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Adrean SD, Peng ET, Chaili S, Grant S. PURPOSEFUL GAS-INDUCED RESORPTION OF SUBMACULAR FLUID IN MACULA-OFF RETINAL DETACHMENTS (PERSIMMON STUDY). Retina 2024; 44:414-420. [PMID: 37972942 DOI: 10.1097/iae.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To examine the visual outcomes in patients with macula-off rhegmatogenous retinal detachments with intentional submacular fluid retention after pars plana vitrectomy (PPV) or PPV/scleral buckle surgery (PPV/SB). METHODS Patients with macula-off retinal detachments were included if they had a PPV or PPV/SB without drainage retinotomy or perfluorocarbon liquid to flatten the retina. RESULTS The mean age of the patients was 65.0 years. The mean presenting vision was 20.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Six months after repair, the vision improved to 62.9; 75.4% of patients had 20/40 or better at best achieved visual acuity. Pseudophakic eyes had better vision compared with phakic eyes ( P = 0.049). Patients younger than 80 years had better best achieved vision ( P = 0.0118) compared with patients 80 years or older. Patients with initial vision better than or equal to 20/100 had better best achieved vision ( P = 0.016) compared with those with initial vision worse than 20/100. CONCLUSION Leaving submacular fluid after macula-off retinal detachments surgery was not detrimental for visual outcomes or anatomic success for retinal detachments repair and may lead to better visual outcomes for patients, specifically for those patients younger than 80 years, who are pseudophakic, and have presenting vision 20/100 or better.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California
| | - Enoch T Peng
- Retina Consultants of Orange County, Fullerton, California
- University of Texas Southwestern Medical School, Dallas, Texas; and
| | - Siyang Chaili
- Retina Consultants of Orange County, Fullerton, California
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, California
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Park JG, Adrean SD, Begaj T, Capone A, Charles S, Chen SN, Chou HD, Cohen MN, Corona ST, Faia LJ, Garg SJ, Garretson BR, Gregori NZ, Haller JA, Houghton OM, Hsu J, Jo J, Kaiser RS, Lai CC, Mahgoub MM, Mansoor M, Matoba R, Morizane Y, Nehemy MB, Raphaelian PV, Regillo CD, Ruby AJ, Runner MM, Sneed SR, Sohn EH, Spirn MJ, Vander JF, Wakabayashi T, Wolfe JD, Wykoff CC, Yonekawa Y, Yoon YH, Mahmoud TH. Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study. Ophthalmology 2024; 131:66-77. [PMID: 37661066 DOI: 10.1016/j.ophtha.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE To report on macular hole repair in macular telangiectasia type 2 (MacTel2). DESIGN Global, multicenter, retrospective case series. PARTICIPANTS Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). METHODS Standardized data collection sheet distributed to all surgeons. MAIN OUTCOME MEASURES Anatomic closure and visual outcomes of MTMH. RESULTS Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34-573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97-697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132-687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P = 0.08). Visual acuity improved at least 2 lines in 25%. CONCLUSIONS Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jong G Park
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California
| | - Tedi Begaj
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Antonio Capone
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Steve Charles
- University of Tennessee and Charles Retina Institute, Memphis, Tennessee
| | - San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Da Chou
- College of Medicine, Chang Gung University, and Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Michael N Cohen
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephanie Trejo Corona
- Retina Consultants of Texas, and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Lisa J Faia
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Sunir J Garg
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bruce R Garretson
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | - Julia A Haller
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Richard S Kaiser
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, and Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Mahsaw Mansoor
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, and Iowa Institute for Vision Research, University of Iowa, Iowa City, Iowa
| | - Ryo Matoba
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Marcio B Nehemy
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paul V Raphaelian
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alan J Ruby
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Margaret M Runner
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Scott R Sneed
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, and Iowa Institute for Vision Research, University of Iowa, Iowa City, Iowa
| | - Marc J Spirn
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James F Vander
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeremy D Wolfe
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Charles C Wykoff
- Retina Consultants of Texas, and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tamer H Mahmoud
- Associated Retinal Consultants, and Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
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Yu JJ, Adrean SD. DEXAMETHASONE INTRAVITREAL IMPLANT COMPLICATIONS INCLUDING VITREOUS HEMORRHAGE AND HYPOTONY. Retin Cases Brief Rep 2023; 17:600-603. [PMID: 35446818 PMCID: PMC10448803 DOI: 10.1097/icb.0000000000001247] [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 cases of visually significant vitreous hemorrhage (VH) following dexamethasone intravitreal implant in our practice and present two cases that required surgical intervention and a case of VH and hypotony following dexamethasone implant. An injection technique that may minimize the incidence of these complications is described and illustrated. METHODS Retrospective case series. RESULTS The overall incidence of VH was 1.7% (8 of 467 injections) and those that required surgical intervention was 0.4% (2/467) over a 10-year period, from June 2010 to June 2020 ( Table 1 ). Overall, 75% (6 of 8) VH resolved spontaneously over time, without surgical intervention. CONCLUSION Nonclearing VH and hypotony are rare but serious complications of dexamethasone implant.
