1
|
Martinuzzi A, Cascaron M, Maldonado N, Schulz J, Roel P, Ocampo R, Traverso M, Carcamo C, Nuñez M, Varela C, Betancurt C, Leiva S, Bogado M. Intestinal rehabilitation in type iii intestinal failure. The patagonian experiences. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.321] [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: 10/23/2022]
|
2
|
Ali TK, Gibbons A, Cartes C, Zarei-Ghanavati S, Gomaa M, Gonzalez I, Gonzalez AE, Ozturk HE, Betancurt C, Perez VL. Use of Autologous Serum Tears for the Treatment of Ocular Surface Disease From Patients With Systemic Autoimmune Diseases. Am J Ophthalmol 2018; 189:65-70. [PMID: 29470971 DOI: 10.1016/j.ajo.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/22/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the safety and efficacy of autologous serum tears (AST) in managing ocular surface disease resistant to conventional therapy in patients with systemic autoimmune disease(s). DESIGN Retrospective, interventional case series. METHODS Records of patients from 2009 to 2015 with systemic autoimmune disease treated with AST (20%-50%) for chronic surface disease were analyzed. Standardized measures of subjective dry eye symptoms, objective dry eye staining of the cornea, and slit-lamp findings including punctate epithelial erosion (PEE), filamentary keratopathy (FK), and corneal epithelial defects (KED) were compared during first and last visit. We attempted to standardize outcomes by creating a scale from 1 to 4 for subjective and objective components: worsening (1), no improvement (2), partial improvement (3), and complete resolution (4). RESULTS Fifty-one patients (101 eyes) were included. The mean age was 59.8 ± 13.2 years (72.5% female). Average use of AST was 14.3 ± 11.7 months. Complete objective improvement of initial slit-lamp findings was achieved in 30% and partial improvement in 55% of eyes. Presence of PEE, FK, and KED decreased from 92.1% to 52.5% (P < .001), from 22.8% to 9.9% (P = .02), and from 5% to 2% (P = .44) of the eyes, respectively. Full subjective improvement of symptoms was achieved in 34.6%, partial in 50.5%, and none in 14.9% of patients. No adverse side effects were noted during follow-up. CONCLUSIONS AST are a safe and effective adjunct therapy in improving both objective signs and subjective symptoms of ocular surface disorders associated with systemic autoimmune disease(s).
Collapse
|
3
|
Zarei-Ghanavati S, Betancurt C, Mas AM, Wang J, Perez VL. Ultra high resolution optical coherence tomography in Boston type I keratoprosthesis. J Ophthalmic Vis Res 2015; 10:26-32. [PMID: 26005549 PMCID: PMC4424714 DOI: 10.4103/2008-322x.156092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 08/20/2013] [Accepted: 10/26/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose: To evaluate the anterior keratoprosthesis-cornea interface in eyes with Boston type I keratoprosthesis (Kpro). Methods: In a prospective non-interventional study, patients with Boston type I Kpro underwent ultra-high resolution optical coherence tomography (UHR-OCT) evaluation. The images were used to measure and describe characteristics of the anterior keratoprosthesis-cornea interface, epithelial interaction at the keratoprosthesis edge and the keratoprosthesis-cornea interface gap. Results: Ten patients including 4 male and 6 female subjects with different preoperative diagnoses, i.e. 8 multiple corneal graft failures and 2 immunological ocular surface diseases, were studied. Mean age was 62.1 ± 20.0 (range, 33.0-83.0) years and mean interval between surgery and UHR-OCT evaluation was 15.2 ± 11.09 months. In eight patients, 360° epithelial growth over the peripheral edge of the Kpro was documented. We detected keratoprosthesis-cornea interface gap in three patients. One subject had developed postoperative endophthalmitis 8 months after surgery and the other two cases were among the high risk group according to the preoperative diagnosis. In one patient with severe ocular hypotony, the Kpro edge was inserted into the anterior stroma and covered with epithelium. Conclusion: UHR-OCT showed that corneal epithelium covers the Kpro edge and seals the potential space between the Kpro and cornea in 80% of cases. The presence of a gap in the interface and lack of epithelial sealing around the Kpro edge might be associated with endophthalmitis.
