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Mahler S, Einan-Lifshitz A, Shemer A, Belkin A, Pras E, Dubinsky-Pertzov B. Reproducibility of manifest refraction in patients with keratoconus compared with healthy subjects: A prospective cohort study. Am J Ophthalmol 2024:S0002-9394(24)00168-5. [PMID: 38677637 DOI: 10.1016/j.ajo.2024.04.023] [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: 12/03/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To measure and compare the inter- examiner reproducibility of manifest refraction in patients with keratoconus. DESIGN Prospective, inter-examiner reliability analysis comparing "cases and controls" METHODS: Patients with Keratoconus (KC) and healthy subjects had undergone manifest refraction by the same two skilled optometrists, each was masked to the refraction of the other, on the same day. The KC group was comprised of patients with KC, who were recruited from the cornea clinic. The control group consisted of healthy individuals who wore spectacles and did not have KC. Participants for the control group were recruited from the clinic's staff, including doctors, technicians, nurses, and medical students. The study took place in one tertiary medical center in Israel from April 2021 to May 2022. The results of the manifest refraction and achieved corrected distance visual acuity (CDVA) were compared between groups. RESULTS A total of 120 eyes of 60 patients were enrolled in the study; Thirty in the keratoconus group and 30 in the control group. A difference of 0.67±0.83 D and 0.19±0.21 D in the absolute manifest cylinder was observed between the optometrists in the keratoconus (95% LoA, -0.96, 2.30) and control group (95% LoA, -0.22, 0.61), respectively (p<0.001). Multivariate analysis revealed a 22-fold higher likelihood of an error exceeding 0.75 D in cylinder measurements (OR, 22.24; 95% CI, 2.39-206.95) and a tenfold likelihood of a difference of at least one row on the Snellen chart for CDVA (OR,10.32; 95% CI,2.39-44.44) in the KC group. CONCLUSION when compared to healthy subjects, patients with KC exhibit greater variability in manifest refraction. This discrepancy has the potential to influence the decision-making process when managing patients with KC.
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Affiliation(s)
- Shahar Mahler
- Joyce and Irving Goldman Faculty of Medicine, Ben-Gurion University, Be'er-Sheva, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of ophthalmology, Meir medical center, Kfar-Saba, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hecht I, Shemer A, Vardi M, Braudo S, Dubinsky-Pertzov B, Or L, Pras E. Between-eye correlation of ocular parameters. Can J Ophthalmol 2024:S0008-4182(23)00389-7. [PMID: 38219792 DOI: 10.1016/j.jcjo.2023.12.009] [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: 07/09/2023] [Revised: 09/28/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE It is accepted that ocular parameters are more correlated with the fellow eye. This poses a challenge in ophthalmic research. There is a relative scarcity of data concerning the extent of correlation. The aim of this study was to analyze and quantify the correlation of different ocular parameters. DESIGN Historical registry analysis. PARTICIPANTS All patients examined in a 10-year period (2011-2021) in one academic tertiary medical centre in central Israel. METHODS Data from optical coherence tomography examinations and biometry of a single examination of both eyes taken at the same time from each patient was included. Pearson's r values were calculated to estimate the extent of correlation. RESULTS A total of 17,212 patients were included. Mean age was 73 ± 12.7 years, and 54.5% were female. All examined parameters were highly statistically significantly correlated between eyes (all with p < 0.1 × 10-36), whereas the strength of correlation differed. Very weak correlation was seen in central macular thickness (r = 0.189), and a weak correlation was seen in anterior-chamber depth (r = 0.379) and retinal nerve fibre layer thickness (r = 0.479). A strong correlation was seen in central corneal thickness (r = 0.754), and a very strong correlation was seen in axial length (r = 0.900). CONCLUSIONS In a retrospective analysis of optical coherence tomography and biometry measurements of >10,000 patients, all examined parameters were highly statistically significantly correlated. Correlation magnitude varied, with structural characteristics more correlated than functional ones. Including both eyes in an outcome analysis likely will introduce bias. We recommend adjusting for inter-eye correlation in all studies assessing ocular outcome measures.
