Publications by authors named "Vinay K Aakalu"

54 Publications

Adjustable Sutures in the Treatment of Strabismus: A Report by the American Academy of Ophthalmology.

Ophthalmology 2021 Aug 23. Epub 2021 Aug 23.

Jules Stein Eye Institute, Los Angeles, California.

Purpose: To review the scientific literature that evaluates the effectiveness of adjustable sutures in the management of strabismus for adult and pediatric patients.

Methods: Literature searches were performed in the PubMed database through April 2021 with no date limitations and were restricted to publications in English. The searches identified 551 relevant citations, of which 55 were reviewed in full text. Of these, 17 articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. The search included all randomized controlled studies regardless of study size and cohort studies of 100 or more patients comparing the adjustable versus nonadjustable suture technique, with a focus on motor alignment outcomes or reoperation rates.

Results: The literature search yielded no level I studies. Of the 17 articles that met the inclusion criteria, 11 were rated level II and 6 were rated level III. Among the 12 studies that focused on motor alignment outcomes, 4 small randomized clinical trials (RCTs) did not find a statistically significant difference between groups, although they were powered to detect only very large differences. Seven of 8 nonrandomized studies found a statistically significant difference in motor alignment success in favor of the adjustable suture technique, both overall and in certain subgroups of patients. Successful motor alignment was seen in both exotropia (in 3 studies that were not limited to children) and esotropia (in 1 study of adults and 2 of children). The majority of included studies that reported on reoperation rates found the rates to be lower in patients who underwent strabismus surgery with adjustable sutures, but this finding was not uniformly demonstrated.

Conclusions: Although there are no level I studies evaluating the effectiveness of adjustable sutures for strabismus surgery, the majority of nonrandomized studies that met the inclusion criteria for this assessment reported an advantage of the adjustable suture technique over the nonadjustable technique with respect to motor alignment outcomes. This finding was not uniformly demonstrated among all studies reviewed and warrants further investigation in the development and analysis of adjustable suture techniques.
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http://dx.doi.org/10.1016/j.ophtha.2021.07.026DOI Listing
August 2021

Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology.

Ophthalmology 2021 Jun 24. Epub 2021 Jun 24.

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Purpose: To review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.

Methods: A literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.

Results: The agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.

Conclusions: The current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.
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http://dx.doi.org/10.1016/j.ophtha.2021.05.018DOI Listing
June 2021

Corneal neurotization for neurotrophic keratopathy: Review of surgical techniques and outcomes.

Ocul Surf 2021 04 26;20:163-172. Epub 2021 Feb 26.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.

Neurotrophic keratopathy is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia. Injuries to neurotrophic corneas are notoriously difficult to treat and have traditionally been approached with supportive management. However, recent progress in the field of corneal neurotization has given new direction for addressing nerve loss directly by stimulating new nerve growth onto the cornea from nearby sensory nerves transferred to the perilimbal region. Herein, we review the surgical techniques utilized in corneal neurotization, including direct transfers and the use of nerve grafts. Considerations in surgical approach, as well as factors that influence prognosis and outcomes of the surgical intervention are also discussed.
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http://dx.doi.org/10.1016/j.jtos.2021.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113161PMC
April 2021

Optic neuropathy and diplopia from thyroid eye disease: update on pathophysiology and treatment.

Curr Opin Neurol 2021 02;34(1):116-121

Department of Ophthalmology and Visual Sciences, Illinois Center for Thyroid Eye Disease, Illinois Eye and Ear Infirmary UIC, Chicago, Illinois, USA.

Purpose Of Review: Thyroid eye disease (TED) is a disfiguring disease that can lead to neuro-ophthalmic manifestations including diplopia and optic neuropathy. The aim of this review is to shed light on the diagnosis of TED based on clinical examination findings and diagnostic imaging. We will also discuss gold standard as well as newly emerging therapies for TED.

Recent Findings: We discussed diagnostic criteria for TED and differentiating TED from other causes of binocular diplopia. We also reviewed the pathophysiology and differential diagnoses for dysthyroid optic neuropathy as well as recent developments on controversial causes. New imaging techniques are available for evaluation and prognosis of TED comorbidities. Most of the recent developments in TED have been focused on new treatment modalities that have thus far had promising results. We reviewed recently approved and novel potential therapies that are helpful in treating both diplopia and dysthyroid optic neuropathy.

