Ophthalmology Commons^™

Development Of A Surgical Instrument Prototype To Perform A More Precise Capsulorhexis, Kirk Haugen

Interdisciplinary Program Research

Performing capsulorhexis is often considered the most difficult part of cataract surgery. Not only is it difficult to perform, but doing it correctly is important for refractive outcomes (Okada, Hersh, Paul, & Straaten, 2013). Poorly done capsulorhexes are associated with problems including posterior capsulor opacification, capsulor fibrosis, and capsulor phimosis (Raviv, The perect capsulorhexis: more critical than ever, 2010). This study investigates whether or not a proposed surgical instrument will produce more precise capsulorhexes as measured by the circularity index. 60 capsulorhexes were performed on cigarette paper laid over clay. Half were done using the continuous curvilinear capsulorhexis method, while …

Bioactive Lysophospholipids Generated By Hepatic Lipase Degradation Of Lipoproteins Lead To Complement Activation Via The Classical Pathway, W. Ma, D. C. Paik, G. R. Barile

Journal Articles

PURPOSE: We determined bioactivity of lysophospholipids generated by degradation of the low-density (LDL), very low-density (VLDL), and high-density (HDL) lipoproteins with hepatic lipase (HL), cholesterol esterase (CE), and lipoprotein-associated phospholipase A2 (Lp-PLA2). METHODS: The LDL, VLDL, and HDL were treated with HL, CE, and Lp-PLA2 after immobilization on plates, and complement activation studies were performed with diluted human serum. Complement component 3 (C3) fixation, a marker for complement activation, was determined with a monoclonal anti-human C3d antibody. Enzymatic properties of HL and CE were assayed with triglyceride and phosphatidylcholine substrates for triglyceride hydrolase and phospholipase A activities. The ARPE-19 cells …

Intermittent Acute Angle Closure Glaucoma And Chronic Angle Closure Following Topiramate Use With Plateau Iris Configuration, Lamise Z. Rajjoub, Nisha Chadha, David A. Belyea

Ophthalmology Faculty Publications

This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma …

Risk Factors Associated With Reticular Pseudodrusen Versus Large Soft Drusen, S. Boddu, M. D. Lee, M. Marsiglia, M. Marmor, K. B. Freund, R. T. Smith

Journal Articles

PURPOSE: To investigate genetic, environmental, and systemic risk factors in prospectively identified subjects with the age-related macular degeneration (AMD) phenotypes of (1) reticular pseudodrusen without large soft drusen and (2) large soft drusen without reticular pseudodrusen. DESIGN: Prospective case-case comparison. METHODS: In a clinical practice setting, patients with AMD were sequentially screened using clinical examination and scanning laser ophthalmoscopy imaging to prospectively identify subjects (n = 73) with the phenotypes of (1) reticular pseudodrusen without large soft drusen (n = 30) or (2) large soft drusen without reticular pseudodrusen (n = 43). Subjects were genotyped for 2 alleles associated with …

Glycated Hemoglobin Measurement And Prediction Of Cardiovascular Disease, E. Di Angelantonio, P. Gao, H. Khan, N. Wald, S. J. L. Bakker, P. H. Whincup, J. Kauhanen, J. T. Salonen, R. Dankner, J. Danesh, +66 Additional Authors

Journal Articles

IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA(1c)) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA(1c) values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories …

Early Initial Clinical Experience With Intravitreal Aflibercept For Wet Age-Related Macular Degeneration, P. J. Ferrone, F. Anwar, J. Naysan, K. Chaudhary, D. Fastenberg, K. Graham, V. Deramo

Journal Articles

Background Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Methods Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6 weeks on …

Gene Therapy In Patient-Specific Stem Cell Lines And A Preclinical Model Of Retinitis Pigmentosa With Membrane Frizzled-Related Protein Defects, Y. Li, W. H. Wu, C. W. Hsu, H. V. Nguyen, Y. T. Tsai, L. Chan, T. Nagasaki, I. H. Maumenee, L. A. Yannuzzi, S. H. Tsang, +3 Additional Authors