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Affiliation(s)
- Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Vardi
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Braudo
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel
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Shemer A, Cohen M, Altarescu A, Atar-Vardi M, Hecht I, Dubinsky-Pertzov B, Shoshany N, Zmujack S, Or L, Einan-Lifshitz A, Pras E. Diagnostic capabilities of ChatGPT in ophthalmology. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-023-06363-z. [PMID: 38183467 DOI: 10.1007/s00417-023-06363-z] [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: 06/28/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
PURPOSE The purpose of this study is to assess the diagnostic accuracy of ChatGPT in the field of ophthalmology. METHODS This is a retrospective cohort study conducted in one academic tertiary medical center. We reviewed data of patients admitted to the ophthalmology department from 06/2022 to 01/2023. We then created two clinical cases for each patient. The first case is according to the medical history alone (Hx). The second case includes an addition of the clinical examination (Hx and Ex). For each case, we asked for the three most likely diagnoses from ChatGPT, residents, and attendings. Then, we compared the accuracy rates (at least one correct diagnosis) of all groups. Additionally, we evaluated the total duration for completing the assignment between the groups. RESULTS ChatGPT, residents, and attendings evaluated 126 cases from 63 patients (history only or history and exam findings for each patient). ChatGPT achieved a significantly lower accurate diagnosis rate (54%) in the Hx, as compared to the residents (75%; p < 0.01) and attendings (71%; p < 0.01). After adding the clinical examination findings, the diagnosis rate of ChatGPT was 68%, whereas for the residents and the attendings, it increased to 94% (p < 0.01) and 86% (p < 0.01), respectively. ChatGPT was 4 to 5 times faster than the attendings and residents. CONCLUSIONS AND RELEVANCE ChatGPT showed low diagnostic rates in ophthalmology cases compared to residents and attendings based on patient history alone or with additional clinical examination findings. However, ChatGPT completed the task faster than the physicians.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Cohen
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Health Science, Ben-Gurion University of the Negev, South District, Beer-Sheva, Israel
| | - Aya Altarescu
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Atar-Vardi
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Shoshany
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Zmujack
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
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Gazit I, Dubinsky-Pertzov B, Or L, Pras E, Einan-Lifshitz A. The outcomes of postoperative eye patching after cataract surgery in patients with Fuchs' endothelial corneal dystrophy. Eur J Ophthalmol 2024; 34:119-125. [PMID: 37128126 DOI: 10.1177/11206721231172808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To investigate the influence of post-operative eye patching on corneal thickness, endothelial cells' loss and visual acuity in patients diagnosed Fuchs' endothelial corneal dystrophy (FECD). SETTING Public healthcare centre, Shamir Medical Centre, Israel. METHODS This randomized controlled trial included patients with FECD undergoing routine cataract surgery in a public medical centre. Patients were randomly assigned to 2 groups: the eye undergoing surgery was covered with a patch for 24 h in the first group (patched group), and a plastic shield was used in the second (non-patched group). Both groups received a unique dose of a local steroid and antibiotic post-operatively. The eyes were examined pre-operatively, and on days 1, 7 and 30 post-surgery . Examination included: best corrected visual acuity (BCVA), comeplete slit lamp examination, intra ocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT) using the IOL Master 700 (Zeiss, Germany) and endothelial cell density (ECD) using Specular microscopy. Cumulative dissipated energy (CDE) and operation time were recorded for all cases. RESULTS The study included 46 eyes of 46 patients diagnosed with FECD. Twenty-three eyes in the patched group, and 23 eyes in the non-patched group . Thirty days post-operatively the CCT in the patched group decreased by 60 ± 38 mµ (9%) compared to 92 ± 80 mµ (13.5%) in the non- patched group (p = 0.04). Seven days post-operatively the CCT in the patched group decreased by 31 ± 35 mµ (5%) compared to 58 ± 76 (8%) in the non-patched group, but this difference did not reach statistical significance (p = 0.081). There was no statistically significant difference in endothelial cells loss as well as BCVA at 1, 7 and 30 days post-operatively between the study groups. CONCLUSIONS Avoiding eye patch post-operatively after cataract surgery in patients with FECD results in better corneal clarity recovery and reduced corneal edema one month post-operatively. Visual acuity and endothelial cell's loss were not influenced by patching.
