Publications by authors named "Yishay Weill"

28 Publications

  • Page 1 of 1

Pediatric Ocular Injury Due to Hand Sanitizer Exposure An Emerging Hazard.

Pediatr Emerg Care 2021 Jun 11. Epub 2021 Jun 11.

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.

Objectives: The objective of this study was to describe the incidence and severity of ocular exposure to alcohol-based hand rub (ABHR) in children presenting to a tertiary medical center during the severe acute respiratory syndrome coronavirus 2 pandemic.

Methods: A retrospective single-center observational study conducted from February 21, 2020, to October 11, 2020. Subjects 10 years or younger who presented with ABHR-induced ocular injury were included. The same period from 2019 was studied and a comparison was performed between the 2 years. Outcome measures included the number of subjects with ocular injury due to ABHR, extent of ocular epithelial defects, length of hospitalization and time to resolution.

Results: A total of 9 patients presented to the Pediatric Emergency Department after sustaining ocular chemical injuries from ABHR during this period. Treatment included immediate irrigation followed by topical antibiotics, steroids, and lubrication. Six children were discharged and followed as outpatients with no reported adverse ocular sequelae. Three patients exhibited epithelial defects involving 85% to 100% of the cornea, 30% to 75% of the conjunctiva and required inpatient treatment ranging from 4 to 11 days. All patients experienced a complete resolution of the ocular epithelial defects after 12 to 19 days. No long-term irreversible damage was observed and visual acuity returned to normal in all patients.

Conclusions: The utilization of ABHR during the severe acute respiratory syndrome coronavirus 2 pandemic resulted in childhood ocular injury. Prompt treatment led to good visual outcomes. These products should be regarded as potentially toxic and stored out of the reach of young children.
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http://dx.doi.org/10.1097/PEC.0000000000002468DOI Listing
June 2021

Keratoplasty Rejection After the BNT162b2 messenger RNA Vaccine.

Cornea 2021 08;40(8):1070-1072

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel.

Purpose: The aim of this report was to report 2 patients who presented with acute corneal graft rejection 2 weeks after receiving the BNT162b2 messenger RNA (mRNA) vaccine for severe acute respiratory syndrome coronavirus 2.

Methods: Case report.

Results: Two men, aged 73 and 56 years, with a history of penetrating keratoplasty due to keratoconus were noted to have acute corneal graft rejection 2 weeks after receiving a first dose of the BNT162b2 mRNA vaccine. Both patients were treated with hourly dexamethasone 0.1% and oral prednisone 60 mg per day with prompt resolution of keratoplasty rejection.

Conclusions: The BNT162b2 mRNA vaccine may be have been associated with a low-risk corneal graft rejection that responded well to topical and systemic steroids. Treating physicians should be aware of this potential complication and patients should be advised to report any visual changes after vaccination.
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http://dx.doi.org/10.1097/ICO.0000000000002761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244807PMC
August 2021

Optical changes and apparent emmetropization in a patient with a peripheral unilateral lens coloboma.

J AAPOS 2021 May 11. Epub 2021 May 11.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Lens coloboma is a developmental defect resulting from abnormalities of the zonules and ciliary body. It may present as an isolated pathology or be accompanied by anomalies in different ocular structures. We report the case of a 20-year-old man referred for evaluation of anisometropic amblyopia in the right eye. Manifest refraction was -2.25 +3.00 ×35 in the right eye; corrected distance visual acuity, 20/50. Corneal topography revealed regular astigmatism of +2.46 D at 124°, and wavefront aberrometry revealed an irregular internal astigmatism of +6.27 D at 35°. Only after full pupillary dilation was a peripheral lens coloboma observed. This case demonstrates that even minor distortions of clear and normally positioned lenses may lead to amblyopia and raises the possibility that corneal changes may occur developmentally through the process of emmetropization partly to compensate for lenticular astigmatism arising from the coloboma.
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http://dx.doi.org/10.1016/j.jaapos.2021.02.006DOI Listing
May 2021

Comparison of corneal surgically induced astigmatism calculations as measured by two biometric devices, and by standard anterior vs total keratometric measurements.

J Cataract Refract Surg 2021 Apr 9. Epub 2021 Apr 9.

1Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel. 2Dept. of Ophthalmology, Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands.

Purpose: To compare calculated corneal surgically induced astigmatism (SIA) by means of anterior-based keratometry (K) and total keratometry (TK) measurements made by 2 biometric devices.

Setting: Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel.

Design: Retrospective, consecutive case series.

