10 research outputs found
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Rose Bengal Photodynamic Antimicrobial Therapy as potential adjuvant treatment for Serratia marcescens corneal ulcer
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Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures
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Long-Term Comprehensive Management of Bilateral Limbal Stem Cell Deficiency Secondary to Severe Chemical Burn: 10 Years of Follow-Up
To describe the long-term management of bilateral limbal stem cell deficiency secondary to a severe chemical burn.
Descriptive case report
This case highlights the importance of early intervention in ocular chemical burns for the preservation of tissue integrity and avoidance of perforation. We also review the use of proper ocular surface reconstructive techniques to restore the function of the limbal area, as well as the immunomodulatory strategies and follow-up needed for these interventions
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Recent United States Developments in the Pharmacological Treatment of Dry Eye Disease
Dry eye disease (DED) can arise from a variety of factors, including inflammation, meibomian gland dysfunction (MGD), and neurosensory abnormalities. Individuals with DED may exhibit a range of clinical signs, including tear instability, reduced tear production, and epithelial disruption, that are driven by different pathophysiological contributors. Those affected often report a spectrum of pain and visual symptoms that can impact physical and mental aspects of health, placing an overall burden on an individual's well-being. This cumulative impact of DED on an individual's activities and on society underscores the importance of finding diverse and effective management strategies. Such management strategies necessitate an understanding of the underlying pathophysiological mechanisms that contribute to DED in the individual patient. Presently, the majority of approved therapies for DED address T cell-mediated inflammation, with their tolerability and effectiveness varying across different studies. However, there is an emergence of treatments that target additional aspects of the disease, including novel inflammatory pathways, abnormalities of the eyelid margin, and neuronal function. These developments may allow for a more nuanced and precise management strategy for DED. This review highlights the recent pharmacological advancements in DED therapy in the United States. It discusses the mechanisms of action of these new treatments, presents key findings from clinical trials, discusses their current stage of development, and explores their potential applicability to different sub-types of DED. By providing a comprehensive overview of products in development, this review aims to contribute valuable insights to the ongoing efforts in enhancing the therapeutic options available to individuals suffering from DED
Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case-Control Study
The purpose of this study was to evaluate the risk of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after corneal transplantation surgery, with cataract surgeries as controls, and the impact of the novel coronavirus disease pandemic in the clinical and surgical complications of corneal transplantation and cataract surgeries.
A retrospective matched case-control study of 480 consecutive individuals who underwent surgery at the Bascom Palmer Eye Institute between May 2020 and November 2020. A total of 240 patients who underwent corneal transplantation with tissue obtained from the Florida Lions Eye Bank were age, race, ethnicity, and sex matched with 240 patients who underwent cataract surgery during the same day and by the same surgical team. Only the first corneal transplant or cataract surgery during this period was considered for each individual. All donors and recipients were deemed SARS-CoV-2 negative by a nasopharyngeal polymerase chain reaction test before surgery. Postoperative SARS-CoV-2 infections were defined as previously SARS-CoV-2(-) individuals who developed symptoms or had a positive SARS-CoV-2 polymerase chain reaction test during the first postoperative month.
Mean age, sex, race, and ethnicity were similar between groups. There were no differences between the corneal transplant and cataract groups in the rates of SARS-CoV-2 infection before (5.8% vs. 7.5%, P= 0.6) or after surgery (2.9% vs. 2.9%, P = 1). The rates of postoperative complications did not increase during the pandemic, compared with previously reported ranges.
In this study, postoperative SARS-CoV-2 infection was similar for individuals undergoing corneal transplantation or cataract surgery. Further research is required to evaluate the transmission of SARS-CoV-2 through corneal tissue
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Infectious and Non-infectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics and Outcomes
To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD).
Retrospective clinical cohort study
Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be non-infectious. Treatment success was defined as re-epithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and non-infectious ulcer groups were compared using two-way independent t-tests, one-way analysis of variances (ANOVAs), and Chi-squared tests, as appropriate.
173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed non-infectious. Risk factors for corneal ulceration included black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, p<0.01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, p<0.01), lid margin abnormalities (HR 3.44, 95% CI 1.69–6.99, p<0.01), and topical steroid use (HR 2.74, 95% CI 1.33–5.62, p<0.01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13–0.66, p<0.01). Infectious ulcers had a significantly higher frequency of treatment failure than non-infectious ulcers (57.1% vs 20.0%, p=0.04).
Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than non-infectious ulcers
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Post-Radiation Cataract Management: Outcomes in Individuals with Uveal Melanoma
Purpose of review To report the visual, clinical, and surgical outcomes of cataractsurgery following radiation therapy for uveal melanoma (UM) while reviewing theavailable literature discussing these outcomes.
Recent Findings Patients were managed with cataractsurgery after radiation for UM at the Bascom Palmer Eye Institute, betweenJanuary 2014 and February 2021, with a minimum follow-up of 6 months. Only theradiated eye was included. Measured outcomes included BCVA (1ogMAR), and OCTmeasurement of macular thickness at 1, 3, 6, and 12 months postoperatively.Paired t-tests were used to compare pre- and postoperative variables.Forty-seven eyes from 47 patients were included. Their mean age was 67.0 +/- 11.0years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiationinducedmaculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae.Cataract types included nuclear sclerosis (80.8%), posterior subcapsular(55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperativeevents reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%),sub-tenon's corticosteroid injections (31.9%), and bevacizumab (21.2%). Therewere no complications. There was a significant improvement in best correctedvisual acuity (BCVA) at the 1st month postoperatively (0.68), and up until thel2th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCTmeasurements of the macular thickness showed a significant increase (363 um)during the 6th postoperative month compared to baseline (327 um; p < 0.01).
