Publications by authors named "Zeeshan Haq"

22 Publications

  • Page 1 of 1

Worsening of Preexisting Psychiatric Conditions During the COVID-19 Pandemic.

Front Psychiatry 2020 16;11:581426. Epub 2020 Dec 16.

BRAINCITY Center of Excellence for Neural Plasticity and Brain Disorders, Nencki Institute of Experimental Biology, Warsaw, Poland.

To ascertain factors associated with worsening of psychiatric conditions during the coronavirus disease 2019 (COVID-19) pandemic. This study anonymously examined 2,734 psychiatric patients worldwide for worsening of their preexisting psychiatric conditions during the COVID-19 pandemic. An independent clinical investigation of 318 psychiatric patients from United States was used for verification. Valid responses mainly from 12 featured countries indicated self-reported worsening of psychiatric conditions in two-thirds of the patients assessed that was through their significantly higher scores on scales for general psychological disturbance, posttraumatic stress disorder, and depression. Female gender, feeling no control of the situation, reporting dissatisfaction with the response of the state during the COVID-19 pandemic, and reduced interaction with family and friends increased the worsening of preexisting psychiatric conditions, whereas optimism, ability to share concerns with family and friends, and using social media like usual were associated with less worsening. An independent clinical investigation from the United States confirmed worsening of psychiatric conditions during the COVID-19 pandemic based on identification of new symptoms that necessitated clinical interventions such as dose adjustment or starting new medications in more than half of the patients. More than half of the patients are experiencing worsening of their psychiatric conditions during the COVID-19 pandemic.
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http://dx.doi.org/10.3389/fpsyt.2020.581426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772353PMC
December 2020

Delayed Acute Granulomatous Anterior Uveitis after Inadvertent Intraocular Injection of Tattoo Ink from a Scleral Tattoo Procedure.

Ocul Immunol Inflamm 2020 Aug 19:1-3. Epub 2020 Aug 19.

Department of Ophthalmology, University of California, San Francisco , San Francisco, CA, USA.

Purpose: To improve awareness of delayed onset uveitis in patients with a history of intraocular tattoo ink injection.

Results: A 47-year-old man underwent a scleral tattoo procedure during which there was inadvertent intraocular injection of tattoo ink into his right eye. He subsequently developed endophthalmitis, retinal detachment, and retinal necrosis. He was treated with intravitreal and oral antibiotics and underwent vitreoretinal surgical intervention. A vitreous specimen was obtained and demonstrated significantly elevated levels of several heavy metals. One month later, he developed an acute granulomatous anterior uveitis in the same eye that was managed with a combination of topical and perioperative intravitreal, intravenous, and oral corticosteroids.

Conclusion: This case highlights the importance of monitoring patients with a history of intraocular tattoo ink injection for delayed onset uveitis in addition to retinal toxicity.
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http://dx.doi.org/10.1080/09273948.2020.1784439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892632PMC
August 2020

Remote corneal suturing wet lab: microsurgical education during the COVID-19 pandemic.

J Cataract Refract Surg 2020 12;46(12):1667-1673

From the Department of Ophthalmology (Pasricha, Haq, Chan, Redd, Seitzman, Parikh, Kim, Schallhorn, Ramanathan), School of Medicine (Ahmad), and Francis I. Proctor Foundation (Redd, Seitzman, Schallhorn), University of California San Francisco, San Francisco, California, USA.

Purpose: To study the feasibility and efficacy of a new remote wet lab for microsurgical education using a corneal suturing task.

Setting: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.

Design: Prospective randomized controlled study.

Methods: Ten ophthalmology residents were stratified by postgraduate year and randomized to perform a corneal suturing task consisting of placing the 4 cardinal sutures for a penetrating keratoplasty in porcine eyes with or without remote ophthalmology attending feedback. Subsequently, both groups repeated the same task without remote feedback to test whether initial remote feedback affected subsequent performance. Finally, the group without feedback was crossed over to repeat the same corneal suturing task with remote feedback. The effectiveness of the remote wet lab was assessed subjectively by survey and objectively by grading each suture pass.

