Publications by authors named "Taher Eleiwa"

15 Publications

  • Page 1 of 1

Orbital inflammatory disease associated with COVID-19 infection.

J AAPOS 2021 May 6. Epub 2021 May 6.

Department of Ophthalmology, Cairo University Hospitals, Cairo, Egypt; Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago. Electronic address:

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http://dx.doi.org/10.1016/j.jaapos.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099788PMC
May 2021

Short-Term Anterior Segment Changes After Nd-YAG Laser Posterior Capsulotomy in Pseudophakic Eyes with Fuchs' Endothelial Dystrophy.

Clin Ophthalmol 2021 30;15:1819-1825. Epub 2021 Apr 30.

Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt.

Purpose: To describe the changes in the central corneal thickness (CCT), endothelial cell count (ECC), intraocular lens (IOL) position, and refractive error 1 and 3 months after Nd-YAG laser posterior capsulotomy (YAG-PC) for posterior capsular opacification (PCO) in pseudophakic eyes with Fuchs' endothelial cell dystrophy (FECD).

Design: Prospective case-control.

Participants: Fifty pseudophakic eyes of 50 patients with visually significant PCO (25 with healthy corneas, and 25 with FECD grade 1 and 2).

Methods: FECD was clinically graded, and only patients without clinically evident corneal edema were included in the study (grade 1 and 2). All patients received YAG-PC and were followed up after 1 and 3 months. Best-corrected visual acuity, refractive errors, ACD, CCT, and ECC were assessed and compared between the pre-laser values and that of the 2 follow-up visits.

Results: In both groups, BCVA showed significant improvement (P<0.05). Compared to healthy controls, a significant hyperopic shift was observed in the FECD eyes at the 2 follow-up visits (P=0.027, and 0.019). A significant backward movement of the IOL was observed in the FECD eyes in the 2 follow-up visits (P=0.043, and 0.02). There was a significant correlation between the hyperopic shift in the FECD eyes and the ACD deepening during the 1st month (R= -0.6, P=0.001) and 3rd month (R= -0.4, P=0.04). Significant drop in the ECC was noted in both groups but without significant increase in the CCT.

Conclusion: Compared to controls, a hyperopic shift and backward movement of the IOL were observed in the FECD eyes after YAG-PC. No significant corneal thickening was found in both groups despite the significant drop in the ECC. Future studies are required to confirm our results and monitor the long-term changes after YAG-PC in FECD.
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http://dx.doi.org/10.2147/OPTH.S305306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096438PMC
April 2021

Multidisease Deep Learning Neural Network for the Diagnosis of Corneal Diseases.

Am J Ophthalmol 2021 Jan 30;226:252-261. Epub 2021 Jan 30.

Bascom Palmer Eye institute, Miller School of Medicine, University of Miami, Miami; Electrical and Computer Engineering, University of Miami, Coral Gables; Biomedical Engineering, University of Miami, Coral Gables, Florida, USA. Electronic address:

Purpose: To report a multidisease deep learning diagnostic network (MDDN) of common corneal diseases: dry eye syndrome (DES), Fuchs endothelial dystrophy (FED), and keratoconus (KCN) using anterior segment optical coherence tomography (AS-OCT) images.

Study Design: Development of a deep learning neural network diagnosis algorithm.

Methods: A total of 158,220 AS-OCT images from 879 eyes of 478 subjects were used to develop and validate a classification deep network. After a quality check, the network was trained and validated using 134,460 images. We tested the network using a test set of consecutive patients involving 23,760 AS-OCT images of 132 eyes of 69 patients. The area under receiver operating characteristic curve (AUROC), area under precision-recall curve (AUPRC), and F1 score and 95% confidence intervals (CIs) were computed.

Results: The MDDN achieved eye-level AUROCs >0.99 (95% CI: 0.90, 1.0), AUPRCs > 0.96 (95% CI: 0.90, 1.0), and F1 scores > 0.90 (95% CI: 0.81, 1.0) for DES, FED, and KCN, respectively.

Conclusions: MDDN is a novel diagnostic tool for corneal diseases that can be used to automatically diagnose KCN, FED, and DES using only AS-OCT images.
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http://dx.doi.org/10.1016/j.ajo.2021.01.018DOI Listing
January 2021

Pathological-Corneas Layer Segmentation and Thickness Measurement in OCT Images.

