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Zaki AM, Pasadhika S, Huang JC, Thomas AS, Burkholder BM, Lim LL, Llop SM, Suhler EB, Adamus G, Rosenbaum JT. Characterization of autoimmune eye disease in association with Down's syndrome. Eye (Lond) 2024; 38:386-392. [PMID: 37598261 PMCID: PMC10810817 DOI: 10.1038/s41433-023-02706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Autoimmunity and deficiency of the transcription factor autoimmune regulator protein (AIRE) are known associations with Down syndrome (DS). Lack of AIRE abrogates thymic tolerance. The autoimmune eye disease associated with DS has not been characterized. We identified a series of subjects with DS (n = 8) and uveitis. In three consecutive subjects, we tested the hypothesis that autoimmunity to retinal antigens might be a contributing factor. SUBJECTS/METHODS This was a multicentred, retrospective case series. Deidentified clinical data of subjects with both DS and uveitis were collected via questionnaire by uveitis-trained ophthalmologists. Anti-retinal autoantibodies (AAbs) were detected using an Autoimmune Retinopathy Panel tested in the OHSU Ocular Immunology Laboratory. RESULTS We characterized eight subjects (mean age 29 [range, 19-37] years). The mean age of detected uveitis onset was 23.5 [range, 11-33] years. All eight subjects had bilateral uveitis (p < 0.001 based on comparison to published university referral patterns), with anterior and intermediate uveitis found in six and five subjects respectively. Each of three subjects tested for anti-retinal AAbs was positive. Detected AAbs included anti-carbonic anhydrase II, anti-enolase, anti-arrestin, and anti-aldolase. DISCUSSION A partial deficiency in the AIRE on chromosome 21 has been described in DS. The similarities in the uveitis presentations within this patient group, the known autoimmune disease predisposition in DS, the recognized association of DS and AIRE deficiency, the reported detection of anti-retinal antibodies in patients with DS in general, and the presence of anti-retinal AAbs in three subjects in our series supports a causal association between DS and autoimmune eye disease.
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Affiliation(s)
- Amr M Zaki
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Jerry C Huang
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Bryn M Burkholder
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Parkville, VIC, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Stephanie M Llop
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Portland Veterans Administration Health Care System, Portland, OR, USA
| | - Grazyna Adamus
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
- Legacy Devers Eye Institute, Portland, OR, USA.
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Corvus Pharmaceuticals, Burlingame, CA, USA.
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Zheng Y, Woodward R, Feng HL, Lee T, Zhang X, Pant P, Thomas AS, Fekrat S. IMPLICATIONS OF COMPLETE POSTERIOR VITREOUS DETACHMENT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION. Retina 2024; 44:159-165. [PMID: 37683266 DOI: 10.1097/iae.0000000000003932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND/PURPOSE To evaluate the status of the posterior vitreous hyaloid on presenting optical coherence tomography images of the macula and its relationship to clinical characteristics, treatment patterns, and outcomes in eyes with central retinal vein occlusion. METHODS This is a retrospective longitudinal cohort study of consecutive patients with acute, treatment-naive central retinal vein occlusion diagnosed between 2009 and 2021 who had at least 12 months of follow-up. Clinical characteristics, treatment patterns, and outcomes were analyzed between eyes stratified based on the presence or absence of a complete posterior vitreous detachment (PVD) on optical coherence tomography at presentation. RESULTS Of 102 acute, treatment-naive central retinal vein occlusions identified, 52 (51%) had complete PVD at presentation and 50 (49%) did not. Central subfield thickness was significantly lower in those with complete PVD (12 months: 284.9 ± 122.9 µ m vs. 426.8 ± 286.4 µ m, P < 0.001; last follow-up: 278 ± 127.9 vs. 372.8 ± 191.0 µ m, P = 0.022). One-year intravitreal injection burden was significantly less for those with a complete PVD than those without (5.1 ± 3.6 injections vs. 6.7 ± 3.3 injections, P = 0.013). CONCLUSION Central retinal vein occlusion with complete PVD on presentation had significantly lower central subfield thickness and 1-year injection burden. Assessment of the vitreomacular interface in central retinal vein occlusion may serve as a prognostic imaging biomarker.
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Affiliation(s)
- Yuxi Zheng
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Richmond Woodward
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Henry L Feng
- Illinois Retina Associates, Rush University Medical Center, Chicago, Illinois ; and
| | - Terry Lee
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Xinxin Zhang
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Praruj Pant
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
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Kundu A, Thomas AS, Mirzania D, Kim JS, Stinnett SS, Fekrat S. Acute, Treatment-Naïve Branch Retinal Vein Occlusion in Younger Individuals: Risk Factors and Clinical Outcomes. J Vitreoretin Dis 2024; 8:51-57. [PMID: 38223779 PMCID: PMC10786076 DOI: 10.1177/24741264231205378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To compare the risk factors and clinical outcomes in patients younger than 50 years with acute, treatment-naïve branch retinal vein occlusion (BRVO) with outcomes in patients 50 years or older. Methods: Patients diagnosed with acute, treatment-naïve BRVO at Duke Eye Center over a 9.5-year period who had BRVO with onset 3 months or less before presentation, BRVO with macular involvement, and 12 months or more of follow-up were included. Demographic data, presenting clinical features, risk factors, treatment patterns, and clinical outcomes were extracted during a retrospective review of medical records. Results: Of 302 patients identified, 23 were younger than 50 years (younger group) and 279 were 50 years or older (older group). Compared with older patients, younger patients had similar rates of hypertension (P = .275), diabetes mellitus (P = 1.000), smokers (P = .787), and open-angle glaucoma (P = .628). The younger group had a lower rate of hyperlipidemia than the older group (35% vs 59%) (P = .028). The 2 groups had similar presenting logMAR visual acuities (VAs) in the BRVO eye (P = .131). At the final follow-up, younger patients had significantly better logMAR VA in the BRVO-affected eye than older patients (mean 0.51 ± 0.65 vs 1.01 ± 1.20) (P = .016). The 2 groups had similar treatment burdens at 1 year (P = .516) and at the final follow-up (P = .782). Conclusions: Younger patients with acute, treatment-naïve BRVO have similar risk factors and treatment patterns as older patients, except for a lower rate of hyperlipidemia. Younger patients with BRVO may have similar presenting VA as older BRVO patients but better final VA, suggesting that age may be a potential prognostic factor.
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Affiliation(s)
- Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | | | - Delaram Mirzania
- Kellogg Eye Center, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jane S. Kim
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sandra S. Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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Pant P, Kundu A, Rathinavelu JK, Wei X, Agrawal R, Stinnett SS, Kim JS, Thomas AS, Fekrat S. Longitudinal Assessment of the Choroidal Vascularity Index in Eyes with Branch Retinal Vein Occlusion-Associated Cystoid Macular Edema. Ophthalmol Ther 2023; 12:2103-2115. [PMID: 37221425 PMCID: PMC10287880 DOI: 10.1007/s40123-023-00731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Cystoid macular edema (CME) is the most common cause of central vision loss in eyes with branch retinal vein occlusion (BRVO eyes). In recent literature, choroidal vascularity index (CVI) has been proposed to be an enhanced depth imaging optical coherence tomography (EDI-OCT) metric that may help characterize choroidal vascular changes in the setting of retinal ischemia, and potentially prognose visual outcomes and treatment patterns for patients with BRVO-related CME. This study sought to further characterize choroidal vascular changes in BRVO by comparing the CVI, subfoveal choroidal thickness (SFCT), and central subfield thickness (CST) in BRVO eyes with CME compared to unaffected fellow eyes. METHODS This was a retrospective cohort study. Subjects included treatment-naïve BRVO eyes with CME diagnosed within 3 months of onset of symptoms and unaffected fellow eyes. EDI-OCT images were collected at baseline and at the 12-month follow-up visit. CVI, SFCT, and CST were measured. Demographics, treatment patterns, and best-corrected visual acuity (VA) were abstracted. Median CVI, SFCT, CST, and VA were compared between the two cohorts. Longitudinal relationships between these variables were analyzed. RESULTS A total of 52 treatment-naïve eyes with BRVO and CME and 48 unaffected fellow eyes were identified. Baseline CVI was lower in eyes with BRVO than in fellow eyes (64.7% vs. 66.4%, P = 0.003). At 12 months, there was no difference in CVI between BRVO eyes and fellow eyes (65.7% vs 65.8%, P = 0.536). In BRVO eyes, there was a strong correlation between reduced CST and improved VA over the 12-month study period (r = 0.671, P < 0.001). CONCLUSION There are differences in CVI in treatment-naïve BRVO eyes with CME at presentation compared to fellow eyes, but these differences resolve over time. Anatomic changes in macular thickness in BRVO eyes with CME may be correlated with VA outcomes.
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Affiliation(s)
- Praruj Pant
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jay K Rathinavelu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Xin Wei
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jane S Kim
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Tennessee Retina, Nashville, TN, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA.
