Publications by authors named "Zvi Gur"

14 Publications

  • Page 1 of 1

Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease.

Ophthalmic Plast Reconstr Surg 2021 Jul 21. Epub 2021 Jul 21.

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, La Jolla, California Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, U.S.A.

Purpose: To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease.

Methods: This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates.

Results: Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0-5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2-13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1-7 mm). Upper eyelid retraction improved on average by 1.8 mm (0-5 mm). Horizontal eye movements improved by 11% on average (-3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss.

Conclusions: The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.
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http://dx.doi.org/10.1097/IOP.0000000000002007DOI Listing
July 2021

Orbital nodular fasciitis in the pediatric population: a case report and review of the literature.

Orbit 2021 Jul 20:1-6. Epub 2021 Jul 20.

Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

A 10-month-old female presented with a rapidly growing, painless mass in the right upper eyelid. Due to suspected malignancy, she underwent an urgent biopsy. Histopathological and immunohistochemical analyses revealed nodular fasciitis. Here, we describe the case and perform a literature review of orbital nodular fasciitis in the pediatric population.
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http://dx.doi.org/10.1080/01676830.2021.1955393DOI Listing
July 2021

Outcomes of Single Suture Mueller's Muscle Conjunctival Resection: Ethnic Considerations.

Ophthalmic Plast Reconstr Surg 2021 Jun 4. Epub 2021 Jun 4.

Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Gyeonggido, Korea Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, U.S.A. Division of Plastic Surgery, UC San Diego, La Jolla, California, U.S.A.

Purpose: To compare outcomes of Mueller's Muscle Conjunctival Resection (MMCR) between 2 groups of patients with different anatomy due to ethnic heritage.

Methods: The medical records of patients who underwent MMCR between 2013 and 2018 were retrospectively reviewed. Patients who underwent additional procedures, such as upper blepharoplasty and browplasty, were excluded from the study. Patients were divided in 2 groups based on self-identified ethnic groups (Asian and Caucasian). Image J software was used to calculate MRD1 from digital images. The improvement of MRD1 (net MRD1) after surgery was evaluated and compared between 2 groups.

Results: Eighty-three eyes of 68 patients were included in this study. The Asian group consisted of 41 eyelids from 28 patients. The Caucasian group consisted of 42 eyelids from 40 patients. The average age was 52.18 (SD 20.176) in the Asian group compared with the 66.45 years (SD 9.22, p< 0.005) in the Caucasian group. The mean improvement of MRD1 was 1.96 ± 0.75 mm in Asian group and 2.05 ± 0.72 mm in Caucasian group, which was not statistically significant (p = 0.62). The incidence of ptosis overcorrection and undercorrection between the groups was also not statistically significant.

Conclusions: There was no statistically significant difference in the surgical outcomes among the 2 study groups. Despite differences in the anatomy of Caucasian and Asian eyelids, MMCR is a successful procedure in patients self-identified from both ethnic groups.
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http://dx.doi.org/10.1097/IOP.0000000000001980DOI Listing
June 2021

Spectral-domain optical coherence tomography features in cases of pre-eclampsia and the relationship with systemic parameters.

Can J Ophthalmol 2020 12 26;55(6):524-526. Epub 2020 Aug 26.

Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2020.06.025DOI Listing
December 2020

Does Intraoperative Ketorolac Increase Bleeding in Oculoplastic Surgery?

Ophthalmic Plast Reconstr Surg 2020 Jul/Aug;36(4):355-358

Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, UC San Diego School of Medicine, La Jolla, California, U.S.A.

Purpose: To report adverse hemorrhagic outcomes in patients who received intravenous (IV) ketorolac during oculofacial plastic surgical procedures.

Methods: The medical records of 111 consecutive patients who underwent lacrimal or orbital surgery, between the years 2016 and 2018, performed by a single surgeon under general anesthesia were retrospectively reviewed. Patients were excluded if they had history of a bleeding coagulopathy, anticoagulant use prior to surgery, or insufficient follow up. Patients were divided into 2 groups based on whether they received intravenous ketorolac. The primary outcome measure was the occurrence of a major postoperative bleeding event, and the secondary outcome measures were the evaluation of postoperative ecchymosis graded at 1 week after surgery and the incidence of persistent ecchymosis beyond 4 weeks.

Results: A total of 111 patients were analyzed further, including 31 patients who received intraoperative IV ketorolac and 80 control patients who did not. The demographic characteristics between the 2 groups were similar. No major bleeding events occurred in either group. And there was no statistically significant difference between the 2 groups in terms of ecchymosis grade and the incidence of development of persistent ecchymosis. Comparing the subgroups of lacrimal and orbital cases, there was also no significance difference between these groups.

