Publications by authors named "Deepak P Edward"

204 Publications

Commentary: Congenital corneal anesthesia: A rare form of type-4 familial dysautonomia.

Indian J Ophthalmol 2022 Jul;70(7):2592-2594

Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA.

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http://dx.doi.org/10.4103/ijo.IJO_1095_22DOI Listing
July 2022

Commentary: Genomic testing is a powerful tool in diagnosing and managing anterior segment dysgenesis.

Indian J Ophthalmol 2022 Jul;70(7):2303-2304

University of Illinois Eye and Ear Infirmary, Chicago, IL, USA.

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http://dx.doi.org/10.4103/ijo.IJO_1022_22DOI Listing
July 2022

Periocular Pigmented Basal Cell Carcinomas: Clinicopathologic Features and Mutational Profile.

Ophthalmic Plast Reconstr Surg 2022 Jun 14. Epub 2022 Jun 14.

King Khaled Eye Specialty Hospital, Riyadh, Saudi Arabia.

Purpose: Pigmented basal cell carcinomas (PBCC) is an uncommon variant of basal cell carcinoma of the periocular region with limited information in the literature. We highlight the clinicopathological profile and somatic mutations in periocular PBCC.

Methods: The clinicopathological features and somatic mutations in patients with periocular PBCC were examined and compared with periocular non-PBCC reported in the literature. Next-generation sequencing panel analysis for the excised tumors identified somatic mutations.

Results: In a total of 31 patients, PBCC was common in females (54%; p = 0.03); as a unilateral lower eyelid (n = 22; 71%), solitary mass (n = 30; 98%). Pathologic subtypes were variable. Most were nodular or mixed variants (n = 23; 74%). During the follow up (2.5-4.5 years), 1 patient (3.5%) had a recurrence. The clinical and pathologic features of PBCC were similar to those reported in nonperiocular locations. Somatic mutations detected in 25/31 tumors. Variants in 50/161 genes in the panel were noted. PTCH1 (14/31), TERT (12/31), and SMO (7/31) variants were common. Fifteen patients had novel drivers, including POLE, FANCD2, and CREBBP. SMO mutations were significantly more common in females (7/7), lower eyelid (5/7), and TERT mutations were more common in nodular subtype (10/12).

Conclusions: In this large cohort of a relatively uncommon variant of BCC, the clinicopathological features and tumor behavior of PBCC was similar to periocular non-PBCC. The somatic mutation spectrum of PBCC resembles that reported in nonperiocular cutaneous BCC with novel drivers identified. We identified several potential actionable mutations that could be targeted with molecular therapy.
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http://dx.doi.org/10.1097/IOP.0000000000002173DOI Listing
June 2022

Newer advances in medical management of glaucoma.

Indian J Ophthalmol 2022 Jun;70(6):1920-1930

Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Illinois, USA.

The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients' neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited.
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http://dx.doi.org/10.4103/ijo.IJO_2239_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359258PMC
June 2022

The association of cosmetic-related lacrimal sac black deposits with primary-acquired nasolacrimal duct obstruction and dry eye disease.

Saudi J Ophthalmol 2021 Jul-Sep;35(3):220-224. Epub 2022 Apr 18.

Division of Oculoplastic and Orbit, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To determine the incidence of cosmetic-related lacrimal sac black deposits (LSBDs) in primary-acquired nasolacrimal duct obstruction (PANDO) biopsies and the role of LSBD in the pathogenesis of PANDO, in addition to their association with dry eye disease (DED).

Methods: A clinicopathological study included all patients who underwent surgical management of PANDO. We excluded patients in whom lacrimal sac biopsy was not taken during the surgery. Lacrimal sac tissues were evaluated for the presence of LSBD and related inflammation, with correlation to the demographics, clinical presentation, and pre-operative clinical assessment of dry eye. <0.05 was considered statistically significant.

Results: Of the 177 PANDO specimens, black deposit aggregates were noted in the sac stroma of 61 lacrimal sac specimens (34.5%; 95% confidence interval: 27.5-47.5). LSBDs were significantly more common in females ( < 0.001). The age, residence, past ailments, and laterality were not associated with LSBD. Dry eye was more common with LSBD ( = 0.004). Other presenting symptoms were not significantly associated with LSBD. The stromal black deposits in biopsies were mostly extracellular or in macrophages. The LSBD in only 10 specimens demonstrated birefringence. Energy dispersive spectroscopy determined that carbon and sulfur were the main elements in the black aggregates.

Conclusion: Cosmetic-related LSBD is unlikely to play a role in the pathogenesis of PANDO. However, they were significantly associated with DED.
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http://dx.doi.org/10.4103/SJOPT.SJOPT_122_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116085PMC
April 2022

Preliminary Surgical Outcomes of a Trimmed-Plate Aurolab Aqueous Drainage Implant (AADI) in Eyes at High Risk of Hypotony.

Clin Ophthalmol 2022 13;16:1487-1496. Epub 2022 May 13.

Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: We describe the technique of trimming the 350 mm AADI glaucoma shunt plate and report preliminary results that test the hypothesis that the IOP-lowering efficacy of the trimmed AADI glaucoma shunt is comparable to the Baerveldt 250 mm glaucoma drainage implant with a comparable safety profile to the standard AADI implant.

Methods: Consecutive patients who had received the modified trimmed-plate AADI, standard AADI and Baerveldt 250 mm were included in the study. This included patients with refractory or primary or secondary glaucoma of all ages and eyes with and without previous glaucoma surgery. The decision for trimming the AADI plate was made according to the surgeon's perceived risk of hypotony. Pre-operative, intraoperative and post-operative data were collected from the hospital electronic medical record system. Surgical success was defined as IOP ≥5 mmHg and ≤21 mmHg on two consecutive visits after 3 months, whilst maintaining at least LP vision and avoiding re-operation for glaucoma.

