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Dohlman TH, Singh RB, Amparo F, Carreno-Galeano T, Dastjerdi M, Coco G, Di Zazzo A, Shikari H, Saboo U, Sippel K, Ciralsky J, Yoo SH, Sticca M, Wakamatsu TH, Murthy S, Hamrah P, Jurkunas U, Ciolino JB, Saeed H, Gomes JA, Perez VL, Yin J, Dana R. Suppression of Neovascularization by Topical and Subconjunctival Bevacizumab After High-Risk Corneal Transplantation. Ophthalmol Sci 2024; 4:100492. [PMID: 38682029 PMCID: PMC11046200 DOI: 10.1016/j.xops.2024.100492] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Abstract
Purpose To assess the effectiveness of topical and subconjunctival bevacizumab in suppressing vascularization in graft and host bed after high-risk corneal transplantation. Design Secondary analysis of prospective, randomized, double-blind, placebo-controlled multicentric clinical trial. Participants The study includes patients aged > 18 years who underwent high-risk penetrating keratoplasty, which was defined as corneal vascularization in ≥ 1 quadrants of the corneal graft and host bed, excluding the limbus. Methods Patients were randomized to treatment and control groups. The patients in the treatment group received subconjunctival injection of bevacizumab (2.5 mg/0.1 ml) on the day of the procedure, followed by topical bevacizumab (10 mg/ml) 4 times per day for 4 weeks. The patients in control group received injection of vehicle (0.9% sodium chloride) on the day of procedure, followed by topical vehicle (carboxymethylcellulose sodium 1%) 4 times a day for 4 weeks. Main Outcome Measures Vessel and invasion area of vessels in the corneal graft and host beds. Results This study included 56 eyes of 56 patients who underwent high-risk corneal transplantation, with equal numbers in the bevacizumab and vehicle (control) treatment groups. The mean age of patients who received bevacizumab was 61.2 ± 15.9 years, and the mean age of those treated with vehicle was 60.0 ± 16.1 years. The vessel area at baseline was comparable in the bevacizumab (16.72% ± 3.19%) and control groups (15.48% ± 3.12%; P = 0.72). Similarly, the invasion areas were also similar in the treatment (35.60% ± 2.47%) and control (34.23% ± 2.64%; P = 0.9) groups at baseline. The reduction in vessel area was significantly higher in the bevacizumab-treated group (83.7%) over a period of 52 weeks compared with the control group (61.5%; P < 0.0001). In the bevacizumab-treated group, invasion area was reduced by 75.8% as compared with 46.5% in the control group. The vessel area was similar at 52 weeks postprocedure in cases of first (3.54% ± 1.21%) and repeat (3.80% ± 0.40%) corneal transplantation in patients who received bevacizumab treatment. In the vehicle-treated patients, the vessel area was significantly higher in repeat (9.76% ± 0.32%) compared with first (8.06% ± 1.02%; P < 0.0001) penetrating keratoplasty. In the bevacizumab treatment group, invasion areas at week 52 were comparable in first (11.70% ± 3.38%) and repeat (11.64% ± 1.74%) procedures, whereas invasion area was significantly higher in repeat (27.87% ± 2.57%) as compared with first (24.11% ± 2.17%) penetrating keratoplasty in vehicle-treated patients. Conclusions In patients undergoing vascularized high-risk corneal transplantation, bevacizumab is efficacious in reducing vascularization of corneal graft and host bed, thereby reducing the risk of corneal graft rejection in vascularized host beds. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas H. Dohlman
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rohan Bir Singh
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tatiana Carreno-Galeano
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Dastjerdi
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Giulia Coco
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Di Zazzo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hasanain Shikari
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ujwala Saboo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Matheus Sticca
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tais H. Wakamatsu
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Somasheila Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Pedram Hamrah
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ula Jurkunas
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B. Ciolino
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hajirah Saeed
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jose A.P. Gomes
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Victor L. Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Jia Yin
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Morgado CR, Santhiago MR, Steigleman WA, Hofmeister EM, Henriquez MA, Zarei-Ghanavati S, Yoo SH, Jacob S, Schallhorn J. Late approach for LASIK flap striae. J Cataract Refract Surg 2023; 49:1285-1289. [PMID: 37982777 DOI: 10.1097/j.jcrs.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
A 24-year-old man was referred for postrefractive surgery evaluation. The patient had a history of uneventful laser in situ keratomileusis (LASIK) in both eyes 3 months previously. According to the surgeon who originally performed the surgery, on slitlamp examination, only microstriae in the left eye was detected on postoperative day 1 and a more conservative follow-up approach was adopted without further immediate intervention. The patient returned only 3 months after surgery, complaining of low vision in the left eye that, according to the patient, had been present since postoperative week 2. The patient was then referred for examination and surgical procedure with a diagnosis of significant postoperative striae. The slitlamp examination revealed a LASIK flap with striae, epithelial filling, and a wrinkled appearance (Figure 1JOURNAL/jcrs/04.03/02158034-202312000-00017/figure1/v/2023-11-20T151558Z/r/image-tiff). There were no signs of infection or inflammation. Originally, the LASIK flap was programmed to be 110 μm. Preoperative manifest refraction in the right eye was -5.25 (20/20) and in the left eye was -5.25 (20/20). Assuming it is a case of late-approach LASIK flap striae, how would you proceed? Would you try to hydrate and lift the flap and just reposition it? Would you avoid lifting and associate phototherapeutic keratectomy (PTK) with excimer laser on top of the flap? Would you consider topo-guided surgery with regularization of the visual axis or even amputation of the flap?
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Aiello F, Gallo Afflitto G, Leviste K, Swaminathan SS, Yoo SH, Findl O, Maurino V, Nucci C. Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 2023; 49:1168-1179. [PMID: 37276258 DOI: 10.1097/j.jcrs.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
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Affiliation(s)
- Francesco Aiello
- From the Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (Aiello, Gallo Afflitto, Nucci); Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Gallo Afflitto, Leviste, Swaminathan, Yoo); Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Maurino); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl)
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Chen J, Elhusseiny AM, Khodeiry MM, Smith MP, Sayed MS, Banitt M, Feuer W, Yoo SH, Lee RK. Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty. J Glaucoma 2023; 32:800-806. [PMID: 37171992 PMCID: PMC10524893 DOI: 10.1097/ijg.0000000000002239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/12/2023] [Indexed: 05/14/2023]
Abstract
PRCIS We evaluated the factors that impacted time from glaucoma drainage implant (GDI) surgery to penetrating keratoplasty (PK) in eyes with previously clear corneas (ie, GDI-first sequence), and that specifically underwent a trabeculectomy before GDI surgery for intraocular pressure (IOP) control. PURPOSE To describe through an event-triggered data collection method the clinical course and the long-term outcomes of 2 procedures that are commonly performed sequentially in complex clinical situations: GDI surgery and PK. The study investigates the clinical factors associated with the progression to PK and determines the GDI success rate and graft survival. METHODS A single, tertiary-care center retrospective interventional cases series including patients with a sequential history of trabeculectomy, GDI surgery, and PK from 1999 to 2009. Outcome measures included IOP, visual acuity, graft failure, GDI failure, and time from GDI to PK. RESULTS Of the eyes, 56% had primary open angle glaucoma. The time from the last trabeculectomy to GDI was 66.5 ± 66.7 months. Of the eyes, 84% received a Baerveldt GDI. Time from GDI to PK was 36.4 ± 28.4 months. IOP at the time of PK was between 5 mm Hg and 21 mm Hg in 90% of eyes. At the last follow-up, 48% of grafts were clear. At 5 years post-PK, 33% of corneal grafts remained clear, whereas 81% of tubes remained functional. CONCLUSIONS Nearly half of the corneal grafts are clear at the last long-term follow-up. Graft failure occurs at a higher rate than tube failure suggesting that IOP control is only one and possibly not the most important factor in graft survival in eyes with prior glaucoma surgery.
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Affiliation(s)
- Jessica Chen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Palo Alto Eye Group, 1805 El Camino Real, Palo Alto, CA 94306
| | - Abdelrahman M. Elhusseiny
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - Mohamed M. Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P. Smith
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Eye Consultants of PA, 1 Granite Point, Wyomissing, PA 19610
| | - Mohamed S. Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Moorfields Eye Hospital, Dubai, UAE
| | - Michael Banitt
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Northwest Eye Surgeons, 332 Northgate Way, Seattle, WA 98125
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Richard K. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
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Lee SW, Jung EH, Kim HJ, Min C, Yoo SH, Kim YJ, Rha SY, Yon DK, Kang B. Risk factors for delirium among patients with advanced cancer in palliative care: a multicenter, patient-based registry cohort in South Korea. Eur Rev Med Pharmacol Sci 2023; 27:2068-2076. [PMID: 36930505 DOI: 10.26355/eurrev_202303_31578] [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] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Previous studies have comprehensively investigated the prevalence and various potential risk factors for delirium among patients with advanced cancer admitted to the acute palliative care unit (APCU). Our objective was to evaluate the comprehensive association between delirium and various risk factors among patients with advanced cancer in an acute palliative care setting using a patient-based multicenter registry cohort. PATIENTS AND METHODS We performed a multicenter, patient-based registry cohort study collected in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified using a medical record review based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS In total, 2,124 eligible patients with advanced cancer in the APCU met the inclusion criteria. There were 127 out of 2,124 patients (prevalence, 6.0%; 95% CI, 5.0 to 7.1) with delirium during admission. Delirium in patients with advanced cancer was associated with age >70 years (OR, 1.793; 95% CI, 1.246 to 2.581), male sex (OR, 1.675; 95% CI, 1.131 to 2.479), no chemotherapy during hospitalization (OR, 2.019; 95% CI, 1.236 to 3.298), hearing impairment (OR, 3.566; 95% CI, 1.176 to 10.810), underweight (OR, 1.826; 95% CI, 1.067 to 3.124), current use of opioid medication (OR, 1.942; 95% CI, 1.264 to 2.982), previous history of delirium (OR, 12.497; 95% CI, 6.920 to 22.568), and mental illness (OR, 2.333; 95% CI, 1.251 to 4.352). CONCLUSIONS In a large-scale multicenter patient-based registry cohort, delirium was associated with old age, male sex, no chemotherapy during hospitalization, hearing impairment, underweight, current use of opioid medication, and a history of delirium and mental illness. Our findings suggest physicians should pay attention to delirium in patients with advanced cancer admitted to the APCU with the above risk factors.
