Publications by authors named "William E Smiddy"

175 Publications

Use of XyCAM RI for Noninvasive Visualization and Analysis of Retinal Blood Flow Dynamics During Clinical Investigations.

Expert Rev Med Devices 2021 Feb 26. Epub 2021 Feb 26.

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

Introduction: Ocular blood flow plays a critical role in eye health by nourishing the retinal and ocular tissues with oxygen and nutrients and removal of ocular metabolic waste. Imaging of retinal and optic blood flow may provide insights for early and more specific diagnoses of ocular vascular disorder and facilitate eye-based biomarkers applicable to neurological health assessment and research.

Areas Covered: The ability of the XyCAM RI (Vasoptic Medical Inc., MD, USA) to visualize and to analyze ocular blood flow dynamics XyCAM RI using laser speckle contrast imaging is reviewed and compared with concurrent clinical ophthalmic imaging technologies like optical coherence tomography - angiography (OCT-A), fundus imaging, fluorescein angiography (FA), indocyanine green angiography (ICGA), laser Doppler flowmetry (LDF), and laser speckle flowgraphy (LSFG).

Expert Opinion: XyCAM RI, with its unprecedented imaging capabilities to assess blood flow dynamics provides a powerful tool to ophthalmic researchers and doctors to obtain greater clinical insights into the physiological status of the posterior segment and treatment approaches for various diseases in a very patient-friendly, noninvasive manner, unlike dye-based angiographic techniques such as FA or ICG. XyCAM RI is well suited as a modality that could close the gap between current screening and comprehensive eye exams.
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http://dx.doi.org/10.1080/17434440.2021.1892486DOI Listing
February 2021

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits.

Clin Ophthalmol 2021 3;15:413-417. Epub 2021 Feb 3.

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

Purpose: To determine secondary effects of the mandated COVID-19 pandemic closure period for elective treatment on non-elective, injection-based retina care and outcomes.

Patients And Methods: In this cross-sectional, retrospective analysis of a single-provider outpatient clinic across multiple satellites, consecutive patients returning for intravitreal injections (IVIs) of anti-vascular endothelial growth factor or corticosteroids were identified as "delayed" or "undelayed" during a six-week study interval during the COVID-19 pandemic that closely following a mandated period of prohibited elective encounters. A "delayed" encounter was defined as having a follow-up interval exceeding 33% of the recommended cycle. Patients seen for IVIs during the corresponding six-week interval a year previously were identified for study as pre-COVID-19 controls. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessment based on findings of intraretinal or subretinal fluid consistent with new or recurrent neovascular events.

Results: The study included 183 eyes of 144 patients who underwent IVI-based care from June 18, 2020, through August 7, 2020, compared to 193 eyes of 154 patients injected during the corresponding interval 1 year before. There were 62 eyes of 46 patients seen in the study period later than scheduled (among 144 patients of 183 eyes in total), which represented a larger proportion of delayed patients compared to the previous year (31.9% vs. 14.9%, p<0.0005). Considering the patterns from the control group, the attributed delay due to COVID-19 was 15.0% of patients. The delayed return eyes had a greater decline in BCVA (3 letters), higher rates of worsened OCT results (48%), and prompted reduction in previously prescribed injection intervals (p<0.02).

Conclusion: The unintended consequence of delayed care of patients on established care regimens should be anticipated, and mitigate strategies considered if similar restrictions are mandated in the future.
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http://dx.doi.org/10.2147/OPTH.S296345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868644PMC
February 2021

Exploratory study of non-invasive, high-resolution functional macular imaging in subjects with diabetic retinopathy.

Int J Ophthalmol 2021 18;14(1):57-63. Epub 2021 Jan 18.

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

Aim: To evaluate a high-resolution functional imaging device that yields quantitative data regarding macular blood flow and capillary network features in eyes with diabetic retinopathy (DR).

Methods: Prospective, cross-sectional comparative case-series in which blood flow velocities (BFVs) and non-invasive capillary perfusion maps (nCPMs) in macular vessels were measured in patients with DR and in healthy controls using the Retinal Functional Imager (RFI) device.

