Ophthalmology Commons^™

Anxiety And Depression In Patients With Advanced Macular Degeneration: Current Perspectives., Verena R Cimarolli, Robin J Casten, Barry W. Rovner, Vera Heyl, Silvia Sörensen, Amy Horowitz

Department of Medicine Faculty Papers

Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression …

Vanishing Retinal Arterial Aneurysms With Anti-Tubercular Treatment In A Patient Presenting With Idiopathic Retinal Vasculitis, Aneurysms, And Neuroretinitis., Ramandeep Singh, Kusum Sharma, Aniruddha Agarwal, Mohit Dogra, Vishali Gupta, Aman Sharma, Mangat R. Dogra

Journal Articles: Ophthalmology

BACKGROUND: Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presents with characteristic clinical manifestations such as aneurysms at arteriolar bifurcations and optic nerve and retinal vascular inflammation. Regression of such features on treatment with anti-tubercular therapy (ATT) combined with corticosteroids has not been reported in literature.

FINDINGS: A 30-year-old female with sudden painless decreased vision in the left eye was referred with a diagnosis of presumed tuberculous retinal vasculitis and a positive tuberculin skin test. Based on the clinical and angiographic features of the right eye, a diagnosis of IRVAN syndrome was made. In the left eye, the patient had …

Modulation Of Angiogenesis, Balamurali Krishna Ambati, Jayakrishna Ambati, Nirbhai Singh

Ophthalmology and Visual Science Faculty Patents

This invention relates to compounds, composJtwns, and methods for the treatment of traits, diseases and conditions that respond to the modulation of angiogenic growth factor bioavailability or biological activity.

Combined Systemic And Ocular Chemotherapy For Anterior Segment Metastasis Of Systemic Mantle Cell Lymphoma., Aniruddha Agarwal, Mohammad Ali Sadiq, William R. Rhoades, Loren S. Jack, Mostafa Hanout, Philip J. Bierman, William W. West, Quan Dong Nguyen

Journal Articles: Ophthalmology

BACKGROUND: Mantle cell lymphoma (MCL) is an aggressive subtype of non-Hodgkin's lymphoma that rarely metastasizes to the iris and the anterior segment. Blastic/pleomorphic morphology is thought to have an adverse effect on prognosis in MCL. MCL is resistant to conventional chemotherapeutic regimens with a tendency for multiple relapses. Management of anterior segment metastasis of systemic MCL has not been described in literature.

FINDINGS: A 58-year-old male presented with an aggressive, relapsing, metastatic, systemic blastic variant of MCL with ocular involvement. At the time of initial presentation, large tumor cells were visible in the anterior chamber (AC) along with hypopyon and …

Outcomes With As-Needed Ranibizumab After Initial Monthly Therapy: Long-Term Outcomes Of The Phase Iii Ride And Rise Trials., David S. Boyer, Quan Dong Nguyen, David M. Brown, Karen Basu, Jason S. Ehrlich

Journal Articles: Ophthalmology

PURPOSE: To determine whether the efficacy and safety achieved with monthly ranibizumab as treatment for diabetic macular edema (DME) can be maintained with less-than-monthly treatment.

DESIGN: Open-label extension (OLE) phase of randomized, sham-controlled phase III trials: RIDE (NCT00473382) and RISE (NCT00473330).

PARTICIPANTS: Five hundred of 582 adults who completed the 36-month randomized core studies elected to enter the OLE.

METHODS: All patients participating in the OLE were eligible to receive 0.5 mg ranibizumab according to predefined re-treatment criteria: Treatment was administered when DME was identified by the investigator on optical coherence tomography or when best-corrected visual acuity (BCVA) worsened by …

A Prospective 3-Year Follow-Up Trial Of Implantation Of Two Trabecular Microbypass Stents In Open-Angle Glaucoma, Eric D. Donnenfeld, Kerry D. Solomon, Lilit Voskanyan, David F. Chang, Thomas W. Samuelson, Iqbal Ike K. Ahmed, L. Jay Katz

Wills Eye Hospital Papers

No abstract provided.

Endogenous Endophthalmitis: Diagnosis, Management, And Prognosis., Mohammad Ali Sadiq, Muhammad Hassan, Aniruddha Agarwal, Salman Sarwar, Shafak Toufeeq, Mohamed K. Soliman, Mostafa Hanout, Yasir Jamal Sepah, Diana V. Do, Quan Dong Nguyen

Journal Articles: Ophthalmology

Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.