Methods: The medical records of patients who had undergone cataract surgery through a 2.4 mm temporal clear corneal incision by a single surgeon between 3/2018 and 11/2020 were retrospectively reviewed. Patients for whom there were preoperative and postoperative keratometry measurements by 2 biometric devices, optical low-coherence reflectometer (OLCR) and swept-source optical coherence tomography (SS-OCT), were identified. Corneal SIA (mean vector value) was calculated by vector analysis for 3 groups: SS-OCT(K), SS-OCT(TK) and OLCR(K). Bivariant analyses were applied for comparisons.

Results: One-hundred forty-seven eyes of 123 patients (73 OD and 74 OS) were enrolled in the study. The OD corneal SIA values were 0.09 D @ 136°, 0.09 D @ 141°, and 0.07 D @ 123°, for the SS-OCT(K), SS-OCT(TK), and OLCR, respectively. The respective OS corneal SIA values were 0.13 D @ 120°, 0.11 D @ 123°, and 0.08 D @ 120°. There were no significant differences between the mean vector value and variance of the corneal SIA for the right, P=.78 and P=.65, and the left, P=.75 and P=.37 eyes of the three groups.

Conclusions: Corneal SIA values were low (0.07 to 0.13 D) and similar for the SS-OCT and the OLCR biometric devices with standard keratometry. Total keratometry measurements yielded similar corneal SIA values compared to anterior corneal-based measurements.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000671DOI Listing
April 2021

A Rare Case of Acute Bilateral Endothelial Decompensation after Prophylactic Nd:YAG Laser Iridotomy Requiring Endothelial Keratoplasty.

J Curr Glaucoma Pract 2020 Sep-Dec;14(3):109-111

Department of Ophthalmology, Shaare Zedek Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel.

Aim: To describe a case of acute bilateral endothelial decompensation following prophylactic Nd:YAG laser iridotomy (LI) for occludable angles.

Background: Although regarded safe, LI can occasionally be a source of various ocular complications, including corneal endothelial damage. In the herein case, we describe the first case of acute bilateral endothelial decompensation after Nd:YAG LI.

Case Description: A 63-year-old man was referred for consultation due to visual acuity deterioration in both eyes 2 weeks after undergoing an uneventful prophylactic LI for occludable angles. On examination, bilateral corneal edema with Descemet's membrane folds was observed. Direct corneal damage from the laser beam was not seen. Specular microscopy failed to count endothelial density. Anterior-segment optical coherence tomography (OCT), ultrasound biomicroscopy, and ocular biometry were performed. The patient was referred for bilateral endothelial keratoplasty.

Conclusion: Subacute endothelial dysfunction should be considered as a possible adverse event following Nd:YAG LI and patients should be advised accordingly.

Clinical Relevance: Surgeons should be aware of the potentially devastating complication of bilateral corneal decompensation following routine Nd:YAG LI, even in patients without preexisting corneal injury. Patients should be advised accordingly.

How To Cite This Article: Weill Y, Abulafia A, Smadja D, A Rare Case of Acute Bilateral Endothelial Decompensation after Prophylactic Nd:YAG Laser Iridotomy Requiring Endothelial Keratoplasty. J Curr Glaucoma Pract 2020;14(3):109-111.
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http://dx.doi.org/10.5005/jp-journals-10078-1285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028029PMC
April 2021

The Additive Value of Foveal OCT-Based Biometry to Fundus Biomicroscopy for Detecting Macular Pathology Prior to Cataract Surgery.

Am J Ophthalmol 2021 Apr 5;228:8-15. Epub 2021 Apr 5.

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel. Electronic address:

Purpose: To assess the additive value of foveal swept-source optical coherence tomography (OCT)-based biometry to the preoperative fundus examinations for diagnosing macular abnormalities in patients scheduled for cataract surgery.

Design: Diagnostic testing evaluation.

Methods: Consecutive patients 50 years of age and older planned for cataract surgery from one institution were retrospectively enrolled. All patients underwent foveal swept-source OCT, and macular spectral domain (SD) OCT scans before pupil dilation as well as dilated fundus biomicroscopy examination. The effectiveness of fundus biomicroscopy examinations, foveal swept-source OCT scans, and the combination of both in identifying macular diseases was analyzed with macular spectral-domain OCT scans as reference.

Results: Seventy-eight of the eligible 442 eyes (442 patients) were excluded because of noninterpretable macular spectral-domain OCT OCT scans or foveal swept-source OCT scans. The remaining 364 eyes of 364 patients (mean age 73.59±9.26 years [range 49-96], 172 males) formed the study group. Fundus biomicroscopy alone vs fundus biomicroscopy with the addition of foveal swept-source OCT yielded 36% vs 63% sensitivity, 94% vs 72% specificity, 79% vs 58% positive predictive value (PPV), and 71% vs 76% negative predictive value (NPV), respectively. This diagnostic improvement was significant compared with fundus biomicroscopy alone (P = 2.98).