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Brown JE, Thomas AS, Armbrust KR, Boyd K, Berkenstock M, Kopplin LJ. Therapeutic Outcomes of Non-Infectious Scleritis Treated with Tumor Necrosis Factor-Alpha Inhibitors. Ocul Immunol Inflamm 2023:1-7. [PMID: 37043601 DOI: 10.1080/09273948.2023.2191712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE We determine the efficacy of tumor necrosis factor-α (TNF) inhibitors in establishing scleritis quiescence. METHODS We conducted a multicenter retrospective chart review of patients with non-infectious scleritis treated with a TNF inhibitor for at least 6 months. The primary endpoint was scleritis quiescence at 6 months. Secondary endpoints included scleritis quiescence at 12 months, TNF inhibitor effects on concurrent doses of systemic corticosteroids and visual acuity outcomes at 6 and 12 months. RESULTS At 6 months, 82.2% (37/45) of subjects obtained scleritis quiescence with TNF inhibition. At 12 months, 76.2% (32/42) of subjects remained quiescent. Baseline daily corticosteroid use (21.5 ± 21.6 mg) decreased to 5.4 ± 8.3 mg by 6 months (p < 0.0001) and 2.8 ± 6.1 mg by 12 months (p < 0.001). There was no significant difference between the baseline and 6-month BCVA (p = 0.52). CONCLUSIONS TNF inhibitors are an effective scleritis therapy with significant systemic corticosteroid sparing effect.
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Affiliation(s)
- Jaime E Brown
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Karen R Armbrust
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kelly Boyd
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Meghan Berkenstock
- Ocular Immunology Division, Johns Hopkins School of Medicine, Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Laura J Kopplin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
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Thomas AS, Thomas MK, Davis EC, Fowler S, Schneider EW, Recchia FM, Awh CC. A Comparison of Peel-Induced Maculopathy Following ILM Peeling Using a Microvacuum Pick Versus Forceps. Ophthalmic Surg Lasers Imaging Retina 2023; 54:37-42. [PMID: 36626207 DOI: 10.3928/23258160-20221216-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare peel-induced maculopathy (PIM) using surgical forceps versus the microvacuum pick (MVP). METHODS Consecutive eyes undergoing internal limiting membrane (ILM) peeling using either the MVP or forceps were assessed. En face optical coherence tomography (OCT) images at the level of the nerve fiber layer were generated for 6-month postoperative visit. The percentage of the imaged area showing PIM was termed the PIM index. PIM severity was additionally measured using a qualitative PIM severity scale. RESULTS Seventy-four consecutive eyes underwent ILM peeling with either the MVP (36/74; 49%) or forceps (38/74; 51%). At month-6 postoperatively, the mean PIM index for forceps was 7.7% vs 4.7% for the MVP (P < 0.001, R2 = 0.15). At 6 months, 26/38 eyes (68.5%) in the forceps group had either moderate or severe PIM compared to 12/36 eyes (33.3%) in the MVP group (P = 0.001). CONCLUSIONS ILM peeling with the MVP resulted in lower PIM severity compared to forceps. [Ophthalmic Surg Lasers Imaging Retina 2023;54:37-42.].
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Abstract
PURPOSE To describe the ocular findings in a patient with glycogen storage disease II (Pompe disease). METHODS Case report. RESULTS A 14-year-old boy with Pompe disease was referred for evaluation of a retinal detachment in the left eye. Indirect ophthalmoscopy revealed bilateral fibrotic snowbanks and an inferior rhegmatogenous retinal detachment extending into the macula. Fluorescein angiography revealed mild diffuse perivascular leakage in both eyes. The retinal detachment was repaired with scleral buckling and cryotherapy. Workup for the etiology of the intermediate uveitis was unrevealing. CONCLUSION Enzyme replacement therapy has improved the survival of individuals with Pompe disease. With greater patient longevity, new ocular associations may continue to emerge. Whether intermediate uveitis is an ocular association of Pompe disease remains to be determined.
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Affiliation(s)
- Akshay S Thomas
- Duke University Eye Center, Durham, North Carolina; and
- Tennessee Retina, Nashville, Tennessee
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Abstract
PURPOSE OF REVIEW Occlusive retinal vasculitis (ORV) has a large differential diagnosis and varied therapeutic approaches. This review highlights existing and novel causes and treatment options for ORV. RECENT FINDINGS Mutations in CAPN5, TREX1, and TNFAIP3 have been associated with dominantly inherited forms of ORV. Various intraocular therapeutics have been shown to occasionally cause ORV; the most recent medications associated with ORV are vancomycin and brolucizumab. In cases of ORV linked to Behçet's disease, clinical trials support the use of tumor necrosis factor alpha inhibitors. SUMMARY Identification of the underlying etiology of ORV is critical to help guide treatment. Treatment in ORV involves both treatment any underlying infection or autoimmune condition, cessation of the any offending causative agent and local treatment of neovascular complications.
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Thomas AS, Duchateau L, Kozma-Wiebe P, Jaffe G. Resolution of outer retinal abnormalities in eyes with vitreomacular traction without macular hole in the OASIS trial. Br J Ophthalmol 2022:bjophthalmol-2021-319500. [PMID: 35288439 DOI: 10.1136/bjophthalmol-2021-319500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To describe the clinical impact of external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption and subretinal fluid (SRF) seen on optical coherence tomography (OCT) in eyes with vitreomacular traction (VMT) without macular hole (MH) in the Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole study. METHODS Phase 3b randomised double-blind sham-controlled multicentre study including 144 eyes with VMT without MH. Eyes were randomised to receive a single intravitreal injection of ocriplasmin or sham injection and were followed for 24 months. Eyes were analysed for presence, course and clinical impact of ELM disruption, EZ disruption and SRF on OCT. RESULTS ELM disruption, EZ disruption and SRF were present in 32.6%, 52.2% and 45.8% of ocriplasmin-treated eyes and 39.6%, 42.6% and 37.5% of sham-treated eyes at baseline. VMT resolution was associated with resolution of ELM and EZ disruption and SRF. A small number of eyes had persistent ELM disruption, EZ disruption and/or SRF at the seventh visit or later (17 months or later) following medical or surgical VMT resolution. Resolution of ELM disruption, EZ disruption and/or SRF was associated with an improvement of visual acuity from baseline. Following VMT resolution, ELM recovery usually preceded EZ recovery and SRF resolution. CONCLUSIONS ELM disruption, EZ disruption and/or SRF are present in a significant percentage of eyes with VMT without MH. Release of VMT is usually associated with outer retinal recovery and an associated improvement in visual acuity. ELM recovery typically precedes EZ recovery and SRF resolution following VMT release.
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Affiliation(s)
| | - Luc Duchateau
- Biometrics Research Centre, Ghent University, Gent, Belgium
| | | | - Glenn Jaffe
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
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Thomas GN, Kiew SY, Singh P, Dmitriev P, Thomas AS, Fekrat S. Central Retinal Vein Occlusion: The Effect of Antiplatelet and Anticoagulant Agents. Journal of VitreoRetinal Diseases 2022; 6:97-103. [PMID: 37008668 PMCID: PMC9976011 DOI: 10.1177/24741264211028508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work evaluates the effect of antiplatelet and anticoagulant agents on clinical outcomes, optical coherence tomography (OCT) parameters, and macular ischemia in eyes with central retinal vein occlusion (CRVO). Methods: A retrospective longitudinal cohort study was performed to evaluate patients with CRVO. Demographics, OCT parameters before and after treatment, macular ischemia on fluorescein angiography, and clinical outcomes including the number of injections received were analyzed. Results: A total of 365 patients with CRVO were identified. The average follow-up was 36 months. Antiplatelet or anticoagulant agent use was not associated with a significant difference in visual acuity (VA), prevalence of macular edema, or central subfield thickness on OCT at presentation or final visit. The use of 81-mg aspirin alone was associated with an increased prevalence of foveal hemorrhage at presentation. Patients who were taking an antiplatelet agent, an anticoagulation agent, or both and had an ischemic CRVO with logMAR VA of less than 1.0 experienced improved VA at the final study visit. Patients given antiplatelet or anticoagulant agents had a similar incidence of neovascular sequelae compared with patients not administered these agents. Conclusions: In eyes with CRVO, the use of antiplatelet or anticoagulant agents at CRVO onset was not associated with significantly different functional outcomes, except in ischemic CRVO eyes with VA of less than 20/200. The use of 81-mg aspirin was associated with foveal hemorrhage at CRVO presentation. Otherwise, the use of any antiplatelet agent or anticoagulation was not associated with any CRVO structural outcomes.
