Publications by authors named "William J Wirostko"

31 Publications

Metastatic Choroidal Melanoma Treated with Ipilimimab.

Ophthalmology 2020 05;127(5):600

Medical College of Wisconsin, Milwaukee, Wisconsin.

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http://dx.doi.org/10.1016/j.ophtha.2020.01.020DOI Listing
May 2020

An innovative visual acuity chart for urgent and primary care settings: validation of the Runge near vision card.

Eye (Lond) 2019 07 21;33(7):1104-1110. Epub 2019 Feb 21.

Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.

Objective: We evaluated the Runge card, a near-vision eye chart designed for ease of use, by testing agreement in visual acuity results between it and the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. As a clinical reference point, we compared the Runge card and an electronic Snellen chart with respect to agreement with ETDRS results.

Methods: Participants consisted of adult eye clinic patient volunteers who underwent a protocol refraction, followed by testing with a Runge card, ETDRS chart, and Snellen chart. Mean logMAR visual acuities were calculated for each method. Agreement levels among the tests were assessed for the group overall and for subjects with good (ETDRS logMAR < 0.6; better than 20/80 Snellen equivalent) and poor (logMAR ≥ 0.6) acuity.

Results: One hundred and thirty-eight participants completed testing. The mean ( ± standard deviation) logMAR visual acuities (Snellen equivalent) with Runge, ETDRS, and Snellen, respectively, were 0.66 ± 0.50 (20/91, n = 138), 0.59 ± 0.51 (20/78, n = 138), and 0.67 ± 0.62 (20/94, n = 137). Runge testing agreed similarly with ETDRS and Snellen testing, with CCC 0.92 between Runge and ETDRS, and 0.87 between Runge and Snellen (p = 0.14). Runge agreed better with ETDRS than Snellen agreed with ETDRS in participants with poor acuity (CCC = 0.79 vs. 0.63, respectively, p = 0.001) but not in those with good acuity (CCC = 0.70 vs. 0.87, respectively, p = 0.005).

Conclusion: Visual acuity measurements with the Runge near card agreed with measurements from the ETDRS to approximately the same degree as did the Snellen chart, suggesting potential utility of the Runge near card, particularly given its user-friendly characteristics and ease of use.
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http://dx.doi.org/10.1038/s41433-019-0372-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707193PMC
July 2019

A case of congenital retinal macrovessel in an otherwise normal eye.

Am J Ophthalmol Case Rep 2017 Dec 9;8:18-21. Epub 2017 Sep 9.

Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, United States.

Purpose: To present the case of a 37-year-old female with a foveal macrovessel.

Observations: The patient had an incidental finding of congenital retinal macrovessel (CRM) in the left eye on optical coherence tomography (OCT). Visual acuity was normal, and slit lamp and dilated fundus examinations were otherwise unremarkable. OCT angiography (OCTA) imaging allowed for visualization of the depth profile of the vessel as well as the foveal avascular zone (FAZ). The FAZ and foveal pit were both smaller in the affected eye compared to the fellow eye.

Conclusions And Importance: We describe findings of OCTA imaging in a patient with CRM. Previous reports have relied on examination using fluorescein angiography, which does not provide sufficient axial resolution to discern the different vascular plexuses. This report further characterizes how this rare condition can affect foveal morphology and retinal vasculature.
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http://dx.doi.org/10.1016/j.ajoc.2017.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731666PMC
December 2017

Local Anesthesia With Blunt Sub-Tenon's Cannula Versus Sharp Retrobulbar Needle for Vitreoretinal Surgery: A Retrospective, Comparative Study.

Ophthalmic Surg Lasers Imaging Retina 2016 Jan;47(1):55-9

Background And Objective: To evaluate the safety and efficacy of a blunt sub-Tenon's cannula for local anesthesia before vitreoretinal surgery compared to a sharp retrobulbar needle.

Patients And Methods: Retrospective, comparative study of all patients undergoing vitreoretinal surgery at the Medical College of Wisconsin between August 2009 and November 2013. Institutional review board approval was obtained.