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Affiliation(s)
- Jeffrey J. Yu
- Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and
| | - Sean D. Adrean
- Retina Consultants of Orange County, Fullerton, California
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Han W, Adrean SD. Valsalva Retinopathy Associated With COVID-19: Diagnosis and Surgical Management. J Vitreoretin Dis 2023; 7:444-447. [PMID: 37701268 PMCID: PMC10158804 DOI: 10.1177/24741264231167698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Purpose: To report a case of severe Valsalva retinopathy secondary to intense coughing and vomiting as symptoms of COVID-19 and describe the presentation, diagnosis, and surgical management. Methods: The patient's subjective findings, examination, fundus photography, optical coherence tomography (OCT) examinations, and laboratory results were used to diagnose the patient. Results: Surgical management was required to remove a vitreous hemorrhage (VH) and a sub-internal limiting membrane (sub-ILM) hemorrhage. Another foveal hemorrhage was determined to be intraretinal with intraoperative OCT. The patient's visual acuity improved from hand motions to 20/20 OD at postoperative week 6. Conclusions: The related COVID-19 symptoms of severe coughing and vomiting led to the Valsalva retinopathy. The VH and sub-ILM hemorrhage were successfully removed surgically. On intraoperative OCT, a foveal hemorrhage was determined to be intraretinal; thus, the decision was made to monitor it and allow it to resolve over time.
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Affiliation(s)
- Wesley Han
- Undergraduate, College of Biological Sciences, University of California, Davis, CA, USA
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Peng ET, Adrean SD. Geographic Atrophy after Reabsorption of Pigment Epithelial Detachment (GARPED) study. BMC Ophthalmol 2023; 23:242. [PMID: 37254103 DOI: 10.1186/s12886-023-02993-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/23/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND To describe the occurrence, rate of geographic atrophy (GA) expansion, and changes in visual acuity (VA) after reabsorption of subfoveal pigment epithelial detachments (PED). METHODS Included patients had reabsorption of a PED followed by GA. Patients underwent clinical examination with SD-OCT. Images were classified by size with grading occurring post reabsorption. VA was recorded pre-reabsorption, post-reabsorption, and over time. RESULTS The average age of the cohort, consisting of 22 eyes from 19 participants, was 86.9 years at reabsorption. Prior to reabsorption, the VA was 20/80 and then declined to 20/200 (p = 0.001) with an average follow-up time of 30.2 months. There was no significant VA change after the initial loss with reabsorption. The average initial lesion size of GA was 0.987 mm2 with an average growth rate of 0.274 mm/year. CONCLUSIONS This study longitudinally examined GA growth rate in patients with reabsorbed PEDs. These patients started with a drusenoid or serous PED, had a dramatic reduction in vision and GA that occurred in place of the PED. These GA lesions have a slower growth rate and a smaller area of onset compared to rates previously reported in the literature. They do not show significant VA change after reabsorption. As we have entered the era of GA therapy, these patients may not benefit from current treatments.
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Affiliation(s)
- Enoch T Peng
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
- UT Southwestern Medical School, Dallas, TX, USA
| | - Sean D Adrean
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA.
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Adrean SD, Chaili S, Hill L, Amador-Patarroyo MJ. PATTERNS OF SUBRETINAL AND/OR INTRARETINAL FLUID RECURRENCE IN PATIENTS WHO RECEIVED AS-NEEDED RANIBIZUMAB THERAPY IN THE HARBOR TRIAL. Retina 2022; 43:624-631. [PMID: 36729084 PMCID: PMC10035653 DOI: 10.1097/iae.0000000000003708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate subretinal (SRF) and/or intraretinal fluid (IRF) recurrence in patients with neovascular age-related macular degeneration (nAMD) who received as-needed (PRN) ranibizumab in a HARBOR (NCT00891735) post hoc analysis. METHODS Analyses included patients with SRF and/or IRF at baseline and fluid recurrence after a ≥3 months absence (N=222). Baseline fluid location(s) was compared with location of recurrence after a ≥3-month absence. RESULTS At baseline, fluid was equally distributed across all locations. On recurrence, the location was most frequently central (69%). Eyes with central fluid at baseline typically had recurrence in the same location (72% versus 47%-53% with fluid in other locations). The type of recurrent fluid was typically the same as at baseline (SRF, 64%; IRF, 75%). Overall, 37% (39/105) of eyes exhibited fluid recurrence in a new location, most frequently central (53%). There was a significant gain in best-corrected visual acuity (mean [95% CI], +2.2 [0.4, 4.0] letters) between the months of SRF resolution and recurrence. CONCLUSION Although the location of SRF and/or IRF were equally distributed at baseline, recurrent fluid was typically centrally located. We identified a subgroup of eyes exhibiting fluid recurrence in a different location than at baseline, potentially indicating new choroidal neovascularization.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California
| | - Siyang Chaili
- Retina Consultants of Orange County, Fullerton, California
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren Hill
- Genentech, Inc., South San Francisco, California
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Schmitt KJ, Agrawal R, Adrean SD. Paracentral acute middle maculopathy following coronary angiography. Am J Ophthalmol Case Rep 2022; 28:101674. [PMID: 36545241 PMCID: PMC9760767 DOI: 10.1016/j.ajoc.2022.101674] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To describe a case of paracentral acute middle maculopathy (PAMM) after coronary angiography. Observations A 65-year-old female patient exhibited a dense central scotoma 5 hrs after coronary angiography. She presented the next day to the retina clinic and received a complete visual examination including slit lamp biomicroscopy, dilated fundus examination, fluorescein angiogram (FA), spectral domain optical coherence tomography (SD-OCT) and OCT-Angiography (OCT-A). She was found to have the characteristic findings of PAMM including a hyperreflective band at the inner nuclear layer (INL) with extension into the inner plexiform layer (IPL) and outer plexiform layer (OPL) on imaging. Conclusions and Importance PAMM lesions can occur immediately following coronary angiography. The acute nature of the presentation and time to examination in this case lend further insights into the pathophysiology of PAMM. When patients undergo cardiovascular interventions and report new onset visual scotomas, the diagnosis of PAMM should be considered with referral for careful ophthalmic examination and work-up.
