Publications by authors named "Kyle D Kovacs"

18 Publications

  • Page 1 of 1

Automated Retinal Layer Segmentation in CLN2-Associated Disease: Commercially Available Software Characterizing a Progressive Maculopathy.

Transl Vis Sci Technol 2021 07;10(8):23

Department of Ophthalmology, Retina Service, Weill Cornell Medical College, New York, NY, USA.

Purpose: CLN2-associated disease is a hereditary, fatal lysosomal storage disorder characterized by progressive brain and retinal deterioration. Here, we characterize the inner and outer retinal degeneration using automated segmentation software in optical coherence tomography scans, providing an objective, quantifiable metric for monitoring subtle changes previously identified with a validated disease classification scale (the Weill Cornell Batten Scale).

Methods: This study is a retrospective, single-center cohort review of images from examinations under anesthesia in treatment-naïve patients with CLN2-associated disease. Automated segmentation software was used to delineate retinal nerve fiber, ganglion cell layer (GCL), and outer nuclear layer (ONL) thickness measurements in the fovea, parafovea, and perifovea based on age groups (months): 30 to 38, 39 to 45, 46 to 52, 53 to 59, 60 to 66, and 67 or older.

Results: Twenty-seven eyes from 14 patients were included, with 8 serial images yielding 36 interpretable optical coherence tomography scans. There was a significant difference in parafoveal ONL thickness between 39 to 45 and 46 to 52 months of age (P = 0.032) not seen in other regions or retinal layers. Perifoveal ONL demonstrated a difference in thickness between the 60 to 66 and greater than 67 months age cohorts (P = 0.047). There was strong symmetry between eyes, and high segmentation repeatability.

Conclusions: Parafoveal ONL thickness represents a sensitive, early age indicator of CLN2-associated degeneration. Outer retinal degeneration is apparent at younger ages than inner retinal changes though in treatment-naïve patients all retinal layers showed significant differences between 60 to 66 and more than 67 months of age.

Translational Relevance: This study establishes sensitive, quantitative biomarkers for assessing retinal degeneration in a large cohort natural history study in anticipation of future clinical trials.
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http://dx.doi.org/10.1167/tvst.10.8.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322716PMC
July 2021

Novel MFRP Mutation with Nanophthalmos, Optic Disc Drusen, and Peripheral Retinoschisis Imaged with Ultra-Widefield OCT.

Retin Cases Brief Rep 2021 Jul 16. Epub 2021 Jul 16.

Department of Ophthalmology, Weill Cornell Medical College, New York, United States.

Purpose: To describe with multimodal imaging including the use of ultra-widefield optical coherence tomography (OCT) imaging a distinct phenotype of autosomal recessive nanophthalmos associated with a novel mutation of the MFRP gene (membrane-type frizzled-related protein).

Methods: Case report and review of the relevant literature.

Patients: Single patient followed by the Weill Cornell Medicine Department of Ophthalmology Retina and Glaucoma Services.

Results: A patient with a novel homozygous mutation in the MFRP gene (c.472C>T) presented with nanophthalmos, optic disc drusen, foveal hypoplasia, and extensive peripheral retinoschisis, which was revealed to be multilevel retinoschisis on ultra-wide field OCT. Unlike other reported cases, the findings associated with this novel mutation did not include foveoschisis nor clinically obvious retinitis pigmentosa. The patient underwent prophylactic peripheral laser iridotomy in both eyes.

Conclusion: Here we present a patient with nanophthalmos, optic disc drusen, and foveal hypoplasia associated with extensive peripheral retinoschisis imaged by ultra-widefield OCT, but not foveal retinoschisis or prominent retinitis pigmentosa. The findings may expand the clinical spectrum of MFRP-associated nanophthalmos.
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http://dx.doi.org/10.1097/ICB.0000000000001179DOI Listing
July 2021

Quantitative Modeling of Ultra-Widefield Choroidal Indocyanine Green Angiography in Systemic Vascular Diseases.

Ophthalmic Surg Lasers Imaging Retina 2021 May 1;52(5):281-287. Epub 2021 May 1.

Background And Objective: To evaluate quantitative measurements of choroidal vasculature as obtained via ultra-widefield indocyanine green angiography (ICGA) in patients with systemic vascular diseases.

Patients And Methods: Retrospective chart review and image analysis of 38 eyes from 21 patients with ICGA as part of routine retinal care. Images were binarized with lines drawn at specific antero-posterior landmarks. The vessel density and mean vessel caliber were measured along these lines and correlated with systemic vascular disease status.