Summary: TED is a complicated disorder with many clinical manifestations as well as treatment modalities. Our aim of this review was to outline new developments in the diagnosis and management of TED.
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http://dx.doi.org/10.1097/WCO.0000000000000894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853658PMC
February 2021

Interventions for Indirect Traumatic Optic Neuropathy: A Report by the American Academy of Ophthalmology.

Ophthalmology 2021 06 6;128(6):928-937. Epub 2020 Nov 6.

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Purpose: To review the literature on the efficacy and safety of medical and surgical interventions for indirect traumatic optic neuropathy (TON), defined as injury to the nerve that occurs distal to the optic nerve head.

Methods: A literature search was conducted on October 22, 2019, and updated on April 8, 2020, in the PubMed database for English language original research that assessed the effect of various interventions for indirect TON. One hundred seventy-two articles were identified; 41 met the inclusion criteria outlined for assessment and were selected for full-text review and abstraction. On full-text review, a total of 32 studies met all of the study criteria and were included in the analysis.

Results: No study met criteria for level I evidence. Seven studies (1 level II study and 6 level III studies) explored corticosteroid therapy that did not have uniformly better outcomes than observation. Twenty studies (3 level II studies and 17 level III studies) assessed optic canal decompression and the use of corticosteroids. Although visual improvement was noted after decompression, studies that directly compared surgery with medical therapy did not report uniformly improved outcomes after decompression. Four studies (1 level II study and 3 level III studies) evaluated the use of erythropoietin. Although initial studies demonstrated benefit, a direct comparison of its use with observation and corticosteroids failed to confirm the usefulness of this medication. One study (level II) documented visual improvement with levodopa plus carbidopa. Complication rates were variable with all of these interventions. Pharmacologic interventions generally were associated with few complications, whereas optical canal decompression carried risks of serious side effects, including hemorrhages and cerebrospinal fluid leakage.

Conclusions: Despite reports of visual improvement with corticosteroids, optic canal decompression, and medical therapy for indirect TON, the weight of published evidence does not demonstrate a consistent benefit for any of these interventions. In summary, no consensus exists from studies published to date on a preferred treatment for TON. Treatment strategies should be customized for each individual patient. More definitive treatment trials will be needed to identify optimal treatment strategies for indirect TON.
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http://dx.doi.org/10.1016/j.ophtha.2020.10.038DOI Listing
June 2021

Electrothermal soft manipulator enabling safe transport and handling of thin cell/tissue sheets and bioelectronic devices.

Sci Adv 2020 Oct 16;6(42). Epub 2020 Oct 16.

Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.

"Living" cell sheets or bioelectronic chips have great potentials to improve the quality of diagnostics and therapies. However, handling these thin and delicate materials remains a grand challenge because the external force applied for gripping and releasing can easily deform or damage the materials. This study presents a soft manipulator that can manipulate and transport cell/tissue sheets and ultrathin wearable biosensing devices seamlessly by recapitulating how a cephalopod's suction cup works. The soft manipulator consists of an ultrafast thermo-responsive, microchanneled hydrogel layer with tissue-like softness and an electric heater layer. The electric current to the manipulator drives microchannels of the gel to shrink/expand and results in a pressure change through the microchannels. The manipulator can lift/detach an object within 10 s and can be used repeatedly over 50 times. This soft manipulator would be highly useful for safe and reliable assembly and implantation of therapeutic cell/tissue sheets and biosensing devices.
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http://dx.doi.org/10.1126/sciadv.abc5630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567602PMC
October 2020

Sentinel Lymph Node Biopsy for Eyelid and Conjunctival Malignancy: A Report by the American Academy of Ophthalmology.

Ophthalmology 2020 12 19;127(12):1757-1765. Epub 2020 Jul 19.

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Purpose: To determine the efficacy and safety of sentinel lymph node biopsy (SLNB) in the management of eyelid and conjunctival malignancy.

Methods: A literature search was performed in August 2019 and January 2020 for articles published in English in the PubMed and Cochrane Library databases. This search yielded 151 articles that were reviewed for relevancy, of which 27 were deemed to have met the inclusion criteria for this assessment. The data from these articles were abstracted and the articles were rated for strength of evidence by the panel methodologist.