Results: The sample consisted of 69 eyes (19 with trimmed-plate AADI implant; 36 eyes with the standard AADI implant and 14 eyes who received a BGI-250). The mean IOP reduction at 1 year was 15 mmHg for the Baerveldt-250, 10 mmHg for the AADI and 13 mmHg for the trimmed-plate AADI. The surgical success rate of the implants over 1 year was 85.7% (95% CI, 53.9-96.2%) for BGI-250, 81.5% (62.6-91.5%) for standard AADI and 78.2% (51.7-91.3%) for the trimmed AADI.

Conclusion: Trimming the plate of the AADI manually may provide a safe and low-cost method of obtaining a successful surgical outcome in eyes at high risk of hypotony.
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http://dx.doi.org/10.2147/OPTH.S343378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9113450PMC
May 2022

Barriers and adherence to glaucoma medication in a paediatric glaucoma population: A cross-sectional survey in central Saudi Arabia.

Eur J Ophthalmol 2022 Apr 25:11206721221094878. Epub 2022 Apr 25.

46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To examine barriers and adherence to topical glaucoma medication in a pediatric glaucoma population in Saudi Arabia.

Methods: This cross-sectional study was undertaken at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia during 2016-2017. Parents (father or mother) of children aged 6 months to 15 years with a history of glaucoma were interviewed. Rasch analysis was performed to assess the psychometric properties of the developed 12-item barriers-to-adherence tool (BAT-12) and to identify barriers deemed highly important. The 12-items were adapted from previous studies examining different barriers to adherence in different populations. Medication adherence was assessed by asking parents a series of closed-ended questions about the frequency of missed medications. Determinants of missed medications on at least 1 out of the last 3 days were examined using Poisson regression.

Results: One hundred and six parents were interviewed. The 12-item scale had acceptable psychometric properties. Barriers deemed important were forgetfulness (logit -0.59), complex dosing regimen (logit 0.09), and being too busy with other work/activities (logit 0.14). When asked how often, on average, their child missed the prescribed medication, 26 (24.5%) reported daily, 17(16.0%) reported few times per week, and 32 (30.2%) reported once per week. A third of parents (n = 37, 34.9%) reported having missed giving all drops on at least one day in the last 3 days. Poisson regression with robust variance revealed that increase in age of the child (prevalence ratio, 1.08 [95% CI, 1.03-1.14]; p = 0.003) and increase in parents' barriers score (prevalence ratio, 2.13 [95% CI, 1.49, 3.03]; p < 0.001) were significantly associated with having missed medications on at least one out of the last three days while adjusting for the effect of father's current employment status and area of residence.

Conclusions: The tool we used to examine barriers to glaucoma medication had acceptable psychometric properties and could be used and strengthened in future studies. Our study highlights poor adherence to glaucoma medications among children with glaucoma.
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http://dx.doi.org/10.1177/11206721221094878DOI Listing
April 2022

Open globe injury and intraocular foreign body following crossbow-related penetrating ocular trauma.

Am J Ophthalmol Case Rep 2022 Jun 23;26:101441. Epub 2022 Feb 23.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA.

Purpose: To describe a case of a penetrating ocular trauma and plastic intraocular foreign body (IOFB), undetected on preoperative imaging.

Observations: We present the findings of a 40-year-old male who sustained an open globe injury and IOFB composed of plastic following crossbow-related trauma. Preoperative detection of the IOFB was unsuccessful on clinical exam, computed tomography (CT) and ultrasonography. During extraction of the traumatic cataract, an intralenticular IOFB was discovered and removed through an enlarged limbal incision. Postoperative review revealed that a fragmented plastic "nock", from the crossbow arrow bolt, was the likely IOFB source. The bolt was produced by injection molding which may lead to trapped gas within the plastic, causing radiolucency on CT.

Conclusions And Importance: Radiolucent plastic warrants consideration on the differential diagnosis when intraocular gas is noted on computed tomography following penetrating ocular trauma. Multimodal imaging should be considered if IOFB is suspected and not detected by CT.
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http://dx.doi.org/10.1016/j.ajoc.2022.101441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889092PMC
June 2022

Secondary developmental glaucoma in eyes with congenital aphakia.

Indian J Ophthalmol 2022 Mar;70(3):834-836

Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois Eye and Ear Infirmary, Chicago, United States.

Purpose: To describe the clinical spectrum and management of glaucoma in congenital aphakia.

Methods: The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020.

Results: There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameterwas 10.5mm (IQR, 9.0-12.5) and 8mm (IQR, 5-10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5-19.5) and 15mm (IQR, 14-16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow-up, the median (IQR) IOP was 14 mm Hg (IQR, 14-17) Hg. The median(IQR) follow-up duration was 4.53 months (IQR, 2.03- 48.06).

Conclusion: One-fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short-term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.
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http://dx.doi.org/10.4103/ijo.IJO_1782_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9114612PMC
March 2022

Spontaneous lens resorption in a patient with Marshall-Stickler Syndrome and glaucoma.

Am J Ophthalmol Case Rep 2022 Mar 9;25:101406. Epub 2022 Feb 9.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, Chicago, IL, United States.

Purpose: The purpose of this case report is to describe the increased fragility of anterior capsule in patients with the rare genetic disease Marshall-Stickler syndrome.

Observations: We describe a 3-year old patient with Marshall-Stickler Syndrome and congenital glaucoma treated with glaucoma drainage implant placement who subsequently developed spontaneous lens resorption in one eye, which was noted incidentally during one follow-up appointment.