Conclusion: Combined fundus biomicroscopy and foveal swept-source OCT scans improved the detection of macular abnormalities prior to cataract surgery but it was inferior to macular spectral-domain OCT scans. Additional studies to assess the cost-effectiveness of adding foveal swept-source OCT scan in comparison to macular spectral-domain OCT scan to the preoperative cataract evaluation are required.
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http://dx.doi.org/10.1016/j.ajo.2021.03.028DOI Listing
April 2021

Interface Fluid Syndrome 2 Decades After Laser-Assisted In situ Keratomileusis.

Eye Contact Lens 2021 06;47(6):381-382

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Purpose: To report a case of late-onset interface fluid syndrome (IFS) after laser-assisted in situ keratomileusis (LASIK).

Methods: A 94-year-old man was referred for evaluation because of persistent corneal edema 10 days after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy.

Results: After an uneventful DSAEK, the patient was treated with topical antibiotics and steroids. On presentation, a well positioned and oriented DSAEK graft was observed in the right eye, yet the cornea was edematous. Applanation tonometry was normal. Anterior-segment optical coherence tomography (AS-OCT) revealed a LASIK flap with a fluid cleft beneath it. Requery confirmed that LASIK was performed 21 years ago. Topical steroids were stopped, and after 2 weeks, the cornea was clear, and AS-OCT revealed complete resolution of the interface fluid.

Conclusions: Even decades later, IFS should be considered as a source of corneal edema in patients after LASIK. Monitoring these patients with AS-OCT is recommended.
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http://dx.doi.org/10.1097/ICL.0000000000000775DOI Listing
June 2021

Influence of Reading on Smartphone Screens on Visual Optical Quality Metrics and Tear Film Stability.

Cornea 2021 Jan 18. Epub 2021 Jan 18.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel; Affiliated with the Hebrew University of Jerusalem; and iSEARCH, Innovation Shaarezedek Eye Advanced Research Center Hub, Jerusalem, Israel.

Purpose: To evaluate the impact of a prolonged reading session on a smartphone screen on optical quality metrics and tear film stability.

Methods: This prospective study was conducted in 41 healthy volunteers who were asked to read an article on a smartphone screen for 20 minutes. The following tests were performed before the reading task in this consecutive order and repeated after the reading task in the same order: automated noninvasive tear break-up time, optical quality assessment including Objective Scatter Index (OSI), modulation transfer function, Strehl ratio, and tear film dynamic analysis as follows: vision break-up time (VBUT) as a function of OSI changes within 20 seconds, using a double-pass aberrometer imaging system, and fluorescein tear break-up time (FBUT) measured using the slit lamp.

Results: All break-up time-related parameters (noninvasive tear break-up time, FBUT and VBUT) were significantly reduced after the reading task (P < 0.01). The OSI was significantly worsened after the reading task (P = 0.01), whereas all the other optical quality metrics (modulation transfer function and Strehl ratio) slightly deteriorated, were not statistically significant. A significant correlation was found between the shortening of the FBUT, VBUT, and the worsening of the OSI (r = -0.33, P < 0.05).

Conclusions: A reading session on a smartphone screen in healthy subjects was found to significantly affect the tear film stability and objectively worsen the retinal image quality.
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http://dx.doi.org/10.1097/ICO.0000000000002656DOI Listing
January 2021

The Impact of COVID-19 on Intravitreal Injection Compliance.

SN Compr Clin Med 2020 Oct 28:1-4. Epub 2020 Oct 28.

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine Jerusalem, 9103102 Jerusalem, Israel.

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti-VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year's total was expected for this time period. Using this model, the 636 reported number of injections for the March-April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti-VEGF treatments.
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http://dx.doi.org/10.1007/s42399-020-00614-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592639PMC
October 2020

Telemedicine comes of age during coronavirus disease 2019 (COVID-19): An international survey of oculoplastic surgeons.

Eur J Ophthalmol 2020 Oct 17:1120672120965471. Epub 2020 Oct 17.

Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.

Purpose: The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic.

Methods: A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and -score of proportions tests, respectively.

Results: The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, = 0.004), while only 12.8% (<0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% ( = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality.

Conclusion: Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.
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http://dx.doi.org/10.1177/1120672120965471DOI Listing
October 2020

Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Thinning in Patients with Type-1 Gaucher Disease.

