Publications by authors named "Vishak John"

17 Publications

  • Page 1 of 1

Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab.

Ophthalmology 2020 10 25;127(10):1345-1359. Epub 2020 Apr 25.

Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.

Purpose: To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration.

Design: Retrospective case series.

Participants: Fifteen eyes from 12 patients identified from 10 United States centers.

Methods: Review of patient demographics, ophthalmologic examination results, and retinal imaging findings.

Main Outcome Measures: Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies.

Results: The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033).

Conclusions: Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ophtha.2020.04.017DOI Listing
October 2020

The development and spontaneous resolution of a full-thickness macular hole in bartonella henselae neuroretinitis in a 12-year-old boy.

Am J Ophthalmol Case Rep 2019 Sep 9;15:100515. Epub 2019 Jul 9.

Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Purpose: To describe an unusual case of neuroretinitis complicated by macular hole (MH) development.

Observations: A full-thickness macular hole developed in a 12-year-old boy in association with serology-confirmed neuroretinitis. Following a period of observation, the MH closed without intervention.

Conclusion And Importance: MH may occur as a complication of neuroretinitis secondary to Cat-Scratch Disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2019.100515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630014PMC
September 2019

ANTERIOR MIGRATION OF INTRAVITREAL FLUOCINOLONE ACETONIDE IMPLANTS: A CASE REPORT.

Retin Cases Brief Rep 2019 Jul 17. Epub 2019 Jul 17.

Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Background/purpose: To describe management of anterior migration of a fluocinolone acetonide(FAc) intravitreal implant.

Methods: A retrospective case report. A 61-year-old man with diabetic macular edema and prior vitrectomy had anterior migration of a FAc implant. Anterior segment photos and optical coherence tomography were performed.

Results: Approximately 3 months after FAc implant was administered, it was noted to have migrated into the anterior chamber. Vision, intraocular pressure, and optical coherence tomography imaging initially remained stable, and no evidence of detectable corneal edema developed in 30 months of follow-up. However, at 36 months of follow-up, after second FAc implant injection, mild corneal edema developed,suspected to be related to the migrating implants.

Conclusion: Anterior migration of a FAc implant may lead to less rapid and severe corneal decompensation compared with other steroid implants. Despite this, delayed corneal edema may occur. Careful monitoring of the cornea and intraocular pressure is recommended in cases of anterior FAc migration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICB.0000000000000897DOI Listing
July 2019

Bilateral exudative retinal detachments due to thrombotic microangiopathy associated with intravenous abuse of Opana ER.

Am J Ophthalmol Case Rep 2018 Sep 4;11:72-74. Epub 2018 Jun 4.

Department of Ophthalmology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.

Purpose: To report the only known case, to our knowledge, of bilateral exudative retinal detachments in the setting of thrombotic microangiopathy associated with intravenous abuse of extended-release oxymorphone (Opana ER).

Observations: A 35-year-old male presented with headaches and acute, painless vision loss in the context of daily IV abuse of crushed oral Opana ER. The patient was found to have microangiopathic hemolytic anemia (MAHA), acute kidney injury in conjunction with hypertensive crisis and bilateral exudative retinal detachments.

Conclusions And Importance: Bilateral exudative retinal detachments are rare ophthalmic complications that have been reported with thrombotic thrombocytopenic purpura (TTP). Non-TTP thrombotic microangiopathy, initially described as a "TTP-like illness" consisting of MAHA and thrombocytopenia, has been associated with the IV abuse of Opana ER. We report a case of bilateral exudative retinal detachments due to thrombotic microangiopathy in the setting of IV abuse of Opana ER.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2018.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038103PMC
September 2018

Bilateral Central Retinal Artery Occlusion Associated with Bilateral Lymphoproliferative Infiltrative Optic Neuropathy.

Ocul Oncol Pathol 2017 Sep 23;3(3):229-234. Epub 2017 Mar 23.

Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Background: Leukemic infiltration of the optic nerve is relatively rare. While previously described in acute leukemia, the infiltration in our case represents central nervous system (CNS) metastasis of Burkitt-type lymphoma that developed as a complication of solid-organ transplantation, resulting in a bilateral infiltrative optic neuropathy with sequential, bilateral central retinal artery occlusion (CRAO) and devastating vision loss.