Journal Articles

Defects in Membrane Frizzled-related Protein (MFRP) cause autosomal recessive retinitis pigmentosa (RP). MFRP codes for a retinal pigment epithelium (RPE)-specific membrane receptor of unknown function. In patient-specific induced pluripotent stem (iPS)-derived RPE cells, precise levels of MFRP, and its dicistronic partner CTRP5, are critical to the regulation of actin organization. Overexpression of CTRP5 in naive human RPE cells phenocopied behavior of MFRP-deficient patient RPE (iPS-RPE) cells. AAV8 (Y733F) vector expressing human MFRP rescued the actin disorganization phenotype and restored apical microvilli in patient-specific iPS-RPE cell lines. As a result, AAV-treated MFRP mutant iPS-RPE recovered pigmentation and transepithelial resistance. The efficacy …

Assessing The Cone Photoreceptor Mosaic In Eyes With Pseudodrusen And Soft Drusen In Vivo Using Adaptive Optics Imaging, S. Mrejen, T. Sato, C. A. Curcio, R. F. Spaide

Journal Articles

PURPOSE: To investigate the cone photoreceptor mosaic in eyes with pseudodrusen as evidenced by the presence of subretinal drusenoid deposits (SDD) and conventional drusen using adaptive optics (AO) imaging integrated into a multimodal imaging approach. DESIGN: Observational case series. PARTICIPANTS: Eleven patients (11 eyes) with pseudodrusen and 6 patients (11 eyes) with conventional drusen. METHODS: Consecutive patients were examined using near-infrared reflectance (IR) confocal scanning laser ophthalmoscopy (SLO) and eye-tracked spectral-domain optical coherence tomography (SD-OCT) and flood-illuminated retinal AO camera of nonconfluent pseudodrusen or conventional drusen. Correlations were made between the IR-SLO, SD-OCT, and AO images. Cone density analysis was …

Late Recurrence Of Myopic Foveoschisis After Successful Repair With Primary Vitrectomy And Incomplete Membrane Peeling, G. Sepulveda, S. Chang, K. B. Freund, S. Park, Q. V. Hoang

Journal Articles

PURPOSE: To report three cases of late recurrence of myopic foveoschisis (MF) after initial successful repair with pars plana vitrectomy and membrane peeling to assess the importance of internal limiting membrane peeling. METHODS: A retrospective noncomparative case series was performed of patients who underwent a primary pars plana vitrectomy by a single surgeon with successful resolution of MF, but eventually underwent repeat pars plana vitrectomy for recurrent MF. Best-corrected visual acuity, fundus photography, and optical coherence tomography were obtained at each examination. RESULTS: Three eyes of three patients underwent pars plana vitrectomy for recurrent MF. Myopic foveoschisis recurrence occurred 6, …

Photoreceptor Perturbation Around Subretinal Drusenoid Deposits As Revealed By Adaptive Optics Scanning Laser Ophthalmoscopy, Y. Zhang, X. Wang, E. B. Rivero, M. E. Clark, C. D. Witherspoon, R. F. Spaide, C. A. Girkin, C. Owsley, C. A. Curcio

Journal Articles

PURPOSE: To describe the microscopic structure of photoreceptors impacted by subretinal drusenoid deposits, also called pseudodrusen, an extracellular lesion associated with age-related macular degeneration (AMD), using adaptive optics scanning laser ophthalmoscopy (AOSLO). DESIGN: Observational case series. METHODS: We recruited 53 patients with AMD and 10 age-similar subjects who had normal retinal health. All subjects underwent color fundus photography, infrared reflectance, red-free reflectance, autofluorescence, and spectral-domain optical coherence tomography (OCT). Subretinal drusenoid deposits were classified by a 3-stage OCT-based grading system. Lesions and surrounding photoreceptors were examined by AOSLO. RESULTS: Subretinal drusenoid deposits were found in 26 eyes of 13 patients …