Results: Of 940 surgeries performed with a sub-Tenon's cannula, 99% (938 of 940) were completed. Of the 771 surgeries performed with a sharp retrobulbar needle, 99% (770 of 771) were completed. Factors associated with use of a sharp retrobulbar needle over sub-Tenon's cannula were presence of prior scleral buckle (P < .01) and inclusion of scleral buckle placement in the procedure (P < .01). No case of globe perforation, severe retrobulbar hemorrhage, or severe conjunctival chemosis was observed in either group.

Conclusion: Blunt sub-Tenon's cannula appears as effective and safe as a sharp retrobulbar needle for local anesthesia during vitreoretinal surgery. Vitreoretinal surgeons may wish to consider a blunt sub-Tenon's cannula for local surgical anesthesia.
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http://dx.doi.org/10.3928/23258160-20151214-08DOI Listing
January 2016

Assessing photoreceptor structure after macular hole closure.

Retin Cases Brief Rep 2015 ;9(1):15-20

*Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin; †Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; ‡Department of Biomedical Engineering, University of Rochester, Rochester, New York; §Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin; and ¶Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.

Purpose: To describe photoreceptor structure and recovery after macular hole (MH) closure with pars plana vitrectomy (PPV) using adaptive optics scanning light ophthalmoscopy and spectral domain optical coherence tomography.

Methods: A pilot imaging study of four eyes from four subjects undergoing PPV for MH was conducted. Imaging with spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy was performed at varying time points after PPV.

Results: Despite successful MH closure, disruption of the foveal inner segment ellipsoid zone was seen in all patients when imaged at a mean of 117 days after PPV. Disruption of the photoreceptor mosaic was seen using adaptive optics scanning light ophthalmoscopy at locations corresponding to regions of ellipsoid zone disruption on spectral domain optical coherence tomography. Cone density immediately surrounding these disruptions was normal, except for one patient. In 2 patients who were imaged serially up to 516 days after PPV, recovery of cone cells within regions of mosaic disruption could be detected over time.

Conclusion: Photoreceptor disruption exists even after apparent MH closure. Remodeling of the foveal cone mosaic continues for many months after surgery, perhaps accounting for the delayed postoperative improvements of visual acuity in some patients. Spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy are useful tools for monitoring photoreceptor recovery after surgical closure of MH.
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http://dx.doi.org/10.1097/ICB.0000000000000117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554764PMC
August 2015

Relationship between foveal cone specialization and pit morphology in albinism.

Invest Ophthalmol Vis Sci 2014 May 20;55(7):4186-98. Epub 2014 May 20.

Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.

Purpose: Albinism is associated with disrupted foveal development, though intersubject variability is becoming appreciated. We sought to quantify this variability, and examine the relationship between foveal cone specialization and pit morphology in patients with a clinical diagnosis of albinism.

Methods: We recruited 32 subjects with a clinical diagnosis of albinism. DNA was obtained from 25 subjects, and known albinism genes were analyzed for mutations. Relative inner and outer segment (IS and OS) lengthening (fovea-to-perifovea ratio) was determined from manually segmented spectral domain-optical coherence tomography (SD-OCT) B-scans. Foveal pit morphology was quantified for eight subjects from macular SD-OCT volumes. Ten subjects underwent imaging with adaptive optics scanning light ophthalmoscopy (AOSLO), and cone density was measured.

Results: We found mutations in 22 of 25 subjects, including five novel mutations. All subjects lacked complete excavation of inner retinal layers at the fovea, though four subjects had foveal pits with normal diameter and/or volume. Peak cone density and OS lengthening were variable and overlapped with that observed in normal controls. A fifth hyper-reflective band was observed in the outer retina on SD-OCT in the majority of the subjects with albinism.

Conclusions: Foveal cone specialization and pit morphology vary greatly in albinism. Normal cone packing was observed in the absence of a foveal pit, suggesting a pit is not required for packing to occur. The degree to which retinal anatomy correlates with genotype or visual function remains unclear, and future examination of larger patient groups will provide important insight on this issue.
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http://dx.doi.org/10.1167/iovs.13-13217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098060PMC
May 2014

Bilateral Acute Retinal Necrosis with Concurrent Retinopathy of Prematurity in Two Neonates.

Ocul Immunol Inflamm 2016 15;24(1):115-7. Epub 2014 May 15.

b The Eye Institute of the Medical College of Wisconsin , Milwaukee , Wisconsin , USA.

