Publications by authors named "Nicolas A Yannuzzi"

89 Publications

Evaluation of the Content, Quality, and Readability of Patient Accessible Online Resources Regarding Cataracts.

Semin Ophthalmol 2021 Feb 26:1-8. Epub 2021 Feb 26.

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

Purpose: To evaluate the content quality, accuracy, and readability of commonly visited websites by cataract patients contemplating cataract surgery.

Setting: Freely available online information.

Design: Cross-sectional study.

Methods: Ten websites were evaluated in a cross-sectional study for content analysis using a grading sheet of 40 questions individually scored by three ophthalmologists. JAMA benchmarks were used to assess the quality. An online readability tool, , was used to assess the readability.

Results: There was a significant difference between the content and accuracy of each website according to a Kruskal-Wallis test (H = 22.623, = .007). The average score for all websites using the grading sheet was 90.85 out of 160 points, or 57% (SD 29.93, CI 95%±17.69). There was no significant correlation between website rank on Google.com and content quality of the website (r = 0.049, = .894). No websites complied with all 4 JAMA criteria for authorship. There was no significant correlation between content quality of each website and number of JAMA requirements met (r = -0.563, = .09). The average Flesch Reading Ease Score for all websites was 52.64 (SD 11.94, CI 95%±7.40), and the average Mean Reading Grade was 10.72 (SD 1.58, CI 95%±0.98). There was a significant difference in Mean Reading Grades between websites (H = 23.703, = .005). There was no significant correlation between content quality of the website and Mean Reading Grade (r = -0.552, = .098).

Conclusion: Commonly accessed online resources on cataracts and cataract surgery are insufficient to provide patients with a clear and complete understanding of their condition as well as available medical and surgical treatment options.
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http://dx.doi.org/10.1080/08820538.2021.1893758DOI Listing
February 2021

Postoperative Endophthalmitis Caused by (Formerly ) Acnes: Case Series and Review.

Case Rep Ophthalmol 2021 Jan-Apr;12(1):1-10. Epub 2021 Jan 7.

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

We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by , formerly known as . This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven from December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5-17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3-15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone ( = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics ( = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics ( = 1). Follow-up treatments included IOL removal ( = 2), intravitreal antibiotics ( = 1), and topical antibiotics ( = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by ( = 120) are listed. A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by is characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.
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http://dx.doi.org/10.1159/000510208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879283PMC
January 2021

Refractive Outcomes of Four-Point Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture.

Clin Ophthalmol 2020 21;14:4431-4437. Epub 2020 Dec 21.

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

Background/objective: To determine the refractive outcomes after 4-point scleral fixation of the Akreos AO60 intraocular lens with Gore-Tex suture.

Methods: This was a single referral center, multi-surgeon, retrospective consecutive case series. A total of 63 eyes met the inclusion criteria for having received surgical implantation of the Akreos AO60 intraocular lens with Gore-Tex suture from August 2014 to December 2018. Exclusion criteria included all ocular pathology that precluded an accurate refraction, concurrent ocular surgery, poor corrected pre-operative visual potential, among other factors. Main outcome measures included post-operative uncorrected visual acuity (VA), best-corrected VA, and spherical equivalent deviation from target.

Results: Mean pre-operative BCVA was 0.67 ± 0.64 LogMAR (20/93 Snellen). Mean final post-operative BCVA was 0.17 ± 0.18 (20/28 Snellen) and mean final post-operative UCVA was 0.31 ± 0.22 (20/41 Snellen). Mean post-operative spherical equivalent was -0.57 D. Mean post-operative astigmatism was 0.85 D.

Conclusion: Refractive outcomes after secondary implantation with Akreos AO60 are favorable in eyes with good visual potential.
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http://dx.doi.org/10.2147/OPTH.S282094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762441PMC
December 2020

Trends in Intravitreal Corticosteroid Agent Use by US Ophthalmologists in Medicare Beneficiaries and Association with Physician-Industry Interactions.

Retina 2020 Dec 10. Epub 2020 Dec 10.

Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136.

Purpose: To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits.

Design: Retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 to December 2017.

Results: A total of 1070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P=.01), but not TA, injections per year. Mid- and late-career physicians performed significantly greater total injections on average compared to early-career physicians (both P<.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P=.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P<.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P<.001).

Conclusion: From 2013 to 2017, the use of DEX increased while TA use remained stable. There was a positive association between DEX use and physician-industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship.
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http://dx.doi.org/10.1097/IAE.0000000000003081DOI Listing
December 2020

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

Am J Ophthalmol 2020 Dec 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
December 2020

UV-Photokeratitis Associated with Germicidal Lamps Purchased during the COVID-19 Pandemic.

Ocul Immunol Inflamm 2021 Jan 20;29(1):76-80. Epub 2020 Nov 20.

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

Purpose: To report photokeratitis caused by the improper use of germicidal lamps purchased during the COVID-19 pandemic.

Methods: Case series.

Results: Seven patients presented with acute ocular surface pain after exposure to UV-emitting germicidal lamps. Visual acuity was 20/30 or better in 13 of 14 eyes (93%). Anterior segment examination revealed varying degrees of conjunctival injection and diffusely distributed punctate epithelial erosions (PEEs) in every patient. No intraocular inflammation was identified across the cohort and all fundus examinations were normal. Treatment varied by provider and included artificial tears alone or in combination with antibiotic ointments and/or topical steroids. Five patients were followed via telehealth, one patient returned for an in-office visit, and one patient was lost to follow-up. Five of six patients endorsed complete resolution of symptoms within 2-3 days.

Conclusions: Patients should follow manufacturer recommendations when using UV-emitting germicidal lamps and avoid direct exposure to the ocular surface.
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http://dx.doi.org/10.1080/09273948.2020.1834587DOI Listing
January 2021

Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis.

Ophthalmol Retina 2020 Nov 14. Epub 2020 Nov 14.

Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.

Purpose: To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison.

Design: Multicenter, retrospective cohort study.

Participants: Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included.

Methods: Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison.

Main Outcome Measures: Single-operation anatomic success between the initial-eye and subsequent-eye RRD.

Results: Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010).

Conclusions: In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
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http://dx.doi.org/10.1016/j.oret.2020.11.002DOI Listing
November 2020

Posterior Segment Complications of Endothelial Keratoplasty.

Int Ophthalmol Clin 2020 ;60(4):97-111

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http://dx.doi.org/10.1097/IIO.0000000000000331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586729PMC
January 2020

The retina as a window to the basal ganglia: Systematic review of the potential link between retinopathy and hyperkinetic disorders in diabetes.

Parkinsonism Relat Disord 2020 11 13;80:194-198. Epub 2020 Oct 13.

The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

There is evidence that glycemic fluctuations trigger vascular-mediated dysfunction in both the retina and the striatopallidal regions in patients with diabetes. The latter is associated with a variety of hyperkinetic disorders that are rare but disabling and potentially preventable. We conducted a systematic review of the potential association between diabetic retinopathy and the risk and prognosis of hyperkinetic disorders in patients with diabetes. We identified a total of 461 articles and 147 were eligible for review. Nine out of 147 articles (6.12%) reported 13 patients with information on diabetic retinopathy. Glycemic fluctuations were present at onset in 10 patients (77%) and retinopathy was present in nine of them (69.23%). The degree of retinopathy was reported in four patients. Two had severe, bilateral proliferative retinopathy, one had moderate-to-severe non-proliferative retinopathy and one had non-proliferative retinopathy. In the nine patients with retinopathy, hyperkinesia persisted, required higher doses of dopamine receptor antagonists or deep brain stimulation. Retinopathy was absent in four cases (30.77%). In these patients, hyperkinesia resolved spontaneously or with lower doses of dopamine receptor antagonists. Diabetic retinopathy could be an indirect marker of striatopallidal microangiopathy in patients with diabetes. The severity of retinopathy may be associated with increased risk or worse prognosis for patients who develop hyperkinetic disorders of the diabetic striatopathy spectrum. Early detection of retinopathy could identify patients in which avoiding glycemic fluctuations may prevent the development of striatopathy and hyperkinetic disorders.
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http://dx.doi.org/10.1016/j.parkreldis.2020.10.025DOI Listing
November 2020

Characterization of Pseudomonas aeruginosa isolates from patients with endophthalmitis using conventional microbiologic techniques and whole genome sequencing.