Int J Mol Sci 2020 Sep 24;21(19). Epub 2020 Sep 24.

Faculty of Medicine, The Hebrew University, Jerusalem 9112001, Israel.

Type-1 Gaucher disease (GD1) is considered to be non- neuronopathic however recent evidence of neurological involvement continues to accumulate. There is limited evidence of retinal abnormalities in GD1. The purpose of this study was to evaluate the retinal findings of patients with GD1. Thirty GD1 individuals and 30 healthy volunteers between the ages 40-75 years were prospectively enrolled. Macular and optic nerve optical coherence tomography (OCT) scans of both eyes of each patient were performed and thickness maps were compared between groups. Patients with a known neurodegenerative disease, glaucoma, high myopia and previous intraocular surgeries were excluded. It was shown that patients with GD1 presented with higher incidence of abnormal pRNFL OCT scan and showed significantly thinner areas of pRNFL and macular ganglion cell complex (GCC) when compared to a healthy control population. Changes in retinal thickness were not associated with GD1 genotype, treatment status, disease monitoring biomarker (lyso-Gb1) and severity score index (Zimran SSI). Further investigations are needed to determine whether these findings possess functional visual implications and if retinal thinning may serve as biomarker for the development of future neurodegenerative disease in this population.
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http://dx.doi.org/10.3390/ijms21197027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582605PMC
September 2020

Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular optical coherence tomography.

J Cataract Refract Surg 2021 Jan;47(1):78-82

From the Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.

Purpose: To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery.

Setting: Shaare-Zedek Medical Center, Jerusalem, Israel.

Design: Retrospective case series.

Methods: Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning before cataract surgery. The scans were reviewed by a retinal specialist for macular pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed.

Results: Four hundred fifty-three eyes of 453 patients were enrolled in the study; 42 eyes (9.2%) were excluded because of noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 eyes (40.6%), including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 patients (26.0%) was modified because of macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopic examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes [17.8%]) and referral to a retinal specialist for consultation (34 eyes [8.3%]).

Conclusions: Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopic examination. The added information could improve patient management.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000389DOI Listing
January 2021

Management of labor after external cephalic version.

J Perinat Med 2020 Aug 18;49(1):30-35. Epub 2020 Aug 18.

Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel.

Objectives: Current literature evaluating the role of induction of labor (IOL) following successful external cephalic version (ECV) attempt as compared to expectant management is limited. We aim to assess the risk of cesarean delivery in those undergoing immediate IOL following successful ECV as compared to those who were expectantly managed.

Methods: A retrospective cohort study of successful external cephalic versions. The study group included 57 women that were induced after procedure in the lack of maternal or fetal indications for induction of labor. These women were compared to 341 expectantly managed women. Maternal and fetal characteristics and outcomes were compared.

Results: Gestation age at delivery was higher among the expectant management group (401/7 vs. 384/7, median, p=0.002) as compared to the induction group. Cesarean delivery rates were similar between both groups (28 [8.2%] vs. 3 [5.3%], p=0.44). In a multivariate logistic regression analysis, only nulliparity was significantly associated with cesarean delivery (adjusted odds ratio 3.42, confidence interval 1.61-7.24, p=0.001). No correlation was found between the version-to-delivery interval and the risk for cesarean delivery.

Conclusions: Induction of labor after successful ECV was not shown to influence cesarean delivery rates. As immediate IOL may result in higher rate of early-term deliveries, and in light of the lack of clinical benefit, we advocate against elective IOL following successful ECV.
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http://dx.doi.org/10.1515/jpm-2020-0290DOI Listing
August 2020

Successful vaginal delivery after external cephalic version (ECV): does time interval from ECV to delivery make a difference? A multicenter study.

Arch Gynecol Obstet 2020 12 4;302(6):1361-1367. Epub 2020 Aug 4.

Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel.

Purpose: The risk of cesarean delivery after a successful external cephalic version for breech presentation is higher as compared with fetuses in cephalic presentation. However, the role of the time interval between version attempt to delivery on the risk for cesarean delivery is unclear. We aimed to study the effect of the time interval from a successful external cephalic version to delivery on the risk for cesarean delivery and assess factors associated with cesarean delivery after a successful version.

Methods: We conducted a multicenter, retrospective cohort study, including all successful external cephalic version at two medical centers between 2011 and 2019. We compared patient baseline characteristics, obstetric characteristics, maternal and neonatal outcomes in women that delivered by vaginal delivery with those who delivered by cesarean delivery.