Conclusions And Importance: It is hypothesized that the lens material left the eye through the glaucoma drainage implant over time. This process was not associated with elevation of intraocular pressures or inflammation and did not require subsequent surgery to remove any residual lens fragments, which has not been reported before to the best of the authors' knowledge.
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http://dx.doi.org/10.1016/j.ajoc.2022.101406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8850679PMC
March 2022

Posterior Embryotoxon Revisited: An Immunohistologic Study.

Ophthalmol Glaucoma 2022 Jul-Aug;5(4):396-401. Epub 2022 Feb 4.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology and Visual Sciences and Department of Pathology, University of Illinois at Chicago, Chicago, Illinois. Electronic address:

Purpose: This series describes the immunopathologic features of posterior embryotoxon (PE) and demonstrates that it is not an anterior displaced Schwalbe's line as commonly described, but a peripheral corneal stromal nub variable in location with abnormal extracellular matrix.

Design: Case series.

Participants: Archived specimens from patients with PE.

Methods: Sections from archived formalin-fixed, paraffin-embedded specimens (n = 9; 7 autopsy and 2 trabeculectomy specimens) were examined by light microscopy. Immunohistochemistry was performed on 5 specimens to characterize the extracellular matrix composition of PE.

Results: Posterior embryotoxon appeared as nubs of whorled collagen extending from the corneal stroma, lined in some instances, by Descemet membrane. These nubs were located anterior to Schwalbe's line (n = 4), posteriorly (n = 1), partially embedded in the trabecular meshwork (n = 1), or at Schwalbe's line (n = 2). Qualitatively, collagen I labeling of the PE stroma was similar or weaker than the corneal stroma, whereas collagen III staining was focal and slightly more intense compared with the corneal stroma. Lumican and keratan sulfate staining was similar or less intense in PE compared with the corneal stroma.

Main Outcome Measures: Identify location of PE and its immunohistochemical features.

Conclusions: In contrast to the widely accepted definition of PE as a prominent, anteriorly displaced Schwalbe line, histologic evidence suggests that it is a direct extension of the corneal stroma with variable locations that may displace the attenuated Descemet membrane when located anterior to or at Schwalbe's line. Immunohistochemical examination revealed that the composition of PE's extracellular matrix was similar to corneal stroma but with some variability in staining intensity.
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http://dx.doi.org/10.1016/j.ogla.2022.01.003DOI Listing
February 2022

Diagnosis and Management of Corneal Abrasion Perception of (Primary Health Care Physicians and Emergency Physicians) and its Determinants in Saudi Arabia - A Survey.

Middle East Afr J Ophthalmol 2021 Jul-Sep;28(3):151-158. Epub 2021 Dec 31.

Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Chicago, IL, USA.

Purpose: The purpose of the study was to determine knowledge, practice, and resources available to primary care physicians to diagnose and manage corneal abrasion in Saudi Arabia.

Methods: This cross-sectional survey was held in 2017. Family physicians and emergency physicians attending an international conference were surveyed. The questions related to demography, invagination, and tools available in their institute were collected. The questionnaire on how to diagnose and how they manage case of corneal abrasion was also collected using tablet-based software.

Results: Two hundred and twenty-five participants participated in the survey. Exposure to eye patients in two-third of participants was too low (93; 39.6%). Resources for diagnosing corneal abrasion were available in limited centers (51; 21.7%). The rate of good practice to manage corneal abrasion was 21.2% (95% confidence interval 16.0; 26.5). Certified emergency physicians ( < 0.001) and western and central regions ( < 0.001) were positively associated with good practice. Availability of slit lamp ( = 0.2) was not significantly associated with the level of practice to manage corneal abrasion. Fluorescein staining and use of cobalt blue light are essential for diagnosing corneal abrasion as per 40% of participants. About 44.7% of participants replied that antibiotics and lubricants should be used to treat. Nearly one-fourth of participants suggested urgent reference to the ophthalmologist. Use of specific antibiotic varied widely; however, ofloxacin was the main choice of antibiotic in treating corneal abrasion.

Conclusion: The knowledge and practice among physicians about corneal abrasion were low. Integrating primary eye care into emergency services through provision of required resources and training physicians is recommended.
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http://dx.doi.org/10.4103/meajo.meajo_96_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763100PMC
February 2022

Expression of Programmed Cell Death-L1 (PD-L1) Protein and Mismatch Repair Mutations in Orbital Tumours-a Pilot Study.

Eur J Ophthalmol 2022 Sep 21;32(5):3097-3102. Epub 2021 Dec 21.

46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: Programmed cell death protein 1 (PD-1) and DNA mismatch repair (MMR) deficiency play an important role in tumour progression and response to treatment.Both markers have been studied in some ocular tumours but little is known about these markers in orbital tumours. This pilot study reports on PD-L1 expression and MMR mutations using next generation sequencing (NGS) in specific orbital tumours.

Methods: We reviewed surgical specimens from patients with rhabdomyosarcoma, adenoid cystic carcinoma (ACC), pleomorphic adenoma (PA) and biopsy negative tissue from orbital tumours used as a control. immunohistochemistry (IHC) was performed on Formalin fixed paraffin embedded tissue using a PD-L1 antibody. DNA was extracted for targeted gene panel NGS of the MMR genes , , and .

