Publications by authors named "Hasenin Al-Khersan"

32 Publications

Progressive Scleral Thinning in a Middle-aged Woman.

JAMA Ophthalmol 2021 Apr 22. Epub 2021 Apr 22.

Bascom Palmer Eye Institute, Miami, Florida.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.5287DOI Listing
April 2021

Primary evisceration for neonatal endogenous endophthalmitis: A report of two cases.

Am J Ophthalmol Case Rep 2021 Jun 3;22:101081. Epub 2021 Apr 3.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL, United States.

Purpose: To present two cases of neonatal endophthalmitis with poor prognosis that were managed with primary evisceration.

Observations: Case 1 is a 27-weeks' gestation neonate who developed endophthalmitis complicated by globe rupture. Case 2 describes a 34-weeks' gestation neonate with endophthalmitis. Both patients had poor prognosis and thus underwent primary evisceration with good long-term cosmetic outcomes at 15 years and 17 months, respectively.

Conclusions And Importance: Primary evisceration should be considered in neonates with endophthalmitis with a poor prognosis and can result in good long-term cosmesis.
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http://dx.doi.org/10.1016/j.ajoc.2021.101081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042423PMC
June 2021

Take a Moment: Reflections on a Pandemic, Suffering, and Humanity.

Am J Ophthalmol 2021 Jan 23. Epub 2021 Jan 23.

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http://dx.doi.org/10.1016/j.ajo.2021.01.009DOI Listing
January 2021

Fundus Pigmentation in the Diagnosis and Treatment of Retinopathy of Prematurity.

Ophthalmology 2020 Dec 29. Epub 2020 Dec 29.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address:

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http://dx.doi.org/10.1016/j.ophtha.2020.12.024DOI Listing
December 2020

Ocular trauma secondary to exercise resistance bands during the COVID-19 pandemic.

Am J Emerg Med 2021 Apr 4;42:217-220. Epub 2020 Dec 4.

Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America.

Objective: To characterize injuries caused by exercise resistance bands.

Method: Single-site retrospective case series of patients presenting to the Bascom Palmer Eye Institute emergency room with ocular injuries secondary to exercise resistance bands from March through September 2020.

Results: Eleven patients (9 males, 2 females, 14 eyes) were reviewed. Eight patients had a unilateral injury (3 right eyes, 5 left eyes) while 3 had bilateral injuries. Iritis was the most common presentation, seen in all 11 patients, followed by hyphema (9 patients, 82%), and vitreous hemorrhage (4 patients, 36%). Among affected eyes, the mean presenting visual acuity was approximately 20/100, improving to 20/40 on the last follow up (p = 0.06). However, 4 eyes (33%) had vision ≤20/60 at last follow up.

Conclusions: Exercise resistance bands can cause a wide spectrum of ocular injuries, some leading to long-term vision loss. As such, we recommend that patients strongly consider using eye protection goggles or glasses while using resistance bands for exercise.
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http://dx.doi.org/10.1016/j.ajem.2020.11.054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716731PMC
April 2021

Comparison Between Graders in Detection of Diabetic Neovascularization With Swept Source Optical Coherence Tomography Angiography and Fluorescein Angiography.

Am J Ophthalmol 2021 04 11;224:292-300. Epub 2020 Dec 11.

Bascom Palmer Eye Institute, Miami, Florida, USA. Electronic address:

Purpose: We compared the ability of ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy using swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA).

Design: Retrospective study comparing diagnostic instruments.

Methods: Eyes with proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy and a high suspicion of NV based on clinical examination were imaged using SS-OCTA and FA at the same visit. Two separate grading sets consisting of scrambled, anonymized SS-OCTA and FA images were created. The ground truth for presence of NV was established by consensus of 2 graders with OCTA experience who did not participate in the subsequent assessment of NV in this study. The 2 anonymized image sets were graded for presence or absence of NV by 12 other graders that included 2 residents, 6 vitreoretinal fellows, and 4 vitreoretinal attending physicians. The percentage of correct grading of NV using SS-OCTA and FA was assessed for each grader and across grader training levels.