Results: Overall, 769 deliveries were included. Of these, 98 women (12.7%) had cesarean delivery and 671 (87.3%) had vaginal delivery. Women who had cesarean delivery had a higher rate of obesity (44.9% vs 21.9%, p < 0.001; OR 2.88, CI 1.65-5.03) and nulliparity (45.9% vs 24.5%, p < 0.001; OR = 2.58, CI 1.67-3.98). The risk for intrapartum cesarean delivery did not differ according to time interval from external cephalic version to delivery.

Conclusions: The time interval between successful external cephalic version and delivery was not associated with mode of delivery. This finding is in contrast to previous reports. The risk for cesarean delivery after successful version is higher in nulliparous, obese women, and women whose weight gain in pregnancy was higher.
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http://dx.doi.org/10.1007/s00404-020-05733-wDOI Listing
December 2020

Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID-19 infection.

J Med Virol 2021 01 30;93(1):139-140. Epub 2020 Sep 30.

Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.

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http://dx.doi.org/10.1002/jmv.26229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361787PMC
January 2021

Response of ophthalmologists in Israel to the novel coronavirus (2019-nCoV) outbreak.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 28;258(7):1419-1426. Epub 2020 Apr 28.

Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine Jerusalem, 9103102, Jerusalem, Israel.

Purpose: The coronavirus disease (COVID-19) pandemic has evolved into a formidable healthcare crisis. Ophthalmologists are at daily personal risk of acquiring and transmitting the virus. Implementation of official practical and protective guidelines can be challenging and is often absent. The purpose of this study was to describe the status of ophthalmology practice in Israel, at the early stages of the outbreak.

Methods: A 17-item questionnaire was distributed to ophthalmologists practicing in Israel. Data was obtained regarding demographics and clinical and surgical practice during the pandemic.

Results: One hundred and sixty-seven ophthalmologists completed the survey from all regions of Israel. The survey was distributed during the early stages of the outbreak. At this time, no official government guidelines were in place. Most respondents reported no reduction of elective clinic visits and surgeries and no utilization of triage questionnaires. COVID-19 guidelines were reportedly promulgated to hospital ophthalmologists but not to community and private physicians. Personal protective equipment (PPE) measures were reportedly utilized; however, many respondents often acquired them individually. A majority of respondents advocated that healthcare institutions limit clinic and surgery services to emergency services.

Conclusion: During the critical early stages of the COVID-19 outbreak in Israel, this study emphasizes the delay in development of emergency guidelines, necessary to protect patients and ophthalmologists from this highly transmissible disease.
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http://dx.doi.org/10.1007/s00417-020-04694-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186536PMC
July 2020

Nifedipine versus ritodrine during external cephalic version procedure: a case control study.

J Matern Fetal Neonatal Med 2021 Sep 13;34(18):3008-3013. Epub 2019 Oct 13.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Objective: Published series regarding interventions for facilitating external cephalic version (ECV) have concluded that parenterally administered beta-stimulant tocolytics, increased ECV success rate and reduced the number of cesarean sections. However, there were insufficient data regarding calcium channel blockers to provide good evidence regarding its efficacy. Given the paucity of literature, we aimed to compare the efficacy of nifedipine to that of ritodrine on ECV success rates.

Methods: This is a retrospective case control study of prospectively collected data of patients who underwent ECV between January 2012 and December 2013 at Bikur Cholim Medical Center and Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Patient undergoing ECV with tocolysis by ritodrine were compared with those using nifedipine as tocolysis. Patients were matched in a one-to-one ration by parity and placental location.

Results: Overall, 148 women received ritodrine and 148 women received nifedipine before ECV procedure. Overall success rate was higher among the ritodrine group (82.4 vs. 63.5%,  < .001). Among nulliparous and among parous, success rate was higher in the ritodrine group (78.9 vs. 57.9 and 88.6 vs. 73.5%,  = .001,  = .04, respectively). Vaginal delivery rate was higher among the ritodrine group (86.5 vs. 68.9%,  < .001). Cesarean delivery rate was 31.1% for the nifedipine group versus 13.5% in the ritodrine group ( < .001). Number needed to treat to benefit (NNTb) 5.7 (95% confidence interval 3.7-12.1). Overall, 216 of 296 (72.9%) of ECV were successful. Ritodrine was associated with higher success rates as compared with nifedipine (56.5 vs. 32.5%,  < .001). In a multivariate analysis, ritodrine tocolytic therapy was independently associated higher ECV success rates as compared to nifedipine (OR 4.54, 95% CI 2.38-9.09). Higher amniotic fluid index (OR 1.16, 95% CI 1.05-1.28) and nulliparity (OR 0.16, 95% CI 0.08-0.30) were additional independent predictors of ECV outcome.

