Publications by authors named "Amir Sternfeld"

17 Publications

  • Page 1 of 1

Long-term retinal vasculature abnormalities following intravitreal bevacizumab for retinopathy of prematurity.

Graefes Arch Clin Exp Ophthalmol 2021 Dec 1. Epub 2021 Dec 1.

Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago, Box 70, Chicago, IL, 60611, USA.

Purpose: To report long-term fluorescein angiography (FA) findings in consecutive patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB), whose ROP seemed to have resolved clinically.

Methods: Data were retrospectively collected for all patients with IVB-treated type 1 ROP who underwent an exam under anesthesia (EUA) and FA at 60 weeks post-gestational age (PGA) or older at a tertiary medical center between 2011 and 2020. FA results were reviewed for pathological vascular findings.

Results: Twenty-nine eyes of 16 patients were included. Mean gestational age and birth weight were 25.3 ± 1.5 weeks and 762.2 ± 189.8 g, respectively. The mean age at the time of EUA and FA was 23.4 ± 15.8 months. All eyes had a peripheral avascular zone and irregular peripheral branching. Vascular loops were seen in 27 eyes (93.1%) and vascular bulbs and anastomoses in 16 eyes each (55.2%). Additional abnormal findings included leakage (10 eyes, 34.5%), vessels crossing the fovea (5 eyes, 17.2%), tortuous arteries and veins (9 eyes, 31%, and 5 eyes, 17.2%, respectively), and neovascularization (2 eyes, 6.9%). When comparing patients who were less than or greater than 70 weeks PGA at follow-up, FA findings in the group with shorter follow-up were significant for more anastomoses and vascular bulbs (p = 0.002 and p = 0.024, respectively) and trended towards more leakage (45.5% vs. 27.8%, p = 0.331).

Conclusion: The vast majority of IVB-treated type 1 ROP eyes suffered from vascular pathologies long after treatment. There may be long-term progression in the vascularization process of the retina in some cases.
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http://dx.doi.org/10.1007/s00417-021-05499-0DOI Listing
December 2021

Outcomes of Combined Scleral Buckling Plus Pneumatic Retinopexy Vs. Scleral Buckling for Primary Rhegmatogenous Retinal Detachment.

Eur J Ophthalmol 2021 Nov 29:11206721211064035. Epub 2021 Nov 29.

Department of Ophthalmology, 573415Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.

Purpose: To evaluate the outcomes and complications of scleral buckle surgery alone or combined with pneumatic retinopexy (pneumatic buckle) for the treatment of primary rhegmatogenous retinal detachment.

Design: Retrospective chart review.

Participants: Two hundred thirteen patients with rhegmatogenous retinal detachment of whom 101 underwent primary scleral buckle surgery at Rabin Medical Center in 2005-2015 (SB group) and 112 underwent pneumatic buckle surgery at Royal Alexandra Hospital in 2013-2015 (PB group).

Methods: All patients were followed for ≥12 months. Data on clinical and surgical parameters, outcome, and complications were collected from the medical files.

Main Outcome Measures: Best corrected visual acuity and anatomical outcomes.

Results: At 12 months, average best corrected visual acuity was 0.3 logMar in the SB group and 0.42 logMar in the PB group ( < 0.05). Rates of anatomical reattachment were high and similar in the two groups (99% and 97%, respectively,  = 0.623). The SB group had a higher percentage of patients requiring additional laser applications (21% vs. 7%;  < 0.01) and buckle readjustment surgery (6% vs. 0;  = 0.01), and the PB group had a higher percentage of patients who required postoperative pars plana vitrectomy (30% vs. 17%;  = 0.03).

Conclusion: Scleral buckle surgery alone is efficient for the treatment of rhegmatogenous retinal detachment. Its combination with pneumatic retinopexy usually has no significant added value in terms of anatomical reattachment rate. Outcomes of Pneumatic buckling vs Scleral Buckling for RRD.
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http://dx.doi.org/10.1177/11206721211064035DOI Listing
November 2021

A unique case of benign intermittent upbeat nystagmus triggered by light stimulation.