Results: Unlike those with other systemic vascular diseases, patients with obstructive sleep apnea (OSA) were found to have increased choroidal vascular density and vessel caliber in all measurements of the peripheral choroid compared with those patients without ( < .05 for all measurements).

Conclusions: Patients with OSA may have increased vascular density secondary to increased choroidal vessel caliber. Further work is needed to validate the modeling and confirm the association. .
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http://dx.doi.org/10.3928/23258160-20210429-06DOI Listing
May 2021

OCT Findings in Presumed Digoxin Retinal Toxicity.

Ophthalmol Retina 2021 May 6. Epub 2021 May 6.

Retina Service, Weill Cornell Medicine, New York, New York. Electronic address:

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http://dx.doi.org/10.1016/j.oret.2021.04.019DOI Listing
May 2021

A 4-Year-Old Girl With Earache and Double Vision.

JAMA Ophthalmol 2021 02;139(2):232-233

Department of Ophthalmology and Visual Science, Yale Medical School, New Haven, Connecticut.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.4057DOI Listing
February 2021

Fractal Dimension Analysis of Widefield Choroidal Vasculature as Predictor of Stage of Macular Degeneration.

Transl Vis Sci Technol 2020 06 19;9(7):22. Epub 2020 Jun 19.

Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA.

Purpose: To evaluate the fractal dimension ( ) of the choroidal vasculature using widefield indocyanine green (ICG) angiography and correlate it with the stage of age-related macular degeneration (AMD).

Methods: Widefield ICG angiography performed on 38 eyes was retrospectively analyzed using the FracLac application within the National Institutes of Health ImageJ software to determine regional fractal dimensions in the macular field and widefield. These values were then associated with a diagnosis of no AMD, non-exudative AMD (subdivided into early/intermediate stage vs. advanced stage), or exudative AMD (subdivided into with or without geographic atrophy). The mean values were compared using Wilcoxon's test.

Results: Early/intermediate non-exudative AMD and exudative AMD without geographic atrophy were found to have statistically significantly lower values compared to an absence of AMD when examining the macular field. Exudative AMD with geographic atrophy was found to have a statistically significant lower choroidal fractal dimension compared to no AMD when studied in the widefield.

Conclusions: Advanced stages of macular degeneration were found to have significantly decreased the fractal dimensions of choroidal vasculature on widefield ICG compared to early/intermediate stages, possibly implying a generalized reduction in complexity and/or vessel caliber of the choroid with advancing stage of AMD. This finding agrees with previous understanding of the development of choriocapillaris atrophy in advanced macular degeneration.

Translational Relevance: These findings suggest that using automated fractal analysis techniques can aid in differentiating stages of macular degeneration and, with further study, may be used to predict advancement of macular degeneration.
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http://dx.doi.org/10.1167/tvst.9.7.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414655PMC
June 2020

Scleral-Sutured Intraocular Lens Dislocations Secondary to Eyelet Fractures.

Am J Ophthalmol 2021 01 8;221:273-278. Epub 2020 Aug 8.

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

Objective: To report clinical features and visual outcomes following eyelet fractures of scleral-sutured enVista MX60 (Bausch + Lomb) intraocular lenses (IOL).

Design: Retrospective, multi-center, multi-surgeon, observational case series.

Methods: Study Population: Patients with scleral-sutured enVista MX60 IOLs that experienced either an intraoperative or post-operative eyelet fracture associated with dislocation or subluxation.

Procedures: All records were reviewed for patients with a dislocated or subluxed scleral-sutured enVista MX60 IOL. Clinical features and outcomes were gathered. Main Outcome Measures: Clinical setting, surgical technique, complications, and visual acuity.

Results: A total of 25 scleral-sutured enVista MX60 IOLs displacements secondary to eyelet fractures in 23 eyes of 23 patients were included. There were 20 IOLs that sustained a postoperative fracture and 5 IOLs that sustained an intraoperative fracture. Of the postoperative fractures, 7 were dislocated and 13 were subluxed. Gore-Tex was the suture of choice for 19 of the postoperative fractures and all 5 of the intraoperative fractures, and Prolene was used for 1 postoperative fracture. The mean time until postoperative fracture was 96 ± 125 days, and the median time was 61 (IQR 48-144) days. Of the postoperative fractures, new MX60s were sutured in 10 patients, and 2 of them experienced repeat displacements due to a new eyelet fracture. In the intraoperative fracture group, new MX60s were sutured in 4 patients and an Akreos AO60 lens was placed in the 5th patient. The mean preoperative best-corrected logMAR visual acuity for all patients improved from 1.2 ± 0.8 (20/317 Snellen equivalent) to 0.5 ± 0.5 (20/63 Snellen equivalent) at most recent follow-up after lens replacement.