Naturally Occurring Deletion Mutants Of The Pig-Specific, Intestinal Crypt Epithelial Cell Protein Clca4b Without Apparent Phenotype., Stephanie Plog, Nikolai Klymiuk, Stefanie Binder, Matthew J. Van Hook, Wallace B. Thoreson, Achim D. Gruber, Lars Mundhenk

Journal Articles: Ophthalmology

The human CLCA4 (chloride channel regulator, calcium-activated) modulates the intestinal phenotype of cystic fibrosis (CF) patients via an as yet unknown pathway. With the generation of new porcine CF models, species-specific differences between human modifiers of CF and their porcine orthologs are considered critical for the translation of experimental data. Specifically, the porcine ortholog to the human CF modulator gene CLCA4 has recently been shown to be duplicated into two separate genes, CLCA4a and CLCA4b. Here, we characterize the duplication product, CLCA4b, in terms of its genomic structure, tissue and cellular expression patterns as well as its in vitro electrophysiological …

Platelet Derived Growth Factor Inhibitors: A Potential Therapeutic Approach For Ocular Neovascularization., Mohammad Ali Sadiq, Mostafa Hanout, Salman Sarwar, Muhammad Hassan, Diana V. Do, Quan Dong Nguyen, Yasir Jamal Sepah

Journal Articles: Ophthalmology

Retinochoroidal vascular diseases are the leading causes of blindness in the developed world. They include diabetic retinopathy (DR), retinal vein occlusion, retinopathy of prematurity, age-related macular degeneration (AMD), and pathological myopia, among many others. Several different therapies are currently under consideration for the aforementioned disorders. In the following section, agents targeting platelet-derived growth factor (PDGF) are discussed as a potential therapeutic option for retinochoroidal vascular diseases. PDGF plays an important role in the angiogenesis cascade that is activated in retinochoroidal vascular diseases. The mechanism of action, side effects, efficacy, and the potential synergistic role of these agents in combination with …

Student Educational Background, Perceptions And Expectations Towards Optometry: An Emerging Eye Health Profession Mozambique., James Loughman, Ving Fai Chan, Vanessa Raquel Moodley, Luigi Bilotto, Kovin Naidoo

Articles

Background: The University of Lurio, School of Optometry in Mozambique is a new program in Africa. The school, the first to serve Portuguese-speaking Africa, can act as a template for such initiatives in other African countries and other limited-resource settings around the world. A major challenge facing such programs is the lack of knowledge about the profession, which impacts the recruitment of students and their expectations of the program. This study was conducted to understand students’ pre-enrollment educational background, perceptions and career expectations as an optometrist in Mozambique so as to inform future enrollment and other similar initiatives. Methods: First-year …

Child Eye Health In Nampula, Mozambique And Ireland, Aoife Phelan

Masters

To examine child eye health, in particular, visual impairment (VI), uncorrected refractive error (URE) and strabismus in two targeted cohorts of children in Mozambique and Ireland.

Ca2+ Diffusion Through Endoplasmic Reticulum Supports Elevated Intraterminal Ca2+ Levels Needed To Sustain Synaptic Release From Rods In Darkness., Minghui Chen, Matthew J. Van Hook, Wallace B. Thoreson

Journal Articles: Ophthalmology

UNLABELLED: In addition to vesicle release at synaptic ribbons, rod photoreceptors are capable of substantial slow release at non-ribbon release sites triggered by Ca(2+)-induced Ca(2+) release (CICR) from intracellular stores. To maintain CICR as rods remain depolarized in darkness, we hypothesized that Ca(2+) released into the cytoplasm from terminal endoplasmic reticulum (ER) can be replenished continuously by ions diffusing within the ER from the soma. We measured [Ca(2+)] changes in cytoplasm and ER of rods from Ambystoma tigrinum retina using various dyes. ER [Ca(2+)] changes were measured by loading ER with fluo-5N and then washing dye from the cytoplasm with …

Gendered Disparities In Quality Of Cataract Surgery In A Marginalised Population In Pakistan: The Karachi Marine Fishing Communities Eye And General Health Survey, Khabir Ahmad, Anthony B Zwi, Daniel J. M. Tarantol, Abdul Qadeem Soomro, Rashid Baig, Iqbal Azam Syed

Department of Surgery

Abstract

BACKGROUND:

Marine fishing communities are among the most marginalised and hard-to-reach groups and have been largely neglected in health research. We examined the quality of cataract surgery and its determinants, with an emphasis on gender, in marine fishing communities in Karachi, Pakistan, using multiple indicators of performance.