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Affiliation(s)
- Inbal Gazit
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Centre, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shemer A, Zloto K, Peretz Z, Eting E, Or L, Pras E, Dubinsky-Pertzov B. RATES OF RECURRENT RETINAL DETACHMENT AFTER VAGINAL VERSUS CESAREAN DELIVERIES: A Retrospective Analysis and Review of the Literature. Retina 2024; 44:78-82. [PMID: 37607406 DOI: 10.1097/iae.0000000000003909] [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: 08/24/2023]
Abstract
PURPOSE To evaluate the risk of a retinal redetachment in women after vaginal delivery versus cesarean delivery. METHODS Retrospective cohort analysis of patients diagnosed with retinal detachment (RD) who had later delivered in one tertiary medical center. Recurrence rates of RD were obtained from medical charts. RESULTS A total of 967 women with RDs were evaluated, and 66 patients met the inclusion criteria. The mean age at the time of RD was 22.64 ± 5.81 SD years and 21.75 ± 5.47 SD years in the vaginal delivery group and the cesarean section group, respectively. None of the patients had a history of eye surgery or traumatic eye injury before the event of RD. In all patients, the detached retina was surgically reattached. Retinal detachment was not recorded in the fellow eye during follow-up. We report four cases of redetachment after birth in four women. In our study, there was a 5% rate (n = 2) of RD after a vaginal delivery as compared with a 7.5% (n = 2) redetachment rate for patients after a cesarean delivery ( P = 0.654). CONCLUSION The risk of a redetachment of the retina in women is not increased after a vaginal delivery as compared with a cesarean delivery. Therefore, in our opinion, there is no ophthalmic benefit in a cesarean section for a woman with prior RD.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Keren Zloto
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ziv Peretz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
| | - Eva Eting
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
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Shemer A, Altarescu A, Nusbaum L, Vardi M, Dubinsky-Pertzov B, Hecht I, Or L, Einan-Lifshitz A, Pras E. Quantum Molecular Resonance Effects on Patients With Dry Eye Disease: A Randomized Controlled Trial. Cornea 2023:00003226-990000000-00446. [PMID: 38166187 DOI: 10.1097/ico.0000000000003443] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/29/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE The aim of the study was to evaluate the efficacy and safety of quantum molecular resonance in the treatment of dry eye disease. METHODS This study was a double-blind randomized control trial in 1 academic medical center, for 2 years. Participants received treatment or a placebo with the Rexon-Eye device, once per week for 4 weeks. The primary outcome was the change in dry eye symptoms assessed by the Ocular Surface Disease Index (OSDI). Secondary outcomes were clinical findings associated with the dry eye such as meibomian gland dysfunction (MGD) score, tear break-up time (TBUT), corneal fluorescein staining, Schirmer test, and best-corrected visual acuity (BCVA). RESULTS Forty patients were recruited, 20 in each arm. The mean age was 63.5 ± 15.1 years and 27 (67.5%) were female. The mean OSDI score significantly improved in the intervention group from 19.15 ± 10.3 to 10.5 ± 7.0 (P < 0.001), whereas the control group showed no significant change (14.4 ± 8.4 to 15.5 ± 8.6, P = 0.830). MGD scores significantly improved in the intervention group (1.57 ± 1.2 to 0.8 ± 0.9, P = 0.006), whereas showing no significant change in the control group (1.60 ± 0.9 to 1.99 ± 1.0, P = 0.244). The corneal staining score also showed significant improvement in the intervention group (P = 0.045) and a nonsignificant decline in the placebo group (P = 0.50). No significant difference was seen in TBUT, visual acuity, and Schirmer scores between groups. No harm resulting from treatment was reported during the duration of the trial. CONCLUSIONS High-frequency electrotherapy may have a positive effect on symptoms and signs of dry eye. This emerging technology may become part of the arsenal of therapeutic modalities for this condition.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Aya Altarescu
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Lee Nusbaum
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Maya Vardi
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
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Einan-Lifshitz A, Achiron A, Hed S, Hecht I, Dubinsky-Pertzov B, Knyazer B. Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus. Eye (Lond) 2023; 37:1219-1224. [PMID: 35590103 PMCID: PMC10102302 DOI: 10.1038/s41433-022-02093-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/19/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Standard corneal collagen cross-linking (S-CXL) is an effective treatment to arrest Keratoconus (KC) progression in children. Less is known on the long-term efficacy of accelerated CXL (A-CXL) in paediatric populations. METHODS A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres in Israel between 2010-2017. Preoperative and 3-year postoperative evaluation included changes in visual acuity (best spectacle corrected [BSCVA]) and uncorrected [UCVA]), refractive errors, and keratometric data. RESULTS Ninety-three eyes of 93 patients were analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 LogMAR UCVA, p < 0.05 for both). Improvement in BSCVA and UCVA following A-CXL was non-inferior to S-CXL (< ± 0.2 LogMAR). Kmax decreased by a mean of 0.98 ± 5.56 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres following A-CXL (p = 0.015). Thinnest pachymetry decreased following both treatments (S-CXL: by 26.8 ± 40.7 µm, p = 0.001, A-CXL: by 10.2 ± 13.4 µm, p = 0.028), the difference between groups was within the non-inferiority margin (< ± 10 µm). CONCLUSIONS Paediatric patients followed for three years after A-CXL showed improved visual function, reduced corneal astigmatism and Kmax, and decreased thinnest corneal thickness. A-CXL was non-inferior to S-CXL at three years in terms of best-corrected and uncorrected visual acuity, thinnest pachymetry, and astigmatism. For Kmax, non-inferiority could not be concluded.