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Affiliation(s)
- George N. Thomas
- Department of Ophthalmology, National University Health System, Singapore
| | | | - Pali Singh
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Pauline Dmitriev
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Akshay S. Thomas
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
- Tennessee Retina, Nashville, Tennessee, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
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Simmons K, Singh P, Borkar DS, Birnbaum F, Thomas AS, Fekrat S. The effect of select systemic medications on outcomes in diabetics with central retinal vein occlusion. Ther Adv Ophthalmol 2022; 14:25158414211063076. [PMID: 35083418 PMCID: PMC8785328 DOI: 10.1177/25158414211063076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a risk factor for central retinal vein occlusion (CRVO); however, it is unclear whether certain commonly used medications among diabetics or glycemic control impact visual outcomes in diabetic eyes with CRVO. PURPOSE To evaluate the effect of select systemic medications and glycemic control on presenting features, treatment burden, and outcomes in patients with diabetes who develop a central retinal vein occlusion (CRVO). METHODS Retrospective longitudinal cohort study at a single tertiary academic referral center from 2009-2017 investigating eyes of patients being treated for diabetes mellitus at CRVO onset. Eyes with a prior history of anti-vascular endothelial growth factor (anti-VEGF) therapy or laser treatment within the year prior to CRVO onset were excluded. Main outcomes and measures were visual acuity (VA), central subfield thickness (CST), cystoid macular edema (CME), and number of intravitreal injections and laser treatment throughout follow-up. RESULTS We identified 138 eyes of 138 participants who were diabetic at CRVO onset. Of these, 49% had an ischemic CRVO. Median follow-up time was 25.5 months. Fifty-five eyes (40%) had a HbA1c within 6 months of CRVO presentation. HbA1c was positively correlated with both presenting CST (p = 0.04) and presence of CME (p < 0.01). In all 138 eyes, mean presenting VA was 20/246, and mean final VA was 20/364. Better-presenting VA was significantly associated with aspirin 325 mg use (p = 0.04). Lower CST at presentation was significantly associated with metformin use (p = 0.02). Sitagliptin use at CRVO onset was associated with a lower prevalence of CME at final follow-up (p < 0.01). Lower final CST was significantly associated with glipizide use at CRVO onset (p = 0.01). There were no significant associations between systemic medications or HbA1c and treatment burden or final VA (p > 0.05). CONCLUSION Although aspirin 325 mg, metformin, sitagliptin, and glipizide were associated with better-presenting VA, lower-presenting CST, lower prevalence of macular edema at final visit, and lower final CST, respectively, none of these systemic agents or glycemic control were associated with decreased treatment burden or improved visual outcomes in diabetics with CRVO.
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Affiliation(s)
| | - Pali Singh
- Duke University School of Medicine, Durham, NC, USA
| | | | | | - Akshay S. Thomas
- Vitreoretinal Surgery and Uveitis, Tennessee Retina, 345 23rd Ave. N, Suite 350, Nashville, TN 37203, USA
| | - Sharon Fekrat
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
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Ma JP, Robbins CB, Thomas GN, Kiew SY, Yoon SP, Thomas AS, Fekrat S. Characteristics of Branch Retinal Vein Occlusion in African American Patients. Ophthalmic Surg Lasers Imaging Retina 2021; 52:492-497. [PMID: 34505806 DOI: 10.3928/23258160-20210821-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To describe the presentation, management, and clinical outcomes of branch retinal vein occlusion (BRVO) in African American patients compared to patients of other racial or ethnic backgrounds. PATIENTS AND METHODS This retrospective cohort study included eyes diagnosed with BRVO and macular edema at a tertiary referral center. Presenting features, treatment, and outcomes were compared based on racial or ethnic backgrounds. RESULTS The study included 285 eyes: 21.8% African American, 78.2% other. African American patients were more likely to have comorbid diabetes (P = .012), open-angle glaucoma (P < .001), and to present with subretinal fluid (P = .049); multivariate analysis showed race and ethnicity alone may not fully explain presenting subretinal fluid (odds ratio = 2.807; 95% CI, 0.997 to 7.903; P = .051). There was no difference in other comparisons of clinical outcomes or treatment burden, including visual acuity, duration, or treatment method. CONCLUSIONS Despite significant differences at presentation, the management and outcomes of BRVO did not differ significantly between African American patients and patients of other racial and ethnic backgrounds. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:492-497.].
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Singh PP, Borkar DS, Robbins CB, Kim JS, Birnbaum F, Gomez-Caraballo M, Thomas AS, Fekrat S. Systemic antiplatelet agents and anticoagulants in eyes with branch retinal vein occlusion. Ther Adv Ophthalmol 2021; 13:25158414211040894. [PMID: 34497976 PMCID: PMC8419548 DOI: 10.1177/25158414211040894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effect of systemic antiplatelet agents and anticoagulants on the structural and functional outcomes of eyes with branch retinal vein occlusion (BRVO). Methods A retrospective longitudinal cohort study was performed on BRVO patients evaluated at a single tertiary care referral center between 2009 and 2017. Medical records were reviewed for antiplatelet agent and anticoagulant use including aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, or dabigatran prior to BRVO onset. In addition, optical coherence tomography (OCT) parameters, clinical outcomes, and treatment patterns were also recorded. Results A total of 354 BRVO eyes were identified with a mean follow-up time of 36 months. Antiplatelet or anticoagulant use was associated with presence of cystoid macular edema (CME) at presentation after controlling for potential confounding variables in a multivariate logistic regression. Multivariate regression also revealed an association between foveal hemorrhage at presentation and use of antiplatelet or anticoagulant medications. There were no significant differences in visual acuity or prevalence of CME at the final visit in those with antiplatelet/anticoagulant use compared to those not on these agents. Conclusion Although the use of systemic antiplatelet or anticoagulant agents was associated with increased prevalence of CME and foveal hemorrhage at presentation of BRVO, the use of these medications was not associated with different visual or structural outcomes at the final visit.
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Affiliation(s)
- Pali P Singh
- Duke University School of Medicine, Durham, NC, USA
| | | | | | - Jane S Kim
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Akshay S Thomas
- Vitreoretinal Surgery and Uveitis, Tennessee Retina, 345 23rd Ave. N, Suite 350, Nashville, TN 37203, USA
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Lee T, Robbins CB, Thomas AS, Fekrat S. Treatment Patterns and Clinical Outcomes for Branch Retinal Vein Occlusion: An 8-Year Experience at a Tertiary Eye Center. Journal of VitreoRetinal Diseases 2021; 5:412-419. [PMID: 37008715 PMCID: PMC9976115 DOI: 10.1177/2474126420978874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work aims to investigate real-world treatment patterns and outcomes in eyes with branch retinal vein occlusion in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective, nonrandomized, comparative study was conducted on eyes diagnosed with branch retinal vein occlusion at a single tertiary center between 2009 and 2017. Medical history, treatment patterns, and visual acuity outcomes were examined. Subanalysis was performed for eyes that met the eligibility criteria for the BRAVO (Ranibizumab for the Treatment of Macular Edema Following Branch Retinal Vein Occlusion) trial. Results: A total of 315 eyes were included, of which 244 were treatment naive. In all eyes, the most common first treatment was the following: intravitreal bevacizumab (38.4%), aflibercept (15.1%), ranibizumab (8.1%), sectoral scatter laser (6.2%), and triamcinolone (3.1%). At 1 year, treatment-naive eyes had received an average of 2.43 anti-VEGF injections. During follow-up, treatment-naive eyes gained an average of 0.21 Early Treatment Diabetic Retinopathy Study lines. Forty eyes that met BRAVO trial criteria received an average of 5.05 anti-VEGF injections in the first year and gained an average of 1.83 Early Treatment Diabetic Retinopathy Study lines. Conclusions: This real-world cohort received fewer anti-VEGF injections at year 1 and experienced less improvement in visual acuity during the course of treatment than clinical trial participants. Trial-eligible patients received more injections and had greater visual gains than those who would not have been eligible for the trial.
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Affiliation(s)
- Terry Lee
- Duke University School of Medicine, Durham, NC, USA
| | | | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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Awh CC, Thomas AS. Rickettsial neuroretinitis: A report of 2 cases. Am J Ophthalmol Case Rep 2021; 22:101065. [PMID: 33732952 PMCID: PMC7937658 DOI: 10.1016/j.ajoc.2021.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The authors present two cases of neuroretinitis caused by Rickettsia rickettsii infection. Observations Case 1 is a 24-year-old male who presented with 2 months of vision loss. Case 2 is a 38-year-old female who presented with 4 weeks of eye pain and vision loss. Examination of both patients revealed neuroretinitis characterized by optic disc swelling with macular exudates, and subsequent serological analysis was positive for Rickettsia rickettsii. Both patients responded favorably to treatment with oral doxycycline and prednisone. Conclusions and importance Given the potential for neuroretinitis to cause permanent vision loss, the presence of acute vision loss, optic disc edema, and macular exudates should prompt an evaluation for Rickettsial disease in endemic areas, even in the absence of systemic symptoms or known history of a tick bite.
