Publications by authors named "Sarwar Zahid"

34 Publications

Development of Choroidal Neovascularization after Treatment with Photodynamic Therapy in a 5-year old Female with Choroidal Osteoma.

Retin Cases Brief Rep 2020 Nov 17. Epub 2020 Nov 17.

Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois, USA.

Purpose: To describe a patient with a choroidal osteoma treated with PDT to prevent tumor growth in whom choroidal neovascularization (CNV) developed after being treated with PDT.

Methods: Case report.

Results: A 5-year-old Hispanic female presented with an asymptomatic choroidal osteoma, temporal to the macula of her right eye. According to the patient's mother, her medical, surgical and family history was unremarkable. At examination, best corrected visual acuity was 20/30 in both eyes. After 11 months of follow-up, signs of tumor growth toward the fovea without any signs of CNV was noted. PDT was performed in order to prevent invasion of the foveola. Two months thereafter, the patient developed CNV in the macula region in the right eye, decreasing visual acuity to 20/200. The patient was treated with four total intravitreal injections of 1.25 mg of bevacizumab over 24 weeks, which resulted in inactivation of the CNV and improved visual acuity to 20/20. CNV had been never reported in her past history as well as her follow up visits over seven years. In addition, no evidence of recurrent neovascular activity or tumor growth was reported.

Conclusions: Choroidal osteoma is a benign tumor that can result in vision-threatening complications, caused by tumor growth and tumor decalcification. PDT is an effective modality in inducing choroidal osteoma decalcification and stabilization; however, CNV due to reperfusion following PDT can be seen in the retina.
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http://dx.doi.org/10.1097/ICB.0000000000001089DOI Listing
November 2020

Assessment of grain yield indices in response to drought stress in wheat ( L.).

Saudi J Biol Sci 2020 Jul 17;27(7):1818-1823. Epub 2019 Dec 17.

Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia.

Drought stress constricts crop production in the world. Increasing human population and predicted temperature increase owing to global warming will lead ruthless problems for agricultural production in near future. Hence, use of high yielding genotypes having drought tolerance and scrutinize of drought sensitive local cultivars for making them tolerant may be the proficient approaches to cope its detrimental outcomes. The current study was executed during 20015-2016 and 2016-2017 in field using randomized complete block design under factorial arrangements on 50 wheat genotypes for exploring their sensitivity and tolerance against drought. Some of the attributes of grain yield and drought tolerance indices were recorded. Grain yield showed negative correlations with tolerance index (TOL), drought index (DI) and stress susceptibility index (SSI) while positive correlation with mean productivity (MP) and geometric mean productivity (GMP) under drought condition. These findings depicted that tolerant genotypes could be chosen by high MP and GMP values and low SSI and TOL values. Based on the results, genotypes GA-02, Faisalabad-83, 9444, Sehar-06, Pirsabak-04 and Kohistan-97 were more tolerant and recognized as suitable for both normal and drought conditions. Genotypes of Chenab-00, Kohsar-95, Parwaz-94 and Kohenoor-83 confirmed more sensitive due to high grain yield loss under drought stress.
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http://dx.doi.org/10.1016/j.sjbs.2019.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296489PMC
July 2020

First record and taxonomic description of the genus (Fabricius) (Lepidoptera: Noctuidae: Plusiinae) from Pakistan.

Saudi J Biol Sci 2020 May 13;27(5):1375-1379. Epub 2019 Dec 13.

Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia.

Species belonging to genus, Fabricius of the subfamily Plusiinae which are polyphagous in nature and pest of vegetables, foods, legumes, fodder, fruits, ornamental plants and cotton crops. Samples were collected from different localities of district Bahawalpur. For collection, comprehensive and comparative surveys were carried out during 2017-18 on taxonomic account of species of the genus Fabricius and resulted identified one species (Fabricius) first time from Pakistan. Morphological characters viz., vertex, frons, labial palpi, antennae, compound eyes, ocelli, proboscis, wing venation, male and female genital characteristics were used for the identification and classification. Dichotomous keys and photographs are also provided. There is hardly any substantial research work on taxonomic studies of subfamily Plusiinae Pakistan. So to fill this gap the present proposal was designed to study the diversity of Noctuid moths from Pakistan and very fruitful results have been obtained.
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http://dx.doi.org/10.1016/j.sjbs.2019.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182779PMC
May 2020

A New Industrial Technology for Mass Production of Graphene/PEBA Membranes for CO/CH Selectivity with High Dispersion, Thermal and Mechanical Performance.

Polymers (Basel) 2020 Apr 5;12(4). Epub 2020 Apr 5.

Faculty of Chemical Technology, Kaunas University of Technology, LT-50254 Kaunas, Lithuania.

Polyether block amide (PEBA) nanocomposite membranes, including Graphene (GA)/PEBA membranes are considered to be a promising emerging technology for removing CO from natural gas and biogas. However, poor dispersion of GA in the produced membranes at industrial scale still forms the main barrier to commercialize. Within this frame, this research aims to develop a new industrial approach to produce GA/PEBA granules that could be used as a feedstock material for mass production of GA/PEBA membranes. The developed approach consists of three sequential phases. The first stage was concentrated on production of GA/PEBA granules using extrusion process (at 170-210 °C, depending on GA concentration) in the presence of Paraffin Liquid (PL) as an adhesive layer (between GA and PEBA) and assisted melting of PEBA. The second phase was devoted to production of GA/PEBA membranes using a solution casting method. The last phase was focused on evaluation of CO/CH selectivity of the fabricated membranes at low and high temperatures (25 and 55 °C) at a constant feeding pressure (2 bar) using a test rig built especially for that purpose. The granules and membranes were prepared with different concentrations of GA in the range 0.05 to 0.5 wt.% and constant amount of PL (2 wt.%). Also, the morphology, physical, chemical, thermal, and mechanical behaviors of the synthesized membranes were analyzed with the help of SEM, TEM, XRD, FTIR, TGA-DTG, and universal testing machine. The results showed that incorporation of GA with PEBA using the developed approach resulted in significant improvements in dispersion, thermal, and mechanical properties (higher elasticity increased by ~10%). Also, ideal CO/CH selectivity was improved by 29% at 25 °C and 32% at 55 °C.
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http://dx.doi.org/10.3390/polym12040831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240517PMC
April 2020

