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Affiliation(s)
- Christopher T Shah
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, USA
| | - James W Mandell
- Department of Pathology and Neuroscience Graduate Program, University of Virginia School of Medicine, Charlottesville, USA
| | - Maria Kirzhner
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, USA
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Engelhard SB, Aronow ME, Shah CT, Sim AJ, Reddy AK. Malpractice Litigation in Ocular Oncology. Ocul Oncol Pathol 2018; 4:135-140. [PMID: 29765942 DOI: 10.1159/000479559] [Citation(s) in RCA: 5] [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: 06/07/2017] [Revised: 07/14/2017] [Indexed: 11/19/2022] Open
Abstract
Aims The aim of this study was to report and analyze the causes and outcomes of ocular oncology malpractice litigation. Methods The WestLaw® database was reviewed for all litigation related to ophthalmology in the United States from 1930 to 2014. All ocular oncology cases were included in this analysis and compared to other ophthalmic subspecialties. Results Sixteen ocular oncology malpractice cases were included in this study. Overall, 56.3% of the cases were resolved in favor of the defendant. A total of 62.5% of cases were resolved via jury verdict, with 30.0% resulting in plaintiff verdicts with mean adjusted awards of USD 511,244.48, comparable to ophthalmology as a whole. Three cases (18.8%) resulted in settlements with mean adjusted indemnities of USD 828,928.14. A total of 87.5% of cases alleged insufficient intervention resulting in loss of vision and/or death. The most common clinical entities were uveal melanoma (31.3%), retinoblastoma (12.5%), and sebaceous cell carcinoma (12.5%). Conclusions Ocular oncology malpractice litigation was relatively rare and outcomes generally favored defendants; however, unlike other subspecialties in ophthalmology, blindness or premature death were common to all cases, highlighting both the importance of prompt diagnosis and treatment and the difficulty inherent in diagnosing ocular malignancies.
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Affiliation(s)
| | - Mary E Aronow
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Austin J Sim
- School of Law and School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ashvini K Reddy
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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Abstract
To describe a novel technique utilizing an amniotic membrane graft (AMT) to create the mucocutaneous portion of the lower eyelid margin in a modified Hughes eyelid reconstruction for secondary revision or prevention of a hyperemic, hypertrophic conjunctival margin with excessive discharge. This was a retrospective, non-comparative interventional study. Thirty consecutive patients who underwent a modified Hughes reconstruction were included. The first step of the reconstruction was performed in a standard fashion using a tarsoconjunctival flap from the ipsilateral upper eyelid. The second stage was accomplished by the division of the tarsoconjunctival flap. The modification of the procedure included the addition of AMT (Ambio 5®, IOP Ophthalmics, CA) to the new mucocutaneous junction. Main outcome measures included the post Mohs surgery defect size, post-reconstruction complications. One patient received AMT for a revision of a hyperemic lid margin following reconstruction, while 29 subsequent patients received AMT as a primary procedure. The mean size of the post-Mohs defect was 23.75 ± 6.6 mm2 horizontally and 9.1 ± 5.4 mm2 vertically, involving 79.53 ± 16.8% of the lower eyelid. There was no evidence of hyperemic or hypertrophic margin at a mean follow-up of 4.41 ± 2.91 months. The addition of an AMT for the revision, or as a primary procedure for prevention of a hyperemic, hypertrophic eyelid margin with excess mucus production in the post-Hughes lower eyelid reconstruction has favorable outcomes in this preliminary study, however warrants further investigation with larger number of patients and longer follow-up.
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Affiliation(s)
- Shruti Aggarwal
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | | | - Maria Kirzhner
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
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Abstract
PURPOSE To guide risk management in uveitis. METHODS Retrospective review of malpractice verdicts, rulings, and settlements. RESULTS The WestLaw® database was reviewed for lawsuits related to uveitis in the United States from 1930-2014. Twenty-five cases met inclusion criteria, and 48% of these were infectious. Overall, 64% of outcomes favored the defendant ophthalmologist. The most common diagnoses were viral retinitis (28%), iritis (12%), syphilis (8%), and toxoplasmosis (8%). Seven suits (28%) were resolved by settlement, with mean adjusted indemnities of $724,302 (median, $409,390; range, $127,837-2,021,887). Two cases (8%) resulted in plaintiff verdict, with adjusted awards of $1,399,800 and $630,799. CONCLUSIONS Despite being a rare diagnosis, viral retinitis (especially acute retinal necrosis) is the most common clinical entity associated with litigation in uveitis and should be considered early. Educating patients about potential adverse events, early testing for syphilis, and maintaining a positive relationship may also minimize risk.