Spectral-Domain Optical Coherence Tomography Staging And Autofluorescence Imaging In Achromatopsia, J. P. Greenberg, J. Sherman, S. A. Zweifel, R. W. Chen, T. Duncker, S. Kohl, B. Baumann, B. Wissinger, L. A. Yannuzzi, S. H. Tsang

Journal Articles

IMPORTANCE Evidence is mounting that achromatopsia is a progressive retinal degeneration, and treatments for this condition are on the horizon. OBJECTIVES To categorize achromatopsia into clinically identifiable stages using spectral-domain optical coherence tomography and to describe fundus autofluorescence imaging in this condition. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was performed between 2010 and 2012 at the Edward S. Harkness Eye Institute, New York-Presbyterian Hospital. Participants included 17 patients (aged 10-62 years) with full-field electroretinography-confirmed achromatopsia. MAIN OUTCOMES AND MEASURES Spectral-domain optical coherence tomography features and staging system, fundus autofluorescence and near-infrared reflectance features and their correlation to optical …

Giant Cell Arteritis Presenting With Bilateral Orbital Inflammatory Disease And Enhancing Superficial Temporal Arteries, J. R. Mitchell, I. Krashin-Bichler, M. Rosenblum, E. L. Diamond, M. J. Dinkin

Journal Articles

No abstract provided.

Complete Binasal Hemianopia, B. T. Bryan, H. D. Pomeranz, K. H. Smith

Journal Articles

Binasal hemianopia is a rarely encountered visual field defect. We examined two asymptomatic female patients, aged 17 and 83, with complete binasal hemianopia. Both patients had unremarkable eye exams except for the visual field deficits and minimally reduced visual acuity and color vision. Both patients had normal neuroimaging. These are the first reported cases of complete binasal visual field defects without an identifiable ocular or neurologic cause.

Differential Eye Movements In Mild Traumatic Brain Injury Vs. Normal Controls, Joanna R. Wares, David X. Cifu, Kathy W. Hoke, Paul A. Wetzel, George Gitchel, William Carne

Department of Math & Statistics Faculty Publications

Objective measures to diagnose and to monitor improvement of symptoms following mild traumatic brain injury (mTBI) are lacking. Computerized eye tracking has been advocated as a rapid, user friendly and field ready technique to meet this need. Eye tracking data collected via a head mounted, video-based binocular eye tracker was used to examine saccades, fixations and smooth pursuit movement in 60 military Service Members with post concussive syndrome (PCS) and 26 asymptomatic control subjects in an effort to determine if eye movement differences could be found and quantified. The diagnosis of mTBI was confirmed by the study physiatrist’s history, physical …

Complement Expression In The Retina Is Not Influenced By Short-Term Pressure Elevation, Konstantin Astafurov, Cecilia Q. Dong, Lampros Panagis, Gautam Kamtham, Lizhen Ren, Anna Rozenboym, Tarique D. Perera, Jeremy D. Coplan, John Danias

Publications and Research

Purpose: To determine whether short-term pressure elevation affects complement gene expression in the retina in vitro and in vivo.

Methods: Muller cell (TR-MUL5) cultures and organotypic retinal cultures from adult mice and monkeys were sub- jected to either 24-h or 72-h of pressure at 0, 15, 30, and 45 mmHg above ambient. C57BL/6 mice were subjected to microbead-induced intraocular pressure (IOP) elevation for 7 days. RNA and protein were extracted and used for analysis of expression levels of complement component genes and complement component 1, q subcomponent (C1q) and comple- ment factor H (CFH) immunoblotting. …

Dendrimer Based Nanotherapeutics For Ocular Drug Delivery, Siva Pramodh Kambhampati

Wayne State University Dissertations

PAMAM dendrimers are a class of well-defined, hyperbranched polymeric nanocarriers that are being investigated for ocular drug and gene delivery. Their favorable properties such as small size, multivalency and water solubility can provide significant opportunities for many biologically unstable drugs and allows potentially favorable ocular biodistribution. This work exploits hydroxyl terminated dendrimers (G4-OH) as drug/gene delivery vehicles that can target retinal microglia and pigment epithelium via systemic delivery with improved efficacy at much lower concentrations without any side effects.