Effects of temperature on baseline susceptibility and stability of insecticide resistance against (Lepidoptera: Plutellidae) in the absence of selection pressure.

Saudi J Biol Sci 2020 Jan 15;27(1):1-5. Epub 2019 Mar 15.

Research Center for Advanced Materials Science (RCAMS), King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia.

L. (Lepidoptera: Plutellidae) is an important pest causing significant losses to vegetables worldwide. Insecticides resistance in is a serious issue for scientists since last 30 years. However, deltamethrin and are commonly used insecticides against but studies involving development of resistance in against these two insecticides at different temperatures are lacking. The current study was aimed to find out the toxicity of deltamethrin and , and resistance development in . Results showed that the positive correlation between the temperature and toxicities of deltamethrin and . The results indicated -0.051, -0.049, -0.047, and -0.046 folds of deltamethrin resistance at 15 °C, 20 °C, 25 °C, and 30 °C temperatures, respectively from 1 to 12 generations. The toxicity of after 24 h was 2.2 and 4.8 folds on 1 generation at 20 °C and 25 °C temperatures, respectively compared to the toxicity recorded at 15 °C (non-overlapping of 95% confidence limits). Based on the results of this study, it is concluded that the temperature has a positive correlation with the toxicity of deltamethrin and against the larvae of This study suggests that deltamethrin and can be included in the management program of on many vegetable crops The baseline susceptibility data might be helpful to understand the resistance mechanisms in .
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http://dx.doi.org/10.1016/j.sjbs.2019.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933245PMC
January 2020

Fitness parameters of (L.) (Lepidoptera; Plutellidae) at four constant temperatures by using age-stage, two-sex life tables.

Saudi J Biol Sci 2019 Nov 27;26(7):1661-1667. Epub 2018 Aug 27.

Department of Botany, Hindu College Moradabad, 244001, India.

Different temperature zones have significant impact on the population dynamics of . Effective management of requires the knowledge of temperature tolerance by different life stages. In the current study, fitness parameters of diamondback moth were reported by using age-stage, two-sex life table traits at four constant temperatures (15, 20, 25 and 30 °C). The life cycle of was significantly longer at 15 °C. The 20 °C level of temperature was found optimal for fecundity, gross reproductive rate (51.74 offspring) and net reproductive rate (44.35 offspring per individual). The adult pre-oviposition period was statistically at par at all four level of temperatures. However, the survival was maximum at 20 °C as compared to other three temperature ranges. Based on the current study, it was concluded that temperature has a great role in population build-up of and effective management tactics should be applied to prevent significant damage to cabbage and other cruciferous crops when the temperature in the field is near 20 °C.
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http://dx.doi.org/10.1016/j.sjbs.2018.08.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864165PMC
November 2019

Pollination biology of (L.) Benth. (Fabaceae: Mimosoideae) with reference to insect floral visitors.

Saudi J Biol Sci 2019 Nov 4;26(7):1548-1552. Epub 2018 Dec 4.

Department of Statistics, Bahauddin Zakariya University, Multan 60800, Pakistan.

Indian siris, (L.) Benth. (Fabaceae: Mimosoideae) has significant importance to human beings for its multipurpose use. Insects play a crucial role in the pollination biology of flowering plants. In the current study, we studied the pollination biology of with special reference to insect floral visitors. The effectiveness of floral visitors was investigated in term of visitation frequency, visitation rate and pollen load during 2012 and 2013. In the second experiment, effect of pollinators on yield of was studied in open and cage pollination experiments. Floral visitor fauna of included eight-bees, two wasps, two flies, and two butterflies species. Among them, , , and had maximum abundance ranging from 349-492, 339-428, 291-342 and 235-255 numbers of individuals, respectively during two flowering seasons. had the highest visitation frequency (6.44 ± 0.49-8.78 ± 0.48 visits/flower/5min) followed by (6.03 ± 0.43-7.99 ± 0.33 visits/flower/5min) and (3.61 ± 0.31-4.44 ± 0.18 visits/flower/5min). , and had the highest visitation rates (18.904 ± 1.53-11.43 ± 1.17 flower visited/min) and pollen load (15333 ± 336.22-19243 ± 648.45 pollen grains). The open pollinated flowers had significantly higher capsule weight (4.97 ± 0.21 g), seed weight (1.04 ± 0.05 g), seed numbers per pod (9.80 ± 0.34) and seed germination percentage (84.0 ± 1.78%) as compared to caged flowers. The results suggested bees especially , and could be effective pollinators of .
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http://dx.doi.org/10.1016/j.sjbs.2018.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864188PMC
November 2019

Simulating vascular leakage on optical coherence tomography angiography using an overlay technique with corresponding thickness maps.

Br J Ophthalmol 2020 04 5;104(4):514-517. Epub 2019 Jul 5.