Results: A total of 27 eyes of 21 subjects were studied [9 eyes nonproliferative diabetic retinopathy (NPDR), 9 eyes proliferative diabetic retinopathy (PDR) and 9 controls]. All diabetic patients were type 2. All patients with NPDR and 5 eyes with PDR also had diabetic macular edema (DME). The NPDR group included eyes with severe (=3) and moderate NPDR (=6), and were symptomatic. A significant decrease in venular BFVs was observed in the macular region of PDR eyes when compared to controls (2.61±0.6 mm/s and 2.92±0.72 mm/s in PDR and controls, respectively, =0.019) as well as PDR eyes with DME compared to NPDR eyes (2.36±0.51 mm/s and 2.94±1.09 mm/s in PDR with DME and NPDR, respectively, =0.01).

Conclusion: The RFI, a non-invasive imaging tool, provides high-resolution functional imaging of the retinal microvasculature and quantitative measurement of BFVs in visually impaired DR patients. The isolated diminish venular BFVs in PDR eyes compared to healthy eyes and PDR eyes with DME in comparison to NPDR eyes may indicate the possibility of more retinal vein compromise than suspected in advanced DR.
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http://dx.doi.org/10.18240/ijo.2021.01.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790667PMC
January 2021

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

Am J Ophthalmol 2020 Dec 11;224:292-300. Epub 2020 Dec 11.

Bascom Palmer Eye Institute, Miami, Florida, USA. Electronic address:

Purpose: We compared the ability of ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy using swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA).

Design: Retrospective study comparing diagnostic instruments.

Methods: Eyes with proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy and a high suspicion of NV based on clinical examination were imaged using SS-OCTA and FA at the same visit. Two separate grading sets consisting of scrambled, anonymized SS-OCTA and FA images were created. The ground truth for presence of NV was established by consensus of 2 graders with OCTA experience who did not participate in the subsequent assessment of NV in this study. The 2 anonymized image sets were graded for presence or absence of NV by 12 other graders that included 2 residents, 6 vitreoretinal fellows, and 4 vitreoretinal attending physicians. The percentage of correct grading of NV using SS-OCTA and FA was assessed for each grader and across grader training levels.

Results: Forty-seven eyes from 24 patients were included in this study. Overall, the mean percentage of correct NV grading was 87.8% using SS-OCTA with B-scans and 86.2% using FA (P = .92). Assessing each grader individually, there was no statistically significant asymmetry in correct grading using SS-OCTA and FA.

Conclusions: Ophthalmologists across training levels were able to identify diabetic NV with equal accuracy using SS-OCTA and FA. Based on these results, SS-OCTA may be an appropriate standalone modality for diagnosing diabetic NV.
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http://dx.doi.org/10.1016/j.ajo.2020.11.020DOI Listing
December 2020

Clinicopathologic Correlation of Preretinal Tissues in Myopic Traction Maculopathy.

Retina 2020 Nov 20. Epub 2020 Nov 20.

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

Purpose: To evaluate histopathologic features of preretinal tissues (PRTs) removed from eyes with myopic traction maculopathy (MTM).

Methods: We retrospectively studied PRT specimens from eyes with MTM removed during pars plana vitrectomy (PPV). A control group of 6 idiopathic epiretinal membranes (ERMs) was studied for comparison.

Results: Six MTM specimens were studied histopathologically. Outer retinal schisis-like thickening was present in 100% of pre-operative OCT images; 4 of 6 eyes had subfoveal neurosensory retinal detachment. Postoperative OCTs demonstrated complete resolution of the schisis-like appearance in all eyes; a full-thickness macular hole occurred in 2 of 6 eyes. Histopathologic examination disclosed fibrocellular tissue that was strongly positive for glial fibrillary acidic protein (GFAP), weak to moderately positive for cytokeratin (CK), and weakly positive for smooth muscle actin (SMA) and CD68. There were no apparent histopathologic or immunohistochemical differences between PRTs from eyes with MTM and idiopathic ERMs from control eyes.

Conclusion: The outer retinal schisis-like thickening, commonly also associated with subretinal fluid, that characterizes MTM is associated with PRTs that are histopathologically indistinguishable from idiopathic ERMs. These findings suggest that anteroposterior traction caused by axial elongation rather than a uniquely abnormal cellular process is the etiologic mechanism of MTM.
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http://dx.doi.org/10.1097/IAE.0000000000003045DOI Listing
November 2020

Cost-Utility of Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion.

Ophthalmol Retina 2020 Sep 28. Epub 2020 Sep 28.

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

Purpose: To evaluate the cost-utility of treatment for macular edema in central retinal vein occlusion (CRVO) using intravitreal injections of the anti-vascular endothelial growth factor (VEGF) agents bevacizumab, ranibizumab, and aflibercept.

