Publications by authors named "Joshua Manusow"

17 Publications

  • Page 1 of 1

Primary ductal adenocarcinoma of the lacrimal gland: A review and report of five cases.

Surv Ophthalmol 2020 May - Jun;65(3):371-380. Epub 2019 Dec 16.

Department of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address:

Primary ductal adenocarcinoma (PDA) is a rare epithelial tumor of the lacrimal gland. Herein we report 5 cases and review 29 published cases of PDA of the lacrimal gland. Among these 5 cases, the most common clinical presentation was painless swelling and/or proptosis of their eye. The size of the lesions ranged from 1.6 to 2.5 cm. Histopathologic examination revealed proliferations of ductal or gland-like cells with vesiculated pleomorphic nuclei and prominent nucleoli. Tumor cells stained positive for epithelial and apocrine differentiation markers. Immunohistochemistry for human epidermal growth factor 2 was positive in 2 of the 4 cases. Four of the five patients were alive at the last follow-up visit. One died with bone metastases, which were diagnosed 25 months after exenteration and then survived an additional 51 months. On reviewing of twenty-nine previously published cases of PDA, the mean age of diagnosis was 58 years, with a male predominance (75%). Fifteen patients (54%) had distant metastases, 1 (4%) had local recurrence, and 10 (37%) suffered from a PDA-related death. PDA is a high-grade aggressive epithelial tumor of the lacrimal gland. Although rare, awareness and recognition of this malignancy are important to help determine prognosis and treatment options.
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http://dx.doi.org/10.1016/j.survophthal.2019.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215120PMC
December 2019

The Toronto experience with the Argus II retinal prosthesis: new technology, new hope for patients.

Can J Ophthalmol 2018 02 23;53(1):9-13. Epub 2017 Dec 23.

Department of Ophthalmology and Vision Sciences, University Health Network Hospitals, University of Toronto, Toronto, Ont. Electronic address:

Surgical restoration of vision with retinal prostheses is a new and developing technology currently available in a select group of countries, Canada among them. The Argus II retinal prosthesis is the first commercially available device for restoration of vision in patients with Retinitis Pigmentosa or with similar retinal pathology who still have minimal residual native vision. The surgery is complex and requires training however it is within the abilities of any experienced retina surgeon. Surgical experience builds up with each case and in our patients length of surgery constantly went down. Complications occurred however we experienced no catastrophic events. Most notable is that in our implanted cases the Argus II technology proved to be beneficial to most patients. In order to obtain optimal results with this surgical intervention it is absolutely required that the surgical work is complemented simultaneously with the work of a specialized rehabilitation team. A review of the technology, of our experience, comments and concerns is presented in this paper.
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http://dx.doi.org/10.1016/j.jcjo.2017.10.043DOI Listing
February 2018

Rehabilitation of lost functional vision with the Argus II retinal prosthesis.

Can J Ophthalmol 2018 02 12;53(1):14-22. Epub 2018 Jan 12.

Low Vision Service (University Health Network Hospitals), Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Toronto, Ont. Electronic address:

The Argus II retinal prosthesis is the first commercially available device for restoration of vision in patients with Retinitis Pigmentosa or with similar retinal pathology who still have minimal residual native vision. The technology is able to restore vision with production of artificial visual percepts which usually are given adequate useful interpretation by the visual system in most implanted patients. The technology usually produces visual perception at the level of shape identification or better in some cases enabling in many less dependence on vision substitution devices and skills. There is no consensus among vision rehabilitation practitioners on single methods for assessments, outcome measures and training, yet there is constant progress in these areas of concern. Hence the current vision rehabilitation practice related to the implantation of the Argus II retinal prosthesis is a work in progress with many learning opportunities for all involved. All agree that implementation of this technology in clinical practice requires the combined work of a multi-disciplinary team which includes a specialized surgical team as well as a specialized rehabilitation team in order to obtain optimal results. Our own experience is presented in this paper and indicates so far that the Argus II technology is beneficial to patients and that it could be successfully managed within the Canadian heath care system.
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http://dx.doi.org/10.1016/j.jcjo.2017.12.001DOI Listing
February 2018

The underemployed ophthalmologist-results of a survey of recent ophthalmology graduates.

