Ophthalmology Commons^™

Ocular Adnexal Metastases From Renal Cell Carcinoma: An Update And Comprehensive Literature Review, Tejal Magan, Tejus Pradeep, Madalina Tuluc, Jurij R. Bilyk, Tatyana Milman

Wills Eye Hospital Papers

PURPOSE: The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC). METHODS: This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC. RESULTS: Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22-87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, …

Ocular Adnexal Lymphoma: A Single-Institution Retrospective Study, César A. Fernández, Roger K. Henry, Carol L. Shields, Jurij R. Bilyk, Sara E. Lally, Ralph C. Eagle, Tatyana Milman

Wills Eye Hospital Papers

PURPOSE: To characterize demographic, clinical, and histopathologic features of ocular adnexal lymphoma (OAL) at a single institution. METHODS: Retrospective review of all patients with pathologic diagnosis of OAL between 2015 and 2020. RESULTS: There were 133 patients with OAL, with a median age of 65 years (range 23-97) and a slight female predominance (male: female = 1:1.46), (n = 79, 59%). The majority of tumors were non-Hodgkin B-cell lymphomas (n = 131, 99%), most frequently Extranodal Marginal Zone B-Cell Lymphoma (EMZL, n = 93, 70%), followed by follicular lymphoma (n = 21, 16%), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = …

Anterior Segment Optical Coherence Tomography Features Of Netarsudil-Associated Reticular Corneal Edema, Ashley Kahlilil, Reza Razeghinejad, Zeba Syed

Wills Eye Hospital Papers

No abstract provided.

Anterior Chamber Characteristics, Endothelial Parameters, And Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty In Patients With Fuchs Dystrophy., Remzi Karadag, Kristin Hammersmith, Parveen Nagra, Christopher J Rapuano

Wills Eye Hospital Papers

Purpose: To compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye.

Methods: This prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups.

Results: The mean age of the patients …

The Influence Of Axial Myopia On Optic Disc Characteristics Of Glaucoma Eyes., Jasmin Rezapour, Christopher Bowd, Jade Dohleman, Akram Belghith, James A Proudfoot, Mark Christopher, Leslie Hyman, Jost B Jonas, Massimo A Fazio, Robert N Weinreb, Linda M Zangwill

Wills Eye Hospital Papers

This study characterizes differences in glaucomatous eyes with and without high axial myopia using custom automated analysis of OCT images. 452 eyes of 277 glaucoma patients were stratified into non (n = 145 eyes), mild (n = 214 eyes), and high axial myopia (axial length (AL) > 26 mm, n = 93 eyes). Optic disc ovality index, tilt and rotation angle of Bruch´s membrane opening (BMO) and peripapillary choroidal thickness (PCT) were calculated using automated and deep learning strategies. High myopic optic discs were more oval and had larger BMO tilt than mild and non-myopic discs (both p < 0.001). Mean PCT was thinnest in high myopic eyes followed by mild and non-myopic eyes (p < 0.001). BMO rotation angle, global retinal nerve fiber layer (RNFL) thickness and BMO-minimum rim width (MRW) were similar among groups. Temporal RNFL was thicker and supranasal BMO-MRW was thinner in high myopic eyes. BMO tilt and PCT showed moderate and temporal RNFL and nasal BMO-MRW showed weak but significant associations with AL in multivariable analyses (all p < 0.05). Large BMO tilt angle and thin PCT are characteristics of highly myopic discs and were not associated with severity of glaucoma. Caution should be exercised when using sectoral BMO-MRW and RNFL thickness for glaucoma management decisions in myopic eyes.