Results: The study included 17 orbital specimens. Scattered membrane PD-L1 staining was noted in 3/6 rhabdomyosarcoma specimens without an accompanying lymphocytic infiltrate. PD-L1 immunostaining was absent in 3/3 ACC, and 5/6 PA specimens. PD-L1 immunostaining was not detected in 2/2 control specimens. 4/17 samples shared the same pathogenic mutation in the gene, including 3/6 rhabdomyosarcoma and 1/3 ACC samples. 1/6 PA samples had a mutation in .

Conclusions: Our study demonstrated scattered, non-quantifiable or absent PD-L1 staining in a limited sample of orbital tumours suggesting that PD-1/PD-L1 inhibitor therapy may not be useful in treatment of malignant orbital tumours (rhabdomyosarcoma and ACC) when refractory to conventional therapy. Our pilot study suggest that PD-L1/MMR axis might not play a major role in the pathogenesis of primary orbital tumour.
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http://dx.doi.org/10.1177/11206721211066203DOI Listing
September 2022

Frequency and risk factors of narrow angles in patients with pseudoexfoliation: a case-control study.

Int Ophthalmol 2022 Apr 20;42(4):1085-1091. Epub 2021 Nov 20.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Purpose: To determine the frequency and risk factors of narrow angles in pseudoexfoliation (PXF) patients.

Methods: A prospective case-control study was conducted during the period from March 2017 to December 2020. Adult patients (above 40 years) presenting with PXF were consecutively enrolled (study group). Cases were matched with individuals above 40 years presenting to a comprehensive ophthalmology clinic without evidence of PXF (control group).

Results: We enrolled 196 PXF patients and 98 controls. The occurrence of narrow angles was 25% in the PXF group and 5.1% in the control group (P = 0.0001). Compared to controls, PXF patients were older (72.6 ± 9.6 vs. 64.4 ± 8.5, P < 0.0001) and had a lower mean ACD (2.79 ± 0.4 vs. 3.05 ± 0.4, P < 0.0001). There was no difference in AL measurements between both groups (23.3 ± 1.4 vs. 23.7 ± 1.0, P = 0.0714). After stratification by age group and gender, the risk of narrow angles was higher in PXF patients above 70 years (OR, 4.15; 95% CI, 0.91-23.87; P, 0.044). There was no gender difference in the risk of developing narrow angles.

Conclusion: Narrow angles are more frequently encountered in PXF patients compared to controls. Advanced age (> 70 years) is significantly associated with an increased likelihood of developing narrow angles.
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http://dx.doi.org/10.1007/s10792-021-02094-4DOI Listing
April 2022

The clinico-pathologic profile of primary and recurrent orbital/periorbital plexiform neurofibromas (OPPN).

PLoS One 2021 21;16(10):e0258802. Epub 2021 Oct 21.

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

To evaluate and compare the clinical and histopathological profile of primary and recurrent orbital-periorbital plexiform neurofibromas (OPPN) in patients with neurofibromatosis type 1. We retrospectively evaluated 43 primary or recurrent neurofibroma (NF) specimens from 26 patients (2002 to 2018) at the King Khaled Eye Specialist Hospital, Saudi Arabia. Demographics, clinical presentation, and surgical intervention data were collected. Histopathological specimens were studied with hematoxylin-eosin, Alcian blue, and immunohistochemical markers; S-100, CD44, CD117, smooth muscle actin (SMA), neurofilament, and Ki-67. Of the 43 NFs specimens, 20 were primary and 23 recurrent tumors. For primary NF, the ratio of plexiform to the diffuse type was 13:7, however in recurrent tumors was 3:8 after the first recurrence, and 1:5 after multiple recurrences. Of the 17 patients with primary tumors that had paired recurrent tumors, 12/17 (70.6%) primary NFs were plexiform and 5/17 (29.4%) were diffuse. However, when tumors recurred, 13/17 tumors (76.5%) were diffuse and only 4/17 tumors (23.5%) had a plexiform pattern. The odds of a tumor having a diffuse pattern in recurrent NF was significantly higher than the plexiform pattern [OR = 7.8 (95% confidence interval 1.69:36.1) P = 0.008]. Primary plexiform NFs underwent an excision at a significantly younger age than the diffuse type. Recurrent NFs had significantly higher CD44, CD117, and neurofilament labeling (P = 0.02, P = 0.01 and P<0.001 respectively) but had significantly decreased Alcian blue, and S-100 labeling (P = 0.03, and P = 0.02 respectively) compared to primary tumors. SMA and Ki-67 proliferation index were not different between primary and recurrent NFs (P = 0.86, and P = 0.3 respectively). There appears to be a high risk for primary plexiform NFs to develop a diffuse histologic pattern when they recur. Immunohistochemical staining suggests a role of mast cells (CD117) and expression of infiltration makers (CD44) in the transformation of plexiform tumors to the diffuse phenotype.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258802PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530295PMC
November 2021

Neovascular Glaucoma Progress and Impact of Therapeutic Intervention in Saudi Arabia.

Cureus 2021 Sep 3;13(9):e17696. Epub 2021 Sep 3.

Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, CAN.

Purpose: This study aimed to present the outcomes of the therapeutic interventions for neovascular glaucoma (NVG) between 2002 and 2012 at a tertiary eye hospital in Saudi Arabia.

Methods: A retrospective chart review of the patients with NVG treated in the last 10 years at King Khaled Eye Specialist Hospital was carried out. The demographics, visual acuity, and intraocular pressure (IOP) at the baseline were compared to that, at last, follow-up. The clinical course of treated eyes and causes for poor vision were reviewed.