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Affiliation(s)
- Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Hed
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
BACKGROUND To describe recent cases of optic neuritis in patients who received a vaccine for COVID-19. METHODS Retrospective case series of patients diagnosed with optic neuritis after a recent COVID-19 vaccination with BNT162b2 (Pfizer-BioNTech), in one university-affiliated tertiary hospital, from January 2021 to June 2021. Data were obtained from medical charts. RESULTS We describe 7 patients who developed optic neuritis after immunization with the BNT162b2 vaccine. CONCLUSIONS A causal relationship cannot be deduced, and the importance of COVID-19 vaccination is not challenged. However, the authors encourage a prospective monitoring and reporting system for all patients receiving COVID-19 vaccines, to further assess the spectrum of adverse events in large databases.
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Dubinsky-Pertzov B, Segal O, Hecht I, Gazit I, Or L, Shemer A, Pras E, Einan-Lifshitz A. Correction to: Predictive accuracy of the ABCD progression display among patients with keratoconus: A historic cohort analysis. Eye (Lond) 2023:10.1038/s41433-022-02296-9. [PMID: 36737521 DOI: 10.1038/s41433-022-02296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Omri Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dubinsky-Pertzov B, Mahler OS, Hecht I, Shemer A, Or L, Gazit I, Pras E, Einan-Lifshitz A. Accuracy of Intraocular Lens Calculation Formulas for the Four-Flanged Fixation Technique in Eyes With No Capsular Support. J Refract Surg 2022; 38:668-673. [DOI: 10.3928/1081597x-20220919-01] [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] [Indexed: 11/05/2022]
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Dubinsky-Pertzov B, Einan-Lifshitz A, Pras E, Hartstein ME, Morad Y. Routine use of non-absorbable sutures in bi-medial rectus recession as a measure to reduce the incidence of consecutive exotropia. Eye (Lond) 2022; 36:1772-1776. [PMID: 34373609 PMCID: PMC9391456 DOI: 10.1038/s41433-021-01724-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of consecutive exotropia following bilateral medial rectus muscle recession surgery (BMR) for esotropia using non-absorbable compared with absorbable sutures in children undergoing strabismus surgery. METHODS A retrospective cohort study of all children with esotropia who underwent BMR by a single surgeon in a tertiary public hospital. As of February 2018, only non-absorbable sutures were used. The primary outcome was the incidence of consecutive exotropia. RESULTS A total of 121 children were included in the analysis, 3.66 ± 2.62 years, 53% were male. In 80 children (66%) non-absorbable sutures were used (non-absorbable group) and in 41 children (34%) absorbable sutures were used (absorbable group). Consecutive exotropia (≥ 8 prism dioptres) occurred in ten children (24%) in the absorbable group and in three children (4%) in the non-absorbable group (OR = 8.28, 95% CI = 2.13-32.13; P = 0.002). This difference between groups remained significant after adjustment for potential confounders and follow-up time (HR = 4.98, 95% CI = 1.30-19.05, P = 0.019). Mean follow-up time was 22 and 12 months in the absorbable and non-absorbable groups, respectively (P < 0.001). Two children in the non-absorbable group had pyogenic granuloma that resolved after 3 months of topical steroidal therapy. CONCLUSION Routine use of non-absorbable sutures in BMR surgery for esotropia may be a preferable alternative to absorbable sutures for the prevention of consecutive exotropia.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris E Hartstein
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Morad
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Rozenberg A, Hadad A, Peled A, Dubinsky-Pertzov B, Or L, Eting E, Efrati S, Pras E, Einan-Lifshitz A. Hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion retrospective comparative analysis from two tertiary medical centres. Eye (Lond) 2022; 36:1261-1265. [PMID: 34140653 PMCID: PMC9151674 DOI: 10.1038/s41433-021-01617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/16/2020] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the visual outcome of patients treated for non-arthritic central retinal artery occlusion (CRAO) in a medical centre that uses hyperbaric oxygen therapy (HBOT) as part of the standard of care (SOC) to medical centres that does not. METHODS The study included data from two tertiary medical centres. The medical records of all patients diagnosed with non-arthritic CRAO without a patent cilioretinal artery between January 2010 and December 2018 in two tertiary medical centres were reviewed. RESULTS One hundred and twenty-one patients were treated by HBOT and 23 patients received only SOC. In the HBOT group, best-corrected visual acuity (BCVA) improved from 2.89 ± 0.98 logMAR at presentation to 2.15 ± 1.07 logMAR upon the end of HBOT (P < 0.001), while the SOC group had no significant improvement, from 3.04 ± 0.82 logMAR at presentation to 2.80 ± 1.50 logMAR (P = 0.24). With adjustment for age, gender, and the duration of symptoms, final BCVA in the HBOT group was significantly better compared to the control group (P = 0.023). Rates of patients achieving vision of 20/200 or better were similar between groups (17.4% vs. 19.8%, P = 0.523). CONCLUSION Utilizing HBOT as part of the SOC for CRAO improves the final visual outcome. HBOT is safe and can be implemented, if available, as part of SOC in all tertiary medical centres.