UIC Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois, USA

Background: To demonstrate a technique for using optical coherence tomography angiography (OCTA) to simulate leakage in eyes with diabetic macular oedema and determine the sensitivity and positive predictive value of detecting leaking microvasculature on OCTA using fluorescein angiography (FA) as the comparative norm.

Methods: 6×6 mm OCT angiograms were overlaid with the corresponding OCT thickness maps. Microvascular abnormalities on the OCT angiogram underlying areas of thickening on the OCT thickness map were assumed to be leaking. Two independent readers blindly read the OCTA overlay images then the FA images cropped to the same approximate region to delineate areas of leaking microvasculature. The results were compared to determine the sensitivity and positive predictive value of OCTA for detection of leaking vessels.

Results: 28 eyes of 19 diabetic patients were included. Each eye demonstrated an average of seven leaking microvascular abnormalities on the OCTA images and 22 leaking abnormalities on the FA images. Sensitivity of leaking microvasculature detection by OCTA was 26.1% and positive predictive value was 68.4%. The correlation coefficient of the two readers' detection of leaking microvasculature was 0.605 for OCTA reads compared with 0.916 for FA.

Conclusion: OCTA as a whole can be used to simulate leakage, but currently, sensitivity of the technique is low. Further understanding of the OCTA technology may yield novel means of detecting retinal pathology.
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http://dx.doi.org/10.1136/bjophthalmol-2019-313976DOI Listing
April 2020

Long-Term Course in Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis.

Ophthalmol Retina 2019 04 12;3(4):380-381. Epub 2019 Jan 12.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois. Electronic address:

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http://dx.doi.org/10.1016/j.oret.2019.01.005DOI Listing
April 2019

Early Diagnosis and Management of Aggressive Posterior Vitreoretinopathy Presenting in Premature Neonates.

Ophthalmic Surg Lasers Imaging Retina 2019 04;50(4):201-207

Background And Objective: Aggressive posterior vitreoretinopathy (APVR) manifests with a broad area of retinal avascularity, progressive neovascularization, and/or tractional retinal detachment during the neonatal period.

Patients And Methods: A multicenter, retrospective, observational, consecutive case series study was performed to evaluate the retinal findings and structural retinal outcomes in patients treated for APVR within the first 3 months of life.

Results: Three premature neonates with a non-retinopathy of prematurity (ROP) APVR identified during routine ROP screening exams exhibited relatively severe, rapidly progressive retinal vascular abnormalities. Immediate laser photocoagulation of the avascular retina and vitrectomy for traction retinal detachment within several days to weeks improved or stabilized the retinal anatomy in all cases.

Conclusions: This series describes clinical features in APVR in premature infants and suggests that early diagnosis and intervention may mitigate the typical aggressive course and poor prognosis of this condition. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:201-207.].
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http://dx.doi.org/10.3928/23258160-20190401-01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864674PMC
April 2019

Optic Nerve Head Edema in a Healthy Man in His 20s.

JAMA Ophthalmol 2019 04;137(4):455-456

Illinois Eye and Ear Infirmary, University of Illinois at Chicago.

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http://dx.doi.org/10.1001/jamaophthalmol.2018.5902DOI Listing
April 2019

APPLICATION OF ADJUNCTIVE TOPICAL MITOMYCIN-C IN SCLEROSTOMY REVISION FOR REFRACTORY IDIOPATHIC UVEAL EFFUSION SYNDROME.

Retin Cases Brief Rep 2019 Jan 3. Epub 2019 Jan 3.

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois.

Background/purpose: To describe the use of topical mitomycin-C in sclerostomy revision for recalcitrant idiopathic uveal effusion syndrome.

Methods: A 50-year-old healthy man presented with painless, gradual vision loss in the right eye. He underwent multimodal retinal imaging with wide-field fundus photography, spectral domain optical coherence tomography, and B-scan and A-scan ultrasonography. He was found to have idiopathic (non-nanophthalmic) uveal effusion syndrome with choroidal and serous retinal detachments in the right eye and a peripheral choroidal detachment in the left eye. Central vision became threatened in the right eye. Medical treatment with oral corticosteroids and surgical treatment with choroidal drainage through sclerostomies and sclerostomy revision were administered.

Results: Initial treatment with systemic corticosteroids was ineffective. Subsequent choroidal drainage through sclerostomies only partially resolved the effusion. Later sclerostomy revision with application of topical mitomycin-C led to complete resolution with anatomical stability maintained after at least 42 months of follow-up.

Conclusion: Successful use of topical mitomycin-C in sclerostomy revision has not previously been reported in idiopathic (non-nanophthalmic) uveal effusion syndrome. We propose that topical mitomycin-C may be considered as a potential therapeutic adjunct in the treatment of refractory idiopathic uveal effusion syndrome before further sclerostomy procedures are attempted in additional quadrants of the eye.
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http://dx.doi.org/10.1097/ICB.0000000000000840DOI Listing
January 2019

Effects of selected synthetic insecticides on the total and differential populations of circulating haemocytes in adults of the red cotton stainer bug Dysdercus koenigii (Fabricius) (Hemiptera: Pyrrhocoridae).

Environ Sci Pollut Res Int 2018 Jun 9;25(17):17033-17037. Epub 2018 Apr 9.

Department of Entomology, University of Agriculture Faisalabad, Faisalabad, Pakistan.