Results: Resident-reported comfort with corneal suturing improved significantly after the remote wet lab for all residents. Residents and attendings rated the remote wet lab as equally or more effective compared with previous in-person wet labs and overall effective in corneal suturing. Attendings rated the remote wet lab as effective in multiple domains of microsurgical education using a modified microsurgical global rating scale. Objective corneal suturing performance was similar for both groups.

Conclusions: The remote wet lab was feasible and effective for training ophthalmology residents in corneal suturing. This represents a new social distancing compliant platform for microsurgical education during the COVID-19 pandemic.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446976PMC
December 2020

Acute Macular Neuroretinopathy Associated With an Oral FLT3 Inhibitor.

JAMA Ophthalmol 2020 10;138(10):1104-1106

Department of Ophthalmology, University of California, San Francisco, San Francisco.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.2815DOI Listing
October 2020

Atypical Valsalva retinopathy from habitual ear popping.

Am J Ophthalmol Case Rep 2020 Sep 17;19:100785. Epub 2020 Jun 17.

Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.

Purpose: To report a unique case of Valsalva retinopathy associated with ear popping behavior.

Observations: A 57-year-old woman with a history of well-controlled hypertension presented with episodes of seeing "spots" in her left eye for many years. Her most recent episode failed to resolve spontaneously. Fundus examination revealed scattered retinal hemorrhages in the left eye, and optical coherence tomography demonstrated sub-internal limiting membrane location of these hemorrhages. Fluorescein angiography did not reveal any vascular abnormalities. Based on these findings and an in-depth review of systems, a diagnosis of Valsalva retinopathy was made associated with patient's ear popping habit.

Conclusions And Importance: Habitual ear popping can be a potential etiology of symptomatic Valsalva retinopathy. This under-appreciated association may be clinically relevant for patients with a history of suspected Eustachian tube narrowing or dysfunction.
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http://dx.doi.org/10.1016/j.ajoc.2020.100785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321967PMC
September 2020

Discordant vascular parameter measurements in diabetic and non-diabetic eyes detected by different optical coherence tomography angiography devices.

PLoS One 2020 16;15(6):e0234664. Epub 2020 Jun 16.

Department of Ophthalmology, University of California, San Francisco, CA, United States of America.

Purpose: To compare quantitative changes in macular parameters in diabetic patients detected by two optical coherence tomography angiography (OCTA) instruments.

Methods: 80 phakic eyes were classified as no diabetes, diabetes without diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), and severe NPDR or proliferative DR (PDR). OCTA was performed using devices from two manufacturers (Zeiss and Heidelberg). Superficial and deeper vascular skeleton density (SVSD, DVSD), superficial and deeper vessel area density (SVAD, DVAD), choriocapillaris flow voids (CCFV), and choroidal flow voids (CFV) were calculated. Inter-device comparisons were performed using the size comparison index (SCI) and the discrepancy index (DI).

Results: The two devices were inconsistent in SVSD, DVSD, DVAD, CCFV and CFV parameters (all P < 0.05). In addition, the SCI was positive for DVAD (all P < 0.001) and negative for SVSD, DVSD, CCFV and CFV in all groups (all P <0.001), except for DVSD in severe NPDR or PDR. The discrepancy index was not significantly different among groups for SVD, SPD, DVD, DPD and CFV (all P> 0.05). The mean DI of CCFV was statistically different between the four groups (P < 0.001).

Conclusions: The two instruments were largely inconsistent in the measurement of macular parameters relevant to DR. The choice of imaging device can impact OCTA analytics and should be taken into account when drawing conclusions about DR-related changes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234664PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297376PMC
August 2020

Vitreomacular traction associated with papillitis.

Am J Ophthalmol Case Rep 2020 Sep 26;19:100759. Epub 2020 May 26.

Department of Ophthalmology, University of California, San Francisco, USA.

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http://dx.doi.org/10.1016/j.ajoc.2020.100759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262546PMC
September 2020

Short-Term Non-Infectious Outcomes After a Pars Plana Intravitreal Antibiotic-Steroid Injection of Triamcinolone, Moxifloxacin, and Vancomycin During Cataract Surgery versus a Standard Postoperative Topical Regimen.

Clin Ophthalmol 2020 23;14:1117-1125. Epub 2020 Apr 23.

Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA.