METHODS AND FINDINGS:

The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional study conducted between March 2009 and April 2010 in fishing communities living on 7 islands and in coastal areas in Keamari, Karachi, located on the Arabian Sea. A population-based sample of 638 adults, aged ≥ …

Iron Toxicity In The Retina Requires Alu Rna And The Nlrp3 Inflammasome, Bradley D. Gelfand, Charles B. Wright, Younghee Kim, Tetsuhiro Yasuma, Reo Yasuma, Shengjian Li, Benjamin J. Fowler, Ana Bastos-Carvalho, Nagaraj Kerur, Annette Uittenbogaard, Youn Seon Han, Dingyuan Lou, Mark E. Kleinman, W. Hayes Mcdonald, Gabriel Núñez, Philippe Georgel, Joshua L. Dunaief, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Publications

Excess iron induces tissue damage and is implicated in age-related macular degeneration (AMD). Iron toxicity is widely attributed to hydroxyl radical formation through Fenton's reaction. We report that excess iron, but not other Fenton catalytic metals, induces activation of the NLRP3 inflammasome, a pathway also implicated in AMD. Additionally, iron-induced degeneration of the retinal pigmented epithelium (RPE) is suppressed in mice lacking inflammasome components caspase-1/11 or Nlrp3 or by inhibition of caspase-1. Iron overload increases abundance of RNAs transcribed from short interspersed nuclear elements (SINEs): Alu RNAs and the rodent equivalent B1 and B2 RNAs, which are inflammasome agonists. Targeting …

Bilateral Papillitis And Unilateral Focal Chorioretinitis As The Presenting Features Of Syphilis., Christy E. Benson, Mohamed K. Soliman, Alexander Knezevic, Daisy D. Xu, Quan D. Nguyen, Diana V V. Do

Journal Articles: Ophthalmology

BACKGROUND: Syphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis.

FINDINGS: This is a retrospective case report with literature review. A 39-year-old Caucasian …

Management Of Neovascular Age-Related Macular Degeneration: Current State-Of-The-Art Care For Optimizing Visual Outcomes And Therapies In Development., Aniruddha Agarwal, William R. Rhoades, Mostafa Hanout, Mohamed Kamel K. Soliman, Salman Sarwar, Mohammad A. Sadiq, Yasir J. Sepah, Diana V. Do, Quan Dong Nguyen

Journal Articles: Ophthalmology

Contemporary management of neovascular age-related macular degeneration (AMD) has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic …

Lower Macular Pigment Optical Density In Foveal-Involved Glaucoma., James Loughman

Articles

Purpose: To evaluate the relationship between macular pigment optical density (MPOD) and structural parameters of the macula and optic nerve head in glaucomatous eyes.

Entral Corneal Thickness Changes After Phacoemulsification, Tanveer Anjum Chaudhry, Muhammad Hamza, Wajiha Koomal, Khabir Ahmad

Department of Surgery

Purpose: To determine when the mean central corneal thickness (CCT) returns to normal values after uneventful phacoemulsification. Material and Methods: This was a prospective case series. The study was carried out at the Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi. Eyes scheduled to undergo phacoemulsification during December 2011 – March 2012 were eligible to be included. Eyes with corneal degenerations, dystrophies or high pre-op astigmatism were excluded. A structured proforma was used to collect data on sociodemographics, comorbids, visual acuity, and CCT before surgery and 1 day, 1 week and 1 month after surgery. Changes in …

Systematic Review And Mixed Treatment Comparison Of Intravitreal Aflibercept With Other Therapies For Diabetic Macular Edema (Dme)., Jean-Francois Korobelnik, Jos Kleijnen, Shona H. Lang, Richard Birnie, Regina M. Leadley, Kate Misso, Gill Worthy, Dominic Muston, Diana V. Do

Journal Articles: Ophthalmology

BACKGROUND: This was an indirect comparison of the effectiveness of intravitreal aflibercept (IVT-AFL) 2 mg every 8 weeks after 5 initial monthly doses (or if different periods, after an initial monthly dosing period) (2q8) and other diabetic macular edema (DME) therapies at doses licensed outside the USA.