Can J Ophthalmol 2016 Jun 11;51(3):147-53. Epub 2016 May 11.

Department of Ophthalmology and Misericordia Health Centre, University of Manitoba, Winnipeg, Man.

Objective: To survey recent graduates of Canadian ophthalmology residency programs with regard to current employment, fellowship, job finding strategies, operating room time and resources, scope of practice, and reasons for difficulty in finding a job.

Design: Cross-sectional survey.

Participants: Graduates of Canadian ophthalmology residency programs between 2009 and 2013 inclusive.

Methods: An electronic survey in English and French distributed via Surveymonkey to Canadian ophthalmology graduates from 2009 to 2013.

Results: Of the eligible ophthalmologists, 72% responded, and 81% of respondents had what they considered a job placement. The class of 2009 had the highest (100%) and the class of 2012 had the lowest (55%) employment rate. Of the respondents, 68% completed or were completing a fellowship, with retina being the most popular. Eighty percent of those with a job had operating room time with a median of 4 days per month, and 61% stated that their practice was open to all consultations, with cataract being the most common. Respondents felt adequately trained within the CanMEDS roles with the exception of manager. Only 11% felt they were adequately trained to run a business.

Conclusions: It is important that an ophthalmology health human resources strategy is developed to ensure that newly trained ophthalmologists can practice their skills to serve health-care needs now and in the future.
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http://dx.doi.org/10.1016/j.jcjo.2016.03.009DOI Listing
June 2016

Two cases of panuveitis with orbital inflammatory syndrome after influenza vaccination.

Can J Ophthalmol 2015 Oct;50(5):e71-4

University of Toronto, Toronto, Ont; University Health Network/Toronto Western Hospital, Toronto, Ont. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2015.05.016DOI Listing
October 2015

Secondary corneal amyloidosis after perforating corneal trauma: A series of 5 cases and review of the literature.

Surv Ophthalmol 2015 Nov-Dec;60(6):590-5. Epub 2015 Aug 4.

Department of Ophthalmology, The Ottawa Hospital, Ottawa, Ontario, Canada.

We retrospectively reviewed the clinical and surgical histories of 5 patients with traumatic secondary corneal amyloidosis, a relatively rare sequela of nonsurgical and surgical perforating corneal trauma. Four had history of nonsurgical trauma, and 1 had surgical trauma to the cornea. Three specimens were obtained by penetrating keratoplasties and 2 by excision of the cornea during evisceration of the ocular contents. All the corneal specimens showed full-thickness scars of a prior perforating wound with congophilic amyloid deposits that exhibited apple-green birefringence under polarized light and dichroism. All cases had variable degrees of predominantly chronic nongranulomatous inflammation. Ultrastructural examination in 1 patient disclosed 8-nm diameter fibrils in disarray, consistent with amyloid. Amyloid P immunostaining was positive in all 3 patients tested for this protein.
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http://dx.doi.org/10.1016/j.survophthal.2015.07.004DOI Listing
May 2016

Bilateral Eyelid Nodules Impairing Eyelid Closure in 2 Siblings.

JAMA Ophthalmol 2015 Jul;133(7):847-8

Department of Ophthalmology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1001/jamaophthalmol.2015.209DOI Listing
July 2015

Unassisted Scleral Depression During Vitrectomy Surgery: Two Simple, Cost-Effective Techniques.

Ophthalmic Surg Lasers Imaging Retina 2015 May;46(5):577-8

Background And Objective: The ability to visualize and work in the region of the vitreous base during vitrectomy surgery is important. However, this usually requires the use of a surgical assistant for scleral depression or expensive chandelier systems requiring extra incisions. The authors describe two alternative simple, cost-effective techniques to independently and simultaneously view and cut (or apply laser) in this difficult anatomical region.

Technique: Light-pipe assisted scleral depression using a standard light pipe and ring depressor indentation while maintaining two intraocular instruments are described.

Conclusion: The described techniques are simple, cost-effective, safe, suitable for phakic and pseudo-phakic patients, and allow the surgeon to operate independently with maximum control.
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http://dx.doi.org/10.3928/23258160-20150521-10DOI Listing
May 2015

Update on pneumatic retinopexy.