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Affiliation(s)
| | | | - Sean D. Adrean
- Retina Consultants of Orange County, Fullerton, CA, USA,Corresponding author. 301 W. Bastanchury Ave #285, Fullerton, CA, USA.
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Peng ET, Adrean SD. Unusual visual loss in a patient with exudative macular degeneration. Am J Ophthalmol Case Rep 2022; 26:101424. [PMID: 35243161 PMCID: PMC8861385 DOI: 10.1016/j.ajoc.2022.101424] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To describe a case of marked vision loss in a patient with neovascular age-related macular degeneration after choroidal neovascular membrane (CNV) improvement and stabilization. Observations An 82-year-old male presented with 20/800 vision having dropped from 20/50 three months prior. He had been undergoing active treatment for exudative macular degeneration over the past seven years, the CNV had stabilized. An extensive ophthalmic workup was performed revealing no CNV progression and no ophthalmic cause was identified for visual loss. An MRI of the brain was obtained, which showed a metastatic brain lesion in the occipital lobe, and subsequent workup determined it originated from an adenosquamous carcinoma of the lung. Conclusions When there is unexplained visual loss in an otherwise stable patient with macular degeneration, suspicion for non-retinal related causes of visual loss could alter the morbidity and mortality for patients with systemic diseases.
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Adrean SD, Knight D, Chaili S, Ramkumar HL, Pirouz A, Grant S. Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept. Int J Retina Vitreous 2022; 8:11. [PMID: 35144686 PMCID: PMC8832635 DOI: 10.1186/s40942-022-00361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study explores the long term anatomic and functional results of patients who were switched to intravitreal aflibercept injections (IAI) after being initially managed with other anti-VEGF agents for neovascular age-related macular degeneration (nAMD). Methods Patients with nAMD were included if they started with another anti-VEGF agent and were switched to IAI. Subjects had at least 3 years of consistent therapy with IAI and at least 1 injection quarterly. Results Eighty-eight patients had at least 3 years of treatment while 58 of those patients, had at least 4 years of IAI. Average treatment time with other anti-VEGF agents was 32 months prior to switching. Baseline best corrected vision (VA) was 59.4 letters (20/70 + 2). At time of switch, VA increased significantly to 66.7 letters (20/50 + 2). At 3 months after switch, VA increased significantly to 69.0 (20/40−) letters. After 3 years of consistent IAI, vision was 67.5 letters (20/40−2), and for those patients that completed 4 years of therapy, the average VA was 66.0 letters (20/50 + 2), with a gain of 6.6 letters over baseline vision. 32.1% of patients gained 3 or more lines of vision. Initial central macular thickness (CMT) was 369 µm, which improved to 347 µm at time of switch, and further improved at 3 months to 301 µm and was maintained over time. Conclusion Patients switched to IAI can maintain vision over the long term. Patients treated on average for 5.7 years, had a visual gain of 8.1 letters after 3 years and 6.6 letters after 4 years of IAI therapy. CMT significantly improved following the switch and was maintained. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-022-00361-9.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA.
| | - Darren Knight
- University of California San Diego, Shiley Eye Institute, La Jolla, CA, 92093, USA
| | - Siyang Chaili
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| | - Hema L Ramkumar
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| | - Ash Pirouz
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| | - Scott Grant
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
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Grant S, Adrean SD. Surgical Macular Hole Closure Without a Gas Tamponade. Journal of VitreoRetinal Diseases 2022; 6:14-21. [PMID: 37007721 PMCID: PMC9976217 DOI: 10.1177/24741264211018958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade. Methods: Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results. Results: Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80– (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30–2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant ( P = .003). The hole that did not close initially without gas tamponade was the largest in the series. Conclusions: Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.
