflammation and worsening vision in the days after intravitreal injections.
Collapse
Affiliation(s)
- Jessica E Weinstein
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | |
Collapse
|
8
|
Greven MA. Coats' Disease Presenting with Macula Star. Ophthalmol Retina 2021; 4:559. [PMID: 32507273 DOI: 10.1016/j.oret.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
9
|
Ahmed K, Ali AS, Delwadia N, Greven MA. Neurodevelopmental Outcomes Following Intravitreal Bevacizumab With Laser Versus Laser Photocoagulation Alone for Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2021; 51:220-224. [PMID: 32348538 DOI: 10.3928/23258160-20200326-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess neurodevelopmental outcomes of infants with treatment-warranted retinopathy of prematurity (TW-ROP) treated with intravitreal bevacizumab (IVB) plus diode laser photocoagulation (DLP) compared to DLP alone. PATIENTS AND METHODS A retrospective review was performed of infants who underwent treatment for TW-ROP with IVB+DLP or DLP alone from 2010 to 2017. Baseline characteristics and coexisting medical comorbidities were recorded. The presence of neurodevelopmental delay (NDD) at 2-year follow-up and composite Bayley-III scores were recorded. RESULTS Sixty-six infants were included in the study; 18 received IVB+DLP, and 48 received DLP alone. Average Bayley-III scores for cognition, language, and motor, as well as rates of documental NDD, did not differ between the groups. CONCLUSION This study does not demonstrate an increased risk of NDD in infants with TW-ROP treated with IVB+DLP compared with DLP alone. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:220-224.].
Collapse
|
10
|
Ludwig CA, Perera C, Myung D, Greven MA, Smith SJ, Chang RT, Leng T. Automatic Identification of Referral-Warranted Diabetic Retinopathy Using Deep Learning on Mobile Phone Images. Transl Vis Sci Technol 2020; 9:60. [PMID: 33294301 PMCID: PMC7718806 DOI: 10.1167/tvst.9.2.60] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/22/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the performance of a deep learning algorithm in the detection of referral-warranted diabetic retinopathy (RDR) on low-resolution fundus images acquired with a smartphone and indirect ophthalmoscope lens adapter. Methods An automated deep learning algorithm trained on 92,364 traditional fundus camera images was tested on a dataset of smartphone fundus images from 103 eyes acquired from two previously published studies. Images were extracted from live video screenshots from fundus examinations using a commercially available lens adapter and exported as a screenshot from live video clips filmed at 1080p resolution. Each image was graded twice by a board-certified ophthalmologist and compared to the output of the algorithm, which classified each image as having RDR (moderate nonproliferative DR or worse) or no RDR. Results In spite of the presence of multiple artifacts (lens glare, lens particulates/smudging, user hands over the objective lens) and low-resolution images achieved by users of various levels of medical training, the algorithm achieved a 0.89 (95% confidence interval [CI] 0.83-0.95) area under the curve with an 89% sensitivity (95% CI 81%-100%) and 83% specificity (95% CI 77%-89%) for detecting RDR on mobile phone acquired fundus photos. Conclusions The fully data-driven artificial intelligence-based grading algorithm herein can be used to screen fundus photos taken from mobile devices and identify with high reliability which cases should be referred to an ophthalmologist for further evaluation and treatment. Translational Relevance The implementation of this algorithm on a global basis could drastically reduce the rate of vision loss attributed to DR.
Collapse
Affiliation(s)
- Cassie A. Ludwig
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Chandrashan Perera
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Myung
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Margaret A. Greven
- Department of Ophthalmology, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Stephen J. Smith
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Robert T. Chang
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theodore Leng
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
11
|
Ji MH, Callaway NF, Greven MA, Vail D, Moshfeghi DM. Telemedicine Follow-Up for Intravitreal Bevacizumab Injection in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Cohort. Clin Ophthalmol 2020; 14:1161-1163. [PMID: 32431486 PMCID: PMC7200391 DOI: 10.2147/opth.s250361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022] Open
Abstract
Telemedicine has emerged as a potential solution to face the disproportion between infants that need to be screened for retinopathy of prematurity (ROP) and the lack of ophthalmologists. We evaluated its utility in the follow-up after off-label intravitreal injection of bevacizumab. None of the treated infants ended up with bad anatomic outcome. Telemedicine is an alternative safe method to monitor patients after treatment.
