Ophthalmology Commons^™

Extrapulmonary Small Cell Carcinoma Presenting As Bilateral Papilledema, Hyponatremia, Encephalitis, Seizures, Crmp5-Igg Reactivity, And Prominent Anterior Tubular Perivascular Spaces, Ramsis Benjamin, Drew Thomas, Nina Mourao, J. Judd Fite, Brianna Woodliff, Shubhank Goyal

School of Medicine Publications

Background: Paraneoplastic syndromes that affect both the optic disc and the brain parenchyma typically harbor antibodies directed toward CV2/collapsin response-mediator protein 5 (anti-CRMP5), amphiphysin, Ma antigen 2 (Ma2/Ta), and Yo. The most common cancers linked to anti-CRMP5 antibodies include small-cell lung carcinoma (SCLC), followed by thymoma, renal cell carcinoma, and thyroid papillary carcinoma. A long-held belief explains papilledema as related to increased pressure within the subarachnoid space or the microvascular capillaries, but intracranial pressures within the normal standard range may exist in a person with a paraneoplastic syndrome and papilledema. The glymphatic system, a central waste-clearance conduit, may play a …

Ocular Blood Flow And Retinal Vascular Reactivity In Alzheimer’S Disease: A Systematic Review Of Retinal Images, Tori Sayers, Alexa Nichols, Amin Ibrahim, Igor Zwir, Andrew Tsin, Lorena Flores-Hernandez, Gladys E. Maestre, Jesus D. Melgarejo

Research Colloquium

Background: Alzheimer’s disease (AD) is the most common form of dementia and one of the leading causes of disability and death in the United States¹. Research efforts aim to identify pathological changes that may help support earlier detection of AD and lead to more accessible tools for monitoring disease progression². The retina is being explored as a potential non-invasive marker of AD, reflecting the shared embryology and microvasculature features between the retina and the brain. Although research has focused on structural changes in retinal vessel diameters and density, few studies have evaluated functional markers of retinal …

Systemic Vascular Dysregulation And Retinal Microvascular Alterations In Glaucoma, Amin Ibrahim, Tori Sayers, Alexa Nichols, Igor Zwir, Andrew Tsin, Lorena Flores-Hernandez, Gladys E. Maestre, Jesus D. Melgarejo

Research Colloquium

Background: Glaucoma is a multifactorial, progressive optic neuropathy, for which both mechanical and vascular mechanisms of pathogenesis have been proposed. Optical coherence tomography angiography (OCTA) enables noninvasive visualization of the choroidal and retinal vasculature and may be used to quantify vascular changes associated with glaucoma. Systemic risk factors, including variations in blood pressure (BP), whether low or elevated, have been associated with the vascular pathogenesis of glaucoma. This systematic review aims to synthesize the current evidence on the relationship between systemic vascular dysregulation and OCTA-derived retinal vascular markers in glaucomatous eyes.

Methods: Following PRISMA guidelines, we conducted a systematic search …

Vegf In Diabetic Retinopathy And Age-Related Macular Degeneration, Andrew Callan, Justin Z. Heckman, Giani Tah, Samantha Lopez, Laura Valdez, Andrew Tsin

School of Medicine Publications

Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis throughout the human body, influencing countless physiological and pathological processes, including tumor growth, preeclampsia, and retinal diseases such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). In DR, VEGF promotes retinal neovascularization and intraretinal fluid accumulation, leading to complications like diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Regular intravitreal anti-VEGF injections are commonly used to manage PDR and DME, though repeated treatments are often required, and efficacy can be limited. AMD, a major cause of vision loss in older adults, is characterized by either dry or …

Trends In Resident Cataract Surgery Complication Rates Under A Single Experienced Supervising Attending, Simran Ohri, Jason A. Zehden, Dipen Kumar, Roma Pegany, Zhidong Zhang, Kenneth Cohen, Alice Y. Zhang

Teaching and Learning Faculty Publications

Purpose: To evaluate resident surgical complication rates under the supervision of an experienced attending surgeon over five years.

Setting: A single academic medical center at University of North Carolina at Chapel Hill, Chapel Hill, NC.

Design: Retrospective chart review.

