Publications by authors named "J Fernando Arevalo"

710 Publications

Visual acuity after cataract surgery in Macular Telangiectasia Type 2 Stage 3 to 5.

Int J Retina Vitreous 2022 Jun 11;8(1):38. Epub 2022 Jun 11.

Wilmer Eye Institute, The Johns Hopkins Hospital, 400 N. Broadway, Smith 3015, Baltimore, USA.

Background: The purpose of this study was to evaluate visual acuity after cataract surgery in eyes with Macular Telangiectasia (MacTel) Type 2.

Methods: Single-center retrospective cohort study of patients with MacTel Type 2 who underwent cataract surgery and were managed at the same institution. Patients underwent pre-operative assessment by a retinal specialist with examination and optical coherence tomography (OCT) at the same institution. The main outcome measure was the post-operative change in best corrected visual acuity (BCVA). Secondary study outcomes were achieving post-operative BCVA better than Snellen acuity of 20/40 and time to BCVA loss by two lines or more (10 or more ETDRS letters).

Results: A total of 20 eyes (11 patients) underwent cataract surgery and were followed for a median of 25.5 months (IQR 17.5-44.2 months). The median post-operative BCVA improvement was 10.5 letters (IQR 3.50-20.25). Nuclear sclerosis severity [β = 8.99 (95% CI 3.35, 14.6), p = 0.00177] was associated with post-operative change in BCVA and central foveal ellipsoid zone (EZ) breaks [OR 1.33 × 10 (95% CI 5.12 × 10-3.43 × 10), p < 0.001] on OCT was inversely correlated with post-operative BCVA > 20/40 using a multivariate generalized linear model. Central foveal EZ breaks [HR 1.77 × 10 (95% CI 3.86 × 10, 8.11 × 10), p < 0.001] and MacTel Type 2 disease stage [HR 2.83, (95% CI 1.12, 7.12), p = 0.027] were independently associated with shorter time to vision loss of two lines or more in a multivariate Cox regression model.

Conclusions: Visual acuity significant improved after cataract surgery in eyes with MacTel Type 2 regardless of disease severity. The presence of central foveal EZ breaks may predict poorer post-operative visual acuity and subsequent vision loss from disease progression.
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http://dx.doi.org/10.1186/s40942-022-00386-0DOI Listing
June 2022

Choroidal Macrovessel Diagnosed on Multimodal Imaging, including Swept-Source Optical Coherence Tomography Angiography.

Case Rep Ophthalmol 2022 Jan-Apr;13(1):215-219. Epub 2022 Mar 24.

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

Choroidal macrovessel (CM) is a rare anomalous vascular lesion in the choroid. In this case report, we describe a 72-year-old Caucasian man diagnosed with an incidental heavily branching CM in the macula of his right eye based on multimodal imaging, including enhanced depth imaging optical coherence tomography (OCT), swept-source OCT angiography, and indocyanine green angiography. Multimodal imaging is valuable in demonstrating the distinctive appearance of this entity and differentiating it from more vision-threatening differential diagnoses, such as ophthalmomyiasis interna, choroidal neoplasms, retinochoroidal anastomosis, and inflammatory conditions.
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http://dx.doi.org/10.1159/000521895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082210PMC
March 2022

Literature Review of Mothers Diagnosed With COVID-19 and the Impact on Breastfeeding Their Newborns.

Nurs Womens Health 2022 Jun 9;26(3):234-241. Epub 2022 May 9.

In early 2020, newborns were separated from their mothers who were diagnosed with COVID-19 infection. The purpose of this literature review is to examine the current evidence to determine if the transmission of COVID-19 infection to the neonate increases if newborns are directly breastfed by mothers who are positive for COVID-19 infection. There were 28 studies conducted in seven countries, with 10 of those studies conducted in the United States. In total, 5,123 neonates were born to mothers diagnosed with COVID-19, with 3,872 neonates determined to have been breastfed or provided mixed feeding including breast milk. Overall, 2.35% (91/3,872) of the newborns tested positive, and all recovered from COVID-19 infection. As frontline health care providers, nurses are instrumental in offering support and education on the risks and benefits of breastfeeding for individuals diagnosed with COVID-19.
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http://dx.doi.org/10.1016/j.nwh.2022.03.010DOI Listing
June 2022

Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis.