Results: All 27 studies were rated level III, and a total of 197 SLNBs were reported. Diagnoses included conjunctival and eyelid cutaneous melanoma (85 and 42 patients, respectively), sebaceous gland carcinoma (35 patients), squamous cell carcinoma (26 patients), Merkel cell carcinoma (6 patients), pigmented epithelioid melanocytoid tumor (1 patient), mucoepidermoid carcinoma (1 patient), and signet ring carcinoma (1 patient). Tracer was found in regional lymph nodes in 100% of patients in 21 of 27 articles and in 191 of 197 patients overall. The number of lymph nodes removed ranged from 1 to 16, with most ranging from 1 to 5. Tumor-positive lymph nodes were found in 33 of 197 patients (16.8%), prompting recommendations for adjuvant treatments. Survival data were reported for 16 of these patients, with follow-up periods ranging from 3 to 36 months (average, 12.7 months). Fourteen of 16 patients received adjuvant treatments. Nine were alive and well, 1 was alive with metastases, and 6 had died of metastatic disease (including 2 patients who declined additional treatment). False-negative SLNB results were reported in 5 articles involving 9 of 197 procedures (4.6%). Complications were documented in 7 of 27 articles and included transient facial nerve weakness, persistent blue dye staining of the conjunctiva, neck hematoma, and suture abscess.

Conclusions: Sentinel lymph node biopsy is a promising procedure in patients with eyelid and conjunctival malignancy, and it is useful in identifying sentinel lymph nodes. However, at present, insufficient evidence exists showing that SLNB improves patient outcomes and survival. Recognition of microscopic metastatic disease may prove beneficial in staging and guiding adjuvant therapy.
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http://dx.doi.org/10.1016/j.ophtha.2020.07.031DOI Listing
December 2020

Intense Pulsed Light for Meibomian Gland Disease: A Report by the American Academy of Ophthalmology.

Ophthalmology 2020 09 21;127(9):1227-1233. Epub 2020 Apr 21.

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Purpose: To review the literature on the efficacy of intense pulsed light (IPL) on the eyelids in the management of meibomian gland disease (MGD) and meibomian gland-related ocular surface disease.

Methods: A literature search was last conducted on May 15, 2019, in the PubMed and Cochrane Library databases for English-language original research that assessed the effect of IPL on MGD in adult patients. Thirty-three articles were identified, and 12 studies were determined to be relevant to the criteria outlined for assessment. The panel methodologist (V.K.A.) assigned a level of evidence rating to each study; 4 studies were rated level II, and 8 studies were rated level III. Five studies had potential conflicts of interest and design limitations that affected interpretation of results.

Results: All studies documented improvement in clinically meaningful metrics, including tear breakup time (TBUT), corneal staining and eyelid margin measurements, meibum quality, meibomian gland expressability, ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED) questionnaire scores. Side effects were relatively uncommon but included discomfort, cutaneous erythema, blistering, eyelash loss, and floaters; these were uniformly self-limited.

Conclusions: Although methodological limitations and potential conflicts of interest in some studies raised concern, the existing body of literature demonstrates improvements in the signs and symptoms of MGD after IPL therapy.
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http://dx.doi.org/10.1016/j.ophtha.2020.03.009DOI Listing
September 2020

Acute-Onset Visual Acuity Loss in a Man With Advanced Diabetes Mellitus.

JAMA Ophthalmol 2020 04;138(4):416-417

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

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http://dx.doi.org/10.1001/jamaophthalmol.2019.5388DOI Listing
April 2020

Bioengineered Acellular Dermal Matrix Spacer Grafts for Lower Eyelid Retraction Repair: A Report by the American Academy of Ophthalmology.

Ophthalmology 2020 05 30;127(5):689-695. Epub 2019 Dec 30.

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Purpose: To review the literature on the efficacy and safety of bioengineered acellular dermal matrix (BADM) grafts for lower eyelid retraction repair.

Methods: A literature search was conducted in the PubMed database initially in January 2018 and updated in July 2019 to identify all studies in the English language literature on the use of BADM grafts in eyelid reconstruction. The searches yielded 193 citations, and 15 of the 34 articles selected for full review met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Two of the 15 studies included were rated level II and 13 were rated level III.

Results: The definition of success varied, but lower eyelid position improvement using lower lid margin-to-pupillary reflex distance was the most common outcome measure. Other end points were the amount of lagophthalmos, cosmesis, exposure, reoperation, or complications, as well as prosthesis retention in anophthalmic socket cases. The surgeon-reported success rate of these outcomes ranged from 75% to 100%. Minor complications included cyst formation, infection, chemosis, pyogenic granuloma, and corneal abrasion. No serious complications such as blindness, anaphylactic reaction, or terminal disease transmission occurred. Of the 526 implants included for assessment in these disparate studies, 27 cases (5%) required reoperation.