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Affiliation(s)
- Scott Grant
- Retina Consultants of Orange County, Fullerton, CA, USA
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Adrean SD, Chaili S, Pirouz A, Grant S. Results of patients with neovascular age-related macular degeneration managed by a treat-extend-stop protocol without recurrence. Graefes Arch Clin Exp Ophthalmol 2021; 259:3665-3673. [PMID: 34251484 DOI: 10.1007/s00417-021-05283-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/05/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess vision, injection quantity, initial lesion size, and final anatomic status in patients with nAMD completing the treat-extend-stop (TES) protocol. METHODS Patients with nAMD received ≥ 3 monthly anti-VEGF injections followed by 1-2 week injection interval extensions, with intra/subretinal fluid resolution on SD-OCT, to 12 weeks. With quiescent disease, and 2 quarterly injections, patients were monitored alone beginning at 4 weeks extending by 1-2 week intervals until quarterly monitoring. RESULTS Eighty-eight of 143 eyes with nAMD completed the TES protocol without disease recurrence. Sixteen (18.2%) developed sub-foveal geographic atrophy (GA), 25 (28.4%) developed fibrovascular scarring (FV) and 47 (53.4%) developed regressed choroidal neovascularization (rCNV) with 16.9 ± 13.3 average injections between the 3 groups which was not statistically significant. Average treatment time was 30.3 ± 26.1 months and subsequent follow-up was 23.2 ± 19.8 months. Average lesion size for FV was 18.77 ± 10.8mm2 vs. GA at 12.00 ± 9.99mm2 vs. regressed CNV at 7.12 ± 6.5mm2 (p < 0.05). Pre, post, and final vision for GA was 39.6 letters (20/160) vs. 32.7 letters (20/200 + 2, p = 0.4725) vs. 25.0 letters (20/320, p = 0.0865); FV was 22.4 letters (20/400 + 2) vs. 11.6 letters (20/640, p = 0.0351) vs. 11.0 letters (20/640 + 1, p = 0.0226), and rCNV was 56.4 letters (20/80 + 1) vs. 69.5 letters (20/40, p < 0.001) vs. 67.3 letters (20/40-2, p = 0.0016). In the rCNV group, 17/46 eyes gained ≥ 3 lines and 30/46 eyes achieved ≥ 20/40 vision. Non-central GA expanded 0.226 ± 0.126 mm vs. 0.225 ± 0.098 mm during and after treatment completion over 24 months (p = 0.99). CONCLUSIONS Central GA or FV portends worse visual outcomes vs. rCNV after cessation of therapy. Anti-VEGF therapy may not affect the rate of GA expansion. Final anatomic character and location are key determinants of final vision.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA.
| | - Siyang Chaili
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Ash Pirouz
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
| | - Scott Grant
- Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA
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Adrean SD, Chaili S, Pirouz A, Grant S. Central Serous Chorioretinopathy in Elderly Patients Mimicking Occult Neovascular Age-Related Macular Degeneration. Clin Ophthalmol 2020; 14:4073-4078. [PMID: 33268981 PMCID: PMC7701152 DOI: 10.2147/opth.s279845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe elderly patients with central serous chorioretinopathy (CSCR) mimicking occult neovascular age-related macular degeneration (nAMD). Materials and Methods The records of 522 patients with initial diagnoses of nAMD over one year were reviewed to determine characteristics meeting diagnostic criteria for CSCR with three or more months of follow-up. Patients were evaluated by clinical examination, fluorescein angiography (FA) and optical coherence tomography (OCT). At the time of initial evaluation, patients were either monitored, treated with anti-VEGF therapy or with combination anti-VEGF and photodynamic therapy (PDT). When no response to anti-vascular endothelial growth factor (anti-VEGF) treatment was observed, the diagnosis of CSCR was favored and patients were observed with close follow-up. The Student’s t-test was used for statistical analysis; a p-value < 0.05 was considered statistically significant. Results Eleven elderly patients met diagnostic criteria for CSCR among 522 patients initially diagnosed with nAMD. Average age was 75.9 years, and average follow-up was 16.9 months. Average presenting visual acuity was 20/50+2 (67.9 ± 5.9 ETDRS letters), and choroidal thickness was 232.0 ± 69.4 µm. After observation or treatment, the average vision improved to 20/40+ (70.5 ± 7.8 ETDRS letters, p=0.289). When intravitreal bevacizumab was given, no changes were observed for patients’ neurosensory