Conclusions: Scleral-sutured MX60 intraocular lenses can experience intraoperative or postoperative eyelet fractures, resulting in lens subluxation or dislocation. Surgeons should be aware of this complication when evaluating secondary intraocular lens options.
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http://dx.doi.org/10.1016/j.ajo.2020.07.049DOI Listing
January 2021

Hypopyon following selective laser trabeculoplasty.

Am J Ophthalmol Case Rep 2020 Jun 20;18:100675. Epub 2020 Mar 20.

Weill Cornell Medical College, Department of Ophthalmology, New York, NY, United States.

Purpose: To report a hypopyon following selective laser trabeculoplasty (SLT).

Observations: An 85-year-old woman with primary open-angle glaucoma underwent routine SLT. In the early post-procedural period, she presented with pain and decreased vision, and she was found to have hypopyon, trabeculitis, and corneal edema. The patient was treated with prednisolone acetate and empirically with valacyclovir due to the possibility of herpetic keratouveitis. Work-up for potential etiologies was unrevealing. Her symptoms resolved with treatment, and at eight months follow-up her visual acuity and intraocular pressure had stabilized to her baseline.

Conclusions: Though safe, SLT may be associated with rare adverse events requiring intervention. Hypopyon following SLT is extremely rare, and investigation for causes unrelated to the history of SLT should be undertaken as appropriate.

Importance: To the best of our knowledge, this is the first report of a hypopyon following SLT in a patient with no history of inflammatory intra-ocular disease.
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http://dx.doi.org/10.1016/j.ajoc.2020.100675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163075PMC
June 2020

Symmetric Age Association of Retinal Degeneration in Patients with CLN2-Associated Batten Disease.

Ophthalmol Retina 2020 07 22;4(7):728-736. Epub 2020 Jan 22.

Department of Ophthalmology, Retina Service, Weill Cornell Medical College, New York, New York. Electronic address:

Purpose: Mutations in the CLN2 gene lead to a neurodegenerative and blinding lysosomal storage disorder: late infantile neuronal ceroid lipofucinosis, also known as "CLN2 disease." The purpose of the current study was to characterize the evolution of CLN2-associated retinal manifestations using the Weill Cornell Batten Scale (WCBS) and the age association of the retinal degeneration using central subfield thickness (CST) measurements and then correlate these findings with fundus photography and OCT to determine a critical period for retinal intervention.

Design: Retrospective, single-center cohort.

Participants: Eighty-four eyes of 42 treatment-naïve patients with CLN2 disease.

Methods: Clinical records, fundus photographs, and OCT imaging for patients with CLN2 disease collected during examinations under anesthesia were reviewed. Imaging was categorized per WCBS criteria by 3 masked graders.

Main Outcome Measures: CLN2-associated retinopathy assessed using WCBS scores, fundus photographs, and OCT imaging, correlated with patient age.

Results: Eighty-four eyes of 42 patients had baseline fundus photographs, with baseline OCT in 31 eyes of 16 patients. Fundus photographs were obtained serially for 26 eyes of 13 patients, and serial OCT scans were obtained in 10 eyes of 5 patients. At baseline, bilateral WCBS scores were highly correlated for OCT and fundus photographs (r = 0.96 and 0.82, respectively). Central subfield thickness was negatively correlated with left and right eye WCBS OCT scores (r = -0.92 and -0.83, respectively; P < 0.001) and fundus photograph scores (r = -0.80 and -0.83, respectively; P < 0.001). OCT thickness was symmetrical between each eye. Baseline OCT data with age fit using a sigmoid function demonstrated a period of accelerated loss between 48 and 72 months of age.

Conclusions: Retinal degeneration associated with CLN2 disease manifests as a progressive, symmetrical decline, which appears to accelerate during a critical period at 48 to 72 months of age, suggesting intervention with retina-specific CLN2 gene therapy should occur ideally before or as early as possible within this critical period. The WCBS is a valuable tool and is highly correlated with the extent of retinal degeneration observed in OCT or fundus photographs; by using the fellow eye as a control, this grading scale can be used to monitor the effect of CLN2 gene therapy in future trials.
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http://dx.doi.org/10.1016/j.oret.2020.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354207PMC
July 2020

Focal Choroidal Excavation Expansion Following Treatment of Associated Choroidal Neovascular Membrane.