Collapse
Affiliation(s)
| | | | | | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| |
Collapse
|
4
|
Gibbons A, Johnson TE, Wester ST, Gonzalez AE, Farias CC, Betancurt C, Amescua G, Perez VL. Management of patients with confirmed and presumed mucous membrane pemphigoid undergoing entropion repair. Am J Ophthalmol 2015; 159:846-52.e2. [PMID: 25644537 DOI: 10.1016/j.ajo.2015.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/15/2014] [Revised: 01/25/2015] [Accepted: 01/26/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the outcomes and medical management necessary to achieve successful lid surgery in patients with biopsy-confirmed and presumed mucous membrane pemphigoid. DESIGN Retrospective, interventional case series. METHODS We included patients with positive biopsy results and cases with a typical clinical active bilateral presentation with negative biopsy results but classic features. We identified 11 operated eyes of 7 patients with lid malposition resulting from mucous membrane pemphigoid, particularly cicatricial entropion, that required surgical correction. Complete ophthalmologic history and examination were performed. The main outcome measures were control of ocular inflammation, progression of disease, and surgical success. RESULTS A bandage lens was used in 8 (72.7%) eyes to protect the cornea while immunosuppression and control of disease activity were achieved. Control of ocular inflammation before lid surgery was achieved in all cases. Immunosuppressive treatment before lid surgery was used in all cases for a mean of 15.1 months (range, 8.2 to 33.1 months) and after surgery for a mean of 6.6 months (range, 3.0 to 11.2 months). The oral immunosuppressive drugs used were mycophenolate and cyclophosphamide. Prednisone was used concomitantly in 4 (57%) patients. Full surgical success was achieved in all patients, with 1 patient requiring a second intervention because of residual disease. The mean postoperative follow-up period was 20.8 months (range, 6.0 to 30.5 months). CONCLUSIONS Successful entropion repair in patients with mucous membrane pemphigoid can be achieved if control of inflammation is attained before the procedure. Ocular surface protection while achieving disease control is essential in the management of these patients.
Collapse
Affiliation(s)
- Allister Gibbons
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Thomas E Johnson
- Division of Oculo-Plastic Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Sara T Wester
- Division of Oculo-Plastic Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Astrid E Gonzalez
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Charles C Farias
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Carolina Betancurt
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Guillermo Amescua
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Victor L Perez
- Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
| |
Collapse
|
5
|
Ghanavati SZ, Shousha MA, Betancurt C, Perez VL. Combined conjunctival autograft and overlay amniotic membrane transplantation; a novel surgical treatment for pterygium. J Ophthalmic Vis Res 2015; 9:399-403. [PMID: 25667744 PMCID: PMC4307667 DOI: 10.4103/2008-322x.143386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022] Open
Abstract
The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.
Collapse
Affiliation(s)
- Siamak Zarei Ghanavati
- Department of Ophthalmology, Khatam-al-Anbia Eye Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carolina Betancurt
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Victor L Perez
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
6
|
Farias CC, Ozturk HE, Albini TA, Berrocal AM, Amescua G, Betancurt C, Parel JM, Oliveros MC, Gibbons A, Vargas JM, Perez VL. Use of intraocular video endoscopic examination in the preoperative evaluation of keratoprosthesis surgery to assess visual potential. Am J Ophthalmol 2014; 158:80-86.e2. [PMID: 24582996 DOI: 10.1016/j.ajo.2014.02.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the clinical utility of intraocular videoendoscopy examination for the evaluation of the retina and optic nerve in patients being considered for a Boston type I keratoprosthesis (KPro). DESIGN Interventional case series study. METHODS Ten patients with a history of corneal blindness caused by failed penetrating keratoplasty (PK) and inability to accurately assess visual potential were included in this study. Ophthalmologic examination, B-scan ultrasonography, and pars plana videoendoscopy were carried out to assess the retina and optic nerve before KPro. RESULTS Posterior segment examination was successfully used to evaluate the retina and optic nerve of all patients with opaque corneas. Out of 10 patients that underwent endoscopic examination, 3 (30%) were considered to be adequate candidates for KPro surgery and 7 (70%) were not. This was based on visualized retinal disease and/or optic nerve pathology. Of the 3 patients that underwent KPro surgery, all of them had a significant improvement of vision, including counting fingers to 20/100, hand motion to 20/5, and light perception to 20/80, as suggested by the endoscopy preoperative examination. No complications of the endoscopy procedure were observed. CONCLUSIONS This report demonstrates the successful use of intraocular videoendoscopy to rule out threats to a good visual outcome for patients being considered as candidates for KPro. Direct visualization of the posterior segment can be part of the preoperative algorithm in the decision process of performing a KPro surgery in patients when visual potential is questionable.
Collapse
Affiliation(s)
- Charles C Farias
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hilal E Ozturk
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Carolina Betancurt
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jean-Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary C Oliveros
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Allister Gibbons
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose M Vargas
- Department of Ophthalmology, Cornea Service, Centro Oftalmologico de Valencia, Valencia, Venezuela
| | - Victor L Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ocular Surface Center of Excellence, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| |
Collapse
|