Transl Vis Sci Technol 2020 10 21;9(11):24. Epub 2020 Oct 21.

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

Purpose: The purpose of this study was to propose a new algorithm for the segmentation and thickness measurement of pathological corneas with irregular layers using a two-stage graph search and ray tracing.

Methods: In the first stage, a graph, with only gradient edge-cost, is used to segment the air-epithelium and endothelium-aqueous boundaries. In the second stage, a graph, with gradient, directional, and multiplier edge-cost, is used to correct segmentation. The optical coherence tomography (OCT) image is flattened using the air-epithelium boundary and a graph search is used to segment the epithelium-Bowman's and Bowman's-stroma boundaries. Then, the OCT image is flattened using the endothelium-aqueous boundary and a graph search is used to segment the Descemet's membrane. Ray tracing is used to correct the inter-boundary distances, then the thickness is measured using the shortest distance. The proposed algorithm was trained and evaluated using 190 OCT images manually segmented by trained operators.

Results: The mean and standard deviation of the unsigned errors of the algorithm-operator and inter-operator were 0.89 ± 1.03 and 0.77 ± 0.68 pixels in segmentation and 3.62 ± 3.98 and 2.95 ± 2.52 µm in thickness measurement.

Conclusions: Our proposed algorithm can produce accurate segmentation and thickness measurements compared with the manual operators.

Translational Relevance: Our algorithm could be potentially useful in the clinical practice.
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http://dx.doi.org/10.1167/tvst.9.11.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594599PMC
October 2020

Mobility improvement of patients with peripheral visual field losses using novel see-through digital spectacles.

PLoS One 2020 14;15(10):e0240509. Epub 2020 Oct 14.

Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America.

Purpose: To evaluate see-through Augmented Reality Digital spectacles (AR DSpecs) for improving the mobility of patients with peripheral visual field (VF) losses when tested on a walking track.

Design: Prospective Case Series.

Participants: 21 patients with peripheral VF defects in both eyes, with the physical ability to walk without assistance.

Methods: We developed the AR DSpecs as a wearable VF aid with an augmented reality platform. Image remapping algorithms produced personalized visual augmentation in real time based on the measured binocular VF with the AR DSpecs calibration mode. We tested the device on a walking track to determine if patients could more accurately identify peripheral objects.

Main Outcome Measures: We analyzed walking track scores (number of recognized/avoided objects) and eye tracking data (six gaze parameters) to measure changes in the kinematic and eye scanning behaviors while walking, and assessed a possible placebo effect by deactivating the AR DSpecs remapping algorithms in random trials.

Results: Performance, judged by the object detection scores, improved with the AR DSpecs (P<0.001, Wilcoxon rank sum test) with an average improvement rate of 18.81%. Two gaze parameters improved with the activated algorithm (P<0.01, paired t-test), indicating a more directed gaze on the central path with less eye scanning. Determination of the binocular integrated VF with the DSpecs correlated with the integrated standard automated perimetry (R = 0.86, P<0.001), mean sensitivity difference 0.8 ± 2.25 dB (Bland-Altman).

Conclusions: AR DSpecs may improve walking maneuverability of patients with peripheral VF defects by enhancing detection of objects in a testing environment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240509PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556490PMC
December 2020

Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis.

Case Rep Ophthalmol Med 2020 15;2020:7237903. Epub 2020 Sep 15.

Department of Ophthalmology, Faculty of Medicine, Benha University, Egypt.

Background: Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty.

Aim: To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). . Hospital-based prospective interventional case series.

Methods: Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA).

Results: The mean age of patients was 22 ± 1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8 ± 1 day, and the mean interval between symptom onset and referral was 14 ± 1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud's medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4 ± 1.2 days of antifungals. In all cases, complete resolution of infection was seen 26 ± 1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14 ± 1.1 months.

Conclusion: MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.
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http://dx.doi.org/10.1155/2020/7237903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7512097PMC
September 2020

Automated diagnosis and staging of Fuchs' endothelial cell corneal dystrophy using deep learning.

Eye Vis (Lond) 2020 1;7:44. Epub 2020 Sep 1.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida 33136 USA.

Background: To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs' endothelial corneal dystrophy (FECD) without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography (HD-OCT).