Design: Decision analysis model of cost-utility.

Participants: Data from study participants in the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study.

Methods: A decision analysis of a disease simulation model was used to calculate comparative cost-utility of intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) for the treatment of macular edema associated with CRVO based on data from the LEAVO study. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital- or facility-based and nonfacility setting from a third-party payer perspective, and societal costs also were calculated. Cost utility was calculated based on the preserved visual utility during the 2 years of the study and also by estimating utility for the expected lifetime.

Main Outcome Measures: Cost of treatment, cost per quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER).

Results: From the third-party payer perspective, the estimated lifetime costs per QALY in the facility and nonfacility settings were $39 325 and $17 944, respectively, for IVB; $114 095 and $92 653, respectively, for IVR; and $78 935 and $63 270, respectively, for IVA. From the societal perspective, the estimated lifetime costs per QALY in the facility setting were $52 754 for IVB, $128 242 for IVR, and $86 262 for IVA. The ICER of IVA compared with that of IVB was $153 633/QALY from the third-party facility setting and $152 992/QALY from the societal perspective. The use of IVB compared with IVR and IVA compared with IVR were cost-saving interventions (ICER, <0) regardless of the perspective or setting.

Conclusions: In the treatment of macular edema in CRVO, IVB yields the best cost utility among the 3 anti-VEGF agents modeled. Intravitreal aflibercept maintains acceptable lifetime cost per QALY while having a favorable cost utility compared with IVR.
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http://dx.doi.org/10.1016/j.oret.2020.09.017DOI Listing
September 2020

The Central Subfoveal Bouquet in Idiopathic Epiretinal Membranes.

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

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

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

Design: Retrospective, consecutive, and observational case series.

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

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

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

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

Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment.

Ophthalmol Retina 2021 Feb 25;5(2):169-175. Epub 2020 Sep 25.

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

Purpose: We compared the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) alone versus combined scleral buckling plus PPV (SB+PPV).

Design: Retrospective, observational study.

Participants: Patients with primary RRD who underwent PPV or SB+PPV from June 1, 2014, through December 31, 2017.

Methods: We performed a single-institution, retrospective, observational study of 488 consecutive patients with primary RRD repaired via PPV alone or SB+PPV and gas tamponade. We excluded patients younger than 18 years and those with advanced proliferative vitreoretinopathy, giant retinal tear, trauma, or secondary forms of RRD. We performed logistic regression and Cox proportional hazard regression analyses to identify potential risk factors associated with a retinal redetachment.

Main Outcome Measures: Single-operation anatomic success (SOAS), defined as adequate retinal reattachment achieved with only 1 procedure.

Results: The mean follow-up interval was 14.3 months. Single-operation anatomic success and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. Single-operation anatomic success was achieved in 90 of 111 eyes (81.1%) with PPV alone compared with 345 of 374 eyes (92.2%) with SB+PPV (P = 0.0010). Scleral buckling plus PPV showed greater SOAS than PPV alone in phakic eyes (P < 0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). Retinal redetachments occurred on average at 1.5 and 9 months after the initial surgery. Significant best-corrected visual acuity improvement was associated with SOAS (P < 0.0001).

Conclusions: Scleral buckling plus PPV resulted in greater SOAS outcomes than PPV alone for primary RRD repair. Phakic eyes achieved greater surgical success with SB+PPV, whereas eyes with a PCIOL achieved similar results with both methods. Most retinal redetachments occurred within the initial postoperative 3-month period. Single-operation anatomic success was associated with statistically significant visual improvement.
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http://dx.doi.org/10.1016/j.oret.2020.09.013DOI Listing
February 2021

Rhegmatogenous Retinal Detachment after Intravitreal Injection.

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

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

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

Design: Retrospecitve case series.

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

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

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

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

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

Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy.

Clin Ophthalmol 2020 10;14:1559-1563. Epub 2020 Jun 10.

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

Objective: To report visual acuity in patients undergoing pars plana vitrectomy (PPV) reoperations for complications of proliferative diabetic retinopathy (PDR).

Design: Retrospective case series.

Subjects: Diabetic patients undergoing reoperation with PPV between 2015 and 2018 at a university referral center.

Methods: Patient charts were reviewed for indication for initial and repeat PPV, baseline clinical characteristics including gender, age, and lens status, and pre- and post-operative best-corrected visual acuity.

