Ophthalmology Commons^™

Effects Of Corneal Transplant On Rates Of Retinal Detachment, Daniel S. Mackinnon, Zeba A. Syed, Md, Durga Borkar, Hannah Levin

Phase 1

Introduction: Corneal transplant remains the gold standard treatment for irreversible corneal damage. The purpose of this study is to evaluate retinal detachment rates and clinical outcomes after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). We hypothesized that corneal transplants would increase the rate of RD.

Methods: This retrospective cohort study utilized corneal transplant data from all surgical visits from PK or EK between April 1, 2012 and August 31, 2018. Individual charts were reviewed from patients who had a subsequent retinal detachment. Incidence of retinal detachment following PK or EK was the main outcome measured.

Results: A total of …

The Efficacy And Safety Profile Of Netarsudil 0.02% In Glaucoma Treatment: Real-World Outcomes, Eric Shiuey, Ms, Melih Ustaoglu, Md, Carina Sanvicente, Md, Reza Razeghinejad, Md, L. Jay Katz, Md, Jonathan Myers, Md, Daniel Lee, Md

Phase 1

Introduction: More effective glaucoma medications are necessary as medication intolerance and non-adherence remain problematic. Netarsudil is a newly FDA-approved Rho kinase inhibitor. We hypothesize that netarsudil will safely reduce intraocular pressure (IOP) compared to baseline even while other glaucoma medications are used.

Methods: This retrospective observational study was conducted on glaucoma patients seen at the Wills Eye Hospital Glaucoma Service who received netarsudil 0.02% between March and September of 2018. Intraocular pressure (IOP, via Goldmann applanation tonometry) and best corrected visual acuity (BCVA, via Snellen visual acuity charts) comparisons between baseline and 1- and 3-month follow-up visits were performed …

Conjunctival Melanoma: Features Based On The Fitzpatrick Skin Type (Fst) In 540 Patients At A Single Ocular Oncology Center, Sunihidi Ramesh, Antonio Yaghy, Lauren A. Dalvin, Sara E. Lally, Jerry A. Shields, Carol L. Shields

Phase 1

Background: The Fitzpatrick skin type (FST) is a classification system for skin pigmentation that has been used to stratify risk for cutaneous melanoma; however, it has not yet been explored in the context of conjunctival melanoma. Herein, we examine FST and its association with the clinical features of conjunctival melanoma.

Methods: A retrospective review was conducted on 540 medical records of patients with pathologic diagnosis of conjunctival melanoma. The patients were categorized according to the FST classification based on their external facial photographs at presentation. This includes: Type I (white skin color), Type II (fair skin color), Type III (average …

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 …

Ahmed Vs Baerveldt Glaucoma Drainage Device In Uveitic Glaucoma, Zoe Mcwatters, Sapna Sinha, Md, Allen Ganjei, Marlene Moster, Md, Michael Pro, Md, Elizabeth Dale, Md, Daniel Lee, Md, Jonathan S. Myers, Md, L. J. Katz, Md, Scott Fudemberg, Md, Anand Mantravadi, Md, Natasha Kolomeyer, Md, Reza Razeghniejad, Md

Phase 1

Introduction: Uveitis is an inflammatory eye disorder which may elevate intraocular pressure (IOP), causing sight-threatening glaucoma. Treatment of refractory uveitic glaucoma involves implantation of a glaucoma drainage device (GDD). Uveitic glaucoma has been a minority diagnosis in prior studies comparing the valved Ahmed GDD and non-valved Baerveldt GDD. Here we compare the safety and efficacy of the Ahmed and Baerveldt GDD in uveitic glaucoma.

Methods: This retrospective comparative study was conducted on patients with uveitic glaucoma (≥14 years old) who underwent Ahmed or Baerveldt GDD implantation between 2006–2018 with a minimum follow-up of 3 months. Success was defined as …

“Trauma To The Eye” – A Low Fidelity Module For Identifying Retrobulbar Hematoma And Practicing Lateral Canthotomy & Cantholysis, Jared Raikin, Dimitrios Papanagnou, Md, Ronald Hall, Md

Phase 1

Purpose: A retrobulbar hematoma (RH) can cause preventable blindness due to damage of the optic nerve. Due to its relative infrequency in the emergency department, Emergency Medecine (EM) residents have limited experience in recognizing and treating a RH. This paper outlines a simulated scenario that was developed to improve EM residents knowledge in diagnosing a RH and performing an emergent lateral canthotomy and cantholysis (LCC).