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http://dx.doi.org/10.3109/09273948.2014.916724DOI Listing
November 2016

Outer retinal structure after closed-globe blunt ocular trauma.

Retina 2014 Oct;34(10):2133-46

*Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin; †Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; ‡Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York; §Icahn School of Medicine at Mount Sinai, New York, New York; ¶Retina Consultants Ltd, Des Plaines, Illinois; and Departments of **Biophysics, and ††Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.

Purpose: To evaluate outer retinal structural abnormalities in patients with visual deficits after closed-globe blunt ocular trauma.

Methods: Nine subjects with visual complaints after closed-globe blunt ocular trauma were examined between 1 month after trauma and 6 years after trauma. Spectral domain optical coherence tomography was used to assess the outer retinal architecture, whereas adaptive optics scanning light ophthalmoscopy was used to analyze the photoreceptor mosaic integrity.

Results: Visual deficits ranged from central scotomas to decreased visual acuity. Spectral domain optical coherence tomography defects included focal foveal photoreceptor lesions, variable attenuation of the interdigitation zone, and mottling of the outer segment band, with one subject having normal outer retinal structure. Adaptive optics scanning light ophthalmoscopy revealed disruption of the photoreceptor mosaic in all subjects, variably manifesting as foveal focal discontinuities, perifoveal hyporeflective cones, and paracentral regions of selective cone loss.

Conclusion: We observe persistent outer retinal disruption in subjects with visual complaints after closed-globe blunt ocular trauma, albeit to a variable degree. Adaptive optics scanning light ophthalmoscopy imaging allows the assessment of photoreceptor structure at a level of detail not resolvable using spectral domain optical coherence tomography or other current clinical imaging tools. Multimodal imaging seems to be useful in revealing the cause of visual complaints in patients after closed-globe blunt ocular trauma. Future studies are needed to better understand how photoreceptor structure changes longitudinally in response to various traumas.
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http://dx.doi.org/10.1097/IAE.0000000000000169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175068PMC
October 2014

A lensing effect of inner retinal cysts on images of the photoreceptor mosaic.

Retina 2014 Feb;34(2):421-2

Departments of *Ophthalmology, †Medical Scientist Training Program, and ‡Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin; §Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; and ¶Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.

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http://dx.doi.org/10.1097/IAE.0b013e3182a2f50cDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946899PMC
February 2014

Scleral buckle removal in the vitrectomy era: a 20-year clinical experience.

Retina 2013 Feb;33(2):387-91

Froedtert and MCW Eye Institute, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Purpose: To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal.

Methods: A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present).

Results: Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD.

Conclusion: Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.
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http://dx.doi.org/10.1097/IAE.0b013e31826415d9DOI Listing
February 2013

Evaluation of normal human foveal development using optical coherence tomography and histologic examination.

Arch Ophthalmol 2012 Oct;130(10):1291-300

Duke University Eye Center, Box 3802 Erwin Rd, Wadsworth Ste 103, Durham, NC 27710, USA.

Objective: To assess outer retinal layer maturation during late gestation and early postnatal life using optical coherence tomography and histologic examination.

Methods: Thirty-nine participants 30 weeks' postmenstrual age or older were imaged using a handheld optical coherence tomography system, for a total of 102 imaging sessions. Foveal images from 16 participants (21 imaging sessions) were normal and evaluated for inner retinal excavation and the presence of outer retinal reflective bands. Reflectivity profiles of central, parafoveal, and parafoveal retina were extracted and were compared with age-matched histologic sections.

Results: The foveal pit morphologic structure in infants was generally distinguishable from that in adults. Reflectivity profiles showed a single hyperreflective band at the fovea in all the infants younger than 42 weeks' postmenstrual age. Multiple bands were distinguishable in the outer retina at the peri fovea by 32 weeks' postmenstrual age and at the fovea by 3 months' postterm. By 17 months' postnatal, the characteristic appearance of 4 hyperreflective bands was evident across the foveal region. These features are consistent with previous results from histologic examinations. A "temporal divot" was present in some infants, and the foveal pit morphologic structure and the extent of inner retinal excavation were variable.

Conclusions: Handheld optical coherence tomography is a viable technique for evaluating neonatal retinas. In premature infants who do not develop retinopathy of prematurity, the foveal region seems to follow a developmental time course similar to that associated with in utero maturation.