Results: Among 597 eyes with NVG, the mean IOP at presentation was 32 mmHg. A total of 335 eyes (56.1%) were treated with pan-retinal photocoagulation (PRP). In 459 (77%) eyes, IOP was controlled with medications or different surgeries. The vision on the last follow-up was 20/20 to 20/40 in 19 (3%) eyes, 20/50 to 20/200 in 67 (11%) eyes, <20/200 to 20/400 in 267 (45%) eyes, and <20/400 in 225 (38%) eyes. Nineteen eyes were soft/enucleated. In 45 (8%, 95% CI 6-10) eyes vision improved. The IOP was reduced to <22 mmHg in 369 (62%, 95% CI 58.2-65.9) eyes, 23-30 mmHg in 69 (12%) eyes and was > 31 mmHg in 102 (17%) eyes. In 26 (3.7%) eyes, ocular hypotony was noted. The causes of poor vision included retinal ischemia (n=75, 13%), optic nerve head cupping (n=104, 17%), retinal detachment (n= 42, 7%) and other (n=17, 3%).

Conclusion: The NVG is a serious ocular ischemic complication. Prompt therapy maintained or improved the vision and controlled IOP in 50% and more cases.
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http://dx.doi.org/10.7759/cureus.17696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489598PMC
September 2021

Glaucoma Care of Incarcerated Patients at an Academic Institution: A Case-Control Study.

J Curr Ophthalmol 2021 Apr-Jun;33(2):177-181. Epub 2021 Jul 5.

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.

Purpose: To evaluate medication and follow-up adherence in incarcerated patients examined at an academic glaucoma clinic, in comparison to nonincarcerated controls.

Methods: Retrospective, case-control study. Consecutive prisoners presenting for initial visits in the Glaucoma Clinic at the Illinois Eye and Ear Infirmary between December 2015 and December 2017 were included in the study. Nonincarcerated patients seen in the same Glaucoma Clinic with similar initial visit dates, age, race, sex, and disease severity were selected as controls. Glaucoma Clinic visits from each patient were reviewed until December 2018. Examination information, surgical intervention, follow-up and treatment recommendations, and patient-reported medication usage were recorded for each visit. Number of visits, loss to follow-up, follow-up delays, and medication nonadherence were studied as primary outcome measures.

Results: Twenty-four prisoners and 24 nonincarcerated controls were included. Prisoners had an average of 2.46 ± 2.38 visits during the study period, compared to 5.04 ± 3.25 for controls ( = 0.001). Follow-up visits occurred more than 30 days after the recommended follow-up time in 57.4% (95% confidence interval [CI]: 44.2%-70.6%) of prisoners, compared to 17.9% (95% CI: 10.2%-25.6%) of controls ( < 0.00001). 70.8% of prisoners (95% CI: 66.3-74.5%) were lost to follow-up, compared to 29.2% of controls (95% CI: 25.5%-32.9%; < 0.01). Medication nonadherence rates were similar between prisoners (13.6%; 95% CI: 12.1%-15.2%) and controls (12.0%; 95% CI: 11.4%-12.6%; = 0.78).

Conclusions: Glaucoma follow-up adherence was significantly worse in prisoners compared to a nonincarcerated control population. Further study into causative factors is needed.
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http://dx.doi.org/10.4103/joco.joco_207_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365574PMC
July 2021

Preclinical Evaluation of the Safety and Efficacy of Cryopreserved Bone Marrow Mesenchymal Stromal Cells for Corneal Repair.

Transl Vis Sci Technol 2021 08;10(10)

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.

Purpose: Mesenchymal stromal cells (MSCs) have been shown to enhance tissue repair as a cell-based therapy. In preparation for a phase I clinical study, we evaluated the safety, dosing, and efficacy of bone marrow-derived MSCs after subconjunctival injection in preclinical animal models of mice, rats, and rabbits.

Methods: Human bone marrow-derived MSCs were expanded to passage 4 and cryopreserved. Viability of MSCs after thawing and injection through small-gauge needles was evaluated by vital dye staining. The in vivo safety of human and rabbit MSCs was studied by subconjunctivally injecting MSCs in rabbits with follow-up to 90 days. The potency of MSCs on accelerating wound healing was evaluated in vitro using a scratch assay and in vivo using 2-mm corneal epithelial debridement wounds in mice. Human MSCs were tracked after subconjunctival injection in rat and rabbit eyes.

Results: The viability of MSCs after thawing and immediate injection through 27- and 30-gauge needles was 93.1% ± 2.1% and 94.9% ± 1.3%, respectively. Rabbit eyes demonstrated mild self-limiting conjunctival inflammation at the site of injection with human but not rabbit MSCs. In scratch assay, the mean wound healing area was 93.5% ± 12.1% in epithelial cells co-cultured with MSCs compared with 40.8% ± 23.1% in controls. At 24 hours after wounding, all MSC-injected murine eyes had 100% corneal wound closure compared with 79.9% ± 5.5% in controls. Human MSCs were detectable in the subconjunctival area and peripheral cornea at 14 days after injection.

Conclusions: Subconjunctival administration of MSCs is safe and effective in promoting corneal epithelial wound healing in animal models.

Translational Relevance: These results provide preclinical data to support a phase I clinical study.
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http://dx.doi.org/10.1167/tvst.10.10.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362636PMC
August 2021

Descemet Stripping Automated Endothelial Keratoplasty in Pediatric Age Group: A Decade of Our Experience.

Cornea 2021 Dec;40(12):1571-1580

Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, IL.

Purpose: This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age.

Methods: Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention.

Results: Median age at surgical intervention was 7.9 years (interquartile range, 5.2-11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9-3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%-90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 ± 0.70 preoperatively to 0.90 ± 0.06 at the last follow-up visit (P < 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 ± 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 ± 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 ± 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years.