Red cotton bug, Dysdercus koenigii (Hemiptera: Pyrrhocoridae), has become the major insect pest of various crops, including cotton, and thereby reducing the yield qualitatively and quantitatively and synthetic insecticides belonging to different groups are the major control agents for such insect pests. A laboratory experiment was carried out to evaluate the effect of different conventional insecticides, i.e., imidacloprid, deltamethrin, lambda cyhalothrin, gamma cyhalothrin and cyfluthirn on haemocytes of D. koenigii. The individuals were exposed to insecticides separately and data was recorded after 30 and 60 min of the exposure. The findings of current study depicted chlorpyrifos to be more effective and significant alterations in total haemocyte counts and differential haemocyte counts were observed in the cyfluthirn treated D. koenigii. In addition to this, cell structure was also disrupted as an immune response. Similar studies would also be helpful to understand the defence mechanisms of insects against the xenobiotics which will help to device efficient management tools for D. koenigii.
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http://dx.doi.org/10.1007/s11356-018-1898-1DOI Listing
June 2018

Multi-Response Optimization of Resin Finishing by Using a Taguchi-Based Grey Relational Analysis.

Materials (Basel) 2018 Mar 15;11(3). Epub 2018 Mar 15.

Hubei Provincial Engineering Laboratory for Clean Production and High Value Utilization of Bio-Based Textile Materials, Wuhan Textile University, Wuhan 430073, China.

In this study, the influence and optimization of the factors of a non-formaldehyde resin finishing process on cotton fabric using a Taguchi-based grey relational analysis were experimentally investigated. An L orthogonal array was selected for five parameters and three levels by applying Taguchi's design of experiments. The Taguchi technique was coupled with a grey relational analysis to obtain a grey relational grade for evaluating multiple responses, i.e., crease recovery angle (CRA), tearing strength (TE), and whiteness index (WI). The optimum parameters (values) for resin finishing were the resin concentration (80 g·L), the polyethylene softener (40 g·L), the catalyst (25 g·L), the curing temperature (140 °C), and the curing time (2 min). The goodness-of-fit of the data was validated by an analysis of variance (ANOVA). The optimized sample was characterized by Fourier-transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), and scanning electron microscope (SEM) to better understand the structural details of the resin finishing process. The results showed an improved thermal stability and confirmed the presence of well deposited of resin on the optimized fabric surface.
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http://dx.doi.org/10.3390/ma11030426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873005PMC
March 2018

VALUE OF FRACTAL ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN VARIOUS STAGES OF DIABETIC RETINOPATHY.

Retina 2018 Sep;38(9):1816-1823

Department of Ophthalmology, New York University Langone Medical Center, New York, New York.

Purpose: To use fractal dimensional analysis to investigate retinal vascular disease patterns in patients with diabetic retinopathy using spectral domain optical coherence tomography angiography.

Methods: A retrospective study was conducted which included 49 eyes from 26 control subjects and 58 eyes from 35 patients known to have diabetic retinopathy. Of the 58 eyes with known retinopathy, 31 were categorized as nonproliferative diabetic retinopathy (13 mild, 9 moderate, and 9 severe) and 27 were categorized as proliferative diabetic retinopathy. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti (Optovue, Inc). Automated segmentation was obtained through both the superficial and deep capillary plexuses for each eye. Grayscale optical coherence tomography angiography images were standardized and binarized using ImageJ (National Institutes of Health). Fractal box-counting analyses were conducted using Fractalyse (ThéMA). Fractal dimensions (FDs) and correlation coefficient of the superficial and deep capillary plexuses were compared between control eyes and those in various stages of diabetic retinopathy.

Results: The superficial and deep capillary plexuses from diabetic and control eyes were analyzed. The average FD for diabetic eyes was significantly lower than in control eyes in the superficial plexus (P = 2.4 × 10) and in the deep capillary plexus (P = 1.87 × 10 ) with a more statistically significant difference noted in the deep capillary plexus. When analyzing diabetic patients without edema noted on optical coherence tomography, the FD was significantly reduced in the superficial (P = 0.001) and deep (P = 1.49 × 10) plexuses. When analyzing diabetic patients with edema noted on optical coherence tomography, the FD was significantly reduced in the superficial (P = 2.0 × 10) and deep (P = 1.85 × 10) plexuses.

Conclusion: The optical coherence tomography angiography FD is significantly lower in both superficial and deep capillary plexuses in eyes with all stages studied of diabetic retinopathy. The results were more often significant for the deep capillary plexus. The use of fractal analysis provides an objective criterion to assess microvascular disease burden in diabetic retinopathy.
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http://dx.doi.org/10.1097/IAE.0000000000001774DOI Listing
September 2018

The Current State of Teleophthalmology in the United States.

Ophthalmology 2017 12 21;124(12):1729-1734. Epub 2017 Jun 21.

New York University (NYU) Langone Eye Center, NYU Langone Medical Center, Department of Ophthalmology, NYU School of Medicine, New York, New York; Department of Neuroscience and Physiology, NYU Langone Medical Center, NYU School of Medicine, New York, New York; Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, New York. Electronic address:

Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via "store and forward" methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.
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http://dx.doi.org/10.1016/j.ophtha.2017.05.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020848PMC
December 2017

An Assessment of Vitreous Degeneration in Eyes with Vitreomacular Traction and Macular Holes.

J Ophthalmol 2017 4;2017:6834692. Epub 2017 Jan 4.

Department of Ophthalmology, Manhattan Eye Ear and Throat Hospital of Northwell Health, 210 East 64th Street, New York, NY 10021, USA; Vitreous Retina Macula Consultants of New York, 460 Park Avenue, New York, NY 10022, USA; Department of Ophthalmology, New York University Langone Medical Center, 462 1st Avenue, New York, NY 10016, USA.