Conclusions: No level I evidence was available, and the existing level II and level III studies have variable primary end points, study design limitations, and only short-term follow-up data. The current literature suggests that BADM grafts represent an implantation option for lower eyelid retraction repair. Short-term results are favorable, and the materials used may fill an important gap in care for patients for whom no acceptable alternatives exist, but long-term safety and efficacy remain unknown.
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http://dx.doi.org/10.1016/j.ophtha.2019.11.011DOI Listing
May 2020

Reply.

Ophthalmology 2020 01;127(1):e8-e9

Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee.

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http://dx.doi.org/10.1016/j.ophtha.2019.09.040DOI Listing
January 2020

Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology.

Ophthalmology 2020 02 13;127(2):261-272. Epub 2019 Oct 13.

Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.

Purpose: To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.

Methods: Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.

Results: Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.

Conclusions: There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
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http://dx.doi.org/10.1016/j.ophtha.2019.08.024DOI Listing
February 2020

A Comparison of Endonasal Dacryocystorhinostomy and External Dacryocystorhinostomy: A Report by the American Academy of Ophthalmology.

Ophthalmology 2019 11 26;126(11):1580-1585. Epub 2019 Jul 26.

Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee.

Purpose: To assess the efficacy of endonasal dacryocystorhinostomy (DCR) compared with external DCR.

Methods: A literature search was conducted in the PubMed database in March 2016 and updated in October 2017 and February 2019. The search strategy was designed to update the first Ophthalmic Technology Assessment on endonasal DCR from 2001 by identifying new peer-reviewed human studies reported since 2000 in the English language that compare results of endonasal DCR with those of external DCR. The searches yielded 169 articles. Of these, 13 met the inclusion criteria and were assigned a level of evidence rating.

Results: Six of the 13 studies included in this assessment were rated level II and 7 were rated level III. Three of the 13 studies drew conclusions based on statistically significant results, but all of these were level III evidence. Two of these significant studies demonstrated lesser efficacy of endonasal laser DCR (63%-64%) compared with external DCR (94%; P = 0.0002, 0.024). The third study reported that nonlaser endonasal DCR was superior to external DCR (84% vs. 70%; P = 0.03). The remainder of the studies did not find statistically significant differences in success rates between the 2 techniques.

Conclusions: Limited data suggest that laser endonasal DCR may be less effective than external DCR. Existing data are inadequate to draw conclusions about whether endonasal DCR is superior to, equivalent to, or inferior to the gold standard external DCR.
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http://dx.doi.org/10.1016/j.ophtha.2019.06.009DOI Listing
November 2019

Intraocular Lens Implantation during Early Childhood: A Report by the American Academy of Ophthalmology.

Ophthalmology 2019 10 21;126(10):1454-1461. Epub 2019 Jun 21.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Purpose: To compare the visual outcomes and adverse events associated with optical correction using an intraocular lens (IOL), contact lenses, or spectacles after cataract surgery in children 2 years of age or younger.

Methods: Literature searches were conducted in PubMed, the Cochrane Library, and the databases of clinical trials in February 2019, without date or language restrictions. The search resulted in 194 potentially relevant citations, and 34 were selected for full-text review. Fourteen studies were determined to be relevant to the assessment criteria and were selected for inclusion in this assessment. The panel methodologist then assigned a level of evidence rating to these studies.

Results: Intraocular lenses were associated with visual outcomes similar to outcomes for contact lenses or spectacles for children who had both bilateral and unilateral cataracts. Intraocular lenses were also associated with an increased risk of visual axis opacities. All treatments were associated with a similar incidence of glaucoma. Although ocular growth was similar for all treatments, infants younger than 6 months who underwent IOL implantation had large myopic shifts that often resulted in high myopia or severe anisometropia later in childhood. Corneal endothelial cell counts were lower in eyes that underwent IOL implantation. The incidence of strabismus was similar with all treatments.

Conclusions: Intraocular lens implantation is not recommended for children 6 months of age or younger because there is a higher incidence of visual axis opacities with this treatment compared with aphakia. The best available evidence suggests that IOL implantation can be done safely with acceptable side effects in children older than 6 months of age. However, the unpredictability of ocular growth means that these children will often have large refractive errors later in childhood that may necessitate an IOL exchange or wearing spectacles or contact lenses with a large refractive correction. In addition, the training and experience of the surgeon as well as ocular and systemic comorbidities should be taken into consideration when deciding whether IOL implantation would be appropriate.
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http://dx.doi.org/10.1016/j.ophtha.2019.05.009DOI Listing
October 2019

Monocanalicular Stents in Eyelid Lacerations: A Report by the American Academy of Ophthalmology.