Methods: Retrospective review of the first 30e50 cases performed by five classes of residents supervised by a single experienced attending surgeon with over twenty years of experience as a surgical educator. Data was collected from Accreditation Council for Graduate Medical Education (ACGME) surgical logs and operative notes. Preoperative risk factors, operative technique, and intraoperative complication rates were analyzed.

Results: A total …

Lamina Cribrosa Insertions Into The Sclera Are Sparser, Narrower, And More Slanted In The Anterior Lamina, Fengting Ji, Mohammad R. Islam, Bingrui Wang, Yi Hua, Ian A. Sigal

Mechanical Engineering Faculty Publications

Purpose: The lamina cribrosa (LC) depends on the sclera for support. The support must be provided through the LC insertions. Although a continuous insertion over the whole LC periphery is often assumed, LC insertions are actually discrete locations where LC collagenous beams meet the sclera. We hypothesized that LC insertions vary in number, size, and shape by quadrant and depth.

Methods: Coronal cryosections through the full LCs from six healthy monkey eyes were imaged using instant polarized light microscopy. The images were registered into a stack, on which we manually marked LC insertion outlines, nothing their position in-depth and quadrant …

Novel Methods Of Identifying Individual And Neighborhood Risk Factors For Loss To Follow-Up After Ophthalmic Screening, Noah Heilenbach, Titilola Ogunsola, Ceyhun Elgin, Dustin Fry, Mina Iskander, Yara Abazah, Ahmed Aboseria, Rahm Alshamah, Jad Alshamah, Gladys Maestre

School of Medicine Publications

Précis

Residence in a middle-class neighborhood correlated with lower follow-up compared to residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms.

Purpose:

To explore which individual and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies.

Participants

and Methods: From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were …

Endophthalmitis In An Elderly Patient - A Case Of Delayed Transfer And Successful Management, Vamsikalayan Borra, Roy Kondapavuluru, Sreejith Pillali, Sabhi Gull, Andres Suarez Parraga

Research Symposium

Introduction: Endophthalmitis is a severe and potentially sight-threatening condition that demands immediate attention and intervention. It is characterized by inflammation and infection within the eye, typically caused by bacterial or fungal organisms entering the eye, often following surgery or trauma. Usually present with sudden, severe eye pain, redness, decreased vision, and photophobia. As endophthalmitis can rapidly progress and cause irreversible damage to the eye, it is considered a true ocular emergency.

Case presentation: An 80-year-old woman, known to have Insulin-dependent Type 2 Diabetes mellitus and a history of breast cancer, arrived at the Emergency Department (ED) with persistent and worsening …

Stem Cell Technology For Age Related Macular Degeneration Intervention, Laura Valdez

Research Symposium

Retinal pigmented epithelium (RPE) cells are located between the choroid and photoreceptors within the eye and are essential to provide nutrients from blood to rods and cones, as well retinoids of the visual cycle. Vision loss and various ocular diseases are attributable to the degeneration or dysfunction of the RPE cells, leading to blindness.One of the major ocular problem from RPE dysfunction is macular degeneration. Age-related macular degeneration (AMD) can be frequently diagnosed in patients over the age of 60. In the early stages of AMD, some symptoms may not be noticeable but will lead to vision loss in both …

A Direct Fiber Approach To Model Sclera Collagen Architecture And Biomechanics, Fengting Ji, Manik Bansal, Bingrui Wang, Yi Hua, Mohammad R. Islam, Felix Matuschke, Markus Axer, Ian A. Sigal

Mechanical Engineering Faculty Publications

Sclera collagen fiber microstructure and mechanical behavior are central to eye physiology and pathology. They are also complex, and are therefore often studied using modeling. Most models of sclera, however, have been built within a conventional continuum framework. In this framework, collagen fibers are incorporated as statistical distributions of fiber characteristics such as the orientation of a family of fibers. The conventional continuum approach, while proven successful for describing the macroscale behavior of the sclera, does not account for the sclera fibers are long, interwoven and interact with one another. Hence, by not considering these potentially crucial characteristics, …

Neuro-Ophthalmology Diseases In Elderly, Aishwarya Gatiganti

School of Medicine Publications

It is well understood that as the body begins to age, its ability to adapt and sustain itself decreases. The eyes are not immune to this effect, and the complex interplay between the eyes and the brain deteriorates insidiously over time. There has been a notable increase in the elderly population, and diseases such as the ones described above need to be at the forefront of an ophthalmologist's mind when treating this population. Neuro-ophthalmology diseases in the elderly are not well known to general practitioners but should be included in the differential due to the potential of rapid deterioration and …

Diabetic Retinopathy And The Role Of Vegf, Aishwarya Gatiganti, Laura Valdez, Andrew Tsin Ph.D.