J AAPOS 2021 Oct 1. Epub 2021 Oct 1.

Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Ophthalmology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address:

A 3-month-old girl with no past medical history presented with new-onset intermittent upbeat nystagmus. Episodes were triggered by movement into the supine position as well as by bright light flashes. They lasted a few seconds and were not associated with any distress. Neurological examination and work-up, including magnetic resonance imaging of the brain and abdominal ultrasonography, were normal. The eye movements completely resolved after 3 months.
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http://dx.doi.org/10.1016/j.jaapos.2021.07.005DOI Listing
October 2021

Orbital Lymphatic-Venous Malformation Accompanied by an Intraocular Vascular Malformation: A Rare Case Study.

Case Rep Ophthalmol 2021 May-Aug;12(2):396-401. Epub 2021 May 10.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Lymphatic-venous malformations (LVMs) are development defects that result in abnormal connections between the lymphatic and venous systems. The authors describe a 7-weeks-old female infant who presented with a right orbital LVM extending to the ipsilateral cheek and subconjunctiva of the right eye, intracranial developmental venous anomalies in the right cerebellum, and a significant right eye intraocular retinal vascular malformation. Since orbital LVM is usually diagnosed in infancy or childhood, pediatric ophthalmologists should actively look for intraocular vascular malformations as such findings can poorly affect a patient's vision.
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http://dx.doi.org/10.1159/000515272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136313PMC
May 2021

Effect of Penetration Angle and Velocity During Intravitreal Injection on Pain.

Semin Ophthalmol 2021 Aug 29;36(5-6):437-443. Epub 2021 Mar 29.

Department of Ophthalmology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.

To evaluate the effect of velocity and angle of the intravitreal injection of anti-vascular endothelial growth factors on pain sensation. Patients were randomly assigned to one of four injection methods: straight and fast, straight and slow, tunneled and fast, and tunneled and slow. Later, they graded their pain sensation on a Visual Analog Scale (range 0-10). The cohort included 180 patients. Mean pain score was 2.81 ± 2.34. There was no statistically significant difference in mean pain score among the four groups ( = .858); between the slow-injection (straight and tunneled) and fast-injection groups ( = .514); and between the straight-injection (fast and slow) and tunneled-injection groups ( = .992), nor other background variables. Velocity and angle of intravitreal injections are unrelated to the pain sensation. Therefore, the method may be left to the clinician's discretion. This implies that the sensation is mostly subjective.
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http://dx.doi.org/10.1080/08820538.2021.1906914DOI Listing
August 2021

A Single Low-Dose of Methylphenidate Improves Abnormal Visual Field Testing.

Curr Eye Res 2021 08 21;46(8):1232-1239. Epub 2020 Dec 21.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: To evaluate the effect of methylphenidate on visual field testing in healthy adults with abnormal visual field results.

Methods: This prospective, randomized, controlled interventional clinical trial comprised all patients who had abnormal visual field test results and normal eye examination and ophthalmic history. Eligible patients were randomly assigned to either the study group or the control group. All patients repeated their visual field testing. Study group patients received a single dose of 10 mg methylphenidate prior to that. The main outcome measures were the percent difference in mean deviation and pattern standard deviation between the second and first visual fields.

Results: The methylphenidate group had greater improvement in all parameters. Mean deviation improved by median 68% (IQR 19%-78%) in the methylphenidate group vs. 27% [-5% to 55%] in the controls. However, this was not statistically significant ( = .83). Pattern standard deviation improved by median 49% (22%-59%) vs. 7% [-9% to 45%], respectively ( = .012). The visual fields were also reviewed by 3 masked experienced ophthalmologists. They indicated that the second visual field improved in 76.2% of the methylphenidate group vs. 48.5% of the controls ( = .04). A normal repeat visual field occurred in 57.7% vs. 21.2%, respectively. A subgroup analysis of patients with prior experience in visual field testing yielded an even more striking improvement in the methylphenidate group vs. controls.