Results: Forty-seven eyes from 24 patients were included in this study. Overall, the mean percentage of correct NV grading was 87.8% using SS-OCTA with B-scans and 86.2% using FA (P = .92). Assessing each grader individually, there was no statistically significant asymmetry in correct grading using SS-OCTA and FA.

Conclusions: Ophthalmologists across training levels were able to identify diabetic NV with equal accuracy using SS-OCTA and FA. Based on these results, SS-OCTA may be an appropriate standalone modality for diagnosing diabetic NV.
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http://dx.doi.org/10.1016/j.ajo.2020.11.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058287PMC
April 2021

Diving Deep into Deep Learning: An Update on Artificial Intelligence in Retina.

Curr Ophthalmol Rep 2020 Sep 7;8(3):121-128. Epub 2020 Jun 7.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA.

Purpose Of Review: In the present article, we will provide an understanding and review of artificial intelligence in the subspecialty of retina and its potential applications within the specialty.

Recent Findings: Given the significant use of diagnostic imaging within retina, this subspecialty is a fitting area for the incorporation of artificial intelligence. Researchers have aimed at creating models to assist in the diagnosis and management of retinal disease as well as in the prediction of disease course and treatment response. Most of this work thus far has focused on diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity, although other retinal diseases have started to be explored as well.

Summary: Artificial intelligence is well-suited to transform the practice of ophthalmology. A basic understanding of the technology is important for its effective implementation and growth.
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http://dx.doi.org/10.1007/s40135-020-00240-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7679067PMC
September 2020

Peripheral combined hamartoma of the retina and retinal pigment epithelium with remote peripapillary choroidal neovascular membrane.

Am J Ophthalmol Case Rep 2020 Dec 1;20:100954. Epub 2020 Oct 1.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: To describe the first reported case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with a remote choroidal neovascular membrane (CNVM).

Observations: A 19-month-old girl with a normal prenatal and infantile history presented with esotropia of the left eye. Fundus examination demonstrated a large, elevated, charcoal-colored lesion in the nasal equatorial retina. There was dragging of the nasal retinal vessels and a retinal fold, presumed to have resulted from nasal traction from the lesion. There was also subretinal hemorrhage in the peripapillary macula. Multimodal imaging demonstrated a peripapillary choroidal neovascular membrane (CNVM) underlying the retinal fold. There was no leakage within the tumor or secondary retinal neovascularization. Examination of the fellow eye was unremarkable. The patient was diagnosed with peripheral CHRRPE with associated peripapillary CNVM. She was treated with serial intravitreal bevacizumab to the affected eye which resulted in a reduction in leakage from the CNVM and resolution of the subretinal hemorrhage. The CHRRPE remained stable on follow-up.

Conclusions: Peripheral CHRRPE can rarely be associated with a remote CNVM.
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http://dx.doi.org/10.1016/j.ajoc.2020.100954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551977PMC
December 2020

Social media in ophthalmology: An analysis of use in the professional sphere.

Health Informatics J 2020 12 18;26(4):2967-2975. Epub 2020 Sep 18.

Bascom Palmer Eye Institute, USA.

To characterize how ophthalmologists are using social media in their practice. A survey regarding ophthalmologists' personal and professional use of social media was distributed online through a university alumni listserv. Data collection occurred over 4 weeks from January to February 2020. In total, 808 ophthalmologists opened the survey email, and 160 responded (19.8%). Of 160 respondents, 115 (71.9%) participated in social media for personal use. Professional use of social media was noted by 63 (39.4%) respondents. Age >40 years old correlated with less personal ( = 5.06,  = 0.025) but not professional use ( = 0.065). Private practice was associated with more use of social media professionally compared to those in an academic or Veteran's Affairs hospital ( = 6.58,  = 0.037). A majority of respondents (58.7%) were neutral regarding the effect of social media on their practice. The present survey showed that nearly 40% of respondents are involved in social media in a professional context. Private practice correlated with increased use of social media professionally, but providers were most commonly neutral regarding the impact of social media on their practice. This finding suggests further avenues of research including how providers using social media professionally are defining and assessing successful use.
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http://dx.doi.org/10.1177/1460458220954610DOI Listing
December 2020

Emergent Ophthalmic Surgical Care at a Tertiary Referral Center During the COVID-19 Pandemic.