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Affiliation(s)
- Ashvini K Reddy
- a Wilmer Eye Institute, Johns Hopkins University , Baltimore , MD , USA
| | - Stephanie B Engelhard
- b Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | - Christopher T Shah
- b Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | - Austin J Sim
- c School of Law and School of Medicine , University of Virginia , Charlottesville , Virginia , USA
| | - Jennifer E Thorne
- a Wilmer Eye Institute, Johns Hopkins University , Baltimore , MD , USA.,d Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
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Martin M, Shah CT, Attawala P, Neaman K, Meldrum M, Hassan AS. Objective Brow Height Measurements Following Pretrichial Brow Lift and Upper Lid Blepharoplasty. J Cutan Aesthet Surg 2016; 9:93-6. [PMID: 27398009 PMCID: PMC4924421 DOI: 10.4103/0974-2077.184041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND As the ptotic brow drops below the supraorbital rim, it can exacerbate dermatochalasis by pushing the adjacent skin of the upper lid further down. AIM The purpose of this study was to evaluate the outcomes associated with a combined pretrichial brow lift and upper lid blepharoplasty in patients with dermatochalasis and mild to moderate brow ptosis. MATERIALS AND METHODS A retrospective case series of 46 patients with dermatochalasis and mild to moderate brow ptosis treated with a combined, bilateral pretrichial brow lift and upper lid blepharoplasty from January 2008 to December 2011. Main outcome measures included measurements of brow lift at 3 months post-operatively, complications encountered, patient satisfaction and surgeon satisfaction. RESULTS Outcomes from 46 patients were evaluated. The mean brow lift was 1.85 mm at the lateral canthus, 1.54 mm at the lateral limbus, 1.31 mm at the mid-pupil, and 1.07 mm at the medial limbus. Brow lift at the lateral canthus was significantly more elevated than at the medial limbus (P < 0.001). Minor complications were encountered in seven of 46 patients (15.2%). Mean patient satisfaction score was 3.20 and surgeon satisfaction 3.24 (max = 4, very satisfied). CONCLUSIONS The modified pretrichial brow lift offered effective lateral lift that complements an upper lid blepharoplasty. This technique was met with a high degree of patient and surgeon satisfaction, and had a minimal complication profile.
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Affiliation(s)
- Matthew Martin
- Grand Rapids Medical Education Partners, Michigan State University Plastic Surgery Residency, Department of Plastic Surgery, Charlottesville, VA, USA
| | - Christopher T Shah
- University of Virginia Ophthalmology Residency, Department of Ophthalmology, Charlottesville, VA, USA
| | - Payal Attawala
- University of Michigan Anesthesiology Residency, Department of Anesthesiology, Ann Arbor, MI
| | - Keith Neaman
- Grand Rapids Medical Education Partners, Michigan State University Plastic Surgery Residency, Department of Plastic Surgery, Charlottesville, VA, USA
| | - Melissa Meldrum
- Department of Eye Plastic and Facial Cosmetic Surgery, Grand Rapids, Michigan; Department of Surgery, Spectrum Health Hospital, Grand Rapids, Michigan
| | - Adam S Hassan
- Department of Eye Plastic and Facial Cosmetic Surgery, Grand Rapids, Michigan; Department of Surgery, Spectrum Health Hospital, Grand Rapids, Michigan
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Shah CT, Ward TS, Matsumoto JA, Shildkrot Y. Foveal hypoplasia in autosomal recessive spastic ataxia of Charlevoix-Saguenay. J AAPOS 2016; 20:81-3. [PMID: 26917082 DOI: 10.1016/j.jaapos.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
A 14-year-old boy presented with a presumed diagnosis of autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). The neurological examination, nerve conduction study, and brain imaging results were all consistent with the diagnosis. The ophthalmologic examination was notable for a prominent myelinated nerve fiber layer extending from the disk along the major temporal arcades in both eyes. Loss of foveal depression was noted clinically and on spectral domain optical coherence tomography. This case highlights a novel finding that may aid in the diagnosis of ARSACS.
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Affiliation(s)
- Christopher T Shah
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia
| | - Tyson S Ward
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia
| | - Julie A Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Yevgeniy Shildkrot
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia.
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Boss JD, Shah CT, Elner VM, Hassan AS. Assessment of Office-Based Practice Patterns on Protective Eyewear Counseling for Patients With Monocular Vision. Ophthalmic Plast Reconstr Surg 2014; 31:361-3. [PMID: 25393903 DOI: 10.1097/iop.0000000000000348] [Citation(s) in RCA: 2] [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: 11/25/2022]
Abstract
PURPOSE To investigate the practice patterns of office-based counseling on the importance of protective eyeglasses in monocular patients and to offer our counseling recommendations. METHODS In this cross-sectional study, data were collected in the form of surveys. Surveys were administered at an oculoplastic ophthalmology clinic in Michigan. Inclusion criteria included adults with vision of 20/400 or worse in only 1 eye. Survey questions were focused on whether patients with monocular vision recall being previously counseled by their primary ophthalmologist about wearing eye protection. RESULTS A total of 60 surveys were completed. The average age was 62.2 years old (range: 23-90 years old). Of the completed surveys, 56.7% (34/60) did not recall receiving education about wearing protective glasses over their better seeing eye, while 35.0% (21/60) recalled having received education from their referring ophthalmologist about eye protection, and 8.3% (5/60) were uncertain about receiving eye protection counseling. Twenty (33.3%) patients reported the reason for decreased vision. Of those, 35% (7/20) of patients reported monocular vision resulting from trauma, while 65% (13/20) reported vision loss due to other reasons. There was no significant difference in recall of receiving counseling about the importance of eye protection between the 2 groups (p = 0.74). CONCLUSIONS The results of this study highlight the current counseling short-comings, as more than half (56.7%) of patients surveyed did not recall being counseled on the importance of protecting their better seeing-eye, or ways of doing so. More counseling on protective eyewear needs to be incorporated into the preferred practice pattern for care of patients with monocular visual impairment because these patients are vulnerable to the devastating consequences of complete blindness as a result of an injury to their functioning eye.