Conclusions: A single low dose of methylphenidate can improve visual field testing in subjects without ocular pathology, and even more in those with prior experience in perimetry.
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http://dx.doi.org/10.1080/02713683.2020.1858430DOI Listing
August 2021

Secondary intraocular lens implantation using the flanged intrascleral fixation technique in pediatric aphakia: case series and review of literature.

J AAPOS 2020 10 9;24(5):286.e1-286.e6. Epub 2020 Oct 9.

Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, United States; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, United States. Electronic address:

Purpose: To present a pediatric case series in which the flanged intrascleral intraocular lens (IOL) fixation technique (Yamane technique) was used to correct aphakia.

Methods: The surgical database of a single tertiary children's hospital was reviewed to identify all patients who underwent secondary IOL implantation by a single surgeon from May 2018 to January 2020. The medical records and operative reports of all patients operated on using the Yamane technique were reviewed retrospectively. Intra- and postoperative complications and pre- and postoperative vision and refraction were documented to assess outcomes.

Results: A total of 12 eyes of 10 consecutive patients were included. Mean age at surgery was 10 ± 6 years. Indications for scleral fixation were ectopia lentis (secondary to Marfan syndrome [n = 3] or idiopathic [n = 1]), lens subluxation with intermittent pupillary block secondary to Weill- Marchesani syndrome (n = 2), early childhood lensectomy with insufficient residual capsular support (n = 5), and traumatic aphakia after an open globe (n = 1). Mean follow-up was 8 ± 5 months. No major intraoperative complications occurred. Postoperatively 1 patient required IOL repositioning 1 week after surgery. The location of one haptic was noted to be intrascleral but superficial in another patient, who did not require surgical intervention. The mean postoperative astigmatism was 2 ± 2 D. Good visual results were achieved in all eyes.

Conclusions: With slight modifications, the Yamane technique can be adapted to the pediatric eye. This technique has significant surgical and anatomic advantages and provides stable IOL fixation. Visual outcomes and adverse events compare favorably with older techniques.
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http://dx.doi.org/10.1016/j.jaapos.2020.06.010DOI Listing
October 2020

Diagnosis of Pseudoexfoliation Syndrome in Pseudophakic Patients.

Ophthalmic Res 2021 30;64(1):28-33. Epub 2020 Apr 30.

Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.

Objective: The aim of this study was to evaluate the sensitivity and specificity of pseudoexfoliation syndrome diagnosis in pseudophakic patients and potential means of improving it.

Methods: This prospective, nonrandomized study comprised 41 consecutive patients (41 eyes) scheduled for cataract surgery at a tertiary medical center during 2016 and 2017. Preoperatively, all patients underwent a detailed slit-lamp examination, including gonioscopic assessment of the iridocorneal angle. The examination was performed by a glaucoma specialist who completed an assessment form documenting the presence/absence of clinical signs of pseudoexfoliation syndrome. It was repeated 1-2 weeks postoperatively by a second, masked, glaucoma specialist.

Results: Sixteen patients (39.0%) were diagnosed with pseudoex-foliation syndrome preoperatively. The diagnosis was confirmed postoperatively in 11/16 patients (68.8% sensitivity) and in an additional patient not diagnosed preoperatively (96% specificity). The ability to diagnose pseudoexfoliation syndrome postoperatively was significantly worse than preoperatively (Z = 12.161, p < 0.0001). Pupillary border deposits (75% of cases) and the Sampaolesi line (83.3%) were the cornerstones of the postoperative diagnosis; anterior capsular deposits were evident in only 41.6% of cases diagnosed postoperatively (31.3% of the originally diagnosed cases).