PLoS One 2022 27;17(4):e0267495. Epub 2022 Apr 27.

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, United States of America.

Background: Previous studies proposed possible applications of spectral-domain optical coherence tomography (SD-OCT) measurements in prognosticating pathologies observed in overweight/obesity, including ocular, vascular, and neurologic consequences. Therefore, we conducted a systematic review and meta-analysis to investigate the changes in the in SD-OCT measurements of the patients with higher body mass index (BMI) compared to normal weight individuals.

Materials And Methods: We conducted a systematic search on PubMed, Scopus, and Embase. The search results underwent two-phase title/abstract and full-text screenings. We then analyzed SD-OCT measurements differences in patients with high BMI and controls, and performed meta-regression, sub-group analysis, quality assessment, and publication bias assessment. The measurements included macular thickness, cup to disc ratio, ganglion cell-inner plexiform layer (GC-IPL) and its sub-sectors, RNFL and peripapillary RNFL (pRNFL) and their sub-layers, and choroidal thickness and its sub-sectors.

Results: 19 studies were included in this meta-analysis accounting for 1813 individuals, 989 cases and 824 controls. There was an overall trend towards decreased thickness in high BMI patients, but only two measurements reached statistical significance: temporal retinal nerve fiber layer (RNFL) (Standardized mean difference (SMD): -0.33, 95% confidence interval (CI): -0.53 to -0.14, p<0.01) and the choroidal region 1.0 mm nasal to fovea (SMD: -0.38, 95% CI: -0.60 to -0.16, p<0.01).

Conclusion: Some ocular layers are thinner in patients with higher BMI than the controls. These SD-OCT measurements might correlate with adverse events related to increased body weight and have prognostic abilities. As SD-OCT is a robust, rapid and non-invasive tool, future guidelines and studies are needed to evaluate the possibility of their integration into care of the patients with obesity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267495PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045631PMC
April 2022

Ischemic retinal events after COVID-19 vaccination.

Am J Ophthalmol Case Rep 2022 Jun 18;26:101540. Epub 2022 Apr 18.

Wilmer Eye Institute, Johns Hopkins, 1800 Orleans St, Baltimore, MD, 21287, USA.

Purpose: We report 2 cases of ischemic retinal events occurring soon after administration of the Moderna and Johnson & Johnson/Janssen COVID-19 vaccines. To our knowledge, these are the first reports of isolated ischemic retinal events occurring after COVID-19 vaccination.

Observations: A 57-year-old female had new onset floaters of the left eye within days of her second Moderna COVID-19 vaccination, which progressively worsened prompting her to present for evaluation. She was diagnosed with a branch retinal vein occlusion in the left eye. A 20-year-old female presented with persistent central scotomata in both eyes, which she first noticed two days after her Johnson & Johnson/Jannsen COVID-19 vaccination. She was diagnosed with acute macular neuroretinopathy of both eyes.

Conclusions And Importance: The potential side effects of COVID-19 vaccines are still being established; however, there has been concern over pro-thrombotic events with these vaccines, with most concerns directed toward the Johnson & Johnson vaccine. We observed likely transient pro-thrombotic retinal milieu in patients who received these vaccines though it remains unclear whether there is a shared mechanism between systemic response to the COVID-19 spike protein and the highly pro-thrombotic state seen in COVID-19 infections. In the case of our patients, we postulate their immunologic responses to the vaccines - and possibly a resultant pro-thrombotic state - may have precipitated their ischemic retinal events. We thus recommend that patients with ocular symptoms after COVID-19 vaccination undergo comprehensive ophthalmologic evaluation.
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http://dx.doi.org/10.1016/j.ajoc.2022.101540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9014657PMC
June 2022
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