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Affiliation(s)
- S W Lee
- Palliative Care Center, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.
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Kunkler AL, Sengillo JD, Al-Khersan H, Fan KC, Laura DM, Miller D, Donaldson KE, Yoo SH, Yannuzzi NA, Sridhar J, Gedde SJ, Smiddy WE, Flynn HW. Acute-onset postoperative endophthalmitis after cataract surgery performed by resident and attending physicians at a university teaching hospital. J Cataract Refract Surg 2022; 48:1312-1317. [PMID: 35786812 DOI: 10.1097/j.jcrs.0000000000000989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate acute-onset postoperative endophthalmitis following cataract surgery and to compare rates between resident and attending physician-performed cohorts. SETTING Bascom Palmer Eye Institute, Miami, Florida. DESIGN Retrospective chart review. METHODS Records of patients diagnosed with endophthalmitis within 6 weeks of surgery performed by attending and resident physicians between January 1, 2015, and December 31, 2020, were reviewed. Total cataract volume was obtained from institutional records, and resident case totals were obtained from case logs. Endophthalmitis cases were obtained from billing records and confirmed with chart review. RESULTS There were 22 cases of endophthalmitis among 32 505 cases (0.068%). Endophthalmitis occurred in 6 of 6447 (0.093%) resident cases and 16 of 26 058 (0.061%) attending cases ( P = .55). The most common bacterial isolates were coagulase-negative Staphylococcus (8/22, 36.3%) and Streptococcus species (3/22, 13.6%), with negative cultures in 10 (10/22, 45.5%). Initial treatment with vitreous tap and injection of intravitreal antibiotics was performed in 21 eyes (21/22, 95.4%) and vitrectomy with intravitreal antibiotic injection in one (1/22, 4.5%). Vitrectomy was performed secondarily in 9 patients (9/22, 40.9%). Corrected distance visual acuity (CDVA) at last follow-up was ≥20/40 in 13 eyes (13/22, 59%) and ≤hand motions in 3 eyes (3/22, 13.6%). CDVA (logMAR mean ± SD) was 1.22 ± 1.16 in resident and 0.49 ± 0.79 in attending cases ( P = .11). CONCLUSIONS In the current study, acute-onset postoperative endophthalmitis developed infrequently following cataract surgery. The rates and visual outcomes of endophthalmitis were similar in resident and attending cases.
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Affiliation(s)
- Anne L Kunkler
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Shen M, Shi Y, Wang L, Russell JF, Jiang X, Laiginhas R, Iyer P, Trivizki O, Thulliez M, Yoo SH, Rose TP, Habash RG, Amescua G, Feuer WJ, Gregori G, Rosenfeld PJ. Impact of Cataract Surgery on Low Luminance Visual Acuity Deficit Measurements. Ophthalmology Science 2022; 2:100170. [PMID: 36245760 PMCID: PMC9559759 DOI: 10.1016/j.xops.2022.100170] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/24/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Purpose The impact of cataract surgery on low luminance visual acuity deficit (LLVAD) measurements was investigated by measuring the LLVAD before and after cataract surgery. Design Prospective, longitudinal study. Participants Patients undergoing cataract surgery. Methods Photopic luminance (PL)–best-corrected visual acuity (BCVA) and low luminance (LL)–BCVA were obtained using the ETDRS chart. Low luminance visual acuity deficit scores were calculated by subtracting the LL-BCVA letter score from the PL-BCVA letter score. To demonstrate the reproducibility of these visual acuity measurements, we used data from drusen-only eyes previously published in the Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration (COMPLETE) study. The PL-BCVA, LL-BCVA, and LLVAD measurements obtained at an interval of 3 months in this cohort were used for comparison. In the current study, the impact of cataract surgery on LLVAD measurements was analyzed by comparing the PL-BCVA, LL-BCVA, and LLVAD measurements before and after cataract surgery. Main Outcome Measures The reproducibility of the visual acuity measurements and the changes in LLVAD measurement after cataract surgery. Results In the COMPLETE study, no clinically significant differences were found in the PL-BCVA, LL-BCVA, or LLVAD measurements between baseline and the 3-month follow-up visits with a change of –1.1 letters, –1.3 letters, and 0.1 letters, respectively (P = 0.02, P = 0.11, and P = 0.88, respectively). In the current study, significant increases were found in the PL-BCVA and LL-BCVA measurements, with a change of 7.3 letters and 10.2 letters after cataract surgery (P < 0.001 for both), and a statistically significant decrease in LLVAD measurements was found, with a change of –3.0 letters after cataract surgery (P = 0.002). Conclusions Because of the variable effect of cataracts on LL-BCVA measurements and the significant change in LLVAD measurements after cataract surgery, investigators should be aware that cataract surgery during a trial will have an unpredictable impact on LLVAD measurements, and pseudophakic and phakic patients should be analyzed separately.
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Affiliation(s)
- Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan F. Russell
- Institute for Vision Research and Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Xiaoshuang Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Rita Laiginhas
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Prashanth Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Marie Thulliez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Sonia H. Yoo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Terri P. Rose
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ranya G. Habash
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William J. Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Correspondence: Philip J. Rosenfeld, MD, PhD, Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136.
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Chang YC, Cabot F, Heilman BM, Meza L, Ruggeri M, Ho A, Yoo SH, Parel JM, Manns F. Predictability of pseudophakic refraction using patient-customized paraxial eye models. J Cataract Refract Surg 2022; 48:1016-1022. [PMID: 35297814 PMCID: PMC9420759 DOI: 10.1097/j.jcrs.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether patient-customized paraxial eye models that do not rely on exact ray tracing and do not consider aberrations can accurately predict pseudophakic refraction. SETTING Bascom Palmer Eye Institute, Miami, Florida. DESIGN Prospective study. METHODS Cataract surgery patients with and without a history of refractive surgery were included. Manifest refraction, corneal biometry, and extended-depth optical coherence tomography (OCT) imaging were performed at least 1 month postoperatively. Corneal and OCT biometry were used to create paraxial eye models. The pseudophakic refraction simulated using the eye model was compared with measured refraction to calculate prediction error. RESULTS 49 eyes of 33 patients were analyzed, of which 12 eyes from 9 patients had previous refractive surgery. In eyes without a history of refractive surgery, the mean prediction error was 0.08 ± 0.33 diopters (D), ranging from -0.56 to 0.79 D, and the mean absolute error was 0.27 ± 0.21 D. 31 eyes were within ±0.5 D, and 36 eyes were within ±0.75 D. In eyes with previous refractive surgery, the mean prediction error was -0.44 ± 0.58 D, ranging from -1.42 to 0.32 D, and the mean absolute error was 0.56 ± 0.46 D. 7 of 12 eyes were within ±0.5 D, 8 within ±0.75 D, and 10 within ±1 D. All eyes were within ±1.5 D. CONCLUSIONS Accurate calculation of refraction in postcataract surgery patients can be performed using paraxial optics. Measurement uncertainties in ocular biometry are a primary source of residual prediction error.
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Affiliation(s)
- Yu-Cherng Chang
- From the Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Chang, Cabot, Heilman, Meza, Ruggeri, Ho, Yoo, Parel, Manns); Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, Florida (Chang, Heilman, Meza, Ruggeri, Ho, Yoo, Parel, Manns); Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Cabot, Yoo, Parel); Brien Holden Vision Institute Limited, Sydney, New South Wales, Australia (Ho, Parel)
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Dohlman TH, McSoley M, Amparo F, Carreno-Galeano T, Wang M, Dastjerdi M, Singh RB, Coco G, Di Zazzo A, Shikari H, Saboo U, Sippel K, Ciralsky J, Yoo SH, Sticca M, Wakamatsu TH, Murthy S, Hamrah P, Jurkunas U, Ciolino JB, Gomes JAP, Perez VL, Yin J, Dana R. Bevacizumab in High-Risk Corneal Transplantation: A Pilot Multicenter Prospective Randomized Control Trial. Ophthalmology 2022; 129:865-879. [PMID: 35358592 PMCID: PMC10742165 DOI: 10.1016/j.ophtha.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To determine the efficacy of local (subconjunctival and topical) bevacizumab (Avastin) treatment in patients undergoing vascularized high-risk corneal transplantation. DESIGN Pilot, prospective, randomized, double-blind, placebo-controlled clinical trial conducted at 5 clinical centers in the United States, India, and Brazil. PARTICIPANTS Patients aged > 18 years undergoing high-risk penetrating keratoplasty, defined as corneal neovascularization (NV) in 1 or more quadrants ≥2 mm from the limbus or extension of corneal NV to the graft-host junction in a previously failed graft. METHODS Patients were randomized to receive subconjunctival bevacizumab (2.5 mg/0.1 ml) or placebo at the time of surgery, followed by topical bevacizumab (10 mg/ml) or topical placebo, administered 4 times per day for 4 weeks. MAIN OUTCOME MEASURE The 52-week endothelial immune rejection rate. RESULTS Ninety-two patients were randomized to receive bevacizumab (n = 48) or control (n = 44). The 52-week endothelial rejection rate was 10% in the bevacizumab group and 19% in the control group (P = 0.20). Post hoc, extended follow-up at the lead study site showed an endothelial rejection rate of 3% in the bevacizumab group and 38% in the control group (P = 0.003). Treatment with bevacizumab was found to have a hazard ratio of 0.15 (95% confidence interval, 0.03-0.65, P = 0.01) in a post hoc Cox regression analysis. CONCLUSIONS In patients undergoing vascularized high-risk corneal transplantation, there was no statistically significant difference in the rate of endothelial rejection at 1 year in the bevacizumab treatment group compared with the control group. This study may have been underpowered to detect a difference between treatment groups, and taken together, our data suggest that, in the current trial design, bevacizumab has a positive but not (yet) significant effect on endothelial rejection.
