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Nitzan I, Derazne E, Afek A, Einan-Lifshitz A, Morad Y, Yahalom C, Peled A. Visual impairment and cognitive performance: A nationwide study of 1.4 million adolescents. Ophthalmic Physiol Opt 2024. [PMID: 38682438 DOI: 10.1111/opo.13323] [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] [Received: 02/12/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents. METHODS A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16-19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<-1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores. RESULTS Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19-1.30) and 0.84 (0.80-0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50-1.75) and 0.81 (0.74-0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual-spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status. CONCLUSIONS Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship.
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Affiliation(s)
- Itay Nitzan
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Yair Morad
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Claudia Yahalom
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
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Mahler S, Einan-Lifshitz A, Shemer A, Belkin A, Pras E, Dubinsky-Pertzov B. Reproducibility of manifest refraction in patients with keratoconus compared with healthy subjects: A prospective cohort study. Am J Ophthalmol 2024:S0002-9394(24)00168-5. [PMID: 38677637 DOI: 10.1016/j.ajo.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To measure and compare the inter- examiner reproducibility of manifest refraction in patients with keratoconus. DESIGN Prospective, inter-examiner reliability analysis comparing "cases and controls" METHODS: Patients with Keratoconus (KC) and healthy subjects had undergone manifest refraction by the same two skilled optometrists, each was masked to the refraction of the other, on the same day. The KC group was comprised of patients with KC, who were recruited from the cornea clinic. The control group consisted of healthy individuals who wore spectacles and did not have KC. Participants for the control group were recruited from the clinic's staff, including doctors, technicians, nurses, and medical students. The study took place in one tertiary medical center in Israel from April 2021 to May 2022. The results of the manifest refraction and achieved corrected distance visual acuity (CDVA) were compared between groups. RESULTS A total of 120 eyes of 60 patients were enrolled in the study; Thirty in the keratoconus group and 30 in the control group. A difference of 0.67±0.83 D and 0.19±0.21 D in the absolute manifest cylinder was observed between the optometrists in the keratoconus (95% LoA, -0.96, 2.30) and control group (95% LoA, -0.22, 0.61), respectively (p<0.001). Multivariate analysis revealed a 22-fold higher likelihood of an error exceeding 0.75 D in cylinder measurements (OR, 22.24; 95% CI, 2.39-206.95) and a tenfold likelihood of a difference of at least one row on the Snellen chart for CDVA (OR,10.32; 95% CI,2.39-44.44) in the KC group. CONCLUSION when compared to healthy subjects, patients with KC exhibit greater variability in manifest refraction. This discrepancy has the potential to influence the decision-making process when managing patients with KC.
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Affiliation(s)
- Shahar Mahler
- Joyce and Irving Goldman Faculty of Medicine, Ben-Gurion University, Be'er-Sheva, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of ophthalmology, Meir medical center, Kfar-Saba, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Shemer A, Cohen M, Altarescu A, Atar-Vardi M, Hecht I, Dubinsky-Pertzov B, Shoshany N, Zmujack S, Or L, Einan-Lifshitz A, Pras E. Diagnostic capabilities of ChatGPT in ophthalmology. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-023-06363-z. [PMID: 38183467 DOI: 10.1007/s00417-023-06363-z] [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] [Received: 06/28/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
PURPOSE The purpose of this study is to assess the diagnostic accuracy of ChatGPT in the field of ophthalmology. METHODS This is a retrospective cohort study conducted in one academic tertiary medical center. We reviewed data of patients admitted to the ophthalmology department from 06/2022 to 01/2023. We then created two clinical cases for each patient. The first case is according to the medical history alone (Hx). The second case includes an addition of the clinical examination (Hx and Ex). For each case, we asked for the three most likely diagnoses from ChatGPT, residents, and attendings. Then, we compared the accuracy rates (at least one correct diagnosis) of all groups. Additionally, we evaluated the total duration for completing the assignment between the groups. RESULTS ChatGPT, residents, and attendings evaluated 126 cases from 63 patients (history only or history and exam findings for each patient). ChatGPT achieved a significantly lower accurate diagnosis rate (54%) in the Hx, as compared to the residents (75%; p < 0.01) and attendings (71%; p < 0.01). After adding the clinical examination findings, the diagnosis rate of ChatGPT was 68%, whereas for the residents and the attendings, it increased to 94% (p < 0.01) and 86% (p < 0.01), respectively. ChatGPT was 4 to 5 times faster than the attendings and residents. CONCLUSIONS AND RELEVANCE ChatGPT showed low diagnostic rates in ophthalmology cases compared to residents and attendings based on patient history alone or with additional clinical examination findings. However, ChatGPT completed the task faster than the physicians.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Cohen
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Health Science, Ben-Gurion University of the Negev, South District, Beer-Sheva, Israel
| | - Aya Altarescu
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Atar-Vardi
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Shoshany
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Zmujack
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
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Gazit I, Dubinsky-Pertzov B, Or L, Pras E, Einan-Lifshitz A. The outcomes of postoperative eye patching after cataract surgery in patients with Fuchs' endothelial corneal dystrophy. Eur J Ophthalmol 2024; 34:119-125. [PMID: 37128126 DOI: 10.1177/11206721231172808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To investigate the influence of post-operative eye patching on corneal thickness, endothelial cells' loss and visual acuity in patients diagnosed Fuchs' endothelial corneal dystrophy (FECD). SETTING Public healthcare centre, Shamir Medical Centre, Israel. METHODS This randomized controlled trial included patients with FECD undergoing routine cataract surgery in a public medical centre. Patients were randomly assigned to 2 groups: the eye undergoing surgery was covered with a patch for 24 h in the first group (patched group), and a plastic shield was used in the second (non-patched group). Both groups received a unique dose of a local steroid and antibiotic post-operatively. The eyes were examined pre-operatively, and on days 1, 7 and 30 post-surgery . Examination included: best corrected visual acuity (BCVA), comeplete slit lamp examination, intra ocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT) using the IOL Master 700 (Zeiss, Germany) and endothelial cell density (ECD) using Specular microscopy. Cumulative dissipated energy (CDE) and operation time were recorded for all cases. RESULTS The study included 46 eyes of 46 patients diagnosed with FECD. Twenty-three eyes in the patched group, and 23 eyes in the non-patched group . Thirty days post-operatively the CCT in the patched group decreased by 60 ± 38 mµ (9%) compared to 92 ± 80 mµ (13.5%) in the non- patched group (p = 0.04). Seven days post-operatively the CCT in the patched group decreased by 31 ± 35 mµ (5%) compared to 58 ± 76 (8%) in the non-patched group, but this difference did not reach statistical significance (p = 0.081). There was no statistically significant difference in endothelial cells loss as well as BCVA at 1, 7 and 30 days post-operatively between the study groups. CONCLUSIONS Avoiding eye patch post-operatively after cataract surgery in patients with FECD results in better corneal clarity recovery and reduced corneal edema one month post-operatively. Visual acuity and endothelial cell's loss were not influenced by patching.
