Publications by authors named "David Zadok"

85 Publications

Ocular Biometric Characteristics Measured by Swept-Source Optical Coherence Tomography in Individuals Undergoing Cataract Surgery.

Am J Ophthalmol 2021 Jul 24. Epub 2021 Jul 24.

Department of Ophthalmology, Shaare Zedek Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel 9103102.

Purpose: To study the distribution of ocular biometric parameters utilizing a swept-source optical coherence tomography (SS-OCT) biometer in adult candidates for cataract surgery.

Design: A retrospective cross-sectional study.

Methods: SETTING: A single-center analysis of consecutive eyes measured with the IOLMaster 700 SS-OCT biometer at a large tertiary medical center between February 2018 and June 2020.

Results: 3836 eyes of 3836 patients were included in the study. The mean age was 72.3±12.8 years and 53% were females. The mean biometric values were: total corneal power (44.17±1.70D), total corneal astigmatism (TCA) (1.11±0.87D), mean posterior keratometry (-5.87±0.26D), posterior corneal astigmatism (-0.26±0.15D), axial length (AL) (23.95±1.66mm), anterior chamber depth (ACD) (3.18±0.42mm), lens thickness (LT) (4.49±0.47mm); white-to-white distance (WTW) (11.92±0.44mm), central corneal thickness (CCT) (0.54 ± 0.04mm), angle alpha (0.49±0.17mm), and angle kappa (0.34±0.17mm). There were sex-related differences in all biometric parameters with the exception of LT (P=.440), angle kappa (P=.216), and corneal astigmatism (P=.103). Biometric parameters demonstrated correlations between AL, WTW distance, ACD, and LT (P<.001). Age correlated with all parameters (P<.001), with the exception of CCT and posterior keratometry. Angle alpha and angle kappa magnitudes also correlated (P<.001). The prevalence of patients with TCA ≥0.75D, 1.0D and 1.5D were 59.1%, 43.4% and22.6%,respectively.

Conclusions: Age significantly correlated with most of the biometric parameters and significant differences between sexes were noted. Furthermore, the high prevalence of TCA and relatively large angle alpha and angle kappa magnitudes were noted among subjects. These data can be relevant in planning local and national health economics.
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http://dx.doi.org/10.1016/j.ajo.2021.06.032DOI Listing
July 2021

Pediatric Ocular Injury Due to Hand Sanitizer Exposure An Emerging Hazard.

Pediatr Emerg Care 2021 Jun 11. Epub 2021 Jun 11.

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.

Objectives: The objective of this study was to describe the incidence and severity of ocular exposure to alcohol-based hand rub (ABHR) in children presenting to a tertiary medical center during the severe acute respiratory syndrome coronavirus 2 pandemic.

Methods: A retrospective single-center observational study conducted from February 21, 2020, to October 11, 2020. Subjects 10 years or younger who presented with ABHR-induced ocular injury were included. The same period from 2019 was studied and a comparison was performed between the 2 years. Outcome measures included the number of subjects with ocular injury due to ABHR, extent of ocular epithelial defects, length of hospitalization and time to resolution.

Results: A total of 9 patients presented to the Pediatric Emergency Department after sustaining ocular chemical injuries from ABHR during this period. Treatment included immediate irrigation followed by topical antibiotics, steroids, and lubrication. Six children were discharged and followed as outpatients with no reported adverse ocular sequelae. Three patients exhibited epithelial defects involving 85% to 100% of the cornea, 30% to 75% of the conjunctiva and required inpatient treatment ranging from 4 to 11 days. All patients experienced a complete resolution of the ocular epithelial defects after 12 to 19 days. No long-term irreversible damage was observed and visual acuity returned to normal in all patients.

Conclusions: The utilization of ABHR during the severe acute respiratory syndrome coronavirus 2 pandemic resulted in childhood ocular injury. Prompt treatment led to good visual outcomes. These products should be regarded as potentially toxic and stored out of the reach of young children.
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http://dx.doi.org/10.1097/PEC.0000000000002468DOI Listing
June 2021

Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye.

Eur J Ophthalmol 2021 May 31:11206721211020632. Epub 2021 May 31.

Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes.

Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography.

Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years;  = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years;  = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D);  < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL.

Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.
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http://dx.doi.org/10.1177/11206721211020632DOI Listing
May 2021

Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate.

Can J Ophthalmol 2021 May 27. Epub 2021 May 27.

Department of Ophthalmology, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Objective: To characterize the association between prolonged supine postoperative positioning of patients undergoing Descemet-stripping automated endothelial keratoplasty (DSAEK) and graft dislocation rate.

Methods: In this retrospective cohort study, medical records of patients who underwent uncomplicated DSAEK surgery at Yitzhak Shamir Medical Center between 2010 and 2019 were reviewed. Nursing documentation of patients' adherence to supine positioning during the postoperative hospitalization period was collected. A patient was considered compliant if he or she was documented as cooperative with supine positioning throughout the first 24 hours.