METHODS: A comprehensive search was undertaken to source relevant studies. Feasibility networks were prepared to identify viable comparisons of 12-month outcomes between IVT-AFL 2q8 and therapies licensed outside the USA, which were assessed for clinical and statistical homogeneity. Pooled effect sizes (mean difference [MD] and relative risk/risk ratio [RR]) were calculated using fixed- …

Spectral Domain Optical Coherence Tomography Changes Following Intravitreal Dexamethasone Implant, Ozurdex® In Patients With Uveitic Cystoid Macular Edema., Pooja Bansal, Aniruddha Agarwal, Vishali Gupta, Ramandeep Singh, Amod Gupta

Journal Articles: Ophthalmology

PURPOSE: To correlate the structural and functional changes following intravitreal injection of dexamethasone 0.7 mg (Ozurdex®) implant in patients with recalcitrant uveitic cystoid macular edema (CME).

MATERIALS AND METHODS: In a prospective, interventional, nonrandomized study, 30 eyes (27 patients) with uveitic CME received Ozurdex® implant and were followed-up for 24 weeks at periodic intervals to monitor structural alterations seen on spectral domain optical coherence tomography (SD-OCT). The outcome measures included change in central macular thickness (CMT) and best-corrected visual acuity (BCVA) as well as structural alterations seen on OCT such as change in the height of cystoid spaces (CSs) and …

Direct Differentiation Of Adult Ocular Progenitors Into Striatal Dopaminergic Neurons., Iqbal Ahmad, Xing Zhao, Sowmya Parameswaran, Christopher J. Destache, J F. Rodriguez-Sierra, Wallace B. Thoreson, Hiba Ahmad, John Sorrentino, Sudha Balasubramanian

Journal Articles: Ophthalmology

Parkinson's disease, characterized by motor dysfunction due to the loss of nigrostriatal dopaminergic neurons, is one of the most prevalent age-related neurodegenerative disorders. Given there is no current cure, the stem cell approach has emerged as a viable therapeutic option to replace the dopaminergic neurons that are progressively lost to the disease. The success of the approach is likely to depend upon accessible, renewable, immune compatible, and non-tumorigenic sources of neural progenitors from which stable dopaminergic neurons can be generated efficaciously. Here, we demonstrate that neural progenitors derived from limbus, a regenerative and accessible ocular tissue, represent a safe source …

Evaluations Of Refraction Competencies Of Ophthalmic Technicians In Mozambique., James Loughman, Kajal Shah, Kovin Naidoo, Margarida Chagunda

Articles

Purpose: Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and confidence at refraction. Methods: Thirty-one trainee OTs and 16 qualified OTs were recruited to the study. A background questionnaire was administered to determine the demographic profile of the OTs. A confidence levels questionnaire explored their self-reported skills.

Powerful Anti-Tumor And Anti-Angiogenic Activity Of A New Anti-Vascular Endothelial Growth Factor Receptor 1 Peptide In Colorectal Cancer Models, Valeria Cicatiello, Ivana Apicella, Laura Tudisco, Valeria Tarallo, Luigi Formisano, Annamaria Sandomenico, Younghee Kim, Ana Bastos-Carvalho, Augusto Orlandi, Jayakrishna Ambati, Menotti Ruvo, Roberto Bianco, Sandro De Falco

Ophthalmology and Visual Science Faculty Publications

To assess the therapeutic outcome of selective block of VEGFR1, we have evaluated the activity of a new specific antagonist of VEGFR1, named iVR1 (inhibitor of VEGFR1), in syngenic and xenograft colorectal cancer models, in an artificial model of metastatization, and in laser-induced choroid neovascularization. iVR1 inhibited tumor growth and neoangiogenesis in both models of colorectal cancer, with an extent similar to that of bevacizumab, a monoclonal antibody anti-VEGF-A. It potently inhibited VEGFR1 phosphorylation in vivo, determining a strong inhibition of the recruitment of monocyte-macrophages and of mural cells as confirmed, in vitro, by the ability to inhibit …

Surgical Outcomes Of Sequential Versus Concomitant Glaucoma Drainage Implant And Boston Keratoprosthesis Type 1, Varum Patel, Marlene R. Moster, Louis J. Kishfy, Julian Barkan, Tingting Zhan, Irving M. Raber, Brandon D. Ayers, Michael J. Pro, Michael Waisbourd

Wills Eye Hospital Papers

BACKGROUND

The Boston Keratoprosthesis Type 1 (KPro) is a surgical device used in patients who have failed traditional corneal transplant treatment or are poor candidates for it.¹ Candidates for KPro often have advanced anterior segment disease that predisposes them to developing glaucoma.² As a result, these patients may require both a KPro, to treat their corneal pathology, and a glaucoma drainage implant (GDI), to treat their glaucoma. To date, there have been no long-term studies comparing the order of GDI placement with KPro surgery and how it affects surgical outcomes.