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Affiliation(s)
- Inbal Gazit
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shemer A, Altarescu A, Nusbaum L, Vardi M, Dubinsky-Pertzov B, Hecht I, Or L, Einan-Lifshitz A, Pras E. Quantum Molecular Resonance Effects on Patients With Dry Eye Disease: A Randomized Controlled Trial. Cornea 2023:00003226-990000000-00446. [PMID: 38166187 DOI: 10.1097/ico.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/29/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE The aim of the study was to evaluate the efficacy and safety of quantum molecular resonance in the treatment of dry eye disease. METHODS This study was a double-blind randomized control trial in 1 academic medical center, for 2 years. Participants received treatment or a placebo with the Rexon-Eye device, once per week for 4 weeks. The primary outcome was the change in dry eye symptoms assessed by the Ocular Surface Disease Index (OSDI). Secondary outcomes were clinical findings associated with the dry eye such as meibomian gland dysfunction (MGD) score, tear break-up time (TBUT), corneal fluorescein staining, Schirmer test, and best-corrected visual acuity (BCVA). RESULTS Forty patients were recruited, 20 in each arm. The mean age was 63.5 ± 15.1 years and 27 (67.5%) were female. The mean OSDI score significantly improved in the intervention group from 19.15 ± 10.3 to 10.5 ± 7.0 (P < 0.001), whereas the control group showed no significant change (14.4 ± 8.4 to 15.5 ± 8.6, P = 0.830). MGD scores significantly improved in the intervention group (1.57 ± 1.2 to 0.8 ± 0.9, P = 0.006), whereas showing no significant change in the control group (1.60 ± 0.9 to 1.99 ± 1.0, P = 0.244). The corneal staining score also showed significant improvement in the intervention group (P = 0.045) and a nonsignificant decline in the placebo group (P = 0.50). No significant difference was seen in TBUT, visual acuity, and Schirmer scores between groups. No harm resulting from treatment was reported during the duration of the trial. CONCLUSIONS High-frequency electrotherapy may have a positive effect on symptoms and signs of dry eye. This emerging technology may become part of the arsenal of therapeutic modalities for this condition.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Aya Altarescu
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Lee Nusbaum
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Maya Vardi
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
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Safir M, Hecht I, Heller D, Pras E, Lifshitz M, Einan-Lifshitz A. Psychiatric Comorbidities Associated With Keratoconus. JAMA Ophthalmol 2023; 141:1145-1150. [PMID: 37943540 PMCID: PMC10636647 DOI: 10.1001/jamaophthalmol.2023.5176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
Abstract
Importance Evaluating risk factors for keratoconus, often associated with recurrent eye rubbing, could generate hypotheses to be tested in future interventional trials. Objective To assess the risk for keratoconus associated with psychiatric comorbidities in adolescents and adults. Design, Setting, and Participants This population-based cross-sectional study included medical records of Israeli adolescents and adults in military service from January 2011 through December 2021. Main Outcomes and Measures The prevalence of anxiety, obsessive compulsive disorder (OCD), autism, and attention-deficit/hyperactivity disorder (ADHD) was evaluated in individuals with and without keratoconus. The association between keratoconus and psychiatric comorbidities was tested using univariate and multivariant analyses. Results Overall, 940 763 adolescents and adults were included. Mean (SD) age was 17.56 (1.47) years, and 59.3% were male. Keratoconus was documented in 1533 individuals, with a prevalence of 0.16%. Patients with keratoconus were more likely to be diagnosed with ADHD compared with the general population (odds ratio [OR], 1.58; 95% CI, 1.38-1.81; P < .001). After adjusting for age, sex, intellectual status, height, and weight, the results remained unchanged (hazard ratio, 1.46; 95% CI, 1.27-1.67; P < .001). Stratification according to age showed an association between keratoconus and ADHD for males (OR, 1.62; 95% CI, 1.39-1.90; P < .001) but not for females (OR, 1.29; 95% CI, 0.96-1.74; P = .09). Conclusions and Relevance In a large cohort of adolescents and adults, ADHD was associated with a diagnosis of keratoconus in male patients, even after adjusting for possible confounders. Although a causative effect could not be ascribed, these findings support further investigation into the potential value of education regarding eye rubbing in this population.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Heller
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Eran Pras
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Lifshitz
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Hebrew University-Hadassah Faculty of Medicine, Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nitzan I, Akavian I, Einan-Lifshitz A, Shemer A, Afek A, Peled A. The Definition-Dependent Nature of Myopia Prevalence: A Nationwide Study of 1.5 Million Adolescents. Ophthalmic Epidemiol 2023; 30:515-522. [PMID: 36598174 DOI: 10.1080/09286586.2022.2159984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The application of myopia definition varies considerably within the literature. The purpose of this study was to examine the relationship between different myopia and high myopia definitions and resultant prevalence estimates. METHODS A population-based cross-sectional study of 1,588,508 Israeli adolescents assessed for medical fitness before mandatory military service at the age of 17 years between 1993 through 2015. Participants underwent non-cycloplegic autorefraction. Nine definitions of myopia and seven definitions of high myopia were examined. Prevalence estimates for each definition were calculated and compared with the reference definition (right eye spherical equivalent (SE)≤-0.50D and ≤-6.00D for myopia and high myopia, respectively), to yield a rate ratio (RR) across definitions. RESULTS Applying the right eye SE≤-0.50D reference definition yielded 31.0% myopia prevalence. While some definitions resulted in similar prevalence estimates, using the right eye SE of ≤-0.75D; ≤-1.00D or least minus meridian of ≤-0.75D definitions yielded 28.8%, 26.3%, and 26.9% myopia prevalence, respectively, which corresponded to a 7.1%, 15.1% and 13.4% reduction in myopia RR, respectively. The prevalence of high myopia demonstrated considerable alternations, with a 1.7-fold increase in prevalence for the narrower threshold of SE≤-5.00D compared with SE≤-6.00D reference definition (4.2% and 2.4%, respectively). CONCLUSIONS The prevalence of myopia and especially high myopia varies between frequently applied definitions, considering diverse thresholds, eye lateralization, and spherical vs. astigmatic refractive components. This variability highlights the pressing need for standardization of myopia definition in ophthalmic research. The results of this study provide crude estimates of a "conversion rate" across data, allowing comparisons between studies that utilize different myopia definitions.
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Affiliation(s)
- Itay Nitzan
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Akavian
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Asaf Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
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Safir M, Satanovsky A, Hecht I, Heller D, Einan-Lifshitz A, Pras E. The association between keratoconus and systemic manifestations of connective tissue hyperlaxity. Cont Lens Anterior Eye 2023; 46:101892. [PMID: 37479535 DOI: 10.1016/j.clae.2023.101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To evaluate the correlation between keratoconus and systemic manifestations of tissue hyperlaxity in the general population. METHODS In this population based cross-sectional study 940,763 medical records of Israeli adolescents and young adults in military service were reviewed. Demographic and medical data were extracted. The prevalence of ligament injuries, habitual orthopedic deformities and umbilical/inguinal hernia was evaluated in cases with and without keratoconus. The association was tested using uni- and multivariant analyses. RESULTS Overall 938,411 adolescents and adults were included. Mean age was 17.55 ± 1.50 years, and 40.70% were female. Keratoconus was documented in 1,529 cases, with a prevalence of 0.16%. Compared to the general population, patients with keratoconus were significantly more likely to be diagnosed with genu varum/valgus (OR = 2.75, CI 1.48-5.13, p = 0.0015), pes planus (OR = 1.97, 95% CI: 1.62-2.38, p < 0.0001), scoliosis (OR = 1.88, 95% CI: 1.45-2.43, p < 0.0001) and umbilical/inguinal hernias (OR = 2.18, 95% CI: 1.47-3.24, p = 0.0001). On multivariate analysis the results remained significant (p < 0.05 for all). Joint injuries (ankle sprains, shoulder dislocation and injury to knee ligaments and menisci) were not significantly related to keratoconus (p > 0.05 for all). CONCLUSIONS In this large cohort of adolescents and young adults, an association was found between keratoconus and connective tissue hyperlaxity manifestations involving the knees, feet, spine and abdomen. These findings suggest that keratoconus might be a manifestation of a generalized connective tissue disorder, rather than just a local ocular phenomenon.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Alexandra Satanovsky
- Department of Orthopedic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Heller
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Ophthalmology Department, Shamir Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sharon T, Naftali Ben Haim L, Rabinowicz N, Kidron D, Kidron A, Ton Y, Einan-Lifshitz A, Assia EI, Belkin A. The effect of hypotensive drugs on intraocular lenses clarity. Eye (Lond) 2023; 37:1696-1703. [PMID: 36071178 PMCID: PMC10219955 DOI: 10.1038/s41433-022-02225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs. METHODS In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX). RESULTS Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs. CONCLUSIONS In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.
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Affiliation(s)
- Tal Sharon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Ein-Tal Eye Center, Tel Aviv, Israel.
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rabinowicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine E-Research Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Arnon Kidron
- Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ein-Tal Eye Center, Tel Aviv, Israel
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10
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Einan-Lifshitz A, Achiron A, Hed S, Hecht I, Dubinsky-Pertzov B, Knyazer B. Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus. Eye (Lond) 2023; 37:1219-1224. [PMID: 35590103 PMCID: PMC10102302 DOI: 10.1038/s41433-022-02093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/19/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Standard corneal collagen cross-linking (S-CXL) is an effective treatment to arrest Keratoconus (KC) progression in children. Less is known on the long-term efficacy of accelerated CXL (A-CXL) in paediatric populations. METHODS A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres in Israel between 2010-2017. Preoperative and 3-year postoperative evaluation included changes in visual acuity (best spectacle corrected [BSCVA]) and uncorrected [UCVA]), refractive errors, and keratometric data. RESULTS Ninety-three eyes of 93 patients were analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 LogMAR UCVA, p < 0.05 for both). Improvement in BSCVA and UCVA following A-CXL was non-inferior to S-CXL (< ± 0.2 LogMAR). Kmax decreased by a mean of 0.98 ± 5.56 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres following A-CXL (p = 0.015). Thinnest pachymetry decreased following both treatments (S-CXL: by 26.8 ± 40.7 µm, p = 0.001, A-CXL: by 10.2 ± 13.4 µm, p = 0.028), the difference between groups was within the non-inferiority margin (< ± 10 µm). CONCLUSIONS Paediatric patients followed for three years after A-CXL showed improved visual function, reduced corneal astigmatism and Kmax, and decreased thinnest corneal thickness. A-CXL was non-inferior to S-CXL at three years in terms of best-corrected and uncorrected visual acuity, thinnest pachymetry, and astigmatism. For Kmax, non-inferiority could not be concluded.
