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Patil SA, Sanchez VJ, Bank G, Nair AA, Pandit S, Schuman JS, Dedania V, Parikh R, Mehta N, Colby K, Modi YS. Follow-up Rates After Teleretinal Screening for Diabetic Retinopathy: Assessing Patient Barriers to Care. J Vitreoretin Dis 2023; 7:125-131. [PMID: 37006661 PMCID: PMC10037748 DOI: 10.1177/24741264221147103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Purpose: To study patient follow-up after they engage in a teleretinal screening program and to understand potential barriers to care. Methods: This was a retrospective analysis and a prospective study of telephone-based patient interviews of outpatients screened for diabetic retinopathy (DR) through a teleretinal referral system. Results: Of 2761 patients screened through a teleretinal referral program, 123 (4.5%) had moderate nonproliferative DR (NPDR), 83 (3.0%) had severe NPDR, and 31 (1.1%) had proliferative DR. Of the 114 patients with severe NPDR or worse, 67 (58.8%) saw an ophthalmologist within 3 months of referral. Eighty percent of interviewed patients reported they were not aware of the need for follow-up eye appointments. Conclusions: Of patients with severe retinopathy or worse, 58.8% presented for in-person evaluation and treatment within 3 months of screening. Although this result was negatively affected by factors related to the COVID-19 pandemic, key elements of patient education and improved referral strategies to facilitate in-person treatment are essential to improving follow-up after patients engage in telescreening.
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Affiliation(s)
- Sachi A. Patil
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Victor J. Sanchez
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Georgia Bank
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Archana A. Nair
- Vanderbilt University Department of
Ophthalmology, Nashville, TN, USA
| | - Saagar Pandit
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Joel S. Schuman
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
- Departments of Biomedical Engineering
and Electrical and Computer Engineering, New York University Tandon School of
Engineering, Brooklyn, New York, USA
- Department of Physiology and
Neuroscience, NYU Grossman School of Medicine, NYU Langone Health, New York
University, New York, NY, USA
- Center for Neural Science, College of
Arts and Science, New York University, New York, NY, USA
| | - Vaidehi Dedania
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Ravi Parikh
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
- Manhattan Retina and Eye, New York, NY,
USA
| | - Nitish Mehta
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Kathryn Colby
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Yasha S. Modi
- New York University Department of
Ophthalmology, NYU Langone Health, New York, NY, USA
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Patil S, Colby K, Lazzaro D. MALT Lymphoma Presenting with Peripheral Ulcerative Keratitis. Int Med Case Rep J 2022; 15:485-490. [PMID: 36120701 PMCID: PMC9477148 DOI: 10.2147/imcrj.s361865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sachi Patil
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
- Correspondence: Sachi Patil, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA, Tel +1 (631)-793-2594, Email
| | - Kathryn Colby
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
| | - Douglas Lazzaro
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
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Colby K. Status of Women in Ophthalmology in 2021-Different Year, Same Story? JAMA Ophthalmol 2021; 139:1078-1079. [PMID: 34383021 DOI: 10.1001/jamaophthalmol.2021.3035] [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: 11/14/2022]
Affiliation(s)
- Kathryn Colby
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
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Lonial S, Nooka AK, Thulasi P, Badros AZ, Jeng BH, Callander NS, Potter HA, Sborov D, Zaugg BE, Popat R, Degli Esposti S, Byrne J, Opalinska J, Baron J, Piontek T, Gupta I, Dana R, Farooq AV, Colby K, Jakubowiak A. Management of belantamab mafodotin-associated corneal events in patients with relapsed or refractory multiple myeloma (RRMM). Blood Cancer J 2021; 11:103. [PMID: 34039952 PMCID: PMC8155129 DOI: 10.1038/s41408-021-00494-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022] Open
Abstract
Belantamab mafodotin (belamaf) demonstrated deep and durable responses in patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM) in DREAMM-2 (NCT03525678). Corneal events, specifically keratopathy (including superficial punctate keratopathy and/or microcyst-like epithelial changes (MECs), eye examination findings with/without symptoms), were common, consistent with reports from other antibody–drug conjugates. Given the novel nature of corneal events in RRMM management, guidelines are required for their prompt identification and appropriate management. Eye examination findings from DREAMM-2 and insights from hematology/oncology investigators and ophthalmologists, including corneal specialists, were collated and used to develop corneal event management guidelines. The following recommendations were formulated: close collaboration among hematologist/oncologists and eye care professionals is needed, in part, to provide optimal care in relation to the belamaf benefit–risk profile. Patients receiving belamaf should undergo eye examinations before and during every treatment cycle and promptly upon worsening of symptoms. Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity. Treatment decisions, including dose modifications, should be based on the most severe finding present. These guidelines are recommended for the assessment and management of belamaf-associated ocular events to help mitigate ocular risk and enable patients to continue to experience a clinical benefit with belamaf.