Main Outcome Measures: Best-corrected visual acuity at last follow-up.

Results: Of 538 eyes (409 patients) undergoing a PPV for diabetic retinopathy, 153 (28.4%) eyes had reoperation. Among the 130 eyes (119 patients) that met the inclusion criteria, 55 eyes (50 patients) underwent reoperation for complications of PDR, defined as non-clearing vitreous hemorrhage (NCVH) and/or tractional retinal detachment (TRD). Within this subgroup of 55 eyes, 19 (34.5%) eyes had an indication for the first surgery of NCVH. Fourteen (73.7%) of these NCVH eyes achieved a visual acuity of 20/80 or better. When the indication for the first surgery was TRD (33 eyes, 60%), 8 (24.2%) eyes achieved this same outcome (p=0.0011).

Conclusion: Approximately one of every four eyes treated with PPV for PDR will undergo repeat PPV during follow-up. VA outcomes after the repeat PPV were variable, with NCVH cases achieving better outcomes compared to TRD.
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http://dx.doi.org/10.2147/OPTH.S252285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293964PMC
June 2020

Surgical management of uveitis-glaucoma-hyphema syndrome.

Int J Ophthalmol 2020 18;13(6):935-940. Epub 2020 Jun 18.

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

Aim: To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH).

Methods: Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange.

Results: The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (=0.04) postoperatively.

Conclusion: IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.
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http://dx.doi.org/10.18240/ijo.2020.06.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270258PMC
June 2020

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

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

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

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

Facedown Postoperative Positioning for Large Macular Holes.

JAMA Ophthalmol 2020 07;138(7):730-731

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

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http://dx.doi.org/10.1001/jamaophthalmol.2020.0986DOI Listing
July 2020

Long-Term Outcomes After Idiopathic Epiretinal Membrane Surgery.

Clin Ophthalmol 2020 31;14:995-1002. Epub 2020 Mar 31.

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

Purpose: To report anatomic and logMAR best-corrected visual acuity (BCVA) outcomes with long-term follow-up after pars-plana vitrectomy and epiretinal membrane peeling (PPV-MP).

Design: A retrospective case-series.

Participants: Patients with epiretinal membrane (ERM) who underwent PPV-MP performed by one surgeon.

Methods: Best-corrected visual acuity (BCVA) was recorded as a logMAR preoperatively and, when available, at 1, 2, 3, 5, 8, 10 years after surgery. The integrity of outer retinal layers was evaluated using spectral domain optical coherence tomography (SD-OCT).

Main Outcome Measures: Postoperative BCVA at different follow-up visits and its correlation with different OCT parameters.

Results: Fifty-five eyes of 49 patients were followed postoperatively with a mean of 8.6± 2.6 years (median: 9 years, range 5-16 years). The mean BCVA improved from 0.56±0.29 (20/72) preoperatively to 0.33±0.25 (20/42) at 1 year, 0.29±0.27 (20/38) at 2 years, 0.25±0.28 (20/35) at 3 years, 0.29±0.32 (20/38) at 5 years, 0.28±0.31 (20/38) at 8 years, and 0.28±0.25 (20/38) at 10 years (p<0.001). The BCVA improved at each of the first 3 years postoperatively and remained stable at 5, 8, and 10 years. Postoperative improvement in the integrity of ELM, and EZ, on SD-OCT correlated with improved BCVA.

Conclusion: BCVA continues to improve after PPV-MP during the first 3 years postoperatively and remains stable. Improved anatomic integrity of outer retinal layers correlated with improved BCVA.
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http://dx.doi.org/10.2147/OPTH.S242681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127775PMC
March 2020

REPLY.

Ophthalmol Retina 2020 03;4(3):e4

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http://dx.doi.org/10.1016/j.oret.2019.12.006DOI Listing
March 2020

Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Rupture-Associated Choroidal Neovascularization.

Ophthalmol Retina 2020 02 21;4(2):226-228. Epub 2019 Sep 21.

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

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http://dx.doi.org/10.1016/j.oret.2019.09.008DOI Listing
February 2020

Much More than Meets the Eye.

Authors:
William E Smiddy

Ophthalmol Retina 2020 01;4(1):90-91

Miami, Florida.

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http://dx.doi.org/10.1016/j.oret.2019.10.002DOI Listing
January 2020

Carboplatin- and/or paclitaxel-induced ischemic retinopathy.