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Affiliation(s)
- Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Hed
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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11
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Dubinsky-Pertzov B, Segal O, Hecht I, Gazit I, Or L, Shemer A, Pras E, Einan-Lifshitz A. Correction to: Predictive accuracy of the ABCD progression display among patients with keratoconus: A historic cohort analysis. Eye (Lond) 2023:10.1038/s41433-022-02296-9. [PMID: 36737521 DOI: 10.1038/s41433-022-02296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Omri Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Dubinsky-Pertzov B, Mahler OS, Hecht I, Shemer A, Or L, Gazit I, Pras E, Einan-Lifshitz A. Accuracy of Intraocular Lens Calculation Formulas for the Four-Flanged Fixation Technique in Eyes With No Capsular Support. J Refract Surg 2022; 38:668-673. [DOI: 10.3928/1081597x-20220919-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Dubinsky-Pertzov B, Einan-Lifshitz A, Pras E, Hartstein ME, Morad Y. Routine use of non-absorbable sutures in bi-medial rectus recession as a measure to reduce the incidence of consecutive exotropia. Eye (Lond) 2022; 36:1772-1776. [PMID: 34373609 PMCID: PMC9391456 DOI: 10.1038/s41433-021-01724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of consecutive exotropia following bilateral medial rectus muscle recession surgery (BMR) for esotropia using non-absorbable compared with absorbable sutures in children undergoing strabismus surgery. METHODS A retrospective cohort study of all children with esotropia who underwent BMR by a single surgeon in a tertiary public hospital. As of February 2018, only non-absorbable sutures were used. The primary outcome was the incidence of consecutive exotropia. RESULTS A total of 121 children were included in the analysis, 3.66 ± 2.62 years, 53% were male. In 80 children (66%) non-absorbable sutures were used (non-absorbable group) and in 41 children (34%) absorbable sutures were used (absorbable group). Consecutive exotropia (≥ 8 prism dioptres) occurred in ten children (24%) in the absorbable group and in three children (4%) in the non-absorbable group (OR = 8.28, 95% CI = 2.13-32.13; P = 0.002). This difference between groups remained significant after adjustment for potential confounders and follow-up time (HR = 4.98, 95% CI = 1.30-19.05, P = 0.019). Mean follow-up time was 22 and 12 months in the absorbable and non-absorbable groups, respectively (P < 0.001). Two children in the non-absorbable group had pyogenic granuloma that resolved after 3 months of topical steroidal therapy. CONCLUSION Routine use of non-absorbable sutures in BMR surgery for esotropia may be a preferable alternative to absorbable sutures for the prevention of consecutive exotropia.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris E Hartstein
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Morad
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Safir M, Hecht I, Ahimor A, Zmujack-Yehiam S, Stein R, Bakshi E, Einan-Lifshitz A, Hartstein ME. The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease - A pilot prospective clinical trial. Cont Lens Anterior Eye 2022; 45:101741. [PMID: 35864019 DOI: 10.1016/j.clae.2022.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the effects of treatment with a thermomechanical skin device to the eyelid area on the clinical signs and symptoms of patients who suffer from dry eye disease (DED) secondary to meibomian gland dysfunction (MGD). METHODS Forty patients aged 45 years or older with DED due to MGD were recruited. Both eyes (n = 80) of each patient received three treatments with the Tixel device (Novoxel®, Israel), with each treatment separated by a 2-week period. Treatment was applied across the upper and lower eyelids, with the same intensity, tip protrusion distance, and contact duration. Two additional follow-up visits were performed at 2-week intervals after treatment cessation. DED status was evaluated during each visit via SPEED II questionnaire, tear break-up time (TBUT), corneal staining score (CSS), MGD score, and frequency of lubricant use. Visual acuity (VA) was recorded during first and last visits. RESULTS Mean age was 64.3 ± 12.4 years and 72.5 % (n = 29) were female. 45 % (n = 18) had a history of blepharitis, 12.5 % (n = 5) had chalazia, and 17.5 % (n = 7) suffered from allergic conjunctivitis. Mean follow-up time was 2.1 ± 0.6 months. Comparing the first and last visits, all parameters showed significant improvement after Tixel treatment: mean SPEED II scores (16.5 ± 5.9 to 11.8 ± 6.7, p < 0.001), CSS (2.0 ± 1.3 to 0.5 ± 0.9, p < 0.001), TBUT (2.7 ± 0.8 s to 6.5 ± 2.2 s, p < 0.001), MGD score (2.7 ± 0.5 to 1.2 ± 0.4, p < 0.001), and rate of lubricant use (3.4 ± 2.4 per day to 1.9 ± 2.0, p < 0.001). VA also improved (0.10 ± 0.11 logMAR to 0.08 ± 0.10 logMAR, p < 0.05). No major side effects were observed. CONCLUSIONS In this pilot study Tixel treatment induced significant improvement of signs and symptoms among patients with DED due to MGD. Benefits persisted for at least one month. Further randomized controlled double-blinded studies are needed.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Ahimor
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Zmujack-Yehiam
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Stein
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Bakshi
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris E Hartstein
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Rozenberg A, Hadad A, Peled A, Dubinsky-Pertzov B, Or L, Eting E, Efrati S, Pras E, Einan-Lifshitz A. Hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion retrospective comparative analysis from two tertiary medical centres. Eye (Lond) 2022; 36:1261-1265. [PMID: 34140653 PMCID: PMC9151674 DOI: 10.1038/s41433-021-01617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the visual outcome of patients treated for non-arthritic central retinal artery occlusion (CRAO) in a medical centre that uses hyperbaric oxygen therapy (HBOT) as part of the standard of care (SOC) to medical centres that does not. METHODS The study included data from two tertiary medical centres. The medical records of all patients diagnosed with non-arthritic CRAO without a patent cilioretinal artery between January 2010 and December 2018 in two tertiary medical centres were reviewed. RESULTS One hundred and twenty-one patients were treated by HBOT and 23 patients received only SOC. In the HBOT group, best-corrected visual acuity (BCVA) improved from 2.89 ± 0.98 logMAR at presentation to 2.15 ± 1.07 logMAR upon the end of HBOT (P < 0.001), while the SOC group had no significant improvement, from 3.04 ± 0.82 logMAR at presentation to 2.80 ± 1.50 logMAR (P = 0.24). With adjustment for age, gender, and the duration of symptoms, final BCVA in the HBOT group was significantly better compared to the control group (P = 0.023). Rates of patients achieving vision of 20/200 or better were similar between groups (17.4% vs. 19.8%, P = 0.523). CONCLUSION Utilizing HBOT as part of the SOC for CRAO improves the final visual outcome. HBOT is safe and can be implemented, if available, as part of SOC in all tertiary medical centres.
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Affiliation(s)
- Assaf Rozenberg
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.
| | - Aviel Hadad
- grid.412686.f0000 0004 0470 8989Department of Ophthalmology, Soroka Medical Center, Be’ersheba, Israel
| | - Alon Peled
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Eva Eting
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
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16
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Safir M, Hecht I, Sharon T, Einan-Lifshitz A, Belkin A. Application of Nd:YAG laser to the anterior vitreous in malignant glaucoma - a systemic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2981-2990. [PMID: 35348842 DOI: 10.1007/s00417-022-05640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The study aims to review the efficacy, safety, and technique of Nd:YAG laser vitreolysis for the management of malignant glaucoma (MG). METHODS We performed a search of electronic databases for all published studies which included technical specifications of Nd:YAG laser application for MG. Individual patient data was extracted and evaluated in a weighted pooled analysis. RESULTS Thirty eyes were reported on from seven studies worldwide. Age of affected patients ranged between 37 and 82 years. Nd:YAG vitreolysis was performed either through an iritodomy (66.7%, 18/27 eyes), transpupillary (18.5%, 5/27 eyes), or through both simultaneously (14.8%, 4/27 eyes). Treatment intensity ranged between 1.0 and 11.00 mJ with 75.9% (22/29 eyes) of treatments being 3.0 mJ or lower. Between 1 and 41 pulses per session were applied. Rates of both anatomical and intraocular pressure resolution were examined. Overall, in a pooled analysis, 77% of eyes demonstrated MG resolution with no further treatment required after Nd:YAG vitreolysis (95% CI: 58.1 to 91.4%). A trend for lower need of additional interventions was seen with transpupillary application (11.1% versus 42.1%). No complications were reported. CONCLUSIONS Nd:YAG laser vitreolysis is a safe procedure, associated with MG resolution in the majority of reported cases, regardless of treatment intensity. Transpupillary treatment may be associated with lower risk of re-intervention.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Ophthalmology Department, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Idan Hecht
- Ophthalmology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Sharon
- Ophthalmology Department, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Ophthalmology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Ophthalmology Department, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Peled A, Raz I, Zucker I, Derazne E, Megreli J, Pinhas-Hamiel O, Einan-Lifshitz A, Morad Y, Pras E, Lutski M, Cukierman-Yaffe T, Mosenzon O, Tzur D, Tirosh A, Gerstein HC, Afek A, Twig G. Myopia and Early-Onset Type 2 Diabetes: A Nationwide Cohort Study. J Clin Endocrinol Metab 2022; 107:e663-e671. [PMID: 34505129 DOI: 10.1210/clinem/dgab669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT A correlation between myopia and insulin resistance has been suggested. OBJECTIVE We investigated the association between myopia in adolescence and type 2 diabetes (T2D) incidence in young adulthood. METHODS This population-based, retrospective, cohort study comprised 1 329 705 adolescents (579 543 women, 43.6%) aged 16 to 19 years, who were medically examined before mandatory military service during 1993 to 2012, and whose data were linked to the Israel National Diabetes Registry. Myopia was defined based on right-eye refractive data. Cox proportional models were applied, separately for women and men, to estimate hazard ratios (HRs) for T2D incidence per person-years of follow-up. RESULTS There was an interaction between myopia and sex with T2D (P < .001). For women, T2D incidence rates (per 100 000 person-years) were 16.6, 19.2, and 25.1 for those without myopia, and with mild-to-moderate and high myopia, respectively. These corresponded to HRs of 1.29 (95% CI, 1.14-1.45) and 1.63 (1.21-2.18) for women with mild-to-moderate and high myopia, respectively, compared to those without myopia, after adjustment for age at study entry, birth year, adolescent body mass index, cognitive performance, socioeconomic status, and immigration status. Results persisted in extensive sensitivity and subgroup analyses. When managed as a continuous variable, every 1-diopter lower spherical equivalent yielded a 6.5% higher adjusted HR for T2D incidence (P = .003). There was no significant association among men. CONCLUSION For women, myopia in adolescence was associated with a significantly increased risk for incident T2D in young adulthood, in a severity-dependent manner. This finding may support the role of insulin resistance in myopia pathogenesis.