J Ophthalmic Inflamm Infect 2020 Sep 28;10(1):25. Epub 2020 Sep 28.

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

Purpose: To demonstrate antibiotic susceptibility and genomic virulence factor profiles of Pseudomonas aeruginosa isolates from patients with culture-confirmed endophthalmitis.

Methods: Clinical isolates from patients diagnosed with pseudomonas endophthalmitis were included. Laboratory antibiotic susceptibility testing and whole genome sequencing was performed on all isolates.

Results: In the current study, 8 patients had vitreous culture-confirmed endophthalmitis due to P. aeruginosa. All isolates were multi-drug resistant but sensitive to ceftazidime and each fluoroquinolone tested. Whole genome sequencing revealed a total of 179 unique genes. The most common type of virulence genes included those involved in adherence and the secretion system. Seven of 8 (88%) isolates were of the cytoinvasive phenotype (exoST) and no isolates contained exoU.

Conclusions: P. aeruginosa associated endophthalmitis is often multi-drug resistant and demonstrates a variety of virulence factors with those involved in adherence and the secretion system being the most common.
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http://dx.doi.org/10.1186/s12348-020-00216-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520479PMC
September 2020

Severe Neovascular Glaucoma Exacerbation as a Complication of Carotid Artery Stenting: A Case Report.

Neurohospitalist 2020 Oct 22;10(4):301-304. Epub 2020 May 22.

Vascular Neurology Division, Department of Neurology, University of Miami Miller School of Medicine, FL, USA.

Introduction: Neovascular glaucoma (NVG) has been rarely reported as an acute complication of carotid endarterectomy, but there is scant literature available regarding this potential condition following carotid artery stenting (CAS). We present a case of severe worsening of NVG occurring after bilateral CAS with progressive deterioration of vision ultimately leading to blindness.

Case Description: A 66-year-old male with multiple stroke risk factors, bilateral cataract extraction, proliferative diabetic retinopathy of left eye, and nonproliferative diabetic retinopathy of right eye, and prior left eye pars plana vitrectomy presented with episodes of transient right eye vision loss in context of bilateral high-grade internal carotid artery stenoses. He underwent right CAS with subsequent elevation of bilateral intraocular pressures (IOPs) concerning for acute NVG. Over time, the patient had some interval improvement in IOPs and underwent planned left CAS. After the procedure, he again developed elevated IOPs, concerning for acute NVG which eventually led to right eye pars plana vitrectomy for vitreous hemorrhage and refractory IOP elevation. At 6-month follow-up from initial stenting, the patient was blind in both eyes.

Discussion: We present a case of recurrent IOP elevations following CAS eventually resulting in bilateral eye blindness. This case is important not only as an illustration of an underrecognized postprocedural CAS complication but also as a demonstration of likely elevated risk of NVG following CAS for patients with other predisposing risk factors for ocular hypertension such as glaucoma, proliferative diabetic retinopathy, prior cataract extraction, and prior pars plana vitrectomy.
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http://dx.doi.org/10.1177/1941874420923914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495707PMC
October 2020

The Central Subfoveal Bouquet in Idiopathic Epiretinal Membranes.

Clin Ophthalmol 2020 17;14:2353-2359. Epub 2020 Aug 17.

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

Purpose: To report both the unoperated clinical course and the surgical outcomes of eyes with a central foveal bouquet (CB) secondary to idiopathic epiretinal membranes (iERMs).

Design: Retrospective, consecutive, and observational case series.