Ophthalmology 2019 09 4;126(9):1324-1329. Epub 2019 Apr 4.

Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee.

Purpose: To determine the efficacy and complication rates of monocanalicular stents in the setting of canalicular lacerations.

Methods: A literature search was performed in May 2018 in the PubMed database to identify all English-language reports of monocanalicular stenting to address canalicular lacerations. Studies that did not include at least 10 patients with at least 3 months of follow-up evaluation after surgery were excluded. Ninety-nine articles were identified, and 15 of these met criteria for data abstraction and were included in this assessment. The panel methodologist (V.K.A.) evaluated the quality of evidence and assigned a level-of-evidence rating to each of these studies.

Results: All 15 studies were rated as level III evidence. Anatomic and functional success rates after surgery ranged from 68% to 100% and 79% to 100%, respectively. Stents were generally well tolerated, although extrusion rates varied from 0% to 29%.

Conclusions: Only level III evidence was available, and studies were not powered to detect differences between groups for rare complications or failure. Monocanalicular stents seem to be efficacious and well tolerated in the management of canalicular lacerations. Potential complications include extrusion (most commonly), tube displacement, granuloma, ectropion, slit punctum, fistula, and infection. Further comparative studies would help to identify the optimal time for device removal and to directly compare monocanalicular with bicanalicular stents.
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http://dx.doi.org/10.1016/j.ophtha.2019.03.045DOI Listing
September 2019

Balloon Dacryoplasty for Congenital Nasolacrimal Duct Obstruction: A Report by the American Academy of Ophthalmology.

Ophthalmology 2018 10 7;125(10):1654-1657. Epub 2018 Jun 7.

Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee.

Purpose: To identify the efficacy and adverse event rates of balloon dacryoplasty in cases of congenital nasolacrimal duct obstruction in children who fail to respond to an initial nasolacrimal duct probing.

Methods: A literature search was last performed in September 2017 in the PubMed database to identify all reports of balloon dacryoplasty. All searches up to and including the last search were limited to the English language, and they yielded 104 articles that were assessed for relevancy. Thirty-six articles were selected for full review, and 8 of these were selected for inclusion in this assessment and assigned a quality of evidence rating by the panel methodologist.

Results: Three of the 8 studies included in this assessment were rated level II, and 5 were rated level III. Success rates varied from 75% to 100%. Only 2 complications were identified, and these were cases of self-limited postoperative emesis. The 2 studies that compared balloon dacryoplasty with lacrimal stenting reported that outcomes were comparable between the 2 techniques.

Conclusions: Although level I evidence was not available, the studies that were uncovered in the literature review indicate that balloon dacryoplasty is a safe, effective procedure to address congenital nasolacrimal duct obstruction that persists after standard probings. The outcomes of this intervention are similar to those of lacrimal stenting, and the absence of an implanted stent theoretically reduces the risk of complications.
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http://dx.doi.org/10.1016/j.ophtha.2018.05.005DOI Listing
October 2018

Solitary fibrous tumor of the orbit with growth during pregnancy: a case report.

Orbit 2019 Jun 21;38(3):256-258. Epub 2018 May 21.

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

We report the case of an anterior orbital tumor in a young woman that enlarged during pregnancy. The mass was excised and found to be a spindle cell tumor with immunohistochemical reactivity consistent with a solitary fibrous tumor, a rare entity in the spectrum of fibroblastic mesenchymal tumors. The tumor was strongly positive for the progesterone receptor, consistent with its clinical growth during the antenatal and postnatal periods. To our knowledge, a primary orbital tumor with these characteristics has rarely been reported in the literature.
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http://dx.doi.org/10.1080/01676830.2018.1474930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249116PMC
June 2019

Rapidly Growing Eyelid Mass in an Elderly Man.

JAMA Ophthalmol 2018 06;136(6):710-711

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

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http://dx.doi.org/10.1001/jamaophthalmol.2017.5480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002893PMC
June 2018

3D printing for low cost, rapid prototyping of eyelid crutches.

Orbit 2019 Aug 2;38(4):342-346. Epub 2018 Mar 2.