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Affiliation(s)
- Alon Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Megreli
- Hebrew University-Hadassah Braun School of Public Health and Community, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Yair Morad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Eran Pras
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel
| | - Miri Lutski
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | | | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
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18
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Weiner C, Hecht I, Kotlyar A, Shoshany N, Zadok D, Elbaz U, Segev F, Maytal A, Hachmo Y, Michiels C, De Backer O, Shomron N, Einan-Lifshitz A, Pras E. Association of Variants in TMEM45A With Keratoglobus. JAMA Ophthalmol 2021; 139:1089-1095. [PMID: 34410316 DOI: 10.1001/jamaophthalmol.2021.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Keratoglobus is a rare corneal disorder characterized by generalized thinning and globular protrusion of the cornea. Affected individuals typically have significantly decreased vision and are at risk of corneal perforation. The genetic basis and inheritance pattern of isolated congenital keratoglobus are currently unknown. Objective To identify the genetic basis of isolated congenital keratoglobus. Design, Setting, and Participants This case series and molecular analysis studied 3 unrelated nonconsanguineous families with keratoglobus at a medical center in Israel. Data were collected from June 2019 to March 2021 and analyzed during the same period. Exposures Whole-exome sequencing and direct Sanger sequencing, expression analysis by real-time polymerase chain reaction, splice-site variant analysis, immunohistochemical staining, and histological evaluation of a knockout mouse model. Main Outcomes and Measure Molecular characteristics associated with keratoglobus. Results Four pediatric patients (3 male individuals) from 3 families had clinical findings consistent with keratoglobus. These included globular protrusion, corneal thinning more prominent at the periphery, and high astigmatism. Truncating and splice site variants were identified in the TMEM45A gene, which fully segregate with the disorder. All affected individuals were homozygous or compound heterozygous for variants in the TMEM45A gene, while unaffected family members were heterozygous carriers. Expression analysis in healthy controls showed that TMEM45A was expressed 23 times higher in the human cornea compared with peripheral blood. Immunohistochemical staining of the TMEM45A protein in normal corneas confirmed its expression in the corneal stroma and epithelium. A TMEM45A knockout mouse model showed structural features consistent with keratoglobus. Conclusions and Relevance Expression of TMEM45A has been previously shown to result in upregulation of extracellular matrix components and fibrosis. These results suggest that isolated congenital keratoglobus is an autosomal recessively inherited disorder associated with variants in the TMEM45A gene.
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Affiliation(s)
- Chen Weiner
- Matlow's Ophthalmo-genetic Laboratory, Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Alina Kotlyar
- Matlow's Ophthalmo-genetic Laboratory, Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Nadav Shoshany
- Matlow's Ophthalmo-genetic Laboratory, Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.,Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Uri Elbaz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Rabin Medical Center, Schneider Hospital, Petah Tikva, Israel
| | - Fani Segev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Maytal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Yafit Hachmo
- Research and Development unit, Shamir Medical Center, Zerifin, Israel
| | | | | | - Noam Shomron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Eran Pras
- Matlow's Ophthalmo-genetic Laboratory, Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
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19
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Dubinsky-Pertzov B, Reinhardt O, Gazit I, Or L, Hecht I, Pras E, Einan-Lifshitz A. The ABCD Keratoconus Grading System-A Useful Tool to Estimate Keratoconus Progression in the Pediatric Population. Cornea 2021; 40:1322-1329. [PMID: 34481408 DOI: 10.1097/ico.0000000000002632] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/24/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ABCD grading system in pediatric keratoconus. METHODS A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included. RESULTS Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82-15.34). There was no significant change in the Amsler-Krumeich classification in the CXL group. CONCLUSIONS Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler-Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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20
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Mahler OS, Einan-Lifshitz A, Hecht I, Biron R, Pras E, Dubinsky-Pertzov B. Modification of intraocular lens insertion using 4-flanged fixation with a standard cartridge and a 2.4 mm corneal incision in eyes with no capsular support. J Cataract Refract Surg 2021; 47:1227-1233. [PMID: 34468460 DOI: 10.1097/j.jcrs.0000000000000600] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
A modification of intraocular lens (IOL) implantation, using the 4-flanged IOL fixation technique, through a 2.4 mm corneal incision using a standard cartridge and injector, is presented. An IOL with 4 eyelets is used, through which a 6-0 polypropylene suture is threaded on one side and then loaded into a provided cartridge and inserted to the anterior chamber through a 2.4 mm corneal incision. Using the handshake technique, the suture ends are eventually threaded through the eyelets and secured outside the eye with the creation of 4 flanges. This technique was used in 6 eyes of 5 consecutive patients with the absence of capsular support. During all follow-up visits, the IOLs were well centered and stable, and the flanges were buried in the sclera and covered with the conjunctiva. No complications were recorded. This modification simplifies the technique and reduces the well-known complications of large corneal incisions.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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21
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Shemer A, Pras E, Einan-Lifshitz A, Dubinsky-Pertzov B, Hecht I. Association of COVID-19 Vaccination and Facial Nerve Palsy: A Case-Control Study. JAMA Otolaryngol Head Neck Surg 2021; 147:739-743. [PMID: 34165512 DOI: 10.1001/jamaoto.2021.1259] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Peripheral facial nerve (Bell) palsy has been reported and widely suggested as a possible adverse effect of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Israel is currently the leading country in vaccination rates per capita, exclusively using the BNT162b2 vaccine, and all residents of Israel are obligatory members of a national digital health registry system. These factors enable early analysis of adverse events. Objective To examine whether the BNT162b2 vaccine is associated with an increased risk of acute-onset peripheral facial nerve palsy. Design, Setting, and Participants This case-control study was performed from January 1 to February 28, 2021, at the emergency department of a tertiary referral center in central Israel. Patients admitted for facial nerve palsy were matched by age, sex, and date of admission with control patients admitted for other reasons. Exposures Recent vaccination with the BNT162b2 vaccine. Main Outcomes and Measures Adjusted odds ratio for recent exposure to the BNT162b2 vaccine among patients with acute-onset peripheral facial nerve palsy. The proportion of patients with Bell palsy exposed to the BNT162b2 vaccine was compared between groups, and raw and adjusted odds ratios for exposure to the vaccine were calculated. A secondary comparison with the overall number of patients with facial nerve palsy in preceding years was performed. Results Thirty-seven patients were admitted for facial nerve palsy during the study period, 22 (59.5%) of whom were male, and their mean (SD) age was 50.9 (20.2) years. Among recently vaccinated patients (21 [56.7%]), the mean (SD) time from vaccination to occurrence of palsy was 9.3 (4.2 [range, 3-14]) days from the first dose and 14.0 (12.6 [range, 1-23]) days from the second dose. Among 74 matched controls (2:1 ratio) with identical age, sex, and admittance date, a similar proportion were vaccinated recently (44 [59.5%]). The adjusted odds ratio for exposure was 0.84 (95% CI, 0.37-1.90; P = .67). Furthermore, analysis of the number of admissions for facial nerve palsy during the same period in preceding years (2015-2020) revealed a relatively stable trend (mean [SD], 26.8 [5.8]; median, 27.5 [range, 17-35]). Conclusions and Relevance In this case-control analysis, no association was found between recent vaccination with the BNT162b2 vaccine and risk of facial nerve palsy.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Trinh T, Mimouni M, Mednick Z, Einan-Lifshitz A, Cohen E, Santaella G, Sorkin N, Slomovic A. Outcomes of Ipsilateral Simple Limbal Epithelial Transplantation, Tenonectomy, Mitomycin and Amniotic Membrane Transplantation for Treatment of Recurrent Pterygium. Cornea 2021; 40:43-47. [PMID: 32304432 DOI: 10.1097/ico.0000000000002336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report on the outcomes of recurrent pterygium treated by ipsilateral simple limbal epithelial transplantation (SLET), mitomycin, tenonectomy, and amniotic membrane transplantation. METHODS A retrospective, interventional study was conducted including all patients with recurrent pterygium who underwent SLET surgery under a single surgeon using ipsilateral donor tissue with a minimum 6-month follow-up at Toronto Western Hospital, Canada. Outcome measures included the following: recurrence rates, best spectacle-corrected visual acuity, and postoperative complications. RESULTS Ten eyes of 10 patients, aged 60.7 ± 18.5 years (range 23-79) with a mean follow-up time of 15.2 ± 10.0 months of which 50% (n = 5) were men, were included. Eight eyes (80%) had a history of 2 or less pterygium operations. Two patients had 3 and 5 previous pterygium operations, respectively. Concurrent limbal stem cell disease was noted in 6 eyes (60%). Average number of pterygium recurrences per eye was 1.9 ± 1.3 (range 1-5). Mean pre-op best-corrected visual acuity was 0.5 LogMAR (Snellen equivalent 20/60, range 20/20 to counting fingers). Best-corrected visual acuity remained the same or improved in 6 eyes (60%). Recurrence was noted in 1 eye (10%) with a history of 5 previous pterygium excisions and remained stable at the last follow-up. No patients required a second operation. CONCLUSIONS Ipsilateral SLET with mitomycin, tenonectomy, and amniotic membrane transplantation is a novel technique to address recurrent pterygium. Concurrent limbal stem cell diseases are often present. Initial results demonstrate low recurrence. Visual improvement is modest. Stabilization of the ocular surface to improve vision is possible.