. To compare the stages of vitreous degeneration in patients with vitreomacular traction (VMT) and macular holes (MH). . A retrospective study was performed analyzing stages of vitreous degeneration of eyes with VMT or MH using swept-source optical coherence tomography (SS-OCT) and spectral-domain optical coherence tomography (SD-OCT). An analogous review was performed on a control group of eyes with contralateral posterior vitreous detachments. Thirty-four eyes with VMT/MH and 39 control eyes were reviewed. Twenty-seven VMT/MH eyes and 31 control eyes were included. Eyes with VMT/MH demonstrated significantly earlier stages of vitreous degeneration when compared to the control group ( = 0.048) despite significantly greater age ( = 0.032). . Vitreoretinal interface disease is more often associated with a formed vitreous and an intact premacular bursa. This is contrary to previous assumptions implicating degeneration of vitreous as a precipitating factor of interface disease when in conjunction with abnormal vitreomacular separation.
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http://dx.doi.org/10.1155/2017/6834692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241468PMC
January 2017

FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME.

Retina 2017 Nov;37(11):2025-2034

*Department of Ophthalmology, New York University Langone Medical Center, New York, New York; †Vitreous Retina Macula Consultants of New York, New York, New York; ‡LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; §Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, New York; ¶Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain; **Ophthalmic Center for Imaging and Laser, Paris, France; ††Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; ‡‡Department of Ophthalmology, Mount Sinai Hospital New York, New York; and §§Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York.

Purpose: To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization.

Methods: Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography.

Results: Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS.

Conclusion: A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
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http://dx.doi.org/10.1097/IAE.0000000000001486DOI Listing
November 2017

LONG-TERM FOLLOW-UP OF RETINAL PIGMENT EPITHELIUM RESTORATION AFTER A TRIPLE TEAR.

Retin Cases Brief Rep 2019 Winter;13(1):5-9

Department of Ophthalmology, New York University Langone Medical Center, New York, New York.

Purpose: To demonstrate longitudinal multimodal imaging findings in a case of neovascular age-related macular degeneration presenting with multiple retinal pigment epithelium (RPE) tears showing progressive RPE restoration.

Methods: Observational clinical case report.

Results: A 79-year-old woman diagnosed with neovascular age-related macular degeneration developed 3 consecutive RPE tears in her right eye during the course of treatment with intravitreal anti-vascular endothelial growth factor therapy. The RPE tears initially appeared hypoautofluorescent on fundus autofluorescence. Spectral domain optical coherence tomography showed contractile folds of the RPE with adjacent subretinal fluid and overlying ellipsoid zone disruption. Over an 8-year follow-up period, the RPE defects progressively resolved with a return of patchy fundus autofluorescence. Eye-tracked spectral domain optical coherence tomography showed gradual restoration of the RPE band defects over an enlarging Type 1 neovascular lesion.

Conclusion: Some RPE tears may show observable remodeling and restoration over time. These changes may be followed longitudinally with multimodal imaging, including eye-tracked spectral domain optical coherence tomography and fundus autofluorescence.
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http://dx.doi.org/10.1097/ICB.0000000000000530DOI Listing
January 2019

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CHORIORETINAL LESIONS DUE TO IDIOPATHIC MULTIFOCAL CHOROIDITIS.

Retina 2017 Aug;37(8):1451-1463

*Department of Ophthalmology, New York University Langone Medical Center, New York, New York; †East Bay Retina Consultants, Oakland, California; ‡Vitreous Retina Macula Consultants of New York, New York, New York; §LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; ¶Department of Physiology and Pharmacology, Lions Eye Institute, University of Western Australia, Perth, Australia; and **Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.

Purpose: To evaluate the spectrum of macular chorioretinal lesions occurring in idiopathic multifocal choroiditis using optical coherence tomography angiography (OCTA) to evaluate those showing neovascular flow.

Methods: This was a descriptive, retrospective study of 18 eyes of 14 patients with multifocal choroiditis. Macular lesions were characterized as subretinal pigment epithelium, subretinal, or mixed and evaluated during active and presumed inactive states of multifocal choroiditis. Correlations between structural optical coherence tomography and OCTA were performed. In select cases, correlations between OCTA, fluorescein angiography, and fundus autofluorescence were evaluated. In 5 eyes, quantitative measurements of neovascular lesions were compared at baseline and following intravitreal anti-vascular endothelial growth factor therapy.

Results: Mean patient age was 48 years (SD: 13.8; 86% women). Optical coherence tomography angiography flow signatures consistent with neovascularization were identified in 83% of eyes, including in 0% of subretinal pigment epithelium, 91% of subretinal, and 100% of mixed lesions. Lesions that did not demonstrate definitive signs of fluorescein angiography leakage were frequently found to have neovascularization using OCTA. There was no change in quantitative measurements of neovascular lesions after anti-vascular endothelial growth factor therapy (all tested variables P > 0.05).

Conclusion: Optical coherence tomography angiography may be a useful imaging modality for understanding the pathophysiology of multifocal choroiditis and monitoring its clinical course.
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http://dx.doi.org/10.1097/IAE.0000000000001381DOI Listing
August 2017

Fractal Dimensional Analysis of Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy.

Invest Ophthalmol Vis Sci 2016 Sep;57(11):4940-4947

Department of Ophthalmology, New York University Langone Medical Center, New York, New York, United States.

Purpose: We used fractal dimensional analysis to analyze retinal vascular disease burden in eyes with diabetic retinopathy using spectral-domain optical coherence tomography angiography (OCTA).

Methods: A retrospective study was performed of 13 eyes with diabetic retinopathy without diabetic macular edema and 56 control eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Automated segmentation was obtained through the superficial and deep capillary plexuses for each eye. Grayscale OCTA images were standardized and binarized using ImageJ. Fractal box-counting analyses were performed using Fractalyse. Fractal dimensions (FD) as well as software-generated vascular density analyses of the superficial and deep capillary plexuses were compared between diabetic and control eyes using 2-tailed t-tests and 1-way multivariate ANOVA (MANOVA) analyses.