Conclusions: Underdiagnosis of pseudoexfoliation syndrome is common in pseudophakic patients and may have significant implications for future management. Careful attention to pupillary border anatomy and meticulous gonioscopic assessment of the iridocorneal angle are essential for accurate diagnosis. Preoperative documentation of pseudoexfoliation syndrome could help prevent this diagnostic pitfall.
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http://dx.doi.org/10.1159/000508336DOI Listing
September 2021

Gene-Related Response of Basal Cell Carcinoma to Biologic Treatment with Vismodegib.

Sci Rep 2020 01 27;10(1):1244. Epub 2020 Jan 27.

The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel.

We aimed to characterise the response of locally advanced basal cell carcinoma (BCC) to systemic treatment with Vismodegib, a Hedgehog pathway inhibitor, by changes in the expression levels of Hedgehog pathway genes. Data were collected prospectively on 12 patients treated systemically for locally advanced BCC. Biopsy samples taken on admission and after treatment cessation were analysed pathologically and with the NanoString nCounter system to quantify the expression of 40 Hedgehog signaling pathway genes. Findings were compared before and after treatment, between complete and partial responders, and with localised BCC samples from 22 patients. Sixteen Hedgehog pathway genes changed significantly from before to after treatment. GAS1 was the only gene with a significantly different expression at baseline between complete responders (6 patients) and partial responders (4 patients) to Vismodegib (P = 0.014). GAS, GLIS2 and PRKACG1 showed different expression before treatment between the locally advanced and localised BCCs. The baseline expression level of GAS1 appears to be predictive of the response of locally advanced BCC to systemic Vismodegib treatment. A change in expression of many Hedgehog pathway genes, albeit expected by the known activity of Vismodegib, may nevertheless serve as an indicator of the response potential of the tumour.
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http://dx.doi.org/10.1038/s41598-020-58117-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985141PMC
January 2020

Ahmed Valve Tube Extension in Pediatric Glaucoma.

J Glaucoma 2020 04;29(4):276-279

Pediatric Ophthalmology Department, Children's Hospital of Michigan, Detroit, MI.

PRéCIS:: Ahmed valve tube extender showed good long-term outcomes for retracted tubes in pediatric glaucoma. The procedure is safe with limited complications.

Purpose: To analyze the long-term outcomes of Ahmed valve tube extension in pediatric glaucoma patients.

Patients And Methods: This study analyzed the records of all children who underwent surgery involving extension of a pediatric Ahmed valve tube, treated at a tertiary medical center between 2007 and 2018. Surgical success was defined as intraocular pressure between 6 and 22 mm Hg and reduced by at least 20% from its preoperative value, with or without intraocular pressure lowering medications, without additional surgical procedures and without vision loss.

Results: Fourteen eyes of 11 children were treated with the Ahmed tube extender during the study period. Mean age of all children was 5.7±4.7 years (range, 3 mo to 16 y). The most common type of glaucoma was congenital glaucoma (n=6, 42.9%). The mean age at the time of initial valve implant was 2.39±3.89 years and the mean duration from initial insertion to the extension was 3.39±2.95 years. The mean follow-up was 72.8±43.3 months (range, 12 to 140 mo), with 85.7% followed for >2 years. The mean survival was 34.1±37.2 months after the extension. Three surgeries (21.4%) were primary failures, 8 patients (57.1%) failed during follow-up (mean, 40.6±44.4 mo after the extension; range, 1 to 125 mo), whereas 3 patients (21.4%) maintained the successful outcome until their last follow-up visit (mean, 37.7±24.1 mo; range, 12 to 70 mo).

Conclusions: The Ahmed valve extender can often save a retracted or obstructed tube. The procedure has limited complications and long-term efficacy in one third of the patients.
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http://dx.doi.org/10.1097/IJG.0000000000001446DOI Listing
April 2020

Effect of different lens status on intraocular pressure elevation in patients treated with anti-vascular endothelial growth factor injections.