School of Medicine Publications

Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. It works by disrupting the neural and vascular components in the retina and leads to loss of neural interaction/function, vascular permeability, and angiogenesis. It can be classified into two general stages: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). DR can also lead to vascular leakage and cause diabetic macular edema (DME), the most common cause of vision loss in DR (Duh, Sun et al. 2017). There are currently a wide range of therapies, but they are limited in their efficacy and side effects. None of …

Cytochrome C: A Potential Early Biomarker Of Diabetic Retinopathy, Ileana G. Villarreal

Theses and Dissertations

Diabetic retinopathy is an ocular disease which appears in patients who experience progression of diabetes mellitus over a continuous period. Oftentimes, patients go undiagnosed due to the fact that there is no way to determine when the exact moment a patient develops diabetic retinopathy. Ophthalmologists and other eye specialists diagnose a patient with diabetic retinopathy once the patient begins to show progressed symptoms of the disease. Various experiments have been previously performed to increase our knowledge of the connection of diabetic retinopathy and early biomarkers of the disease. Several studies have determined the effects of diabetic retinopathy and apoptosis with …

Nutrigenetic Reprogramming Of Oxidative Stress, Joseph Ryu, Huzeifa Gulamhusein, Jin Kyun Oh, Joseph H. Chang, Jocelyn Chen, Stephen H. Tsang

School of Medicine Publications

Retinal disorders such as retinitis pigmentosa, age-related retinal degeneration, oxygen-induced retinopathy, and ischemia-reperfusion injury cause debilitating and irreversible vision loss. While the exact mechanisms underlying these conditions remain unclear, there has been a growing body of evidence demonstrating the pathological contributions of oxidative stress across different cell types within the eye. Nuclear factor erythroid-2-related factor (Nrf2), a transcriptional activator of antioxidative genes, and its regulator Kelch-like ECH-associated protein 1 (Keap1) have emerged as promising therapeutic targets. The purpose of this review is to understand the protective role of the Nrf2-Keap1 pathway in different retinal tissues and shed light on the …

Real-Time Mobile Teleophthalmology For The Detection Of Eye Disease In Minorities And Low Socioeconomics At-Risk Populations, Lama A. Al-Aswad, Cansu Yuksel Elgin, Vipul Patel, Deborah Popplewell, Kalashree Gopal, Dan Gong, Zach Thomas, Devon Joiner, Cha-Kai Chu, Gladys E. Maestre

School of Medicine Publications

Purpose: To examine the benefits and feasibility of a mobile, real-time, community-based, teleophthalmology program for detecting eye diseases in the New York metro area.

Design: Single site, nonrandomized, cross-sectional, teleophthalmologic study.

Methods: Participants underwent a comprehensive evaluation in a Wi-Fi-equipped teleophthalmology mobile unit. The evaluation consisted of a basic anamnesis with a questionnaire form, brief systemic evaluations and an ophthalmologic evaluation that included visual field, intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated in real-time and follow-up calls were scheduled to complete a secondary questionnaire form. Risk …

Investigating The Protective Role Of Irbp Against Oxidative Stress In Diabetic Retinopathy, Matthew N. Parvus, Federico Gonzalez-Fernandez, Reanna Rodriguez, Daniela Gonzalez, Andrew Tsin

MEDI 9331 Scholarly Activities Clinical Years

Introduction:

Diabetic retinopathy is an ocular condition caused by a multitude of factors as a result of elevated blood glucose. One of the primary mechanisms of damage is a result of oxidative stress. It has been found that levels of IRBP in the vitreous are decreased in the setting of diabetic retinopathy, which could be associated with damage from resulting oxidative stress.