Purpose: To compare short-term non-infectious clinical outcomes after cataract surgery with an intraoperative pars plana intravitreal antibiotic-steroid (IVAS) injection of triamcinolone, moxifloxacin, and vancomycin (TMV) versus a standard postoperative topical regimen.

Patients And Methods: A retrospective comparative case series of 1058 eyes (control = 487, treatment = 571) undergoing cataract surgery were included. Endpoints included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the unplanned use of anti-inflammatory topical medication in the postoperative period. The follow-up period ranged from 1 to 6 months.

Results: A final monocular BCVA of 20/25 or better was achieved in 78.8% and 87.4% of eyes in the control and treatment groups, respectively (p = 0.001). The overall incidence of an IOP spike (Δ ≥ 10 mm Hg) was not significantly different between the two groups (0.4% versus 1.9%, p = 0.027). The rates of persistent anterior chamber inflammation (PACI), rebound anterior chamber inflammation (RACI), and cystoid macular edema (CME) in the control and treatment groups were 8.0% vs 2.6% (p < 0.001), 6.4% vs 2.6% (p = 0.003), and 3.9% vs 4.7% (p = 0.511), respectively. The use of an IVAS injection of TMV conferred an increased risk of CME (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.42 to 7.23) but no significant effect on the risk of PACI (OR = 0.34, 95% CI = 0.10 to 1.14) or RACI (OR = 0.52, 95% CI = 0.18 to 1.54) when compared to a topical regimen.

Conclusion: An intraoperative IVAS injection after uncomplicated cataract surgery may be as safe and effective as a standard topical regimen in terms of postoperative IOP and anterior chamber inflammatory events, respectively. However, the efficacy of a TMV formulation for CME prophylaxis appears to be unsatisfactory. Future studies with prospective and randomized designs are needed to further evaluate this technique.
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http://dx.doi.org/10.2147/OPTH.S247739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185344PMC
April 2020

Inverse Pseudohypopyon from Emulsified Silicone Oil in the Macula.

Ophthalmol Retina 2020 02;4(2):203

Department of Ophthalmology, University of California, San Francisco, San Francisco, California.

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http://dx.doi.org/10.1016/j.oret.2019.11.001DOI Listing
February 2020

A randomized, controlled trial of video supplementation on the cataract surgery informed consent process.

Graefes Arch Clin Exp Ophthalmol 2019 Aug 30;257(8):1719-1728. Epub 2019 May 30.

Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, 60637, USA.

Purpose: To assess the effects of the American Academy of Ophthalmology's 2015 patient education video on patient information retention and anxiety preoperatively, on the day of surgery and postoperatively.

Methods: This is a prospective, surgeon-blinded randomized controlled trial at the University of Chicago Medical Center. Ninety-one patients with a diagnosis of first-eye cataract were randomized into either a video or control group. Subjects in both groups received face-to-face discussion with the surgeon and an informational brochure at the preoperative evaluation. Participants in the video group then viewed a four-minute educational video at the preoperative evaluation and on the day of surgery. Both groups completed an information retention quiz and a state anxiety assessment at the preoperative visit, on the day of surgery, and on the postoperative week one visit. Subject understanding of cataract surgery was measured using a twelve-question multiple choice quiz. State anxiety was measured by State Trait Anxiety Inventory-Y1 survey score.

Results: Participants in the video group did not score significantly higher on the information retention quiz compared with the control group at the preoperative evaluation (8.7 ± 2.4 vs 7.7 ± 2.5, P = 0.07), but did so on the day of surgery (11.2 ± 0.8 vs 8.4 ± 1.7, P < 0.001) and postoperative week 1 visit (10.8 ± 1.5 vs 9.0 ± 2.0, P < 0.001). Subjects in the video group were significantly less anxious on the day of surgery (26.4 ± 5.1 vs 41.1 ± 10.3, P < 0.001).

Conclusions: Video supplementation to the traditional informed consent process demonstrated an improvement in patient understanding of cataract surgery at multiple timepoints and decreased anxiety on the day of surgery.
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http://dx.doi.org/10.1007/s00417-019-04372-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846231PMC
August 2019

Strategies for reconstructing the limbal stem cell niche.