Conclusions: This study suggests that intraoperative ketorolac use does not increase the risk of postoperative bleeding complications in oculofacial procedures. This alternative to opioids may assist with pain control and lessen the narcotic burden.
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http://dx.doi.org/10.1097/IOP.0000000000001549DOI Listing
March 2021

Exposed Scleral Buckle Causing Atypical Mycobacterial Infection.

Ophthalmic Plast Reconstr Surg 2020 May/Jun;36(3):e83

Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology.

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http://dx.doi.org/10.1097/IOP.0000000000001458DOI Listing
March 2021

Complete Excision of a Simple Dacryops Using Fibrin Sealant and Trypan Blue Mixture.

Ophthalmic Plast Reconstr Surg 2019 Jan/Feb;35(1):e16-e18

Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology.

A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.
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http://dx.doi.org/10.1097/IOP.0000000000001283DOI Listing
December 2019

Association between delivery of small-for-gestational age neonate and long-term pediatric ophthalmic morbidity.

Arch Gynecol Obstet 2018 12 1;298(6):1095-1099. Epub 2018 Oct 1.

Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Objective: To investigate whether delivery of small for gestational age (SGA) neonate poses a risk for subsequent long-term ophthalmic morbidity.

Methods: In this population-based study, all deliveries between 1991 and 2014 were included. Congenital malformations and multiple gestations were excluded from the analysis. Offspring were defined as either SGA (weight below the 5th percentile for gestational age) or non-SGA. Comparison was performed regarding the incidence of long-term ophthalmic morbidity in a cohort of neonates who were born SGA and those who were not. Ophthalmic morbidity was documented during any encounter with the hospital for a period of up to 18 years after delivery. Ophthalmic morbidity included infections of the eye or the adnexa, inflammation of any cause requiring admission, visual disturbances, and other hospital admissions carrying an ICD-9 code of ophthalmic designation. A Cox proportional hazards model was used to estimate the adjusted hazards ratio (HR) for ophthalmic morbidity During the study period, 243,682 deliveries met the inclusion criteria, of which 11,290 (4.63%) were defined as SGA.

Results: During the follow-up period, SGA neonates had higher rates of ophthalmic-related hospitalizations (1.2% versus 1.0%; OR = 1.22, 95% CI 1.02-1.46; p = 0.026). In a Cox proportional hazards model, adjusted for confounders such as maternal age, gestational age at delivery, child birth year, low 5 min Apgar scores (< 7), gestational diabetes, maternal hypertensive disorders, placental abruption and placenta previa, SGA neonate was independently associated with subsequent long-term ophthalmic morbidity (adjusted HR = 1.22; 95% CI 1.02-1.47; p = 0.024).

Conclusion: Delivery of an SGA neonate is an independent risk factor for long-term ophthalmic morbidity.
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http://dx.doi.org/10.1007/s00404-018-4901-7DOI Listing
December 2018

Predicting Refractive Surgery Outcome: Machine Learning Approach With Big Data.

J Refract Surg 2017 Sep;33(9):592-597

Purpose: To develop a decision forest for prediction of laser refractive surgery outcome.

Methods: Data from consecutive cases of patients who underwent LASIK or photorefractive surgeries during a 12-year period in a single center were assembled into a single dataset. Training of machine-learning classifiers and testing were performed with a statistical classifier algorithm. The decision forest was created by feature vectors extracted from 17,592 cases and 38 clinical parameters for each patient. A 10-fold cross-validation procedure was applied to estimate the predictive value of the decision forest when applied to new patients.

Results: Analysis included patients younger than 40 years who were not treated for monovision. Efficacy of 0.7 or greater and 0.8 or greater was achieved in 16,198 (92.0%) and 14,945 (84.9%) eyes, respectively. Efficacy of less than 0.4 and less than 0.5 was achieved in 322 (1.8%) and 506 (2.9%) eyes, respectively. Patients in the low efficacy group (< 0.4) had statistically significant differences compared with the high efficacy group (≥ 0.8), yet were clinically similar (mean differences between groups of 0.7 years, of 0.43 mm in pupil size, of 0.11 D in cylinder, of 0.22 logMAR in preoperative CDVA, of 0.11 mm in optical zone size, of 1.03 D in actual sphere treatment, and of 0.64 D in actual cylinder treatment). The preoperative subjective CDVA had the highest gain (most important to the model). Correlations analysis revealed significantly decreased efficacy with increased age (r = -0.67, P < .001), central corneal thickness (r = -0.40, P < .001), mean keratometry (r = -0.33, P < .001), and preoperative CDVA (r = -0.47, P < .001). Efficacy increased with pupil size (r = 0.20, P < .001).