Int J Ophthalmol 2020 18;13(1):79-84. Epub 2020 Jan 18.

Department of Ophthalmology, Rabin Medical Center Beilinson Hospital, Petach Tikva 4941402, Israel.

Aim: To assess the effect of lens status on sustained intraocular pressure (IOP) elevation in patients treated intravitreally with anti-vascular endothelial growth factor (VEGF) agents.

Methods: Data were retrospectively collected for all patients treated with intravitreal injections of anti-VEGF medication at a tertiary medical center in July 2015. Findings were analyzed by lens status during 6 months' follow-up. The main outcome measure was a sustained increase in IOP (≥21 mm Hg or change of ≥6 mm Hg from baseline on ≥2 consecutive visits, or addition of a new IOP-lowering medication during follow-up).

Results: A total of 119 eyes of 100 patients met the study criteria: 40 phakic, 40 pseudophakic, and 39 pseudophakic after Nd:YAG capsulotomy. The rate of sustained IOP elevation was significantly higher in the post-capsulotomy group (23.1%) than in the phakic/pseudophakic groups (8.1%; =0.032), with no statistically significant differences among the 3 groups in mean number of injections, either total (=0.82) or by type of anti-VEGF mediation (bevacizumab: =0.19; ranibizumab: =0.13), or mean follow-up time (=0.70).

Conclusion: Nd:YAG capsulotomy appears to be a risk factor for sustained IOP elevation in patients receiving intravitreal anti-VEGF injections. This finding has important implications given the growing use of anti-VEGF treatment and the irreversible effects of elevated IOP.
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http://dx.doi.org/10.18240/ijo.2020.01.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942959PMC
January 2020

Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair.

Int J Ophthalmol 2019 18;12(12):1872-1877. Epub 2019 Dec 18.

Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.

Aim: To determine the rate and possible contributors for post-pars plana vitrectomy (PPV) epiretinal membrane (ERM) in patients treated for rhegmatogenous retinal detachment (RRD).

Methods: This prospective, nonrandomized study comprised 47 consecutive patients (47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD.

Results: ERM developed postoperatively in 23 eyes (48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity (median logMAR 1.9 0.3, respectively; =0.003) rate of macula-off (69.6% 37.5%, respectively, =0.028), and rate of ≥5 cryo-applications (55.6% and 18.8%, respectively, =0.039). ERM developed mainly between the 1 and 3 months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81 (=0.031).

Conclusion: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.
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http://dx.doi.org/10.18240/ijo.2019.12.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901877PMC
December 2019

Effect of Subretinal Fluid Drainage Using Perfluorocarbon During Retinal Detachment Repair on Postoperative Metamorphopsia.

Ophthalmic Surg Lasers Imaging Retina 2018 12;49(12):e263-e270

Background And Objective: To determine whether subretinal fluid drainage (SRF) using perfluorocarbon (PFC) during rhegmatogenous retinal detachment (RRD) repair reduces postoperative metamorphopsia.

Patients And Methods: Consecutive patients after RRD were evaluated for best-corrected visual acuity (BCVA), funduscopy, and metamorphopsia using M-CHARTS. Fundus autofluorescence and optical coherence tomography were performed. Clinical and operative data were collected.

Results: The cohort included 30 patients, of whom 11 (36.7%) underwent intraoperative PFC injection. Rates of macula-off RRD were similar in the two groups (54.5% and 47.4%, P = .705). No association was found between PFC injection and metamorphopsia score. Preoperative macula-off RRD was associated with significantly higher vertical and horizontal metamorphopsia scores than preoperative macula-on. BCVA was significantly worse in the patients with metamorphopsia (logMAR 0.15 vs. logMAR 0.04; P = .042) CONCLUSION: Intraoperative SRF drainage with PFC appears to have no beneficial effect on postoperative metamorphopsia. Metamorphopsia is associated with macular status. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e263-e270.].
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http://dx.doi.org/10.3928/23258160-20181203-17DOI Listing
December 2018

Long-term follow-up of benign positional vertical opsoclonus in infants: retrospective cohort.