Ophthalmic Surg Lasers Imaging Retina 2019 12;51(1):54-57

The authors describe a case of a previously unreported phenomenon of focal choroidal excavation (FCE) expansion, in absence of inflammation, due to treatment of an associated choroidal neovascular membrane (CNVM). A patient with new type 2 CNVM, treated during 43 months of follow-up with aflibercept, experienced significant expansion of an FCE with conversion from nonconforming to conforming type. FCE is part of the pachychoroid spectrum and the regression of an associated CNVM during aflibercept treatment as seen in the authors' patient may elucidate the pathogenesis of some forms of focal choroidal excavation and their evolution over time. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:54-57.].
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http://dx.doi.org/10.3928/23258160-20191211-08DOI Listing
December 2019

Corneal hysteresis and anterior segment optical coherence tomography anatomical parameters in primary angle closure suspects.

Clin Exp Ophthalmol 2018 07 11;46(5):468-472. Epub 2018 Jan 11.

Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA.

Importance: Corneal hysteresis (CH) is a dynamic marker of structural and functional changes in the cornea associated with intraocular pressure (IOP) and central corneal thickness, but its utility in assessing primary angle closure suspects (PACS) has not been fully elucidated.

Background: This study assesses if anterior segment measurements correlate with CH in PACS patients.

Design: IRB-approved retrospective review of imaging and records at a university practice.

Participants: Sixty-three eyes from 37 patients diagnosed as PACS, without other ocular pathology.

Methods: Every eye underwent measurements including: ocular response analyzer (ORA), anterior segment optical coherence tomography (OCT) and a clinical evaluation. ORA measurements were correlated with other anatomic parameters using a mixed effects multivariable linear regression framework.

Main Outcome Measures: ORA measurements included: CH, corneal resistance factor, Goldmann IOP (IOP ) and corneal compensated IOP (IOP ). Anterior segment OCT measurements included: central corneal thickness (CCT ), nasal and temporal peripheral corneal thicknesses (PCT1 and PCT2), anterior chamber depth (ACD), nasal angle to temporal angle distance (ATA) and temporal and nasal angle measurements. Clinical measurements included: central corneal thickness via pachymetry, IOP measured by Goldmann applanation, axial length by A-scan ultrasound and spherical equivalent.

Results: CH was negatively correlated with IOP and ACD CH was positively correlated with CCT , CCT , CRF, PCT1 and PCT2. Females were found to have lower CH. In multivariable regression controlling for gender, CCT, PCT, IOP and ACD, no correlation was seen between CH and anatomic measurements.

Conclusions And Relevance: CH values in PACS do not correlate with anterior segment anatomy.
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http://dx.doi.org/10.1111/ceo.13135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327184PMC
July 2018

Cicatricial Eyelid Paralysis Secondary to Trigeminal Trophic Syndrome.

Ophthalmic Plast Reconstr Surg 2017 May/Jun;33(3):e78

Department of Ophthalmology and Visual Science, Yale University Medical School, New Haven, Connecticut, U.S.A.

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http://dx.doi.org/10.1097/IOP.0000000000000766DOI Listing
December 2017

Delayed bilateral fibrinous anterior chamber reaction following autologous bone marrow transplant and cataract surgery.

Am J Ophthalmol Case Rep 2016 Jul 14;2:8-10. Epub 2016 Apr 14.

Department of Ophthalmology and Visual Science, Yale University School of Medicine, 40 Temple Street, New Haven, CT 06510, USA.

Purpose: Immune reconstitution uveitis (IRU) is a well-described phenomenon that by definition occurs in patients with AIDS who undergo highly active antiretroviral therapy resulting in a rebound inflammatory response to the presence of clinically latent cytomegalovirus (CMV). We hypothesize that similar phenomena may exist in other cohorts who undergo transient immunosuppression with rapid white blood cell count recovery.

Observations: A patient developed rebound inflammation a few months after cataract surgery with intraocular lens placement characterized by photophobia, significant anterior chamber cell and fibrinous deposits. She had a history of multiple myeloma treated with chemotherapy and a recovery of white blood cell counts following autologous bone marrow transplant. She underwent a thorough work-up for infectious etiologies, as well as the presence of intraocular CMV, which were negative. Her vision and symptoms improved to baseline with the use of topical steroids and at one year her exam remained stable.