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Affiliation(s)
- Assaf Rozenberg
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel.
| | - Aviel Hadad
- grid.412686.f0000 0004 0470 8989Department of Ophthalmology, Soroka Medical Center, Be’ersheba, Israel
| | - Alon Peled
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Eva Eting
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel
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13
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Dubinsky-Pertzov B, Reinhardt O, Gazit I, Or L, Hecht I, Pras E, Einan-Lifshitz A. The ABCD Keratoconus Grading System-A Useful Tool to Estimate Keratoconus Progression in the Pediatric Population. Cornea 2021; 40:1322-1329. [PMID: 34481408 DOI: 10.1097/ico.0000000000002632] [Citation(s) in RCA: 2] [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] [Received: 08/20/2020] [Accepted: 10/24/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ABCD grading system in pediatric keratoconus. METHODS A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included. RESULTS Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82-15.34). There was no significant change in the Amsler-Krumeich classification in the CXL group. CONCLUSIONS Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler-Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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14
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Mahler OS, Einan-Lifshitz A, Hecht I, Biron R, Pras E, Dubinsky-Pertzov B. Modification of intraocular lens insertion using 4-flanged fixation with a standard cartridge and a 2.4 mm corneal incision in eyes with no capsular support. J Cataract Refract Surg 2021; 47:1227-1233. [PMID: 34468460 DOI: 10.1097/j.jcrs.0000000000000600] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Abstract
A modification of intraocular lens (IOL) implantation, using the 4-flanged IOL fixation technique, through a 2.4 mm corneal incision using a standard cartridge and injector, is presented. An IOL with 4 eyelets is used, through which a 6-0 polypropylene suture is threaded on one side and then loaded into a provided cartridge and inserted to the anterior chamber through a 2.4 mm corneal incision. Using the handshake technique, the suture ends are eventually threaded through the eyelets and secured outside the eye with the creation of 4 flanges. This technique was used in 6 eyes of 5 consecutive patients with the absence of capsular support. During all follow-up visits, the IOLs were well centered and stable, and the flanges were buried in the sclera and covered with the conjunctiva. No complications were recorded. This modification simplifies the technique and reduces the well-known complications of large corneal incisions.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Shemer A, Pras E, Einan-Lifshitz A, Dubinsky-Pertzov B, Hecht I. Association of COVID-19 Vaccination and Facial Nerve Palsy: A Case-Control Study. JAMA Otolaryngol Head Neck Surg 2021; 147:739-743. [PMID: 34165512 DOI: 10.1001/jamaoto.2021.1259] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Peripheral facial nerve (Bell) palsy has been reported and widely suggested as a possible adverse effect of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Israel is currently the leading country in vaccination rates per capita, exclusively using the BNT162b2 vaccine, and all residents of Israel are obligatory members of a national digital health registry system. These factors enable early analysis of adverse events. Objective To examine whether the BNT162b2 vaccine is associated with an increased risk of acute-onset peripheral facial nerve palsy. Design, Setting, and Participants This case-control study was performed from January 1 to February 28, 2021, at the emergency department of a tertiary referral center in central Israel. Patients admitted for facial nerve palsy were matched by age, sex, and date of admission with control patients admitted for other reasons. Exposures Recent vaccination with the BNT162b2 vaccine. Main Outcomes and Measures Adjusted odds ratio for recent exposure to the BNT162b2 vaccine among patients with acute-onset peripheral facial nerve palsy. The proportion of patients with Bell palsy exposed to the BNT162b2 vaccine was compared between groups, and raw and adjusted odds ratios for exposure to the vaccine were calculated. A secondary comparison with the overall number of patients with facial nerve palsy in preceding years was performed. Results Thirty-seven patients were admitted for facial nerve palsy during the study period, 22 (59.5%) of whom were male, and their mean (SD) age was 50.9 (20.2) years. Among recently vaccinated patients (21 [56.7%]), the mean (SD) time from vaccination to occurrence of palsy was 9.3 (4.2 [range, 3-14]) days from the first dose and 14.0 (12.6 [range, 1-23]) days from the second dose. Among 74 matched controls (2:1 ratio) with identical age, sex, and admittance date, a similar proportion were vaccinated recently (44 [59.5%]). The adjusted odds ratio for exposure was 0.84 (95% CI, 0.37-1.90; P = .67). Furthermore, analysis of the number of admissions for facial nerve palsy during the same period in preceding years (2015-2020) revealed a relatively stable trend (mean [SD], 26.8 [5.8]; median, 27.5 [range, 17-35]). Conclusions and Relevance In this case-control analysis, no association was found between recent vaccination with the BNT162b2 vaccine and risk of facial nerve palsy.