Collapse
Affiliation(s)
- Marco H Ji
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Natalia F Callaway
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daniel Vail
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| |
Collapse
|
12
|
Greven MA, Sanislo S. Intraoperative Optical Coherence Tomography Demonstrating Macular Hole Associated With Ruptured Retinal Arterial Macroaneurysm. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e125-e127. [PMID: 30998256 DOI: 10.3928/23258160-20190401-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
A 67-year-old female presented with vitreous hemorrhage and sub-internal limited membrane (ILM) hemorrhage in her right eye associated with ruptured retinal arterial macroaneurysm. During pars plana vitrectomy, intraoperative optical coherence tomography aided in the diagnosis of a small macular hole previously obscured by the sub-ILM hemorrhage. Nonexpansile gas was placed followed by postoperative prone positioning, and the hole closed successfully. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e125-e127.].
Collapse
|
13
|
Greven MA, Weinstein J, Tsamis K, Ayres PF, Barnes EW, Peacock JE. 114. Chorioretinal Lesions in Persons Who Inject Drugs and Are Hospitalized with Bloodstream and Related Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809648 DOI: 10.1093/ofid/ofz360.189] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Eye infection is one of the many potential sites of infection in persons who inject drugs (PWID). The purpose of this study was to determine the prevalence of chorioretinal (CR) lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in PWID hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI). Methods Actively using PWID 18 years or older admitted to Wake Forest Baptist Med Ctr with documented BSI or MFI related to injection drug use (IDU) were prospectively enrolled after providing informed consent. All patients, whether or not they had eye symptoms, received a dilated retinal examination as soon as feasible after admission. Ocular symptoms, visual acuity, and ocular examination findings were recorded and fundus photos were obtained as indicated. Patients could be re-enrolled if re-admitted with a different infection. Results Fifty-three PWID with 55 episodes of disseminated infection related to IDU underwent ophthalmic exams at a median of 7 days post-admission. Mean age was 33.4 years and 51% were female. Twenty (38%) patients had HCV viremia but none had active HIV infection. Heroin was the injection drug of choice in 55% of patients. Of the 55 episodes of systemic infection, 33 were classified as infective endocarditis (IE), 6 were BSI only, 10 were BSI with MFI, and 5 were MFI without active BSI. Nine (17%) patients had CR involvement on examination but only 33% (3/9) were symptomatic. Of those with ocular involvement, 1 had fungal endophthalmitis due to Candida albicans. Single or multifocal subretinal infiltrates were found in 5/9 patients (MSSA 2, MRSA 2, H. parainfluenzae 1), 2/9 had cotton wool spots (S. mitis 1, MRSA 1), and 7/9 had intraretinal or white-centered hemorrhages (MSSA 3, MRSA 2, S. mitis 1, H. parainfluenzae 1). Of the 9 patients with CR lesions, 7 had IE. Interestingly, 3.8% (3/53) had old multifocal CR scars, possibly related to prior disseminated infection. Conclusion PWID admitted with BSI or MFI may have ophthalmic involvement even in the absence of ocular symptoms, especially in the setting of IE. Further study is needed to characterize the epidemiology of these infections, to identify risk factors for ocular involvement, and to optimize diagnosis and management. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | - Kathy Tsamis
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Erin W Barnes
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - James E Peacock
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| |
Collapse
|
14
|
Gunzenhauser RC, Rubino SM, John V, Greven MA. The development and spontaneous resolution of a full-thickness macular hole in bartonella henselae neuroretinitis in a 12-year-old boy. Am J Ophthalmol Case Rep 2019; 15:100515. [PMID: 31341998 PMCID: PMC6630014 DOI: 10.1016/j.ajoc.2019.100515] [Citation(s) in RCA: 2] [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] [Received: 12/04/2018] [Revised: 05/16/2019] [Accepted: 07/08/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To describe an unusual case of Bartonella henselae neuroretinitis complicated by macular hole (MH) development. Observations A full-thickness macular hole developed in a 12-year-old boy in association with serology-confirmed Bartonella henselae neuroretinitis. Following a period of observation, the MH closed without intervention. Conclusion and importance MH may occur as a complication of neuroretinitis secondary to Cat-Scratch Disease.