Purpose:

This article will address the protective role of IRBP in diabetic retinopathy by discussing the overexpression and under expression of IRBP and its resulting effect on the retina. Increased levels of IRBP in rats with diabetic retinopathy …

Heritability Of Ocular Traits In Hispanics, Aaron T. Gomez, Gladys E. Maestre, Jesus D. Melgarejo, Vincent P. Diego, Nicholas B. Blackburn, Juan B. Yepez, Michele Petitto, Felipe A. Murati, Rosa V. Pirela, Carlos A. Chavez, Winston Lee, Lama A. Al-Aswad, Matthew P. Johnson, Joseph H. Lee, John Blangero

MEDI 9331 Scholarly Activities Clinical Years

Purpose: The burden of glaucoma disease among Hispanics is significantly higher than in their white counterparts. It remains unclear to what extent these differences are determined by genetic factors in Hispanics. We therefore examined a highly inbred family population-based cohort in Venezuela to estimate the proportion of genetic contribution of ocular traits relevant to glaucoma disease.

Methods: A subset of 67 participants ≥40y from the Maracaibo Aging Study (MAS) with family pedigree were randomly included. The papillary retinal nerve fiber layer (RNFL) and macular thickness were measured with Spectralis Domain-OCT. Heritability analyses (h², expressed as %) …

Involvement Of Tgfβ Signaling Pathway In Oxidative Stress And Diabetic Retinopathy, Reanna Rodriguez, Kristine L. Lowe, Megan Keniry, Andrew Tsin

School of Medicine Publications

Diabetic Retinopathy (DR) is a leading cause of blindness in the U.S. However, not much is known of underlying molecular mechanism and how oxidative stress contributes to its development. In the present study, we investigated the involvement of TGFβ signaling pathway on the effect of oxidative stress on VEGF secretion and viability of retinal cells. VEGF is the hallmark that exacerbates DR progression in prolonged diabetes. Some major concerns that have arisen are the underlying effects of antioxidants in elevating VEGF secretion in diabetes. In this study, we evaluated how hypoxia (or low oxygen) impacts viability and VEGF secretion using …

Assessing Disease Severity Of Diabetic Retinopathy Using Novel Graphical Interpretation Of Flicker Electroretinogram, Anjalee Choudhury, Jonas Moses, Victor Gonzalez

MEDI 9331 Scholarly Activities Clinical Years

Purpose: To assess the clinical value of reporting full-field electroretinogram (eg, flicker ERG) findings graphically to determine the severity of diabetic retinopathy (DR) within an office-based setting.

Methods: Patients with type 2 diabetes mellitus were included and classified into varying degrees of DR based on presence and severity. Flicker ERG responses were recorded and compared between groups.

Results: Between the varying disease stages, significant differences in the mean magnitude and phase values were found. There was also a significant difference between the proportions of the magnitude and phase color-coded frequencies between groups of severity and threat to …

Diabetic Retinopathy: Targeting Bigh3 To Develop Novel Molecular Therapies, Reanna Rodriguez, Anjalee Choudhury, Daniela Gonzalez, Cristian Mercado, Andrew Tsin

School of Medicine Publications

Diabetic retinopathy (DR) is a complication of diabetes due to damage of blood vessels in the retina. Aside from being a major cause of blindness in the world, DR also has a significant impact on quality of life. Although there are methods to delay the progression of DR, there are no existing therapeutic regimens for early intervention. Thus, it is critical to develop cost-effective therapies towards preventing DR development.

Recent Advances On Visual Cycle Protein Research And Progress On Clinical Translation, Xin Yee Ooi, Rujman Khan, Anjalee Choudhury, Francisco Xavier Elisarraras, Jeff Grigsby, Brandi Obregon, Andrew T C Tsin

School of Medicine Publications

Since the publication of our previous paper, Visual cycle proteins: Structure, function, and roles in human retinal disease (Tsin, et.al, JBC 293:13016, 2018) there has been significant progress on multiple topics discussed in this paper. In the present communication, we further explore research advances on two visual cycle proteins: DES1 and IRBP. In addition, we emphasize the progress of clinical translation of other visual cycle protein research, including the breakthrough of FDA-approved gene therapy for Leber’s congenital amaurosis, and additional gene therapies at different stages of clinical trials for various retinal diseases such as retinitis pigmentosa, diabetic retinopathy, and Stargardt’s …

Keratoconus In A Patient With Alport Syndrome: A Case Report, Majid Moshirfar, David F. Skanchy, Aaron T. Gomez, Yasmyne C. Ronquillo, Benjamin Buckner, Phillip C. Hoopes

School of Medicine Publications

BACKGROUND Known ocular manifestations of Alport syndrome include features such as anterior lenticonus and fleck retinopathy. Reports of keratoconus in such patients are limited. We report tomographic findings consistent with keratoconus in a patient with Alport syndrome.