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Affiliation(s)
- Thomas H Dohlman
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Matthew McSoley
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Francisco Amparo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tatiana Carreno-Galeano
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohammad Dastjerdi
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rohan Bir Singh
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Giulia Coco
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Di Zazzo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hasanain Shikari
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ujwala Saboo
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Sippel
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Jessica Ciralsky
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Matheus Sticca
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tais H Wakamatsu
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Somasheila Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Pedram Hamrah
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ula Jurkunas
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph B Ciolino
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jose A P Gomes
- Cornea and External Disease Service, Paulista Medical School/Universidade Federal de São Paulo, São Paulo, Brazil
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Foster Center for Ocular Immunology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Jia Yin
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Cornea Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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10
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Ruggeri M, Belloni G, Chang YC, Durkee H, Masetti E, Cabot F, Yoo SH, Ho A, Parel JM, Manns F. Combined anterior segment OCT and wavefront-based autorefractor using a shared beam. Biomed Opt Express 2021; 12:6746-6761. [PMID: 34858678 PMCID: PMC8606132 DOI: 10.1364/boe.435127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 05/30/2023]
Abstract
We have combined an anterior segment (AS) optical coherence tomography (OCT) system and a wavefront-based aberrometer with an approach that senses ocular wavefront aberrations using the OCT beam. Temporal interlacing of the OCT and aberrometer channels allows for OCT images and refractive error measurements to be acquired continuously and in real-time. The system measures refractive error with accuracy and precision comparable to that of clinical autorefractors. The proposed approach provides a compact modular design that is suitable for integrating OCT and wavefront-based autorefraction within the optical head of the ophthalmic surgical microscope for guiding cataract surgery or table-top devices for simultaneous autorefraction and ocular biometry.
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Affiliation(s)
- Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Giulia Belloni
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, Modena, MO 41125, Italy
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Ettore Masetti
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, Modena, MO 41125, Italy
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2033, Australia
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
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11
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Palioura S, Tsiampali C, Dubovy SR, Yoo SH. Endothelial Biopsy for the Diagnosis and Management of Culture-Negative Retrocorneal Fungal Keratitis With the Assistance of Optical Coherence Tomography Imaging. Cornea 2021; 40:1193-1196. [PMID: 33332896 PMCID: PMC8206233 DOI: 10.1097/ico.0000000000002626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of a culture-negative deep fungal corneal infection that was diagnosed after histopathology of an anterior segment optical coherence tomography-guided endothelial biopsy. METHODS A 22-year-old woman with history of contact lens wear and concomitant topical steroid use presented with a mid-stromal corneal infiltrate that failed to respond to oral acyclovir and topical fortified antibiotics. Although cornea stains, cultures, and confocal microscopy showed negative results, there was high clinical suspicion for fungal keratitis. After 2 months on topical natamycin, oral voriconazole, and serial intrastromal and intracameral voriconazole injections, the infiltrate enlarged and deepened. Imaging with anterior segment optical coherence tomography revealed that the infection had progressed to an endothelial plaque. RESULTS Diagnostic endothelial biopsy was performed in the operating room. Cultures showed again negative results, whereas histopathology of the removed specimen revealed fungal elements. The postoperative edema at the site of the biopsy resolved over the course of 4 weeks, and a posterior stromal scar formed. Serial intrastromal and intracameral voriconazole injections were continued for the first postoperative month. At the 1-year and the 3-year follow-up examinations, the patient's vision was 20/20 without recurrence. CONCLUSIONS Intraoperative scraping of the endothelial plaque and histopathologic evaluation of the specimen proved to be of utmost importance for definitive diagnosis and resolution of the culture-negative deep fungal infection in this case. This young patient's cornea was retained and vision remains excellent.
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Affiliation(s)
- Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
| | - Chara Tsiampali
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sander R. Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Monterano Mesquita G, Patel D, Chang YC, Cabot F, Ruggeri M, Yoo SH, Ho A, Parel JMA, Manns F. In vivo measurement of the attenuation coefficient of the sclera and ciliary muscle. Biomed Opt Express 2021; 12:5089-5106. [PMID: 34513244 PMCID: PMC8407821 DOI: 10.1364/boe.427286] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
We acquired 1325 nm OCT images of the sclera and ciliary muscle of human subjects. The attenuation coefficients of the sclera and ciliary muscle were determined from a curve fit of the average intensity profile of about 100 A-lines in a region of interest after correction for the effect of beam geometry, using a single scattering model. The average scleral attenuation coefficient was 4.13 ± 1.42 mm-1 with an age-related decrease that was near the threshold for statistical significance (p = 0.053). The average ciliary muscle attenuation coefficient was 1.72 ± 0.88 mm-1, but this value may be an underestimation due to contributions from multiple scattering. Overall, the results suggest that inter-individual variations in scleral attenuation contribute to variability in the quality of transscleral OCT images of the ciliary muscle and the outcome of transscleral laser therapies.
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Affiliation(s)
- Gabrielle Monterano Mesquita
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Disha Patel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2033, Australia
| | - Jean-Marie A. Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
- Brien Holden Vision Institute, Sydney, NSW 2052, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL 33146, USA
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13
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Eleiwa T, Elsawy A, Ozcan E, Chase C, Feuer W, Yoo SH, Perez VL, Abou Shousha MF. Prediction of corneal graft rejection using central endothelium/Descemet's membrane complex thickness in high-risk corneal transplants. Sci Rep 2021; 11:14542. [PMID: 34267265 PMCID: PMC8282599 DOI: 10.1038/s41598-021-93892-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022] Open
Abstract
To determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet's complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.
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Affiliation(s)
- Taher Eleiwa
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr Elsawy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA
| | - Eyup Ozcan
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Collin Chase
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA
| | - Victor L Perez
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Mohamed F Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 900 NW 17 Street, Miami, FL, 33136, USA. .,Electrical and Computer Engineering, University of Miami, Miami, FL, USA. .,Biomedical Engineering, University of Miami, Miami, FL, USA.
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14
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Pasricha ND, Leviste KD, Volante V, Chang L, Yoo SH. Prevalence of COVID-19 in asymptomatic patients at a refractive surgery center. J Cataract Refract Surg 2021; 47:821-822. [PMID: 33929800 DOI: 10.1097/j.jcrs.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Neel D Pasricha
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Pasricha, Leviste, Volante, Yoo); Department of Biology, Washington University in St. Louis, St. Louis, Missouri (Chang)
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15
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Abstract
Cataract surgery is one of the most common surgical procedures performed in the United States. The decision to remove a cataract is determined by the patient's ability to perform activities of daily living, such as reading, driving, and watching television. Cataract surgery also offers the potential of spectacle independence with a wide array of premium intraocular lens options. In addition, with the continuing advances in ophthalmology, patients now also have the option of selecting between traditional approaches and femtosecond laser-assisted procedures. Cataract surgery continues to be an effective and ever-improving procedure for vision restoration.
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Affiliation(s)
- Sonia H Yoo
- Cornea and Refractive Surgery Department, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 Northwest 17th Street, Miami, FL 33136, USA; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 Northwest 17th Street, Miami, FL 33136, USA.