Curr Opin Ophthalmol 2015 May;26(3):194-9

aDepartment of Ophthalmology and Vision Sciences, University of Toronto bDepartment of Ophthalmology, University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada.

Purpose Of Review: Pneumatic retinopexy is an effective, cost-efficient procedure for retinal detachment repair. We review the history, indications, procedure, outcomes, economics, and trends regarding this in-office procedure.

Recent Findings: Pneumatic retinopexy is classically performed in patients with small, superior retinal breaks, but these indications are expanding, with good results. Retinal reattachment rates with pneumatic retinopexy vary from 60% to 91% depending upon patient selection. Pneumatic retinopexy is less costly to perform than scleral buckling and pars plana vitrectomy and avoids many of the complications associated with these procedures. Despite these good results, recent data suggest that the use of pneumatic retinopexy is on the decline.

Summary: Recent review of the literature and our own personal experience using pneumatic retinopexy in selected cases of retinal detachment indicate that it is an effective and inexpensive procedure that avoids many of the complications that are associated with other retinal reattachment procedures.
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http://dx.doi.org/10.1097/ICU.0000000000000148DOI Listing
May 2015

Retinal vasculitis and ocular vitreous metastasis following complete response to PD-1 inhibition in a patient with metastatic cutaneous melanoma.

J Immunother Cancer 2014 16;2(1):41. Epub 2014 Dec 16.

University of Toronto Department of Ophthalmology and Vision Sciences, University Health Network/Toronto Western Hospital, 399 Bathurst Street, 6 East Room 415, Toronto, Ontario M5T 2S8 Canada.

We report on a 36-year-old woman treated with the anti PD-1 antibody Pembrolizumab for metastatic cutaneous melanoma in the first line setting. She achieved a complete response and then relapsed with metastases to the vitreous cavity with an associated angiographically determined retinal vasculitis. Vitreous metastasis without choroidal involvement is unusual and may be due to individual cell extravasation, vitreous hemorrhage containing malignant cells, or direct spread through the optic nerve. This finding highlights the need for immune sanctuary sites to be monitored in the presence of PD-1 inhibition and we hypothesize that the use of PD-1 inhibitor potentiated the patient's angiographically determined retinal vasculitis.
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http://dx.doi.org/10.1186/s40425-014-0041-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266968PMC
December 2014

Restoration of vision after surgical removal of an intraocular needlefish jaw.

Retin Cases Brief Rep 2012 ;6(3):298-300

Departments of *Ophthalmology †Laboratory Medicine (Pathology), University of Ottawa and The Ottawa Hospital, Ottawa, Canada.

Purpose: To describe the case of a globe-penetrating intraocular needlefish injury.

Methods: Clinicopathologic case report.

Results: A 38-year-old man had a globe-penetrating injury while swimming without eye protection in the Caribbean Sea. The foreign body was impaled in the nasal retina. After surgical removal, retinal repair, and subsequent cataract surgery, the best-corrected visual acuity was 20/20 in the affected eye. Histopathologic examination of the foreign body was consistent with a needlefish jaw.

Conclusion: This is the first reported case of a successful visual outcome after the surgical removal of an intraocular needlefish jaw. Furthermore, we advise that ophthalmologists should be recommending eye protection to people swimming in waters endemic to this dangerous fish.
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http://dx.doi.org/10.1097/ICB.0b013e318234cd1aDOI Listing
November 2014

Myxomatous corneal degeneration: a clinicopathological study of six cases and a review of the literature.

Surv Ophthalmol 2012 May-Jun;57(3):264-71. Epub 2012 Feb 25.

Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.

Thirteen cases with myxomatous changes of the corneal stroma have been reported to date. We report six additional cases with clinical, histopathological, and immunohistochemical data. The clinical appearance is most often a gelatinous, whitish elevation with insidious onset. Histopathologically, there are inconspicuous spindle- and stellate-shaped cells in a loose, myxoid matrix. The typical location is in the anterior cornea beneath the epithelium, with varying degrees of extension into the stroma. Vimentin and smooth-muscle actin immunohistochemical stains are characteristically positive, and staining occasionally may be seen with muscle-specific actin, whereas CD34 staining usually is negative. In most cases, myxomatous changes are a degenerative process involving transformation of stromal keratocytes into cells with prominent secretory activity and myofibroblastic differentiation. Most occur in corneas with a history of ocular disease or trauma that disrupts Bowman's layer. We suggest labelling lesions with these features as "myxomatous corneal degeneration." So-called "primary corneal myxomas" also exist where there is no significant history. It remains unclear whether the myxomatous changes in such lesions are neoplastic or degenerative. Myxomatous corneal changes are likely under-recognized and under-diagnosed.
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http://dx.doi.org/10.1016/j.survophthal.2011.09.006DOI Listing
June 2012

Isolated conjunctival lymphangioma.