Methods: In this observational case-control study, 104 eyes (53 FECD eyes and 51 healthy controls) received HD-OCT imaging (Envisu R2210, Bioptigen, Buffalo Grove, IL, USA) using a 6 mm radial scan pattern centered on the corneal vertex. FECD was clinically categorized into early (without corneal edema) and late-stage (with corneal edema). A total of 18,720 anterior segment optical coherence tomography (AS-OCT) images (9180 healthy; 5400 early-stage FECD; 4140 late-stage FECD) of 104 eyes (81 patients) were used to develop and validate a deep learning classification network to differentiate early-stage FECD eyes from healthy eyes and those with clinical edema. Using 5-fold cross-validation on the dataset containing 11,340 OCT images (63 eyes), the network was trained with 80% of these images (3420 healthy; 3060 early-stage FECD; 2700 late-stage FECD), then tested with 20% (720 healthy; 720 early-stage FECD; 720 late-stage FECD). Thereafter, a final model was trained with the entire dataset consisting the 11,340 images and validated with a remaining 7380 images of unseen AS-OCT scans of 41 eyes (5040 healthy; 1620 early-stage FECD 720 late-stage FECD). Visualization of learned features was done, and area under curve (AUC), specificity, and sensitivity of the prediction outputs for healthy, early and late-stage FECD were computed.

Results: The final model achieved an AUC of 0.997 ± 0.005 with 91% sensitivity and 97% specificity in detecting early-FECD; an AUC of 0.974 ± 0.005 with a specificity of 92% and a sensitivity up to 100% in detecting late-stage FECD; and an AUC of 0.998 ± 0.001 with a specificity 98% and a sensitivity of 99% in discriminating healthy corneas from all FECD.

Conclusion: Deep learning algorithm is an accurate autonomous novel diagnostic tool of FECD with very high sensitivity and specificity that can be used to grade FECD severity with high accuracy.
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http://dx.doi.org/10.1186/s40662-020-00209-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460770PMC
September 2020

Case Series of Brittle Cornea Syndrome.

Case Rep Ophthalmol Med 2020 20;2020:4381273. Epub 2020 Mar 20.

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

Purpose: This case series demonstrate diagnostic features, treatment options, and challenges for Brittle Cornea Syndrome. . Three cases presented with bluish sclera and extremely thin cornea. Genetic workup was performed and confirmed the diagnosis of Brittle Cornea Syndrome, a rare autosomal recessive disorder characterized by corneal thinning and blue sclera. Case 1 was a 4-year-old boy who developed cataract and glaucoma after undergoing right tectonic penetrating keratoplasty (PK) secondary to a spontaneous corneal rupture. Glaucoma was controlled medically. Later, the kid underwent right transcorneal lensectomy and vitrectomy with synechiolysis. After 6 weeks, he sustained graft dehiscence that was repaired using onlay patch graft. Case 2 was a 7-year-old boy who underwent PK in the right eye, then a pericardial patch graft in the left eye following spontaneous corneal rupture. Glaucoma in both eyes was controlled medically. Case 3 was the 2-year-old sister of the 2 case. She had a pachymetry of 238 m OD and 254 m OD and 254 .

Conclusions: Long-term follow-up of children diagnosed with Brittle Cornea Syndrome is paramount to minimize the morbidity of corneal rupture and late-onset extraocular conditions.
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http://dx.doi.org/10.1155/2020/4381273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109549PMC
March 2020

Diagnostic Performance of 3-Dimensional Thickness of the Endothelium-Descemet Complex in Fuchs' Endothelial Cell Corneal Dystrophy.

Ophthalmology 2020 07 19;127(7):874-887. Epub 2020 Jan 19.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida; Department of Biomedical Engineering, University of Miami, Miami, Florida. Electronic address:

Purpose: To describe the diagnostic accuracy of 3-dimensional (3D) endothelium-Descemet's membrane complex thickness (En-DMT) in Fuchs' endothelial corneal dystrophy (FECD) and determine its potential role as an objective index of disease severity.

Design: Observational case-control study.

Participants: One hundred four eyes of 79 participants (64 eyes of 41 FECD patients and 40 eyes of 38 healthy controls).