CASE SUMMARY A 52-year-old female was referred to our ophthalmology clinic with decreased vision and increased tearing. She was diagnosed with stage III Alport syndrome two years prior. Upon examination she was found to have average keratometries of 48 D bilaterally with tomographic evidence of keratoconus.

CONCLUSION Although a rare presentation, concurrent Alport syndrome and keratoconus should be considered when reviewing the ocular …

Expression Of Integrin And Tgfbi In Human Retinal Pericytes, Andrew T C Tsin, Brenda Su, Laura Valdez, Edgar Serrato

School of Medicine Publications

Purpose: The aim for this study is to investigate the expression of integrin α3, β1 and TGF-β induced protein (TGFBI) and the secretion of TGFBI by primary culture of human retinal pericytes (pHRP). Evidence suggests that chronic diabetes associate with HRP apoptosis leading to the development of diabetic retinopathy.

Methods: pHRP (Cell Systems) were cultured in complete media (15mM glucose) in a humidified, 5% CO2, 37°C condition. Cells were seeded at passage 6 to 8 into a 24 well-plate with coverslips or P10 dishes. Cells (85% confluence) media were then replaced by DMEM media with euglycemic glucose (5.5mM) or hyperglycemic …

Eyelid Cosmetic Enhancements And Their Associated Ocular Adverse Effects, Maliha Masud, Majid Moshirfar, Tirth J. Shah, Aaron T. Gomez, Michele R. Avila, Yasmyne C. Ronquillo

School of Medicine Publications

Numerous cosmetic enhancements and augmentations to the natural appearance of the periorbital area are readily available today. Due to the increasing popularity of these cosmetic procedures, it is important for ophthalmologists to be aware of their potential risks, complications and adverse effects. The aim of this literature review was to introduce some of the most common ocular cosmetic enhancements and provide a comprehensive overview of their associated adverse effects reported in various medical journals. PubMed, Embase, and Google Scholar were used to identify articles related to the following ocular cosmetic procedures; eyelash extensions, permanent eyelid tattooing, and eyelash dyeing. The …

Ophthalmic Manifestations Of Congenital Zika Syndrome In Colombia And Venezuela, Juan B. Yepez, Felipe A. Murati, Michele Petitto, Carlos F. Peñaranda, J. Fernando Arevalo, Gladys E. Maestre

School of Medicine Publications

IMPORTANCE The ocular manifestations and sequelae of Zika virus infection are not well known. Recently, the World Health Organization changed the declaration of Zika as a public health emergency and designated the viral outbreak and related microcephaly clusters as a long-term program of work. This change indicates the urgent need to evaluate and document ophthalmic manifestations in patients for timely management of this disease. In addition, confirmation whether the public health problem in Brazil extends to other regions in South America is needed.

OBJECTIVE To report the ocular manifestations of congenital Zika syndrome with microcephaly in Colombia and Venezuela.

DESIGN, …

Horner's Syndrome Secondary To Neuroblastoma, Roberto A. Cruz, T. K. Tran, Nicky R. Holdeman, Christian Cajavilca, Rosa A. Tang

School of Medicine Publications

Horner’s syndrome is classically characterized by a triad of miosis, partial ptosis and anhidrosis. The etiology is due to an interruption in the sympathetic innervation to the eye. A prompt diagnosis is crucial, given that Horner’s syndrome could be a manifestation of a life-threatening condition. A thorough case history and clinical evaluation must be employed to arrive at the diagnosis. An important means for confirming Horner’s syndrome is pharmacological testing, which is also used to localize the level where the sympathetic chain is compromised. Following the diagnosis and localization of the lesion, an algorithm should be followed to determine the …