Results: The superficial and deep plexuses from diabetic and control eyes were analyzed. The average FD for diabetic eyes was significantly lower than control eyes for the superficial (P = 4.513 × 10-3) and deep (P = 2.653 × 10-3) capillary plexuses. In diabetic eyes, the vascular density also was significantly reduced in the superficial (P = 8.068 × 10-5) and deep (P = 3.120 × 10-6) capillary plexuses. One-way MANOVA showed a significant difference between diabetic and control eyes.

Conclusions: The OCTA FD is significantly reduced in the superficial and deep capillary plexuses in eyes with diabetic retinopathy. Applying fractal analysis to OCTA imaging holds the potential to establish quantitative parameters for microvascular pathology.
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http://dx.doi.org/10.1167/iovs.16-19656DOI Listing
September 2016

Optical Coherence Tomography Evaluation of Valsalva-Induced Suprachoroidal Hemorrhage.

Ophthalmic Surg Lasers Imaging Retina 2016 07;47(7):674-6

Suprachoroidal hemorrhage is typically observed in patients with hypotony in the context of intraocular surgery and trauma. We report a rare presentation of suprachoroidal hemorrhage associated with emesis (Valsalva maneuver) in a myopic patient with few other identifiable risk factors. This diagnosis was confirmed with wide-field fundus photography and B-scan ultrasound and was localized to the suprachoroidal space using both enhanced depth and swept-source optical coherence tomography imaging. This case is unique in its presentation and demonstrates the utility of newer imaging techniques to localize hemorrhages using a multimodal approach. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:674-676.].
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http://dx.doi.org/10.3928/23258160-20160707-11DOI Listing
July 2016

Vision Loss After Central Retinal Artery Occlusion Secondary to Orbital Sarcoid Mass.

Ophthalmic Plast Reconstr Surg 2016 Mar-Apr;32(2):e37-40

Departments of *Ophthalmology and Visual Sciences, †Internal Medicine, and ‡Radiology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.

The authors describe the first report in the literature of central retinal artery occlusion as the presenting manifestation of sarcoidosis. A 33-year-old man with asthma, headache, and 6 days of intermittent, transient vision loss in the OS presented with persistent vision loss in the OS. Ophthalmic examination was consistent with diagnosis of central retinal artery occlusion in the OS. Vascular imaging with CT angiography revealed an incidental finding of an intraconal mass surrounding the left optic nerve and hilar lymphadenopathy. Broncho scopic lymph node biopsy demonstrated noncaseating granulomas consistent with sarcoidosis. This case proffers a unique mechanism of vision loss in sarcoidosis and highlights that atypical causes of central retinal artery occlusion must be considered in patients without typical risk factors.
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http://dx.doi.org/10.1097/IOP.0000000000000223DOI Listing
August 2016

Digital quantification of Goldmann visual fields (GVFs) as a means for genotype-phenotype comparisons and detection of progression in retinal degenerations.

Adv Exp Med Biol 2014 ;801:131-7

Department of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, 1000 Wall Street, 48105, Ann Arbor, MI, USA,

Purpose: To develop a reliable and efficient digital method to quantify planimetric Goldmann visual field (GVF) data to monitor disease course and treatment responses in retinal degenerative diseases.

Methods: A novel method to digitally quantify GVFs using Adobe Photoshop CS3 was developed for comparison to traditional digital planimetry (Placom 45C digital planimeter; Engineer Supply, Lynchburg, Virginia, USA). GVFs from 20 eyes from 10 patients with Stargardt disease were quantified to assess the difference between the two methods (a total of 230 measurements per method). This quantification approach was also applied to 13 patients with X-linked retinitis pigmentosa (XLRP) with mutations in RPGR.

Results: Overall, measurements using Adobe Photoshop were more rapidly performed than those using conventional planimetry. Photoshop measurements also exhibited less inter- and intraobserver variability. GVF areas for the I4e isopter in patients with the same mutation in RPGR who were nearby in age had similar qualitative and quantitative areas.

Conclusions: Quantification of GVFs using Adobe Photoshop is quicker, more reliable, and less user dependent than conventional digital planimetry. It will be a useful tool for both retrospective and prospective studies of disease course as well as for monitoring treatment response in clinical trials for retinal degenerative diseases.
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http://dx.doi.org/10.1007/978-1-4614-3209-8_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618319PMC
July 2014

Sonic hedgehog signals to multiple prostate stromal stem cells that replenish distinct stromal subtypes during regeneration.

Proc Natl Acad Sci U S A 2013 Dec 11;110(51):20611-6. Epub 2013 Nov 11.

Developmental Biology Program, Sloan-Kettering Institute, New York, NY 10065.

The adult mouse prostate has a seemingly endless capacity for regeneration, and sonic hedgehog (SHH) signaling has been implicated in this stem cell-driven process. However, it is not clear whether SHH acts on the epithelium or stromal cells that secrete factors required for epithelial expansion. Because little is known about stromal stem cells compared with their epithelial counterparts, we used in vivo mouse genetics tools to characterize four prostate stromal subtypes and their stem cells. Using knockin reporter alleles, we uncovered that SHH signals from prostate basal epithelial cells to adjacent stromal cells. Furthermore, the SHH target gene Gli1 is preferentially expressed in subepithelial fibroblast-like cells, one of four prostate stromal subtypes and the subtype closest to the epithelial source of SHH. Using Genetic Inducible Fate Mapping to mark adult Gli1- or Smooth muscle actin-expressing cells and follow their fate during regeneration, we uncovered that Gli1-expressing cells exhibit long-term self-renewal capacity during multiple rounds of androgen-mediated regeneration after castration-induced involution, and depleted smooth muscle cells are mainly replenished by preexisting smooth muscle cells. Based on our Genetic Inducible Fate Mapping studies, we propose a model where SHH signals to multiple stromal stem cells, which are largely unipotent in vivo.
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http://dx.doi.org/10.1073/pnas.1315729110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870668PMC
December 2013

Diagnostic fundus autofluorescence patterns in achromatopsia.