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Affiliation(s)
- Sagar Lonial
- Emory University, Winship Cancer Institute, Atlanta, GA, USA.
| | - Ajay K Nooka
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Ashraf Z Badros
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Douglas Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Brian E Zaugg
- Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Rakesh Popat
- University College London Hospitals, NHS Foundation Trust, London, UK
| | - Simona Degli Esposti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | | | | | | | - Ira Gupta
- GlaxoSmithKline, Upper Providence, PA, USA
| | - Reza Dana
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Asim V Farooq
- University of Chicago Medical Center, Chicago, IL, USA
| | - Kathryn Colby
- New York University Grossman School of Medicine, New York, NY, USA
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Affiliation(s)
- Kathryn Colby
- Department of Ophthalmology, New York University Grossman School of Medicine, New York
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Affiliation(s)
- Kathryn Colby
- New York University Grossman School of Medicine Department of Ophthalmology, New York
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Affiliation(s)
- Kathryn Colby
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois
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Ang M, Moriyama A, Colby K, Sutton G, Liang L, Sharma N, Hjortdal J, Shun Chiu Lam D, P Williams G, Armitage J, S Mehta J. Corneal transplantation in the aftermath of the COVID-19 pandemic: an international perspective. Br J Ophthalmol 2020; 104:1477-1481. [PMID: 32732343 PMCID: PMC7587225 DOI: 10.1136/bjophthalmol-2020-317013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Marcus Ang
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aline Moriyama
- Sorocaba Eye Bank, Brazil.,Federal University of São Paulo, Brazil
| | | | - Gerard Sutton
- Save Sight Institute, University of Sydney, Australia.,New South Wales Eye & Tissue Bank, Australia
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, China
| | - Namrata Sharma
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
| | - Jesper Hjortdal
- The Danish Cornea Bank, Ophthalmology, Aarhus University Hospital, Denmark
| | - Dennis Shun Chiu Lam
- C-MER Dennis Lam Eye Center, C-MER International Eye Care Group Limited, Hong Kong, China.,International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), China
| | - Geraint P Williams
- Worcestershire Acute Hospitals NHS Trust, United Kingdom.,University of Birmingham, United Kingdom
| | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore .,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
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Farooq AV, Degli Esposti S, Popat R, Thulasi P, Lonial S, Nooka AK, Jakubowiak A, Sborov D, Zaugg BE, Badros AZ, Jeng BH, Callander NS, Opalinska J, Baron J, Piontek T, Byrne J, Gupta I, Colby K. Corneal Epithelial Findings in Patients with Multiple Myeloma Treated with Antibody-Drug Conjugate Belantamab Mafodotin in the Pivotal, Randomized, DREAMM-2 Study. Ophthalmol Ther 2020; 9:889-911. [PMID: 32712806 PMCID: PMC7708586 DOI: 10.1007/s40123-020-00280-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Patients with relapsed or refractory multiple myeloma (RRMM) represent an unmet clinical need. Belantamab mafodotin (belamaf; GSK2857916) is a first-in-class antibody-drug conjugate (ADC; or immunoconjugate) that delivers a cytotoxic payload, monomethyl auristatin F (MMAF), to myeloma cells. In the phase II DREAMM-2 study (NCT03525678), single-agent belamaf (2.5 mg/kg) demonstrated clinically meaningful anti-myeloma activity (overall response rate 32%) in patients with heavily pretreated disease. Microcyst-like epithelial changes (MECs) were common, consistent with reports from other MMAF-containing ADCs. METHODS Corneal examination findings from patients in DREAMM-2 were reviewed, and the clinical descriptions and accompanying images (slit lamp microscopy and in vivo confocal microscopy [IVCM]) of representative events were selected. A literature review on corneal events reported with other ADCs was performed. RESULTS In most patients receiving single-agent belamaf (72%; 68/95), MECs were observed by slit lamp microscopy early in treatment (69% had their first event by dose 4). However, IVCM revealed hyperreflective material. Blurred vision (25%) and dry eye (15%) were commonly reported symptoms. Management of MECs included dose delays (47%)/reductions (25%), with few patients discontinuing due to MECs (1%). The first event resolved in most patients (grade ≥2 MECs and visual acuity [each 77%], blurred vision [67%], and dry eye [86%]), with no reports of permanent vision loss to date. A literature review confirmed that similar MECs were reported with other ADCs; however, event management strategies varied. The pathophysiology of MECs is unclear, though the ADC cytotoxic payload may contribute to on- or off-target effects on corneal epithelial cells. CONCLUSION Single-agent belamaf represents a new treatment option for patients with RRMM. As with other ADCs, MECs were observed and additional research is warranted to determine their pathophysiology. A multidisciplinary approach, involving close collaboration between eye care professionals and hematologist/oncologists, is needed to determine appropriate diagnosis and management of these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03525678.
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Affiliation(s)
- Asim V Farooq
- University of Chicago Medical Center, Chicago, IL, USA.
| | - Simona Degli Esposti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Rakesh Popat
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | - Sagar Lonial
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Ajay K Nooka
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Douglas Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Brian E Zaugg
- Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Ashraf Z Badros
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Ira Gupta
- GlaxoSmithKline, Upper Providence, PA, USA
| | - Kathryn Colby
- University of Chicago Medical Center, Chicago, IL, USA
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Farooq AV, Colby K. Contact Lenses in the Management of Corneal Dystrophies. Klin Monbl Augenheilkd 2020; 237:175-179. [DOI: 10.1055/a-0735-9801] [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: 10/27/2022]
Abstract
AbstractAmong the group of diseases comprising corneal dystrophies, there are a number for which contact lenses may be considered. For example, soft contact lenses may be beneficial in the management of recurrent corneal erosions and advanced bullous keratopathy and may lead to disease attenuation in some conditions. They also may be used in conjunction with surgical procedures to promote tissue healing and patient comfort in the postoperative period. Rigid contact lenses may be beneficial in the setting of irregular astigmatism. The present review of the literature will discuss the use of contact lenses in the management of corneal dystrophies.
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Affiliation(s)
- Asim Visal Farooq
- Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois, United States
| | - Kathryn Colby
- Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois, United States
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Paschalis EI, Taniguchi EV, Chodosh J, Pasquale LR, Colby K, Dohlman CH, Shen LQ. Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis. Curr Eye Res 2019; 44:599-606. [PMID: 30632412 DOI: 10.1080/02713683.2019.1568500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: Boston keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14-0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8-883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: keratoprosthesis with glaucoma; KPro NoG: keratoprosthesis without glaucoma; KPro: keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2.
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Affiliation(s)
- Eleftherios I Paschalis
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Elise V Taniguchi
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,d Department of Ophthalmology , Universidade Federal de Sao Paulo , Sao Paulo , Brazil
| | - James Chodosh
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Louis R Pasquale
- e Department of Ophthalmology , Icahn School of Medicine, Mount Sinai Hospital , New York , NY , USA
| | - Kathryn Colby
- f Department of Ophthalmology , University of Chicago , Chicago , IL , USA
| | - Claes H Dohlman
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA
| | - Lucy Q Shen
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA
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Abstract
Purpose This article evaluates whether a targeted, stepwise curriculum for microbypass stent placement leads to successful insertion of the iStent (Glaukos, Laguna Hills, CA) by resident surgeons.