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Simantov I, Or L, Gazit I, Dubinsky-Pertzov B, Zadok D, Pras E, Hartstein M, Einan Lifshitz A. Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye. Eur J Ophthalmol 2021; 32:1482-1490. [PMID: 34058903 DOI: 10.1177/11206721211020632] [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: 11/16/2022]
Abstract
BACKGROUND Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. METHODS Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. RESULTS Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm (p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D (p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. CONCLUSION CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.
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Affiliation(s)
- Iliya Simantov
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris Hartstein
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan Lifshitz
- Department of Ophthalmology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Dubinsky-Pertzov B, Bernardini FP, Or L, Gazit I, Hartstein ME. Late-Onset Upper Eyelid and Brow Edema as a Long-Term Complication of Hyaluronic Acid Filler Injection. Aesthet Surg J 2021; 41:NP464-NP471. [PMID: 32427315 DOI: 10.1093/asj/sjaa126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Late-onset upper eyelid edema is an uncommonly recognized complication of hyaluronic acid (HA)-based filler injection to the supraorbital area. OBJECTIVES The authors sought to report their experience in diagnosing and managing late-onset upper eyelid edema. METHODS This was a noncomparative, retrospective study of a series of 17 consecutive patients who presented with upper eyelid edema 6 to 24 months after uneventful HA filler injection in the supraorbital area. RESULTS The study group included 17 female patients. The average time of presentation was 13.9 months. Thirteen patients (76.4%) were satisfied after hyaluronidase and requested no further treatment (observation only); 4 patients (23.5%) elected to receive HA filler re-treatment, with satisfactory results. All patients were followed-up for at least 6 months after the re-treatment. CONCLUSIONS The incidence of late-onset upper eyelid edema is likely to increase as the number of patients undergoing HA filler injection to the supraorbital area increases. Our study emphasizes the importance of recognizing this condition and suggests a suitable noninvasive treatment with satisfying results for both the patient and the physician. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris E Hartstein
- Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Dubinsky-Pertzov B, Pras E, Morad Y. Superior oblique split tendon elongation for Brown's syndrome: Long-term outcomes. Eur J Ophthalmol 2021; 31:3332-3336. [PMID: 33685221 DOI: 10.1177/1120672121991050] [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: 11/15/2022]
Abstract
PURPOSE To report the outcomes of superior oblique split tendon elongation in Brown's syndrome. METHODS Charts of 17 consecutive Brown's syndrome patients who underwent superior oblique split tendon elongation were reviewed and clinical data regarding preoperative, intraoperative, and postoperative data were collected. RESULTS About 17 eyes of 17 children with congenital Brown's syndrome underwent superior oblique split tendon elongation between January 2012 and March 2020 by a single surgeon. Mean age at surgery was 5.47 ± 2.82 (range 1.50-13.2). Eight (47.1%) were female. Preoperative deficit of elevation in adduction was -4 in all children. At the end of surgery, all eyes were freely elevated on adduction, on forced duction test. Mean follow-up time of 26.24 ± 11.22 (range 11-53) months. In 15 of 17 children (88.2%), motility improved, orthotropia in primary position was achieved, and head posture eliminated (p < 0.001). Superior oblique palsy occurred in two children, who after reoperation, achieved an acceptable outcome. No intraoperative complications were recorded. CONCLUSION The superior oblique split tendon elongation procedure is a useful surgical technique with stable and satisfying outcomes for the treatment of severe congenital Brown's syndrome.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Morad