Conclusions And Importance: With a negative work-up for infectious etiologies, and the timing and clinical presentation, the patient's inflammation was likely the result of rapid white blood cell count recovery following iatrogenic immunosuppression similar to the mechanism described for IRU.
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http://dx.doi.org/10.1016/j.ajoc.2016.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757366PMC
July 2016

Case-matched comparison of vitrectomy, peripheral retinal endolaser, and endocyclophotocoagulation versus standard care in neovascular glaucoma.

Retina 2015 Jun;35(6):1072-83

*Retina Service, Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; †University of California, San Diego School of Medicine, San Diego, California; ‡College of Human Medicine, Michigan State University, East Lansing, Michigan; §Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts; ¶Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt; and **Albert Einstein College of Medicine, New York, New York.

Purpose: To evaluate the efficacy of combination pars plana vitrectomy, endoscopic peripheral panretinal photocoagulation, and endocyclophotocoagulation (ECP) as compared with standard care in patients with neovascular glaucoma.

Methods: This age-matched case-controlled retrospective series of 54 eyes compared the clinical outcomes between a consecutive series of combination pars plana vitrectomy/panretinal photocoagulation/ECP (n = 27) versus the current standard of care (n = 27) for patients with neovascular glaucoma. "Standard" treatments for patients with neovascular glaucoma include panretinal photocoagulation, intravitreal bevacizumab, filtration surgery, pars plana vitrectomy, and Ahmed valve placement.

Results: After 1 year, mean intraocular pressure reduced from 40.7 ± 12.40 mmHg preoperatively to 12.3 ± 4.84 mmHg (P < 0.001) in the ECP group and from 34.7 ± 12.38 mmHg to 23.2 ± 12.34 mmHg in the control group (P = 0.002). Compared with controls, the mean drop in intraocular pressure in the ECP group was significantly greater at all postoperative visits. Logarithm of the minimal angle of resolution visual acuity outcomes were similar in both groups. There were 2 cases (7.4%) of postoperative phthisis bulbi in each group.

Conclusion: Endoscopic pars plana vitrectomy, panretinal photocoagulation, and ECP seem to control intraocular pressure to a greater extent than standard glaucoma treatments in patients with neovascular glaucoma. In this aged-matched comparative case series, there was no significant difference between the two treatments' effects on visual acuity.
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http://dx.doi.org/10.1097/IAE.0000000000000449DOI Listing
June 2015

Morphologic differences in epiretinal membranes on ocular coherence tomography as a predictive factor for surgical outcome.

Retina 2011 Sep;31(8):1692-8

Division of Ophthalmology, Retina Service Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.

Purpose: To evaluate whether morphologic differences in idiopathic epiretinal membranes seen on optical coherence tomography may help predict surgical outcomes.

Methods: Seventy-five eyes of 74 patients who underwent primary pars plana vitrectomy with membrane peeling were retrospectively reviewed. Outcome measures included visual acuity, macular contour on optical coherence tomography, central macular thickness, and reoperation rate.

Results: According to the preoperative macular contour, 75 eyes were categorized into 4 types: 42 eyes were included in the diffuse (DIF) type, 12 in the cystoid macular edema (CME) type, 14 in the pseudolamellar hole (PLH) type, and 7 in the vitreomacular traction (VMT) type. Surgical procedure significantly improved vision in all types except for the PLH type (DIF, P < 0.0001; CME, P = 0.0378; PLH, P = 0.838; and VMT, P = 0.0273). There was a significant relationship between pre- and postoperative macular contour. All preoperative VMT showed normal contour on postoperative optical coherence tomography but had the highest reoperation rate.

Conclusion: Surgical intervention for the PLH-type epiretinal membrane was not associated with the visual improvement seen in other epiretinal membrane types, and the VMT type had the highest reoperation rate. Future studies should evaluate the potential benefit of internal limiting membrane peeling with or without short-term gas tamponade in these cases.
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http://dx.doi.org/10.1097/IAE.0b013e31820f49d0DOI Listing
September 2011

A retrospective analysis of triple combination therapy with intravitreal bevacizumab, posterior sub-tenon's triamcinolone acetonide, and low-fluence verteporfin photodynamic therapy in patients with neovascular age-related macular degeneration.

Retina 2011 Mar;31(3):446-52

Division of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.