Ocul Surf 2019 04 8;17(2):230-240. Epub 2019 Jan 8.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA. Electronic address:

The epithelial cell layer that covers the surface of the cornea provides a protective barrier while maintaining corneal transparency. The rapid and effective turnover of these epithelial cells depends, in part, on the limbal epithelial stem cells (LESCs) located in a specialized microenvironment known as the limbal niche. Many disorders affecting the regeneration of the corneal epithelium are related to deficiency and/or dysfunction of LESCs and the limbal niche. Current approaches for regenerating the corneal epithelium following significant injuries such as burns and inflammatory attacks are primarily aimed at repopulating the LESCs. This review summarizes and assesses the clinical feasibility and efficacy of current and emerging approaches for reconstruction of the limbal niche. In particular, the application of mesenchymal stem cells along with appropriate biological scaffolds appear to be promising strategies for long-term revitalization of the limbal niche.
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http://dx.doi.org/10.1016/j.jtos.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529262PMC
April 2019

APPLICATION OF ADJUNCTIVE TOPICAL MITOMYCIN-C IN SCLEROSTOMY REVISION FOR REFRACTORY IDIOPATHIC UVEAL EFFUSION SYNDROME.

Retin Cases Brief Rep 2019 Jan 3. Epub 2019 Jan 3.

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois.

Background/purpose: To describe the use of topical mitomycin-C in sclerostomy revision for recalcitrant idiopathic uveal effusion syndrome.

Methods: A 50-year-old healthy man presented with painless, gradual vision loss in the right eye. He underwent multimodal retinal imaging with wide-field fundus photography, spectral domain optical coherence tomography, and B-scan and A-scan ultrasonography. He was found to have idiopathic (non-nanophthalmic) uveal effusion syndrome with choroidal and serous retinal detachments in the right eye and a peripheral choroidal detachment in the left eye. Central vision became threatened in the right eye. Medical treatment with oral corticosteroids and surgical treatment with choroidal drainage through sclerostomies and sclerostomy revision were administered.

Results: Initial treatment with systemic corticosteroids was ineffective. Subsequent choroidal drainage through sclerostomies only partially resolved the effusion. Later sclerostomy revision with application of topical mitomycin-C led to complete resolution with anatomical stability maintained after at least 42 months of follow-up.

Conclusion: Successful use of topical mitomycin-C in sclerostomy revision has not previously been reported in idiopathic (non-nanophthalmic) uveal effusion syndrome. We propose that topical mitomycin-C may be considered as a potential therapeutic adjunct in the treatment of refractory idiopathic uveal effusion syndrome before further sclerostomy procedures are attempted in additional quadrants of the eye.
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http://dx.doi.org/10.1097/ICB.0000000000000840DOI Listing
January 2019

Tacrolimus Eye Drops as Adjunct Therapy in Severe Corneal Endothelial Rejection Refractory to Corticosteroids.

Cornea 2017 Oct;36(10):1195-1199

*Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; and †Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.

Purpose: To evaluate the safety and efficacy of tacrolimus eye drops as adjunctive therapy in the treatment of severe corneal endothelial rejection after penetrating keratoplasty refractory to corticosteroids.

Methods: In this prospective interventional case series, 11 eyes of 11 patients assessed for severe corneal endothelial rejection, with an inadequate response to topical, local, and systemic corticosteroids, were treated with either 0.01% or 0.05% tacrolimus eye drops 4 times daily. Improvement in signs of rejection, visual function, and development of complications were monitored.

Results: The duration of steroid treatment before intervention was 8.1 ± 1.4 days (range = 7-11). Patients were subsequently administered topical tacrolimus 0.01% or 0.05% qid. The time to clinical improvement was 10.3 ± 3.4 days (range = 3-17). The time to rejection reversal was 27.8 ± 16.3 days (range = 7-52). After 3 months, 10 patients (90.8%) demonstrated clinical improvement, and complete restoration of graft clarity was achieved in 5 patients (45.4%). In responsive cases, steroid therapy was successfully tapered off after 60.2 ± 19.7 days (range = 36-93). The best spectacle-corrected visual acuity improved from 1.7 ± 0.9 to 0.8 ± 0.5 logMAR (P = 0.0016). Reported side effects included stinging on drop instillation and punctate epithelial keratopathy.