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

Blepharoptosis or ptosis is a common and potentially debilitating clinical problem. Long-term surgical treatment for ptosis caused by progressive myopathies can be challenging due to potential recurrence and complications associated with facial muscle weakness. When surgical treatment is no longer effective, an eyelid crutch can be used as an alternative intervention. This report demonstrates how 3D printing was used to rapidly design, prototype, and manufacture new custom-fit eyelid crutches at a low cost.
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http://dx.doi.org/10.1080/01676830.2018.1445760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119648PMC
August 2019

Engineering Polymersomes for Diagnostics and Therapy.

Adv Healthc Mater 2018 04 15;7(8):e1701276. Epub 2018 Jan 15.

Department of Chemical and Biomolecular Engineering, Department of Bioengineering, Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.

Engineered polymer vesicles, termed as polymersomes, confer a flexibility to control their structure, properties, and functionality. Self-assembly of amphiphilic copolymers leads to vesicles consisting of a hydrophobic bilayer membrane and hydrophilic core, each of which is loaded with a wide array of small and large molecules of interests. As such, polymersomes are increasingly being studied as carriers of imaging probes and therapeutic drugs. Effective delivery of polymersomes necessitates careful design of polymersomes. Therefore, this review article discusses the design strategies of polymersomes developed for enhanced transport and efficacy of imaging probes and therapeutic drugs. In particular, the article focuses on overviewing technologies to regulate the size, structure, shape, surface activity, and stimuli- responsiveness of polymersomes and discussing the extent to which these properties and structure of polymersomes influence the efficacy of cargo molecules. Taken together with future considerations, this article will serve to improve the controllability of polymersome functions and accelerate the use of polymersomes in biomedical applications.
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http://dx.doi.org/10.1002/adhm.201701276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377267PMC
April 2018

Strategies for Regenerating the Lacrimal Gland.

Curr Ophthalmol Rep 2017 Sep 29;5(3):193-198. Epub 2017 May 29.

Lacrimal Cell Biology Laboratory, University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, Chicago, Illinois, USA.

Purpose Of Review: Aqueous deficient dry eye disease, a significant cause of morbidity worldwide, is due to dysfunction of the main and accessory lacrimal glands. Recent advances in efforts to regenerate lacrimal gland are reviewed.

Recent Findings: Several strategies are being explored: culture models of human and non-human lacrimal gland epithelial and myoepithelial cells, isolation and characterization of adult precursor cells within lacrimal glands, directed differentiation of stem cells to lacrimal gland cells, and organogenesis and engraftment techniques.

Summary: Conditions for primary cell culture and expansion are being established and will help in the characterization of lacrimal cells. Presumed adult precursor cells have been isolated, laying down foundations for regeneration. Stem cells have been induced to express features of lacrimal gland cells. Engraftment of cultured lacrimal tissue is proof of concept that lacrimal gland regeneration and repopulation is possible.
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http://dx.doi.org/10.1007/s40135-017-0142-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662123PMC
September 2017

Orbital Implants in Enucleation Surgery: A Report by the American Academy of Ophthalmology.

Ophthalmology 2018 02 9;125(2):311-317. Epub 2017 Sep 9.

Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee.

Purpose: To compare the motility and complication rates of porous and nonporous implants after enucleation surgery.

Methods: Literature searches of the PubMed and Cochrane Library databases were last performed in February 2017 to identify studies published between 2003 and 2017 on outcomes after enucleation surgeries in which a variety implants were used. The searches were limited to the English language with abstracts and yielded 43 articles, which the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel reviewed for relevancy. Twenty-five articles were considered to have met the search strategy, and the panel methodologist assigned ratings to them according to the level of evidence.

Results: Only 2 of the 25 articles identified met the criteria for level I evidence. Eighteen of the studies did not assess motility after enucleation surgery, and the 7 that did evaluate this metric involved porous implants. The studies that analyzed this outcome reported favorable results, but the results were not uniformly based on objective analysis. Both porous and nonporous implants were well tolerated, and complication rates were generally low for both types.

Conclusions: In keeping with increasing surgeon preference for porous implants, most studies identified in this literature search involved the use of this type of implant. These implants resulted in excellent motility after enucleation surgery, although many studies did not assess this outcome. Regardless of implant type, major complications were rare, and infection was exceptionally uncommon after enucleation. Given the paucity of data on motility and the absence of direct, objective comparisons of porous and nonporous implants, definitive conclusions about the impact of implant material on motility cannot be made. Since few studies evaluated nonporous implants, direct comparisons cannot be made definitively between implant types, and future investigations are needed to enable a critical assessment.
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http://dx.doi.org/10.1016/j.ophtha.2017.08.006DOI Listing
February 2018

Tumid lupus: An unexpected diagnosis for the otolaryngologist.