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Affiliation(s)
- Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Zale Mednick
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Gisella Santaella
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Ophthalmology Department, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Allan Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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23
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Mahler OS, Biron R, Hecht I, Pras E, Einan-Lifshitz A. Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation. J Cataract Refract Surg 2021; 47:476-481. [PMID: 33149040 DOI: 10.1097/j.jcrs.0000000000000474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation. SETTING Shamir Medical Center, Israel. DESIGN Retrospective cohort analysis. METHODS Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography. RESULTS Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P = .965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients. CONCLUSIONS Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Shemer A, Einan-Lifshitz A, Itah A, Dubinsky-Pertzov B, Pras E, Hecht I. Ocular involvement in coronavirus disease 2019 (COVID-19): a clinical and molecular analysis. Int Ophthalmol 2020; 41:433-440. [PMID: 32929665 PMCID: PMC7489575 DOI: 10.1007/s10792-020-01592-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/05/2020] [Indexed: 02/02/2023]
Abstract
Purpose Coronavirus disease 2019 (COVID-19) caused a global pandemic with millions infected worldwide. Little is known on the ocular involvement associated with the disease. The aim of this study was to assess the clinical and molecular ocular involvement among patients with confirmed COVID-19 admitted to a tertiary care facility. Methods Consecutive patients admitted to the COVID-19 Ward of the Shamir Medical Center in Israel during March and April, 2020 were included. The control group included patients negative for COVID-19 admitted during a similar period to a different ward. Patients were examined by trained Ophthalmologists. SARS-CoV-2 conjunctival swab samples were obtained. Results Included were 48 patients, 16 with confirmed COVID-19 and 32 controls. Median patient age was 68.5 (interquartile range: 31.5, mean: 63 ± 21) years and 48% were male. Active conjunctival injection was present in three patients (19%) with COVID-19, compared to none in the controls (p = 0.034). Patients with COVID-19 were more likely to complain of foreign body sensation (31.3% vs 3.1%, p = 0.005) and redness of the eye (25% vs 0%, p = 0.003). Conjunctival injection was associated with loss of smell and taste (75% vs 7.7%, p = 0.018). Viral conjunctival swab tests all showed negative results for all three viral genes tested (E, N, and RdRp). Conclusions Among patients admitted to a tertiary referral center with confirmed COVID-19, active conjunctival injection was noted in one out of five cases, and was associated with loss of smell and taste. Conjunctival swabs for viral RNA were negative in patients with and without ocular involvement. Electronic supplementary material The online version of this article (10.1007/s10792-020-01592-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Itah
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, The Hebrew University - Hadassah School of Medicine, Hadassah Campus, Jerusalem, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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25
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Dubinsky-Pertzov B, Hecht I, Gazit I, Or L, Mahler O, Rotman S, Pras E, Einan-Lifshitz A. Clinical outcomes of Ankoris toric intraocular lens implantation using a computer-assisted marker system. Int Ophthalmol 2020; 40:3259-3267. [PMID: 32720169 DOI: 10.1007/s10792-020-01511-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the clinical outcomes of patients who underwent cataract surgery with implantation of Ankoris monofocal toric intraocular lens (IOL) (PhysIOL SA, Liège, Belgium) using the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA). METHODS We conducted a retrospective case series of patients who underwent routine cataract extraction and implantation of Ankoris toric IOL using the Zeiss Callisto eye between January 2018 and December 2018 by four senior surgeons. Patients' medical records were reviewed, and clinical outcomes including postoperative refraction, visual acuity outcomes, IOL position and deviation from planned axis were collected. RESULTS Fifty-six eyes of 56 patients were included, 48% were female, and the mean age was 70 ± 8 years. Patients with pseudoexfoliation syndrome, glaucoma or keratoconus were excluded from the study. Pre-operative mean corneal astigmatism was 2.38 ± 0.78 diopters (D), and mean implanted IOL cylindrical power was 3.06 ± 1.07 D. IOL rotation 30 days postoperatively was within 5° in 82% of eyes and between 6° and 10° in 10.8% of eyes. Mean postoperative refractive astigmatism 30 days postoperatively was 0.22 ± 0.36 D; in 84% of eyes the postoperative refractive astigmatism was ≤ 0.50 D. IOL rotation significantly increased between day 1 to day 7 postoperatively (1.91 ± 3.15° to 3.18 ± 3.3°, P = 0.001). However, no significant rotation had occurred between day 7 and day 30 postoperatively (P = 0.093). CONCLUSION Cataract surgery with implantation of Ankoris monofocal toric IOL using the Zeiss Callisto Eye marking system is predictable and effective in reducing refractive astigmatism.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel.
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Ori Mahler
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Shlomo Rotman
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
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26
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Achiron A, Elbaz U, Hecht I, Spierer O, Einan-Lifshitz A, Karesvuo P, Laine I, Tuuminen R. The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 128:410-416. [PMID: 32717342 DOI: 10.1016/j.ophtha.2020.07.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery. DESIGN Cohort study. PARTICIPANTS Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. METHODS Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included. MAIN OUTCOME MEASURE Neovascular age-related macular degeneration-free survival. RESULTS Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n = 88; non-BLF group, n = 76). The nAMD-free survival was similar between the groups (P = 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79-1.47; P = 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P = 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P = 0.527), number of anti-vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P = 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P = 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n = 71; non-BLF, n = 74), the clinical outcomes again were comparable (all P > 0.05). CONCLUSIONS In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Bristol Eye Hospital, Bristol, United Kingdom
| | - Uri Elbaz
- Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, and Bristol Eye Hospital, Bristol, United Kingdom
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petteri Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Laine
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Automation and Electrical Engineering, Aalto University, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland.