Conclusions: DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.
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http://dx.doi.org/10.1097/ICO.0000000000002811DOI Listing
December 2021

RNA-sequencing highlights differential regulated pathways involved in cell cycle and inflammation in orbitofacial neurofibromas.

Brain Pathol 2022 01 23;32(1):e13007. Epub 2021 Jul 23.

Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Although most commonly benign, neurofibromas (NFs) can have devastating functional and cosmetic effects in addition to the possibility of malignant transformation. Orbitofacial NFs, in particular, may cause progressive, disfiguring tumors of the lid, brow, temple, face, and orbit, and clinical evidence suggests that they may have increased local aggressiveness compared to NFs developing at other sites. The purpose of this study was to identify biological differences between orbitofacial NFs and those occurring at other anatomic sites. We performed RNA-sequencing in orbitofacial (n = 10) and non-orbitofacial (n = 9) NFs. Differential gene expression analysis demonstrated that a variety of gene sets including genes involved in cell proliferation, interferon, and immune-related pathways were enriched in orbitofacial NF. Comparisons with publicly available databases of various Schwann cell tumors and malignant peripheral nerve sheath tumor (MPNST) revealed a significant overlap of differentially expressed genes between orbitofacial versus non-orbitofacial NF and plexiform NF versus MPNST. In summary, we identified gene expression differences between orbitofacial NF and NFs occurring at other locations. Further investigation may be warranted, given that orbitofacial NF are notoriously difficult to treat and associated with disproportionate morbidity.
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http://dx.doi.org/10.1111/bpa.13007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713532PMC
January 2022

Primary angle closure glaucoma is characterized by altered extracellular matrix homeostasis in the iris.

Proteomics Clin Appl 2021 11 22;15(6):e2000094. Epub 2021 Jul 22.

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Purpose: To characterize the proteome of the iris in primary angle closure glaucoma (PACG).

Experimental Design: In this cross-sectional study, iris samples were obtained from surgical iridectomy of 48 adults with PACG and five normal controls. Peptides from iris were analysed using liquid chromatography-tandem mass spectrometry on an Orbitrap Q Exactive Plus mass spectrometer. Verification of proteins of interest was conducted using selected reaction monitoring on a triple quadrupole mass spectrometer. The main outcome was proteins with a log two-fold difference in expression in iris between PACG and controls.

Results: There were 3,446 non-redundant proteins identified in human iris, of which 416 proteins were upregulated and 251 proteins were downregulated in PACG compared with controls. Thirty-two upregulated proteins were either components of the extracellular matrix (ECM) (fibrillar collagens, EMILIN-2, fibrinogen, fibronectin, matrilin-2), matricellular proteins (thrombospondin-1), proteins involved in cell-matrix interactions (integrins, laminin, histidine-rich glycoprotein, paxillin), or protease inhibitors known to modulate ECM turnover (α-2 macroglobulin, tissue factor pathway inhibitor 2, papilin). Two giant proteins, titin and obscurin, were up- and down-regulated, respectively, in the iris in PACG compared with controls.

Conclusions And Clinical Relevance: This proteomic study shows that ECM composition and homeostasis are altered in the iris in PACG.
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http://dx.doi.org/10.1002/prca.202000094DOI Listing
November 2021

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Telemed J E Health 2022 02 17;28(2):176-188. Epub 2021 May 17.

Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, < 0.001), older age (χ = 270, df = 3, < 0.001), history of cataract surgery (OR = 2.0, < 0.001), longer duration of diabetes (χ = 1084, < 0.001), and type 1 diabetes (OR = 3.9,  = 0.01). There was a statistically significant variation of DR by geographic zones (χ = 310, < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes ( < 0.001), cataract surgery in the past ( = 0.02), and females ( = 0.001) were predictors of STDR. This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.
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http://dx.doi.org/10.1089/tmj.2021.0019DOI Listing
February 2022

Peters Anomaly in Nail-Patella Syndrome: A Case Report and Clinico-Genetic Correlation.

Cornea 2021 Nov;40(11):1487-1490

University of Illinois Eye and Ear Infirmary, Chicago, IL; and.

Purpose: The purpose of this study was to report the clinicopathological features of Peters anomaly in a child with nail-patella syndrome.

Methods: Nail-patella syndrome (NPS) is a rare autosomal dominant connective tissue disorder characterized by several anomalies of the extremities, joints and nails, glomerulopathy, and rarely ocular involvement. NPS is caused by heterozygous loss-of-functional mutations in the LMX1B gene that encodes the LIM homeodomain proteins.

Results: This case reports a new association of Peters anomaly in a child with NPS that also had classic skeletal/nail anomalies and protein losing nephropathy. Furthermore, DNA sequence analysis identified a novel missense heterozygous mutation in the LMX1B gene (Transcript ID: NM_001174146) resulting in the replacement of tryptophan by serine in codon 266, suggesting that the mutation (p.Trp.266Ser) affects LMX1B function by disturbing its interactions with other proteins. To the best of our knowledge, this association of Peters anomaly is novel and has not been reported earlier in the ophthalmic and systemic literature on NPS.

Conclusion: The corneal findings in our case with NPS are similar to those seen in congenital corneal opacification because of Peters anomaly. This novel association of Peters anomaly with NPS may be related to the effects of the LMX1B mutation on corneal development.
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http://dx.doi.org/10.1097/ICO.0000000000002731DOI Listing
November 2021

The Proportion of Complementary and Alternative Medicine Utilization Among Saudi Population for Eye Care: Cross-Sectional Study.

Cureus 2021 Feb 3;13(2):e13109. Epub 2021 Feb 3.

Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, USA.