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Affiliation(s)
- Caroline C Awh
- UH Regional Hospitals, 27100 Chardon R, Richmond Heights, OH, 44143, USA
| | - Akshay S Thomas
- Tennessee Retina, 345 23rd Ave N, Ste 350, Nashville, TN, USA, 37203
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Mirzania D, Thomas AS, Stinnett S, Fekrat S. Differences in Presentation and Outcomes in Males and Females With Branch Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2020; 51:564-572. [DOI: 10.3928/23258160-20201005-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
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17
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Thomas AS, Hsu ST, House RJ, Finn AP, Kelly MP, Toth CA, Materin MA, Vajzovic L. Microvascular Features of Treated Retinoblastoma Tumors in Children Assessed Using OCTA. Ophthalmic Surg Lasers Imaging Retina 2020; 51:43-49. [PMID: 31935302 DOI: 10.3928/23258160-20191211-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the microvascular features of treated, clinically regressed, or reactivated retinoblastoma lesions using an investigational portable optical coherence tomography angiography (OCTA) system. PATIENTS AND METHODS Single-center, prospective, cross-sectional, consecutive case-series of children with previously treated retinoblastoma who underwent portable OCTA of posterior retinoblastoma lesions. RESULTS Eight tumors from seven eyes of five children with retinoblastoma were included. Tumors with types 1 (calcified remnant, n = 3), 2 (non-calcified remnant, n = 1), and 3 (both calcified and noncalcified remnants, n = 1) regression revealed persistent intrinsic superficial vasculature on OCTA (five of five lesions; 100%). Lesions with type 4 regression (atrophic scar, n = 2) had complete vascular flow voids in the involved retina and underlying choriocapillaris. A reactivated tumor (n = 1) showed a distinct area of vascularity with prominent feeder/draining vessels. CONCLUSIONS OCTA revealed that significant vascularity exists in inactive retinoblastoma lesions. Dilated feeder vessels may suggest continued disease activity. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:43-49.].
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Abstract
PURPOSE To describe the finding of inferior corneal haze secondary to presumed inflammatory endothelio-10 pathy in a series of patients with pars planitis. METHODS Single-center retrospective observational consecutive case-series. RESULTS Seven patients with an established diagnosis of pars planitis are described in this case series including four females and three males. The ages ranged from 5 to 31 years at presentation. Pars planitis was bilateral in six patients and unilateral in one patient. Fundus examinations revealed vitreous opacities and pars plana exudates in all seven patients, cystoid macular edema in four patients, and peripheral retinal vasculitis in two patients. Corneal examination revealed opacification of the posterior cornea in an inferior location in 10 of the 13 eyes with pars planitis. Only one of these eyes had keratic precipitates. For a given patient, corneal involvement was more commonly seen in the more inflamed eye. In one patient with active inflammation, microcystic corneal edema was noted to predate the formation of inferior corneal endothelial opacification, suggesting that physical proximity to the site of inflammation at the inferior pars plana is the cause of this notable physical finding. CONCLUSIONS Inferior posterior corneal haze related to inflammatory endotheliopathy may occur in eyes with pars planitis. As patients with pars planitis may be otherwise asymptomatic, this corneal finding shouldprompt a detailed funduscopic examination to rule out this form of uveitis.
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Affiliation(s)
- Akshay S Thomas
- Department of Ophthalmology, Oregon Health & Science University, Portland, VA, USA.,Tennessee Retina , Nashville, TN, USA
| | - Amro Ali
- Department of Ophthalmology, Oregon Health & Science University, Portland, VA, USA.,New York Medical College , Valhalla, NY, USA
| | - Sruthi Arepalli
- Department of Ophthalmology, Oregon Health & Science University, Portland, VA, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, VA, USA.,Portland Veterans Affairs Medical Center , Portland, OR, USA
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Kiew SY, Thomas GN, Thomas AS, Fekrat S. Characteristics of Central Retinal Vein Occlusion in African Americans. Journal of VitreoRetinal Diseases 2020; 4:186-191. [PMID: 37007449 PMCID: PMC9982256 DOI: 10.1177/2474126419882829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article studies whether the characteristics and clinical course of African American patients with central retinal vein occlusion (CRVO) differ from other racial groups. Methods: This retrospective cohort study included consecutive patients diagnosed with CRVO at Duke Eye Center, Durham, North Carolina. Presenting characteristics, examination findings, treatment course, and functional and structural outcomes were compared based on patient-reported race. Results: A total of 479 patients with CRVO were included (64.7% white, 22.2% African American, 1.7% mixed race, and 11.4% other races). African American patients were older (68.1 vs 64.3 years, P = .049), more likely to be hypertensive ( P = .001) and diabetic ( P = .000), and had higher rates of open-angle glaucoma ( P < .000). Presenting visual acuity (VA) was worse in African Americans (logarithm of the minimum angle of resolution 1.25 vs 0.96, P = .010). There were no significant differences in the proportion of patients requiring panretinal photocoagulation, intravitreal antivascular endothelial growth factor (anti-VEGF), or intravitreal corticosteroid; however, analysis of treatment-naive individuals showed a higher number of anti-VEGF injections in the first year in African Americans. Final VA was not significantly different between groups, but African Americans had higher rates of neovascular sequelae (25.0% vs 11.8%, P = .019; odds ratio, 2.295, P = .088). Conclusions: African Americans with CRVO presented with more severe visual impairment and more systemic and ocular risk factors for CRVO. Treatment-naive African Americans had a greater treatment burden during the first year of follow-up.
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Affiliation(s)
| | - George N. Thomas
- Department of Ophthalmology, National University Hospital, Singapore
| | | | - Sharon Fekrat
- Duke Eye Center, Department of Ophthalmology, Duke University, Durham, NC, USA
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Mirzania D, Thomas AS, Rothman AL, Berry D, Stinnett S, Fekrat S. Sex Differences in Presentation, Treatment Patterns, and Clinical Outcomes in Central Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2020; 51:279-285. [PMID: 32511731 DOI: 10.3928/23258160-20200501-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the impact of sex differences on the presenting features, treatment patterns, and clinical outcomes in patients with central retinal vein occlusions (CRVO). PATIENTS AND METHODS This retrospective, longitudinal cohort study included 476 patients diagnosed with CRVO over a 7-year period. Charts were reviewed and clinical data were abstracted. RESULTS The average age at CRVO onset was lower in males (63.8 years vs. 66.1 years; P = .048). More males (104/224, 54%) had an ischemic CRVO compared to females (113/252, 45%) at 12 months (P = .05). Males with CRVO had a greater central subfield thickness at the baseline (546.7 ± 306.8 μm vs. 438.4 ± 252.9 μm; P = .003) and final visits (343 ± 179.5 μm vs. 304.6 ± 176.2 μm; P = .005). Foveal avascular zone enlargement was more likely in males (39/102, 38% vs. 29/116, 25%; P = .04). CONCLUSIONS Sex differences exist in presenting features of patients with CRVO. Further inquiry may help provide individualized recommendations for management of CRVO. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:279-285.].
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Mir TA, Thomas AS, Yoon SP, Birnbaum F, Goerlitz-Jessen M, Fekrat S. Eyes With Acute, Treatment-Naïve CRVO and Foveal Intraretinal Hemorrhage: Characteristics and Outcomes. Ophthalmic Surg Lasers Imaging Retina 2020; 50:752-759. [PMID: 31877220 DOI: 10.3928/23258160-20191119-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare outcomes in eyes with central retinal vein occlusion (CRVO) presenting with (group 1) or without (group 2) fovea-involving intraretinal hemorrhage (IRH). PATIENTS AND METHODS Retrospective review of patients diagnosed with acute, treatment-naïve CRVO between January 2009 and July 2016. RESULTS One hundred fifteen (39.8%) of 289 CRVO eyes had fovea-involving IRH. At baseline, eyes in group 1 had significantly worse visual acuity (VA) (1.2 ± 0.10 logMAR vs. 0.9 ± 0.06 logMAR; P = .001) and greater central subfield thickness (CST) (610.4 μm ± 35.9 μm vs. 435.0 μm + 21.6 μm; P < .001) than eyes in group 2. Final visual outcomes were comparable between groups (1.24 ± 0.09 logMAR vs. 1.02 ± 0.08 logMAR; P = .08). Group 1 received a significantly greater number of intravitreal anti-vascular endothelial growth factor injections during the first year (7.80 ± 0.40 vs. 5.20 ± 0.40; P = .001). CONCLUSIONS Although treatment-naïve eyes with acute CRVO and fovea-involving IRH had worse VA and greater CST at presentation, the final VA was comparable to eyes without such a hemorrhage. Eyes with foveal IRH had a greater treatment burden in the first 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:752-759.].
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Yu JJ, Thomas AS, Berry D, Yoon S, Fekrat S, Grewal DS. Association of Retinal Inner Layer Disorganization With Ultra-Widefield Fluorescein Angiographic Features and Visual Acuity in Branch Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2020; 50:354-364. [PMID: 31233152 DOI: 10.3928/23258160-20190605-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the impact of the disorganization of retinal inner layers (DRIL) on visual acuity (VA) and its correlation with ischemic index (IsI) on ultra-widefield fluorescein angiography (UWFFA) in eyes with acute, treatment-naïve branch retinal vein occlusion (BRVO). PATIENTS AND METHODS Retrospective, longitudinal study of BRVO eyes with 1 year of follow-up or more. Area of intraretinal cysts, DRIL length, extent of disruption of external limiting membrane (ELM), and ellipsoid zone (EZ) were graded on the central 1,000 μm of foveal optical coherence tomography (OCT) scan. Baseline IsI was calculated on UWFFA. RESULTS Thirty eyes of 30 patients with a mean follow-up of 25.4 months ± 11.0 months were evaluated. At baseline, 50% had DRIL (mean 443.1 μm ± 460.4 μm). DRIL length at baseline was predictive of worse VA at 12 months (P = .029), and DRIL length at 12 months was predictive of worse final VA(P = .011). In multivariate analyses, DRIL length was associated with final VA (P = .008) after controlling for other OCT parameters. There was no association between baseline IsI on UWFFA and DRIL. CONCLUSIONS DRIL served as an independent OCT biomarker predictive of worse VA during a period of 2 years in acute, treatment-naïve BRVO. Development of DRIL was influenced by presence of CME, intraretinal cyst area, and extent of ELM and EZ disruption, but not by severity of baseline IsI. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:354-364.].