Conclusions: This model could support clinical decision making and may lead to better individual risk assessment. Expanding the role of machine learning in analyzing big data from refractive surgeries may be of interest. [J Refract Surg. 2017;33(9):592-597.].
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http://dx.doi.org/10.3928/1081597X-20170616-03DOI Listing
September 2017

Post-LASIK Epithelial Ingrowth.

Isr Med Assoc J 2016 Aug;18(8):501

Department of Ophthalmology, Wolfson Medical Center, Holon, Israel.

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August 2016

Pseudoexfoliation: An Ocular Finding with Possible Systemic Implications.

Isr Med Assoc J 2017 Jan;19(1):49-54

Department of Ophthalmology, Wolfson Medical Center, Holon, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Pseudoexfoliation syndrome (PES) is a common age-related disorder affecting 60-70 million people worldwide. Patients with PES have abnormal production and deposition of fibrillar material in the anterior chamber of the eye. These exfoliated fibrils, easily detected by ocular slit-lamp examination, have also been found to exist systematically in the skin, heart, lungs, liver and kidneys. Recently, myriad studies have associated PES with systemic conditions such as increased vascular risk, risk of dementia and inflammatory state. We review here the most current literature on the systemic implications of PES. Our aim is to encourage further studies on this important clinical entity.
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January 2017

Uveitis-Glaucoma-hyphema Syndrome.

Nepal J Ophthalmol 2016 Jan;8(15):99

After 20 years of catarct surgery, a 66 years old man has found to have subluxtaed intraocular lens with satbilizing haptic protuding through the pupil.
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http://dx.doi.org/10.3126/nepjoph.v8i1.16165DOI Listing
January 2016

Comparison of the Tolerability of Diclofenac and Nepafenac.

J Ocul Pharmacol Ther 2016 11 11;32(9):601-605. Epub 2016 Aug 11.

1 Department of Ophthalmology, The Edith Wolfson Medical Center , Holon, Israel .

Purpose: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the prevention and treatment of inflammation and pain following cataract surgery. Preservative-free diclofenac and nepafenac drops are commonly used ophthalmic NSAIDs. The purpose of this study was to compare the tolerability of diclofenac to that of nepafenac.

Methods: In this prospective patient-blinded study, consecutive patients undergoing cataract surgery were included. One drop of nepafenac 0.1% and diclofenac sodium 0.1% were instilled in the right and left eyes, respectively, one immediately after the other, 1 day before surgery. Visual analog scale (scale 0-10) was used to measure patient discomfort, itching, burning, and pain at 1 second (s), 15 s, 1 minute (min), and 5 min postadministration.

Results: Overall, 44 eyes of 22 patients were included in this study. Diclofenac and nepafenac had high and similar tolerability at all time points with no significant difference regarding all aspects of tolerability. A vast majority of patients (72%) did not prefer 1 drop over the other in terms of overall comfort.

Conclusions: Both diclofenac and nepafenac seem to have similar high tolerability. Diclofenac may be an affordable alternative to nepafenac and therefore should be considered by prescribing physicians, specifically in preoperative cataract patients.
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http://dx.doi.org/10.1089/jop.2016.0057DOI Listing
November 2016

Quantifying metamorphopsia in patients with diabetic macular oedema and other macular abnormalities.

Acta Ophthalmol 2015 Dec 20;93(8):e649-53. Epub 2015 Apr 20.

Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel.

Purpose: To quantify subjective visual metamorphopsia in newly diagnosed patients suffering from diabetic macular oedema (DME) and other macular abnormalities and to evaluate anti-VEGF treatment effect.

Methods: Patients with DME, subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) or retinal venous occlusion (RVO) were recruited. Metamorphopsia score (Mscore) was calculated using M-Charts at baseline and at the end of a series of anti-VEGF injections.

Results: Fifteen eyes of 10 patients with DME, 14 eyes of 13 patients with AMD-CNV and five patients with RVO were included in this study. At baseline, positive Mscore was observed in 46.6% of eyes with DME, 50% of eyes with AMD-CNV and four of five eyes with RVO. Treatment led to a complete metamorphopsia reduction (Mscore = 0) in 71.4% of DME patients, 35.7% of AMD and 0% of RVO patients.

Conclusion: We suggest that the M-charts may serve as an additional test for diagnosis and follow-up, complementary to morphological evaluation by imaging, in diabetic patients facing their first anti-VEGF treatment.
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http://dx.doi.org/10.1111/aos.12735DOI Listing
December 2015
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