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Boutin T, Sorkin N, Einan-Lifshitz A, Mednick Z, Mimouni M, Cohen E, Trinh T, Santaella G, Buys YM, Trope G, Chan CC, Rootman DS. Descemet membrane endothelial keratoplasty in patients with prior glaucoma surgery. Eur J Ophthalmol 2020; 31:2121-2126. [PMID: 32605435 DOI: 10.1177/1120672120936178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/15/2022]
Abstract
OBJECTIVE To present outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior trabeculectomy or a glaucoma drainage device (GDD). METHODS A retrospective case series, including patients that had previously undergone trabeculectomy and/or GDD implantation, who later underwent DMEK between 2013 and 2016 at Toronto Western Hospital and the Kensington Eye Institute. Outcome measures: best spectacle-corrected visual acuity (BSCVA), endothelial cell (EC) density, intraoperative and postoperative complications. RESULTS Twenty-seven eyes of 27 patients were included. All DMEK procedures were uneventful. Mean follow-up time was 14.6 ± 6.1 months. In eyes with no visually limiting comorbidities (n = 16), BSCVA improved from 1.34 ± 0.65 logMAR (Snellen equivalent ~20/440) preoperatively to 0.51 ± 0.24 logMAR (Snellen equivalent ~20/65) and 0.50 ± 0.33 logMAR (Snellen equivalent ~20/65) at 6 and 12 months, respectively (p < 0.001 for both). In eyes with visually limiting comorbidities (n = 11), BSCVA improved from 1.92 ± 0.72 logMAR (Snellen equivalent ~20/1665) preoperatively to 1.43 ± 0.83 logMAR (Snellen equivalent ~20/540) and 1.37 ± 0.99 logMAR (Snellen equivalent ~20/470) at 6 and 12 months, respectively (p = 0.008 and p = 0.037).Graft detachment rate was 24.1% and rebubble rate was 17.2%. Primary and secondary graft failure rates were 3.7% and 10.3%, respectively. Rejection rate was 17.2%. EC-loss rate at 6 months and 12 months was 36.7% and 50.5%, respectively. CONCLUSIONS DMEK performed in eyes with previous trabeculectomy or a GDD is more challenging than conventional DMEK, but has good outcomes. Higher rates of graft rejection and secondary graft failure in this setting should be further evaluated in long-term studies.
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Affiliation(s)
- Tanguy Boutin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Zale Mednick
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Gisella Santaella
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Graham Trope
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Sorkin N, Mimouni M, Santaella G, Trinh T, Cohen E, Einan-Lifshitz A, Chan CC, Rootman DS. Comparison of Manual and Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty for Failed Penetrating Keratoplasty. Am J Ophthalmol 2020; 214:1-8. [PMID: 31758925 DOI: 10.1016/j.ajo.2019.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare outcomes of manual Descemet membrane endothelial keratoplasty (M-DMEK) and femtosecond laser-assisted Descemet membrane endothelial keratoplasty (F-DMEK) in treatment of penetrating keratoplasty (PK) graft failure. METHODS Setting: Retrospective, interventional comparative case series. PatientPopulation: Included were all patients with a failed PK graft who underwent either F-DMEK (10 eyes of 10 patients) or M-DMEK (29 eyes of 29 patients) at Toronto Western Hospital and the Kensington Eye Institute between 2014 and 2019, and had 6 months of postoperative follow-up. OutcomeMeasures: Rates of graft detachment, rebubbling, rejection and failure, best spectacle-corrected visual acuity (BSCVA), and endothelial cell (EC) density. RESULTS Rate of significant graft detachment (detachment requiring either rebubble or repeat keratoplasty) was 10.0% in F-DMEK and 65.5% in M-DMEK (P = .003). Rebubble rate was 10.0% in F-DMEK and 58.6% in M-DMEK (P = .011). Primary failure rate was 0% in F-DMEK and 27.6% in M-DMEK (P = .086). Rates of rejection and secondary failure did not differ between the groups (P = 1.000 for both). In a multivariable analysis, F-DMEK was found to be the only independent factor significantly associated with reduced postoperative detachment. Postoperative BSCVA at 6 months returned to prefailure levels in both groups, with no significant difference between the groups at any time point. EC loss rates were 43.8% in F-DMEK and 38.0% in M-DMEK at 6 months (P = .453). CONCLUSIONS F-DMEK is a safe and effective procedure in failed PK patients, with outcomes comparable to M-DMEK, and with reduced detachment and rebubble rates. A trend towards reduced primary failure should be further studied.
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Gomel N, Barequet IS, Lipsky L, Bourla N, Einan-Lifshitz A. The effect of the glycemic control on the aqueous humor glucose levels in diabetic patients undergoing elective cataract surgery. Eur J Ophthalmol 2020; 31:415-421. [PMID: 32162546 DOI: 10.1177/1120672120910375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Aqueous humor glucose levels play a role in the anterior segment disorders' pathophysiology, mainly in diabetics. Our purpose was to evaluate the ratio of aqueous humor glucose levels to blood glucose levels in diabetics and to evaluate the correlation between this ratio and blood glycated hemoglobin (HbA1c) levels. METHODS This prospective study was performed in Sheba Medical Center during 2016-2018. The study included type 2 diabetic patients admitted for elective cataract surgery. Blood glucose levels were measured immediately before surgery. HbA1c was obtained within 3 months preoperatively. At the beginning of surgery, 0.05-0.1 mL aqueous humor was drawn. Main outcome measures were aqueous humor glucose/blood glucose ratio and the correlation between HbA1c and aqueous humor glucose/blood glucose ratio. RESULTS Thirty-seven patients (mean age 75.2 ± 11.2 years) were recruited. The average aqueous humor glucose/blood glucose ratio was 0.69 ± 0.20. A significant positive correlation was found between aqueous humor and blood glucose levels, Pearson coefficient constant R = 0.63 (p < 0.01), and specifically stronger among older patients R = 0.89 (p < 0.01), females R = 0.74 (p < 0.01), patients with short-term disease (<10 years) R = 0.80 (p < 0.01), and patients treated with oral anti-diabetic treatment R = 0.74 (p < 0.01). A significant strong positive correlation was found between HbA1c levels and aqueous humor glucose/blood glucose ratio R = 0.62 (p < 0.01), and specifically stronger among older patients R = 0.82 (p < 0.01), males R = 0.70 (p < 0.01), patients with prolonged disease (⩾10 years) R = 0.540 (p < 0.05), and patients treated with oral anti-diabetic treatment R = 0.62 (p < 0.01). CONCLUSION A significant strong correlation was found between aqueous humor glucose levels and blood glucose levels. Poor glycemic control was strongly correlated with an increased ratio, reflecting an increased anterior chamber's glucose permeability. Older age group was found to have stronger correlation of poor glycemic control with this ratio.
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Affiliation(s)
- Nir Gomel
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Lipsky
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nirit Bourla
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Adi Einan-Lifshitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Assaf Harofeh Medical Center, Tzrifin, Israel
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Einan-Lifshitz A, Sorkin N, Smollan G, Barequet I. The effect of recurrent povidone-iodine usage on conjunctival flora in diabetic patients undergoing intravitreal injections. Eur J Ophthalmol 2020; 31:607-611. [PMID: 31983226 DOI: 10.1177/1120672120902032] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema. METHODS Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection. RESULTS Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (p = 0.63), and 1 month after the last injection, 18% of cultures were positive (p = 0.495). The mean HbA1C was 8.1% ± 1.7%. HbA1C of patients with positive cultures was 8.0% ± 1.1% at the first intravitreal injection and 8.2% ± 1.0% at the third intravitreal injection. This was compared with HBA1C in eyes with negative cultures: 7.4% ± 1.2% (p = 0.45) and 7.1% ± 1.0% (p = 0.14), respectively. CONCLUSION Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.
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Affiliation(s)
- Adi Einan-Lifshitz
- Department of Ophthalmology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Sorkin
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Gill Smollan
- Clinical Microbiology Laboratory, Sheba Medical Center, Ramat Gan, Israel
| | - Irit Barequet
- The Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Einan-Lifshitz A, Rozenberg A, Wang L, Koch DD, Shoshany N, Zadok D, Avni I, Abulafia A. Accuracy and feasibility of axial length measurements by a new optical low-coherence reflectometry-based device in eyes with posterior subcapsular cataract. J Cataract Refract Surg 2019; 43:898-901. [PMID: 28823435 DOI: 10.1016/j.jcrs.2017.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the feasibility and accuracy of measuring axial length (AL) by a new optical low-coherence reflectometry (OLCR)-based device in eyes with central posterior subcapsular cataract (PSC). SETTING Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel. DESIGN Retrospective case series. METHODS Consecutive cases of patients who had uneventful cataract surgery and whose preoperative AL measurements were not feasible with the partial coherence interferometry (PCI) device because of a central PSC were assessed. Preoperative AL was measured by the OLCR device and immersion ultrasound (US). Preoperative results were compared with the postoperative AL measurements obtained by the PCI. RESULTS Twenty-seven patients (27 eyes) were enrolled in the study. The median difference between the OLCR and the PCI AL measurements (0.07 mm) was lower than the median difference between the US and the PCI AL measurements (0.13 mm) (P = .016). The ranges of the limits of agreement were 0.15 mm between OLCR and PCI, and 0.88 mm between US and PCI. The proportion of eyes with an AL difference of less than 0.1 mm was significantly higher between the OLCR and the PCI devices (24 eyes [88.9%]) than between the US and the PCI devices (9 eyes [33.3%]) (P = .001). CONCLUSIONS The OLCR-based device successfully measured the preoperative AL in all eyes with central PSC for which preoperative PCI scans were not feasible. These measurements had a high level of agreement with the postoperative AL measurements obtained by the PCI device.