Methods: The medical record, serial ophthalmic examination findings, clinical course, and imaging including magnetic resonance imaging (MRI), fundus photographs, and fluorescein angiography of a single patient were retrospectively reviewed.

Results: MRI demonstrated multifocal cortical and leptomeningeal CNS involvement, including the left optic nerve. Serial fundus examination/photography and fluorescein angiography showed that despite urgent whole-brain irradiation and systemic chemotherapy, CNS disease progressed to bilateral optic nerve infiltration and CRAO with no light perception vision in both eyes.

Conclusion: CRAO can occur as a devastating and irreversible complication of lymphoproliferative optic nerve infiltration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000458414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649333PMC
September 2017

Correspondence.

Retina 2017 05;37(5):e52-e54

1Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan 2Retina and Vitreous of Texas, Houston, Texas 3NYC Retina, New York, New York 4Retina Vitreous Consultants, Pittsburgh, Pennsylvania 5Retina Consultants, Ltd, Chicago, Illinois 6Long Island Vitreoretinal Consultants, Long Island, New York 7Duke Eye Center, Durham, North Carolina 8Children's Hospital of Los Angeles, Los Angeles, California 9Emory Eye Center, Atlanta, Georgia 10University of Occupational and Environmental Health, Kitakyushu, Japan 11Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 12Shiley Eye Institute, University of California San Diego, La Jolla, California 13Moorfields Hospital, London, United Kingdom 14Great Ormond Street Hospital for Children, London, United Kingdom 15Royal Free Hospital, London, United Kingdom 16Kindai University Sakai Hospital, Osaka, Japan 17Retina Associates Southwest, Tucson, Arizona 18Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois 19Bascom Palmer Eye Institute, Miami, Florida 20Foundation Ophthalmic A. de Rothschild, Paris, Neuilly s/Seine, France 21Murray Ocular Oncology and Retina, Miami, Florida 22Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 23Hospital de Olhos do Paraná, Curitiba, Puerto Rico, Brasil 24Austin Retina Associates, Austin, Texas 25Clinica Oftalmologica Kydoft Arauco, Santiago, Chile 26Hospital del Salvador de Santiago, Santiago, Chile 27Asociación Para Evitar la Ceguera en Mexico-Retina Service, Mexico City, Mexico 28Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan 29Department of Medicine, Taiwan and Chang Gung University, College of Medicine, Guishan, Taoyuan, Taiwan 30Casey Eye Institute, Oregon Health and Science University, Portland, Oregon 31Clínica de Enfermedades de los Ojos, Toluca, Mexico 32Asociacion Para Evitar la Ceguera en Mexico-Retina Service, Mexico City, Mexico 33Department of Ophthalmology, School of Medicine, Fukuoka University, Japan 34Vitreo Retinal Surgery, Pennsylvania, Minneapolis, Minnesota 35Bumrungrad International Hospital, Bangkok, Thailand 36Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah 37Doheny Eye Center, University of California Los Angeles, Log Angeles, California 38Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Canada 39Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 40Stanford Byers Eye Institute, Stanford University, Palo Alto, California.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000001602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657297PMC
May 2017

Sector Retinitis Pigmentosa Associated With Novel Compound Heterozygous Mutations of CDH23.

Ophthalmic Surg Lasers Imaging Retina 2016 Feb;47(2):183-6

Usher syndrome is an autosomal recessive condition characterized by retinitis pigmentosa (RP) and congenital hearing loss, with or without vestibular dysfunction. Allelic variants of CDH23 cause both Usher syndrome type 1D (USH1D) and a form of nonsyndromic hearing loss (DFNB12). The authors describe here a 34-year-old patient with congenital hearing loss and a new diagnosis of sector RP who was found to have two novel compound heterozygous mutations in CDH23, including one missense (c.8530C > A; p.Pro2844Thr) and one splice-site (c.5820 + 5G > A) mutation. This is the first report of sector RP associated with these types of mutations in CDH23.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/23258160-20160126-14DOI Listing
February 2016

Retinopathy of Prematurity Versus Familial Exudative Vitreoretinopathy: Report on Clinical and Angiographic Findings.