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Awh C, Reichstein DA, Thomas AS. A case of giant cell arteritis presenting with nodular posterior scleritis mimicking a choroidal mass. Am J Ophthalmol Case Rep 2020; 17:100583. [PMID: 32095658 PMCID: PMC7033388 DOI: 10.1016/j.ajoc.2019.100583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose Herein we present a case of giant cell arteritis presenting with nodular posterior scleritis and exudative retinal detachment mimicking a choroidal mass. Observations A 67-year-old man presented with sudden onset left-sided periorbital pain, blurry vision, and a choroidal lesion in the posterior pole. Despite treatment with high-dose oral prednisone for suspected nodular posterior scleritis mimicking a choroidal mass, the vision in his left eye did not recover, and he developed optic nerve pallor on exam. Further evaluation revealed an ESR of >140 mm/hr (Upper limit of normal = 20 mm/hr), a CRP of 113 mg/L (Upper limit of normal = 9 mg/L), and a temporal artery biopsy consistent with GCA. The patient was started on methotrexate and the oral steroids were slowly tapered. Conclusions Given the potential for GCA to present with scleritis and the potential for nodular posterior scleritis to mimic a choroidal mass, presence of a painful choroidal lesion with optic nerve swelling should prompt an evaluation for GCA to prevent permanent and bilateral vision loss.
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Affiliation(s)
| | | | - Akshay S. Thomas
- Corresponding author. 345 23rd Ave N, Ste 350, Nashville, TN, 37203, USA.
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Stallworth JY, Thomas AS, Constantine R, Stinnett SS, Fekrat S. Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era. Journal of VitreoRetinal Diseases 2019; 4:13-21. [PMID: 37009559 PMCID: PMC9976087 DOI: 10.1177/2474126419878922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.
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Affiliation(s)
| | | | | | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University, Durham, NC, USA
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Chan MMH, Thomas AS, Yoon SP, Leitner D, Fekrat S. Clinical Characteristics of Patients With CRVO in One Eye With Subsequent RVO in The Fellow Eye: A Retrospective Observational Study. Ophthalmic Surg Lasers Imaging Retina 2019; 50:444-449. [PMID: 31344244 DOI: 10.3928/23258160-20190703-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare risk factors in patients with a central retinal vein occlusion (CRVO) in the first eye and a subsequent retinal vein occlusion (RVO) in the fellow eye versus those with only unilateral CRVO. PATIENTS AND METHODS Records of patients who presented to the Duke Eye Center with unilateral CRVO were evaluated. Logistic regression models were performed to identify potential covariates of subsequent development of RVO in the fellow eye. RESULTS Of the 287 patients with CRVO in one eye, 31 (10.8%) developed an RVO in the fellow eye during a mean ± standard deviation follow-up of 36.7 months ± 38.86 months. The conversion rate of unilateral-to-bilateral RVO was 3.4% per year. Several comorbidities were observed to be unique to 25.8% of patients with bilateral RVO. Patients who used oral pentoxifylline (P = .008) or those who had an ischemic CRVO in the first eye (P = .001) were less likely to develop an RVO in the fellow eye. CONCLUSION This information may be used to develop a predictive model to assess the risk of developing bilateral RVO in patients with unilateral CRVO. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:444-449.].
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Powers JH, Thomas AS, Mir TA, Kim JS, Birnbaum FA, Yoon SP, Khan K, Gomez-Caraballo M, Fekrat S. Impact and Implication of Fovea-Involving Intraretinal Hemorrhage after Acute Branch Retinal Vein Occlusion. Ophthalmol Retina 2019; 3:760-766. [PMID: 31175051 DOI: 10.1016/j.oret.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare clinical outcomes in patients with branch retinal vein occlusion (BRVO) with (group A) or without (group B) fovea-involving intraretinal hemorrhage (IRH). DESIGN Retrospective cohort study. PARTICIPANTS All patients diagnosed with acute, treatment-naive BRVO seen by the Duke Eye Center Retina Service from January 1, 2009, through June 30, 2017 who had treatment-naive BRVO with disease onset <3 months before presentation, macular involvement, spectral-domain OCT and color fundus photographs at presentation, and >12 months offollow-up. METHODS Retrospective study using a database of patients diagnosed with BRVO over an 8-year period. The presence of fovea-involving IRH was determined from baseline fundus photographs by human graders and confirmed with multimodal imaging. Presenting features, treatment patterns, and clinical outcomes were compared. MAIN OUTCOME MEASURES Visual acuity (VA), cystoid macular edema (CME), central subfield thickness (CST), and number of anti-vascular endothelial growth factor (VEGF) injections. RESULTS Of 172 patients with BRVO, 33 (19.2%) presented with fovea-involving IRH. At presentation, group A had worse VA (0.54±0.06 logMAR [Snellen equivalent, 20/69] vs. 0.34±0.03 logMAR [Snellen equivalent, 20/44]; P = 0.001), greater CST (523.8±32 μm vs. 345.9±11.8 μm; P < 0.001), were more likely to have CME (93.9% vs. 48.2%; P < 0.001), and received more anti-VEGF injections in the first year (4.50±3.43 vs. 1.89±3.26; P < 0.001) than group B. Final VA was worse in group A (0.57±0.12 logMAR [Snellen equivalent, 20/74] vs. 0.35±0.05 logMAR [Snellen equivalent, 20/45]; P = 0.05). More patients in group A had loss of >2 lines of VA (36.4% vs. 18.7%; P = 0.04) or >3 lines (27.3% vs. 10.8%; P = 0.05) at final follow-up. Group A was more likely to have CME (63.6% vs. 27.3%; P < 0.001) at final follow-up with greater treatment burden, yet experienced a greater decrease in CST (-197.8±45.3 μm vs. -51.7±14.7 μm; P = 0.005). CONCLUSIONS Acute BRVO presenting with fovea-involving IRH is associated with worse presenting features, greater treatment burden, and worse clinical outcomes despite current therapeutic interventions.
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Affiliation(s)
- James H Powers
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Akshay S Thomas
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Tennessee Retina, Nashville, Tennessee
| | - Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Jane S Kim
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Faith A Birnbaum
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Stephen P Yoon
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Kirin Khan
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Sharon Fekrat
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Thomas AS, Folgar FA, Jaffe GJ, Toth CA, Mahmoud TH. Subfoveal Lucency after Treatment of Vitreomacular Traction without Macular Hole in the Phase 3 Trials of Ocriplasmin Vitreolysis. Ophthalmol Retina 2019; 3:42-52. [PMID: 30929816 DOI: 10.1016/j.oret.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the clinical impact of subfoveal lucency (SFL) seen on OCT before and after treatment of vitreomacular traction (VMT) or symptomatic vitreomacular adhesion (VMA) without macular hole (MH) in the prospective phase 3 trials of ocriplasmin vitreolysis. DESIGN Randomized double-blind placebo-controlled multicenter study. PARTICIPANTS Four hundred ninety-nine eyes with VMT or VMA without MH. METHODS Eyes were randomized to either a single intravitreal injection of ocriplasmin or placebo treatment and were followed up for 6 months. MAIN OUTCOME MEASURES Eyes were analyzed for presence, dimensions, and course of SFL on OCT, release of VMT, and their effect on visual acuity (VA). RESULTS Among eyes without baseline SFL, new SFL was more frequent after ocriplasmin than placebo at week 1 (23.1% vs. 6.54%; P = 0.0002) and week 2 (19.7% vs. 3.85%; P = 0.0001), but was similar in frequency by week 4 (8.37% vs. 7.69%; P = 0.83). Six-month VA for eyes demonstrating SFL after ocriplasmin during the first 2 weeks was comparable with those without SFL at any point in the study (P = 0.12). In placebo-treated eyes but not ocriplasmin-treated eyes, SFL was associated with worse VA at all visits. The increase in SFL width from baseline to week 2 was significantly greater with ocriplasmin than placebo (P = 0.029). Among ocriplasmin-treated eyes at month 6, those with SFL and VMT release had better VA than those with SFL and persistent adhesion (P = 0.037) and similar VA to those with persistent adhesion without SFL (P = 0.17). In the placebo group, those with baseline SFL showed low rates of spontaneous VMT release at month 6 compared with those without baseline SFL (3/21 eyes vs. 33/99 eyes; P = 0.045). CONCLUSIONS Compared with placebo, SFL occurred more frequently only in the initial weeks after treatment with ocriplasmin. When SFL developed after ocriplasmin administration, VA was not impacted at the 6-month visit. Persistent SFL in ocriplasmin-treated eyes at month 6 was associated with poorer vision if VMT had not released. Eyes with SFL at baseline had low rates of spontaneous VMT release and may need treatment.