Am J Ophthalmol 2021 02 2;222:368-372. Epub 2020 Sep 2.

Bascom Palmer Eye Institute, Miami, Florida, USA. Electronic address:

Purpose: This study characterized the delivery of emergent ophthalmic surgical care during April 2020 of the coronarvirus disease-19 (COVID-19) pandemic compared with the same interval the previous year.

Design: Retrospective observational before-and-after study.

Methods: This study reviewed and characterized each emergent and/or urgent procedure performed during April 2020 and April 2019 at a single tertiary ophthalmology referral center. Information collected included the details of patient presentation, diagnosis, surgical procedure, and preoperative COVID-19 testing.

Results: In total, 117 surgical procedures were performed on 114 patients during the month of April 2020 compared with 1,107 performed in April 2019 (P < .0001). Retinal detachment repair was the most common procedure (n = 37; 31.6%) in April 2020, whereas elective cataract surgery (n = 481; 47.3%) was the most common procedure in April 2019. The mean age of patients was 50.0 years in April 2020 compared with 59.0 years (P < .0001) the previous year. During April 2020, the mean age of surgeons performing procedures was 42.3 years compared with 48.4 years (P < .0001) during April 2019. In April 2020, all but 5 patients (96%) had reverse transcriptase polymerase chain reaction based COVID-19 testing before their procedure. One patient (0.88%) had a positive COVID-19 test.

Conclusions: The COVID-19 pandemic decreased our institution's surgical volume in April 2020 to approximately 10% of the usual volume. The pandemic changed the type of cases performed and led to a statistically significant decrease in both the age of our surgeons and patients relative to the same interval in the previous year. Broad preoperative screening led to 1 positive COVID-19 test in an asymptomatic patient.
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http://dx.doi.org/10.1016/j.ajo.2020.08.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462885PMC
February 2021

Persistent Tunica Vasculosa Lentis as an Independent Risk Factor for Treatment in Retinopathy of Prematurity.

Ophthalmol Retina 2021 02 8;5(2):217-219. Epub 2020 Aug 8.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address:

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http://dx.doi.org/10.1016/j.oret.2020.08.002DOI Listing
February 2021

Chronic, Recurrent Bacterial Endophthalmitis Caused by : Clinical Features and Management.

Int Med Case Rep J 2020 9;13:265-269. Epub 2020 Jul 9.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, 33136, USA.

A 79-year-old man presented to a tertiary referral center from the Dominican Republic with an opaque corneal graft and a diagnosis of chronic, recurrent culture-positive endophthalmitis of the left eye. The patient had a history of penetrating keratoplasty for Fuchs' dystrophy and had undergone multiple intraocular surgeries including pars plana vitrectomy and anterior chamber wash out for the diagnosis and management of chronic endophthalmitis. After being referred, the patient underwent a third PKP, removal of his intraocular lens (IOL), capsulectomy, and injection of intravitreal antibiotics. All surgical specimens demonstrated the growth of . Five months after surgery, the graft remained clear without evidence of infection and best-corrected visual acuity was 20/350.
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http://dx.doi.org/10.2147/IMCRJ.S259899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358084PMC
July 2020

Widefield Fluorescein Angiography in the Fellow Eyes of Patients with Presumed Unilateral Persistent Fetal Vasculature.

Ophthalmol Retina 2021 03 26;5(3):301-307. Epub 2020 Jul 26.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Florida. Electronic address:

Purpose: To examine the retinal vascular findings on widefield fluorescein angiography (FA) in the fellow eyes of patients with unilateral persistent fetal vasculature (PFV).