Results: A total of 170 eyes of 138 patients were found eligible. Main indications for surgery were pseudophakic bullous keratopathy (50.6%), previous graft failure (25.9%), and Fuch's endothelial dystrophy (FED; 20.6%). Twelve surgeries were combined with cataract extraction. Postoperative graft detachment occurred in 26 eyes (15.3%) after an average period of 1 day (range, 0-20 days). Compliance with supine positioning was documented in 84.1% (n = 143 patients). Noncompliance rates during the first 24 hours in the detached and nondetached groups were 26.9% (n = 7) and 14.4% (n = 20), respectively; after adjustment for possible confounders, the odds ratio (OR) was 1.44 (p = 0.249). Graft dislocation was observed in 13.3% (19 of 143) and 25.9% (7 of 27) of cooperative and noncooperative patients, respectively (p = 0.17). Subanalysis of 120 eyes with either BPK or FED for which it was the first transplantation demonstrated a protective effect of supine positioning (OR 3.42, confidence interval 1.095-10.700; p = 0.034). Findings for both groups remained unchanged in multivariate analysis.

Conclusions: We found a statistically significant protective effect of 24 hours of postoperative supine positioning against graft detachment after DSAEK in eyes with no prior transplantations.
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http://dx.doi.org/10.1016/j.jcjo.2021.04.012DOI Listing
May 2021

Keratoplasty Rejection After the BNT162b2 messenger RNA Vaccine.

Cornea 2021 08;40(8):1070-1072

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel.

Purpose: The aim of this report was to report 2 patients who presented with acute corneal graft rejection 2 weeks after receiving the BNT162b2 messenger RNA (mRNA) vaccine for severe acute respiratory syndrome coronavirus 2.

Methods: Case report.

Results: Two men, aged 73 and 56 years, with a history of penetrating keratoplasty due to keratoconus were noted to have acute corneal graft rejection 2 weeks after receiving a first dose of the BNT162b2 mRNA vaccine. Both patients were treated with hourly dexamethasone 0.1% and oral prednisone 60 mg per day with prompt resolution of keratoplasty rejection.

Conclusions: The BNT162b2 mRNA vaccine may be have been associated with a low-risk corneal graft rejection that responded well to topical and systemic steroids. Treating physicians should be aware of this potential complication and patients should be advised to report any visual changes after vaccination.
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http://dx.doi.org/10.1097/ICO.0000000000002761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244807PMC
August 2021

Evaluating the prediction accuracy of the Hill-RBF 3.0 formula using a heteroscedastic statistical method.

J Cataract Refract Surg 2021 May 18. Epub 2021 May 18.

Department of Ophthalmology, Shaare Zedek Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel 9103102 Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

Purpose: To evaluate the accuracy of the Hill-RBF 3 formula, with and without direct measurements of total corneal power, using a heteroscedastic statistical method for analysis.

Setting: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

Study Design: Retrospective, consecutive case series.

Methods: Records of consecutive patients who underwent routine cataract surgery between February 2018 and June 2020 were retrospectively reviewed. The prediction accuracy of the Hill-RBF 3.0 formula was compared to the Barrett Universal II (BUII), Emmetropia Verifying Optical 2.0 (EVO), Haigis, HILL-RBF 2.0, Hoffer Q, Holladay 1, Holladay 2, Kane, Olsen, and SRK/T formulas, based on biometry measurements by swept-source optical coherence tomography (SS-OCT) with standard keratometry )K(, SS-OCT with total keratometry (TK), and an optical low-coherence reflectometer (OLCR). Statistical analysis was applied according to a heteroscedastic statistical method with a standard deviation (SD) of prediction errors as the main parameter for formula performance.

Results: The study included 153 eyes of 153 patients. The SD values that were obtained by HILL-RBF 3.0 (0.266-0.285D) were significantly lower compared to Hill-RBF 2.0 (0.290-0.309D), Hoffer Q (0.387-0.407D), Holladay 1 (0.367-0.385D), Holladay 2 (0.386-0.401D), and SRK/T (0.377-0.399D) formulas, P < .036. The prediction accuracy of the Hill-RBF 3.0 was similar across the SS-OCT (K), SS-OCT (TK), and OLCR methods of measurement (P > .51).

Conclusions: HILL-RBF 3.0 was more accurate than Hill-RBF 2.0 and older generation formulas and had similar prediction accuracy compared to new generation formulas. The use of total keratometry did not provide significant improvement to its prediction accuracy.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000702DOI Listing
May 2021

Optical changes and apparent emmetropization in a patient with a peripheral unilateral lens coloboma.

J AAPOS 2021 May 11. Epub 2021 May 11.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Lens coloboma is a developmental defect resulting from abnormalities of the zonules and ciliary body. It may present as an isolated pathology or be accompanied by anomalies in different ocular structures. We report the case of a 20-year-old man referred for evaluation of anisometropic amblyopia in the right eye. Manifest refraction was -2.25 +3.00 ×35 in the right eye; corrected distance visual acuity, 20/50. Corneal topography revealed regular astigmatism of +2.46 D at 124°, and wavefront aberrometry revealed an irregular internal astigmatism of +6.27 D at 35°. Only after full pupillary dilation was a peripheral lens coloboma observed. This case demonstrates that even minor distortions of clear and normally positioned lenses may lead to amblyopia and raises the possibility that corneal changes may occur developmentally through the process of emmetropization partly to compensate for lenticular astigmatism arising from the coloboma.
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http://dx.doi.org/10.1016/j.jaapos.2021.02.006DOI Listing
May 2021

Comparison of corneal surgically induced astigmatism calculations as measured by two biometric devices, and by standard anterior vs total keratometric measurements.