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Affiliation(s)
- Akshay S Thomas
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Francisco A Folgar
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Carolina Eyecare Physicians, Charleston, South Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Tamer H Mahmoud
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Affiliation(s)
- Akshay S Thomas
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.,Tennessee Retina, Nashville, TN, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.,Legacy Devers Eye Institute, Portland, OR, USA
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Finn AP, House RJ, Hsu ST, Thomas AS, El-Dairi MA, Freedman S, Materin MA, Vajzovic L. Hyperreflective Vitreous Opacities on Optical Coherence Tomography in a Patient With Bilateral Retinoblastoma. Ophthalmic Surg Lasers Imaging Retina 2019; 50:50-52. [DOI: 10.3928/23258160-20181212-08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
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House RJ, Hsu ST, Thomas AS, Finn AP, Toth CA, Materin MA, Vajzovic L. Vascular Findings in a Small Retinoblastoma Tumor Using OCT Angiography. Ophthalmol Retina 2018; 3:194-195. [PMID: 31014771 DOI: 10.1016/j.oret.2018.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Robert J House
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - S Tammy Hsu
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Avni P Finn
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Miguel A Materin
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Lejla Vajzovic
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Finn AP, Thomas AS, Stinnett SS, Keenan RT, Grewal DS, Jaffe GJ. The role of cystoid macular edema as a marker in the progression of non-paraneoplastic autoimmune retinopathy. Graefes Arch Clin Exp Ophthalmol 2018; 256:1867-1873. [PMID: 30128606 DOI: 10.1007/s00417-018-4084-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the relationship between cystoid macular edema (CME) and disease severity and progression in non-paraneoplastic autoimmune retinopathy (npAIR). METHODS A retrospective study was conducted on patients seen between 2008 and 2016 with npAIR as defined by electroretinogram (ERG) dysfunction, visual field changes, presence of antiretinal antibodies, a negative malignancy workup, and no other apparent cause for visual dysfunction. Optical coherence tomography (OCT) scans were reviewed for each patient. A minimum follow-up of 1 year was necessary for study inclusion. The presence or absence of CME and the length of the preserved EZ on the centermost line scan of the SD-OCT images was recorded at each visit. The main outcome measure assessed was the rate of EZ loss (EZ final - EZ initial / days follow-up) over time, a marker for disease progression. RESULTS Thirty-two eyes (16 patients) were included with an average follow-up of 42 months. Twenty-one eyes (66%) had CME on initial presentation and final follow-up (group 1), eight eyes (25%) did not have CME on presentation or final follow-up (group 2), and three eyes (9%) did not have CME on presentation but developed CME during follow-up (group 3). Group 1 eyes had a lower maximal a-wave amplitude (59.0 vs. 220.9 mV, p = 0.012) and lower maximal b-wave amplitude (88.1 vs 256.9 mV, p = 0.017) on baseline ERG compared to Group 2 eyes. The rate of EZ loss over time was significantly greater for group 1 with CME compared to group 2 without CME both at 12 months (- 1.26 μm/day vs. - 0.26 μm/day, p = 0.022) and at final follow-up (- 1.03 μm/day vs. - 0.08 μm/day, p = 0.012). CONCLUSIONS CME was associated with decreased ERG amplitudes and greater velocity of EZ loss, suggesting that CME is a useful biomarker of more severe and more progressive disease in npAIR.
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Affiliation(s)
- Avni P Finn
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Robert T Keenan
- Department of Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
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Hirji N, Bradley PD, Li S, Vincent A, Pennesi ME, Thomas AS, Heon E, Bhan A, Mahroo OA, Robson A, Inglehearn CF, Moore AT, Michaelides M. Jalili Syndrome: Cross-sectional and Longitudinal Features of Seven Patients With Cone-Rod Dystrophy and Amelogenesis Imperfecta. Am J Ophthalmol 2018; 188:123-130. [PMID: 29421294 PMCID: PMC5873517 DOI: 10.1016/j.ajo.2018.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To characterize a series of 7 patients with cone-rod dystrophy (CORD) and amelogenesis imperfecta (AI) owing to confirmed mutations in CNNM4, first described as "Jalili Syndrome." DESIGN Retrospective observational case series. METHODS Seven patients from 6 families with Jalili Syndrome were identified at 3 tertiary referral centers. We systematically reviewed their available medical records, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence imaging (FAF), color fundus photography, and electrophysiological assessments. RESULTS The mean age at presentation was 6.7 years (range 3-16 years), with 6 male and 1 female patient. CNNM4 mutations were identified in all patients. The mean Snellen best-corrected visual acuity (BCVA) at presentation was 20/246 (range 20/98 to 20/399) in the right eye and 20/252 (range 20/98 to 20/480) in the left. Nystagmus was observed in all 7 patients, and photophobia was present in 6. Funduscopic findings at presentation were variable, ranging from only mild disc pallor to retinal vascular attenuation and macular atrophy. Multimodal imaging demonstrated disease progression in all 7 patients over time. Electroretinography uniformly revealed progressive cone-rod dysfunction. CONCLUSIONS Jalili Syndrome is a rare CORD associated with AI. We have further characterized its ocular phenotype, including describing SD-OCT, FAF, and electrophysiological features; and report several novel disease-causing sequence variants. Moreover, this study presents novel longitudinal data demonstrating structural and functional progression over time, allowing better informed advice on prognosis.
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Affiliation(s)
- Nashila Hirji
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Patrick D Bradley
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Shuning Li
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada
| | - Ajoy Vincent
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark E Pennesi
- Oregon Health & Science University, Casey Eye Institute, Portland, Oregon
| | | | - Elise Heon
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Aparna Bhan
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada
| | - Omar A Mahroo
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Anthony Robson
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Anthony T Moore
- UCSF School of Medicine, Department of Ophthalmology, San Francisco, California
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
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Glaser T, Thomas AS, Materin MA. Successive Uveal Melanomas with Different Gene Expression Profiles in an Eye with Ocular Melanocytosis. Ocul Oncol Pathol 2018; 4:236-239. [PMID: 30643768 DOI: 10.1159/000484937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/01/2017] [Indexed: 12/30/2022] Open
Abstract
Ocular melanocytosis portends a higher risk of uveal melanoma. Multifocal uveal melanoma has been described previously and has been associated with ocular melanocytosis. Historically, histopathology has been used to differentiate tumors; however, molecular profiling now allows for better prognostication and determination of metastatic risk. The present case describes a patient with ocular melanocytosis who developed two sequential uveal melanomas in the same eye separated by 4 years. The uveal melanoma-specific gene expression profile (GEP) testing for the first tumor was class 1A and the second tumor was class 2. While the first tumor had low metastatic risk, the second tumor had a higher risk of metastasis, demonstrating the importance of GEP testing in cases of multifocal disease.
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Affiliation(s)
- Tanya Glaser
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University, Durham, NC, USA
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Ong SS, Thomas AS, Fekrat S. Improvement of Recalcitrant Diabetic Macular Edema After Peritoneal Dialysis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:834-837. [PMID: 29020428 DOI: 10.3928/23258160-20170928-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/02/2017] [Indexed: 01/21/2023]
Abstract
Nephropathy may be an independent and contributory risk factor for diabetic macular edema (DME). A 69-year-old man who had previously been treated with panretinal laser photocoagulation for proliferative diabetic retinopathy as well as with steroid and anti-vascular endothelial growth factor injections for DME declined additional treatment for the DME, which was worse in the right eye. The DME was observed without further treatment for the next 36 months. Despite well-controlled blood sugar, blood pressure, and lipid levels, the DME remained unchanged. Peritoneal dialysis was started due to end-stage renal disease. Three months after commencing dialysis, the DME improved significantly. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:834-837.].
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Thomas AS, Redd T, Campbell JP, Palejwala NV, Baynham JT, Suhler EB, Rosenbaum JT, Lin P. The Impact and Implication of Peripheral Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Uveitis. Ocul Immunol Inflamm 2017; 27:349-355. [PMID: 29035614 DOI: 10.1080/09273948.2017.1367406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To study if peripheral vascular leakage (PVL) on ultra-widefield fluorescein angiography (UWFFA) prognosticates complications of uveitis or necessitates treatment augmentation. Methods: Retrospective cohort study of uveitis patients imaged with UWFFA and ≥1 yr of follow-up. Results: We included 73 eyes of 42 patients with uveitis. There was no difference in baseline, intermediate, final visual acuity (p = 0.47-0.95) or rates of cystoid macular edema (CME) (p = 0.37-0.87) in eyes with PVL vs. those without. Eyes with PVL receiving baseline treatment augmentation were more likely to have baseline CME but were not more likely to have impaired visual acuity at final follow-up. PVL was independently associated with treatment augmentation on generalized estimating equation analysis with multivariable linear regression (OR: 4.39, p = 0.015). Conclusions: PVL did not confer an increased risk of impaired VA or CME at ≥1 yr follow-up but was possibly an independent driver of treatment augmentation.