Participants Senior (postgraduate year 4) ophthalmology residents (9 residents) from three classes during the 2015 to 2016, 2016 to 2017, and 2017 to 2018 academic years.
Design Residents participated in a three-stage surgical curriculum. First, a wet laboratory was held for residents to gain familiarity with the device and develop bimanual surgical proficiency. The wet laboratory involved several stations, with each station requiring increased dexterity for successful completion. Next, residents practiced bimanual intraoperative gonioscopy after routine phacoemulsification procedures. Finally, residents performed combined phacoemulsification and iStent insertion under the supervision of an experienced attending surgeon. Primary success was determined by correct anatomical placement of the device confirmed via subsequent intraoperative gonioscopy by the supervising surgeon. Secondary success was measured by change in intraocular pressure (IOP) and number of topical hypotensive medications used after surgery. Residents provided feedback about the effectiveness of the curriculum via an online survey.
Results There were a total of 43 cases. There were no significant intraoperative complications, including hyphema. The iStent location was confirmed during both intraoperative and postoperative gonioscopy and was noted to be in appropriate position for the duration of the follow-up period (6–12 months) for all patients. Average preoperative IOP in our subjects was 17.5 ± 4.0 mm Hg and mean number of preoperative medications was 1.4 ± 1.0. At 6 months' postoperative, average IOP was 14.5 ± 2.2 mm Hg (13% reduction from baseline [±15%]). At 12 months' postoperative, average IOP was 14.4 ± 3.5 mm Hg, with a reduction of 14% (±18%). The mean number of medications at follow-up was 1.2 ± 1.1. Mean postoperative IOP at 6 and 12 months was significantly lower compared with baseline (p = 0.0002, p = 0.0001). Residents agreed that the curriculum prepared them to perform iStent insertion during residency and most residents felt prepared after residency.
Conclusion This stepwise surgical curriculum for trabecular microbypass stent placement leads to successful performance of the procedure by residents and is a useful model for other residency programs.
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Affiliation(s)
- Farida Hakim
- Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Varun Malhotra
- Department of Ophthalmology and Visual Science, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Kathryn Colby
- Department of Ophthalmology and Visual Science, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Kamran Riaz
- Department of Ophthalmology and Visual Science, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
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Chen T, Colby K, Rodriguez S, Slidell M, Kandel J, Shah H. Availability of Resources for After-Hours Surgical Management of Eye Injuries. J Acad Ophthalmol 2018. [DOI: 10.1055/s-0038-1666849] [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: 10/28/2022] Open
Abstract
Background Approximately 2.4 million eye injuries per year occur in the United States. Because of the complexity of these injuries, many of these cases present to academic institutions. Ophthalmology residency programs have a wide range of resources available for eye injuries requiring after-hours surgical intervention.
Purpose The purpose of this study was to determine availability of resources for after-hours eye surgery and their effect on clinician satisfaction.
Methods Association of University Professors of Ophthalmology (AUPO) program directors were surveyed to assess the availability of eye-trained operating room (OR) nurses, functional operating microscopes, and suitable surgical supplies. The primary outcome measure was the availability of resources for after-hours eye surgery. Secondary outcome measures included the impact of resources on clinician satisfaction.
Results Fifty-seven program directors completed the survey. Most programs operated at level 1 trauma centers (95%), had access to a functional microscope (95%), and had frequent adequate surgical supplies (88%). On the other hand, only 28 (49%) programs reported consistent access to OR nurses with ophthalmologic training. Clinician satisfaction scores were three times higher for programs with frequent access to trained surgical OR staff than for programs without (p < 0.001).
Conclusion Approximately half of programs report consistent access to ophthalmologic-trained OR staff after hours. In contrast, most programs report access to a functional microscope and surgical supplies. The results of this survey suggest that directing resources toward improving access to after-hours staffing with specialty OR staff may improve clinician satisfaction.