Methods: All patients examined between January 1, 2014, and December 31, 2019, for evaluation of epiretinal membrane with a CB lesion identified on spectral domain optical coherence tomography (SD-OCT) were included. Exclusion criteria included vitreoretinal comorbidities associated with secondary ERMs and an absence of CB lesions on SD-OCT. Patients were divided into two groups: those who were followed with observation (Group I) and those who received surgery (Group II). Each group had 3 different types of mechanical abnormalities of the CB previously described as cotton ball sign, subfoveal detachment, or acquired vitelliform lesion, without a subanalysis discrimination.

Main Outcome Measures: Best-corrected visual acuity (BCVA) at baseline and last follow-up, subjective metamorphopsia, central retinal thickness (CMT), mechanical stress lesions of the CB, and resolution or evolution of the CB lesions during the follow-up interval.

Results: Two hundred seventy-six eyes with iERM were reviewed, and 46 eyes met the inclusion criteria. Among these, 21 of 46 (46%) were observed, and 25 of 46 (54%) underwent surgery. Metamorphopsia was identified in 61.9% of patients in Group I and 81.2% of patients in Group II, at baseline. The mean BCVA was 0.19 ± 0.17 (20/30) in Group I and 0.31 ± 0.33 (20/40) in Group II at presentation. At the final exam, patients in Group I achieved a mean BCVA of 0.24 ± 0.18 (20/30), while patients in Group II obtained a mean BCVA of 0.15 ± 0.21 (20/30). Spontaneous resolution of the CB sign occurred in 5 of 21 eyes (23.8%) that were observed, whereas, after surgery, the CB sign resolved in 16 of 25 eyes (61.5%). Mean CMT was 422 ± 84.2μm in Group I and 531 ± 143.9μm in Group II, at baseline, while at the latest follow-up, the mean CMT was 400 ± 40.8μm in the cases followed with observation and 454 ± 148.7μm in the surgical cases.

Conclusion: The clinical course and surgical outcomes of CB findings in iERM are favorable in terms of visual acuity. However, those receiving surgery had an increase in visual acuity and resolution of the CB abnormality.
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http://dx.doi.org/10.2147/OPTH.S254544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493214PMC
August 2020

Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica.

Cureus 2020 Aug 20;12(8):e9896. Epub 2020 Aug 20.

Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA.

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis.
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http://dx.doi.org/10.7759/cureus.9896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505538PMC
August 2020

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

Am J Ophthalmol 2020 Sep 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
September 2020

Complex Combined Tractional and Rhegmatogenous Retinal Detachment in a Twenty-Three-Year-Old Male With Wagner Syndrome.

Ophthalmic Surg Lasers Imaging Retina 2020 08;51(8):467-471

Wagner syndrome is a rare hereditary vitreoretinopathy that has been reported in only about 300 people worldwide. It is caused by a mutation in the VCAN gene that encodes for the proteoglycan versican, which is a major component of the extracellular matrix of the vitreous gel; retinal detachment is uncommon in these cases. The authors report a case of a 23-year-old male who presented with bilateral combined tractional and rhegmatogenous retinal detachments. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:467-471.].
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http://dx.doi.org/10.3928/23258160-20200804-07DOI Listing
August 2020

Gender Differences in Self-Reported Procedural Volume Among Vitreoretinal Fellows.

Retina 2020 Aug 7. Epub 2020 Aug 7.

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

Purpose: A prior study revealed discrepancies in self-reported surgical numbers between male and female ophthalmology residents. This study further investigates the gender differences in self-reported procedural volume amongst vitreoretinal surgery fellows and examines the differences for surgical, medical, and total self-reported procedural volume between male and female vitreoretinal fellows.

Methods: A retrospective review of case logs submitted to the American Society of Retina Specialists by first and second year vitreoretinal fellows from 7/1/2018 to 6/30/2019 was performed. Fellows that reported fewer than 100 pars plana vitrectomies were excluded. A total of 133 fellows were included.