Resident Immune Cells Of The Avascular Lens: Mediators Of The Injury And Fibrotic Response Of The Lens., A. Menko, Jodirae Dedreu, Caitlin M. Logan, Heather Paulson, Alex V Levin, Janice L Walker

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Tissues typically harbor subpopulations of resident immune cells that function as rapid responders to injury and whose activation leads to induction of an adaptive immune response, playing important roles in repair and protection. Since the lens is an avascular tissue, it was presumed that it was absent of resident immune cells. Our studies now show that resident immune cells are a shared feature of the human, mouse, and chicken lens epithelium. These resident immune cells function as immediate responders to injury and rapidly populate the wound edge following mock cataract surgery to function as leader cells. Many of these resident …

Umbilical Amnion And Amniotic Membrane Transplantation For Infectious Scleritis And Scleral Melt: A Case Series., Zeba Syed, Christopher J Rapuano

Wills Eye Hospital Papers

Purpose: To report the outcomes of two cases of infectious scleritis with severe scleral thinning managed using combined mechanical debridement, cryopreserved umbilical amnion (UA) and amniotic membrane (AM) grafts, and antimicrobial therapy.

Observations: Two patients presented with severe infectious scleritis with progressive scleral melts secondary to Pseudomonas aeruginosa subsequent to pterygium surgery and intravitreal injection, respectively. Surgical debridement was followed by UA grafting, AM transplantation, and antimicrobial therapy. Epithelialization and vascularization were seen within 1–4 weeks post-operatively. At last follow up of 5–6 months, the structural integrity of the sclera remained preserved with no infection recurrence, graft necrosis, or wound …

White Paper On Ophthalmic Imaging For Choroidal Nevus Identification And Transformation Into Melanoma, Carol Shields, Sara E. Lally, Lauren Dalvin, Mandeep Sagoo, Marco Pellegrini, Swathi Kaliki, Ahmet Kaan Gündüz, Minoru Furuta, Prithvi Mruthyunjaya, Adrian T. Fung, Jay S. Duker, Sara M. Selig, Antonio Yaghy, Sandor R. Ferenczy, Malvina B. Eydelman, Mark S. Blumenkranz

Wills Eye Hospital Papers

Purpose: To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process. Methods: White paper. Results: Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use …

Microbial Keratitis After Penetrating And Endothelial Keratoplasty, Nicolas Dohse, Turner D. Wibbelsman, Sara Rapuano, Kristin Hammersmith, Parveen Nagra, Christopher Rapuano, Zeba A. Syed

Phase 1

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK).

Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes.

Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial …

Retinal Ganglion Cell And Inner Plexiform Layer Loss Correlate With Visual Acuity Loss In Lhon: A Longitudinal, Segmentation Oct Analysis., Stephen J Moster, Mark L Moster, Molly Scannell Bryan, Robert C Sergott

Wills Eye Hospital Papers

PURPOSE: Describe changes in the retina as vision loss progresses in Leber's Hereditary Optic Neuropathy (LHON) using spectral-domain optical coherence tomography (SD-OCT) autosegmentation, and determine if relationship exists between retinal changes and vision loss.

METHODS: From patient records we identified nine LHON patients who underwent periodic neuro-ophthalmologic examinations and high-resolution SD-OCT as part of their care. We describe the impact of LHON progression on each retinal layer, and the relationship between these structural changes and visual acuity using generalized estimating equations and nonparametric tests.

RESULTS: The thickness of the ganglion cell layer (GCL) and inner plexiform layer (IPL) decreased immediately …

Radiotherapy For Iris Metastasis From Esophageal Carcinoma: A Series Of Three Cases., Chandana Das, Carol L Shields

Wills Eye Hospital Papers

BACKGROUND: Description of three cases of metastatic esophageal carcinoma to the iris and focus on management strategies.