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Shemer A, Einan-Lifshitz A, Itah A, Dubinsky-Pertzov B, Pras E, Hecht I. Ocular involvement in coronavirus disease 2019 (COVID-19): a clinical and molecular analysis. Int Ophthalmol 2020; 41:433-440. [PMID: 32929665 PMCID: PMC7489575 DOI: 10.1007/s10792-020-01592-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/05/2020] [Indexed: 02/02/2023]
Abstract
Purpose Coronavirus disease 2019 (COVID-19) caused a global pandemic with millions infected worldwide. Little is known on the ocular involvement associated with the disease. The aim of this study was to assess the clinical and molecular ocular involvement among patients with confirmed COVID-19 admitted to a tertiary care facility. Methods Consecutive patients admitted to the COVID-19 Ward of the Shamir Medical Center in Israel during March and April, 2020 were included. The control group included patients negative for COVID-19 admitted during a similar period to a different ward. Patients were examined by trained Ophthalmologists. SARS-CoV-2 conjunctival swab samples were obtained. Results Included were 48 patients, 16 with confirmed COVID-19 and 32 controls. Median patient age was 68.5 (interquartile range: 31.5, mean: 63 ± 21) years and 48% were male. Active conjunctival injection was present in three patients (19%) with COVID-19, compared to none in the controls (p = 0.034). Patients with COVID-19 were more likely to complain of foreign body sensation (31.3% vs 3.1%, p = 0.005) and redness of the eye (25% vs 0%, p = 0.003). Conjunctival injection was associated with loss of smell and taste (75% vs 7.7%, p = 0.018). Viral conjunctival swab tests all showed negative results for all three viral genes tested (E, N, and RdRp). Conclusions Among patients admitted to a tertiary referral center with confirmed COVID-19, active conjunctival injection was noted in one out of five cases, and was associated with loss of smell and taste. Conjunctival swabs for viral RNA were negative in patients with and without ocular involvement. Electronic supplementary material The online version of this article (10.1007/s10792-020-01592-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Itah
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Faculty of Medicine, The Hebrew University - Hadassah School of Medicine, Hadassah Campus, Jerusalem, Israel
| | - Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Matlow's Ophthalmo-Genetics Laboratory, Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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20
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Dubinsky-Pertzov B, Hecht I, Gazit I, Or L, Mahler O, Rotman S, Pras E, Einan-Lifshitz A. Clinical outcomes of Ankoris toric intraocular lens implantation using a computer-assisted marker system. Int Ophthalmol 2020; 40:3259-3267. [PMID: 32720169 DOI: 10.1007/s10792-020-01511-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the clinical outcomes of patients who underwent cataract surgery with implantation of Ankoris monofocal toric intraocular lens (IOL) (PhysIOL SA, Liège, Belgium) using the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA). METHODS We conducted a retrospective case series of patients who underwent routine cataract extraction and implantation of Ankoris toric IOL using the Zeiss Callisto eye between January 2018 and December 2018 by four senior surgeons. Patients' medical records were reviewed, and clinical outcomes including postoperative refraction, visual acuity outcomes, IOL position and deviation from planned axis were collected. RESULTS Fifty-six eyes of 56 patients were included, 48% were female, and the mean age was 70 ± 8 years. Patients with pseudoexfoliation syndrome, glaucoma or keratoconus were excluded from the study. Pre-operative mean corneal astigmatism was 2.38 ± 0.78 diopters (D), and mean implanted IOL cylindrical power was 3.06 ± 1.07 D. IOL rotation 30 days postoperatively was within 5° in 82% of eyes and between 6° and 10° in 10.8% of eyes. Mean postoperative refractive astigmatism 30 days postoperatively was 0.22 ± 0.36 D; in 84% of eyes the postoperative refractive astigmatism was ≤ 0.50 D. IOL rotation significantly increased between day 1 to day 7 postoperatively (1.91 ± 3.15° to 3.18 ± 3.3°, P = 0.001). However, no significant rotation had occurred between day 7 and day 30 postoperatively (P = 0.093). CONCLUSION Cataract surgery with implantation of Ankoris monofocal toric IOL using the Zeiss Callisto Eye marking system is predictable and effective in reducing refractive astigmatism.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel.