Can J Ophthalmol 2020 06 23;55(3):e95-e98. Epub 2019 Dec 23.

University of Miami Miller School of Medicine, Miami, FL. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2019.09.004DOI Listing
June 2020

The Clinical Course of Patients with Idiopathic Epiretinal Membranes and Good Visual Acuity Managed Without Surgery.

Clin Ophthalmol 2019 12;13:2469-2475. Epub 2019 Dec 12.

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

Background/aims: To report the clinical course of patients with idiopathic epiretinal membranes (iERMs) and good baseline best-corrected visual acuity (BCVA) managed without surgical treatment.

Methods: Retrospective, observational case series of patients with iERMs and 20/50 or better BCVA who did not undergo surgery between January 2014 and December 2017 with a 1-year follow-up. Secondary epiretinal membranes were excluded. iERMs were stratified into two groups: Group I (BCVA 20/30 or better) and Group II (BCVA 20/40 to 20/50). The main outcome measures included baseline and final follow-up BCVA, central macular thickness (CMT) on OCT.

Results: The study included 174 eyes (145 patients): 139 eyes (79.8%) had typical iERMs and 35 eyes (18%) had LMH. For Group I typical iERMs, the logMAR baseline and final mean BCVA were 0.09 ± 0.1 (Snellen equivalent 20/25) and 0.10 ± 0.1 (20/25) respectively (p = 0.22). In this group, the baseline and final mean CMT were 335 ± 73µm and 342 ± 78µm, respectively (p = 0.47). For Group II typical iERMs, the logMAR baseline and final mean BCVA were 0.3 ± 0.1 (20/44) and 0.4 ± 0.2 (20/45) respectively (p = 0.31). In this group, the baseline and final mean CMT were 386 ± 95µm and 391 ± 93µm, respectively (p = 0.84).

Conclusion: The clinical course of patients with iERM and good baseline BCVA is generally favorable without surgery and includes stable BCVA and OCT measurements after at least one year.
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http://dx.doi.org/10.2147/OPTH.S218662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6914657PMC
December 2019

Surgical Outcomes Of Rhegmatogenous Retinal Detachment In Young Adults Ages 18-30 Years.

Clin Ophthalmol 2019 31;13:2135-2141. Epub 2019 Oct 31.

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

Purpose: The purpose of this study is to investigate associations with and surgical outcomes of rhegmatogenous retinal detachment (RRD) in young adults.

Methods: This is a retrospective consecutive case series of patients aged 18-30 years who underwent surgical repair for RRD between January 1, 2014 and December 1, 2016 at a university referral center.

Results: The current study includes 38 eyes with RRD. Documented high or moderate myopia was present in 28 (74%) eyes. Connective tissue disease was present in 3 (8%) eyes. Median pre-operative visual acuity (VA) was 20/70. Surgery was performed via scleral buckle (SB) alone in 27/38 (71%) and via combined SB and pars plana vitrectomy (SB/PPV) in 11/38 (29%) eyes. Single surgery anatomical success (SSAS) rate was 20/27 (74%) for SB and 7/11 (64%) for SB/PPV. The retina was reattached at last follow-up in 25/27 (93%) for SB and 11/11 (100%) for SB/PPV. The median postoperative VA was 20/40.

Conclusion: In the current study of young adults with RRD, the most common association was high or moderate myopia. Visual and anatomic outcomes at last follow-up were generally favorable.
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http://dx.doi.org/10.2147/OPTH.S213042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827499PMC
October 2019

Long-Term Outcomes after Macular Hole Surgery.

Ophthalmol Retina 2020 04 2;4(4):369-376. Epub 2019 Oct 2.

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

Purpose: To evaluate the structural and visual outcomes after pars plana vitrectomy (PPV) for idiopathic full-thickness macular hole (MH) with at least 5 years of follow-up information.

Design: Retrospective case series.

Participants: Patients with idiopathic MH who had at least 5 years of follow-up information after PPV.

Methods: Best-corrected visual acuity (BCVA) was recorded preoperatively and, when available, at 1, 2, 3, 5, 8, and 10 years after surgery. Reestablishment of the postoperative integrity of the ellipsoid zone (EZ) and the external limiting membrane (ELM) and presence of cystoid spaces were evaluated using spectral-domain (SD) OCT.

Main Outcome Measures: Postoperative BCVA and its correlation with different SD OCT parameters.