| | - Mike Zein
- McKnight Vision Research Center, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, 900 Northwest 17th Street, Miami, FL 33136, USA
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16
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Patel NA, Fan KC, Yannuzzi NA, Fortun JA, Haddock LJ, Yoo SH, Persad PJ, Vanner EA, Read SP, Williams BK, Sridhar J, Albini TA, Flynn HW, Donaldson K, Townsend JH. Refractive Outcomes of Four-Point Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture. Clin Ophthalmol 2020; 14:4431-4437. [PMID: 33376297 PMCID: PMC7762441 DOI: 10.2147/opth.s282094] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
Background/Objective To determine the refractive outcomes after 4-point scleral fixation of the Akreos AO60 intraocular lens with Gore-Tex suture. Methods This was a single referral center, multi-surgeon, retrospective consecutive case series. A total of 63 eyes met the inclusion criteria for having received surgical implantation of the Akreos AO60 intraocular lens with Gore-Tex suture from August 2014 to December 2018. Exclusion criteria included all ocular pathology that precluded an accurate refraction, concurrent ocular surgery, poor corrected pre-operative visual potential, among other factors. Main outcome measures included post-operative uncorrected visual acuity (VA), best-corrected VA, and spherical equivalent deviation from target. Results Mean pre-operative BCVA was 0.67 ± 0.64 LogMAR (20/93 Snellen). Mean final post-operative BCVA was 0.17 ± 0.18 (20/28 Snellen) and mean final post-operative UCVA was 0.31 ± 0.22 (20/41 Snellen). Mean post-operative spherical equivalent was −0.57 D. Mean post-operative astigmatism was 0.85 D. Conclusion Refractive outcomes after secondary implantation with Akreos AO60 are favorable in eyes with good visual potential.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Luis J Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sonia H Yoo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Patrice J Persad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.,Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kendall Donaldson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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17
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Diakonis VF, Kounis GA, Yesilirmak N, Warren D, Tsaousis KT, Davis Z, Yoo SH, Donaldson KE. Outcomes of toric intraocular lens implantation after femtosecond laser and traditional cataract surgery. Clin Exp Optom 2020; 104:69-73. [PMID: 32519369 DOI: 10.1111/cxo.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
CLINICAL RELEVANCE Having an understanding of the refractive outcomes of different forms of cataract surgery will assist optometrists in explaining the implication of such procedures to patients being referred for such procedures. BACKGROUND The purpose of this study was to compare the refractive outcomes after toric intraocular lens implantation between femtosecond laser-assisted cataract surgery and traditional phacoemulsification. METHODS This retrospective non-randomised case series included 114 eyes of 92 consecutive patients (59 male and 55 female) aged 71.65 ± 10.46-years (range 57 to 92-years), who underwent either femtosecond laser-assisted cataract surgery (using two laser platforms) (group 1) or traditional phacoemulsification (group 2) between August 2013 and September 2015. Pre-operative keratometric values, the attempted refraction from the biometry platform and the toric intraocular lens web-based calculator, and the one month post-operative manifest refraction were assessed to evaluate the refractive outcomes of the two groups. RESULTS Mean pre-operative topographic corneal astigmatism was -1.94 ± 0.73 D (range 0.91 to 4.61 D) and -1.98 ± 0.60 D (range 1.07 to 3.43 D) for groups 1 and 2, respectively (p > 0.05). Mean axial length was 24.22 ± 0.73-mm (range 21.78 to 29.30-mm) and 24.60 ± 1.09-mm (range 21.82 to 25.95-mm) for groups 1 and 2, respectively (p > 0.05). Multivariate vector analysis of the remaining refractive error between the two groups (desired refraction minus achieved refraction) revealed no statistically significant difference (p > 0.05). Analysis within each group demonstrated a higher accuracy of refractive outcomes for the femtosecond laser-assisted cataract surgery eyes (p < 0.05) when compared to the traditional phacoemulsification (p > 0.05). CONCLUSION Femtosecond laser-assisted cataract surgery and traditional phacoemulsification demonstrate similar refractive outcomes after toric intraocular lens implantation, while femtosecond laser-assisted cataract surgery seems to provide a slightly higher accuracy.
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Affiliation(s)
- Vasilios F Diakonis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - George A Kounis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Nilufer Yesilirmak
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Daniel Warren
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Konstantinos T Tsaousis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Zachary Davis
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Sonia H Yoo
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
| | - Kendall E Donaldson
- Department of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine , Miami, Florida, USA
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18
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Kim JH, Kim I, Kang CK, Jun KI, Yoo SH, Chun JY, Jung J, Kim YJ, Kim DY, Jo HB, Kim DY, Koh Y, Shin DY, Hong J, Kim NJ, Yoon SS, Kim TS, Park WB, Oh MD. Enhanced antimicrobial stewardship based on rapid phenotypic antimicrobial susceptibility testing for bacteraemia in patients with haematological malignancies: a randomized controlled trial. Clin Microbiol Infect 2020; 27:69-75. [PMID: 32272171 DOI: 10.1016/j.cmi.2020.03.038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recently, rapid phenotypic antimicrobial susceptibility testing (AST) based on microscopic imaging analysis has been developed. The aim of this study was to determine whether implementation of antimicrobial stewardship programmes (ASP) based on rapid phenotypic AST can increase the proportion of patients with haematological malignancies who receive optimal targeted antibiotics during early periods of bacteraemia. METHODS This randomized controlled trial enrolled patients with haematological malignancies and at least one positive blood culture. Patients were randomly assigned 1:1 to conventional (n = 60) or rapid phenotypic (n = 56) AST. The primary outcome was the proportion of patients receiving optimal targeted antibiotics 72 hr after blood collection for culture. RESULTS The percentage receiving optimal targeted antibiotics at 72 hr was significantly higher in the rapid phenotypic AST group (45/56, 80.4%) than in conventional AST group (34/60, 56.7%) (relative risk (RR) 1.42, 95% confidence interval (CI) 1.09-1.83). The percentage receiving unnecessary broad-spectrum antibiotics at 72 hr was significantly lower (7/26, 12.5% vs 18/60, 30.0%; RR 0.42, 95% CI 0.19-0.92) and the mean time to optimal targeted antibiotic treatment was significantly shorter (38.1, standard deviation (SD) 38.2 vs 72.8, SD 93.0 hr; p < 0.001) in the rapid phenotypic AST group. The mean time from blood collection to the AST result was significantly shorter in the rapid phenotypic AST group (48.3, SD 17.6 vs 83.1, SD 22.2 hr). DISCUSSION ASP based on rapid phenotypic AST can rapidly optimize antibiotic treatment for bacteraemia in patients with haematological malignancy. Rapid phenotypic AST can improve antimicrobial stewardship in immunocompromised patients.
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Affiliation(s)
- J-H Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - I Kim
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - C K Kang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - K-I Jun
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - S H Yoo
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - J Y Chun
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - J Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Y J Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - H B Jo
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Y Koh
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - D-Y Shin
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - J Hong
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - N J Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - S-S Yoon
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - T S Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - W B Park
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
| | - M-D Oh
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
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19
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Eleiwa TK, Elsawy A, Syed ZA, Roongpoovapatr V, Sayed AM, Yoo SH, Abou Shousha M. In-vivo Three-dimensional Characteristics of Bowman's Layer and Endothelium/Descemet's Complex Using Corneal Microlayer Tomography in Healthy Subjects. Curr Eye Res 2020; 45:659-667. [PMID: 32064952 DOI: 10.1080/02713683.2019.1691238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To characterize the three-dimensional (3D) thickness profile and age-related changes of Bowman's layer (BL), and endothelium/Descemet's membrane (En/DM) complex among healthy individuals using Corneal Microlayer Tomography (CML-T), and to describe its repeatability and accuracy.Methods: Sixty-six eyes of 41 healthy volunteers; 27 eyes (< 40 years old), and 39 eyes (>40 years old) were imaged using HD-OCT. Automatic and manual segmentation of the corneal layers was performed, and 3D thickness maps were generated, using custom-built CML-T software. A regional analysis of mean thickness parameters between the 2 age groups was performed. A regression analysis was used to assess the correlation between age, and thickness maps. Intraclass Correlation Coefficients (ICC), Coefficients of Variation (COV), and Bland-Altman plots were used to assess the reliability of the repeated measurements in 198 locations.Results: CML-T successfully mapped the BL and En/DM in all included eyes. Thickness maps showed a significant increase in corneal thickness (CT), BL thickness (BMT), and En/DM complex thickness (DMT) toward the periphery with a mean difference 28 µm (p < .001), 1.1 µm (p < .001), and 1.4 µm (p < .001), respectively. There was a strong correlation between age and central DMT (r = 0.61; p < .001), while there was no correlation between age and both CT, and BMT. ICC values ranged from 0.9 (BMT) to 0.997 (DMT), and from 0.808 (BMT) to 0.979 (CT) for intraoperator repeatability of manual measurements, and the accuracy of auto matic measurements, respectively. COV values were lower than 7.5% in all cases.Conclusion: CML-T is a novel tool that can generate 3D-thickness maps of both BL and En/DM. CT, BMT, and DMT increase toward the periphery in healthy corneas. DMT increases with aging, while BMT does not. We also report excellent repeatability, accuracy and good agreement between automatic and manual measurements.
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Affiliation(s)
- Taher K Eleiwa
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr Elsawy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA
| | - Zeba A Syed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Ahmed M Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Biomedical Engineering Department, Helwan University, Helwan, Egypt
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA.,Biomedical Engineering, University of Miami, Miami, FL, USA
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20
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Chang YC, Mesquita GM, Williams S, Gregori G, Cabot F, Ho A, Ruggeri M, Yoo SH, Parel JM, Manns F. In vivo measurement of the human crystalline lens equivalent refractive index using extended-depth OCT. Biomed Opt Express 2019; 10:411-422. [PMID: 30800489 PMCID: PMC6377882 DOI: 10.1364/boe.10.000411] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 05/04/2023]
Abstract
The lens equivalent refractive index (RI) is commonly used in calculations of crystalline lens power. However, accurate determination of the equivalent RI in vivo is challenging due to the need of multiple measurements with different ocular biometry devices. A custom extended-depth Spectral Domain-OCT system was utilized to provide measurements of corneal and lens surface curvatures and all intraocular distances required for determination of the lens equivalent RI. Ocular biometry and refraction were input into a computational model eye from which the equivalent RI was calculated. Results derived from human subjects of a wide age range show a decrease in RI with age and demonstrate the capability of in vivo measurements of the equivalent RI with extended-depth OCT.