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Affiliation(s)
- Joseph D Boss
- *Kresge Eye Institute, Wayne State University, Detroit, Michigan; †Department of Ophthalmology, University of Virginia, Charlottesville, Virginia; ‡Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; §Eye Plastic & Facial Cosmetic Surgery, Grand Rapids, Michigan; and ‖Department of Surgery, Spectrum Health Hospital, Grand Rapids, Michigan, U.S.A
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Shevchenko L, Boss J, Shah CT, Droste PJ, Hassan AS. Alphasphere as a successful ocular implant in primary enucleation and secondary orbital implant exchange. Orbit 2013; 32:161-165. [PMID: 23514047 DOI: 10.3109/01676830.2013.772208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/01/2023]
Abstract
PURPOSE To describe the surgical technique for a novel poly-HEMA (2-hydroxyethyl methacralate)[PHEMA] implant (Alphasphere, Addition Technology, Des Plaines, IL) in primary enucleation and placement of secondary orbital implant. METHODS Retrospective chart review of all patients receiving an Alphasphere implant for primary enucleation or secondary implant exchange from October 2009 to 2011. Interval follow-up was performed again on January 2013. Patient demographics, indications for surgery, and post-operative complications were reviewed. RESULTS Twelve patients received an Alphasphere implant for primary enucleation (n = 10) or secondary exchange (n = 2), with follow-up that ranged from 2 weeks to 14 months. The study included 9 adult and 3 pediatric patients with a mean age of 40 years, range 8-82 years. The indication for enucleation included: painful blind eye (n = 9), enophthalmos with difficult prosthesis fit in cases of secondary implant exchange (n = 2), and prophylaxis for sympathetic ophthalmia (n = 1). Only one patient required removal of the implant, due to a sinus infection with subsequent extrusion of the implant. Otherwise, the only other complication experienced was slight implant migration (n = 1). CONCLUSION This initial report indicates that Alphasphere can be successfully used in the management of an anophthalmic socket. The advantages of the Alphasphere implant include: it does not require tissue wrapping, extraocular muscles can be directly sutured to the implant, it maintains a smooth surface to limit risk of exposure due to conjunctival breakdown, and undergoes anterior orbital fibrovascular ingrowth which optimizes prosthesis location and socket motility.
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Affiliation(s)
- Liliya Shevchenko
- Metro Health Hospital, Michigan State University Ophthalmology Residency, Grand Rapids, Michigan, USA
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Heo YS, Cabrera LM, Bormann CL, Shah CT, Takayama S, Smith GD. Dynamic microfunnel culture enhances mouse embryo development and pregnancy rates. Hum Reprod 2010; 25:613-22. [PMID: 20047936 DOI: 10.1093/humrep/dep449] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite advances in in vitro manipulation of preimplantation embryos, there is still a reduction in the quality of embryos produced leading to lower pregnancy rates compared with embryos produced in vivo. We hypothesized that a dynamic microfunnel embryo culture system would enhance outcomes by better mimicking the fluid-mechanical and biochemical stimulation embryos experience in vivo from ciliary currents and oviductal contractions. METHODS AND RESULTS Mouse embryos were cultured in microdrop-static control, microfunnel-static control or microfunnel-dynamic conditions with microfluidics. All groups tested had greater than 90% total blastocyst development from zygotes after 96 h culture. Blastocyst developmental stage was significantly enhanced (P < 0.01) under dynamic microfunnel culture conditions as evidenced by an increased percentage of hatching or hatched blastocysts (Microdrop-control 31%; Microfunnel-control 23%; Microfunnel-pulsatile 71%) and significantly higher (P < 0.01) average number of cells per blastocyst (Microdrop-control 67 +/- 3; Microfunnel-control 60 +/- 3; Microfunnel-pulsatile 109 +/- 5). Blastocyst cell numbers in dynamic microfunnel cultures (109 +/- 5) more closely matched numbers obtained from in vivo grown blastocysts (144 +/- 9). Importantly, dynamic microfunnel culture significantly improved embryo implantation and ongoing pregnancy rates over static culture to levels approaching that of in utero derived preimplantation embryos. CONCLUSIONS The improved pregnancy outcomes along with the simple and user-friendly design of the microfluidic/microfunnel system has potential to alleviate many inefficiencies in embryo production for biomedical research, genetic gain in domestic species and assisted reproductive technologies in humans.
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Affiliation(s)
- Y S Heo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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