Methods: This module used a low fidelity task trainer and case vignette created for EM residents to practice recognizing a RH and perfroming a LCC. Participants took an assessment questionnaire before and after the teaching …

Comparison Of Three Different Techniques Of Inverted Internal Limiting Membrane Flap In Treatment Of Large Idiopathic Full-Thickness Macular Hole., Fariba Ghassemi, Hassan Khojasteh, Alireza Khodabande, Lauren A. Dalvin, Mehdi Mazloumi, Hamid Riazi-Esfahani, Masoud Mirghorbani

Wills Eye Hospital Papers

Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.

Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group A - hemicircular ILM peel with temporally hinged inverted flap; group B - circular ILM peel with temporally hinged inverted flap; and group C - circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) …

Neurofibromatosis Type-1 With Retinal Microvascular Corkscrew Tortuosity., Adrian J Battiston, Lauren A Dalvin, Carol L Shields

Wills Eye Hospital Papers

No abstract available.

Melanocytoma Of The Optic Disk: A Review., Jerry A. Shields, Hakan Demirci, Arman Mashayekhi, Ralph C. Eagle Jr., Carol L. Shields

Wills Eye Hospital Papers

Melanocytoma is a deeply pigmented variant of melanocytic nevus that classically occurs in the optic disk, sometimes with contiguous involvement of the adjacent retina or choroid. Historically, this tumor was often confused with malignant melanoma both clinically and histopathologically. Today, however, it is generally recognized by its typical clinical features that differ from most melanomas and erroneous enucleation is rarely done. Histopathologically, melanocytoma is composed of intensely pigmented round to oval nevus cells with benign features. Although traditionally believed to be a relatively stationary lesion, it is now known to exhibit minor enlargement in 10--15% of cases and can cause …

Conjunctival Melanoma With Orbital Invasion And Liver Metastasis Managed With Systemic Immune Checkpoint Inhibitor Therapy., Michael Chang, Sara E Lally, Lauren A Dalvin, Marlana Orloff, Carol L Shields

Wills Eye Hospital Papers

A 60-year-old Caucasian female was referred for biopsy-proven amelanotic orbito-conjunctival melanoma. Map biopsies revealed residual invasive melanoma on the deep tarsal margin at the site of previous surgery. Repeat excisions were required after recurrence was detected following 3 months and 7 months. Positron emission tomography scan detected liver metastasis and additional orbito-conjunctival melanoma recurrence. Biomarker testing showed NRAS mutation without BRAF or c-KIT mutations and without PD-L1 expression. Systemic checkpoint inhibitor therapy was initiated with regression of both the orbito-conjunctival melanoma and liver metastasis. Invasive, non resectable orbito-conjunctival melanoma with liver metastasis can demonstrate a response to systemic checkpoint inhibitor …

Management Of Retinoblastoma In Older Children (>5 Years) Using Intra-Arterial Chemotherapy: Comparison Of Outcomes To Prechemotherapy And Intravenous Chemotherapy Eras., Evan B. Selzer, R. Joel Welch, Pascal Jabbour, Ann M. Leahey, Carol L. Shields

Wills Eye Hospital Papers

Purpose: Intra-arterial chemotherapy (IAC) has emerged as an effective treatment for retinoblastoma (RB) however, little information exists regarding its use in older patients (>5 years). In the present study, we evaluate the use of IAC (2008-2018) for RB in older patients and compare the outcomes to those in the prechemotherapy (<1994) and intravenous chemotherapy (IVC) (1994-2007) eras.

Methods: A retrospective analysis of all patients older than 5 years treated with IAC for RB from 2008-2018. Comparisons were made to 26 active RB cases in older children treated in the prechemotherapy era and to 12 active RB cases treated in the IVC era.

Results: There were …

From Lepidoptera To Uveal Melanoma: Finding My Career In Ocular Oncology., Jerry A Shields

Wills Eye Hospital Papers

No abstract provided.

Tumors Of The Conjunctiva And Cornea., Carol L. Shields, Jerry A. Shields

Wills Eye Hospital Papers

Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Melanocytic lesions include nevus, racial melanosis, primary acquired melanosis, melanoma, and other ocular surface conditions like ocular melanocytosis and secondary pigmentary deposition. The most frequent nonmelanocytic neoplastic lesions include squamous cell carcinoma and lymphoma, both of which have typical features appreciated on clinical examination. …

Prognostication Of Uveal Melanoma Is Simple And Highly Predictive Using The Cancer Genome Atlas (Tcga) Classification: A Review., Carol L. Shields, Lauren A. Dalvin, Pornpattana Vichitvejpaisal, Mehdi Mazloumi, Arupa Ganguly, Jerry A. Shields