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Affiliation(s)
- Tina Chen
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
| | - Kathryn Colby
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
| | - Mark Slidell
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
| | - Jessica Kandel
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
| | - Hassan Shah
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
- Section of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, Chicago, Illinois
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Cruzat A, Hamrah P, Cavalcanti BM, Zheng L, Colby K, Pavan-Langston D. Corneal Reinnervation and Sensation Recovery in Patients With Herpes Zoster Ophthalmicus: An In Vivo and Ex Vivo Study of Corneal Nerves. Cornea 2016; 35:619-25. [PMID: 26989956 DOI: 10.1097/ico.0000000000000797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO). METHODS Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves. RESULTS The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft. CONCLUSIONS We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.
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Affiliation(s)
- Andrea Cruzat
- *Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA;†Department of Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile;‡New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA;§Eye Center, Somerville Hospital, Department of Surgery, Cambridge Health Alliance, Somerville, MA; and¶Department of Ophthalmology, University of Chicago, Chicago, IL
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Conaboy C, Rosen A, Colby K, Hirst R. A-52Abnormal Test Scores Not so Abnormal in Children's Baseline Sport Concussion Testing. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.52] [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: 11/12/2022] Open
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Colby K. Medical Treatment of Fuchs' Dystrophy in our Lifetime? Invest Ophthalmol Vis Sci 2013. [DOI: 10.1167/iovs.13-12034] [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: 11/24/2022] Open
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Bunch D, Mcgregor J, Aybar L, Studstill E, Hu Y, Hogan S, Colby K, Poulton C, Mendoza C, Schmitz J, Falk R, Nachman P. Low %CD5+ B cells in patients with ANCA vasculitis portends a shorter time to relapse after rituximab. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yoder JS, Verani J, Heidman N, Hoppe-Bauer J, Alfonso EC, Miller D, Jones DB, Bruckner D, Langston R, Jeng BH, Joslin CE, Tu E, Colby K, Vetter E, Ritterband D, Mathers W, Kowalski RP, Acharya NR, Limaye AP, Leiter C, Roy S, Lorick S, Roberts J, Beach MJ. Acanthamoebakeratitis: The Persistence of Cases Following a Multistate Outbreak. Ophthalmic Epidemiol 2012; 19:221-5. [DOI: 10.3109/09286586.2012.681336] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Loharikar A, Briere E, Schwensohn C, Weninger S, Wagendorf J, Scheftel J, Garvey A, Warren K, Villamil E, Rudroff JA, Kurkjian K, Levine S, Colby K, Morrison B, May A, Anderson S, Daly E, Marsden-Haug N, Erdman MM, Gomez T, Rhorer A, Castleman J, Adams JK, Theobald L, Lafon P, Trees E, Mitchell J, Sotir MJ, Behravesh CB. Four Multistate Outbreaks of Human Salmonella Infections Associated with Live Poultry Contact, United States, 2009. Zoonoses Public Health 2012; 59:347-54. [DOI: 10.1111/j.1863-2378.2012.01461.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Riboflavin-induced ultraviolet light (UV) cross linking has received a significant amount of attention in recent years. It is currently approved in Europe as a treatment for keratoconus and is also being used for other corneal disorders. The goal of this paper is to review in detail seminal papers and studies that have been done to support cross linking as a safe and effective treatment for patients with early stages of keratoconus.