retinal detachments (NSRD). When NSRD changes were observed, they likewise did not correlate to the timing of anti-VEGF treatment. For patients who were monitored alone, one patient lost one line of vision, one gained one line, one gained two lines, and one gained three lines. One patient subsequently developed a choroidal neovascular membrane (CNVM) during initial follow-up with visual improvement after anti-VEGF treatment. Four patients developed CNVM overall with long term follow-up. Conclusion CSCR in elderly patients can mimic occult CNVM, especially on FA. In this group, many patients were monitored without treatment, which typically resulted in stable or improved vision. Careful monitoring is required because of possible development of CNVM.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, CA 92835, USA
| | - Siyang Chaili
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ash Pirouz
- Retina Consultants of Orange County, Fullerton, CA 92835, USA
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, CA 92835, USA
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Chaili S, Mok A, Adrean SD. Purtscher-like retinopathy following total knee arthroplasty: A report of 2 cases. Am J Ophthalmol Case Rep 2020; 20:100945. [PMID: 33083634 PMCID: PMC7554326 DOI: 10.1016/j.ajoc.2020.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/22/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe two cases of Purtscher-like retinopathy after total knee arthroplasty. Observations Two patients were referred for blurred vision after knee surgery. They received a complete vision examination including slit lamp exam, dilated fundus exam, fluorescein angiogram and optical coherence tomography. Two patients developed Purtscher-like retinopathy after knee surgery. The first was a 58-year-old male who underwent bilateral total knee arthroplasty. The second patient developed an infected joint and subsequently received a total knee arthroplasty revision surgery. Both patients experienced decreased vision and were found to have characteristic findings of Purtscher-like retinopathy including vessel attenuation, cotton wool spots and nerve fiber layer infarcts following their respective operations in the absence of other injury. Conclusions and Importance Purtscher-like retinopathy can occur immediately following total knee arthroplasty. Factors including fatty acid liberation, endothelial damage, aberrant coagulation cascade activation, leukocyte aggregation, embolic vascular occlusion and microinfarction likely contributed to these findings. When patients undergo knee arthroplasty and complain of visual scotomas, the diagnosis of Purtscher-like retinopathy should be considered with careful ophthalmic examination and work-up.
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Affiliation(s)
- Siyang Chaili
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, 2311 Pierce Ave.Nashville, TN, 37232, USA
| | - Audrey Mok
- Eye Treatment Center, 3900 Long Beach Blvd, Long Beach, CA, 90807, USA
| | - Sean D Adrean
- Retinal Consultants of Orange County, 301 W Bastanchury Rd #285, Fullerton, CA, 92835, USA
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Adrean SD, Morgenthien E, Ghanekar A, Ali FS. Subretinal Fibrosis in HARBOR Varies by Choroidal Neovascularization Subtype. Ophthalmol Retina 2020; 4:752-754. [PMID: 32414568 DOI: 10.1016/j.oret.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California.
| | | | | | - Ferhina S Ali
- Genentech, Inc., South San Francisco, California; Retina Center of Texas, Dallas, Texas
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Adrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Reply. Ophthalmology 2018; 125:e84-e85. [PMID: 30343938 DOI: 10.1016/j.ophtha.2018.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sean D Adrean
- Retinal Consultants of Orange County, Fullerton, California.
| | - Siyang Chaili
- Retinal Consultants of Orange County, Fullerton, California
| | - Hema Ramkumar
- Retinal Consultants of Orange County, Fullerton, California
| | - Ash Pirouz
- Retinal Consultants of Orange County, Fullerton, California
| | - Scott Grant
- Retinal Consultants of Orange County, Fullerton, California
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Adrean SD, Chaili S, Pirouz A, Grant S. Reply. Ophthalmol Retina 2018; 2:e10-e11. [PMID: 31047543 DOI: 10.1016/j.oret.2018.04.024] [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: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California.