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Affiliation(s)
- Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Gabrielle Monterano Mesquita
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Siobhan Williams
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Giovanni Gregori
- Quantitative Imaging Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Brien Holden Vision Institute, Sydney, NSW, Australia
- School of Optometry & Vision Science, University of New South Wales, Australia
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Brien Holden Vision Institute, Sydney, NSW, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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21
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Terry MA, Aldave AJ, Szczotka-Flynn LB, Liang W, Ayala AR, Maguire MG, Croasdale C, Daoud YJ, Dunn SP, Hoover CK, Macsai MS, Mauger TF, Pramanik S, Rosenwasser GOD, Rose-Nussbaumer J, Stulting RD, Sugar A, Tu EY, Verdier DD, Yoo SH, Lass JH. Donor, Recipient, and Operative Factors Associated with Graft Success in the Cornea Preservation Time Study. Ophthalmology 2018; 125:1700-1709. [PMID: 30098353 PMCID: PMC6196643 DOI: 10.1016/j.ophtha.2018.08.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To associate donor, recipient, and operative factors with graft success 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS). DESIGN Cohort study within a multicenter, double-masked, randomized clinical trial. PARTICIPANTS One thousand ninety individuals (1330 study eyes) with a median age of 70 years undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE; 6% of eyes). METHODS Eyes undergoing DSAEK were randomized to receive a donor cornea with preservation time (PT) of 0 to 7 days (n = 675) or 8 to 14 days (n = 655). Donor, recipient, and operative parameters were recorded prospectively. Graft failure was defined as regraft for any reason, a graft that failed to clear by 8 weeks after surgery, or an initially clear graft that became and remained cloudy for 90 days. Failure in the first 8 weeks was classified further as primary donor failure or early failure, in the absence or presence of operative complications, respectively. Proportional hazards and logistic regression models were used to estimate risk ratios (RR) and 99% confidence intervals (CIs) for graft failure. MAIN OUTCOME MEASURES Graft success at 3 years. RESULTS One thousand two hundred fifty-one of 1330 grafts (94%) remained clear at 3 years and were considered successful. After adjusting for PT, tissue from donors with diabetes (RR, 2.35; 99% CI, 1.03-5.33) and operative complications (RR, 4.21; 99% CI, 1.42-12.47) were associated with increased risk for primary or early failure. Preoperative diagnosis of PACE (RR, 3.59; 99% CI, 1.05-12.24) was associated with increased risk for late failure by 3 years after surgery compared with Fuchs dystrophy. Graft success showed little variation among other factors evaluated, including donor age (RR, 1.19 per decade; 99% CI, 0.91-1.56 per decade), preoperative donor endothelial cell density (RR, 1.10 per 500 cells; 99% CI, 0.74-1.63 per 500 cells), graft diameter (RR, 1.22 per 1 mm; 99% CI, 0.39-3.76 per 1 mm), and injector use for graft insertion (RR, 0.92; 99% CI, 0.40-2.10). CONCLUSIONS Descemet stripping automated endothelial keratoplasty success in the early and entire postoperative period is more likely when the donor did not have diabetes and was without operative complications and in the long-term postoperative period in recipients with Fuchs dystrophy compared with those with PACE. Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study.
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Affiliation(s)
| | - Anthony J Aldave
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio
| | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Maureen G Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Yassine J Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Steven P Dunn
- Michigan Cornea Consultants, PC, Southfield, Michigan
| | | | | | - Thomas F Mauger
- The Ohio State University Wexner Medical Center, Havener Eye Institute, Columbus, Ohio
| | | | | | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | | | - Alan Sugar
- University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan
| | - Elmer Y Tu
- University of Illinois Chicago Eye and Ear Infirmary, Chicago, Illinois
| | | | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan H Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
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22
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Davidson RS, Dhaliwal D, Hamilton DR, Jackson M, Patterson L, Stonecipher K, Yoo SH, Braga-Mele R, Donaldson K. Surgical correction of presbyopia. J Cataract Refract Surg 2018; 42:920-30. [PMID: 27373400 DOI: 10.1016/j.jcrs.2016.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 01/02/2023]
Abstract
UNLABELLED Presbyopia is the most common refractive disorder for people older than 40 years. It is characterized by a gradual and progressive decrease in accommodative amplitude. Many surgical procedures for the correction of presbyopia exist, with additional procedures on the horizon. This review describes the prevalent theories of presbyopia and discusses the available surgical options for correction. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Richard S Davidson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Deepinder Dhaliwal
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - D Rex Hamilton
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mitchell Jackson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Larry Patterson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karl Stonecipher
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sonia H Yoo
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rosa Braga-Mele
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kendall Donaldson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
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23
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Yoo SH, Kwon JH, Nam SW, Kim HY, Kim CW, You CR, Choi SW, Cho SH, Han JY, Song DS, Chang UI, Yang JM, Lee HL, Lee SW, Han NI, Kim SH, Song MJ, Hwang S, Sung PS, Jang JW, Bae SH, Choi JY, Yoon SK. Early development of de novo hepatocellular carcinoma after direct-acting agent therapy: Comparison with pegylated interferon-based therapy in chronic hepatitis C patients. J Viral Hepat 2018; 25:1189-1196. [PMID: 29660199 DOI: 10.1111/jvh.12918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 01/18/2023]
Abstract
Patients with chronic hepatitis C who achieve a sustained viral response after pegylated interferon therapy have a reduced risk of hepatocellular carcinoma, but the risk after treatment with direct-acting antivirals is unclear. We compared the rates of early development of hepatocellular carcinoma after direct-acting antivirals and after pegylated interferon therapy. We retrospectively analysed 785 patients with chronic hepatitis C who had no history of hepatocellular carcinoma (211 treated with pegylated interferon, 574 with direct-acting antivirals) and were followed up for at least 24 weeks after antiviral treatment. De novo hepatocellular carcinoma developed in 6 of 574 patients receiving direct-acting antivirals and in 1 of 211 patients receiving pegylated interferon. The cumulative incidence of early hepatocellular carcinoma development did not differ between the treatment groups either for the whole cohort (1.05% vs 0.47%, P = .298) or for those patients with Child-Pugh Class A cirrhosis (3.73% vs 2.94%, P = .827). Multivariate analysis indicated that alpha-fetoprotein level >9.5 ng/mL at the time of end-of-treatment response was the only independent risk factor for early development of hepatocellular carcinoma in all patients (P < .0001, hazard ratio 176.174, 95% confidence interval 10.768-2882.473) and in patients treated with direct-acting agents (P < .0001, hazard ratio 128.402, 95% confidence interval 8.417-1958.680). In conclusion, the rate of early development of hepatocellular carcinoma did not differ between patients treated with pegylated interferon and those treated with direct-acting antivirals and was associated with the serum alpha-fetoprotein level at the time of end-of-treatment response.
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Affiliation(s)
- S H Yoo
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - J H Kwon
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - S W Nam
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - H Y Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - C W Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - C R You
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S W Choi
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S H Cho
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J-Y Han
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - D S Song
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - U I Chang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - J M Yang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - H L Lee
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - S W Lee
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - N I Han
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - M J Song
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - S Hwang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - P S Sung
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J W Jang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S H Bae
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J Y Choi
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S K Yoon
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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24
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Palioura S, Relhan N, Leung E, Chang V, Yoo SH, Dubovy SR, Flynn HW. Delayed-onset Candida parapsilosis cornea tunnel infection and endophthalmitis after cataract surgery: Histopathology and clinical course. Am J Ophthalmol Case Rep 2018; 11:109-114. [PMID: 29998210 PMCID: PMC6038826 DOI: 10.1016/j.ajoc.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)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 11/06/2022] Open
Abstract
Purpose To describe a patient with late post-operative endophthalmitis and clear cornea tunnel infection caused by Candida parapsilosis that was masquerading as chronic anterior uveitis. Observations A 62-year old woman with history of uncomplicated cataract surgery 7 months prior and chronic postoperative anterior uveitis, presented with an endothelial plaque, hypopyon, and infiltrates in the capsular bag and within the clear corneal tunnel. Anterior chamber cultures identified C. parapsilosis and pathology of the endothelial plaque showed fungus. Anterior chamber washout, scraping of the endothelial plaque, serial intracameral and intravitreal injections with amphotericin B (10 mcg) failed to control the infection. Pars plana vitrectomy, removal of the intraocular lens and capsular bag, a corneal patch graft, and administration of intravitreal antifungal agents were performed. One year later the patient remains free of recurrence and her best-corrected vision is 20/25 with a rigid gas permeable contact lens. Conclusions and Importance: Persistent intraocular and intracorneal inflammation after cataract surgery should raise suspicion of endophthalmitis caused by fungi non-responsive to topical and intravitreal antibiotics. Surgical intervention and removal of the nidus of infection, which is often the intraocular lens and capsular bag, may be necessary for a successful outcome.
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Affiliation(s)
- Sotiria Palioura
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ella Leung
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victoria Chang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H Yoo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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Diakonis VF, Anagnostopoulos AG, Moutsiopoulou A, Yesilirmak N, Cabot F, Waren DP, O'Brien TP, Yoo SH, Weinstock RJ, Donaldson KE. The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E 2 Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy. J Ophthalmol 2018; 2018:1891249. [PMID: 30116626 PMCID: PMC6079456 DOI: 10.1155/2018/1891249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/24/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. METHODS This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. RESULTS Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. CONCLUSION Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.
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Affiliation(s)
- Vasilios F. Diakonis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Eye Institute of West Florida, Largo, FL, USA
| | | | | | - Nilufer Yesilirmak
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Florence Cabot
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel P. Waren
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Terrence P. O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Kendall E. Donaldson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Chang YC, Liu K, Cabot F, Yoo SH, Ruggeri M, Ho A, Parel JM, Manns F. Variability of manual ciliary muscle segmentation in optical coherence tomography images. Biomed Opt Express 2018; 9:791-800. [PMID: 29552413 PMCID: PMC5854079 DOI: 10.1364/boe.9.000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 05/09/2023]
Abstract
Optical coherence tomography (OCT) offers new options for imaging the ciliary muscle allowing direct in vivo visualization. However, variation in image quality along the length of the muscle prevents accurate delineation and quantification of the muscle. Quantitative analyses of the muscle are accompanied by variability in segmentation between examiners and between sessions for the same examiner. In processes such as accommodation where changes in muscle thickness may be tens of microns- the equivalent of a small number of image pixels, differences in segmentation can influence the magnitude and potentially the direction of thickness change. A detailed analysis of variability in ciliary muscle thickness measurements was performed to serve as a benchmark for the extent of this variability in studies on the ciliary muscle. Variation between sessions and examiners were found to be insignificant but the magnitude of variation should be considered when interpreting ciliary muscle results.