Am J Otolaryngol 2017 Mar - Apr;38(2):257-259. Epub 2017 Jan 17.

Department of Pathology, University of Illinois Hospital and Health Sciences System, 840 S. Wood Street, CSN 130, Chicago, IL 60612, United States. Electronic address:

Tumid lupus is an uncommon variant of lupus erythematosus. Patients present with subcutaneous lesions. Ophthalmic literature reports disease manifestation as orbital inflammation. Autoimmune serology is often negative. Without a high index of suspicion, the diagnosis is easily overlooked delaying treatment. Tumid lupus is not significantly discussed in the Otolaryngologic literature. Here we present a Case Report of a male who initially presented to Ophthalmology with unilateral orbital complaint of eyelid puffiness. Orbital biopsy and subsequent biopsy of his submental skin lesions ultimately led to this unexpected diagnosis. We discuss the method to diagnose tumid lupus including representative histopathologic findings.
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http://dx.doi.org/10.1016/j.amjoto.2017.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826658PMC
December 2017

Evaluation of Accessory Lacrimal Gland in Muller's Muscle Conjunctival Resection Specimens for Precursor Cell Markers and Biological Markers of Dry Eye Disease.

Curr Eye Res 2017 04 9;42(4):491-497. Epub 2016 Sep 9.

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

Purpose: The accessory lacrimal glands (ALGs) are an understudied component of the tear functional unit, even though they are important in the development of dry eye syndrome (DES). To advance our understanding of aging changes, regenerative potential, and histologic correlates to human characteristics, we investigated human ALG tissue from surgical samples to determine the presence or absence of progenitor cell markers and lacrimal epithelial markers and to correlate marker expression to relevant patient characteristics.

Materials And Methods: ALG tissues obtained from Muller's muscle conjunctival resection (MMCR) specimens were created using tissue microarrays (TMAs). Immunofluorescence staining of MMCR sections was performed using primary antibodies specific to cell protein markers. Cell marker localization in TMAs was then assessed by two blinded observers using a standardized scoring system. Patient characteristics including age, race, and status of ocular surface health were then compared against expression of stem cell markers.

Results: Human ALG expressed a number of epithelial markers, and in particular, histatin-1 was well correlated with the expression of epithelial markers and was present in most acini. In addition, we noted the presence of precursor cell markers nestin, ABCG2, and CD90 in ALG tissue. There was a decrease in precursor cell marker expression with increasing age. Finally, we noted that a negative association was present between histatin-1 expression and DES.

Conclusions: Thus, we report for the first time that human ALG tissues contain precursor marker-positive cells and that this marker expression may decrease with increasing age. Moreover, histatin-1 expression may be decreased in DES. Future studies will be performed to use these cell markers to isolate and culture lacrimal epithelial cells from heterogeneous tissues, determine the relevance of histatin-1 expression to DES, and isolate candidate precursor cells from ALG tissue.
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http://dx.doi.org/10.1080/02713683.2016.1214966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551074PMC
April 2017

Surgical Microanatomy of Lower Eyelid Tarsal Ectropion Repair With a Putterman Ptosis Clamp.

Ophthalmic Plast Reconstr Surg 2017 Jul/Aug;33(4):261-263

*Illinois Eye and Ear Infirmary, Oculoplastic and Reconstructive Surgery Service, Chicago, Illinois, †Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, and ‡Fort Lauderdale Eye Institute, Plantation, Florida, U.S.A.

Purpose: To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction.

Methods: Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains.

Results: Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls.

Conclusion: The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.
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http://dx.doi.org/10.1097/IOP.0000000000000737DOI Listing
September 2017

Efficacy of Muller's Muscle and Conjunctiva Resection With or Without Tarsectomy for the Treatment of Severe Involutional Blepharoptosis.

Ophthalmic Plast Reconstr Surg 2017 Jul/Aug;33(4):273-278

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, U.S.A.

Purpose: To determine if Muller's muscle and conjunctiva resection with or without tarsectomy is an efficacious procedure for the treatment of severe involutional blepharoptosis.