Collapse
Affiliation(s)
- Robert C Gunzenhauser
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
15
|
Greven MA, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): telemedicine-based examination after laser photocoagulation for treatment-warranted retinopathy of prematurity. Eye (Lond) 2019; 33:1347-1355. [PMID: 30867576 DOI: 10.1038/s41433-019-0392-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
16
|
Greven MA, Leng T, Silva RA, Leung LSB, Karth PA, Moshfeghi DM, Sanislo SR, Schachar IH. Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment. Br J Ophthalmol 2018; 103:1503-1506. [PMID: 30504489 DOI: 10.1136/bjophthalmol-2018-313191] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/02/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine if final visual acuity (VA) is affected by duration of macular detachment (DMD) within the first week of macula-off retinal detachment (RD). METHODS This is a retrospective study of eyes that underwent repair within 7 days with vitrectomy or vitrectomy with scleral buckle for macula-off RD at Stanford University Hospital between 1 May 2007 and 1 May 2017. A generalised linear model was constructed using DMD, postoperative lens status, preoperative VA, patient age and surgeon as the independent variables and the final VA as the dependent variable. The main outcome measure was the final VA. RESULTS Seventy-nine eyes met the entry criteria. Group 1 included 52 eyes with RD repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD. The average final VA in group 1 eyes was logarithm of the minimum angle of resolution (logMAR) 0.21 (Snellen 20/33) and in group 2 eyes was logMAR 0.54 (Snellen 20/69). In group 1 and group 2 eyes, preoperative VA (p=0.017and p=0.007), DMD (p=0.004 and p=0.041) and final lens status (p<0.0001 and p<0.001) predicted postoperative VA. Post-hoc analysis showed significant differences in final VA between detachments of 1day vs 3 days (p=0.0009). CONCLUSION DMD affects the final VA even among patients whose DMD is <3 days. Based on these results, interventions that shorten DMD, including those occurring within the first 3days, may result in improved long-term VA outcomes.
Collapse
Affiliation(s)
- Margaret A Greven
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Theodore Leng
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ruwan Amila Silva
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Loh-Shan Bryan Leung
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Darius M Moshfeghi
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Steven R Sanislo
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ira H Schachar
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
17
|
Greven MA, Leung LSB. Photodynamic Therapy-Induced Macular Hole. Ophthalmic Surg Lasers Imaging Retina 2018; 49:270-272. [PMID: 29664985 DOI: 10.3928/23258160-20180329-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
A 72-year-old female with neovascular macular degeneration refractory to anti-vascular endothelial growth factor injections underwent photodynamic therapy and subsequently developed a macular hole (MH) associated with vitreomacular traction. After a period of observation, the MH enlarged. Pars plana vitrectomy was performed, and the MH was closed successfully. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:270-272.].
Collapse
|
18
|
Ludwig CA, Greven MA, Moshfeghi DM. Predictors of treatment-warranted retinopathy of prematurity in the SUNDROP cohort: influence of photographic features. Graefes Arch Clin Exp Ophthalmol 2017; 255:1935-1946. [DOI: 10.1007/s00417-017-3745-3] [Citation(s) in RCA: 7] [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: 01/26/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 02/01/2023] Open
|
19
|
Greven MA, Moshfeghi DM. Incontinentia pigmenti with secondary Raynaud's phenomenon: A case report and review of the literature. Am J Ophthalmol Case Rep 2017; 6:27-29. [PMID: 29260049 PMCID: PMC5722168 DOI: 10.1016/j.ajoc.2016.12.012] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/06/2016] [Accepted: 12/22/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe a patient with incontinentia pigmenti (IP) and Raynaud's phenomenon (RP). Observations A 5 year-old girl with history of IP was noted to have RP. Visual acuity was unaffected in both eyes, and fundus examination demonstrated regressed peripheral neovascularization. Photos of the patient's hands demonstrated pale discoloration associated with exposure to cold. Conclusions and importance IP, known to affect small cerebral and retinal blood vessels, can also affect the small blood vessels in the extremities, resulting in secondary RP.