Methods: All participants received high-definition OCT imaging (Envisu R2210; Bioptigen, Buffalo Grove, IL). Fuchs' endothelial corneal dystrophy was classified clinically into early-stage (without edema) and late-stage (with edema) disease. Automatic and manual segmentation of corneal layers was performed using a custom-built segmental tomography algorithm to generate 3D maps of total corneal thickness (TCT) and En-DMT of the central 6-mm cornea. Regional En-DMT, regional TCT, and central-to-peripheral total corneal thickness ratio (CPTR) were evaluated and correlated to the clinical severity of FECD. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess the reliability of the repeated measurements in all eyes.

Main Outcome Measures: Central-to-peripheral total corneal thickness ratio and average En-DMT and TCT of central, paracentral, and peripheral regions.

Results: In FECD, a significant increase in En-DMT, CPTR and TCT was found compared to controls (P < 0.001). For identifying FECD, average En-DMT of paracentral and peripheral regions achieved 94% sensitivity and 100% specificity (cutoffs, 19 μm and 20 μm, respectively), whereas CPTR showed 94% sensitivity with a 73% specificity (cutoff, 0.97). Regarding early-stage FECD, average En-DMT of central zones achieved 92% sensitivity and 97% specificity (cutoff, 18 μm), whereas CPTR showed 90% sensitivity and 88% specificity (cutoff, 0.97). The average En-DMT of central, paracentral, and peripheral regions was correlated highly with FECD clinical stage (Spearman's ρ = 0.813, 0.793, and 0.721, respectively; all P < 0.001), compared with CPTR and mean TCT of paracentral zones (0.672 and 0.481, respectively; P < 0.001). The ICC values ranged from 0.98 (En-DMT) to 0.99 (TCT) with a good agreement between the automatic and manual measurements.

Conclusions: Regional 3D En-DMT is a novel diagnostic tool of FECD that can be used to quantify the disease severity with excellent reliability.
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http://dx.doi.org/10.1016/j.ophtha.2020.01.021DOI Listing
July 2020

Role of Matrix Metalloproteinase 9 in Ocular Surface Disorders.

Eye Contact Lens 2020 Mar;46 Suppl 2:S57-S63

Department of Ophthalmology (E.C.J.), Columbia University Medical Center, New York, NY; Bascom Palmer Eye Institute (A.M.E., T.K.E.), University of Miami Miller School of Medicine, Miami, FL; Department of Ophthalmology (A.M.E., R.H.E., Y.M.E.S.), Kasr Al-Ainy, Cairo University, Giza, Egypt; and Department of Ophthalmology (T.K.E.), Faculty of Medicine, Benha University, Benha, Egypt.

Objectives: (1) To explore the role and significance of Matrix Metalloproteinase 9 (MMP-9), a proteolytic enzyme, in various ocular surface diseases of inflammatory, infectious, and traumatic etiology (2), to further elucidate the molecular mechanisms responsible for its overexpression in ocular surface disease states, and (3) to discuss possible targets of therapeutic intervention.

Methods: A literature review was conducted of primary sources from 1995 onward using search results populated from the US National Library of Medicine search database.

Results: MMP-9 overexpression has been found in in vitro and in vivo models of dry eye disease (DED), corneal ulceration, microbial keratitis, corneal neovascularization, ultraviolet light-induced radiation, and a host of additional surface pathologies. MMP-9 is involved in an intricate signal transduction cascade that includes induction by many proinflammatory molecules including interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-a), nuclear factor kappa light chain enhancer of activated B cells (NF-kB), platelet-activating factor, activator protein 1 (AP-1), and transforming growth factor beta (TGF-B). MMP-9 expression is blunted by a diverse array of molecular factors, such as tissue inhibitors of metalloproteinases, cyclosporine A (CyA), PES_103, epigalloccatechin-3-gallate (EGCG), N-acetylcysteine (NaC), ascorbate, tetracyclines, and corticosteroids. Inhibition of MMP-9 frequently led to improvement of ocular surface disease.

Conclusions: Novel insights into the mechanistic action of MMP-9 provide potential for new therapeutic modulations of ocular surface diseases mediated by its overexpression.
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http://dx.doi.org/10.1097/ICL.0000000000000668DOI Listing
March 2020

In-vivo Three-dimensional Characteristics of Bowman's Layer and Endothelium/Descemet's Complex Using Corneal Microlayer Tomography in Healthy Subjects.

Curr Eye Res 2020 06 16;45(6):659-667. Epub 2020 Feb 16.