Methods: A retrospective chart review was performed for all consecutive patients with severe involutional blepharoptosis during a 12-year period treated by a single surgeon (AMP) with a Muller's muscle and conjunctiva resection with or without tarsectomy. The inclusion criteria was good levator function (≥10 mm eyelid excursion), adequate response to phenylephrine (change in eyelid height ≥1.5 mm), and severe involutional blepharoptosis (margin-to-reflex-distance-1 ≤0 mm).

Results: One hundred eyelids of 69 patients were identified that met the inclusion criteria. Mean preoperative margin-to-reflex-distance-1 was -0.65 mm and mean postoperative margin-to-reflex-distance-1 was 3.00 mm for all patients. For patients treated with Muller's muscle and conjunctiva resection without tarsectomy, mean preoperative and postoperative margin-to-reflex-distance-1 was -0.51 mm and 2.98 mm with 97.5% of the patients obtaining a lift greater than 1.5 mm.

Conclusions: The results demonstrate that Muller's muscle and conjunctiva resection with or without tarsectomy does provide another alternative to the surgeon for the management of severe involutional blepharoptosis.
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http://dx.doi.org/10.1097/IOP.0000000000000748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5236006PMC
September 2017

Histatin-1 Expression in Human Lacrimal Epithelium.

PLoS One 2016 29;11(1):e0148018. Epub 2016 Jan 29.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Background: Study of human lacrimal cell biology is limited by poor access to tissue samples, heterogeneous cell composition of tissue and a lack of established lacrimal epithelial markers. In order to further our understanding of lacrimal cell biology, we sought to find a better marker for human lacrimal epithelial cells, compared to what has been reported in the literature.

Methods: We utilized human Muller's muscle conjunctival resection (MMCR) specimens containing accessory lacrimal gland (ALG) and cadaveric main lacrimal gland (MLG) as sources of lacrimal tissue. Candidate markers were sought using human ALG tissue from MMCR specimens, isolated by laser capture microdissection (LCM). Affymetrix® analysis was performed on total RNA isolated from FFPE samples to profile transcription in ALG. MMCR tissue sections were assessed by immunofluorescence using antibodies for histatin-1, lactoferrin, E-cadherin (E-cad) and alpha-smooth muscle actin (ASMA). Reverse transcriptase polymerase chain reaction (RT-PCR) analysis was performed to analyze the expression of histatin-1, E-cad and lactoferrin from cadaveric MLG.

Results: Histatin-1 is expressed in ALG and MLG, localizes to lacrimal epithelium, and to a greater degree than do other putative lacrimal epithelial markers.

Conclusions: Histatin-1 is a good marker for human lacrimal epithelium in ALG and MLG and can be used to identify lacrimal cells in future studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148018PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732786PMC
July 2016

Review of Ocular Manifestations of Nevoid Basal Cell Carcinoma Syndrome: What an Ophthalmologist Needs to Know.

Middle East Afr J Ophthalmol 2015 Oct-Dec;22(4):421-7

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

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare, autosomal dominant disorder characterized by multiple basal cell carcinomas (BCCs), odontogenic keratocysts, palmar and/or plantar pits, and ectopic calcifications of the falx cerebri. Myriad ophthalmologic findings are associated with NBCCS, including periocular BCCs, hypertelorism, strabismus, myelinated nerve fibers, and disorders of the retina and retinal pigment epithelium. We performed a literature search in PubMed for articles on the ophthalmologic manifestations of Gorlin syndrome, published between 1984 and 2014. Of 33 papers, 31 were included. Although Gorlin syndrome is due to mutations in a single gene, it displays variable phenotypic expressivity. Therefore, familiarity with this disorder across clinical specialties is necessary to avoid misdiagnosis. The ophthalmologist should be included in the multidisciplinary team for the management of Gorlin syndrome in order to prevent visual loss and improve the quality of life of these patients.
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http://dx.doi.org/10.4103/0974-9233.167815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660526PMC
May 2016

Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center.

Orbit 2015 Jun 23;34(3):152-9. Epub 2015 Apr 23.

Department of Ophthalmology, University of Illinois at Chicago College of Medicine , Chicago, Illinois , USA.

Purpose: To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center.

Methods: Retrospective case series.

Results: From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn's disease. Another patient had a history of alcoholic liver cirrhosis, Crohn's disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization.

Conclusions: Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.
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http://dx.doi.org/10.3109/01676830.2015.1014512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466351PMC
June 2015
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