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Affiliation(s)
- Akshay S Thomas
- a Department of Ophthalmology , Duke University Eye Center , Durham , North Carolina , USA
| | - Travis Redd
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
| | - John P Campbell
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
| | | | | | - Eric B Suhler
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA.,e Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - James T Rosenbaum
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA.,f Devers Eye Institute , Portland , Oregon , USA
| | - Phoebe Lin
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
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Thomas AS, Branham K, Van Gelder RN, Daiger SP, Sullivan LS, Bowne SJ, Heckenlively JR, Pennesi ME. Multimodal Imaging in Wagner Syndrome. Ophthalmic Surg Lasers Imaging Retina 2017; 47:574-9. [PMID: 27327288 DOI: 10.3928/23258160-20160601-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
Wagner syndrome is a rare vitreoretinopathy described in a limited number of families. Here the authors describe four cases of suspected Wagner syndrome. All four cases had depressed rod and cone function on electroretinography, outer retinal disruption on spectral-domain optical coherence tomography, and constricted central visual fields with smaller isopter testing. Fundus autofluorescence performed in one patient highlighted a perivascular pattern to chorioretinal atrophy. Two patients had a history of uveitis with active cystoid macular edema. The diagnosis of Wagner syndrome was supported in three cases with genetic testing for VCAN mutations, whereas the other case harbored a variation of unknown significance in VCAN that may have been nonpathogenic. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:574-579.].
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Thomas AS, Walter SD, Fekrat S. Bilateral Prefoveal Sub-Internal Limiting Membrane Hemorrhage in Autoimmune Hemolytic Anemia. Ophthalmic Surg Lasers Imaging Retina 2017; 47:1151-1153. [PMID: 27977840 DOI: 10.3928/23258160-20161130-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022]
Abstract
Severe anemia can cause multilayered retinal hemorrhages. A 65-year-old woman noted "red spheres" in the central vision of both eyes during a hospital admission for autoimmune hemolytic anemia. Examination revealed extensive multilayered retinal hemorrhages, including bilateral foveal preretinal hemorrhage. Spectral-domain optical coherence tomography localized the preretinal blood to the sub-internal limiting membrane (ILM) space. Various options are available for management of such hemorrhage, including observation for spontaneous resolution, YAG laser membranotomy, or pars plana vitrectomy with ILM peeling. In the authors' patient, the size of the sub-ILM hemorrhage spontaneously improved during the course of 1 month, with both subjective and objective visual improvement. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1151-1153.].
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Abstract
PURPOSE OF REVIEW Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) are numerous and can often involve the eye. This review highlights the ocular complications associated with IBD including the critical role the ophthalmologist can play in the diagnosis of IBD, the pathogenesis of IBD, its ocular complications, and the treatment of ocular inflammation associated with IBD. RECENT FINDINGS Polygenic and environmental influences, as well as gut microbial dysbiosis, have been implicated in the pathogenesis of IBD. IBD and its EIMs appear to respond well to TNFα-targeted biologics. SUMMARY IBD is thought to be caused by polygenic and environmental influences, including a dysbiotic gut microbiota. It is a systemic immune-mediated disease with varying types of ocular manifestations that can precede, occur simultaneously, or follow intestinal involvement. The diagnosis of IBD can be confused with other seronegative spondyloarthropathies as well as Behçet's disease. Treatment of IBD-associated ocular inflammation can range from corticosteroids to steroid-sparing immunosuppression such as azathioprine or methotrexate. Refractory disease can respond well to TNFα inhibitors.
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Affiliation(s)
- Akshay S Thomas
- Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon, USA
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Kopplin LJ, Thomas AS, Cramer S, Kim YH, Yeh S, Lauer AK, Flaxel CJ. Long-Term Surgical Outcomes of Retinal Detachment Associated With Acute Retinal Necrosis. Ophthalmic Surg Lasers Imaging Retina 2016; 47:660-4. [DOI: 10.3928/23258160-20160707-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/06/2016] [Indexed: 11/20/2022]
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Thomas AS, Flaxel CJ, Pennesi ME. Spectral-domain optical coherence tomography and fundus autofluorescence evaluation of torpedo maculopathy. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e8-10. [PMID: 25751084 DOI: 10.3928/01913913-20150303-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
The authors describe the spectral-domain optical coherence tomography and fundus autofluorescence findings in a case of torpedo maculopathy. Spectral-domain optical coherence tomography revealed loss or disruption of the retinal pigment epithelium and overlying disruption of the outer neurosensory retina. Fundus autofluorescence revealed reduced fundus autofluorescence of the lesion surrounded by a rim of increased fundus autofluorescence.
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Gupta RK, Ezeonyeji AN, Thomas AS, Scully MA, Ehrenstein MR, Isenberg DA. A case of pure red cell aplasia and immune thrombocytopenia complicating systemic lupus erythematosus: response to rituximab and cyclophosphamide. Lupus 2011; 20:1547-50. [PMID: 21993386 DOI: 10.1177/0961203311411349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pure red cell aplasia (PRCA) is a recognized but rare complication of systemic lupus erythematosus (SLE) and is characterized by the near absence of red blood cell precursors in the bone marrow but with normal megakaryocyte and granulocytes. We report a novel case of acquired PRCA occurring simultaneously with immune thrombocytopenia in the context of active SLE. Both syndromes were refractory to conventional treatment but responded to rituximab and cyclophosphamide.
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Affiliation(s)
- R K Gupta
- Department of Rheumatology, University College Hospital, London, UK
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Kim E, Bowsher J, Thomas AS, Sakhalkar H, Dewhirst M, Oldham M. Improving the quantitative accuracy of optical-emission computed tomography by incorporating an attenuation correction: application to HIF1 imaging. Phys Med Biol 2008; 53:5371-83. [PMID: 18765891 DOI: 10.1088/0031-9155/53/19/007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Optical computed tomography (optical-CT) and optical-emission computed tomography (optical-ECT) are new techniques for imaging the 3D structure and function (including gene expression) of whole unsectioned tissue samples. This work presents a method of improving the quantitative accuracy of optical-ECT by correcting for the 'self'-attenuation of photons emitted within the sample. The correction is analogous to a method commonly applied in single-photon-emission computed tomography reconstruction. The performance of the correction method was investigated by application to a transparent cylindrical gelatin phantom, containing a known distribution of attenuation (a central ink-doped gelatine core) and a known distribution of fluorescing fibres. Attenuation corrected and uncorrected optical-ECT images were reconstructed on the phantom to enable an evaluation of the effectiveness of the correction. Significant attenuation artefacts were observed in the uncorrected images where the central fibre appeared approximately 24% less intense due to greater attenuation from the surrounding ink-doped gelatin. This artefact was almost completely removed in the attenuation-corrected image, where the central fibre was within approximately 4% of the others. The successful phantom test enabled application of attenuation correction to optical-ECT images of an unsectioned human breast xenograft tumour grown subcutaneously on the hind leg of a nude mouse. This tumour cell line had been genetically labelled (pre-implantation) with fluorescent reporter genes such that all viable tumour cells expressed constitutive red fluorescent protein and hypoxia-inducible factor 1 transcription-produced green fluorescent protein. In addition to the fluorescent reporter labelling of gene expression, the tumour microvasculature was labelled by a light-absorbing vasculature contrast agent delivered in vivo by tail-vein injection. Optical-CT transmission images yielded high-resolution 3D images of the absorbing contrast agent, and revealed highly inhomogeneous vasculature perfusion within the tumour. Optical-ECT emission images yielded high-resolution 3D images of the fluorescent protein distribution in the tumour. Attenuation-uncorrected optical-ECT images showed clear loss of signal in regions of high attenuation, including regions of high perfusion, where attenuation is increased by increased vascular ink stain. Application of attenuation correction showed significant changes in an apparent expression of fluorescent proteins, confirming the importance of the attenuation correction. In conclusion, this work presents the first development and application of an attenuation correction for optical-ECT imaging. The results suggest that successful attenuation correction for optical-ECT is feasible and is essential for quantitatively accurate optical-ECT imaging.
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Affiliation(s)
- E Kim
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Cox KJ, Thomas AS. The application of immunoblotting to the phenotyping of haptoglobin. J Forensic Sci 1992; 37:1652-5. [PMID: 1453173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An immunoblotting method for phenotyping haptoglobin in serum and bloodstains has been developed. Haptoglobin isoproteins were separated by polyacrylamide gradient gel electrophoresis and then transferred to nitrocellulose by electroblotting. The use of 1 mm gels facilitated more rapid and effective transfer than conventional 3 mm thick gels. Nitrocellulose blots were developed by double antibody enzyme immunoassay. The detection limit for serum and bloodstains was improved 16 times compared to conventional staining using O-tolidine. The method could detect haptoglobin phenotypes from 0.001 microliter of whole blood. This detection limit is approximately 8 times lower than that of group specific-component analysis by immunoblotting.