Design: Retrospective case series.

Participants: Consecutive patients with unilateral PFV evaluated by a single physician at an academic medical center from February 1, 2011, to November 30, 2018.

Methods: Clinical and demographic information, including age, gender, race, ethnicity, affected eye, subtype, stalk origin, complications on presentation, length of follow-up, and examination findings, was reviewed using the electronic medical record. Fluorescein angiograms of the affected and fellow eyes were reviewed by 2 authors for characteristic retinal vascular abnormalities. Agreement between the authors' scores was analyzed using Cohen's Kappa.

Main Outcome Measures: Fluorescein angiography abnormalities, including peripheral vessel avascularity, aberrant circumferential vessels, terminal supernumerary branching, regional capillary dropout, terminal bulbing, abnormal choroidal flush, abnormal vessel straightening, and peripheral vessel leakage or dilation.

Results: Inclusion criteria were met by 41 patients. The average age at initial visit was 10.0 months. The average length of follow-up was 36.4 months. Abnormalities on FA were seen in 31 (75.6%) fellow eyes: peripheral vessel avascularity in 27.5 (67.1%), aberrant circumferential vessels in 20 (48.8%), terminal supernumerary branching in 17 (41.5%), regional capillary dropout in 9 (22.0%), terminal bulbing in 6 (14.6%), abnormal choroidal flush in 3.5 (8.5%), and abnormal vessel straightening and peripheral vessel leakage in 2.5 (6.1%). Statistical analysis disclosed an overall observed agreement of 93.4% among the raters (κ = 0.84, P < 0.0001).

Conclusions: Retinal vascular abnormalities seen in patients with unilateral PFV were present in the majority of fellow eyes. This suggests that unilateral PFV may in fact be a bilateral, asymmetric process, but the clinical significance of these subtle findings is not known.
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http://dx.doi.org/10.1016/j.oret.2020.07.020DOI Listing
March 2021

Acute Ptosis in a Middle-aged Man With Hypertension.

JAMA Ophthalmol 2020 09;138(9):996-997

Bascom Palmer Eye Institute, Miami, Florida.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.1320DOI Listing
September 2020

Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy.

Clin Ophthalmol 2020 10;14:1559-1563. Epub 2020 Jun 10.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: To report visual acuity in patients undergoing pars plana vitrectomy (PPV) reoperations for complications of proliferative diabetic retinopathy (PDR).

Design: Retrospective case series.

Subjects: Diabetic patients undergoing reoperation with PPV between 2015 and 2018 at a university referral center.

Methods: Patient charts were reviewed for indication for initial and repeat PPV, baseline clinical characteristics including gender, age, and lens status, and pre- and post-operative best-corrected visual acuity.

Main Outcome Measures: Best-corrected visual acuity at last follow-up.

Results: Of 538 eyes (409 patients) undergoing a PPV for diabetic retinopathy, 153 (28.4%) eyes had reoperation. Among the 130 eyes (119 patients) that met the inclusion criteria, 55 eyes (50 patients) underwent reoperation for complications of PDR, defined as non-clearing vitreous hemorrhage (NCVH) and/or tractional retinal detachment (TRD). Within this subgroup of 55 eyes, 19 (34.5%) eyes had an indication for the first surgery of NCVH. Fourteen (73.7%) of these NCVH eyes achieved a visual acuity of 20/80 or better. When the indication for the first surgery was TRD (33 eyes, 60%), 8 (24.2%) eyes achieved this same outcome (p=0.0011).

Conclusion: Approximately one of every four eyes treated with PPV for PDR will undergo repeat PPV during follow-up. VA outcomes after the repeat PPV were variable, with NCVH cases achieving better outcomes compared to TRD.
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http://dx.doi.org/10.2147/OPTH.S252285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293964PMC
June 2020

Asymmetric retinopathy of prematurity in presumed fungal endophthalmitis.