Conclusions: Tacrolimus eye drops may be able to play an adjunctive therapeutic role in patients with severe corneal endothelial rejection refractory to conventional steroid treatment. Controlled studies are needed to further investigate the role of tacrolimus in this setting.
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http://dx.doi.org/10.1097/ICO.0000000000001298DOI Listing
October 2017

Dark Retinal Lesion in a Young Asymptomatic Man.

JAMA Ophthalmol 2017 Feb;135(2):155-156

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

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http://dx.doi.org/10.1001/jamaophthalmol.2016.2839DOI Listing
February 2017

Periorbital Mass Refractory to Outpatient Management.

JAMA Ophthalmol 2017 Jan;135(1):73-74

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.

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http://dx.doi.org/10.1001/jamaophthalmol.2016.2743DOI Listing
January 2017

Biofilm Formation on Bandage Contact Lenses Worn by Patients with the Boston Type 1 Keratoprosthesis: A Pilot Comparison Study of Prophylactic Topical Vancomycin 15 mg/mL and Linezolid 0.2.

Eye Contact Lens 2018 Sep;44 Suppl 1:S106-S109

Department of Ophthalmology & Visual Sciences (A.V.F., S.J., Z.H., E.Y.T., J.d.l.C., M.S.C.), University of Illinois at Chicago, Chicago, IL; and Department of Ophthalmology & Visual Neurosciences (J.H.H.), University of Minnesota, Minneapolis, MN.

Objectives: To determine the rate of biofilm formation on bandage contact lenses worn by patients with the Boston type 1 keratoprosthesis (K-Pro) while on prophylactic topical vancomycin versus linezolid.

Methods: Patients wearing a bandage contact lens (BCL) with a K-Pro were eligible for enrollment. After irrigation of the ocular surface with 5% povidone-iodine solution, each patient was placed on either topical vancomycin 15 mg/mL or linezolid 0.2% BID for one month. At the one-month visit, the BCL was collected and stored in fixative solution. Standard photographs were taken of each lens at high magnification using scanning electron microscopy (SEM), which were subsequently analyzed for evidence of biofilm.

Results: Nineteen contact lenses were obtained from 12 K-Pro patients at the Illinois Eye and Ear Infirmary. Zero of eight (0%; 95% CI=0 to 37%) contact lenses from patients treated with topical vancomycin, and 1 of 11 (9%; 95% CI=0 to 41%; P-value=1.00) contact lenses from patients treated with topical linezolid were found to have biofilm formation at one month as detected by SEM. None of the patients developed a clinically significant infection while on either prophylactic vancomycin or linezolid during the study period.

Conclusions: Overall, the rate of biofilm formation as detected by SEM on the surface of bandage contact lenses was low. These results suggest that vancomycin and linezolid are both relatively effective in reducing biofilm-forming bacterial growth at one month. Accordingly, linezolid may be an effective alternative to vancomycin in patients with allergy or intolerance. However, further investigation is required to develop evidence-based antibiotic prophylaxis regimens.
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http://dx.doi.org/10.1097/ICL.0000000000000337DOI Listing
September 2018

Current and Upcoming Therapies for Ocular Surface Chemical Injuries.

Ocul Surf 2017 01 17;15(1):48-64. Epub 2016 Sep 17.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address:

Chemical injuries frequently result in vision loss, disfigurement, and challenging ocular surface complications. Acute interventions are directed at decreasing the extent of the injury, suppressing inflammation, and promoting ocular surface re-epithelialization. Chronically, management involves controlling inflammation along with rehabilitation and reconstruction of the ocular surface. Future therapies aimed at inhibiting neovascularization and promoting ocular surface regeneration should provide more effective treatment options for the management of ocular chemical injuries.
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http://dx.doi.org/10.1016/j.jtos.2016.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5191942PMC
January 2017

Late Acute Rejection After Allograft Limbal Stem Cell Transplantation: Evidence for Long-Term Donor Survival.

Cornea 2017 Jan;36(1):26-31

*Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; †Department of Ophthalmology, Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH; ‡Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and §Department of Internal Medicine, University of Cincinnati, Cincinnati, OH.

Purpose: To describe the clinical presentation and management of late (>3.0 years) acute graft rejection in keratolimbal allograft (KLAL) recipients.