Conclusion: Ritodrine significantly improve the success of ECV compared with nifedipine. Both drugs are shown to be safe.
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http://dx.doi.org/10.1080/14767058.2019.1677589DOI Listing
September 2021

Enhanced depth imaging in swept-source optical coherence tomography: Improving visibility of choroid and sclera, a masked study.

Eur J Ophthalmol 2020 Nov 26;30(6):1295-1300. Epub 2019 Jul 26.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

Purpose: To compare enhanced depth imaging in swept-source optical coherence tomography and non-enhanced depth imaging optical coherence tomography in their ability to capture choroidal and scleral details.

Methods: Averaged foveal B-Scans were obtained from 40 eyes of 20 healthy volunteers by swept-source optical coherence tomography with and without enhanced depth imaging. Visibility and contrast of vascular details within the choroid, choroidoscleral junction, and sclera were evaluated by masked readers using an ordinal scoring scale. Outcomes were analyzed using the Wilcoxon signed rank-sum test.

Results: Visibility of the choroidal vascular details ( = 5.94,  < .001), the choroidoscleral junction ( = 5.85,  < .001), and the sclera ( = 6.80,  < .001) was significantly higher with enhanced depth imaging than with non-enhanced depth imaging swept-source optical coherence tomography. Similarly, image contrast was significantly higher with enhanced depth imaging than with non-enhanced depth imaging swept-source optical coherence tomography for the choroidal vascular details ( = 9.47,  < .001), for the choroidoscleral junction ( = 9.28,  < .001), and for the sclera ( = 9.42,  < .001).

Conclusion: Enhanced depth imaging applied to swept-source optical coherence tomography-averaged foveal B-scans enhances visualization of the choroidal details, of the choroidoscleral junction, and of the sclera. This novel modality can easily be implemented in clinics and could improve our understanding of conditions involving the choroid or the sclera.
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http://dx.doi.org/10.1177/1120672119863560DOI Listing
November 2020

Late preterm versus term external cephalic version: an audit of a single obstetrician experience.

Arch Gynecol Obstet 2019 10 16;300(4):875-880. Epub 2019 Jul 16.

Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel.

Purpose: Recent literature evaluating the optimal timing for external cephalic version (ECV) in non-cephalic presentation is limited and hampered by methodological issues. We aimed to compare late preterm ECV [term (36-37 weeks of gestation] to term ECV ( > 37 weeks).

Methods: We conducted a retrospective cohort study of prospectively collected data of ECV procedures performed by a single operator during a 6 year period. Maternal, ECV procedure, delivery and fetal characteristics were compared between preterm ECV and term ECV.

Results: Overall, 547 (91.6%) of ECVs were term ECV while 50 (8.4%) procedures were preterm ECV. Success rate of ECV was 72.0% in the preterm ECV group vs. 71.5% in the term ECV group, p = 0.93. Proportion of preterm delivery was higher among the preterm ECV group (8% vs. 0%, p < 0.001), so does the proportion of early term deliveries (36.0% vs. 22.8%, p = 0.03). The rate of low birth weight was higher among the preterm ECV group (10.0% vs. 3.11%, p = 0.01). Rates of Apgar score at 5 min ≤ 8 were higher in the preterm ECV (4.0% vs. 0.5%, p = 0.007). Vaginal delivery and intrapartum cesarean delivery rates did not differ between study groups (72.0% vs. 73.2%, p = 0.83 and 10% vs. 8.4%, p = 0.69).

Conclusion: Initiating ECV before term is associated with increased rate of preterm delivery, early term delivery and low birth weight. No effect was found in mode of delivery, intrapartum cesarean delivery, reversion and spontaneous version. We advocate against preterm ECV until future prospective trials will better delineate the effect of preterm ECV on maternal and neonatal outcomes.
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http://dx.doi.org/10.1007/s00404-019-05244-3DOI Listing
October 2019

External cephalic version at term: A 6-year single-operator experience.

Birth 2019 12 2;46(4):616-622. Epub 2019 Apr 2.

Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel.

Background: External cephalic version (ECV) should be offered for patients presenting with a noncephalic pregnancy that are willing to deliver vaginally. Various reports have evaluated predictors for successful ECV. Yet, none have reported a single-operator large cohort experience. We aim to analyze the outcome of referrals for ECV.

Methods: We conducted a retrospective cohort study of prospectively collected data. We performed a multivariate analysis of data with respect to ECV procedures performed by a single operator in a 6-year period. Maternal and fetal characteristics were compared between ECV success and failure groups.