METHODS: A 48-year-old man (Case 1) with previously treated stage IV esophageal carcinoma presented with blurred vision in the left eye (OS) for 3 weeks. Initial fine needle aspiration biopsy (FNAB) was negative for malignant cells, so incisional biopsy was performed and confirmed metastatic carcinoma. A 53-year-old man (Case 2) with previously treated stage III esophageal cancer experienced 2 months of pain and 1 month of blurred vision OS. Documented tumor growth suggested esophageal carcinoma metastasis. A 65-year-old man (Case 3) with previously …

Consecutive Bilateral Decompression Retinopathy After Mitomycin C Trabeculectomy: A Case Report., Ana Raquel Marcos Figueiredo, Isabel Coutinho Sampaio, Maria João Fernandes Dos Santos Menéres, George L. Spaeth

Wills Eye Hospital Papers

BACKGROUND: After a successful trabeculectomy, a sudden intraocular pressure decrease may alter the intracranial to intraocular pressure ratio and cause decompression retinopathy. Frequent Valsalva maneuvers may also play a role in its pathogenesis. This condition may manifest as multiple retinal hemorrhages, edema of the optic disc, macular edema, or a sudden decrease in visual acuity postoperatively. Outcomes for patients are usually good, with spontaneous resolution occurring within a matter of weeks. It has been rarely reported in the literature as a bilateral condition.

CASE PRESENTATION: We present a case of consecutive bilateral decompression retinopathy in a 54-year-old severely obese Caucasian …

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.

Treatment Of Steroid-Induced Elevated Intraocular Pressure With Anecortave Acetate: A Randomized Clinical Trial., Ingeborg Stalmans, David G. Callanan, Monte S. Dirks, Marlene R. Moster, Alan L. Robin, Joachim Van Calster, Sally A. Scheib, Jaime E. Dickerson, Theresa A. Landry, Michael V. W. Bergamini

Wills Eye Hospital Papers

PURPOSE: The present study is the first randomized clinical trial designed to evaluate the intraocular pressure (IOP)-lowering effect of anecortave acetate (AA) administered at 3 doses (3, 15, or 30 mg) as an anterior juxtascleral depot (AJD) in patients experiencing elevated IOP due to corticosteroid therapy.

METHODS: This was a double-masked, randomized, placebo-controlled, multicenter, parallel group trial. Eligible patients had an IOP of at least 24 mmHg and an IOP increase of at least 10 mmHg relative to their IOP before treatment with steroids. A target IOP was established for each patient at baseline. Patients were randomized to 1 of …

Structural Changes In Glaucoma: A Volumetric Mri Study, John Lackey, Alice L. Williams, Srinivas Gatla, Sheryl S. Wizov, Thomas Chia, George Spaeth, Song Lai

Department of Radiology Faculty Papers

Purpose: To investigate brain structural changes in patients with glaucoma.

Methods: High resolution 3D T1-weighted MP-RAGE MRI images were collected in 11 glaucoma patients (5 female, 6 male, 65+/-11 yrs), and 11 age- and gender-matched controls (64+/-12 yrs). The images were first analyzed using an automatic voxel-based morphometry technique which combines a fully automated spatial normalization approach, dubbed HAMMER [1], in conjunction with a tissue mass preserving framework called RAVENS [2]. Four consecutive steps were carried out: removal of non-brain voxels, tissue segmentation, spatial normalization to a standardized template, and generation of a mass-preserving tissue density map (i.e. RAVENS map) …

Patient Education In Glaucoma: What Do Patients Know About Glaucoma?, Vital Paulino Costa, George L Spaeth, Maura Smith, Cordelia Uddoh, José Paulo Cabral Vasconcellos, Newton Kara-José

Wills Eye Hospital Papers

PURPOSE: To evaluate the knowledge glaucoma patients have about their disease and its treatment.

METHODS: One hundred and eighty-three patients were interviewed at the Glaucoma Service of Wills Eye Hospital (Philadelphia, USA, Group 1) and 100 at the Glaucoma Service of University of Campinas (Campinas, Brazil, Group 2). An informal, relaxed atmosphere was created by the interviewer before asking a list of 18 open-ended questions.

RESULTS: In Group 1, 44% of the 183 patients did not have an acceptable idea about what glaucoma is, 30% did not know the purpose of the medications they were taking, 47% were not aware …