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

: To characterize the three-dimensional (3D) thickness profile and age-related changes of Bowman's layer (BL), and endothelium/Descemet's membrane (En/DM) complex among healthy individuals using Corneal Microlayer Tomography (CML-T), and to describe its repeatability and accuracy.: Sixty-six eyes of 41 healthy volunteers; 27 eyes (< 40 years old), and 39 eyes (>40 years old) were imaged using HD-OCT. Automatic and manual segmentation of the corneal layers was performed, and 3D thickness maps were generated, using custom-built CML-T software. A regional analysis of mean thickness parameters between the 2 age groups was performed. A regression analysis was used to assess the correlation between age, and thickness maps. Intraclass Correlation Coefficients (ICC), Coefficients of Variation (COV), and Bland-Altman plots were used to assess the reliability of the repeated measurements in 198 locations.: CML-T successfully mapped the BL and En/DM in all included eyes. Thickness maps showed a significant increase in corneal thickness (CT), BL thickness (BMT), and En/DM complex thickness (DMT) toward the periphery with a mean difference 28 µm ( < .001), 1.1 µm ( < .001), and 1.4 µm ( < .001), respectively. There was a strong correlation between age and central DMT (r = 0.61; < .001), while there was no correlation between age and both CT, and BMT. ICC values ranged from 0.9 (BMT) to 0.997 (DMT), and from 0.808 (BMT) to 0.979 (CT) for intraoperator repeatability of manual measurements, and the accuracy of auto matic measurements, respectively. COV values were lower than 7.5% in all cases.: CML-T is a novel tool that can generate 3D-thickness maps of both BL and En/DM. CT, BMT, and DMT increase toward the periphery in healthy corneas. DMT increases with aging, while BMT does not. We also report excellent repeatability, accuracy and good agreement between automatic and manual measurements.
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http://dx.doi.org/10.1080/02713683.2019.1691238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239712PMC
June 2020

Diagnostic Performance of Three-Dimensional Endothelium/Descemet Membrane Complex Thickness Maps in Active Corneal Graft Rejection.

Am J Ophthalmol 2020 02 1;210:48-58. Epub 2019 Nov 1.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA; Biomedical Engineering, University of Miami, Miami, Florida, USA. Electronic address:

Purpose: To evaluate the performance of 3-dimensional (3D) endothelium/Descemet membrane complex thickness (En/DMT) maps vs total corneal thickness (TCT) maps in the diagnosis of active corneal graft rejection.

Design: Cross-sectional study.

Methods: Eighty-one eyes (32 clear grafts and 17 with active rejection, along with 32 age-matched control eyes) were imaged using high-definition optical coherence tomography (HD-OCT), and a custom-built segmentation algorithm was used to generate 3D color-coded maps of TCT and En/DMT of the central 6-mm cornea. Regional En/DMT and TCT were analyzed and compared between the studied groups. Receiver operating characteristic curves were used to determine the accuracy of En/DMT and TCT maps in differentiating between studied groups. Main outcome measures were regional En/DMT and TCT.

Results: Both regional TCT and En/DMT were significantly greater in actively rejecting grafts compared to both healthy corneas and clear grafts (P < .001). Using 3D thickness maps, central, paracentral, and peripheral En/DMT achieved 100% sensitivity and 100% specificity in diagnosing actively rejecting grafts (optimal cut-off value [OCV] of 19 μm, 24 μm, and 26 μm, respectively), vs only 82% sensitivity and 96% specificity for central TCT, OCV of 587 μm. Moreover, central, paracentral, and peripheral En/DMT correlated significantly with graft rejection severity (r = 0.972, r = 0.729, and r = 0.823, respectively; P < .001).

Conclusion: 3D En/DMT maps can diagnose active corneal graft rejection with excellent accuracy, sensitivity, and specificity. Future longitudinal studies are required to evaluate the predictive and prognostic role of 3D En/DMT maps in corneal graft rejection.
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http://dx.doi.org/10.1016/j.ajo.2019.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002262PMC
February 2020

Toward Improving the Mobility of Patients with Peripheral Visual Field Defects with Novel Digital Spectacles.

Am J Ophthalmol 2020 02 10;210:136-145. Epub 2019 Oct 10.

Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; Department of Electrical and Computer Engineering, University of Miami, Miami, Florida, USA; Biomedical Engineering Department, University of Miami, Miami, Florida, USA. Electronic address:

Purpose: To assess the efficacy of novel Digital spectacles (DSpecs) to improve mobility of patients with peripheral visual field (VF) loss.

Design: Prospective case series.

Methods: Binocular VF defects were quantified with the DSpecs testing strategy. An algorithm was implemented that generated personalized visual augmentation profiles based on the measured VF. These profiles were achieved by relocating and resizing video signals to fit within the remaining VF in real time. Twenty patients with known binocular VF defects were tested using static test images, followed by dynamic walking simulations to determine if they could identify objects and avoid obstacles in an environment mimicking a real-life situation. The effect of the DSpecs were assessed for visual/hand coordination with object-grasping tests. Patients performed these tests with and without the DSpecs correction profile.

Results: The diagnostic binocular VF testing with the DSpecs was comparable to the integrated monocular standard automated perimetry based on point-by-point assessment with a mismatch error of 7.0%. Eighteen of 20 patients (90%) could identify peripheral objects in test images with the DSpecs that they could not previously. Visual/hand coordination was successful for 17 patients (85%) from the first trial. The object-grasping performance improved to 100% by the third trial. Patient performance, judged by finding and identifying objects in the periphery in a simulated walking environment, was significantly better with the DSpecs (P = 0.02, Wilcoxon rank sum test).

Conclusions: DSpecs may improve mobility by facilitating the ability of patients to better identify moving peripheral hazardous objects.
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http://dx.doi.org/10.1016/j.ajo.2019.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002240PMC
February 2020

Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion.

J Ophthalmol 2019 25;2019:9648614. Epub 2019 Jul 25.

Saint Louis University Eye Institute, St Louis, MO, USA.

Purpose: To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone.

Patients And Methods: Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications.

Results: All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with , 1 with coagulase-negative staphylococci, and 1 with . Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (-2.29 ± 0.72 LogMAR, versus -2.95 ± 0.30 LogMAR; =0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits.

Conclusion: The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.
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http://dx.doi.org/10.1155/2019/9648614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701324PMC
July 2019

Automatic Segmentation of Corneal Microlayers on Optical Coherence Tomography Images.

Transl Vis Sci Technol 2019 May 11;8(3):39. Epub 2019 Jun 11.

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

Purpose: To propose automatic segmentation algorithm (AUS) for corneal microlayers on optical coherence tomography (OCT) images.

Methods: Eighty-two corneal OCT scans were obtained from 45 patients with normal and abnormal corneas. Three testing data sets totaling 75 OCT images were randomly selected. Initially, corneal epithelium and endothelium microlayers are estimated using a corneal mask and locally refined to obtain final segmentation. Flat-epithelium and flat-endothelium images are obtained and vertically projected to locate inner corneal microlayers. Inner microlayers are estimated by translating epithelium and endothelium microlayers to detected locations then refined to obtain final segmentation. Images were segmented by trained manual operators (TMOs) and by the algorithm to assess repeatability (i.e., intraoperator error), reproducibility (i.e., interoperator and segmentation errors), and running time. A random masked subjective test was conducted by corneal specialists to subjectively grade the segmentation algorithm.

Results: Compared with the TMOs, the AUS had significantly less mean intraoperator error (0.53 ± 1.80 vs. 2.32 ± 2.39 pixels; < 0.0001), it had significantly different mean segmentation error (3.44 ± 3.46 vs. 2.93 ± 3.02 pixels; < 0.0001), and it had significantly less running time per image (0.19 ± 0.07 vs. 193.95 ± 194.53 seconds; < 0.0001). The AUS had insignificant subjective grading for microlayer-segmentation grading (4.94 ± 0.32 vs. 4.96 ± 0.24; = 0.5081), but it had significant subjective grading for regional-segmentation grading (4.96 ± 0.26 vs. 4.79 ± 0.60; = 0.025).

Conclusions: The AUS can reproduce the manual segmentation of corneal microlayers with comparable accuracy in almost real-time and with significantly better repeatability.

Translational Relevance: The AUS can be useful in clinical settings and can aid the diagnosis of corneal diseases by measuring thickness of segmented corneal microlayers.
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http://dx.doi.org/10.1167/tvst.8.3.39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561132PMC
May 2019