| | - Siyang Chaili
- Retina Consultants of Orange County, Fullerton, California
| | - Ash Pirouz
- Retina Consultants of Orange County, Fullerton, California
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, California
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Adrean SD, Chaili S, Grant S, Pirouz A. Recurrence Rate of Choroidal Neovascularization in Neovascular Age-Related Macular Degeneration Managed with a Treat–Extend–Stop Protocol. ACTA ACUST UNITED AC 2018; 2:225-230. [DOI: 10.1016/j.oret.2017.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022]
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Adrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Consistent Long-Term Therapy of Neovascular Age-Related Macular Degeneration Managed by 50 or More Anti-VEGF Injections Using a Treat-Extend-Stop Protocol. Ophthalmology 2018; 125:1047-1053. [PMID: 29439828 DOI: 10.1016/j.ophtha.2018.01.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To examine the clinical results for patients with neovascular age-related macular degeneration (nAMD) who were managed with a treat-extend-stop (TES) protocol and received 50 or more injections of anti-vascular endothelial growth factor (VEGF) agents. DESIGN Retrospective case study. PARTICIPANTS Data for patients from a private retina practice meeting the following criteria were included: diagnosis of nAMD and having received 50 or more intravitreal injections of anti-VEGF agents. METHODS The patients' baseline visual acuity (VA; obtained using Snellen charts and converted to Early Treatment Diabetic Retinopathy Study [ETDRS] letters), age, length of follow-up, anti-VEGF agents used, and interval between treatments were obtained. These data were examined through the 51st injection and at the last follow-up examination. Patients were excluded if they lost significant vision because of a diagnosis unrelated to AMD during therapy. MAIN OUTCOME MEASURES Visual acuity and complications. RESULTS Seventy-one eyes of 67 patients were identified who met inclusion criteria. The mean age of patients was 83.0 years. Women made up 58.2% of the study population, whereas men constituted 41.8%. The mean initial VA was 55.6 ETDRS letters. The mean duration of follow-up at the 51st visit for an injection was 6.5 years, and the mean duration of follow-up at the last visit was 8 years. The mean number of injections at final follow-up was 63.7. The mean interval between treatments at the 51st follow-up was 5.4 weeks, and the mean follow-up at the last examination was 6.4 weeks. Mean VA at the 51st injection was 65.3 letters, and the mean change from baseline was 9.7 letters (P < 0.001, Student paired t test). The mean vision gained at last follow-up was 8.7 letters from baseline (P < 0.001), or 64.3 letters. CONCLUSIONS In this study, patients gained a mean of 2 ETDRS lines after 50 injections. This study had a mean follow-up of 8 years, and 35.2% of eyes had a 3-line or more gain in VA at the last follow-up examination. Patients who require consistent long-term anti-VEGF therapy, managed with a TES protocol, are likely able to maintain or improve their vision.
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Affiliation(s)
- Sean D Adrean
- Retina Consultants of Orange County, Fullerton, California.
| | - Siyang Chaili
- Retina Consultants of Orange County, Fullerton, California
| | - Hema Ramkumar
- Retina Consultants of Orange County, Fullerton, California
| | - Ash Pirouz
- Retina Consultants of Orange County, Fullerton, California
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, California
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Kiang L, Pirouz A, Grant S, Adrean SD, Malihi M, Lin P. Aspergillus Endophthalmitis Resulting in Development of Retinal Aspergilloma. Ophthalmic Surg Lasers Imaging Retina 2017; 48:680-683. [PMID: 28810046 DOI: 10.3928/23258160-20170802-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
Abstract
A 78-year-old immunocompetent man presented with a 3-month history of painless decreased vision and panuveitis with a macular lesion presumed to be due to endogenous endophthalmitis. He had been treated with systemic, intravenous, and intravitreal antibiotics and antifungal agents as well as intravitreal steroids. A culture from a prior vitrectomy had grown a single colony of Aspergillus thought to be a contaminant. The macular lesion enlarged and caused a tractional retinal detachment. The patient underwent surgery including resection of what appeared to be an invasive retinal aspergilloma, from which polymerase chain reaction and histopathology confirmed Aspergillus fumigatus. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:680-683.].