Am J Ophthalmol 2013 Dec 20;156(6):1211-1219.e2. Epub 2013 Aug 20.

Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.

Purpose: To describe the unique diagnostic fundus autofluorescence (FAF) patterns in patients with achromatopsia and the associated findings on optical coherence tomography (OCT).

Design: Observational case series.

Methods: We evaluated 10 patients with achromatopsia by means of best-corrected visual acuity (BCVA), ophthalmoscopy, Goldmann visual field, full-field electroretinography (ffERG), OCT, and FAF photography. FAF patterns were compared with patient age and foveal changes on OCT.

Results: Patients fell into two dichotomous age groups at the time of evaluation: six patients ranged from 11 to 23 years of age, and 3 patients ranged from 52 to 63 years of age. All patients had severely reduced photopic ffERG responses, including those exhibiting preserved foveal structure on OCT. The younger patients had absent to mild foveal atrophy on OCT, and four of the six demonstrated foveal and parafoveal hyperfluorescence on FAF. In addition, a 7-month-old child with compound heterozygous mutations in CNGA3 demonstrated similar foveal hyperfluorescence. The older patients demonstrated advanced foveal atrophy and punched-out foveal hypofluorescence with discrete borders on FAF imaging corresponding to the area of outer retinal cavitation on OCT.

Conclusions: Foveal hyperfluorescence is an early sign of achromatopsia that can aid in clinical diagnosis. In our cohort, patients with achromatopsia demonstrated age-dependent changes in FAF, which are likely to be progressive and to correlate with foveal atrophy and cavitation on OCT. This finding may be useful in charting the natural course of the disease and in defining a therapeutic window for treatment.
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http://dx.doi.org/10.1016/j.ajo.2013.06.033DOI Listing
December 2013

Quantification of fundus autofluorescence to detect disease severity in nonexudative age-related macular degeneration.

JAMA Ophthalmol 2013 Aug;131(8):1009-15

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan 48105, USA.

Importance: Accurate assessment of disease burden and determination of disease progression are challenging in dry age-related macular degeneration (AMD). We assessed the utility of quantified fundus autofluorescence in (FAF) the evaluation and follow-up of dry AMD.

Objective: To develop a method for quantitative FAF image analysis that is capable of stratifying severity of nonexudative AMD.

Design, Setting, And Participants: A retrospective analysis from 2008 to 2012 at a university eye center of FAF images taken of normal and nonexudative AMD eyes compared the Index of Retinal Autofluorescence (IRA) with retinal specialists' clinical rankings of FAF images and the Age-Related Eye Disease Study (AREDS) grading scheme of corresponding color fundus photographs.

Intervention: Digital files of Heidelberg Spectralis FAF images taken of normal and nonexudative AMD eyes were analyzed. For each image, a unique horizontally oriented FAF signature composed of vertically averaged gray-scale values was generated through the fovea. A pairwise comparison of 2 signatures was performed using a modified difference of squares method, which generated a single quantitative value, the IRA.

Main Outcomes And Measures: The effects of intersession testing, cataract extraction, pupillary dilation, focal plane, and gain settings on the IRA were assessed.

Results: The FAF images taken of the same subjects at different times demonstrated low intersession variability of the IRA (intraclass coefficient = 0.75; 95% CI, 0.45-0.92). The IRA was affected by cataract severity, cataract extraction, small pupillary diameters (<5.5 mm), defocusing, and excessive high or low camera gain. The IRA values correlated with both subjective clinical rankings by retinal specialists (r(s) = 0.77). The IRA was positively correlated with AREDS score (r(s) = 0.73) and could statistically distinguish AREDS grades 3 and 4 (P < .001). Serial imaging demonstrated the utility of the method for identifying clinically meaningful disease progression.

Conclusions And Relevance: The IRA method applied to FAF digital files can quantify AMD disease severity and may be helpful in identifying AMD progression.
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http://dx.doi.org/10.1001/jamaophthalmol.2013.4014DOI Listing
August 2013

Autofluorescence quantification of benign and malignant choroidal nevomelanocytic tumors.

JAMA Ophthalmol 2013 Aug;131(8):1004-8

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA.

Importance: Accurate diagnosis of choroidal melanoma is challenging and has important implications for both physicians and patients. We assessed the utility of quantification of fundus autofluorescence in the evaluation and follow-up of choroidal nevomelanocytic tumors.

Objective: To assess the utility of autofluorescence quantification in distinguishing clinically diagnosed choroidal nevi, melanoma, and indeterminate nevomelanocytic lesions.

Design, Setting, And Participants: A retrospective observational study from 2006 to 2012 of patients with choroidal nevomelanocytic lesions who had digital autofluorescence and color fundus imaging performed at the University of Michigan Kellogg Eye Center.

Intervention: ImageJ software was used to output autofluorescence gray-scale values for each pixel of a 500 × 50-pixel region within each lesion and a corresponding adjacent control region.