J Cataract Refract Surg 2021 Apr 9. Epub 2021 Apr 9.

1Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel. 2Dept. of Ophthalmology, Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands.

Purpose: To compare calculated corneal surgically induced astigmatism (SIA) by means of anterior-based keratometry (K) and total keratometry (TK) measurements made by 2 biometric devices.

Setting: Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel.

Design: Retrospective, consecutive case series.

Methods: The medical records of patients who had undergone cataract surgery through a 2.4 mm temporal clear corneal incision by a single surgeon between 3/2018 and 11/2020 were retrospectively reviewed. Patients for whom there were preoperative and postoperative keratometry measurements by 2 biometric devices, optical low-coherence reflectometer (OLCR) and swept-source optical coherence tomography (SS-OCT), were identified. Corneal SIA (mean vector value) was calculated by vector analysis for 3 groups: SS-OCT(K), SS-OCT(TK) and OLCR(K). Bivariant analyses were applied for comparisons.

Results: One-hundred forty-seven eyes of 123 patients (73 OD and 74 OS) were enrolled in the study. The OD corneal SIA values were 0.09 D @ 136°, 0.09 D @ 141°, and 0.07 D @ 123°, for the SS-OCT(K), SS-OCT(TK), and OLCR, respectively. The respective OS corneal SIA values were 0.13 D @ 120°, 0.11 D @ 123°, and 0.08 D @ 120°. There were no significant differences between the mean vector value and variance of the corneal SIA for the right, P=.78 and P=.65, and the left, P=.75 and P=.37 eyes of the three groups.

Conclusions: Corneal SIA values were low (0.07 to 0.13 D) and similar for the SS-OCT and the OLCR biometric devices with standard keratometry. Total keratometry measurements yielded similar corneal SIA values compared to anterior corneal-based measurements.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000671DOI Listing
April 2021

A Rare Case of Acute Bilateral Endothelial Decompensation after Prophylactic Nd:YAG Laser Iridotomy Requiring Endothelial Keratoplasty.

J Curr Glaucoma Pract 2020 Sep-Dec;14(3):109-111

Department of Ophthalmology, Shaare Zedek Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel.

Aim: To describe a case of acute bilateral endothelial decompensation following prophylactic Nd:YAG laser iridotomy (LI) for occludable angles.

Background: Although regarded safe, LI can occasionally be a source of various ocular complications, including corneal endothelial damage. In the herein case, we describe the first case of acute bilateral endothelial decompensation after Nd:YAG LI.

Case Description: A 63-year-old man was referred for consultation due to visual acuity deterioration in both eyes 2 weeks after undergoing an uneventful prophylactic LI for occludable angles. On examination, bilateral corneal edema with Descemet's membrane folds was observed. Direct corneal damage from the laser beam was not seen. Specular microscopy failed to count endothelial density. Anterior-segment optical coherence tomography (OCT), ultrasound biomicroscopy, and ocular biometry were performed. The patient was referred for bilateral endothelial keratoplasty.

Conclusion: Subacute endothelial dysfunction should be considered as a possible adverse event following Nd:YAG LI and patients should be advised accordingly.

Clinical Relevance: Surgeons should be aware of the potentially devastating complication of bilateral corneal decompensation following routine Nd:YAG LI, even in patients without preexisting corneal injury. Patients should be advised accordingly.

How To Cite This Article: Weill Y, Abulafia A, Smadja D, A Rare Case of Acute Bilateral Endothelial Decompensation after Prophylactic Nd:YAG Laser Iridotomy Requiring Endothelial Keratoplasty. J Curr Glaucoma Pract 2020;14(3):109-111.
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http://dx.doi.org/10.5005/jp-journals-10078-1285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028029PMC
April 2021

The Additive Value of Foveal OCT-Based Biometry to Fundus Biomicroscopy for Detecting Macular Pathology Prior to Cataract Surgery.

Am J Ophthalmol 2021 Apr 5;228:8-15. Epub 2021 Apr 5.

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel. Electronic address:

Purpose: To assess the additive value of foveal swept-source optical coherence tomography (OCT)-based biometry to the preoperative fundus examinations for diagnosing macular abnormalities in patients scheduled for cataract surgery.

Design: Diagnostic testing evaluation.

Methods: Consecutive patients 50 years of age and older planned for cataract surgery from one institution were retrospectively enrolled. All patients underwent foveal swept-source OCT, and macular spectral domain (SD) OCT scans before pupil dilation as well as dilated fundus biomicroscopy examination. The effectiveness of fundus biomicroscopy examinations, foveal swept-source OCT scans, and the combination of both in identifying macular diseases was analyzed with macular spectral-domain OCT scans as reference.

Results: Seventy-eight of the eligible 442 eyes (442 patients) were excluded because of noninterpretable macular spectral-domain OCT OCT scans or foveal swept-source OCT scans. The remaining 364 eyes of 364 patients (mean age 73.59±9.26 years [range 49-96], 172 males) formed the study group. Fundus biomicroscopy alone vs fundus biomicroscopy with the addition of foveal swept-source OCT yielded 36% vs 63% sensitivity, 94% vs 72% specificity, 79% vs 58% positive predictive value (PPV), and 71% vs 76% negative predictive value (NPV), respectively. This diagnostic improvement was significant compared with fundus biomicroscopy alone (P = 2.98).