Am J Ophthalmol Case Rep 2020 Jun 23;18:100722. Epub 2020 Apr 23.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: To report a case of asymmetric retinopathy of prematurity (ROP) in a neonate with endophthalmitis.

Observations: A 25-week old female was born by caesarean section due to preeclampsia. The patient required supplemental oxygen after birth. The neonatal period was complicated by sepsis secondary to necrotizing enterocolitis with intestinal perforation. The patient subsequently developed endophthalmitis in the right eye. A fungal ball was seen overlying the termination of a persistent hyaloid artery. The patient also had ROP, identified at 31 weeks postconceptional age, which progressed asymmetrically and demonstrated greater severity in the eye affected by endophthalmitis. The endophthalmitis resolved with intravitreal antifungal treatment and systemic therapy. The right eye was also treated with intravitreal bevacizumab, demonstrating regression of ROP severity on follow up.

Conclusions And Importance: The present case describes the first reported case of asymmetric ROP associated with endophthalmitis. The more severe ROP occurred in the eye with endophthalmitis suggesting that, outside of systemic factors, the local ocular inflammatory environment is important in determining the progression of ROP. Additionally, the fungal ball present in the eye affected by endophthalmitis was seen at the termination of the hyaloid artery, suggesting the hyaloid artery as the route of entry of the fungus into the vitreous.
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http://dx.doi.org/10.1016/j.ajoc.2020.100722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200213PMC
June 2020

Rapidly Progressive Bilateral Visual Acuity Loss in a Middle-Aged Woman.

JAMA Ophthalmol 2020 06;138(6):706-707

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.0580DOI Listing
June 2020

Wide field swept source OCT angiography of multifocal retinal and choroidal occlusions from embolic triamcinolone acetonide.

Am J Ophthalmol Case Rep 2020 Jun 14;18:100704. Epub 2020 Apr 14.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: Multifocal retinal arterial occlusions and choroidal infarctions due to embolic triamcinolone acetonide (TA) administered during a septoplasty were imaged using swept source OCT angiography (SS-OCTA) to demonstrate the utility of this imaging modality for the diagnosis and longitudinal follow-up of retinal and choroidal vascular diseases.

Observations: A 37-year-old man presented with vision loss in his left eye upon awakening from a left-sided septoplasty during which TA was injected. Examination of the left eye demonstrated retinal whitening in the macula, white material in the distal lumen of retinal arterioles, and multifocal hypopigmented choroidal lesions. SS-OCTA imaging showed the absence of detectable flow in areas of retinal and choroidal whitening. Corresponding B-scans demonstrated hyperreflective material, thought to be embolic TA, within the retinal vessels and inner choroid.

Conclusions: Wide field SS-OCTA was sufficient for the diagnosis and longitudinal evaluation of retinal and choroidal occlusions without the need for dye-based angiography.
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http://dx.doi.org/10.1016/j.ajoc.2020.100704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170946PMC
June 2020

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone.

J Ophthalmic Inflamm Infect 2020 Feb 27;10(1). Epub 2020 Feb 27.

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.

Background: To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues.

Methods: Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin).

Results: Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL.

Conclusion: Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.
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http://dx.doi.org/10.1186/s12348-020-0200-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044395PMC
February 2020

Retinal Nonperfusion in Proliferative Diabetic Retinopathy Before and After Panretinal Photocoagulation Assessed by Widefield OCT Angiography.

Am J Ophthalmol 2020 05 13;213:177-185. Epub 2020 Mar 13.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address:

Purpose: Widefield swept source optical coherence tomography angiography (WF SS-OCTA) imaging was compared with ultra-widefield (UWF) fluorescein angiography (FA) imaging to better understand changes in retinal nonperfusion before and after panretinal photocoagulation (PRP) in treatment-naïve eyes with proliferative diabetic retinopathy (PDR).

Design: Prospective, observational, consecutive case series.