Can J Ophthalmol 2011 Aug 7;46(4):369-70. Epub 2011 Jul 7.

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http://dx.doi.org/10.1016/j.jcjo.2011.06.018DOI Listing
August 2011

Osseous metaplasia with formation of hematopoietic bone marrow in a blind, painful eye.

Ophthalmic Plast Reconstr Surg 2011 May-Jun;27(3):e81-3

Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.

A 31-year-old woman underwent an evisceration of her blind, painful right eye with placement of an aluminum oxide orbital implant. Histopathologic assessment revealed functional hematopoietic bone marrow, confirmed by immunohistochemistry, within osseous metaplasia of the retinal pigment epithelium. This finding is exceedingly rare, with few cases reported in the English literature. This report raises numerous questions, including the association between pain and hematopoietic bone marrow formation, the potential benefits of hematopoietic bone marrow in the eye, and the molecular biologic basis for this rare phenomenon.
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http://dx.doi.org/10.1097/IOP.0b013e3181eea809DOI Listing
August 2011

Bilateral massive posterior embryotoxon.

J Pediatr Ophthalmol Strabismus 2010 Sep 22;47 Online:e1-3. Epub 2010 Sep 22.

Department of Ophthalmology and Laboratory Medicine (Pathology), University of Ottawa, Ottawa, Ontario, Canada.

A 10-week-old infant died suddenly and unexpectedly. Histopathologic examination of the globes showed no signs of trauma but did disclose incidental bilateral, extremely prominent Schwalbe's rings (posterior embryotoxon). The authors believe this case is the largest example of posterior embryotoxon ever published and present a brief review of its associated syndromes.
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http://dx.doi.org/10.3928/01913913-20100920-07DOI Listing
September 2010

TLR signaling tailors innate immune responses in human microglia and astrocytes.

J Immunol 2005 Oct;175(7):4320-30

Neuroimmunology Unit, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.

The specific signals mediating the activation of microglia and astrocytes as a prelude to, or consequence of, CNS inflammation continue to be defined. We investigated TLRs as novel receptors mediating innate immune responses in human glial cells. We find that microglia express mRNA for TLRs 1-9, whereas astrocytes express robust TLR3, low-level TLR 1, 4, 5, and 9, and rare-to-undetectable TLR 2, 6, 7, 8, and 10 mRNA (quantitative real-time PCR). We focused on TLRs 3 and 4, which can signal through both the MyD88-dependent and -independent pathways, and on the MyD88-restricted TLR2. By flow cytometry, we established that microglia strongly express cell surface TLR2; TLR3 is expressed at higher levels intracellularly. Astrocytes express both cell surface and intracellular TLR3. All three TLRs trigger microglial activation upon ligation. TLR3 signaling induces the strongest proinflammatory polarizing response, characterized by secretion of high levels of IL-12, TNF-alpha, IL-6, CXCL-10, and IL-10, and the expression of IFN-beta. CXCL-10 and IL-10 secretion following TLR4 ligation are comparable to that of TLR3; however, other responses were lower or absent. TLR2-mediated responses are dominated by IL-6 and IL-10 secretion. Astrocytes respond to TLR3 ligation, producing IL-6, CXCL-10, and IFN-beta, implicating these cells as contributors to proinflammatory responses. Initial TLR-mediated glial activation also regulates consequent TLR expression; while TLR2 and TLR3 are subject to positive feedback, TLR4 is down-regulated in microglia. Astrocytes up-regulate all three TLRs following TLR3 ligation. Our data indicate that activation of innate immune responses in the CNS is not homogeneous but rather tailored according to cell type and environmental signal.
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http://dx.doi.org/10.4049/jimmunol.175.7.4320DOI Listing
October 2005