Results: Eighty-seven eyes of 80 patients with a mean age at surgery of 68.9±7.03 years were included. The mean postoperative follow-up was 9.6±4.3 years (median, 9 years; range, 5-22 years). The mean preoperative BCVA was 0.20±0.14 (range, 0.03-0.66). Postoperative BCVA was improved at all time points compared with preoperative BCVA (P < 0.05). Improvement in the postoperative BCVA remained stable 10 years after surgery. Initial successful closure of MH was achieved in 82 eyes (94%). Macular hole reopening occurred in 7 eyes (8.0%). Eleven eyes (13%) were reoperated: 4 eyes (4.5%) for persistence and 7 eyes (8.0%) for reopening of MH. Indocyanine green (ICG) stain was used in 22 eyes (25.2%). Among 57 patients (66%) who were phakic before surgery, 52 eyes (91.2%) underwent cataract extraction after PPV at a mean duration of 32.7±38.5 months (range, 2-187 months). Postoperative EZ integrity was restored in 52 eyes (60%), ELM integrity was restored in 54 eyes (62%), and cystoid spaces of variable severity were observed in 28 eyes (32%). Preoperative BCVA of 20/60 or better and postoperative reestablished ELM and EZ integrity were associated significantly with better postoperative BCVA at different postoperative follow-up visits (P < 0.05).

Conclusions: Visual acuity improvement after MH surgery continued during the first 3 years after PPV and was maintained thereafter in a substantial fraction of patients, and final BCVA correlated with better preoperative BCVA and better postoperative OCT parameters.
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http://dx.doi.org/10.1016/j.oret.2019.09.015DOI Listing
April 2020

Geographic Atrophy: How to Count the Costs?

Authors:
William E Smiddy

Ophthalmol Retina 2019 11 30;3(11):927-928. Epub 2019 Jul 30.

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

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http://dx.doi.org/10.1016/j.oret.2019.07.013DOI Listing
November 2019

Docetaxel-induced maculopathy possibly potentiated by concurrent hydroxychloroquine use.

Am J Ophthalmol Case Rep 2019 Dec 26;16:100560. Epub 2019 Sep 26.

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

Purpose: To report a case of bilateral non-leaking cystoid macular degeneration induced by docetaxel, possibly potentiated by hydroxychloroquine.

Observations: A 63-year-old female patient with a long-term history of rheumatoid arthritis controlled on hydroxychloroquine for 33 years with no evidence of retinopathy developed bilateral loss of vision after having been on docetaxel chemotherapy for breast cancer. Optical coherence tomography showed bilateral cystic maculopathy with no angiographic evidence of leakage on fluorescein angiography. The patient was treated conservatively with no further interventions. Marked improvement of the macular degeneration occurred over the subsequent 9 months, but without visual improvement, although a cataract likely confounded final visual acuity measurement.

Conclusions And Importance: Docetaxel-induced maculopathy has been previously reported, but with only four case reports in literature, and most often in conjunction with concurrent therapies or conditions also known to cause macular edema. This is the first case report of docetaxel-induced maculopathy in a setting of hydroxychloroquine therapy which may possibly has potentiated the effect of docetaxel to induce maculopathy. Impaired transcellular retinal pigment epithelial transport might be the cause of non-leaking cystic maculopathy.
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http://dx.doi.org/10.1016/j.ajoc.2019.100560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804700PMC
December 2019

Follow the nevus: the cost-utility of monitoring for growth of choroidal nevi.

Int J Ophthalmol 2019 18;12(9):1456-1464. Epub 2019 Sep 18.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida 33136, United States.

Aim: To develop a model to evaluate the cost-utility of choroidal nevi monitoring recommendations with varying clinical risk factors.

Methods: A Markov model was created to evaluate the cost-utility in cost per quality-adjusted life-year ($/QALY) for monitoring patients with choroidal nevus. This probabilistic model was applied both to a hypothetically monitored and unmonitored group of patients beginning at different ages and with varying clinical risk factors of the nevus. Duration of screening was modeled for the remainder of the patients' life expectancy. Best available clinical data on the prevalence and incidence of choroidal nevi/melanoma, and relative risk of nevus transformation were combined with the initial and downstream costs of screening, downstream costs of melanoma-related mortality, and QALY saved by monitoring, to estimate the best monitoring regimen. Main outcome measures were average $/QALY saved by consensus recommended monitoring scenarios for the duration of a patient's remaining life expectancy in comparison with no follow-up, and the cost-utility of modified regimens.