Results: Six hundred and two women underwent ECV. Of them, ECV was successful in 432 (71.7%). A multivariate binary logistic regression model demonstrated that high liquor volume was a predictor of ECV success (Adj OR 1.17 [95% CI 1.09-1.26]). Failure of ECV was correlated with anterior placenta (0.44 [0.56-0.76]) and nulliparity (0.21 [0.11-0.36]). Adverse events were rare and mostly minor, occurring in 1% of procedures.

Conclusions: ECV has a high success rate and a low complication rate, enabling vaginal birth and avoiding cesarean. The role of manipulation of modifiable determinants such as liquor volume should be further assessed in future studies.
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http://dx.doi.org/10.1111/birt.12429DOI Listing
December 2019

Optical coherence tomography angiographic findings in preeclampsia - A novel longitudinal report.

Eur J Obstet Gynecol Reprod Biol 2019 Mar 21;234:225-226. Epub 2019 Jan 21.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

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http://dx.doi.org/10.1016/j.ejogrb.2018.12.032DOI Listing
March 2019

Magnetic Resonance Imaging of a Medially Displaced Optic Nerve in a Rare Case of Extreme Exotropia.

JAMA Ophthalmol 2018 12 13;136(12):e183420. Epub 2018 Dec 13.

Department of Ophthalmology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.

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http://dx.doi.org/10.1001/jamaophthalmol.2018.3420DOI Listing
December 2018

The role of bladder volume in the success of external cephalic version.

Eur J Obstet Gynecol Reprod Biol 2018 Nov 2;230:178-181. Epub 2018 Oct 2.

Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel.

Objective: Numerous studies have evaluated the factors associated with ECV success. Yet, bladder volume has never been examined. We hypothesize that maternal bladder volume may affect ECV success rate. We aim to evaluate the role of maternal bladder volume during external cephalic version (ECV) on the procedure success rates.

Study Design: We reviewed prospective collected data of all patients who underwent ECV at our center during 2001-2012. The study group included 100 patients that underwent ECV with bladder volume below 400 ml. These patients were matched to 400 patients that underwent ECV with bladder volume equal or above 400 ml which composed the control group. Maternal and fetal characteristics and outcomes were compared.

Results: ECV was successfully performed in 80/100 (80.0%) of patients in the study group as compared to 257/400 (64.3%) in the control group (P = 0.002). Factors associated with ECV success were older age (P = 0.003), having prior delivery (P < 0.0001), higher amniotic fluid index (AFI) (P = 0.001) and placenta located in the posterior wall (P = 0.001). In a logistic regression analysis, bladder volume was found to be an independent predictor of ECV success Odds radio (OR) for ECV success 2.5 (CI 1.42-4.34). Posterior placenta and higher AFI were found to be an independent predictors of ECV success as well; OR 2.7 (CI 1.74-4.34) and OR 1.07 (CI 1.02-1.13) respectively.

Conclusion: ECV is more successful in patient with bladder volume below 400 ml. Amniotic fluid volume and placental location were found as independent predictors of ECV outcome as well.
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http://dx.doi.org/10.1016/j.ejogrb.2018.10.003DOI Listing
November 2018

An unusual case of globe-sparing penetrating orbital injury by a nail.

Oman J Ophthalmol 2018 Jan-Apr;11(1):92-93

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

We describe a case of a 28-month-old boy who presented to our emergency department with a right orbital penetration by an iron nail. At presentation, no pain or functional loss were noted. Plain head radiographs and computed tomography were performed and demonstrated a two centimeters long nail penetrating the right orbit. The foreign body was extracted carefully in the operating room. No complications were observed upon follow-up. Rarely, orbital penetration by an iron-nail can present without functional disturbances or pain and is not necessarily accompanied by sequelae.
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http://dx.doi.org/10.4103/ojo.OJO_120_2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848363PMC
March 2018

In Vivo Study of the Long Term Structural Changes Induced by Macular Argon Laser.

Curr Eye Res 2018 04 28;43(4):511-516. Epub 2017 Dec 28.

a Department of Ophthalmology , Shaare Zedek Medical Center , Jerusalem , Israel.

Purpose: To assess the long-term structural changes induced by macular argon laser using en face optical coherence tomography (OCT).

Materials And Methods: We reviewed the charts and OCT pictures of patients who had undergone macular laser for diabetic macular edema at least four years ago. Clinical parameters were recorded for each eye, including laser settings. We obtained En face pictures, that were flattened at the RPE (retinal pigment epithelium) plane. We then measured the retinal surface covered by laser marks and the maximal diameter of the largest identified lesion at this plane.  The most superficial level of neurosensory retinal damage as well as the total retinal thickness at this location were measured from the RPE. We also measured the distance between the RPE and the deeper plane at which laser marks were detected.