Conclusion: Combined fundus biomicroscopy and foveal swept-source OCT scans improved the detection of macular abnormalities prior to cataract surgery but it was inferior to macular spectral-domain OCT scans. Additional studies to assess the cost-effectiveness of adding foveal swept-source OCT scan in comparison to macular spectral-domain OCT scan to the preoperative cataract evaluation are required.
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http://dx.doi.org/10.1016/j.ajo.2021.03.028DOI Listing
April 2021

Interface Fluid Syndrome 2 Decades After Laser-Assisted In situ Keratomileusis.

Eye Contact Lens 2021 06;47(6):381-382

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Purpose: To report a case of late-onset interface fluid syndrome (IFS) after laser-assisted in situ keratomileusis (LASIK).

Methods: A 94-year-old man was referred for evaluation because of persistent corneal edema 10 days after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy.

Results: After an uneventful DSAEK, the patient was treated with topical antibiotics and steroids. On presentation, a well positioned and oriented DSAEK graft was observed in the right eye, yet the cornea was edematous. Applanation tonometry was normal. Anterior-segment optical coherence tomography (AS-OCT) revealed a LASIK flap with a fluid cleft beneath it. Requery confirmed that LASIK was performed 21 years ago. Topical steroids were stopped, and after 2 weeks, the cornea was clear, and AS-OCT revealed complete resolution of the interface fluid.

Conclusions: Even decades later, IFS should be considered as a source of corneal edema in patients after LASIK. Monitoring these patients with AS-OCT is recommended.
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http://dx.doi.org/10.1097/ICL.0000000000000775DOI Listing
June 2021

Influence of Reading on Smartphone Screens on Visual Optical Quality Metrics and Tear Film Stability.

Cornea 2021 Jan 18. Epub 2021 Jan 18.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel; Affiliated with the Hebrew University of Jerusalem; and iSEARCH, Innovation Shaarezedek Eye Advanced Research Center Hub, Jerusalem, Israel.

Purpose: To evaluate the impact of a prolonged reading session on a smartphone screen on optical quality metrics and tear film stability.

Methods: This prospective study was conducted in 41 healthy volunteers who were asked to read an article on a smartphone screen for 20 minutes. The following tests were performed before the reading task in this consecutive order and repeated after the reading task in the same order: automated noninvasive tear break-up time, optical quality assessment including Objective Scatter Index (OSI), modulation transfer function, Strehl ratio, and tear film dynamic analysis as follows: vision break-up time (VBUT) as a function of OSI changes within 20 seconds, using a double-pass aberrometer imaging system, and fluorescein tear break-up time (FBUT) measured using the slit lamp.

Results: All break-up time-related parameters (noninvasive tear break-up time, FBUT and VBUT) were significantly reduced after the reading task (P < 0.01). The OSI was significantly worsened after the reading task (P = 0.01), whereas all the other optical quality metrics (modulation transfer function and Strehl ratio) slightly deteriorated, were not statistically significant. A significant correlation was found between the shortening of the FBUT, VBUT, and the worsening of the OSI (r = -0.33, P < 0.05).

Conclusions: A reading session on a smartphone screen in healthy subjects was found to significantly affect the tear film stability and objectively worsen the retinal image quality.
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http://dx.doi.org/10.1097/ICO.0000000000002656DOI Listing
January 2021

The Impact of COVID-19 on Intravitreal Injection Compliance.

SN Compr Clin Med 2020 Oct 28:1-4. Epub 2020 Oct 28.

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine Jerusalem, 9103102 Jerusalem, Israel.

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti-VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year's total was expected for this time period. Using this model, the 636 reported number of injections for the March-April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti-VEGF treatments.
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http://dx.doi.org/10.1007/s42399-020-00614-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592639PMC
October 2020

Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons.

Eur J Ophthalmol 2020 Oct 17:1120672120965471. Epub 2020 Oct 17.

Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.

Purpose: The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic.

Methods: A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and -score of proportions tests, respectively.

Results: The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, = 0.004), while only 12.8% (<0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% ( = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality.

Conclusion: Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.
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http://dx.doi.org/10.1177/1120672120965471DOI Listing
October 2020

Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Thinning in Patients with Type-1 Gaucher Disease.

Int J Mol Sci 2020 Sep 24;21(19). Epub 2020 Sep 24.

Faculty of Medicine, The Hebrew University, Jerusalem 9112001, Israel.

Type-1 Gaucher disease (GD1) is considered to be non- neuronopathic however recent evidence of neurological involvement continues to accumulate. There is limited evidence of retinal abnormalities in GD1. The purpose of this study was to evaluate the retinal findings of patients with GD1. Thirty GD1 individuals and 30 healthy volunteers between the ages 40-75 years were prospectively enrolled. Macular and optic nerve optical coherence tomography (OCT) scans of both eyes of each patient were performed and thickness maps were compared between groups. Patients with a known neurodegenerative disease, glaucoma, high myopia and previous intraocular surgeries were excluded. It was shown that patients with GD1 presented with higher incidence of abnormal pRNFL OCT scan and showed significantly thinner areas of pRNFL and macular ganglion cell complex (GCC) when compared to a healthy control population. Changes in retinal thickness were not associated with GD1 genotype, treatment status, disease monitoring biomarker (lyso-Gb1) and severity score index (Zimran SSI). Further investigations are needed to determine whether these findings possess functional visual implications and if retinal thinning may serve as biomarker for the development of future neurodegenerative disease in this population.
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http://dx.doi.org/10.3390/ijms21197027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582605PMC
September 2020

Cataract induced by eyelid cosmetic treatment with intense focused ultrasound.