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Ori Mahler
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Shlomo Rotman
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 70300, Be'er Ya'akov, Tel Aviv, Israel
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Dubinsky-Pertzov B, Temkin E, Harbarth S, Fankhauser-Rodriguez C, Carevic B, Radovanovic I, Ris F, Kariv Y, Buchs NC, Schiffer E, Cohen Percia S, Nutman A, Fallach N, Klausner J, Carmeli Y. Carriage of Extended-spectrum Beta-lactamase-producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study. Clin Infect Dis 2020; 68:1699-1704. [PMID: 30204851 DOI: 10.1093/cid/ciy768] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/07/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. METHODS We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE-positive patients. The unexposed group was a random sample of ESBL-PE-negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. RESULTS A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50-3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27-3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70-10.56). CONCLUSIONS ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland
| | - Carolina Fankhauser-Rodriguez
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland
| | - Biljana Carevic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Ivana Radovanovic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Frederic Ris
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Yehuda Kariv
- Department of Surgery, Tel Aviv Sourasky Medical Center, Israel
| | - Nicolas C Buchs
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Eduardo Schiffer
- Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Shimrit Cohen Percia
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Noga Fallach
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Joseph Klausner
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Surgery, Tel Aviv Sourasky Medical Center, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Nutman A, Temkin E, Harbarth S, Carevic B, Ris F, Fankhauser-Rodriguez C, Radovanovic I, Dubinsky-Pertzov B, Cohen-Percia S, Kariv Y, Buchs N, Schiffer E, Fallach N, Klausner J, Carmeli Y. Personalized Ertapenem Prophylaxis for Carriers of Extended-spectrum β-Lactamase–producing Enterobacteriaceae Undergoing Colorectal Surgery. Clin Infect Dis 2019; 70:1891-1897. [DOI: 10.1093/cid/ciz524] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Carriers of extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) who receive cephalosporin-based prophylaxis have twice the risk of surgical site infection (SSI) following colorectal surgery as noncarriers. We tested whether ESBL-PE screening and personalized prophylaxis with ertapenem reduces SSI risk among carriers.
Methods
We conducted a prospective nonrandomized, nonblinded, interventional study in 3 hospitals in Israel, Switzerland, and Serbia. Patients were screened for ESBL-PE carriage before elective colorectal surgery. During the baseline phase, departmental guidelines advised prophylaxis with a cephalosporin plus metronidazole. In the intervention phase, guidelines were changed for ESBL-PE carriers to receive ertapenem. The primary outcome was any type of SSI within 30 days. We calculated adjusted risk differences (ARDs) following logistic regression.
Results
The intention-to-treat analysis compared 209 ESBL-PE carriers in the baseline phase to 269 in the intervention phase. SSI rates were 21.5% and 17.5%, respectively (ARD, –4.7% [95% confidence interval {CI}, –11.8% to 2.4%]). Unplanned crossover was high (15%), so to assess efficacy we performed an as-treated analysis comparing 247 patients who received cephalosporin-based prophylaxis with 221 who received ertapenem. SSI rates were 22.7% and 15.8%, respectively (ARD, –7.7% [95% CI, –14.6% to –.8%]), and rates of SSI caused by ESBL-PE were 6.5% and 0.9%, respectively (ARD, –5.6% [95% CI, –8.9% to –2.3%]). There was no significant difference in the rate of deep SSI. The number needed to treat to prevent 1 SSI in ESBL-PE carriers was 13.
Conclusions
Screening for ESBL-PE carriage before colorectal surgery and personalizing prophylaxis for carriers is efficacious in reducing SSI.
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Affiliation(s)
- Amir Nutman
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Elizabeth Temkin
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Switzerland
| | - Biljana Carevic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Frederic Ris
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Carolina Fankhauser-Rodriguez
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Switzerland
| | - Ivana Radovanovic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Biana Dubinsky-Pertzov
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
| | - Shimrit Cohen-Percia
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
| | - Yehuda Kariv
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Israel
| | - Nicolas Buchs
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Eduardo Schiffer
- Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Noga Fallach
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
| | - Joseph Klausner
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Israel
| | - Yehuda Carmeli
- National Center for Infection Control and Antibiotic Resistance, Tel-Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
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