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Affiliation(s)
- Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Keke Liu
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
- Brien Holden Vision Institute, Sydney, NSW, Australia
- School of Optometry & Vision Science, University of New South Wales, Australia
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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Kymionis GD, Ide T, Yoo SH. Flap Amputation with Phototherapeutic Keratectomy (PTK) and Adjuvant Mitomycin C for Severe Post-Lasik Epithelial Ingrowth. Eur J Ophthalmol 2018; 19:301-3. [DOI: 10.1177/112067210901900223] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To report a patient with severe post–laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC). Methods Case report. Results A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D. Conclusions Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.
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Affiliation(s)
- George D. Kymionis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL - USA
| | - Takeshi Ide
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL - USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL - USA
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Abstract
Chronic myelomonocytic leukemia (cmml) is an indolent disease in the category of myelodysplastic and myeloproliferative neoplasms, which can often evolve into acute leukemic neoplasms. Although cytogenetic abnormalities such as trisomy 8 or absence of chromosome Y are well known, few reports about cmml with trisomy 11 have been published. Here, we report a case of cmml with trisomy 11 as the sole chromosomal abnormality, resulting in a very poor outcome. Based on a bone marrow specimen, cmml-1 with trisomy 11 was diagnosed in a 79-year-old man presenting with anemia and atypical peripheral blood cells. Because of the patient's age, he was followed without receiving anticancer treatment. Two months after his diagnosis, the patient's leucocytosis and anemia rapidly worsened, with increasing numbers of immature peripheral cells, which was strongly suggestive of leukemic transformation. Because of acute kidney injury superimposed on chronic kidney disease that led to poor performance status, cytotoxic chemotherapy was not considered feasible, and the patient was transferred to a hospice care facility.
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Affiliation(s)
- S H Yoo
- Department of Internal Medicine, Seoul National University College of Medicine
| | - J Lim
- Department of Internal Medicine, Seoul Red Cross Hospital, and
| | - J M Byun
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - J H Park
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - K H Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - I S Choi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Henderson LE, Abdelmegeed MA, Yoo SH, Rhee SG, Zhu X, Smith MA, Nguyen RQ, Perry G, Song BJ. Enhanced Phosphorylation of Bax and Its Translocation into Mitochondria in the Brains of Individuals Affiliated with Alzheimer's Disease. Open Neurol J 2017; 11:48-58. [PMID: 29290835 PMCID: PMC5738752 DOI: 10.2174/1874205x01711010048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/11/2017] [Revised: 09/05/2017] [Accepted: 10/10/2017] [Indexed: 12/22/2022] Open
Abstract
Background: Despite increased neuronal death, senile plaques, and neurofibrillary tangles observed in patients suffering from Alzheimer’s disease (AD), the detailed mechanism of cell death in AD is still poorly understood. Method: We hypothesized that p38 kinase activates and then phosphorylates Bax, leading to its translocation to mitochondria in AD brains compared to controls. The aim of this study was to investigate the role of p38 kinase in phosphorylation and sub-cellular localization of pro-apoptotic Bax in the frontal cortex of the brains from AD and control subjects. Increased oxidative stress in AD individuals compared to control was evaluated by measuring the levels of carbonylated proteins and oxidized peroxiredoxin, an antioxidant enzyme. The relative amounts of p38 kinase and phospho-Bax in mitochondria in AD brains and controls were determined by immunoblot analysis using the respective antibody against each protein following immunoprecipitation. Results: Our results showed that the levels of oxidized peroxiredoxin-SO3 and carbonylated proteins are significantly elevated in AD brains compared to controls, demonstrating the increased oxidative stress. Conclusion: The amount of phospho-p38 kinase is increased in AD brains and the activated p38 kinase appears to phosphorylate Thr residue(s) of Bax, which leads to its mitochondrial translocation, contributing to apoptosis and ultimately, neurodegeneration.
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Affiliation(s)
- L E Henderson
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9410, USA
| | - M A Abdelmegeed
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9410, USA
| | - S H Yoo
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9410, USA
| | - S G Rhee
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - X Zhu
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - M A Smith
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - R Q Nguyen
- Department of Biology, College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA
| | - G Perry
- Department of Biology, College of Sciences, University of Texas at San Antonio, San Antonio, TX, USA
| | - B J Song
- Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9410, USA
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Yoo SH, Hong JS, Yoo HB, Han TH, Jeong JH, Kim YY. Influence of various levels of milk by-products in weaner diets on growth performance, blood urea nitrogen, diarrhea incidence, and pork quality of weaning to finishing pigs. Asian-Australas J Anim Sci 2017; 31:696-704. [PMID: 29103280 PMCID: PMC5930280 DOI: 10.5713/ajas.16.0840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/21/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was conducted to evaluate various levels of milk by-product in weaning pig diet on growth performance, blood profiles, carcass characteristics and economic performance for weaning to finishing pigs. METHODS A total of 160 weaning pigs ([Yorkshire×Landrace]×Duroc), average 7.01±1.32 kg body weight (BW), were allotted to four treatments by BW and sex in 10 replications with 4 pigs per pen in a randomized complete block design. Pigs were fed each treatment diet with various levels of milk by-product (Phase 1: 0%, 10%, 20%, and 30%, Phase 2: 0%, 5%, 10%, and 15%, respectively). During weaning period (0 to 5 week), weaning pigs were fed experimental diets and all pigs were fed the same commercial feed during growing-finishing period (6 to 14 week). RESULTS In the growth trial, BW, average daily gain (ADG), and average daily feed intake (ADFI) in the nursery period (5 weeks) increased as the milk by-product level in the diet increased (linear, p<0.05). Linear increases of pig BW with increasing the milk product levels were observed until late growing period (linear, p = 0.01). However, there were no significant differences in BW at the finishing periods, ADG, ADFI, and gain:feed ratio during the entire growing-finishing periods. The blood urea nitrogen concentration had no significant difference among dietary treatments. High inclusion level of milk by-product in weaner diet decreased crude protein (quadratic, p = 0.05) and crude ash (Linear, p = 0.05) of Longissimus muscle. In addition, cooking loss and water holding capacity increased with increasing milk product levels in the weaner diets (linear, p<0.01; p = 0.05). High milk by-product treatment had higher feed cost per weight gain compared to non-milk by-products treatment (linear, p = 0.01). CONCLUSION Supplementation of 10% to 5% milk by-products in weaning pig diet had results equivalent to the 30% to 15% milk treatment and 0% milk by-product supplementation in the diet had no negative influence on growth performance of finishing pigs.
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Affiliation(s)
- S H Yoo
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
| | - J S Hong
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
| | - H B Yoo
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
| | - T H Han
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
| | - J H Jeong
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
| | - Y Y Kim
- School of Agricultural Biotechnology, College of Agricultural Life Sciences, Seoul National University, Seoul 08826, Korea
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Kim MH, Cho EJ, Lee JW, Kim EK, Yoo SH, Park CW. A study on setting of the fatigue limit of temporary dental implants. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:1962-1965. [PMID: 29060278 DOI: 10.1109/embc.2017.8037234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A temporary dental implant is a medical device which is temporarily used to support a prosthesis such as an artificial tooth used for restoring patient's masticatory function during implant treatment. It is implanted in the oral cavity to substitute for the role of tooth. Due to the aging and westernization of current Korean society, the number of tooth extraction and implantation procedures is increasing, leading to an increase in the use and development of temporary dental implants. Because an implant performs a masticatory function in place of a tooth, a dynamic load is repeatedly put on the implant. Thus, the fatigue of implants is reported to be the most common causes of the fracture thereof. According to the investigation and analysis of the current domestic and international standards, the standard for fatigue of implant fixtures is not separately specified. Although a test method for measuring the fatigue is suggested in an ISO standard, it is a standard for permanent dental implants. Most of the test standards for Korean manufacturers and importers apply 250 N or more based on the guidance for the safety and performance evaluation of dental implants. Therefore, this study is intended to figure out the fatigue standard which can be applied to temporary dental implants when measuring the fatigue according to the test method suggested in the permanent dental implant standard. The results determined that suitable fatigue standards of temporary dental implants should be provided by each manufacturer rather than applying 250 N. This study will be useful for the establishment of the fatigue standards and fatigue test methods of the manufacturers and importers of temporary dental implants.