Clinical Relevance: As pediatric optical coherence tomography becomes more common, a better understanding of normal foveal and macular development is needed. Longitudinal imaging offers the opportunity to track postnatal foveal development among preterm infants in whom poor visual outcomes are anticipated or to follow up treatment outcomes in this population.
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http://dx.doi.org/10.1001/archophthalmol.2012.2270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724218PMC
October 2012

Collaborative Ocular Oncology Group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma.

Ophthalmology 2012 Aug 21;119(8):1596-603. Epub 2012 Apr 21.

Washington University and Siteman Cancer Center, St. Louis, Missouri, USA.

Purpose: This study evaluates the prognostic performance of a 15 gene expression profiling (GEP) assay that assigns primary posterior uveal melanomas to prognostic subgroups: class 1 (low metastatic risk) and class 2 (high metastatic risk).

Design: Prospective, multicenter study.

Participants: A total of 459 patients with posterior uveal melanoma were enrolled from 12 independent centers.

Testing: Tumors were classified by GEP as class 1 or class 2. The first 260 samples were also analyzed for chromosome 3 status using a single nucleotide polymorphism assay. Net reclassification improvement analysis was performed to compare the prognostic accuracy of GEP with the 7th edition clinical Tumor-Node-Metastasis (TNM) classification and chromosome 3 status.

Main Outcome Measures: Patients were managed for their primary tumor and monitored for metastasis.

Results: The GEP assay successfully classified 446 of 459 cases (97.2%). The GEP was class 1 in 276 cases (61.9%) and class 2 in 170 cases (38.1%). Median follow-up was 17.4 months (mean, 18.0 months). Metastasis was detected in 3 class 1 cases (1.1%) and 44 class 2 cases (25.9%) (log-rank test, P<10(-14)). Although there was an association between GEP class 2 and monosomy 3 (Fisher exact test, P<0.0001), 54 of 260 tumors (20.8%) were discordant for GEP and chromosome 3 status, among which GEP demonstrated superior prognostic accuracy (log-rank test, P = 0.0001). By using multivariate Cox modeling, GEP class had a stronger independent association with metastasis than any other prognostic factor (P<0.0001). Chromosome 3 status did not contribute additional prognostic information that was independent of GEP (P = 0.2). At 3 years follow-up, the net reclassification improvement of GEP over TNM classification was 0.43 (P = 0.001) and 0.38 (P = 0.004) over chromosome 3 status.

Conclusions: The GEP assay had a high technical success rate and was the most accurate prognostic marker among all of the factors analyzed. The GEP provided a highly significant improvement in prognostic accuracy over clinical TNM classification and chromosome 3 status. Chromosome 3 status did not provide prognostic information that was independent of GEP.
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http://dx.doi.org/10.1016/j.ophtha.2012.02.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404209PMC
August 2012

Topographical Choroidal Thickness Change Following PDT for CSC: An OCT Case Report.

J Ophthalmol 2012 12;2012:347206. Epub 2012 Jan 12.

Department of Ophthalmology, The Eye Institute, Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226, USA.

Purpose. To describe topographical changes in choroidal thickness as measured by optical coherence tomography following photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). Methods. Case report. Results. By 1 month following PDT, mean (SD) choroidal thickness decreased from 562 microns (24) to 424 microns (27) (P < 0.01) at 3 mm temporal to fovea, 483 microns (9) to 341 microns (21) (P < 0.01) at 1.5 mm temporal to fovea, 576 microns (52) to 370 microns (81) (P < 0.01) under the fovea, 442 microns (30) to 331 microns (54) (P < 0.04) at 1.5 mm nasal to fovea, and 274 microns (39) to 171 microns (17) (P < 0.01) at 3 mm nasal to fovea. The Location of greatest choroidal thickness (648 microns) prior to treatment was at point of leakage on fluorescein angiogram (FA). This region decreased to 504 microns following treatment. Conclusion. A decrease in choroidal thickness can be seen following PDT for CSC as far as 3 mm temporal and 3 mm nasal to fovea. The Location of greatest choroidal thickness may be at point of leakage on FA.
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http://dx.doi.org/10.1155/2012/347206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265181PMC
August 2012

Intracameral bevacizumab administered for non-small cell lung cancer metastasis to iris.