Results: The $/QALY of the recommended monitoring scenarios varied substantially based on nevus clinical risk factors, patient age, frequency of follow-up, and objective testing utilized. The $/QALY for the recommended monitoring scenario of a flat nevus without risk factors in a 60-year-old patient was $77 180. The $/QALY for monitoring a nevus with 3 clinical risk factors in a 60-year-old patient was $85 393. The $/QALY values for differently-aged patients were larger, and intermediate degrees of risk factors for nevus growth varied, depending largely upon the specifics of the modeled monitoring scenarios.

Conclusion: The average $/QALY of currently recommended monitoring scenarios fall within economically acceptable standards and could provide insight for formulating appropriate clinical strategies. Cost-utility could be enhanced by targeting higher risk groups and considering less frequent monitoring for the lower risk groups.
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http://dx.doi.org/10.18240/ijo.2019.09.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739572PMC
September 2019

Cost Analysis of Pneumatic Retinopexy versus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment.

Ophthalmol Retina 2019 11 12;3(11):956-961. Epub 2019 Jun 12.

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

Purpose: To perform a cost-utility analysis and comparison between pneumatic retinopexy (PR) and pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair.

Design: A cost-utility analysis using decision analysis.

Participants: There were no participants.

Methods: A decision analysis model was constructed based on results from the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial to calculate the costs, lifetime usefulness, and lifetime cost per quality-adjusted life year (QALY) for the treatment of RRD with PR or PPV. Data from the Centers for Medicare and Medicaid Services were used to calculate the associated adjusted costs in facility and nonfacility practice settings.

Main Outcome Measures: Cost of intervention, utility gain over natural history, QALY gained, and cost per QALY.

Results: The total imputed costs (all in 2019 United States dollars) for primary repair of RRD in facility and nonfacility settings were $4451 and $2456, respectively, in the PR group and $7108 and $4514, respectively, in the PPV group. The estimated lifetime QALYs gained were 5.9 and 5.4 in the PR and PPV groups, respectively. The cost per QALY for facility and nonfacility settings was $751 and $414, respectively, in the PR group and $1312 and $833, respectively, in the PPV group.

Conclusions: Cost-utility analysis of both PR and PPV demonstrated excellent results for both methods for RRD repair, with the metrics for PR somewhat more favorable independent of the practice settings (facility or nonfacility based).
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http://dx.doi.org/10.1016/j.oret.2019.06.003DOI Listing
November 2019

Indications and Outcomes for the Removal of Intraocular Lens Implants in a Retinal Surgery Practice.

Ophthalmic Surg Lasers Imaging Retina 2019 08;50(8):504-508

Background And Objective: To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery.

Patients And Methods: This is a retrospective, noncomparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications.

Results: The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and subretinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and final best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85).

Conclusion: The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:504-508.].
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http://dx.doi.org/10.3928/23258160-20190806-05DOI Listing
August 2019

In Reply: Fluid Misdirection Syndrome: The Unified Definition of Malignant Glaucoma.

J Glaucoma 2019 11;28(11):e165

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, FL.

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http://dx.doi.org/10.1097/IJG.0000000000001338DOI Listing
November 2019

Cost-effectiveness of Voretigene Neparvovec-rzyl Therapy.

JAMA Ophthalmol 2019 Jul 18. Epub 2019 Jul 18.

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

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http://dx.doi.org/10.1001/jamaophthalmol.2019.2517DOI Listing
July 2019

Case Series of Recurring Spontaneous Closure of Macular Hole.

Case Rep Ophthalmol Med 2019 16;2019:2398342. Epub 2019 Jun 16.

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

Macular hole can undergo spontaneous reopening and reclosure. This is a retrospective review of three patients who had spontaneous reopening and reclosure of previously spontaneously closed macular hole documented by optical coherence tomography. We report the first case of nivolumab-uveitis-associated macular hole formation. The authors hypothesize that cystoid macular edema (CME) might alter the integrity of foveal tissues or conversely the orientation of the macular hole edges and play a role in formation and resolution of a macular hole.
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http://dx.doi.org/10.1155/2019/2398342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601469PMC
June 2019

Current Trends in Vitreoretinal Anesthesia.

Ophthalmol Retina 2019 09 29;3(9):804-805. Epub 2019 May 29.

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

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http://dx.doi.org/10.1016/j.oret.2019.05.020DOI Listing
September 2019