Results: 21 eyes of 16-patients were analyzed. The mean age (±SD) was 61.7 ± 15.5 years. Patients had undergone macular laser 6.5 ± 2.8 years prior to entering our study.  In 16 eyes the most superficial laser marks were detected at the inner plexiform/inner nuclear layers. The level of neurosensory retinal damage was 159 ± 48 microns over the RPE (62.6 ± 18.3% of the retinal thickness). The deepest level at which laser marks were retrieved was 125 ± 110 microns below the RPE.  The growth of laser marks was correlated to time (Pearson's correlation coefficient = 0.23; p = 0.1).

Conclusions: Argon laser marks gradually expand in the horizontal and vertical axes. The damage induced by argon laser in the neurosensory retina often reaches inner layers.
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http://dx.doi.org/10.1080/02713683.2017.1419572DOI Listing
April 2018

Choroidal Nevus-Associated Neovascular Membrane Demonstrated by OCT Angiography.

Case Rep Ophthalmol 2017 Jan-Apr;8(1):104-107. Epub 2017 Feb 17.

Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

We present a case of choroidal nevus, complicated by a choroidal neovascular membrane (CNV) that was detected by OCT angiography. Choroidal nevi are relatively common intraocular tumors. The presence of subretinal and intraretinal fluids can indicate that a CNV has occurred as a complication, warranting prompt management. However, subretinal and intraretinal fluids are also documented in nevi without CNV. OCT angiography may be of great help in determining whether those fluids are associated or not with a CNV, therefore guiding therapy.
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http://dx.doi.org/10.1159/000458516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346919PMC
February 2017

Vitreous hemorrhage as an early sign of acute bacterial endophthalmitis following intravitreal ranibizumab injection.

Int Ophthalmol 2018 Apr 1;38(2):799-802. Epub 2017 Apr 1.

Department of Ophthalmology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.

Purpose: To report a case of acute bacterial endophthalmitis after antivascular endothelial growth factor injection with a rare presentation of vitreous hemorrhage.

Methods: An 84-year-old woman presented with sudden painless vision loss in her left eye, 3 days after intravitreal ranibizumab injection for cystoid macular edema due to neovascular age-related macular degeneration. The patient was otherwise asymptomatic. Dense vitreous hemorrhage was observed. At follow-up the next day, the patient complained on severe left eye pain. After examination, acute endophthalmitis was diagnosed.

Results: Intravitreal injection of vancomycin, ceftazidime and dexamethasone was performed. Vitreous and aqueous cultures grew Enterococcus faecalis. After treatment, the inflammation subsided but it took 3 months for the vitreous hemorrhage to totally resorb. Visual acuity was reduced to light perception.

Conclusions: Vitreous hemorrhage may be an atypical presentation of acute bacterial endophthalmitis occurring after intravitreal injection.
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http://dx.doi.org/10.1007/s10792-017-0505-7DOI Listing
April 2018

The efficacy and safety of external cephalic version after a previous caesarean delivery.

Aust N Z J Obstet Gynaecol 2017 Jun 14;57(3):323-326. Epub 2016 Sep 14.

Department of Obstetrics & Gynecology, Meuhedet HMO, Jerusalem, Israel.

Background: External cephalic version (ECV) in the presence of a uterine scar is still considered a relative contraindication despite encouraging studies of the efficacy and safety of this procedure. We present our experience with this patient population, which is the largest cohort published to date.

Aims: To evaluate the efficacy and safety of ECV in the setting of a prior caesarean delivery.

Materials And Methods: A total of 158 patients with a fetus presenting as breech, who had an unscarred uterus, had an ECV performed. Similarly, 158 patients with a fetus presenting as breech, and who had undergone a prior caesarean delivery also underwent an ECV. Outcomes were compared.

Results: ECV was successfully performed in 136/158 (86.1%) patients in the control group. Of these patients, 6/136 (4.4%) delivered by caesarean delivery. In the study group, 117/158 (74.1%) patients had a successful ECV performed. Of these patients, 12/117 (10.3%) delivered by caesarean delivery. There were no significant complications in either of the groups.

Conclusions: ECV may be successfully performed in patients with a previous caesarean delivery. It is associated with a high success rate, and is not associated with an increase in complications.
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http://dx.doi.org/10.1111/ajo.12527DOI Listing
June 2017
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