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Abbott RL, Adrean SD, Al-Muammar A, Akhtar J, Alfonso EC, Allen RC, Almond MC, Alvarenga L, Alward WLM, Ambrósio R, Anwar M, Azar DT, Ball JL, Barney NP, Bartow RM, Baum J, Belin MW, Bell JH, Benetz BA, Berbos Z, Beuerman RW, Bhasin AK, Bhat PV, Biber JM, Bidros M, Birnbaum AD, Bouchard CS, Bradley JC, Brandt JD, Brasington RD, Brilakis HS, Burkat CN, Calatayud M, Cameron JD, Campos M, Carpel EF, Cavanagh HD, Chan C, Chang RI, Chang BH, Chern KC, Ching S, Chodosh J, Choo PH, Chung G, Ciolino JB, Clayton JA, Cohen EJ, Comyn O, Cortina MS, Cowden JW, Croasdale CR, Davidson RS, Davis EA, Daya SM, Freitas DD, DeMill DL, de Oliveira LA, de Smet MD, de Sousa LB, Djalilian AR, Dohlman CH, Donnenfeld ED, Dortzbach RK, Driebe WT, Dunn SP, Eagle RC, Edelstein SL, Eiferman RA, Eliason JA, Farid M, Faulkner WJ, Feder RS, Feiz V, Feng MT, Fingert JH, Florakis GJ, Fontana L, Forster RK, Foster CS, Foster FS, Foulks GN, Friedlander MH, Fukuda M, Galor A, Gan TJ, Garg P, Garg S, Glasser DB, Goins KM, Goldstein DA, Gottlieb C, Grimmett MR, Gris O, Groos EB, Gruzensky WD, Güell JL, Gupta PK, Hamill MB, Hammersmith KM, Hamrah P, Hannush SB, Hardten DR, Harrison A, Heck EL, Heidemann DG, Herman DC, Heur JM, Hodge WG, Hoffman CJ, Holland EJ, Holland GN, Honig MA, Hood CT, Hoskins EN, Huang AJW, Huang D, Hui JI, Iuorno JD, Jackson WB, Jakobiec FA, Jeng BH, Jester JV, Jordan DR, Kaiura TL, Karp CL, Katz DG, Kaufman SC, Kersten RC, Khachikian SS, Kim JH, Kim JY, Kim SK, Kim T, Kirkness CM, Klyce SD, Koch DD, Kowalski RP, Krachmer JH, Laibson PR, Lane SS, Lass JH, Lee WB, Lee OA, Lemp MA, Lenhart PD, Li Y, Liesegang TJ, Lim MC, Lin LK, Lin MP, Lindquist TD, Lindstrom RL, Litoff D, Liu C, Lowder CY, Lubniewski AJ, McGee HT, McLean IW, Macsai MS, Manero F, Mannis MJ, Mantopoulos D, Martinez CE, Mártonyi CL, Mashor RS, Mathers WD, Mehta MN, Meisler DM, Mian SI, Miller D, Miller CA, Montoya M, Morral M, Moyes AL, Murphy ML, Nassiri N, Neff KD, Nelson JD, Nerad JA, Netto MV, Newton CJ, Nijm LM, Nishida T, Noble BA, Nordlund ML, Nussenblatt RB, O'Day DG, Ongkosuwito JV, Oxford KW, Palay DA, Palmon FE, Paranjpe DR, Parikh M, Park DH, Park DJJ, Parsons MR, Pavlin CJ, Pearlstein ES, Perry A, Petroll WM, Pfister DR, Pfister RR, Pflugfelder SC, Price FW, Price MO, Probst LE, Purcell JJ, Pyott AAE, Raizman MB, Raju LV, Randleman JB, Rao GN, Rapuano CJ, Reilly CD, de Candelaria Renesto A, Rezende RA, Robertson DM, Rootman DS, Rothman JS, Rubinfeld RS, Sadowsky AE, Saika S, Sakhalkar MV, Salz JJ, Sangwan VS, Scarpi M, Scharf BH, Schmidt G, Schmitt A, Schmitt FP, Schteingart MT, Schwab IR, Schwam BL, Schwartz GS, Sen HN, Shapiro MB, Shimmura S, Singal N, Skeens HM, Skolnick CA, Slomovic AR, Smith JA, Snyder ME, Solomon R, Soukiasian SH, Srinivasan S, Stamler JF, Steinert RF, Stoller GL, Streeten BW, Stulting RD, Sugar A, Sugar J, Tan D, Tauber J, Terry MA, Tessler HH, Torrabadella M, Traboulsi EI, Trattler WB, Tsai JH, Tse DT, Tu EY, Ursea R, Vaddavalli PK, Van Meter WS, Varley GA, Vasaiwala R, Verachtert AJ, Verdier DD, Vieira AC, Virasch VV, Wang L, Waring GO, Waring GO, Warner MA, Warrian KJ, Webster GF, Weikert MP, Weisenthal RW, Weiss JS, Wichiensin P, Wilhelmus KR, Wilson SE, Woodward MA, Yee RW, Yoo S. Contributors. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bandyopadhyay S, Adrean SD, Puklin JE, Feng J. Choroidal metastasis from an occult primary diagnosed by fine-needle aspiration: a case report. Diagn Cytopathol 2009; 37:38-41. [PMID: 18973116 DOI: 10.1002/dc.20918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Choroidal masses are rarely the first presentation without the primary tumor being discovered. We described fine needle aspiration biopsy (FNAB) of a choroidal mass for diagnosis and determining the primary site. The patient, a 50-year-old Caucasian male without significant past medical history, presented with visual disturbances and headaches. Intraoperative ocular FNA was performed which was sparsely cellular showing a few loosely cohesive sheets and singly arranged epithelial cells with moderate amount cytoplasm, round large nuclei and prominent nucleoli. Immunohistochemical stainings on the cell block material showed positive staining of cytokeratin and negative staining of melanoma markers. The diagnosis of metastatic adenocarcinoma was rendered. During clinical follow up studies, the patient was found to have a PET positive lung nodule and multiple visceral metastasis.
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Abstract
PURPOSE To describe a case of a perforated corneal ulcer leading to a bacterial endophthalmitis in a patient with graft-versus-host disease (GVHD). METHODS Clinical history and examination; slit-lamp photography; surgical intervention; laboratory evaluation including microbiology, polymerase chain reaction (PCR), flow cytometry, and cytopathology. RESULTS A diagnostic and therapeutic pars plana vitrectomy was performed. The vitreous aspirate was evaluated with microbiology; PCR for herpes simplex, herpes zoster, and cytomegalovirus; flow cytometry; and cytopathology. The patient received intravitreal antibiotics and antifungal and antiviral medication. The vitreous culture grew Staphylococcus epidermidis. CONCLUSION Patients with GVHD are at risk for corneal ulcers with subsequent perforation. Commensal ocular flora may seed the vitreous and cause an endophthalmitis. Patients with GVHD may develop a vitritis from many causes including viral, fungal, and bacterial etiologies or a relapse of their original disease. When patients with GVHD present with vitritis, consideration should be given to obtaining a large vitreous aspirate to establish the etiology.