Ocular Complications Of Inflammatory Bowel Disease, Rana Mady, Will Grover, Salim Butrus

Ophthalmology Faculty Publications

No abstract provided.

Assessment Of Changes In Quality Of Life Among Patients In The Save Study - Sirolimus As Therapeutic Approach To Uveitis: A Randomized Study To Assess The Safety And Bioactivity Of Intravitreal And Subconjunctival Injections Of Sirolimus In Patients With Non-Infectious Uveitis., Erin M. Vigil, Yasir J. Sepah, Anthony L. Watters, Mohammad A. Sadiq, Mehreen Ansari, Millena G. Bittencourt, Mohamed A. Ibrahim, Diana V. Do, Quan Dong Nguyen

Journal Articles: Ophthalmology

BACKGROUND: The National Eye Institute 39-Question Visual Function Questionnaire (NEI VFQ-39) is an indicator of vision-related quality of life (QoL). The NEI VFQ-39 is used to assess the QoL in patients with non-infectious posterior uveitis, intermediate uveitis, or panuveitis, treated with subconjunctival (SCJ) or intravitreal (IVT) sirolimus as an immunomodulatory therapeutic (IMT) agent, delivered subconjunctivally (SCJ) or intravitreally (IVT) (the SAVE Study). Thirty subjects with non-infectious uveitis were randomized (SCJ:IVT, 1:1) for a prospective clinical trial. The 39-Question Visual Function Questionnaire (VFQ-39) was administered at baseline (BL), month 6 (M6), and month 12 (M12) visits. The survey measures self-reported vision …

Macular Pigment Optical Density Is Lower In Type 2 Diabetes, Compared With Type 1 Diabetes And Normal Controls., James Loughman, Grainne Scanlon, Paul Connell, Audrey Murphy, Karen O'Conner, Mathew Ratzlaff, Brittany Foerg

Articles

Purpose: This study was designed to investigate the optical density of macular pigment in Type 1 and Type 2 diabetes subjects relative to normal controls

Toll Like Receptor (Tlr) Stimulation For Ocular Angiogenesis And Macular Degeneration, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Patents

Provided are methods and compositions for the treatment or prevention of ocular angiogenesis and neovascularization. Administration of stimulators of the TLR3 and TLR7 receptors, Trif or of IL-10 and IL-12 inhibits ocular angiogenesis. Furthermore, all siRNAs (both targeted and non-targeted) can inhibit ocular angiogenesis.

Self-Perceived Barriers To Eye Care In A Hard-To-Reach Population: The Karachi Marine Fishing Communities Eye And General Health Survey, Khabir Ahmad, Anthony B. Zwi, Daniel J. M. Tarantola, Tanveer Anjum Chaudhry

Department of Surgery

Abstract

Purpose.: We examined self-reported barriers to eye care among marginalized, hard-to-reach fishing communities in Karachi, Pakistan.

Methods.: The Karachi Marine Fishing Communities Eye and General Health Survey was a cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on seven islands and coastal areas were interviewed regarding sociodemographic background, experience of eye problems, eye care use, and barriers to access. They also were examined to determine visual acuity with a reduced logMAR chart and underwent a detailed eye examination.

Results.: …

Long-Term (60-Month) Results For The Implantable Miniature Telescope: Efficacy And Safety Outcomes Stratified By Age In Patients With End-Stage Age-Related Macular Degeneration, D. Boyer, K. B. Freund, C. Regillo, M. H. Levy, S. Garg

Journal Articles

BACKGROUND: The purpose of this study was to evaluate the long-term results of an implantable miniature telescope (IMT) in patients with bilateral, end-stage, age-related macular degeneration (AMD). METHODS: A prospective, open-label, multicenter clinical trial with fellow eye controls enrolled 217 patients (mean age 76 years) with AMD and moderate-to-profound bilateral central visual acuity loss (20/80-20/800) resulting from untreatable geographic atrophy, disciform scars, or both. A subgroup analysis was performed with stratification for age (patient age 65 to[group 1; n=70] and patient age >/=75 years [group 2; n=127]), with a comparative evaluation of change in best-corrected distance visual acuity (BCDVA), quality …