Methods: Participants with treatment-naïve PDR were imaged using the SS-OCTA 12- × 12-mm scan pattern at baseline and at 1 week, 1 month, and 3 months after PRP. UWF FA was obtained at baseline and 3 months after PRP. Selected eyes were imaged using 5 SS-OCTA 12- × 12-mm scans to create a posterior pole montage, and 5 eyes also underwent SS-OCTA imaging at 6 months and 1 year. Areas of retinal nonperfusion (RNP) were drawn independently by 2 masked graders, and analysis of variance (ANOVA) tests were used to compare areas of RNP over time. Main outcome measurements consisted of areas and boundaries of RNP visualized using WF SS-OCTA and UWF FA.

Results: From January 2018 through January 2019, WF SS-OCTA was performed on 20 eyes with treatment-naïve PDR from 15 patients. Areas of RNP identified on UWF FA images co-localized with RNP areas visualized on WF SS-OCTA images. There were no statistically significant changes in RNP area on WF SS-OCTA images through 3 months after PRP. Even eyes that were severely ischemic at baseline had no significant changes in RNP area 1 year after PRP.

Conclusions: RNP in PDR can be identified at baseline and imaged serially after PRP using WF SS-OCTA. Retinal perfusion in PDR does not change significantly after PRP. The ability of WF SS-OCTA to longitudinally evaluate RNP areas provides additional justification for adopting WF SS-OCTA as the sole imaging modality for clinical management of PDR.
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http://dx.doi.org/10.1016/j.ajo.2020.01.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962743PMC
May 2020

ANALYSIS OF THE VITREORETINAL SURGICAL FELLOWSHIP APPLICANT POOL: Publication Misrepresentations and Predictors of Future Academic Output.

Retina 2020 Oct;40(10):2026-2033

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.

Purpose: To evaluate characteristics associated with misrepresentation of publication record, future career placement, and subsequent academic output among vitreoretinal surgical fellowship applicants.

Methods: A retrospective review of 337 vitreoretinal surgical applicants between 2015 and 2018 was conducted. Publications reported in the applications were verified using PubMed, Google, and Google Scholar. Applications were considered misrepresented if there was no record of the publication or if there was an inconsistency in authorship. Applicants were followed after graduation and their employment position and postgraduation publications were recorded. The main outcome measures were the number of unverifiable publications, postfellowship job placement, and postgraduate peer-reviewed publications.

Results: Of the 377 applicants, 309 (82.0%) listed peer-reviewed publications. Of those with a publication, 32 (10.4%) had misrepresentations. A reported desire to pursue an academic career was associated with a future career in academic medicine, whereas Alpha Omega Alpha status was correlated with a future career in private practice. Alpha Omega Alpha status, a reported desire to pursue an academic career, and the number of peer-reviewed publications before fellowship were positively correlated with higher numbers of peer-reviewed publications after fellowship.

Conclusion: Unverifiable authorship among vitreoretinal surgical fellowship applicants is significant, affecting nearly one in 10 applicants with peer-reviewed publications. A reported desire to pursue academic medicine as listed on the fellowship application is a useful indicator for a future career in academics, and for increased number of peer-reviewed publications after fellowship.
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http://dx.doi.org/10.1097/IAE.0000000000002698DOI Listing
October 2020

Surgical Therapy for Macular Edema: What We Have Learned through the Decades.

Ocul Immunol Inflamm 2019 24;27(8):1242-1250. Epub 2019 Oct 24.

Byers Eye Institute, Stanford University, Palo Alto, CA, USA.

Macular edema is a leading cause of functional visual loss in retinal vascular or ocular inflammatory diseases. Because persistent macular edema can lead to irreversible retinal damage, multi-approached treatment should be considered to achieve complete resolution of macular edema. With an enhanced understanding of its pathophysiology, numerous therapeutic options have been developed for the management of macular edema over the decades. Although medical therapies account for the mainstay of treatment, surgical approaches with vitrectomy can play an important role in the management of macular edema, depending on its mechanism of fluid accumulation. The index review focuses on the efficacy of surgical therapy for macular edema secondary to various ocular diseases including diabetic retinopathy, uveitis, and retinal vein occlusion, and consequently provides the evidences that may expand the knowledge and support the employment of surgical options.
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http://dx.doi.org/10.1080/09273948.2019.1672194DOI Listing
May 2020

Innovative therapies for neovascular age-related macular degeneration.