Clin Pract 2011 May 30;1(2):e39. Epub 2011 May 30.

The Eye Institute, Department of Ophthalmology, Medical College of Wisconsin;

Ocular iris metastasis from lung cancer is uncommon. We report a patient with metastatic non-small cell lung cancer who was found to have a metastatic lesion to the iris. Local therapy for pain control and vision loss was administered with intracameral bevacizumab. Complete resolution of pain, improvement in vision, and near complete resolution of iris tumor were seen within two months. No ocular toxicity to anterior segment structures was detectable on corneal pachymetry and corneal specular microscopy. This is the first case report demonstrating safety and efficacy of intracameral bevacizumab for iris metastasis from non-small cell lung cancer.
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http://dx.doi.org/10.4081/cp.2011.e39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981238PMC
May 2011

RetCam II Fluorescein Angiography to Guide Treatment and Diagnosis of Coats Disease.

Ophthalmic Surg Lasers Imaging 2010 Mar 9:1-3. Epub 2010 Mar 9.

Coats disease is a well-described clinical condition featuring peripheral leakage from telangiectatic vasculature, resulting in exudative retinal detachments and exudative deposits. It often affects pediatric patients, requiring examinations and treatments to be performed under anesthesia. It can be difficult to distinguish from retinoblastoma. The RetCam II is a wide-field fundus imaging system that can also obtain intraoperative fluorescein angiography. The case of a 5-year-old girl diagnosed with Coats disease is presented. She presented with an exudative detachment, a submacular nodule, and peripheral telangiectasis. An examination under anesthesia, including angiography, was performed. The angiograph revealed characteristic aneurysms as well as extensive areas of telangiectasis and ischemia not readily visible on examination. The angiogram allowed more diagnostic certainty and guided a more complete treatment than otherwise possible. We propose that fluorescein angiography with the RetCam II system can be a useful tool when examining and treating pediatric patients with Coats disease.
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http://dx.doi.org/10.3928/15428877-20100215-86DOI Listing
March 2010

Physician assessment of changing lesion size of predominantly classic choroidal neovascular membranes in age-related macular degeneration.

Ophthalmic Surg Lasers Imaging 2009 Nov-Dec;40(6):554-60

Retina Service, Eye Institute, Medical College of Wisconsin, Milwaukee, WI, USA.

Background And Objective: To quantify the interpretation of fluorescein angiograms of evolving predominantly classic choroidal neovascularization in age-related macular degeneration.

Patients And Methods: Thirty-six fluorescein angiograms of predominantly classic choroidal neovascularization were used to define 22 fluorescein angiogram pairs. Imaging software was used to measure surface area and greatest linear dimension (GLD). Six retina physicians estimated the change in surface area and GLD for each pair before and after demarcation of the lesions' borders and GLD.

Results: For enlarging lesions, the smallest changes consistently detected by physicians were a 5% to 15% increase in surface area and a 5% to 15% increase in GLD; for shrinking lesions, they were a 5% to 15% decrease in surface area and a 5% to 15% decrease in GLD. Linear regression demonstrated moderate correlation between physician and software estimates of surface area and GLD change (r(2) = 0.50 and 0.67, respectively; P < .001), which was higher with lesion demarcation (r(2) = 0.91 and 0.93, respectively; P < .001).

Conclusion: Computer-assisted demarcation of lesion surface area and GLD reduced variability in physicians' estimates of choroidal neovascularization size change and improved correlation with software measurements.
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http://dx.doi.org/10.3928/15428877-20091030-04DOI Listing
January 2010

Candida keratitis after descemet stripping and automated endothelial keratoplasty.

Cornea 2009 May;28(4):471-3

Eye Institute, Froedtert and The Medical College of Wisconsin, Milwaukee, WI, USA.

Purpose: To report the donor-to-host transmission of Candida albicans after Descemet stripping and automated endothelial keratoplasty (DSAEK).

Methods: An 80-year-old woman with pseudophakic bullous keratopathy developed an infiltrate in the donor corneal lenticule after DSAEK.