Methods: This was a multicenter, retrospective observational case series. Six eyes of 6 patients with ocular surface transplant at a mean age of 36.2 years were seen at 3 tertiary referral centers for acute graft rejection between 2007 and 2013. Main outcome measures included strength of systemic immunosuppression (SI) at the time of rejection, time to rejection, and clinical presentation of rejection.

Results: Preoperative diagnoses included total limbal stem cell deficiency because of aniridia (n = 2) or chemical injury (n = 4). After an initially successful outcome, patients experienced late acute graft rejection at a mean time of 67.8 ± 24.1 months (range: 41-98) after KLAL while receiving suboptimal levels of SI because of medication taper (n = 5) or noncompliance (n = 1). Objective findings included an epithelial rejection line (n = 6), edema (n = 2), corneal epithelial irregularities (n = 2), and neovascularization (n = 1). Antirejection management consisted of topical corticosteroids (n = 6) and augmentation of SI therapy (n = 5).

Conclusions: These cases of late acute graft rejection in KLAL patients support the notion that allodonor cells can persist over the long run and remain at risk for immunologic rejection. It further underscores the fact that long-term success with KLAL may require extension of SI beyond the first few years, albeit at lower levels individualized to each patient.
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http://dx.doi.org/10.1097/ICO.0000000000000970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138087PMC
January 2017

Infections after refractive surgery.

Curr Opin Ophthalmol 2016 Jul;27(4):367-72

aPritzker School of Medicine, University of Chicago, Chicago, Illinois bDepartment of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA.

Purpose Of Review: The purpose of the review is to provide a summary of the recent literature concerning infections after refractive surgery pertinent to each procedure category.

Recent Findings: New data from a large retrospective study suggest that the incidence of post-laser assisted in-situ keratomileusis infectious keratitis is declining. Additionally, recent case studies have reported viral, fungal, and Acanthamoeba pathogens. Corneal collagen cross-linking is emerging as an alternative therapeutic option for early stage post-LASIK infectious keratitis. Postoperative bandage contact lens used in patients undergoing surface ablation procedures may confer a higher risk of infection because of greater colonization rates in those individuals, such as healthcare providers, with relatively high risk of exposure to potential pathogens. In the setting of post-penetrating keratoplasty astigmatism, femtosecond laser astigmatic keratotomy procedures pose a risk of infectious keratitis and even endophthalmitis. Lastly, recent case reports of endophthalmitis after refractive lens procedures highlight the importance of postoperative monitoring for this sight threatening, albeit rare, complication.

Summary: The risks and management of infections after surgical refractive procedures vary widely depending on the specific technique employed. As technology and treatment options continue to evolve with further research, we anticipate continued success in the management of postoperative infections after refractive surgery.
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http://dx.doi.org/10.1097/ICU.0000000000000275DOI Listing
July 2016

The prognostic role of mitral regurgitation after primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

Catheter Cardiovasc Interv 2012 Nov 10;80(5):779-86. Epub 2012 Jan 10.

Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.

Objectives: The aim of this study was to elucidate the prognostic significance of mitral regurgitation (MR) after primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (STEMI).

Background: MR has prognostic implications after myocardial infarction (MI). However, for STEMI patients receiving primary PCI, the influence of MR on long-term (3-5 years) outcome is unknown.

Methods: We examined 888 STEMI patients receiving primary PCI enrolled in a prospective database at a regional STEMI center, who had an echocardiogram within 72 hr following successful primary PCI. MR was graded by color Doppler as none/trace vs. mild vs. moderate/severe. Mean ± SD follow-up was 3.1 ± 1.4 years.

Results: For patients with none/trace (n = 469), mild (n = 325), and moderate/severe (n = 94) MR, mortality at 3 years was 8.1%, 13.6%, and 25.7% and at 5 years was 12.7%, 18.3%, and 33.5%, respectively (P < 0.0001, log-rank test). Patients with moderate/severe MR tended to be older (P < 0.0001) with lower ejection fraction (P < 0.0001) and were less likely to have had an anterior MI (P < 0.001). Independent predictors of mortality included age, creatinine, and heart rate.

Conclusions: Following primary PCI for STEMI, echocardiographic detected MR in the first 72 hr following PCI stratifies mortality risk. However, when accounting for age, MR is not an independent predictor of mortality.
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http://dx.doi.org/10.1002/ccd.23400DOI Listing
November 2012