Results: 37 of 57 (65%) first year fellows and 59 of 76 (78%) second year fellows were male. An average of 1120 procedures were self-reported amongst all vitreoretinal fellows. In the group of second year fellows at the completion of fellowship, men reported more total procedures (1171 [864-1600] vs. 1005 [719-1257], p=0.072). Women reported statistically significant fewer endolaser (p=0.018), internal limiting membrane peel (p=0.042), and cryoretinopexy (p=0.002) procedures compared to men. When splitting the data by total surgical versus medical procedures, men reported more procedures than women both surgically (1077 [799-1490] vs. 925 [622-1208], p=0.085) and medically (72 [41-116] vs. 56 [20-94], p=0.141), although these differences were not statistically significant.

Conclusions: There is a trend for female vitreoretinal fellows to report fewer surgical procedures than their male counterparts, raising concerns for gender gaps in vitreoretinal surgical training. Further research is needed to verify this discrepancy and identify potential barriers facing female vitreoretinal surgeons in training.
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http://dx.doi.org/10.1097/IAE.0000000000002942DOI Listing
August 2020

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

Ophthalmol Retina 2021 Feb 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

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

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 2020 Jul 26. 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
July 2020

Rhegmatogenous Retinal Detachment after Intravitreal Injection.

Ophthalmol Retina 2021 Feb 14;5(2):178-183. Epub 2020 Jul 14.

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

Purpose: To describe the clinical features and outcomes in patients with rhegmatogenous retinal detachment (RRD) after intravitreal injection of pharmacologic agents.

Design: Retrospecitve case series.

Participants: Patients diagnosed with rhegmatogenous retinal detachment within 3 months of receiving an intravitreal injection of a pharmacologic agent for treatment of macular disease.

Methods: Retrospective case series of reported cases of RRD in patients with prior intravitreal injection who underwent subsequent surgical repair at a university referral center.

Main Outcome Measures: Visual acuity (VA), single surgery anatomic success rate (SSAS) and retinal reattachment at last follow-up.

Results: Thirteen patients were identified to have RRD within 3 months of intravitreal injection. Injection was performed in the inferotemporal quadrant in 12 of 13 eyes (92%) with a 31- or 32-gauge needle. Additional risk factors for RRD other than intravitreal injection were present in 5 of 13 eyes (38%), including prior pars plana vitrectomy (3 eyes), history of retinal tear (1 eye), and history of RRD in the fellow eye (1 eye). Average duration from time of injection to diagnosis of RRD was 27 days (range, 5-43 days). Retinal reattachment was achieved in 12 of 13 eyes (92%). Visual acuity returned to baseline in only 3 of 13 eyes (23%) at the last follow-up visit.

Conclusions: Although RRD after intravitreal injection is rare, prior retinal surgery and alternate risk factors for RRD may predispose to RRD after intravitreal injection. Surgical outcomes were generally favorable, but VA outcomes were limited by the high rate of macula-off RRD and the underlying macular disease.
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http://dx.doi.org/10.1016/j.oret.2020.07.007DOI Listing
February 2021

Akreos AO60 Intraocular Lens Opacification after Retinal Detachment Repair.

Ophthalmol Retina 2020 08 11;4(8):854-856. Epub 2020 Apr 11.

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

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http://dx.doi.org/10.1016/j.oret.2020.03.030DOI Listing
August 2020

Bilateral atypical lamellar holes in a patient with oculocutaneous albinism.

Ophthalmic Genet 2020 10 16;41(5):448-450. Epub 2020 Jun 16.

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

Background: Albinism can present with a wide range of ophthalmic findings and variable expressivity. With the use of optical coherence tomography, there has been increasing awareness of the variability of macular findings in this condition.

Materials And Methods: Case report.

Results: We present a case of oculocutaneous albinism with bilateral atypical lamellar holes which may represent part of the spectrum of retinal abnormalities in this condition.

Conclusion: Optical coherence tomography can be helpful in diagnosing albinism. Variable expressivity leads to a range of macular pathology in albinism which may include atypical lamellar holes as described in this patient.
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http://dx.doi.org/10.1080/13816810.2020.1765397DOI Listing
October 2020

A unique case of coats plus syndrome and dyskeratosis congenita in a patient with CTC1 mutations.