Main Outcome And Measure: A single value was generated, termed the Index of Retinal Autofluorescence (IRA), to represent the total difference in gray-scale values between the 2 regions in each affected eye.

Results: Thirteen of the 14 clinically diagnosed nevi exhibited an IRA less than 150 gray-scale intensity squared (gsi2). Eight of 9 clinically diagnosed melanomas exhibited an IRA more than 150 gsi2. An IRA of 150 gsi2 distinguished nevi from melanomas with a sensitivity of 0.89 and specificity of 0.93. Fifteen of 19 patients with indeterminate nevomelanocytic lesions underwent clinical assessment and initial imaging with clinical follow-up at a median of 10 months. All 3 patients with an IRA less than 150 gsi2 showed no evidence of clinical progression and 6 of 12 lesions with an IRA more than 150 gsi2 showed clinical progression to melanoma. An IRA of 150 gsi2 identifies indeterminate lesions that progressed to melanoma with a sensitivity of 1.00 and specificity of 0.33.

Conclusions And Relevance: Quantification of digital autofluorescence images can differentiate between clinically benign and malignant choroidal nevomelanocytic lesions and may be predictive for clinical progression of indeterminate lesions.
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http://dx.doi.org/10.1001/jamaophthalmol.2013.4007DOI Listing
August 2013

Phenotypic conservation in patients with X-linked retinitis pigmentosa caused by RPGR mutations.

JAMA Ophthalmol 2013 Aug;131(8):1016-25

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA.

Importance: For patients with X-linked retinitis pigmentosa and clinicians alike, phenotypic variability can be challenging because it complicates counseling regarding patients' likely visual prognosis.

Objective: To evaluate the clinical findings from patients with X-linked retinitis pigmentosa with 13 distinct RPGR mutations and assess for phenotypic concordance or variability.

Design: Retrospective medical record review of data collected from 1985 to 2011.

Setting: Kellogg Eye Center, University of Michigan.

Patients: A total of 42 patients with X-linked retinitis pigmentosa with mutations in RPGR. Age at first visit ranged from 4 to 53 years, with follow-up ranging from 1 to 11 visits (median follow-up time, 5.5 years; range, 1.4-32.7 years, for 23 patients with >1 visit).

Main Outcomes And Measures: Clinical data assessed for concordance included visual acuity (VA), Goldmann visual fields (GVFs), and full-field electroretinography (ERG). Electroretinography phenotype (cone-rod vs rod-cone dysfunction) was defined by the extent of photopic vs scotopic abnormality. Qualitative GVF phenotype was determined by the GVF pattern, where central or peripheral loss suggested cone or rod dysfunction, respectively. Goldmann visual fields were also quantified and compared among patients.

Results: Each mutation was detected in 2 or more related or unrelated patients. Five mutations in 11 patients displayed strong concordance of VA, while 4 mutations in 16 patients revealed moderate concordance of VA. A definitive cone-rod or rod-cone ERG pattern consistent among patients was found in 6 of 13 mutations (46.2%); the remaining mutations were characterized by patients demonstrating both phenotypes or who had limited data or nonrecordable ERG values. Concordant GVF phenotypes (7 rod-cone pattern vs 4 cone-rod pattern) were seen in 11 of 13 mutations (84.6%). All 6 mutations displaying a constant ERG pattern within the mutation group revealed a GVF phenotype consistent with the ERG findings.

Conclusions And Relevance: While VA and ERG phenotypes are concordant in only some patients carrying identical mutations, assessment of GVF phenotypes revealed stronger phenotypic conservation. Phenotypic concordance is important for establishing proper counseling of patients diagnosed as having X-linked retinitis pigmentosa, as well as for establishing accurate patient selection and efficacy monitoring in therapeutic trials.
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http://dx.doi.org/10.1001/jamaophthalmol.2013.120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627494PMC
August 2013

Risk of endophthalmitis and other long-term complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).

Am J Ophthalmol 2013 Apr 13;155(4):674-680, 680.e1. Epub 2012 Dec 13.

Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.

Purpose: To report the risk of endophthalmitis and other long-term complications in patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study.

Design: A longitudinal cohort study using data collected from a multicenter, randomized clinical trial.

Methods: Long-term postoperative complications in the 300 patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study were tabulated. Kaplan-Meier analyses were used to estimate the time-related probabilities of blebitis, hypotony, and endophthalmitis.

Results: Two hundred eighty-five patients were included in the final trabeculectomy cohort after accounting for declining treatment assignment and other early events. Patients were followed up for an average of 7.2 years. One hundred sixty-three patients (57%) received 5-fluorouracil during surgery. Of the 247 patients with at least 5 years of follow-up, 50 required further treatment for glaucoma. Cataract extraction was performed in 57 patients (20%). Forty patients (14%) required bleb revision at least once. Bleb-related complications included bleb leak (n = 15), blebitis (n = 8), and hypotony (n = 4). Three patients were noted to have endophthalmitis, although the diagnosis in 2 patients was presumptive. The occurrences of blebitis, hypotony, or endophthalmitis were not significantly associated with 5-fluorouracil use. The Kaplan-Meier calculated risks of blebitis and hypotony at 5 years were both 1.5%, whereas the risk of endophthalmitis was 1.1%.

Conclusions: The potential efficacy of trabeculectomy must be weighed against the long-term risk of complications, especially endophthalmitis, when selecting treatments for patients with open-angle glaucoma. We report a low 5-year risk of endophthalmitis (1.1%) and other bleb-related complications in the trabeculectomy cohort of the Collaborative Initial Glaucoma Treatment Study.
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http://dx.doi.org/10.1016/j.ajo.2012.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608803PMC
April 2013