Ophthalmic Surg Lasers Imaging Retina 2016 Jan;47(1):14-9

Background And Objective: Retinopathy of prematurity (ROP) and familial exudative vitreoretinopathy (FEVR) are classified as distinct diseases; however, emerging genetic research and fluoresce-in angiographic evidence suggest a margin of overlap between the two. PATIENTS AND METHODS This was an institutional review board-approved, retrospective case series. A literature review was performed, and medical records of all pediatric patients who underwent examination under anesthesia and laser for FEVR at the Bascom Palmer Eye Institute Pediatric Retina Service by one of the authors (AMB) from Jan. 1, 2006, to June 30, 2013, were analyzed retrospectively.

Results: Nine infants born prematurely had fluorescein angiograms and a clinical course most consistent with FEVR. Angiographic findings included irregular sprouts of vascularization at the vascular/ avascular junction, distinct pruning of vessels, pinpoint areas of hyperfluorescence, and segmental areas of vascular leakage.

Conclusion: The authors propose a classification of ROPER (ROP vs. FEVR) to more accurately stratify these patients. Identification of this subset of patients will allow for sustained surveillance of infants with ROPER who demonstrate a continuing risk of disease activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/23258160-20151214-02DOI Listing
January 2016

Clinical Course of Vitreomacular Traction Managed Initially by Observation.

Ophthalmic Surg Lasers Imaging Retina 2015 May;46(5):571-6

Background And Objective: To investigate the clinical course and outcomes of patients with vitreomacular traction (VMT) managed initially by observation.

Patients And Methods: This noncomparative case series included patients with a diagnosis of VMT based on clinical symptoms and findings on spectral-domain optical coherence tomography (SD-OCT) between 2005 and 2014. VMT was documented using a standardized grading system based on the degree of distortion of the foveal contour. Data were collected at five retina clinics using standardized collection forms. Visual acuity, changes in SD-OCT findings, and timing of the release of VMT as seen on SD-OCT were recorded.

Results: The study included 230 eyes of 185 patients. Mean age was 72.5 years, and mean follow-up was 32 months. At baseline, VMT grading was grade 1 in 92 eyes (40%), grade 2 in 118 eyes (51.3%), and grade 3 in 20 eyes (8.7%). By last follow-up, spontaneous release of VMT occurred in 73 eyes (31.7%). Spontaneous release of VMT occurred at a mean of 18 months (median: 10.9 months) after initial visit. Mean logMAR best corrected visual acuity (BCVA) was 0.28 (20/55) (range: 20/20 to 20/400) at baseline and 0.25 (20/51) (range: 20/20 to 20/400) at last follow-up. Pars plana vitrectomy was performed in 10 eyes (4.1%) for macular hole (six eyes) and increased VMT (four eyes); BCVA was at least 20/40 in eight of the 10 eyes at last follow-up.

Conclusion: Patients with VMT generally had a favorable clinical course when managed initially by observation. Spontaneous release of VMT occurred in approximately one-third of patients. At last follow-up, pars plana vitrectomy was performed in fewer than 5% of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/23258160-20150521-09DOI Listing
May 2015

Peripheral retinal vasculopathy in childhood glaucoma.

Retina 2015 May;35(5):1028-35

*Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; †Department of Ophthalmology, University of Minnesota, Minneapolis, Minneapolis; and ‡Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California. Dr. Kim is now at the Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California.

Purpose: To report wide-field fluorescein angiography findings in the peripheral retina of eyes with childhood glaucoma.

Methods: Fluorescein angiograms were examined retrospectively in 12 patients with childhood glaucoma who underwent wide-field fluorescein angiography after surgical or medical treatment of glaucoma. This series included 12 eyes of 6 patients with primary congenital glaucoma, 5 eyes of 3 patients with glaucoma associated with congenital cataract surgery, 4 eyes of 2 patients with glaucoma associated with a systemic condition, and 1 eye of 1 patient with phakomatosis pigmentovascularis Type II. RetCam fundus photography images and digital fluorescein angiography were performed under general anesthesia.

Results: The most common finding observed in our series was peripheral retinal nonperfusion, which affected 20 eyes (91%). Other notable features seen were circumferential branching of the retinal vessels parallel to the ora serrata (77%), venous shunts (50%), and abnormal capillary branching patterns, including capillary dilatation (41%) and tortuous capillary tangles (18%). Leakage at the junction of vascular and avascular retina was not commonly seen (13.6%). None of the eyes had evidence of retinal neovascularization or fibrovascular proliferation.