Wills Eye Hospital Papers

Purpose: The cancer genome atlas (TCGA) is a comprehensive project supported by the National Cancer Institute (NCI) in the United States to explore molecular alterations in cancer, including uveal melanoma (UM). This led to TCGA classification for UM. In this report, we review the American Joint Committee on Cancer (AJCC) classification and TCGA classification for UM from the NCI's Center for Cancer Genomics (NCI CCG) (based on enucleation specimens [n = 80 eyes]) and from Wills Eye Hospital (WEH) (based on fine needle aspiration biopsy [FNAB] specimens [n = 658 eyes]). We then compare accuracy and predictability of AJCC versus …

Intraocular Amyloidosis With Multifocal Iris And Anterior Chamber Translucent Spherules., Sima Das, Sweety Tiple, Julie Pegu, Suneeta Dubey, Umang Mathur, Kaustabh Mulay, Carol L Shields

Wills Eye Hospital Papers

Ocular amylodosis, although a rare entity, is known to affect the conjunctiva, extraocular muscles, orbit, lacrimal gland, and skin around the eyes. Intraocular deposition of amyloid mainly confines to the vitreous and cornea. In this report, we describe two cases of intraocular amyloidosis presenting as multiple iris and anterior chamber cysts. Histopathological examination with special stain like Congo Red and Transmission Electron Microscopy confirmed the diagnosis of amyloidosis. Systemic investigations ruled out systemic association confirming the diagnosis of primary ocular amyloidosis.

Trifocal Choroidal Melanoma In An Eye With Oculodermal Melanocytosis: A Case Report., Samuel J Fallon, Charlotte N Shields, Maura Di Nicola

Wills Eye Hospital Papers

We report a case of trifocal choroidal melanoma (three separate tumors) in a 48-year-old Caucasian female who had been followed for oculodermal melanocytosis since childhood. At presentation, no tumor was present and annual examination was advised. Seventeen years later, three choroidal melanocytic lesions were detected in the right eye. Growth of each was documented, enucleation was performed, and histopathology revealed three independent choroidal melanomas. The patient developed extensive liver and bone metastases and subsequently died. Oculodermal melanocytosis is a risk factor for the development of uveal melanoma and a potential marker for worse prognosis. Careful long-term follow-up is required.

Worldwide Inequality In Access To Full Text Scientific Articles: The Example Of Ophthalmology., Christophe Boudry, Patricio Alvarez-Muñoz, Ricardo Arencibia-Jorge, Didier Ayena, Niels J Brouwer, Zia Chaudhuri, Brenda Chawner, Emilienne Epee, Khalil Erraïs, Akbar Fotouhi, Almutez M Gharaibeh, Dina H Hassanein, Martina C Herwig-Carl, Katherine Howard, Dieudonne Kaimbo Wa Kaimbo, Patricia-Ann Laughrea, Fernando A Lopez, Juan D Machin-Mastromatteo, Fernando K Malerbi, Papa Amadou Ndiaye, Nina A Noor, Josmel Pacheco-Mendoza, Vasilios P Papastefanou, Mufarriq Shah, Carol L Shields, Ya Xing Wang, Vasily Yartsev, Frederic Mouriaux

Wills Eye Hospital Papers

Background: The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide.

Methods: A total of 200 references from articles were retrieved using the …

Eyelid Chalazion Or Not?, Jerry A. Shields, Sara E. Lally, Tatyana Milman, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Vascular Perfusion In Persistent Pupillary Membrane Of The Iris., Michael Chang, David Ancona-Lezama, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Evidence To Date: Ranibizumab And Its Potential In The Treatment Of Retinopathy Of Prematurity, Samir Patel, Michael A. Klufas

Wills Eye Hospital Papers

Retinopathy of prematurity (ROP) is a leading and preventable cause of childhood blindness worldwide. Although laser photocoagulation remains the gold standard for treatment, the off-label use of anti-vascular endothelial growth factor (anti-VEGF) therapy to treat ROP, particularly posterior zone I disease, is increasing. Although initial studies on anti-VEGF therapy for ROP have focused on bevacizumab, recent studies have proposed that ranibizumab may be a safer and more effective alternative for use in this population. This review updates recent evidence regarding the use of ranibizumab in the management of ROP.