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Affiliation(s)
- Adi Einan-Lifshitz
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA.
| | - Assaf Rozenberg
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - Douglas D Koch
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - Nadav Shoshany
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - David Zadok
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - Isaac Avni
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
| | - Adi Abulafia
- From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA
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Sorkin N, Trinh T, Einan-Lifshitz A, Mednick Z, Santaella G, Telli A, Belkin A, Chan CC, Rootman DS. Outcomes of femtosecond laser-assisted Descemet membrane endothelial keratoplasty for failed penetrating keratoplasty. Can J Ophthalmol 2019; 54:741-745. [DOI: 10.1016/j.jcjo.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Shoshany N, Weiner C, Safir M, Einan-Lifshitz A, Pokroy R, Kol A, Modai S, Shomron N, Pras E. Rare Genetic Variants in Jewish Patients Suffering from Age-Related Macular Degeneration. Genes (Basel) 2019; 10:genes10100825. [PMID: 31635417 PMCID: PMC6826738 DOI: 10.3390/genes10100825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: To identify rare genetic variants in early age-related macular degeneration (AMD) utilizing whole-exome sequencing (WES). Methods: Eight non-related early-AMD families of different Jewish ethnicities were ascertained. Initial mutation screening (phase-1) included common complement factor-H (CFH) p.Y402H; and age related maculopathy susceptibility 2 (ARMS2) p.A69S; and rare variants complement factor-I (CFI) p.V412M; and hemicentin1 (HMCN1) c.4163delC identified previously in our population. Four families, whose initial screening for the aforementioned variants was negative, underwent WES (phase-2). Bioinformatics filtering was based on functionality (from a panel of 234 genes with proven or presumed association to AMD); predicted severity; and frequency (rare variants with minor allele frequency <1%). When applicable, further screening for specific rare variants was carried out on additional cases of similar ethnicities and phenotypes (phase-3). Results: Phase-1 identified three families carrying CFI p.V412M mutation. WES analysis detected probable disease-related variants in three out of the remaining families. These included: a family with a variant in PLEKHA1 gene p.S177N; a family with previously reported variant p.R1210C in CFH gene; and two families with the C3 p.R735W variant. Conclusions: Rare, high-penetrance variants have a profound contribution to early-AMD pathogenesis. Utilization of WES in genetic research of multifactorial diseases as AMD, allows a thorough comprehensive analysis with the identification of previously unreported rare variants.
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Affiliation(s)
- Nadav Shoshany
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
| | - Chen Weiner
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Margarita Safir
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Adi Einan-Lifshitz
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Russell Pokroy
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
| | - Ayala Kol
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
| | | | - Noam Shomron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
- Variantyx Inc, MA 01701, USA.
| | - Eran Pras
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir (formerly Assaf-Harofeh) Medical Center, Zerifin 70300, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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Kreimei M, Sorkin N, Einan-Lifshitz A, Rootman DS, Chan CC. Long-term outcomes of donor eyes after conjunctival limbal autograft and allograft harvesting. Can J Ophthalmol 2019; 54:565-569. [DOI: 10.1016/j.jcjo.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 12/15/2022]
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Sella R, Einan-Lifshitz A, Sorkin N, Chan CC, Afshari NA, Rootman DS. Learning curve of two common Descemet membrane endothelial keratoplasty graft preparation techniques. Can J Ophthalmol 2019; 54:467-472. [DOI: 10.1016/j.jcjo.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022]
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Alnabulsi R, Showail M, Sorkin N, Einan-Lifshitz A, Rootman D. Fuchs' endothelial dystrophy masquerading as keratoconus. Can J Ophthalmol 2019; 54:e176-e180. [PMID: 31358161 DOI: 10.1016/j.jcjo.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
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Einan-Lifshitz A, Mednick Z, Belkin A, Sorkin N, Alshaker S, Boutin T, Chan CC, Rootman DS. Comparison of Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty in the Treatment of Failed Penetrating Keratoplasty. Cornea 2019; 38:1077-1082. [DOI: 10.1097/ico.0000000000001993] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Belkin A, Einan-Lifshitz A, Mathew DJ, Sorkin N, Buys YM, Trope GE, Rootman DS. Intraocular pressure control after trans-scleral intraocular lens fixation in glaucoma patients. Eur J Ophthalmol 2019; 30:685-689. [PMID: 30943784 DOI: 10.1177/1120672119840913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraocular lens fixation surgery is associated with fluctuations in intraocular pressure. This may be significantly relevant in glaucoma patients. OBJECTIVES To assess short- and medium-term intraocular pressure control after trans-scleral intraocular lens fixation surgery in glaucoma patients. METHODS The charts of all glaucoma patients who underwent trans-scleral intraocular lens fixation surgery with at least 6 months follow-up by a single surgeon between the years 2004 and 2017 were reviewed. Primary outcomes were intraocular pressure at 1 day and 6 months after surgery. Secondary outcome measures were hypotensive medication use and the need for further intraocular pressure lowering interventions. RESULTS Eleven eyes of 10 patients were included in the analysis. Mean follow-up post intraocular lens fixation surgery was 54.6 months. Mean intraocular pressure before, 6 months, and last follow-up after intraocular lens fixation surgery was 15.8 ± 5.3 mmHg (range 10.6-25.3), 13.5 ± 3.8 mmHg (range 8-21, p = 0.2), and 11.8 ± 5.6 (range 6-21, p = 0.09) on a mean of 2.3 ± 1.6, 2 ± 1.6 (p = 0.23), and 1.7 ± 1.5 (p = 0.08) hypotensive medications, respectively. A pressure spike was noted in 5 of the 11 eyes on the first post-operative day (mean spike 15.2 mmHg, range 6-23). Four of 11 eyes in the study (36%) needed additional interventions to control intraocular pressure by the 6-month point. One eye required the addition of two classes of topical medications, one eye required laser trabeculoplasty, and two eyes required trabeculectomy. CONCLUSION Over a third of glaucomatous eyes required a change in the management of their disease in the early post-operative period. Close follow-up of patients undergoing trans-scleral intraocular lens fixation surgery is warranted.
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Affiliation(s)
- Avner Belkin
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
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Sorkin N, Einan-Lifshitz A, Boutin T, Showail M, Borovik A, Chan CC, Rootman DS. Descemet membrane endothelial keratoplasty in iridocorneal endothelial syndrome and posterior polymorphous corneal dystrophy. Can J Ophthalmol 2019; 54:190-195. [DOI: 10.1016/j.jcjo.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
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Mednick Z, Boutin T, Einan-Lifshitz A, Sorkin N, Slomovic A. Simple limbal epithelial transplantation for recurrent pterygium: A case series. Am J Ophthalmol Case Rep 2018; 12:5-8. [PMID: 30101206 PMCID: PMC6083897 DOI: 10.1016/j.ajoc.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Pterygium recurrence is a common complication of pterygium removal. Multiple surgical and medical approaches have been utilized to reduce recurrence rates. The present case series proposes a novel way to treat recurrent pterygia, by using the simple limbal epithelial transplantation (SLET) technique. OBSERVATIONS The cases of four patients who presented with recurrent pterygium were reviewed. In all four of the cases reported, the SLET procedure went without complication. There were no significant recurrences at each of the patient's most recent follow-up visits. CONCLUSIONS AND IMPORTANCE This is the first report of SLET being used as a treatment modality for recurrent pterygium. Further studies are required to more reliably demonstrate the utility of the procedure in this clinical circumstance, but our results are encouraging that in select patients, this may be a viable option in treating aggressive recurrent pterygia.
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Affiliation(s)
- Zale Mednick
- University of Toronto, Department of Ophthalmology and Vision Sciences, Canada
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Showail M, Obthani MA, Sorkin N, Einan-Lifshitz A, Boutin T, Borovik A, Chan CC, Rootman DS. Outcomes of the first 250 eyes of Descemet membrane endothelial keratoplasty: Canadian centre experience. Can J Ophthalmol 2018; 53:510-517. [DOI: 10.1016/j.jcjo.2017.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 10/17/2022]
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Mednick Z, Betsch D, Boutin T, Einan-Lifshitz A, Sorkin N, Slomovic A. Bilateral BrightOcular iris implants necessitating explantation and subsequent endothelial keratoplasty. Am J Ophthalmol Case Rep 2018; 12:1-4. [PMID: 30094397 PMCID: PMC6072912 DOI: 10.1016/j.ajoc.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To demonstrate the dangers associated with the BrightOcular iris implant, a model that had initially been touted as safer than its predecessors. Observations A 41-year-old male presented with decreased vision in both eyes, approximately two years following bilateral BrightOcular cosmetic iris implantation performed in Mexico. On initial consultation, he was found to have bilateral corneal decompensation with stromal edema and a significantly reduced endothelial cell count (ECC). On follow up 5 weeks later, his vision and corneal edema had further detriorated. In the following month, he underwent explantation of the cosmetic iris implants in both eyes. Significant corneal edema persisted in the right eye several months post-operatively, to the point of necessitating endothelial keratoplasty. Conclusions and importance Despite numerous reports in the literature of the significant ocular complications that can arise secondary to cosmetic iris implantation, individuals continue to willingly undergo this surgery. Our intention with presenting this case to the ophthalmologic community is two-fold: to highlight the ongoing clinical risk that BrightOcular devices pose, despite being marketed as safer than the older NewColourIris models, and to stress the urgency with which cosmetic iris implants should be removed from the eye.