Br J Ophthalmol 2018 06 13;102(6):757-760. Epub 2017 Sep 13.

Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel.

Background/aims: Benign positional vertical opsoclonus in infants, also described as paroxysmal tonic downgaze, is an unsettling phenomenon that leads to extensive work-up, although benign course has been reported in sporadic cases. We describe long-term follow-up of a series of infants with the phenomenon.

Methods: This retrospective cohort included all infants diagnosed with rapid downgaze eye movement in 2012-2015 and followed until 2016. The databases of two medical centres were retrospectively reviewed. Benign positional vertical opsoclonus was diagnosed based on clinical findings of experienced neuro-ophthalmologists. Data were collected on demographics, symptoms and signs, neuro-ophthalmological and neurological evaluations, and outcome. Imaging studies were reviewed. Main outcome measures were long-term outcome and findings of the thorough investigation.

Results: The cohort included six infants. All infants were born at term. Age at presentation was several days to 12 weeks. Episodes lasted a few seconds and varied in frequency from <10 to dozens per day. In five infants, symptoms occurred in the supine position. There was a wide variability in the work-up without any pathological findings. Follow-up ranged from 1 to 2.5 years. Ocular symptoms gradually decreased until resolution. Infants reached normal developmental milestones.

Conclusions: Our identification of six patients in only 3 years suggests benign positional vertical opsoclonus may be more prevalent than previously described. In our experience, it affects otherwise healthy infants and resolves spontaneously. In view of the good long-term outcome, a comprehensive clinical investigation may not be necessary.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310893DOI Listing
June 2018

Prevention of Exposure Keratopathy in Critically Ill Patients: A Single-Center, Randomized, Pilot Trial Comparing Ocular Lubrication With Bandage Contact Lenses and Punctal Plugs.

Crit Care Med 2017 Nov;45(11):1880-1886

1Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 2Department of Opthalmology, Rabin Medical Center, Campus Beilinson, Petah Tikva, Israel. 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Objectives: To compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients.

Design: Single-center, prospective, randomized, pilot study.

Setting: Sixteen-bed, general ICU at a tertiary academic medical center.

Patients: Adults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days.

Interventions: Patients were randomized to receive eye care with ocular lubricants (n = 38), bandage contact lenses (n = 33), or punctal plugs (n = 33). The bandage contact lenses were changed every 4 days, whereas the punctal plugs remained in situ for the entire study.

Measurements And Main Results: The primary endpoint was the presence or absence of corneal damage as assessed by the grade of keratopathy. Patients were examined by an ophthalmologist blinded to the study group every 4 days and at the time of withdrawal from the study, due to cessation of sedation, discharge from the ICU, or death. The mean duration of the study was 8.6 ± 6.2 days. The grade of keratopathy in the ocular lubricant group increased significantly in both eyes (p = 0.01 for both eyes) while no worsening was noted in either the lens or punctal plugs groups. In a post hoc analysis of patients with an initially abnormal ophthalmic examination, significant healing of keratopathy was noted in the lens group (p = 0.02 and 0.018 for left and right eyes, respectively) and in the right eye of the plugs group (p = 0.005); no improvement was noted in the ocular lubricant group.

Conclusions: Compared with ocular lubrication, bandage contact lenses and punctal plugs were more effective in limiting keratopathy, and their use, particularly of bandage contact lenses, was associated with significant healing of existing lesions.
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http://dx.doi.org/10.1097/CCM.0000000000002681DOI Listing
November 2017

Advantages of diabetic tractional retinal detachment repair.

Clin Ophthalmol 2015 23;9:1989-94. Epub 2015 Oct 23.

Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.

Purpose: To evaluate the outcomes and complications of patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV).

Patients And Methods: We retrospectively studied a case series of 24 eyes of 21 patients at a single tertiary, university-affiliated medical center. A review was carried out on patients who underwent PPV for the management of TRD due to proliferative diabetic retinopathy from October 2011 to November 2013. Preoperative and final visual outcomes, intraoperative and postoperative complications, and medical background were evaluated.

Results: A 23 G instrumentation was used in 23 eyes (95.8%), and a 25 G instrumentation in one (4.2%). Mean postoperative follow-up time was 13.3 months (4-30 months). Visual acuity significantly improved from logarithm of the minimum angle of resolution (LogMAR) 1.48 to LogMAR 1.05 (P<0.05). Visual acuity improved by ≥3 lines in 75% of patients. Intraoperative complications included iatrogenic retinal breaks in seven eyes (22.9%) and vitreal hemorrhage in nine eyes (37.5%). In two eyes, one sclerotomy was enlarged to 20 G (8.3%). Postoperative complications included reoperation in five eyes (20.8%) due to persistent subretinal fluid (n=3), vitreous hemorrhage (n=1), and dislocated intraocular lens (n=1). Thirteen patients (54.2%) had postoperative vitreous hemorrhage that cleared spontaneously, five patients (20.8%) required antiglaucoma medications for increased intraocular pressure, seven patients (29.2%) developed an epiretinal membrane, and two patients (8.3%) developed a macular hole.

Conclusion: Patients with diabetic TRD can benefit from PPV surgery. Intraoperative and postoperative complications can be attributed to the complexity of this disease.
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http://dx.doi.org/10.2147/OPTH.S90577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629980PMC
November 2015

Inverse correlation between coronary and retinal blood flows in patients with normal coronary arteries and slow coronary blood flow.

Atherosclerosis 2014 Jan 12;232(1):149-54. Epub 2013 Nov 12.

Department of Cardiology, Tel Aviv Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: The "Slow Coronary Flow" (SCF) phenomenon in the presence of angiographically normal coronaries is attributed to microvascular and endothelial dysfunction. The microcirculation can be non-invasively assessed by measuring retinal blood flow velocity. The aim of the present study was to evaluate the efficacy of the "Retinal Functional Imager" (RFI) device as a noninvasive method of diagnosing patients with slow coronary flow.

Methods: Coronary blood flow velocity assessed by corrected TIMI Frame Count and retinal arterioles blood flow assessed by RFI were measured in 28 consecutive patients with normal coronary arteries. The patients were divided into 2 groups: a slow coronary flow (SCF) and a normal coronary flow (NCF) groups.

Results: Inverse correlation was found between retinal and coronary blood flows so that higher retinal arterial flow velocity was observed in the SCF group (3.8 ± 1.1 mm/s vs. 2.9 ± 0.61 mm/s, respectively, p = 0.022). RFI provided 73% sensitivity and 77% specificity for diagnosing SCF using ROC analysis. Additionally, patients with SCF had higher values of serum LDL cholesterol (104.7 ± 18.93 mg/dl vs. 81.55 ± 14.62 mg/dl in NCF, p = 0.005), Glucose (96.9 ± 23.0 mg/dl vs. 83.55 ± 9.7 mg/dl in NCF, p = 0.024), and lower percentage of statin consumption (40.0% vs. 76.9% in NCF, p = 0.049).

Conclusions: Slow coronary blood flow can be non-invasively diagnosed with Retinal Functional Imager. Patients with normal coronary arteries and slow coronary blood flow have high retinal arteriolar blood flow. Early non-invasive diagnosis of SCF might help detect individuals who are at higher risk to develop coronary atherosclerosis, and to provide them with early preventive measures.
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http://dx.doi.org/10.1016/j.atherosclerosis.2013.10.033DOI Listing
January 2014
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