Results: Donor corneoscleral rim cultures grew C. albicans. Gram stain of the removed corneal lenticule demonstrated budding yeast and pseudohyphae, and cultures yielded C. albicans. Despite topical and systemic antifungal therapy and therapeutic penetrating keratoplasty, the patient developed a blind painful eye and underwent enucleation.

Conclusions: This case report indicates that fungal keratitis may occur from donor-to-host transmission after DSAEK. The location of the infected tissue poses diagnostic and therapeutic challenges for the surgeon.
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http://dx.doi.org/10.1097/ICO.0b013e31818ad9bcDOI Listing
May 2009

Complete and durable response of choroid metastasis from non-small cell lung cancer with systemic bevacizumab and chemotherapy.

J Thorac Oncol 2009 May;4(5):661-2

Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.

Ocular metastasis from lung cancer is uncommon. We report a patient with metastatic non-small cell lung cancer who was found to have a metastatic lesion in the choroid at the time of presentation. The patient was treated with carboplatin, gemcitabine, and bevacizumab. After three cycles of chemotherapy, radiologic imaging and ophthalmologic examination demonstrated complete resolution of the choroid lesion. This case report demonstrates the durable response of choroidal metastasis from non-small cell lung cancer to systemic bevacizumab and chemotherapy.
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http://dx.doi.org/10.1097/JTO.0b013e31819c9a73DOI Listing
May 2009

Microbiological spectrum of organisms isolated from explanted scleral buckles.

Ophthalmic Surg Lasers Imaging 2009 Mar-Apr;40(2):201-2

The Eye Institute, The Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226-4812, USA.

Scleral buckle removal is an uncommon procedure performed for various reasons. Microbiological information on explanted scleral buckles remains limited. The authors identified 37 cases of scleral buckle removal during an 18-year period. Bacterial cultures isolated an organism in 4 of 9 patients (44%) with clinical infection. Organisms identified included methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Mycobacterium abscessus, and coagulase-negative Staphylococcus species. Bacterial cultures isolated an organism in 3 of 11 patients (27%) without clinical infection. Organisms identified included Nocardia species, Alcaligenes xylosoxidans, and Mycobacterium chelonae. Scleral buckles appearing clinically infected may be associated with more virulent organisms and a greater chance of identifying an organism. Bacterial cultures may be of value for scleral buckles upon removal.
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http://dx.doi.org/10.3928/15428877-20090301-22DOI Listing
April 2009

Risk factors for scleral buckle removal: a matched, case-control study.

Am J Ophthalmol 2008 Sep 9;146(3):434-439. Epub 2008 Jul 9.

Retina Service of the Eye Institute, Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226, USA.

Purpose: To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal.

Design: Retrospective, consecutive, matched, case-control study.

Methods: Cases included all patients undergoing SB removal between August 1988 and December 2007 at a single academic center. Cases were matched against four randomly selected control patients who underwent SB implantation during the same year as the case. Odds ratios (OR) were calculated for each factor investigated.

Results: Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, using univariate analysis, included concurrent globe-penetrating injury at time of SB placement (OR, 24; 95% confidence interval [CI], 2.9 to 200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; 95% CI, 4.9 to 61), diabetes mellitus (DM) (OR, 7.3; 95% CI, 1.8 to 30), prior chronic topical ocular therapy (OR, 4.3; 95% CI, 1.7 to 11), and subsequent ocular procedures (OR, 3.4; 95% CI, 1.5 to 7.5). Factors independently associated with SB removal using multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; 95% CI, 1.7 to 426), concurrent PPV (OR, 11.3; 95% CI, 2.9 to 45), DM (OR, 8.9; 95% CI, 1.3 to 58), and subsequent ocular procedures (OR, 3.9; 95% CI, 1.4 to 11). Factors that did not alter SB removal risk included patient age; gender; and type, size, or location of buckling elements used.

Conclusions: Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.
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http://dx.doi.org/10.1016/j.ajo.2008.05.023DOI Listing
September 2008

Risk factors for scleral buckle removal: a matched, case-control study.

Trans Am Ophthalmol Soc 2008 ;106:171-7; discussion 177-8

Retina Service of the Eye Institute, Medical College of Wisconsin, Milwaukee, USA.

Purpose: To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal.