J Cataract Refract Surg 2020 12;46(12):e27-e29

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

A 45-year-old woman, immediately after receiving a cosmetic treatment with intense focused ultrasound (IFUS) over the eyelids, developed an acute, progressive, severe cataract with a unique shape as an adverse effect of the IFUS esthetic treatment. At examination of the lens in the right eye, 4 drop-like dense lens opacities aligned consecutively in a horizontal line together with a posterior capsular opacity in a stellate-shaped fashion. It rapidly progressed into a dense posterior cataract, leaving the patient with an uncorrected distance visual acuity (UDVA), from 20/20 prior to the event, to 20/160 4 days later. Phacoemulsification and intraocular lens implantation were performed, restoring her UDVA to 20/25. Cosmetic and ophthalmic healthcare providers should be aware of the potentially damaging effect of IFUS.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000357DOI Listing
December 2020

Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular optical coherence tomography.

J Cataract Refract Surg 2021 Jan;47(1):78-82

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Purpose: To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery.

Setting: Shaare-Zedek Medical Center, Jerusalem, Israel.

Design: Retrospective case series.

Methods: Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning before cataract surgery. The scans were reviewed by a retinal specialist for macular pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed.

Results: Four hundred fifty-three eyes of 453 patients were enrolled in the study; 42 eyes (9.2%) were excluded because of noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 eyes (40.6%), including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 patients (26.0%) was modified because of macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopic examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes [17.8%]) and referral to a retinal specialist for consultation (34 eyes [8.3%]).

Conclusions: Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopic examination. The added information could improve patient management.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000389DOI Listing
January 2021

Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID-19 infection.

J Med Virol 2021 01 30;93(1):139-140. Epub 2020 Sep 30.

Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.

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http://dx.doi.org/10.1002/jmv.26229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361787PMC
January 2021

Response of ophthalmologists in Israel to the novel coronavirus (2019-nCoV) outbreak.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 28;258(7):1419-1426. Epub 2020 Apr 28.

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine Jerusalem, 9103102, Jerusalem, Israel.

Purpose: The coronavirus disease (COVID-19) pandemic has evolved into a formidable healthcare crisis. Ophthalmologists are at daily personal risk of acquiring and transmitting the virus. Implementation of official practical and protective guidelines can be challenging and is often absent. The purpose of this study was to describe the status of ophthalmology practice in Israel, at the early stages of the outbreak.

Methods: A 17-item questionnaire was distributed to ophthalmologists practicing in Israel. Data was obtained regarding demographics and clinical and surgical practice during the pandemic.

Results: One hundred and sixty-seven ophthalmologists completed the survey from all regions of Israel. The survey was distributed during the early stages of the outbreak. At this time, no official government guidelines were in place. Most respondents reported no reduction of elective clinic visits and surgeries and no utilization of triage questionnaires. COVID-19 guidelines were reportedly promulgated to hospital ophthalmologists but not to community and private physicians. Personal protective equipment (PPE) measures were reportedly utilized; however, many respondents often acquired them individually. A majority of respondents advocated that healthcare institutions limit clinic and surgery services to emergency services.

Conclusion: During the critical early stages of the COVID-19 outbreak in Israel, this study emphasizes the delay in development of emergency guidelines, necessary to protect patients and ophthalmologists from this highly transmissible disease.
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http://dx.doi.org/10.1007/s00417-020-04694-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186536PMC
July 2020

Enhanced depth imaging in swept-source optical coherence tomography: Improving visibility of choroid and sclera, a masked study.

Eur J Ophthalmol 2020 Nov 26;30(6):1295-1300. Epub 2019 Jul 26.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

Purpose: To compare enhanced depth imaging in swept-source optical coherence tomography and non-enhanced depth imaging optical coherence tomography in their ability to capture choroidal and scleral details.

Methods: Averaged foveal B-Scans were obtained from 40 eyes of 20 healthy volunteers by swept-source optical coherence tomography with and without enhanced depth imaging. Visibility and contrast of vascular details within the choroid, choroidoscleral junction, and sclera were evaluated by masked readers using an ordinal scoring scale. Outcomes were analyzed using the Wilcoxon signed rank-sum test.

Results: Visibility of the choroidal vascular details ( = 5.94,  < .001), the choroidoscleral junction ( = 5.85,  < .001), and the sclera ( = 6.80,  < .001) was significantly higher with enhanced depth imaging than with non-enhanced depth imaging swept-source optical coherence tomography. Similarly, image contrast was significantly higher with enhanced depth imaging than with non-enhanced depth imaging swept-source optical coherence tomography for the choroidal vascular details ( = 9.47,  < .001), for the choroidoscleral junction ( = 9.28,  < .001), and for the sclera ( = 9.42,  < .001).