Collapse
Affiliation(s)
- Margaret A. Greven
- Corresponding author. Byers Eye Institute, Horngren Family Vitreoretinal Center, Dept. of Ophthalmology, Stanford University School of Medicine, 2452 Watson Court, Suite 2200, Palo Alto, CA 94303, United States.Byers Eye InstituteHorngren Family Vitreoretinal CenterDept. of OphthalmologyStanford University School of Medicine2452 Watson CourtSuite 2200Palo AltoCA94303United States
| | | |
Collapse
|
20
|
de Sisternes L, Jonna G, Greven MA, Chen Q, Leng T, Rubin DL. Individual Drusen Segmentation and Repeatability and Reproducibility of Their Automated Quantification in Optical Coherence Tomography Images. Transl Vis Sci Technol 2017; 6:12. [PMID: 28275527 PMCID: PMC5338477 DOI: 10.1167/tvst.6.1.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/29/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To introduce a novel method to segment individual drusen in spectral-domain optical coherence tomography (SD-OCT), and evaluate its accuracy, and repeatability/reproducibility of drusen quantifications extracted from the segmentation results. Methods Our method uses a smooth interpolation of the retinal pigment epithelium (RPE) outer boundary, fitted to candidate locations in proximity to Bruch's Membrane, to identify regions of substantial lifting in the inner-RPE or inner-segment boundaries, and then separates and evaluates individual druse independently. The study included 192 eyes from 129 patients. Accuracy of drusen segmentations was evaluated measuring the overlap ratio (OR) with manual markings, also comparing the results to a previously proposed method. Repeatability and reproducibility across scanning protocols of automated drusen quantifications were investigated in repeated SD-OCT volume pairs and compared with those measured by a commercial tool (Cirrus HD-OCT). Results Our segmentation method produced higher accuracy than a previously proposed method, showing similar differences to manual markings (0.72 ± 0.09 OR) as the measured intra- and interreader variability (0.78 ± 0.09 and 0.77 ± 0.09, respectively). The automated quantifications displayed high repeatability and reproducibility, showing a more stable behavior across scanning protocols in drusen area and volume measurements than the commercial software. Measurements of drusen slope and mean intensity showed significant differences across protocols. Conclusion Automated drusen outlines produced by our method show promising accurate results that seem relatively stable in repeated scans using the same or different scanning protocols. Translational Relevance The proposed method represents a viable tool to measure and track drusen measurements in early or intermediate age-related macular degeneration patients.
Collapse
Affiliation(s)
- Luis de Sisternes
- Department of Radiology, Stanford University, Stanford, CA, USA ; Department Medicine (Biomedical Informatics), Stanford University, Stanford, CA, USA ; Currently at Carl Zeiss Meditec, Inc., Dublin, CA, USA
| | - Gowtham Jonna
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Margaret A Greven
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Theodore Leng
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel L Rubin
- Department of Radiology, Stanford University, Stanford, CA, USA ; Department Medicine (Biomedical Informatics), Stanford University, Stanford, CA, USA
| |
Collapse
|
21
|
Greven MA, Elkin Z, Nelson RW, Leng T. En Face Imaging of Epiretinal Membranes and the Retinal Nerve Fiber Layer Using Swept-Source Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2016; 47:730-4. [DOI: 10.3928/23258160-20160808-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/20/2022]
|
22
|
Greven MA, Garg S, Chiu B, Shah SP, Wolfe J, Fine HF, Roth DB, Robinson J, Mong J, Hsu J, Regillo C, Ho A, Haller JA. Vitrectomy After ocriplasmin for VitreOmacular adhesion Or Macular hole (VAVOOM) study. Br J Ophthalmol 2015; 100:1211-5. [DOI: 10.1136/bjophthalmol-2015-307701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/08/2015] [Indexed: 11/04/2022]
|