Ophthalmic Genet 2020 08 16;41(4):363-367. Epub 2020 Jun 16.

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

Coats plus syndrome (CP) is a rare condition characterized by bilateral exudative retinal telangiectasias with associated systemic disorders primarily affecting the brain, bone and gastrointestinal tract due to a mutation in the gene. mutations are also known to cause dyskeratosis congenita (DC), which is an inherited bone marrow failure syndrome characterized by skin pigmentation abnormalities, nail dystrophy, and oral leukoplakia. This is the first reported case of a patient diagnosed with both CP and DC caused by compound heterozygous gene mutations. Moreover, one of the variant mutations found in this patient has never been published before.
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http://dx.doi.org/10.1080/13816810.2020.1772315DOI Listing
August 2020

Follow-up Non-Compliance: A Significant Risk Factor for Reduced Visual Outcomes in Patients With Diabetic Retinopathy.

Am J Ophthalmol 2020 08 11;216:A12-A13. Epub 2020 Jun 11.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida 33126, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ajo.2020.04.004DOI Listing
August 2020

Vitrectomy using the Eckardt temporary keratoprosthesis.

Am J Ophthalmol Case Rep 2020 Sep 1;19:100709. Epub 2020 May 1.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: to present the now vitrectomy technique through a limbus via preexisting holes in the Eckardt TKP.

Methods: the surgical technique performed in a case of four-year-old girl presented with a complete hyphema and vitreous hemorrhage in the left eye.

Results: the vitrectomy was performed vial a limbal approach from the TKP without making additional sclerotomies. The vitreous hemorrhage was evacuated, the hyaloid elevated, the periphery examined with an excellent widefield view without scleral depression an air-fluid exchange performed, and the air exchanged for silicone oil. Finally, the TKP was replaced with a permanent graft. The surgical video was presented additionally.

Conclusion And Importance: Eckardt TKP allows for a limbal approach in aphakic or non-lens sparing vitrectomy surgery while maintaining a stable intraocular pressure, excellent peripheral and posterior access and while avoiding the need for pars plana sclerotomy placement which can be challenging in complex cases.
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http://dx.doi.org/10.1016/j.ajoc.2020.100709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251374PMC
September 2020

and endogenous panophthalmitis: clinical and histopathological features.

Am J Ophthalmol Case Rep 2020 Sep 11;19:100738. Epub 2020 May 11.

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

Purpose: To report an unusual case of endogenous panophthalmitis involving and describe its clinical and histopathological features.

Findings: A 30 year-old man with history of human immunodeficiency virus, polysubstance abuse, syphilis, and recently treated pneumonia presented with polymicrobial endogenous panophthalmitis. Two separate ocular specimens confirmed simultaneous and involvement. Histopathological analysis demonstrated fulminant polymorphonuclear infiltration of all ocular tissue layers. Despite aggressive management including two intravitreal injections and enucleation, the patient died, ultimately after receiving care at four neighboring urban medical centers.

Conclusions And Importance: has been a recently and increasingly described pathogen leading to mortality in metropolitan hospitals worldwide. To the authors' knowledge, has not previously been reported with endophthalmitis or panophthalmitis. Future cases may be expected with the reported rise in . A high suspicion of its contribution to panophthalmitis could be warranted early in the evaluation and management of profoundly immunocompromised patients, particularly those who have had sequential care at multiple neighboring metropolitan hospitals.
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http://dx.doi.org/10.1016/j.ajoc.2020.100738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240712PMC
September 2020

Diffuse Retinal Cavernous Hemangioma in a 2-Year-Old Girl.

JAMA Ophthalmol 2020 05 14;138(5):e191696. Epub 2020 May 14.

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

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http://dx.doi.org/10.1001/jamaophthalmol.2019.1696DOI Listing
May 2020

Surgical Techniques for the Subretinal Delivery of Pediatric Gene Therapy.

Ophthalmol Retina 2020 06 5;4(6):644-645. Epub 2020 Feb 5.

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.2020.01.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313618PMC
June 2020