Conclusion: Enhanced depth imaging applied to swept-source optical coherence tomography-averaged foveal B-scans enhances visualization of the choroidal details, of the choroidoscleral junction, and of the sclera. This novel modality can easily be implemented in clinics and could improve our understanding of conditions involving the choroid or the sclera.
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http://dx.doi.org/10.1177/1120672119863560DOI Listing
November 2020

Ocular Effects of Sildenafil in Naïve Mice and a Mouse Model of Optic Nerve Crush.

Invest Ophthalmol Vis Sci 2019 05;60(6):1987-1995

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

Purpose: To investigate the potential neuroprotective effect of sildenafil on the ocular circulation in mice with/without optic nerve crush (ONC).

Methods: Male adult mice (n = 63) were treated with intravitreal (IVT) sildenafil 24 μg/3 μL, intraperitoneal (IP) sildenafil 24 μg/300 μL, or IP saline immediately before right ONC induction (ONC group). A second group (n = 123) received the same treatments without ONC induction (naïve group). Evaluations included fluorescein angiography (naïve group; day 0), molecular studies (days 1 and 3), and retinal and optic nerve histology (day 21).

Results: Maximal retinal vessel dilatation and increased choroidal effusion were detected within 30 minutes of sildenafil injection. In the ONC group, moderate retinal ganglion cell (RGC) loss was noted at 21 days. However, molecular studies showed increased stress induced gene expression (IP superoxide dismutase [SOD]-1: 3.1-fold; heme oxygenase [HO]-1: 5.8-fold; IVT SOD-1: 1.47-fold), proapoptotic gene expression (IP BAX/B-cell lymphoma [BCL]-2 10.8-/2.3-fold), and glial gene expression (IP glial fibrillary acidic protein [GFAP]: 2.8- and myelin basic protein [MBP]: 2.5-fold). In the naïve group, IVT sildenafil was not associated with RGC loss or optic nerve stroke on histology, although in two samples, molecular parameters were compatible with stroke, showing increased gene expression of HO-1 (3.8-fold) and BCL-2 (2.5-fold). In the IP sildenafil subgroup, optic neuropathy was observed in 6/120 optic nerves, including 3 cyan fluorescence protein (CFP)-Thy-1 mice. Levels of antiapoptosis and anti-ischemia genes were decreased (<0.5-fold) except for three outliers.

Conclusions: Sildenafil affects retinal and choroidal perfusion in mice. When injected immediately before ONC, molecular parameters showed a preconditioning neuroprotective effect while histologic studies did not. In the absence of ONC, it is associated with neuropathy, possibly dose-dependent.
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http://dx.doi.org/10.1167/iovs.18-26333DOI Listing
May 2019

Optical coherence tomography angiographic findings in preeclampsia - A novel longitudinal report.

Eur J Obstet Gynecol Reprod Biol 2019 Mar 21;234:225-226. Epub 2019 Jan 21.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

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http://dx.doi.org/10.1016/j.ejogrb.2018.12.032DOI Listing
March 2019

Mini-monoka stenting for patients with perennial allergic conjunctivitis.

Orbit 2019 Aug 11;38(4):285-289. Epub 2018 Sep 11.

a Department of Ophthalmology, Assaf Harofeh Medical Center , Tzrifin , Israel.

To assess the effectiveness of mini-monoka (MM) stenting in treating patients with perennial allergic conjunctivitis (PAC) and punctal stenosis. A retrospective case analysis was performed on 20 patients (40 eyes) who suffered from PAC with punctal stenosis who underwent MM (FCI Ophthalmics, Pembroke, MA, USA) stenting. Nineteen patients (95%) were females, with an age range of 19-66 years (average 40.6 ± 25.4 years). All 20 patients (100% of eyes) had signs of PAC and punctal stenosis. All 20 patients (40 eyes) had received previous topical treatment including steroids. Nineteen patients (95% of eyes) had significant improvement in their allergy symptoms (tearing and conjunctival inflammation) following MM stenting. Stenosis of the punctum may play a role in the relapsing symptoms in PAC. MM stenting is a simple, safe, effective, and relatively non-invasive treatment option for the management of PAC in the presence of punctal stenosis.
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http://dx.doi.org/10.1080/01676830.2018.1518465DOI Listing
August 2019

Corneal Cross-Linking in Pediatric Patients: Evaluating Treated and Untreated Eyes-5-Year Follow-Up Results.

Cornea 2018 Aug;37(8):1013-1017

Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel.

Purpose: To evaluate the long-term results of corneal collagen cross-linking (CXL) for treatment of pediatric keratoconus and the long-term outcomes of the fellow untreated keratoconic eye in patients younger than 18 years old.

Methods: A retrospective case analysis was performed on 88 eyes of 44 patients aged 18 years or younger, with keratoconus, who underwent CXL in at least 1 eye. Follow-up measurements, for the treated and untreated eye pair, taken up to 5 years after treatment, were compared with baseline values. Parameters included uncorrected distance visual acuity (UCDVA), best spectacle-corrected distance visual acuity (BCDVA), manifest refraction, pachymetry, and corneal topography and tomography.