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Kim HJ, Nam SO, Jeong JH, Fang LH, Yoo HB, Yoo SH, Hong JS, Son SW, Ha SH, Kim YY. Various levels of copra meal supplementation with β-Mannanase on growth performance, blood profile, nutrient digestibility, pork quality and economical analysis in growing-finishing pigs. J Anim Sci Technol 2017; 59:19. [PMID: 28725450 PMCID: PMC5513317 DOI: 10.1186/s40781-017-0144-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND To reduce use of main feed ingredient like corn, soy bean meal (SBM) and wheat, alternative ingredients has been studied like copra meal (CM). Production amount of CM which has been high makes CM to be an alternative feed stuff. However, low digestibility on AA and low energy content by high fiber content can be an obstacle for using CM. This experiment was conducted to evaluate the effects of CM supplementation with β-mannanase on growth performance, blood profile, nutrient digestibility, pork quality and economic analysis in growing-finishing pigs. METHODS A total of 100 growing pigs ([Yorkshire × Landrace] × Duroc) averaging 31.22 ± 2.04 kg body weight were allotted to 5 different treatments by weight and sex in a randomized complete block (RCB) design in 5 replicate with 4 pigs per pen. Treatments were 1) Control (corn-SBM based diet + 0.1% of β-mannanase (800 IU)), 2) CM10 (10% copra meal + 0.1% β-mannanase (800 IU)), 3) CM15 (15% copra meal + 0.1% β-mannanase (800 IU)), 4) CM20 (20% copra meal + 0.1% β-mannanase (800 IU)) and 5) CM25 (25% copra meal + 0.1% β-mannanase (800 IU)). Four phase feeding program was used: growing I (week 1-3), growing II (week 4-6), finishing I (week 7-9) and finishing II (week 10-12). RESULTS In growth performance, there was no significant difference among treatments during whole experimental period. In growingI phase, G:F ratio tended to increase when CM was increased (P = 0.05), but ADG and ADFI tended to decrease in finishingII phase (linear, P = 0.08). Also, increasing CM reduced ADG (linear, P = 0.02) and feed efficiency (linear, P = 0.08) during the whole finishing period. In blood profiles, BUN was linearly increased as CM increased (linear, P = 0.02) at growingII period. In digestibility trial, there was no significant difference in dry matter, crude fat, crude ash and nitrogen digestibility. However, crude protein digestibility was decreased linearly (linear, P = 0.02). In economic analysis, feed cost per weight gain and total feed cost per pig were reduced in overall period when CM was provided by 25% (linear, P = 0.02). CONCLUSION CM with 0.1% of β-mannanase (800 IU) could be supplemented instead of corn and SBM up to 25% without detrimental effects on growth performance and pork quality of growing-finishing pigs.
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Affiliation(s)
- H J Kim
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - S O Nam
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - J H Jeong
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - L H Fang
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - H B Yoo
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - S H Yoo
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - J S Hong
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
| | - S W Son
- PuKyung Pig Farmers Agricultural Cooperative, Gimhae, 50925 Republic of Korea
| | - S H Ha
- PuKyung Pig Farmers Agricultural Cooperative, Gimhae, 50925 Republic of Korea
| | - Y Y Kim
- Department of Agricultural Biotechnology, College of Agriculture and Life Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 Republic of Korea
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Abou Shousha M, Yoo SH, Sayed MS, Edelstein S, Council M, Shah RS, Abernathy J, Schmitz Z, Stuart P, Bentivegna R, Fernandez MP, Smith C, Yin X, Harocopos GJ, Dubovy SR, Feuer WJ, Wang J, Perez VL. In Vivo Characteristics of Corneal Endothelium/Descemet Membrane Complex for the Diagnosis of Corneal Graft Rejection. Am J Ophthalmol 2017; 178:27-37. [PMID: 28259779 DOI: 10.1016/j.ajo.2017.02.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection. DESIGN Diagnostic reliability study. METHODS One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea. RESULTS In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 μm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 μm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001). CONCLUSIONS In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.
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Chang YC, Liu K, de Freitas C, Pham A, Cabot F, Williams S, Adre E, Gregori G, Ruggeri M, Yoo SH, Ho A, Parel JM, Manns F. Assessment of eye length changes in accommodation using dynamic extended-depth OCT. Biomed Opt Express 2017; 8:2709-2719. [PMID: 28663900 PMCID: PMC5480507 DOI: 10.1364/boe.8.002709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
It has been suggested that accommodation induces increases in axial eye length which could contribute to the development of myopia. However, it is debated whether changes in eye length occur during accommodation as the degree of change varies widely across literature. In this study, an extended-depth optical coherence tomography (OCT) system that provides dynamic whole eye biometry was utilized to assess changes in lens thickness (LT) and axial eye length (AEL) in young subjects responding to step disaccommodation stimuli of amplitude 2D, 4D, and 6D. The decrease in lens thickness with disaccommodation was strongly correlated with stimulus amplitude. No statistically significant changes in AEL during accommodation were observed.
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Affiliation(s)
- Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Keke Liu
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Carolina de Freitas
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alex Pham
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Siobhan Williams
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Ethan Adre
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Giovanni Gregori
- Quantitative Imaging Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Arthur Ho
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
- Brien Holden Vision Institute, Sydney, NSW, Australia
- School of Optometry & Vision Science, University of New South Wales, Australia
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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Diakonis VF, Kontadakis GA, Anagnostopoulos AG, Yesilirmak N, Waren DP, Cabot F, Yoo SH, Donaldson KE. Effects of Short-term Preoperative Topical Ketorolac on Pupil Diameter in Eyes Undergoing Femtosecond Laser–Assisted Capsulotomy. J Refract Surg 2017; 33:230-234. [DOI: 10.3928/1081597x-20170111-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/03/2017] [Indexed: 11/20/2022]
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Diakonis VF, Yesilirmak N, Kymionis GD, Yoo SH. Intraocular lens power overestimation in a patient with history of circling keratorraphy. Saudi J Ophthalmol 2017; 30:198-200. [PMID: 28210183 PMCID: PMC5299111 DOI: 10.1016/j.sjopt.2016.06.004] [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: 09/16/2015] [Revised: 02/02/2016] [Accepted: 06/12/2016] [Indexed: 11/24/2022] Open
Abstract
We report a case of cataract extraction and intraocular lens (IOL) power overestimation in a patient with history of hyperopia managed with circling keratorraphy. A 65-year-old female presented to our institute complaining of decreased vision in both eyes. The patient had a history of bilateral hyperopia that was managed 20 years ago (1994) with circling keratorraphy. At presentation her uncorrected distance visual acuity (UDVA) was 20/70 and 20/60 in her right eye (OD) and left eye (OS), respectively, while her corrected distance visual acuity (CDVA) was 20/25 OD and 20/25 OS with manifest refraction of −0.50 + 1.50 × 75 OD and +0.50sph + 1.50cyl × 30 OS. Slit lamp examination revealed the presence of a circular intrastromal corneal suture (6 mm diameter) and mild (+1) nuclear sclerosis in both eyes. The patient was scheduled to undergo cataract extraction targeting plano, using a toric IOL; one month after the surgery, the manifest refraction of the operated right eye was −2.00 + 0.50 × 175, reflecting an overestimation of the intraocular lens (IOL) power for the attempted target. Cataract extraction in patients with history of circling keratorraphy for the management of hyperopia results in IOL power overestimation, consistent with that which is seen in patients with other previous hyperopic corneal refractive procedures.
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Affiliation(s)
- Vasilios F Diakonis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nilufer Yesilirmak
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George D Kymionis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Yesilirmak N, Diakonis VF, Sise A, Waren DP, Yoo SH, Donaldson KE. Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems. J Cataract Refract Surg 2017; 43:16-21. [DOI: 10.1016/j.jcrs.2016.11.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/06/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
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Diakonis VF, Yesilirmak N, Sayed-Ahmed IO, Warren DP, Kounis GA, Davis Z, Cabot F, Yoo SH, O'Brien TP, Donaldson KE. Effects of Femtosecond Laser-Assisted Cataract Pretreatment on Pupil Diameter: A Comparison Between Three Laser Platforms. J Refract Surg 2016; 32:84-8. [PMID: 26856424 DOI: 10.3928/1081597x-20151229-03] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/20/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms. METHODS This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler. RESULTS A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis. CONCLUSIONS FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (≤ 6 mm) after FLACS pretreatment.
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Yesilirmak N, Palioura S, Culbertson W, Yoo SH, Donaldson K. Intraoperative Wavefront Aberrometry for Toric Intraocular Lens Placement in Eyes With a History of Refractive Surgery. J Refract Surg 2016; 32:69-70. [PMID: 26812720 DOI: 10.3928/1081597x-20151210-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pantanelli SM, Diakonis VF, Al-Mohtaseb Z, Cabot F, Yesilirmak N, Kounis GA, Sayed-Ahmed IO, Waren D, Yoo SH, Donaldson KE. Anterior Capsulotomy Outcomes: A Comparison Between Two Femtosecond Laser Cataract Surgery Platforms. J Refract Surg 2016; 31:821-5. [PMID: 26653727 DOI: 10.3928/1081597x-20151118-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare capsulotomy outcomes between two femtosecond laser platforms for cataract surgery. METHODS This retrospective case series included 205 eyes of 162 consecutive patients (75 male and 87 female) aged 68.32 ± 10.27 years (range: 38 to 92 years) who underwent femtosecond laser-assisted cataract surgery (FLACS) using either the LenSx (Alcon Laboratories, Inc., Fort Worth, TX) or the Catalys (Abbott Medical Optics, Abbott Park, IL) laser platform. Intraoperative assessment of the capsulotomy was performed and graded as one of the following four types: complete treatment pattern (type 1), microadhesions (type 2), incomplete treatment pattern (type 3), and complete pattern but not continuous (type 4). RESULTS Ninety-seven eyes underwent FLACS using the LenSx platform and 108 eyes using the Catalys platform. Ninety-four capsulotomies in the LenSx group were graded as type 1 (96.91%), and three were graded as type 2 (3.09%); all capsulotomies in the Catalys group were graded as type 1 (100%). There was no statistically significant difference between the LenSx and Catalys groups (P > .05). No intraoperative complications (specifically, no posterior capsular extension or vitreous loss) were noticed in any of the eyes included in the study. CONCLUSIONS The LenSx and Catalys laser platforms demonstrate similar capsulotomy outcomes. The microadhesions that were demonstrated in three cases in the LenSx group did not lead to intraoperative or postoperative complications.