Expert Opin Pharmacother 2019 Oct 12;20(15):1879-1891. Epub 2019 Jul 12.

Retinal Consultants of Arizona , Phoenix , Arizona.

: Investigational anti-VEGF treatments for neovascular age-related macular degeneration (nAMD) aim to improve visual outcomes and reduce treatment burden; these include long-acting agents, combination strategies, topical agents, sustained-release, and genetic therapies. : The authors provide a comprehensive review of investigational therapies for nAMD, focusing on therapies currently in clinical trial. : Long-acting anti-VEGF agents have demonstrated promising results in phase 3 studies, and include Brolucizumab, a single-chain antibody fragment, and Abicipar, a designed ankyrin repeat protein (DARPin). Other unique anti-VEGF agents in current trials include Conbercept - a fusion protein of the VEGF receptor domains, KSI-301 - an anti-VEGF antibody biopolymer conjugate, and OPT-302 - an inhibitor of VEGF-C/D. Strategies to activate the Tie-2 receptor, some in combination with VEGF inhibition, are of interest, with recent trials of Faricimab, ARP-1536, and nesvacumab. Topical anti-VEGF ± anti-PDGF agents, such as pazopanib, squalamine lactate, regorafenib, and LHA510 have shown limited efficacy and/or have not been advanced, although PAN-90806 continues to advance with promising initial results. Sustained-release anti-VEGF treatments, to address treatment burden, include the ranibizumab Port Delivery System, GB-102, NT-503, hydrogel depot, Durasert, and ENV1305. Similarly, genetic therapies, including RGX-314 and ADVM-022, aim to provide sustained anti-VEGF expression from the retina.
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http://dx.doi.org/10.1080/14656566.2019.1636031DOI Listing
October 2019

Intermittent Temporal Visual Field Loss in a Middle-aged Man.

JAMA Ophthalmol 2019 Sep;137(9):1072-1073

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

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http://dx.doi.org/10.1001/jamaophthalmol.2019.1638DOI Listing
September 2019

Long-term outcomes after intravitreal dexamethasone treatment in steroid responders.

Acta Diabetol 2019 Jun 24;56(6):675-680. Epub 2019 Feb 24.

LV Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, 500 034, India.

Aims: Intravitreal steroid implants have emerged as an adjunctive therapy in diabetic macular edema (DME) in patients refractory to anti-vascular endothelial growth factor agents. However, the use of these agents in patients with a prior history of steroid-induced ocular hypertension is limited. The present study aimed to analyze long-term intraocular pressure (IOP) response to the dexamethasone implant in patients with DME and a history of steroid-induced increase in IOP.

Methods: In a multicenter retrospective review, 17 eyes with DME and a history of steroid-induced increase in IOP to > 21 mmHg were treated with the dexamethasone implant and followed for 18 months. Patients with a history of vitrectomy of vitreoretinal interface pathology were excluded. The primary outcomes were the change in IOP and use of IOP-lowering agents.

Results: Among the study population (17 eyes), there was no significant change in mean IOP from baseline through 18 months (15.9 ± 2.0-14.6 ± 2.8 mmHg; p = 0.18). The number of patients requiring IOP-lowering agents rose from 5 at baseline to 14 at 18 months (p = 0.0049). None of the study eyes required surgical treatment.

Conclusions: Though dexamethasone does predictably lead to an increase in IOP, this adverse effect was effectively managed with topical treatment. The present study suggests that the intravitreal dexamethasone implant may be considered in patients with DME and a history of steroid-induced ocular hypertension who have exhausted first-line treatments.
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http://dx.doi.org/10.1007/s00592-019-01299-5DOI Listing
June 2019

Mutations in MERTK are not associated with age-related macular degeneration.