Methods: A retrospective, consecutive, matched, case-control study. Cases included all patients undergoing SB removal between 1988 and 2007 at a single academic center. Case patients were matched against 4 randomly selected control patients who underwent SB implantation during the same year as the case patients. Odds ratios (ORs) were calculated for each factor investigated.

Results: Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, according to univariate analysis, included concurrent globe-penetrating injury at the time of SB placement (OR, 24; 95% confidence interval [CI], 2.9-200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; CI, 4.9-61), diabetes mellitus (DM) (OR, 7.3; CI, 1.8-30), prior long-term topical ocular therapy (OR, 4.3; CI, 1.7-11), and subsequent ocular procedures (OR, 3.4; CI, 1.5-7.5). Factors independently associated with SB removal according to multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; CI, 1.7-426), concurrent PPV (OR, 11.3; CI, 2.9-45), DM (OR, 8.9; CI, 1.3-58), and subsequent ocular procedures (OR, 3.9; CI, 1.4-11). Factors that did not alter SB removal risk included patient age; sex; and type, size, or location of buckling elements used.

Conclusions: Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646451PMC
March 2009

Photodynamic therapy for extrafoveal choroidal neovascularization associated with choroidal nevus.

Retina 2006 Apr;26(4):477-9

The Eye Institute, The Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226-4812, USA.

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http://dx.doi.org/10.1097/01.iae.0000238543.67003.6aDOI Listing
April 2006

Central retinal vein occlusion in patients treated with long-term warfarin sodium (Coumadin) for anticoagulation.

Retina 2006 Mar;26(3):285-91

Duke University Eye Center, Durham, North Carolina 27710, USA.

Purpose: To describe the clinical features of persons who developed central retinal vein occlusion (CVO) while being treated with Coumadin for chronic anticoagulation.

Methods: In a retrospective, comparative, noninterventional case series of patients diagnosed with CVO while being treated with Coumadin as a systemic anticoagulant, visual and anatomical outcomes were compared with those for a cohort of patients diagnosed with CVO who were not treated with any systemic anticoagulation.

Results: Fourteen eyes of 14 patients treated with Coumadin were identified. At presentation, the median international normalization ratio (INR) was 2.20 (range, 1.3-5.0). Eight patients (57%) had a therapeutic INR at the time of CVO. Their visual acuity and perfusion status were similar to those of patients with subtherapeutic INR. At the last follow-up (median, 16 months), visual acuity and perfusion status of the group of 14 eyes were similar to baseline findings (P = 0.62). Clinical features and outcomes were similar to those for a cohort of patients with CVO who were not being treated with systemic anticoagulation.

Conclusion: CVO can occur in patients being treated with Coumadin for systemic anticoagulation. Final visual acuity and perfusion status were similar to those in a cohort of patients with CVO who were not treated with Coumadin. Although visual acuity is unaffected, ensuring that the INR for these patients remains in the therapeutic range may be important to help prevent secondary systemic thrombotic and embolic disease.
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http://dx.doi.org/10.1097/00006982-200603000-00006DOI Listing
March 2006

Staphylococcus hominis endophthalmitis associated with a capsular hypopyon.

Am J Ophthalmol 2005 May;139(5):930-2

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee,Wisconsin, USA.

Purpose: To report a case of Staphylococcus hominis endophthalmitis associated with a capsular hypopyon.

Design: Interventional case report.

Methods: A 51-year-old man presented with chronic postcataract extraction inflammation and underwent vitrectomy, partial capsulectomy, and intravitreal antibiotic injections, followed by explantation of the intraocular lens and capsule.

Results: A capsular hypopyon in the absence of an anterior chamber hypopyon was noted. Cultures of the vitreous and capsule revealed Staphylococcus hominis, a coagulase-negative gram-positive organism.

Conclusions: We are unaware of previous reports of endophthalmitis caused by Staphylococcus hominis, and could find none in a computerized search using MEDLINE. This case adds Staphylococcus hominis to the list of causative organisms in chronic endophthalmitis and illustrates the rare finding of a capsular hypopyon.
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http://dx.doi.org/10.1016/j.ajo.2004.10.060DOI Listing
May 2005

Intravitreally injected human immunoglobulin attenuates the effects of Staphylococcus aureus culture supernatant in a rabbit model of toxin-mediated endophthalmitis.