Summary Cataract surgery is safe and effectivein improving visual acuity in individuals with post-radiation cataracts. Routine macular thickness monitoring should be considered in order to optimizetheir visual outcome. In the treatment of these patients, a multidisciplinaryapproach and proper surgical planning are essential, with a focus on early,aggressive antiinflammatory and anti-VEGF therapy.
Setting Bascom Palmer Eye Institute, USA.
Design Retrospective chart review.
Methods Patients were managed with cataract surgery after radiation for UM at the Bascom Palmer Eye Institute, between January 2014 and February 2021, with a minimum follow-up of 6 months. Only the radiated eye was included. Measured outcomes included BCVA (logMAR) and OCT measurement of macular thickness at 1, 3, 6, and 12 months postoperatively. Paired t-tests were used to compare pre and postoperative variables.
Results Forty-seven eyes from 47 patients were included. Their mean age was 67.0 +/- 11.0 years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiation-induced maculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae. Cataract types included nuclear sclerosis (80.8%), posterior subcapsular (55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperative events reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%), subtenon's corticosteroid injections (31.9%), and bevacizumab (21.2%). There were no complications. There was a significant improvement in best corrected visual acuity (BCVA) at the 1st month postoperatively (0.68) and up until the 12th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCT measurements of the macular thickness showed a significant increase (363 mu m) during the 6th postoperative month compared to baseline (327 mu m; p < 0.01).
Conclusion Cataract surgery is safe and effective in improving visual acuity in individuals with post-radiation cataracts. A multi-disciplinary approach, proper surgical planning, and postoperative anti-inflammatory care are paramount in the management of these individuals
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Rose Bengal Photodynamic Antimicrobial Therapy: A review of the intermediate term clinical and surgical outcomes
To evaluate the intermediate term clinical outcomes of Rose Bengal Photodynamic Antimicrobial Therapy (RB-PDAT) for infectious keratitis. Secondarily, to evaluate the surgical outcomes of individuals that underwent optical keratoplasty after RB-PDAT.
Retrospective cohort study.
Retrospective chart review of 31 eyes from 30 consecutive individuals with infectious keratitis refractory to standard medical therapy who underwent RB-PDAT at the Bascom Palmer Eye Institute between January 2016 and July 2020. Data collected included demographics, risk factors for infectious keratitis, microbiological diagnosis, Best Spectacle-Corrected Visual Acuity (BCVA), clinical outcomes after RB-PDAT and complication rates post-keratoplasty. RB-PDAT was performed as described in previous studies. Graft survival was evaluated using Kaplan Meier curves with log-ranks in individuals that underwent keratoplasty after RB-PDAT.
Mean age of the study population was 53±18.0 years. 70% were female; 53.3% self-identified as non-Hispanic White; 43.3% as Hispanic. Mean follow-up time was 28.0±14.4 months. Risk factors included contact lens use (80.6%), history of infectious keratitis (19.3%), and ocular surface disease (16.1%). Cultures were positive for Acanthamoeba (51.6%), Fusarium (12.9%), and Pseudomonas (6.5%). 22.5% of individuals with Acanthamoeba infection were treated with concomitant Miltefosine. Clinical resolution was achieved in 77.4% of individuals on average 2.72±1.85 months after RB-PDAT with 22.5% requiring therapeutic penetrating keratoplasties and 54.8% subsequently requiring optical penetrating keratoplasties. At 2 years, the overall probability of graft survival was 78.7% and the graft failure rate was 21.3%.
RB-PDAT is a potential adjunct therapy for infectious keratitis that may reduce the need for a therapeutic penetrating keratoplasty. Cases that undergo keratoplasty after RB-PDAT may have a higher probability of graft survival at one year postoperatively
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Automatic Classification of Slit-Lamp Photographs by Imaging Illumination
PURPOSEThe aim of this study was to facilitate deep learning systems in image annotations for diagnosing keratitis type by developing an automated algorithm to classify slit-lamp photographs (SLPs) based on illumination technique. METHODSSLPs were collected from patients with corneal ulcer at Kellogg Eye Center, Bascom Palmer Eye Institute, and Aravind Eye Care Systems. Illumination techniques were slit beam, diffuse white light, diffuse blue light with fluorescein, and sclerotic scatter (ScS). Images were manually labeled for illumination and randomly split into training, validation, and testing data sets (70%:15%:15%). Classification algorithms including MobileNetV2, ResNet50, LeNet, AlexNet, multilayer perceptron, and k-nearest neighborhood were trained to distinguish 4 type of illumination techniques. The algorithm performances on the test data set were evaluated with 95% confidence intervals (CIs) for accuracy, F1 score, and area under the receiver operator characteristics curve (AUC-ROC), overall and by class (one-vs-rest). RESULTSA total of 12,132 images from 409 patients were analyzed, including 41.8% (n = 5069) slit-beam photographs, 21.2% (2571) diffuse white light, 19.5% (2364) diffuse blue light, and 17.5% (2128) ScS. MobileNetV2 achieved the highest overall F1 score of 97.95% (CI, 97.94%-97.97%), AUC-ROC of 99.83% (99.72%-99.9%), and accuracy of 98.98% (98.97%-98.98%). The F1 scores for slit beam, diffuse white light, diffuse blue light, and ScS were 97.82% (97.80%-97.84%), 96.62% (96.58%-96.66%), 99.88% (99.87%-99.89%), and 97.59% (97.55%-97.62%), respectively. Slit beam and ScS were the 2 most frequently misclassified illumination. CONCLUSIONSMobileNetV2 accurately labeled illumination of SLPs using a large data set of corneal images. Effective, automatic classification of SLPs is key to integrating deep learning systems for clinical decision support into practice workflows