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Affiliation(s)
- K J Cox
- Forensic Biology section, Queensland Department of Health, Brisbane, Australia
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Thomas AS, Aaskov JG. Routine phenotyping of native and desialyzed alpha 2HS-glycoprotein from blood stains. Forensic Sci Int 1990; 47:173-80. [PMID: 2227732 DOI: 10.1016/0379-0738(90)90211-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The application of a polyacrylamide gel isoelectric focusing (PAGIEF) and immunoblotting procedure for the identification of native alpha 2HS-glycoprotein (AHSG) in routine casework blood stains has produced reportable results on 57.2% of samples. This reporting rate is lower than that for group specific component (GC) (83.8%) and phosphoglucomutase (PGM 1) (72.8%) phenotyping of the same samples. Blood stain samples were desialyzed with 1 U/ml neuraminidase, overnight at room temperature prior to PAGIEF in gels containing pharmalyte pH 5-6 and 2.5 M urea. Simple AHSG patterns were developed by immunoblotting. This procedure was five times as sensitive as the native AHSG method and desialyzation was reproducible over a range of incubation times and neuraminidase concentrations. The application of the desialyzed AHSG analysis to routine casework samples has resulted in a significant increase in the number of reportable results (762 reported out of 1027 samples). This reporting rate (74.2%) compares favourably with that for GC (79.1%) and PGH 1 (69.6%) phenotyping of the same samples. The three AHSG alleles (AHSG*1, 2 and 3) are clearly resolved after sample desialyzation and separation in gels containing pharmalyte pH 5-6 and 2.5 M urea. The sensitivity of desialyzed AHSG phenotyping approaches that of GC and this technique is worthy of inclusion in blood stain screening protocols of forensic laboratories in regions where the population has a limited range of rare AHSG alleles.
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Affiliation(s)
- A S Thomas
- Forensic Biology Section, State Health Laboratory, Brisbane, Queensland, Australia
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Abstract
A sensitive immunoblotting procedure has been applied to the detection of alpha-2-HS-glycoprotein (A2HS) phenotypes from control and casework bloodstains. A2HS phenotypes were separated by thin layer polyacrylamide gel isoelectric focusing (PAGIEF) in gels containing Pharmalyte pH 4.2-4.9. After transfer to nitrocellulose by a rapid capillary blot, the A2HS phenotypes were developed using a double antibody enzyme-immunoassay. The evaluation of A2HS phenotyping of casework material was undertaken in parallel with phosphoglucomutase (PGM) phenotyping by PAGIEF. A total of 598 water extracts from casework bloodstains have been tested. Positive results were obtained in 84% and 75% of samples for PGM and A2HS respectively. The A2HS gene frequencies A2HS*1 = 0.6420, A2HS*2 = 0.3530, and A2HS*3 = 0.0050 were determined from a survey of 1000 people in Brisbane.
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Abstract
The performance of the polymorphic marker systems group-specific component (GC), phosphoglucomutase-1 (PGM), alpha-2-HS-glycoprotein (A2HS), haptoglobin (Hp), and erythrocyte acid phosphatase (EAP) was evaluated on control bloodstains. The major factors considered were: sensitivity of the test system; stability of the marker; laboratory economics of each test; and distinguishing power (Dp) of the system. GC was considered to be the most suitable marker for routine screening because of its high stability and Dp, and the sensitivity of the immunoblotting detection method. PGM and A2HS were the next most valuable markers followed by Hp. EAP could only be considered useful when large amounts of relatively fresh bloodstain were available.
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Cheung R, Dickins J, Nicholson PW, Thomas AS, Smith HH, Larson HE, Deshmukh AA, Dobbs RJ, Dobbs SM. Compliance with anti-tuberculous therapy: a field trial of a pill-box with a concealed electronic recording device. Eur J Clin Pharmacol 1988; 35:401-7. [PMID: 3197749 DOI: 10.1007/bf00561372] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have conducted a field trial of a pill-box containing a concealed electronic device for monitoring compliance in 23 consecutive adult out patients taking a rifampicin/isoniazid combination once daily. In 22 cases, the times when the box was opened were successfully recorded for the entire period (mean (SD) 26 (5) days) between successive clinic visits. In the other patient the record terminated after one week, a broken box being returned. Both totality of compliance (as assessed by box openings) and consistency of compliance (the proportion of the total number of intervals between openings which were of 22 to 26 h in length) were significantly greater in those studied in the intensive than in the maintenance phase of therapy. Patients may have taken the reduction in medication at the end of the intensive phase as signalling cure. A computer program has been developed to display the recorded data. This allowed the physician responsible to assimilate at a glance the patient's tablet-taking habits. In routine practice knowledge of the presence of the device may improve compliance and a discussion of the graphical display may prove of value in counselling.
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Affiliation(s)
- R Cheung
- Clinical Research Centre, Northwick Park Hospital, Harrow, Middlesex, UK
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Thomas AS, Dunn S. Plant growth with new fluorescent lamps : II. Growth and reproduction of mature bean plants and dwarf marigold plants. Planta 1966; 72:208-212. [PMID: 24554213 DOI: 10.1007/bf00387484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/1966] [Indexed: 06/03/2023]
Abstract
Bean and marigold plants were grown to maturity under several kinds of fluorescent lamps to evaluate the effects of spectral differences on development and reproduction. Six kinds of lamps were tested including five lamps that were used in closely related experiments on tomato seedling growth (THOMAS and DUNN, 1967). Evaluation was by fresh- and dry-weight yields of immature and mature pods, and of vegetative tops of plants for bean; and by flowering and fresh-and dry-weight yields for marigold.Bean plants grown under two experimental lamps, Com I and IR III produced significantly higher fresh- and dry-weight yields of both mature and total pods than under Warm-white lamps. This effect could be attributed largely to the considerable energy emitted by the experimental lamps in the red and far-red, as compared to a larger emission in the green and blue for the Warm-white lamps. The differences in the yields for immature pods and vegetative portions of the mature tops were not significant.In a comparison of the effects of three experimental lamps with those of three commercial lamps on growth response of bean plants, the yields were in general higher for the experimental lamps, except for immature pods. The yields of vegetative tops were significantly greater for the 78/22 lamp over the yields for all other lamps. The larger proportion of red and far-red light emitted by the experimental lamps is again the probable cause of the higher yields with these lamps.Two sets of experiments on growth and flowering of marigold under various experimental and commercial lamps were largely inconclusive although there was some indication of beneficial effects by the experimental lamps.In general, the results with bean agree with those for tomato (THOMAS and DUNN, 1967), in that best growth was obtained with a lamp high in red light emission, a moderate amount in the far-red, and very little in the blue part of the spectrum.
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Affiliation(s)
- A S Thomas
- Botany Department, University of New Hampshire, Durham, New Hampshire, USA
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Thomas AS, Dunn S. Plant growth with new fluorescent lamps : I. Fresh and dry weight yields of tomato seedlings. Planta 1966; 72:198-207. [PMID: 24554212 DOI: 10.1007/bf00387483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/1966] [Indexed: 06/03/2023]
Abstract
Tomato seedlings were grown under seven kinds of fluorescent lamps, including two that are commercially available, and five experimental lamps. Detailed descriptions and spectral emission curves for these lamps are presented.The 78/22 lamp, which emitted most of its energy above 500 mμ, more than ten percent above 700 mμ, and had a sharp peak output at 660 mμ, generally produced superior fresh and dry weight yields. This effect may be due primarily to the high peak of energy emitted at approximately 660 mμ, combined with a considerable emission in the far-red, which in turn may be related to the red ↔ far-red reversibility phenomeon.The Com I lamp, which lacked the sharp peak output at 660 mμ and emitted more energy in the blue than the 78/22 lamp, was generally second only to the latter in promoting plant growth. A high moisture content was found in plants under this lamp in some experiments.The IRIII lamp had the sharp peak output at 660 mμ but greater output in the blue than the 78/22 lamp. The 282 lamp output was similar to the 78/22 but lacked the high peak. Both of these lamps generally gave improved results over those produced by commercial Gro-Lux, Warm-white, and FLAT lamps. This was attributed to the greater percentage of red and far-red energy emission by the former two lamps. The yields with the FLAT lamp were consistently lowest of all. This has been attributed to the high percentage of emitted energy in the blue and green portions of the spectrum.Both length of the test period (13 days versus 26 days) and light intensity (550 μw/cm(2) versus 1100 μw/cm(2)) may be important factors in determining which composition of spectral energy emission produces the greatest yields. Under low intensity and short test period the Com I light produced highest fresh- and dry-weight yields, but under high intensity and longer growth period the 78/22 lamp gave greatest yields. This effect may be due to inhibition of leaf expansion by red light in the early stages of growth.The experiments demonstrate that it is possible to develop a fluorescent lamp for plant growth that combines the desirable characteristics of both incandescent and fluorescent light. This work also shows that the tomato plant in the seedling stage grows best under an artificial light source with a high percentage of energy emission in the red, a considerable amount in the far-red, and a very small amount in the blue part of the spectrum.
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Affiliation(s)
- A S Thomas
- Botany Department, University of New Hampshire, Durham, New Hampshire, USA
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