Arch Ophthalmol 2004 Oct;122(10):1499-506

Eye Institute, Medical College of Wisconsin, Milwaukee 53226-4812, USA.

Objective: To determine whether human immunoglobulin attenuates the toxic effects of Staphylococcus aureus culture supernatant in a rabbit model of endophthalmitis.

Methods: Immunoglobulin binding to products of S aureus strain RN4220 was tested by Western blot analysis using known toxins (beta-hemolysin and toxic shock syndrome toxin-1) and a concentrated culture supernatant containing S aureus exotoxins (pooled toxin). To induce endophthalmitis, pooled toxin was injected into the rabbit vitreous. For immunoglobulin treatment, immunoglobulin and pooled toxin were either mixed and injected simultaneously or immunoglobulin was injected immediately after or 6 hours after pooled toxin injection. Severity of endophthalmitis was graded according to a 9-day course with clinical examination (slitlamp biomicroscopy or indirect ophthalmoscopy) and evaluation of histologic sections.

Results: The toxic effects of pooled toxin were markedly reduced when immunoglobulin was mixed with pooled toxin and injected simultaneously. Delayed injection of immunoglobulin diminished its ability to reduce toxicity. Clinical and histologic signs of toxicity were partially attenuated when immunoglobulin was injected immediately after pooled toxin, but only minimal clinically detectable reductions in toxicity were observed when immunoglobulin injection was delayed for 6 hours.

Conclusion: Pooled human immunoglobulin can attenuate the toxic intravitreal effects of a concentrated culture supernatant containing S aureus exotoxins. Clinical Relevance Immunoglobulin may represent a novel adjuvant in the treatment of bacterial endophthalmitis. To optimize the potential therapeutic benefit, maximizing the mixture of immunoglobulin with bacterial products and early intervention are likely to be important.
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http://dx.doi.org/10.1001/archopht.122.10.1499DOI Listing
October 2004

Subconjunctival antibiotics for acute postcataract extraction endophthalmitis--is it necessary?

Am J Ophthalmol 2004 Jun;137(6):1120-1

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, 53226, USA.

Purpose: To evaluate the efficacy of adjunctive subconjunctival antibiotic injection in the treatment of acute postcataract extraction endophthalmitis.

Design: Retrospective cohort study.

Methods: Patients who presented with hand motions or better vision and received subconjunctival antibiotics (SC+ group) were compared with those who did not (SC- group) in the treatment of acute postoperative endophthalmitis.

Results: The rate of obtaining a final vision of 20/40 or better was 60% in the SC+ group (n = 25) compared with 72% in the SC- group (n = 18) (P =.69), and the mean change in logMAR was -1.36 (improvement) versus -1.34 (P =.93). Based on a linear regression model controlling for presenting vision, there was no statistical difference in the mean logMAR change between the two groups (P =.73).

Conclusion: Subconjunctival antibiotic injection as an adjunct to intravitreal antibiotics was unassociated with treatment benefit in patients with acute postoperative endophthalmitis presenting with vision of hand motions or better.
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http://dx.doi.org/10.1016/j.ajo.2003.12.042DOI Listing
June 2004

Successful treatment of orthodontic-associated traumatic endophthalmitis.

Am J Ophthalmol 2002 Sep;134(3):449-50

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA.

Purpose: To report successful management of orthodontic-associated traumatic endophthalmitis.

Design: Interventional case report.

Methods: A 17-year-old boy developed endophthalmitis after a penetrating corneal injury produced during removal of an orthodontic wire. Treatment included pars plana vitrectomy (PPV) with broad-spectrum intravitreal and systemic antibiotics.

Results: Clinical endophthalmitis resolved after PPV with injection of intravitreal vancomycin (1 mg) and ceftazidime (2.25 mg), along with oral ciprofloxacin (750 mg twice daily). Microbiologic cultures of intraocular samples produced Staphylococcus epidermidis, Streptococcus viridans, and Lactobacillus species. Visual acuity improved to 20/20.

Conclusions: Orthodontic-associated endophthalmitis can involve multiple organisms. It can be successfully treated with current treatment modalities, including PPV, intravitreal antibiotics, and systemic antibiotics.
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http://dx.doi.org/10.1016/s0002-9394(02)01589-1DOI Listing
September 2002
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