Int Ophthalmol 2019 Jan 3;39(1):63-67. Epub 2018 Jan 3.

Grassi Retina, 1012 95th St., Suite 9, Naperville, IL, 60564, USA.

Purpose: To assess whether mutations in Mer tyrosine kinase (MERTK) are associated with age-related macular degeneration (AMD).

Methods: An association study using whole-genome sequencing was performed to determine whether rare variants in MERTK are associated with AMD. The data set included 4787 propensity score-matched case-control samples: 2394 AMD cases and 2393 controls. Whole-genome sequencing was performed and variants in MERTK were identified. Combined annotation-dependent depletion (CADD) scores and allele frequencies were calculated for each variant identified in MERTK. Student's t-test was used to assess the mean number of MERTK variants per subject between case and control cohorts (Bonferroni adjusted α = 0.0125). The number of subjects carrying at least one high CADD score loss-of-function or nonsynonymous mutation in each cohort was compared using Fisher's exact test (p < 0.05).

Results: No significant difference was found in the mean number of MERTK variants in AMD versus control subjects (p = 0.0502). Additionally, there was no significant difference between cohorts in the number of subjects with at least one high CADD score loss-of-function or nonsynonymous variant (p = 0.15 at CADD > 10 and p = 0.91 at CADD > 20).

Conclusions: The present study provides a meaningfully negative result demonstrating that rare variants in MERTK are not associated with AMD. The study also demonstrates the role of large sample size genetic studies utilizing whole-genome sequencing as a powerful tool that can resolve clinically relevant questions regarding the genetic basis of ophthalmic disease.
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http://dx.doi.org/10.1007/s10792-017-0789-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092259PMC
January 2019

Reply.

Am J Ophthalmol 2018 02 9;186:165. Epub 2017 Dec 9.

Hyderabad, India.

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http://dx.doi.org/10.1016/j.ajo.2017.10.031DOI Listing
February 2018

Early Response to Intravitreal Dexamethasone Implant Therapy in Diabetic Macular Edema May Predict Visual Outcome.

Am J Ophthalmol 2017 Dec 13;184:121-128. Epub 2017 Oct 13.

L.V. Prasad Eye Institute, Hyderabad, India. Electronic address:

Purpose: To determine whether early visual acuity response to intravitreal dexamethasone implant therapy in diabetic macular edema (DME) is associated with long-term outcome.

Design: Retrospective case series.

Methods: Multicenter (8 sites) retrospective review of medical records of eyes with DME treated with 0.7 mg intravitreal dexamethasone implant and minimum 18-month follow-up. One hundred and two eyes were included. Eyes with vitreoretinal interface abnormalities or that had undergone vitrectomy were excluded. Eyes were categorized into 3 groups based on change in best-corrected visual acuity (BCVA) at 3 months (logMAR equivalence of <5-letter, 5-9-letter, or ≥10-letter gain). Visual acuity outcomes were determined for each early response group. The relationship between early (3-month) and overall change in BCVA was assessed using regression analysis.

Results: In the study population (102 eyes), <5-letter, 5- to 9-letter, and ≥10-letter BCVA improvements were seen in 44.1%, 18.6%, and 37.3% of eyes, respectively, at 3 months. Among suboptimal (<5-letter) responders at 3 months, 6.7% showed ≥10-letter gains at study conclusion compared to 29% in the robust (≥10-letter) early response group (P = .009). Change in BCVA at 3 months showed significant positive correlation with overall change in BCVA (coefficient = 0.44, P = .002).

Conclusions: A similar proportion of eyes demonstrated suboptimal (<5-letter) and robust (≥10-letter) early response to treatment at 3 months. Eyes with a robust early response demonstrated ≥10-letter long-term gain in BCVA at a significantly higher rate compared to those with poor early response. Early treatment response directly correlated with overall change in BCVA.
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http://dx.doi.org/10.1016/j.ajo.2017.10.004DOI Listing
December 2017