Unilateral Enophthalmos., Grace L. Su, Sara E. Lally, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Moisture Chamber For Eye Care After Facial Nerve Injury, Ryan Rimmer, Md, Lauren Bogdan, Md, Gregory Epps, Md, Nikolaus Hjelm, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Introduction

• Patients with various lesions of the head and neck may have compromise of facial nerve function.
• Facial nerve (CN VII) has various roles, including movement of facial muscles and, importantly, eye closure.
• When facial nerve is sacrificed or damaged during a surgical cases, steps are often taken intraop to surgically correct the deficit and allow eye closure. However, these patients may not immediately realize the benefit of these interventions.
• In the postop period, appropriate eye care is critical to prevent exposure keratopathy due to inability to close eye.
• Exposure keratopathy is damage to the cornea that occurs primarily due …

Improving Diabetic Retinopathy Screening In A Large Ambulatory Practice, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Jennifer Moyer, Md, Rachel Ehrman-Dupre, Md, Andrew Rabovsky, Md, Simon Newsom, Md, Pooja Padgaonkar, Md, Julita Mienko, Md, Sarah Hirsh, Md, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim 1: To increase the percentage of JFMA diabetic patients with up-to-date retinopathy screening to 60% by April 1, 2019.

Aim 2: To increase the utilization of an in-office portable retinal scanner by identifying current barriers to its use and developing a standardized workflow to overcome these barriers.

Outcome measure: The percentage of adult diabetic patients with a JFMA provider listed as the PCP who have been seen in the Jefferson health system within the last 24 months, who had retinopathy screening once in the last 24 months.

Process measure: The number of retinal scans completed each week.

Optimizing Resident Clinic Efficiency Through Process Flow Analysis, Michael Abendroth, Md, Mba, Saumya Copparam, Md, Qiang Zhang, Phd, Rose Costello, Ma, Tara Uhler, Md, Robert Bailey, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Abstract

Introduction: Clinic process inefficiencies cause lengthy visit and wait times, which frustrate patients and providers and limit clinic capacity

Objective: To identify process inefficiencies and assess process flow interventions

Methods: Prospective, consecutive series of resident clinic visits over a 3-week period after transferring refraction from tech to resident. Personnel recorded the time spent waiting for and undergoing each clinic process. The clinic also piloted a “Fast Track” from registration to resident for appropriate established patients.

Results: Patients spent 53% of the visit waiting, primarily for the tech. Transferring refraction from tech to resident decreased the wait for tech …

Intra-Arterial Chemotherapy In Retinoblastoma - A Paradigm Change., Fairooz P. Manjandavida, Christina Stathopoulos, Jing Zhang, Santhosh G. Honavar, Carol L. Shields

Wills Eye Hospital Papers

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the …

Coats Disease In 351 Eyes: Analysis Of Features And Outcomes Over 45 Years (By Decade) At A Single Center., Carol L. Shields, Sanika Udyaver, Lauren A. Dalvin, Li-Anne S. Lim, Hatice T Atalay, Chloe T.L. Khoo, Mehdi Mazloumi, Jerry A. Shields

Wills Eye Hospital Papers

Purpose: To assess features and outcomes of Coats disease over 5-decades.

Methods: Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation.

Results: There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features …

Changes In Ultraviolet Radiation Exposure To The Ocular Region: A Population-Based Study., Ezekiel Weis, Sebastian Q. Vrouwe, David B. Lebaron, Matthew B. Parliament, Jerry A Shields, Carol L. Shields

Wills Eye Hospital Papers

In contrast to the well-established association between ultraviolet radiation (UVR) exposure and skin cancers, the relationship between UVR and uveal malignant melanoma (UM) remains controversial. To address this controversy, we evaluated the incidence rates of cutaneous malignancies in the eyelids as a proxy for UVR exposure in the ocular region using a population-based cancer registry. Overall, 74,053 cases of eyelid basal cell carcinoma (BCC) and 7890 cases of melanoma over a 26-year period (1982–2007) were analyzed. The incidence of eyelid basal cell carcinoma and uveal melanoma remained stable, whereas other cutaneous areas demonstrated an increase in the rates. A comparability …

Trust And Glycemic Control In Black Patients With Diabetic Retinopathy: A Pilot Study, Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). …

Papilledema Or Pseudopapilledema?, Lin Liu, Michael D. Yu, Carol L. Shields

Wills Eye Hospital Papers

No abstract provided.

Is Retinal Metabolic Dysfunction At The Center Of The Pathogenesis Of Age-Related Macular Degeneration?, Thierry Léveillard, Nancy J. Philp, Florian Sennlaub

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The retinal pigment epithelium (RPE) forms the outer blood⁻retina barrier and facilitates the transepithelial transport of glucose into the outer retina via GLUT1. Glucose is metabolized in photoreceptors via the tricarboxylic acid cycle (TCA) and oxidative phosphorylation (OXPHOS) but also by aerobic glycolysis to generate glycerol for the synthesis of phospholipids for the renewal of their outer segments. Aerobic glycolysis in the photoreceptors also leads to a high rate of production of lactate which is transported out of the subretinal space to the choroidal circulation by the RPE. Lactate taken up by the RPE is converted to pyruvate and metabolized …