Purpose To estimate the prevalence, determinants and perceived benefit of complementary and alternative medicine (CAM) use for ophthalmic purposes among the Saudi population. Methods A cross-sectional study was carried out in 2019 targeting visitors of King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. The survey had 18 questions in Arabic regarding the use of CAM for eye ailments. The magnitude was associated to the demographic and eye-related factors. Results We interviewed 999 participants. The prevalence of CAM usage was 21.9% (95% confidence interval 19.3; 24.5). Castor oil (49.3%), antimony (khohl alethmed) (40.6%), chamomile (19.6%), and green tea leaves (11.4%) were the most common medications used. Other traditional eye treatments included eye vitamins, faith healing (prayer, reciting Quran, Zamzam water), cautery, cupping, and acupuncture. Conclusions One in five Saudi eye patients used CAM. The factors governing this health behavior should be studied to change this practice pattern.
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http://dx.doi.org/10.7759/cureus.13109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935158PMC
February 2021

Experience with netarsudil 0.02% and latanoprostene bunod 0.024% as adjunctive therapy for glaucoma.

Eur J Ophthalmol 2022 Jan 2;32(1):322-326. Epub 2021 Mar 2.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.

Purpose: To assess the effectiveness and safety of adjunctive topical netarsudil 0.02% and latanoprostene bunod 0.024% in patients with glaucoma.

Methods: A retrospective, multi-center, cohort study of patients with glaucoma treated with netarsudil 0.02% or latanoprostene bunod from five tertiary care centers. Inclusion criteria included patients with glaucoma treated with either medication as adjunctive therapy. Outcomes included mean absolute intraocular pressure (IOP) reduction and relative IOP reduction from baseline. Adverse reactions and reasons for discontinuation were reported. One-way analysis of variance, Kruskal-Wallis rank sum test, and Mann Whitney test compared the outcomes.

Results: A total of 95 eyes (95 patients) on netarsudil and 41 eyes (41 patients) on latanoprostene bunod were analyzed. Mean duration of use was 54.3 ± 28 days for netarsudil and 82.9 ± 51.2 days for latanoprostene bunod. At the final visit, mean IOP reduction was 3.9 ± 4.6 mmHg (17.5 ± 6.0%) ( < 0.0001) with netarsudil and 2.9 ± 3.7 mmHg (13.6 ± 16.3%) ( < 0.0001) with latanoprostene bunod. IOP lowering did not depend on baseline number of IOP-lowering medications. The most common reason for discontinuation was non-effectiveness in both groups.

Conclusion: Similar to monotherapy, netarsudil and latanoprostene bunod demonstrated efficacy in lowering IOP when used as adjunctive therapy.
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http://dx.doi.org/10.1177/1120672121998913DOI Listing
January 2022

Enrichment of IGF-1R and PPARγ signalling pathways in orbital inflammatory diseases: steps toward understanding pathogenesis.

Br J Ophthalmol 2022 07 26;106(7):1012-1017. Epub 2021 Feb 26.

Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA

Background: Orbital inflammatory disease (OID) encompasses a wide range of pathology including thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis and non-specific orbital inflammation (NSOI), accounting for up to 6% of orbital diseases. Understanding the underlying pathophysiology of OID can improve diagnosis and help target therapy.

Aims: To test the hypothesis that shared signalling pathways are activated in different forms of OID.

Methods: In this secondary analysis, pathway analysis was performed on the previously reported differentially expressed genes from orbital adipose tissue using patients with OID and healthy controls who were characterised by microarray. For the original publications, tissue specimens were collected from oculoplastic surgeons at 10 international centres representing four countries (USA, Canada, Australia and Saudi Arabia). Diagnoses were independently confirmed by two masked ocular pathologists (DJW, HEG). Gene expression profiling analysis was performed at the Oregon Health & Science University. Eighty-three participants were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 25 with NSOI and 20 healthy controls.

Results: Among the 83 subjects (mean (SD) age, 52.8 (18.3) years; 70% (n=58) female), those with OID demonstrated perturbation of the downstream gene expressions of the IGF-1R (MAPK/RAS/RAF/MEK/ERK and PI3K/Akt/mTOR pathways), peroxisome proliferator-activated receptor-γ (PPARγ), adipocytokine and AMPK signalling pathways compared with healthy controls. Specifically, GPA samples differed from controls in gene expression within the insulin-like growth factor-1 receptor (IGF-1R, PI3K-Akt (p=0.001), RAS (p=0.005)), PPARγ (p=0.002), adipocytokine (p=0.004) or AMPK (p=<0.001) pathways. TAO, sarcoidosis and NSOI samples were also found to have statistically significant differential gene expression in these pathways.

Conclusions: Although OID includes a heterogenous group of pathologies, TAO, GPA, sarcoidosis and NSOI share enrichment of common gene signalling pathways, namely IGF-1R, PPARγ, adipocytokine and AMPK. Pathway analyses of gene expression suggest that other forms of orbital inflammation in addition to TAO may benefit from blockade of IGF-1R signalling pathways.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318330DOI Listing
July 2022

Association of Rare CYP39A1 Variants With Exfoliation Syndrome Involving the Anterior Chamber of the Eye.

JAMA 2021 02;325(8):753-764

Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.

Importance: Exfoliation syndrome is a systemic disorder characterized by progressive accumulation of abnormal fibrillar protein aggregates manifesting clinically in the anterior chamber of the eye. This disorder is the most commonly known cause of glaucoma and a major cause of irreversible blindness.

Objective: To determine if exfoliation syndrome is associated with rare, protein-changing variants predicted to impair protein function.