Two different drugs Triamcinolone acetonide (TA) and N-Acetyl Cysteine (NAC) conjugated to G4-OH dendrimers showed tailorable sustained release in physiological relevant …

Emerging Therapies For Noninfectious Uveitis: What May Be Coming To The Clinics., Jose R. Maya, Mohammad A. Sadiq, Liz J. Zapata, Mostafa Hanout, Salman Sarwar, Nithya Rajagopalan, Kathleen E. Guinn, Yasir J. Sepah, Quan Dong Nguyen

Journal Articles: Ophthalmology

Corticosteroids along with other immunomodulatory therapies remain as the mainstay of treatment tor all patients with noninfectious uveitis (NIU). However, the systemic side effects associated with the long-term use of these drugs has encouraged the development of new therapeutic agents in recent times. This review article discusses upcoming therapeutic agents and drug delivery systems that are currently being used to treat patients with NIU. These agents mediate their actions by blocking specific pathways involved in the inflammatory process. Agents discussed in this review include full or recombinant monoclonal antibodies against interleukins such as IL-17 (secukinumab), IL-l (gevokizumab), and IL-6 (tocilizumab …

Standardized Training Examinations Among Ophthalmology Residents And The American Board Of Ophthalmology Written Qualifying Examination First Attempt: The Morsani College Of Medicine Experience, Andrew Carey, Mitchell Drucker

Ophthalmology Faculty Publications

Purpose: The aim of the study is to demonstrate whether resident performance on the United States Medical Licensing Exam (USMLE) Step 1 and the Ophthalmology Knowledge Assessment Program (OKAP) correlates to American Board of Ophthalmology Written Qualifying Examination (ABO-WQE).

Design: This is a retrospective cohort study.

Participants: Forty-one residents who completed their postgraduate training between 1999 and 2011 from our institution were included in the study.

Methods: Percentiles on the USMLE Step 1, OKAP, and ABO-WQE first attempt were recorded and analyzed for possible correlations among scores across examinations using Pearson rank correlation, chi-square analysis, Fisher exact test, and Student …

Nucleoside Reverse Transcriptase Inhibitors Are Anti-Inflammatory And Target Dry Age-Related Macular Degeneration, Benjamin J. Fowler

Theses and Dissertations--Physiology

Age-related macular degeneration (AMD) is a principal cause of blindness in the United States and other industrialized nations. An estimated 10 million Americans are afflicted with AMD, which is comparable in scope to the 12 million living with cancer, or the 5 million with Alzheimer’s disease. The prevalence of AMD steadily increases with age, affecting 2% of the population at age 40, and one in four people by age 80. For reasons that are not fully understood, AMD is more common in lightly-pigmented and female populations. Treatment of AMD is largely an unmet need: There are no FDA approved therapies …

Effects Of Hyperbaric Oxygen On Eye Tracking Abnormalities In Males After Mild Traumatic Brain Injury, Joanna R. Wares, David X. Cifu, Kathy W. Hoke, Paul A. Wetzel, George Gitchel, William Carne

Department of Math & Statistics Faculty Publications

The effects of hyperbaric oxygen (HBO2) on eye movement abnormalities in 60 military servicemembers with at least one mild traumatic brain injury (mTBI) from combat were examined in a single-center, randomized, double-blind, sham-controlled, prospective study at the Naval Medicine Operational Training Center. During the 10 wk of the study, each subject was delivered a series of 40, once a day, hyperbaric chamber compressions at a pressure of 2.0 atmospheres absolute (ATA). At each session, subjects breathed one of three preassigned oxygen fractions (10.5%, 75%, or 100%) for 1 h, resulting in an oxygen exposure equivalent to breathing either surface air, …