Results: Mean age of patients was 15.6 ± 2.1 years. For the treated eyes, during all years of follow-up, UCDVA improved significantly (from 0.83 ± 0.30 to 0.72 ± 0.28 logMAR; P = 0.01). Improvement in BCDVA was not statistically significant (from 0.28 ± 0.19 to 0.23 ± 0.15 logMAR; P = 0.06). The manifest cylinder showed a significant reduction (from 5.8 ± 3.6 to 4.3 ± 2.5 diopters; P = 0.006). There was no significant change in maximum keratometry. Average keratometry and corneal thickness reduced significantly (P = 0.009 and P = 0.002, respectively). Five patients had very mild corneal haze after CXL. For the fellow untreated eyes-during 5 years of follow-up, UCDVA showed a slight decrease that was not statistically significant. BCDVA, average keratometry, and maximum keratometry remained stable.

Conclusions: Our long-term follow-up study suggests that CXL is a safe procedure in the pediatric age, and there is no urgency in treating pediatric patients with keratoconus without proof of progression.
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http://dx.doi.org/10.1097/ICO.0000000000001629DOI Listing
August 2018

Accuracy and feasibility of axial length measurements by a new optical low-coherence reflectometry-based device in eyes with posterior subcapsular cataract.

J Cataract Refract Surg 2017 07;43(7):898-901

From the Assaf Harofeh Medical Center (Einan-Lifshitz, Rozenberg, Shoshany, Zerifin, Avni), the Sackler School of Medicine (Einan-Lifshitz, Rozenberg, Shoshany, Avni), Tel Aviv University, Tel Aviv, and the Shaare Zedek Medical Centre (Zadok, Abulafia) and the Hebrew University of Jerusalem (Zadok, Abulafia), Jerusalem, Israel; the Cullen Eye Institute (Wang, Koch), Baylor College of Medicine, Houston, Texas, USA.

Purpose: To evaluate the feasibility and accuracy of measuring axial length (AL) by a new optical low-coherence reflectometry (OLCR)-based device in eyes with central posterior subcapsular cataract (PSC).

Setting: Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel.

Design: Retrospective case series.

Methods: Consecutive cases of patients who had uneventful cataract surgery and whose preoperative AL measurements were not feasible with the partial coherence interferometry (PCI) device because of a central PSC were assessed. Preoperative AL was measured by the OLCR device and immersion ultrasound (US). Preoperative results were compared with the postoperative AL measurements obtained by the PCI.

Results: Twenty-seven patients (27 eyes) were enrolled in the study. The median difference between the OLCR and the PCI AL measurements (0.07 mm) was lower than the median difference between the US and the PCI AL measurements (0.13 mm) (P = .016). The ranges of the limits of agreement were 0.15 mm between OLCR and PCI, and 0.88 mm between US and PCI. The proportion of eyes with an AL difference of less than 0.1 mm was significantly higher between the OLCR and the PCI devices (24 eyes [88.9%]) than between the US and the PCI devices (9 eyes [33.3%]) (P = .001).

Conclusions: The OLCR-based device successfully measured the preoperative AL in all eyes with central PSC for which preoperative PCI scans were not feasible. These measurements had a high level of agreement with the postoperative AL measurements obtained by the PCI device.
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http://dx.doi.org/10.1016/j.jcrs.2017.04.035DOI Listing
July 2017

Macular Corneal Dystrophy and Posterior Corneal Abnormalities.

Cornea 2016 Dec;35(12):1605-1610

*The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel;†Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and‡Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: This study reports the presentation of 2 families with macular corneal dystrophy (MCD). The aim of this study was to show whether ultrasound biomicroscopy (UBM) can, based on posterior changes of the cornea in MCD, assist in the choice of surgery, either anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK), compared with optical coherence tomography (OCT) and Scheimpflug.

Methods: Six patients with MCD were examined for their best-corrected visual acuity, slit-lamp, OCT, UBM, and Scheimpflug findings. Blood samples for DNA and exons of the CHST6 gene were screened for mutations.

Results: All 6 patients showed typical MCD signs at the slit lamp. Corneal transplantation was required in 2 patients in both eyes. Recurrence of MCD was observed in 2 eyes after the DALK procedure (patient A5, age 48 years, right eye and B1, 51 years, left eye), whereas the 2 eyes after PK (patient A5, age 48 years, left eye and patient B1, 51 years, right eye) remained clear (for 10 years of follow-up in patient A5 and 4 years in patient B1). In 2 patients (A1 and A3), corneal thinning could be evaluated by OCT. In 3 patients (A2, 3, and 4), UBM disclosed deeper pathologies including opacities, loss of continuity, and focal protrusions of the posterior cornea, which were not evident by other devices. In family A, a novel mutation was identified.

Conclusions: Our UBM examination of MCD shows alterations of the cornea's posterior layer and confirms the known clinical and histological findings of MCD that PK represents the therapy of choice, contrary to DALK. The novel CHST6 mutation shows the heterogeneity of MCD.
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http://dx.doi.org/10.1097/ICO.0000000000001054DOI Listing
December 2016

Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models.

J Cataract Refract Surg 2016 Feb;42(2):296-301

From the Department of Ophthalmology (Weinberg, Kleinmann) and the Department of Pathology (Huszar, Harari), Kaplan Medical Center, and Harlan Biotech Laboratories (Klein, Ezov), Rehovot, and the Department of Ophthalmology (Zadok), Assaf Harofeh Medical Center, Zerifin, Israel. Electronic address:

Purpose: To evaluate lens epithelial cell (LEC) proliferation on the anterior optic of 2 types of hydrophobic intraocular lenses (IOLs).