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Affiliation(s)
- Sean D Adrean
- Kresge Eye Institute, Department of Ophthalmology, Detroit, MI, USA
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Darlington JK, Adrean SD, Schwab IR. Trends of penetrating keratoplasty in the United States from 1980 to 2004. Ophthalmology 2006; 113:2171-5. [PMID: 16996602 DOI: 10.1016/j.ophtha.2006.06.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 06/19/2006] [Accepted: 06/21/2006] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To examine the changing trends in penetrating keratoplasties (PKs) performed in the United States. DESIGN Retrospective review. METHODS Review of Eye Bank Association of America (EBAA) data on corneal tissue distribution in the United States from 1980 to 2004. Data analysis was retrospective. United States population census data were obtained and used for population-adjusted calculations. A series of Poisson regression models were calculated looking at the temporal trends over time. MAIN OUTCOME MEASURES The estimated yearly percent change and P values were calculated using Poisson regression models. RESULTS The total number of corneas distributed for PKs from EBAA member eye banks have steadily increased since 1980. In 1990, the international and domestic distribution data were separated. The total number of PKs performed from EBAA-supplied tissue has continued to rise since 1990; however, the total number of PKs performed in the United States has steadily declined and when population-adjusted rates are examined, the rate of decline is more dramatic. CONCLUSION Although both absolute numbers and age-adjusted numbers of PKs have declined recently, the population-adjusted rates have dropped more significantly.
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Affiliation(s)
- Jason K Darlington
- Cornea, External Disease, and Refractive Surgery Service, Department of Ophthalmology, University of California, Davis, Sacramento, California, USA
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Abstract
PURPOSE To report a case of a patient who underwent cataract extraction with intraocular lens (IOL) implantation after previous penetrating keratoplasty (PK) followed by laser in situ keratomileusis (LASIK). METHODS Case report and literature review of cataract surgery after PK and LASIK. Cataract surgery was successfully performed in a patient with previous PK and LASIK. This paper outlines our method of calculating the correct power IOL for implant. RESULTS The patient's 1-month postoperative uncorrected visual acuity was 20/70 and best spectacle-corrected visual acuity was 20/30+ with -0.75 +0.50 x 180. CONCLUSIONS We report the case of a patient with cataract extraction with IOL implantation after PK and LASIK as well as a description of the method used to calculate IOL power after PK and LASIK. While the IOL selection can be difficult, using the appropriate nomogram can result in good visual outcomes.
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Affiliation(s)
- Sean D Adrean
- Department of Ophthalmology, University of California, Davis, School of Medicine, Sacramento, 95817, USA
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Abstract
PURPOSE To present 3 cases in 2 patients of infectious keratitis of the astigmatic keratotomy (AK) site in patients who had previous penetrating keratoplasty. METHODS History, clinical examination, chart review, cultures, and laboratory results were obtained from 2 patients with infectious keratitis within the donor stroma of their graft after an AK was performed. RESULTS One patient had an early infiltrate of the AK site that was culture negative. This cleared with fortified antibiotics, and the patient had a final visual acuity of 20/30-2. The second patient developed 2 late infections, the first with coagulase negative Staphylococcus and the second infection with Pseudomonas aeruginosa. Both of these infections cleared with fortified antibiotics, and the final visual acuity was 20/25. Neither patient developed a rejection episode from the infections, and both grafts survived. CONCLUSIONS We report a series of 3 cases of infectious keratitis in 2 patients after AKs in corneal grafts. This, to the best of our knowledge, has not been previously reported. Patients who suffer infectious keratitis after AK in corneal grafts may have good visual outcomes if managed with appropriate antibiotic regimens and closely followed.
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Affiliation(s)
- Sean D Adrean
- Department of Ophthalmology, University of California, Davis, School of Medicine, Sacramento, 95817, USA
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Abstract
PURPOSE To document a case of central retinal vein occlusion (CRVO) associated with renal cell carcinoma and elevated levels of anticardiolipin and antiphospholipid antibodies. DESIGN Observational case report. METHODS History, clinical examination, chart review, and laboratory serologies were performed on a 63-year-old man with renal cell carcinoma with a 6-week history of decreased vision in his left eye. RESULTS Vision was 20/40 in the left eye. Dilated fundus examination revealed a CRVO. Laboratory serologies revealed markedly elevated levels of anticardiolipin and antiphospholipid antibodies. CONCLUSION This case illustrates an association between CRVO and renal cell carcinoma. A paraneoplastic process, consisting of both antiphospholipid and anticardiolipin antibodies, may be a mechanism for CRVO.
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Affiliation(s)
- Sean D Adrean
- Department of Ophthalmology, School of Medicine, University of California, Davis, California 95817, USA
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