Conclusion: Retinal vascular abnormalities and peripheral nonperfusion are novel findings in childhood glaucoma. Further studies are needed to understand the significance and possible long-term consequences of these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000000415DOI Listing
May 2015

Retained subretinal date palm tree thorn in a child.

J AAPOS 2013 Oct;17(5):545-7

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

A 3-year-old boy presented with severe eye pain and nausea after colliding with a date palm tree branch. Examination under anesthesia revealed a self-sealed corneal laceration and traumatic cataract in his left eye. Cultures were taken and the patient received prophylactic subconjunctival, intravitreal, and systemic antibiotics because of the high risk of endophthalmitis. A thorn from the same tree grew Bacillus cereus. Examination after 2 weeks of the injury revealed a subretinal foreign body (a palm tree thorn), although there were no signs of endophthalmitis or retinal detachment. The patient underwent cataract extraction and laser demarcation of the subretinal foreign body, which was not removed. He was fitted for an aphakic contact lens. With alternate patching, his best-corrected visual acuity improved to 20/30.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2013.05.016DOI Listing
October 2013

Accidental Nd:YAG laser-induced macular hole in a pediatric patient.

Ophthalmic Surg Lasers Imaging Retina 2013 Oct 9;44 Online(6):e7-10. Epub 2013 Oct 9.

After being exposed to an industrial Nd:YAG laser, an 11-year-old boy developed a full-thickness macular hole in the right eye with resultant visual acuity of 20/100. Five months after the initial injury, the vision was stable and the hole was still present. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade with prone positioning. Three months postoperatively, visual acuity improved to 20/25 with closure of the macular hole; however, there was a focal photoreceptor deficit. A review of the English-language literature identified 15 eyes with similar macular hole injuries after Nd:YAG exposure. Three eyes were surgically managed. While all holes were successfully closed, only two experienced visual improvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/23258160-20130926-01DOI Listing
October 2013

Clinical course of vitreomacular adhesion managed by initial observation.

Retina 2014 Mar;34(3):442-6

*Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; †Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma; and ‡Retina-Vitreous Associates Medical Group, Los Angeles, California.

Purpose: The purpose of the study was to investigate the clinical course of patients with idiopathic vitreomacular adhesion (VMA).

Methods: A noncomparative case series of patients who had clinical symptoms and spectral-domain optical coherence tomography findings consistent with VMA. The VMA was graded based on the optical coherence tomography findings at initial and follow-up examinations. Grade 1 was incomplete cortical vitreous separation with attachment at the fovea, Grade 2 was the Grade 1 findings and any intraretinal cysts or clefts, and Grade 3 was the Grade 2 findings and the presence of subretinal fluid.

Results: One hundred and six eyes of 81 patients were identified as having VMA by spectral-domain optical coherence tomography at 3 retina clinics. The mean age was 73 years and the mean time of follow-up was 23 months. Forty-three eyes (41%) had Grade 1 VMA, 56 eyes (52%) had Grade 2 VMA, and 7 eyes (7%) had Grade 3 VMA. By the last follow-up, spontaneous release of VMA occurred in 34 eyes (32%), and pars plana vitrectomy was performed in 5 eyes (4.7%). Mean best-corrected visual acuity was 0.269 logarithm of the minimum angle of resolution or 20/37 at baseline (range, 20/20-20/200) and logarithm of the minimum angle of resolution 0.251 or 20/35 at the last examination (range, 20/20-20/400).

Conclusion: In this selected patient cohort with mild symptoms, the clinical course of patients with VMA managed by initial observation was generally favorable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0b013e3182a15f8bDOI Listing
March 2014

Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy.

Int Ophthalmol 2014 Feb 14;34(1):91-5. Epub 2013 Feb 14.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Suite #252, Miami, FL, 33136, USA.

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10792-013-9731-9DOI Listing
February 2014

Bilateral choroidal metastasis as the presenting sign of small cell lung carcinoma.

J Thorac Oncol 2010 Aug;5(8):1289

Department of Ophthalmology, Emory University, Atlanta; and daggerGeorgia Retina, Decatur, GA 30322, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JTO.0b013e3181e004cdDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989178PMC
August 2010