Design, Setting, And Participants: A 2-stage, case-control, whole-exome sequencing association study with a discovery cohort and 2 independently ascertained validation cohorts. Study participants from 14 countries were enrolled between February 1999 and December 2019. The date of last clinical follow-up was December 2019. Affected individuals had exfoliation material on anterior segment structures of at least 1 eye as visualized by slit lamp examination. Unaffected individuals had no signs of exfoliation syndrome.

Exposures: Rare, coding-sequence genetic variants predicted to be damaging by bioinformatic algorithms trained to recognize alterations that impair protein function.

Main Outcomes And Measures: The primary outcome was the presence of exfoliation syndrome. Exome-wide significance for detected variants was defined as P < 2.5 × 10-6. The secondary outcomes included biochemical enzymatic assays and gene expression analyses.

Results: The discovery cohort included 4028 participants with exfoliation syndrome (median age, 78 years [interquartile range, 73-83 years]; 2377 [59.0%] women) and 5638 participants without exfoliation syndrome (median age, 72 years [interquartile range, 65-78 years]; 3159 [56.0%] women). In the discovery cohort, persons with exfoliation syndrome, compared with those without exfoliation syndrome, were significantly more likely to carry damaging CYP39A1 variants (1.3% vs 0.30%, respectively; odds ratio, 3.55 [95% CI, 2.07-6.10]; P = 6.1 × 10-7). This outcome was validated in 2 independent cohorts. The first validation cohort included 2337 individuals with exfoliation syndrome (median age, 74 years; 1132 women; n = 1934 with demographic data) and 2813 individuals without exfoliation syndrome (median age, 72 years; 1287 women; n = 2421 with demographic data). The second validation cohort included 1663 individuals with exfoliation syndrome (median age, 75 years; 587 women; n = 1064 with demographic data) and 3962 individuals without exfoliation syndrome (median age, 74 years; 951 women; n = 1555 with demographic data). Of the individuals from both validation cohorts, 5.2% with exfoliation syndrome carried CYP39A1 damaging alleles vs 3.1% without exfoliation syndrome (odds ratio, 1.82 [95% CI, 1.47-2.26]; P < .001). Biochemical assays classified 34 of 42 damaging CYP39A1 alleles as functionally deficient (median reduction in enzymatic activity compared with wild-type CYP39A1, 94.4% [interquartile range, 78.7%-98.2%] for the 34 deficient variants). CYP39A1 transcript expression was 47% lower (95% CI, 30%-64% lower; P < .001) in ciliary body tissues from individuals with exfoliation syndrome compared with individuals without exfoliation syndrome.

Conclusions And Relevance: In this whole-exome sequencing case-control study, presence of exfoliation syndrome was significantly associated with carriage of functionally deficient CYP39A1 sequence variants. Further research is needed to understand the clinical implications of these findings.
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http://dx.doi.org/10.1001/jama.2021.0507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903258PMC
February 2021

The Iris Thickness in a Healthy Saudi Population.

Cureus 2021 Jan 6;13(1):e12521. Epub 2021 Jan 6.

Epidemiology and Public Health, King Khalid Eye Specialist Hospital, Riyadh, SAU.

Purpose Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in the normal Saudi population. Methods Quantitative information on IT was evaluated in healthy Saudi eyes using anterior segment optical coherence tomography (ASOCT). IT and iris volume was measured with the room 'light on' (LON) and 'light off' (LOFF) using Image J software. IT in the nasal and temporal iris was measured at 500 µm (IT500) and 750 µm (IT750) from the scleral spur (SS). Differences in IT measurements by age, gender and type of refractive error were evaluated. Results We included 100 eyes of 50 healthy adult Saudis without ocular disease other than refractive errors. The mean age of 56 males and 44 females in the study group was 41.7 ± 14.5 years. The refractive status was as follows: emmetropia (35 eyes), mild/moderate myopia (33 eyes), high myopia (17 eyes) and hyperopia (15 eyes). The IT750 with LON was significantly more than IT500 both nasally (P = 0.03) and temporally (P < 0.001). The difference in IT750 and IT500 with LOFF was significantly more nasally (P = 0.03), temporally (P = 0.02), and with LON nasally (P = 0.005). IT was thicker in males when compared to females and variation of IT by refractive error was significant but not by age. The mean pupil diameter and anterior chamber depth decreased with age (P < 0.001). Anterior chamber width was not affected by age or illumination. Conclusion The baseline iris thickness in the Saudi eyes could be used to compare iris thickness in eyes with angle closure glaucoma among the Arab population.
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http://dx.doi.org/10.7759/cureus.12521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863027PMC
January 2021

Rosai-Dorfman disease: Isolated epibulbar mass in patient with vernal keratoconjunctivitis.

Saudi J Ophthalmol 2020 Jan-Mar;34(1):53-55. Epub 2020 Nov 22.

Pathology and Glaucoma, King Khaled Eye Specialist Hospital, Saudi Arabia.

A 29-year-old male known case of vernal keratoconjunctivitis (VKC) presented with 5-month history of a rapidly growing mass on the temporal aspect of the right cornea. The 9 × 9 mm epibulbar lesion was excised and histologically showed features of extranodal Rosai Dorfman disease (RDD) with emperipolesis of eosinophils. The lesion did not recur following excision. The association of RDD with VKC has not been previously reported; however, the causal relationship remains unclear.
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http://dx.doi.org/10.4103/1319-4534.301290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849862PMC
November 2020

Minimally invasive glaucoma surgery devices in glaucoma: A time for reflection.

Oman J Ophthalmol 2020 Sep-Dec;13(3):109-111. Epub 2020 Nov 2.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA.

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http://dx.doi.org/10.4103/ojo.OJO_240_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852411PMC
November 2020
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