Purpose: To assess the efficacy of triple combination therapy (TCT) including bevacizumab (BEV), low-fluence photodynamic therapy, and posterior sub-Tenon's triamcinolone acetonide in patients with wet age-related macular degeneration.

Methods: This institutional review board-approved retrospective consecutive case series included 31 eyes treated for wet age-related macular degeneration with TCT at the Beth Israel Deaconess Medical Center between June 2004 and November 2008. Outcome measures included visual acuity, retinal thickness as measured by optical coherence tomography, time to retreatment, and complications.

Results: Triple combination therapy eyes showed significant 3-month and 6-month improvement in visual acuity of 0.140 ± 0.273 logarithm of the minimum angle of resolution and 0.182 ± 0.383 logarithm of the minimum angle of resolution after treatment, respectively (P = 0.0219 and 0.0470, respectively). Central retinal thickness significantly improved at 3 months (-123.8 ± 102.7 μm), 6 months (-87.7 ± 99.8 μm), and 12 months (-101.6 ± 103.3 μm) on optical coherence tomography. Half of eyes that underwent TCT required retreatment by the conclusion of their follow-up, and eyes that underwent TCT had a 1-year Kaplan-Meier survival rate of 62.1 ± 10.8%.

Conclusion: Triple combination therapy (TCT) appears to effectively improve visual acuity and decrease retinal thickness often without need for subsequent retreatment within the first year of follow-up. Further investigation of TCT in prospective trials is warranted.
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http://dx.doi.org/10.1097/IAE.0b013e3181f6391fDOI Listing
March 2011

Apoptosis in diabetic fibrovascular membranes after panretinal photocoagulation.

Ophthalmic Surg Lasers Imaging 2010 Jun 30;41 Online. Epub 2010 Jun 30.

University of Massachusetts Medical School, Department of Ophthalmology, Boston, Massachusetts, USA.

A more complete understanding of the role of apoptosis in the regression of diabetic neovasculature following laser panretinal photocoagulation (PRP) will both elucidate the treatment's therapeutic mechanism and potentially lead to novel treatments for neovascularization associated with proliferative diabetic retinopathy that target apoptotic pathways. Pars plana vitrectomy with fibrovascular membrane delamination was performed on five patients with proliferative diabetic retinopathy, with four having received previous PRP treatment and one no previous laser treatment. Using in situ terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, propidium iodide and hematoxylin-eosin staining, apoptotic cells were identified in the excised membranes. The authors found evidence of cells undergoing apoptosis in all of the excised membranes, with increasing amounts of preoperative PRP associated with an increased number of apoptotic cells per millimeter of membrane. The preliminary data suggest that the decrease in ambient mitogen, initiated by PRP treatment, activates apoptosis in diabetic fibrovascular membranes.
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http://dx.doi.org/10.3928/15428877-20100625-06DOI Listing
June 2010

Minocycline inhibition of photoreceptor degeneration.

Arch Ophthalmol 2009 Nov;127(11):1475-80

Department of Ophthalmology, Peking University First Hospital, Beijing, China.

Objective: To determine whether systemic minocycline can protect photoreceptors in experimental retinal detachment (RD).

Methods: Retinal detachment was induced in mice by subretinal injection of sodium hyaluronate, 1.4%. In 1 experiment, mice received daily injections of minocycline (group 1) or saline (group 2). In a second experiment, mice were treated with minocycline or saline beginning 24 hours prior, immediately after, or 24 hours after experimental RD. In both experiments, photoreceptor cell survival and apoptosis were assessed by immunohistochemistry with primary antibodies against photoreceptor cell markers, rod rhodopsin, and cone opsin, and by terminal deoxynucleotidyl transferase-mediated dUTP-biotin end labeling.

Results: Photoreceptor cell apoptosis was detected at day 1 after experimental RD, with apoptotic cells peaking in number at day 3 and dropping by day 7. Treatment with minocycline significantly reduced the number of apoptotic photoreceptor cells associated with RD when given 24 hours before or even 24 hours after RD.

Conclusions: Our data suggest that minocycline may be useful in the treatment of photoreceptor degeneration associated with RD, even when given up to 24 hours after RD.

Clinical Relevance: Use of minocycline in patients with macula-off RD may prevent photoreceptor apoptosis and glial cell proliferation, improving final visual outcomes.
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http://dx.doi.org/10.1001/archophthalmol.2009.288DOI Listing
November 2009
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