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Yesilirmak N, Chhadva P, Diakonis VF, Waren DP, Yoo SH, Donaldson KE. The Effect of LASIK on Timing of Cataract Surgery. J Refract Surg 2016; 32:306-10. [DOI: 10.3928/1081597x-20160217-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 12/15/2015] [Indexed: 11/20/2022]
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Ruggeri M, de Freitas C, Williams S, Hernandez VM, Cabot F, Yesilirmak N, Alawa K, Chang YC, Yoo SH, Gregori G, Parel JM, Manns F. Quantification of the ciliary muscle and crystalline lens interaction during accommodation with synchronous OCT imaging. Biomed Opt Express 2016; 7:1351-64. [PMID: 27446660 PMCID: PMC4929646 DOI: 10.1364/boe.7.001351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 05/21/2023]
Abstract
Two SD-OCT systems and a dual channel accommodation target were combined and precisely synchronized to simultaneously image the anterior segment and the ciliary muscle during dynamic accommodation. The imaging system simultaneously generates two synchronized OCT image sequences of the anterior segment and ciliary muscle with an imaging speed of 13 frames per second. The system was used to acquire OCT image sequences of a non-presbyopic and a pre-presbyopic subject accommodating in response to step changes in vergence. The image sequences were processed to extract dynamic morphological data from the crystalline lens and the ciliary muscle. The synchronization between the OCT systems allowed the precise correlation of anatomical changes occurring in the crystalline lens and ciliary muscle at identical time points during accommodation. To describe the dynamic interaction between the crystalline lens and ciliary muscle, we introduce accommodation state diagrams that display the relation between anatomical changes occurring in the accommodating crystalline lens and ciliary muscle.
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Affiliation(s)
- Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carolina de Freitas
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Siobhan Williams
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, FL, USA
| | - Victor M. Hernandez
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, FL, USA
| | - Florence Cabot
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Hospital Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nilufer Yesilirmak
- Anne Bates Leach Eye Hospital Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karam Alawa
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yu-Cherng Chang
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, FL, USA
| | - Sonia H. Yoo
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Anne Bates Leach Eye Hospital Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Gregori
- Quantitative Imaging Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, FL, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
- Brien Holden Vision Institute, Sydney, NSW, Australia
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami, College of Engineering, Coral Gables, FL, USA
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Diakonis VF, Yoo SH, Kontadakis GA, El Danasoury AM, Donaldson KE, Culbertson WW. Femtosecond laser-assisted cataract surgery in a patient with posterior chamber phakic intraocular lens. Am J Ophthalmol Case Rep 2016; 1:11-12. [PMID: 29503881 PMCID: PMC5757340 DOI: 10.1016/j.ajoc.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 11/26/2022] Open
Abstract
We describe a case of modified femtosecond laser settings for cataract extraction in a patient with a posterior chamber phakic intraocular lens (PIOL), to avoid incomplete treatment patterns and treatment displacement. Modification of laser settings (increased depth for the capsulotomy, increased vertical spot spacing for the capsulotomy and increased anterior and posterior capsule safety margins for lens fragmentation) seems to make femtosecond laser-assisted cataract surgery feasible in patients with posterior chamber PIOLs, as complete treatment patterns are achieved.
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Affiliation(s)
- Vasilios F Diakonis
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Georgios A Kontadakis
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Kendal E Donaldson
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - William W Culbertson
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Abstract
Purpose: To report a case of herpes simplex virus (HSV) endotheliitis following simultaneous phacoemulsification, intraocular lens (IOL) implantation and descemet's membrane endothelial keratoplasty (DMEK). Case Report: A;45 year-old female with corneal endothelial decompensation and a mature cataract, and history of anterior uveitis underwent simultaneous phacoemulsification, IOL implantation and DMEK. Increased corneal edema and descemet's membrane (DM) detachment occurred on postoperative day 3 and 5, respectively. One week after surgery, active keratic precipitates (KPs) appeared. Polymerase chain reaction (PCR) analysis was performed on an aqueous sample which was positive for herpes simplex virus (HSV). After initiating oral acyclovir and frequent topical corticosteroids, the corneal edema resolved and the donor tissue became spontaneously reattached to the recipient corneal stroma. Conclusion: HSV endotheliitis may occur in the early postoperative period after DMEK and manifest as endothelial dysfunction leading to donor detachment. Anti-viral medication may help treat the acute phase and reduce the risk of recurrence.
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Affiliation(s)
| | - Reza Alizadeh
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sonia H Yoo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Chhadva P, Yesilirmak N, Cabot F, Yoo SH. Intrastromal Corneal Ring Segment Explantation in Patients With Keratoconus: Causes, Technique, and Outcomes. J Refract Surg 2015; 31:392-7. [PMID: 26046706 DOI: 10.3928/1081597x-20150521-05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/17/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the causes for intrastromal corneal ring segment (Intacs; Addition Technology Inc., Lombard, IL) explantation in patients with keratoconus, and technique for explantation, long-term outcomes, and secondary procedures to correct visual acuity. METHODS Ten eyes of 8 patients with a history of Intacs explantation between 2004 and 2012 were included in a retrospective study performed at the Bascom Palmer Eye Institute, Miami, Florida. Causes of Intacs removal, surgical technique, preoperative and postoperative corneal examination, and uncorrected and corrected distance visual acuity were documented. Additionally, corneal topography (Tomey, Nagoya, Japan) parameters such as average keratometry and corneal cylinder were assessed. RESULTS Although the segments were well positioned, the most common cause of Intacs removal was worsening visual acuity (80%). There was no statistically significant difference between pre-Intacs placement, post-Intacs placement, and post-Intacs removal in uncorrected and corrected distance visual acuity, average keratometry, or corneal cylinder, except between 1-year post-Intacs placement corrected distance visual acuity (0.57 logMAR [20/75 Snellen]) and 1-month post-Intacs removal corrected distance visual acuity (0.25 logMAR [20/36 Snellen], P =.03). Four patients underwent penetrating keratoplasty after Intacs removal with good visual outcomes. CONCLUSION This study demonstrates the visual and structural outcomes that returned to near baseline after Intacs explantation in keratoconic eyes.
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Affiliation(s)
- Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Neda Nikpoor
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Dias J, Diakonis VF, Lorenzo M, Gonzalez F, Porras K, Douglas S, Avila M, Yoo SH, Ziebarth NM. Corneal stromal elasticity and viscoelasticity assessed by atomic force microscopy after different cross linking protocols. Exp Eye Res 2015; 138:1-5. [PMID: 26093276 DOI: 10.1016/j.exer.2015.06.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/04/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate elasticity and viscoelasticity in the anterior and deeper stromal regions of the cornea after cross linking with three different protocols using atomic force microscopy (AFM) through indentation. A total of 40 porcine corneas were used in this study and were divided into 4 groups (10 corneas per group): control (no treatment), Dresden (corneal epithelial debridement, riboflavin pretreatment for 30 min and a 3mw/cm(2) for 30 min UVA irradiation), accelerated (corneal epithelial debridement, riboflavin pretreatment for 30 min and a 30mw/cm(2) for 3 min UVA irradiation), and genipin (corneal epithelial debridement and submersion of anterior surface in a 1% genipin solution for 4 h). Elasticity and viscoelasticity were quantified using AFM through indentation for all corneas, for the anterior stroma and at a depth of 200 μm. For the control, Dresden, accelerated, and genipin groups, respectively, the average Young's modulus for the anterior stromal region was 0.60 ± 0.58 MPa, 1.58 ± 1.04 MPa, 0.86 ± 0.46 MPa, and 1.71 ± 0.51 MPa; the average for the 200 μm stromal depth was 0.08 ± 0.06 MPa, 0.08 ± 0.04 MPa, 0.08 ± 0.04 MPa, and 0.06 ± 0.01 MPa. Corneas crosslinked with the Dresden protocol and genipin were significantly stiffer than controls (p < 0.05) in the anterior region only. For the control, Dresden, Accelerated, and genipin groups, respectively, the average calculated apparent viscosity for the anterior stroma was 88.2 ± 43.7 kPa-s, 8.3 ± 7.1 kPa-s, 8.1 ± 2.3 kPa-s, and 9.5 ± 3.8 kPa-s; the average for the 200 μm stromal depth was 35.0 ± 3.7 kPa-s, 49.6 ± 35.1 kPa-s, 42.4 ± 17.6 kPa-s, and 41.8 ± 37.6 kPa-s. All crosslinking protocols resulted in a decrease in viscosity in the anterior region only (p < 0.05). The effects of cross-linking seem to be limited to the anterior corneal stroma and do not extend to the deeper stromal region. Additionally, the Dresden and genipin protocols seem to produce a stiffer anterior corneal stroma when compared to the accelerated protocol.
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Affiliation(s)
- Janice Dias
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA
| | | | - Michael Lorenzo
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA
| | - Felipe Gonzalez
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA
| | - Kevin Porras
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA
| | - Simone Douglas
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA
| | - Marcel Avila
- Department of Ophthalmology, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, Miller School of Medicine, Miami, FL, USA
| | - Noël M Ziebarth
- Biomedical Atomic Force Microscopy Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Miami, FL, USA.
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Yesilirmak N, Diakonis VF, Battle JF, Yoo SH. Application of a Hydrogel Ocular Sealant to Avoid Recurrence of Epithelial Ingrowth After LASIK Enhancement. J Refract Surg 2015; 31:275-7. [DOI: 10.3928/1081597x-20150303-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 11/20/2022]
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