Setting: Harlan Biotech Israel and Kaplan Medical Center, Rehovot, Israel.

Design: Experimental study.

Methods: Ten New Zealand white rabbits had crystalline lens removal and implantation of an Acrysof IOL in 1 eye (Group 1) and a Tecnis IOL in the fellow eye (Group 2). A weekly biomicroscopy examination was performed during the 2-week study duration, after which the rabbits were humanely killed. The eyes were enucleated, and the complexes containing the IOL and the capsular bag were evaluated for the presence of LECs and large cells (macrophages and giant cells) on the IOL anterior optic and for proteinaceous matrix deposits along the capsulorhexis margin.

Results: Lens epithelial cell were detected on all of the IOLs in Group 1 and on none in Group 2 (P < .001). Areas of proteinaceous matrix deposits adjacent to the edge of the capsulorhexis were detected on 8 IOLs in Group 1 and on none in Group 2 (P < .001). Large cells were identified on all IOLs in Group 1 and on 9 IOLs in Group 2 (P = 1.0). No difference in the general inflammation markers was found between the 2 IOL types (P = .234).

Conclusions: Lens epithelial cell with corresponding proteinaceous matrix deposits were significantly more abundant on the IOLs in Group 1 than on the IOLs in Group 2. There was no difference in the presence of large cells or in general inflammation markers between the 2 IOL types.

Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2015.08.020DOI Listing
February 2016

Ocular anterior segment changes in pregnancy.

J Cataract Refract Surg 2014 Nov 10;40(11):1868-71. Epub 2014 Sep 10.

From the Department of Ophthalmology (Goldich, Cooper, Barkana, Avni, Zadok) and the Department of Obstetrics & Gynaecology (Tovbin, Ovadia), Assaf Harofeh Medical Center, Zerifin, Israel; the Department of Ophthalmology (Goldich), Toronto Western Hospital, Ontario, Canada.

Purpose: To evaluate the changes occurring in the cornea, anterior segment anatomy, and intraocular pressure (IOP) in pregnant women.

Setting: Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel.

Design: Prospective single-center comparative study.

Methods: The Ocular Response Analyzer dynamic bidirectional applanation device and the Pentacam HR Scheimpflug imaging system were used to obtain data on the anterior eye segments of healthy pregnant and nonpregnant women.

Results: Sixty pregnant and 60 nonpregnant women were enrolled. The Goldmann-correlated IOP and corneal-compensated IOP were significantly lower in the pregnant group (mean 10.96 mm Hg versus 12.97 mm Hg, P<.001; and 10.97 mm Hg versus 13.16 mm Hg, P<.001, respectively). The corneal front steep keratometry value was statistically significantly higher in the pregnant group (44.81 diopters [D] versus 44.1 D, P=.039). No significant difference was found in corneal hysteresis, the corneal resistance factor, corneal posterior curvature, central corneal thickness and volume, anterior chamber depth and volume, or iridocorneal angle.

Conclusions: Pregnancy was associated with greater corneal curvature and lower IOP. Further studies should be performed to learn whether these alterations result from changes in corneal biomechanical properties during pregnancy.

Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2014.02.042DOI Listing
November 2014

Penetration of moxifloxacin through crosslinked corneas.

J Cataract Refract Surg 2014 Jul 27;40(7):1177-81. Epub 2014 May 27.

From the Ophthalmology Department (Litvin), Meir Medical Center, Kfar Saba, Harlan Biotech Israel (Ben Eliahu), the Ophthalmology Department (Rotenberg, Marcovich, Kleinmann), Kaplan Medical Center, the Weizmann Institute of Science (Marcovich), Rehovot, and the Ophthalmology Department (Zadok), Assaf Harofeh Medical Center, Rishon Lezion, Israel. Electronic address:

Purpose: To determine the ability of moxifloxacin to penetrate the rabbit eye after corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light irradiation.

Setting: Harlan Biotech Israel, Rehovot, Israel.

Design: Experimental study.

Methods: One eye of 10 New Zealand white rabbits had CXL treatment. One month after treatment and 1 hour before an aqueous humor sample was obtained, 1 drop of 5 mg/mL moxifloxacin (Vigamox) was applied to both eyes of each rabbit every 15 minutes for a total of 4 drops. The aqueous humor samples were sent for high-performance liquid chromatography for antibiotic-concentration analysis. The eyes were enucleated and sent for histology analysis.

Results: Moxifloxacin levels were obtained and analyzed for all 20 eyes. The mean level of moxifloxacin was 2.26 μg/mL ± 0.89 (SD) (range 1.09 to 4.20 μg/mL) in the treated eyes and 2.43 ± 1.17 μg/mL (range 0.89 to 4.72 μg/mL) in the untreated eyes. The difference between the groups was not statistically significant. Of the 10 eye pairs, lower moxifloxacin aqueous humor concentrations were found in 6 treated eyes and 4 untreated eyes.

Conclusion: Penetration of moxifloxacin into the anterior chamber of rabbits was not influenced by previous CXL treatment.

Financial Disclosures: No author has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2014.01.030DOI Listing
July 2014
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