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Affiliation(s)
- Zale Mednick
- Cornea Service, Department of Ophthalmology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
| | - Devin Betsch
- Dalhousie University, Faculty of Medicine, 1459 Oxford Street, Halifax, NS, B3H 4R2, Canada
| | - Tanguy Boutin
- Cornea Service, Department of Ophthalmology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
| | - Adi Einan-Lifshitz
- Cornea Service, Department of Ophthalmology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
| | - Nir Sorkin
- Cornea Service, Department of Ophthalmology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
| | - Allan Slomovic
- Cornea Service, Department of Ophthalmology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada
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Sorkin N, Einan-Lifshitz A, Boutin T, Showail M, Borovik A, Chan CC, Rootman DS. Topography-Guided Photorefractive Keratectomy in the Treatment of Corneal Scarring. J Refract Surg 2018; 33:639-644. [PMID: 28880340 DOI: 10.3928/1081597x-20170718-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/14/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcome of topography-guided photorefractive keratectomy (TG-PRK) in the treatment of patients with corneal scarring. METHODS A retrospective, interventional case series including 6 eyes of 6 patients with corneal scarring and irregular astigmatism who underwent TG-PRK. The etiologies for scarring were: infectious corneal ulcers, foreign body trauma, LASIK flap buttonhole, and lamellar keratoplasties performed to correct corneal perforation secondary to corneal melting. Main outcome measures were corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction, and corneal regularity on topography maps. RESULTS Average age was 56.5 ± 19.6 years and average follow-up time was 14.8 ± 6.1 months. Three patients had corneal scarring with cataract and underwent TG-PRK to achieve sufficient regularization of corneal astigmatism to enable the implantation of a toric intraocular lens (IOL). The three remaining patients had TG-PRK performed to improve visual acuity, and all had improvement in uncorrected (improvement between one and three Snellen lines) and corrected (improvement between two and three Snellen lines) distance visual acuity. There were no intraoperative or postoperative complications and no loss of visual acuity. CONCLUSIONS The use of TG-PRK for corneal scarring may improve visual acuity in selected cases, obviate the need for keratoplasty in some cases, and facilitate toric IOL implantation in some cases. [J Refract Surg. 2017;33(9):639-644.].
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Einan-Lifshitz A, Sorkin N, Boutin T, Showail M, Borovik A, Alobthani M, Chan CC, Rootman DS. Comparison of Femtosecond Laser-Enabled Descemetorhexis and Manual Descemetorhexis in Descemet Membrane Endothelial Keratoplasty. Cornea 2017; 36:767-770. [PMID: 28594697 DOI: 10.1097/ico.0000000000001217] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To introduce a novel method to perform descemetorhexis in Descemet membrane endothelial keratoplasty (DMEK) using the femtosecond laser and to compare it with Descemet membrane endothelial keratoplasty performed with manual descemetorhexis (M-DMEK). METHODS A retrospective medical chart review of 2 groups of patients who underwent DMEK surgery combined with cataract surgery secondary to Fuchs corneal endothelial dystrophy and cataract: 17 patients underwent femtosecond laser-enabled descemetorhexis Descemet membrane endothelial keratoplasty (FE-DMEK) and 89 patients underwent DMEK surgery with M-DMEK. Best spectacle-corrected visual acuity, endothelial cell density (ECD), graft detachment rate, and complications were compared. RESULTS Average age of the 106 patients (64 women and 42 men) was 68 ± 11 years. Postoperative best spectacle-corrected visual acuity was 0.19 ± 0.13 logarithm of the minimum angle of resolution in the FE-DMEK group and 0.35 ± 0.48 logarithm of the minimum angle of resolution in the M-DMEK group (P = 0.218). One day after surgery, there were no significant graft detachments in the FE-DMEK group, compared with 20% graft detachment rate in the M-DMEK group (P = 0.041). Rebubbling was performed in 17% of eyes in the M-DMEK group compared with none in the FE-DMEK group (P = 0.066). The mean endothelial cell count in the FE-DMEK and M-DMEK groups at 6 months after surgery were 2105 ± 285 cells per square millimeter (24% cells loss) and 1990 ± 600 cells per square millimeter (29% cells loss), respectively (P = 0.579). CONCLUSIONS FE-DMEK shows efficacy similar to that of M-DMEK with apparently less graft detachment and reduced need for rebubbling.
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Affiliation(s)
- Adi Einan-Lifshitz
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Abstract
PURPOSE To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. METHODS Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. RESULTS An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. CONCLUSIONS Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.
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Affiliation(s)
- Nadav Shoshany
- a The Matlow's Ophthalmo-genetics Laboratory , Assaf-Harofeh Medical Center , Zerifin , Israel.,b Department of Ophthalmology , Assaf-Harofeh Medical Center , Zerifin , Israel
| | - Isaac Avni
- a The Matlow's Ophthalmo-genetics Laboratory , Assaf-Harofeh Medical Center , Zerifin , Israel.,b Department of Ophthalmology , Assaf-Harofeh Medical Center , Zerifin , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yair Morad
- b Department of Ophthalmology , Assaf-Harofeh Medical Center , Zerifin , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Chen Weiner
- a The Matlow's Ophthalmo-genetics Laboratory , Assaf-Harofeh Medical Center , Zerifin , Israel
| | - Adi Einan-Lifshitz
- b Department of Ophthalmology , Assaf-Harofeh Medical Center , Zerifin , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Eran Pras
- a The Matlow's Ophthalmo-genetics Laboratory , Assaf-Harofeh Medical Center , Zerifin , Israel.,b Department of Ophthalmology , Assaf-Harofeh Medical Center , Zerifin , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Abstract
PURPOSE This study reports the presentation of 2 families with macular corneal dystrophy (MCD). The aim of this study was to show whether ultrasound biomicroscopy (UBM) can, based on posterior changes of the cornea in MCD, assist in the choice of surgery, either anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK), compared with optical coherence tomography (OCT) and Scheimpflug. METHODS Six patients with MCD were examined for their best-corrected visual acuity, slit-lamp, OCT, UBM, and Scheimpflug findings. Blood samples for DNA and exons of the CHST6 gene were screened for mutations. RESULTS All 6 patients showed typical MCD signs at the slit lamp. Corneal transplantation was required in 2 patients in both eyes. Recurrence of MCD was observed in 2 eyes after the DALK procedure (patient A5, age 48 years, right eye and B1, 51 years, left eye), whereas the 2 eyes after PK (patient A5, age 48 years, left eye and patient B1, 51 years, right eye) remained clear (for 10 years of follow-up in patient A5 and 4 years in patient B1). In 2 patients (A1 and A3), corneal thinning could be evaluated by OCT. In 3 patients (A2, 3, and 4), UBM disclosed deeper pathologies including opacities, loss of continuity, and focal protrusions of the posterior cornea, which were not evident by other devices. In family A, a novel mutation was identified. CONCLUSIONS Our UBM examination of MCD shows alterations of the cornea's posterior layer and confirms the known clinical and histological findings of MCD that PK represents the therapy of choice, contrary to DALK. The novel CHST6 mutation shows the heterogeneity of MCD.
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Affiliation(s)
- Yair Rubinstein
- *The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel;†Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and‡Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND Festoons are redundant folds of loose skin, muscle, fat, and interstitial edema which extend from beyond the lateral cheek often past the midpupillary line, or even from canthus to canthus. Despite the fact that various treatments have been suggested for festoons, this entity still remains difficult and frustrating to treat. OBJECTIVE The authors report the results of their approach for the treatment of festoons by lower lid tightening and direct excision. METHODS Fifteen eyes of 8 patients with festoons were treated with direct excision, between 2009 and 2011. RESULTS No major complications were observed in any of the patients in this series. Both the patients and surgeon were very satisfied with the results with minimal to no visible scar. CONCLUSIONS Lower lid festoons have remained frustrating to treat. Our experience suggests that direct excision of the festoons can provide a successful, reliable and safe therapy.
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Affiliation(s)
- Adi Einan-Lifshitz
- Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Israel.
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