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Affiliation(s)
- Anne Keating
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
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Gower EW, Keay LJ, Oechsler RA, Iovieno A, Alfonso EC, Jones DB, Colby K, Tuli SS, Patel SR, Lee SM, Irvine J, Stulting RD, Mauger TF, Schein OD. Trends in fungal keratitis in the United States, 2001 to 2007. Ophthalmology 2010; 117:2263-7. [PMID: 20591493 DOI: 10.1016/j.ophtha.2010.03.048] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/16/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Fungal keratitis is a serious ocular infection that is considered to be rare among contact lens wearers. The recent Fusarium keratitis outbreak raised questions regarding the background rate of Fusarium-related keratitis and other fungal keratitis in this population. DESIGN Retrospective, multicenter case series. PARTICIPANTS Six hundred ninety-five cases of fungal keratitis cases who presented to 1 of 10 tertiary medical centers from 2001 to 2007. METHODS Ten tertiary care centers in the United States performed a retrospective review of culture-positive fungal keratitis cases at their centers between January 2001 and December 2007. Cases were identified using microbiology, pathology, and/or confocal microscopy records. Information was collected on contact lens status, method of diagnosis, and organism(s) identified. The quarterly number of cases by contact lens status was calculated and Poisson regression was used to evaluate presence of trends. The Johns Hopkins Medicine Institutional Review Board (IRB) and the IRBs at each participating center approved the research. MAIN OUTCOME MEASURES Quarterly number of fungal keratitis cases and fungal species. RESULTS We identified 695 fungal keratitis cases; 283 involved the use of contact lenses. The quarterly number of Fusarium cases increased among contact lens wearers (CLWs) during the period that ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY) was on the market, but returned to prior levels after withdrawal of the product from the market. The quarterly frequency of other filamentous fungi cases showed a statistically significant increase among CLWs comparing October 2004 through June 2006 with July 2006 through December 2007 with January 2001 through September 2004 (P < 0.0001). CONCLUSIONS The quarterly number of Fusarium fungal keratitis cases among CLWs returned to pre-Renu with Moistureloc levels after removal of the product from the market. However, the number of other filamentous fungal keratitis cases, although small, seems to have increased among refractive CLWs. Reasons for these apparent increases are unclear.
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Affiliation(s)
- Emily W Gower
- Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
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Boyd T, Wright C, Colby K, Sens M, Elliott A, Folkerth R, Kinney H, Odendaal H. O139 PASS stillbirth classification: Incorporating mechanism, etiology and recurrence. Prenatal alcohol stillbirth and SIDS (PASS) network, NIAAA/NICHD. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60511-7] [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: 10/20/2022]
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Todani A, Gupta P, Colby K. Type I Boston keratoprosthesis with cataract extraction and intraocular lens placement for visual rehabilitation of herpes zoster ophthalmicus: the "KPro Triple". Br J Ophthalmol 2009; 93:119. [PMID: 19098045 DOI: 10.1136/bjo.2008.146415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Management of corneal scarring following herpes zoster ophthalmicus (HZO) is challenging due to the dense corneal anesthesia that results from viral damage to the subepithelial nerve plexus. These patients have significant risk of graft failure following traditional corneal transplantation. We present a case of a 74-year-old white woman with counting fingers vision from HZO-associated corneal scarring and mature cataract where visual rehabilitation was accomplished with a Type I Boston keratoprosthesis (KPro) and concurrent extracapsular cataract extraction and posterior chamber intraocular lens placement (the "KPro Triple"). One month following surgery, the patient's uncorrected visual acuity improved to 20/25; this level of vision has been maintained for 7 months at present. SURGICAL TECHNIQUE (SEE VIDEO) The keratoprosthesis is assembled by creating a sandwich composed of the KPro front plate, the donor cornea, and the KPro backplate that is secured with a locking ring. The host cornea is then trephined and posterior synechiae lysed to allow access to the mature cataract. The cataract is manually expressed and a posterior chamber intraocular lens implanted. The assembled keratoprosthesis is then sutured into position with 9.0 nylon. A bandage contact lens is placed. COMMENT In patients with severe neurotrophic keratopathy, traditional penetrating keratoplasty is fraught with problems, including poor epithelial healing and corneal ulceration. The Boston KPro can provide rapid visual rehabilitation, despite corneal anaesthesia in these patients, and is currently our treatment of choice as a primary procedure for HZO patients who need corneal transplantation.
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Affiliation(s)
- A Todani
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Huy NHT, Donnadieu B, Mathey F, Muller A, Colby K, Bardeen CJ. A Novel Family of Phosphole-Thiophene Oligomers for Optoelectronic Applications. Organometallics 2008. [DOI: 10.1021/om800644m] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ngoc Hoa Tran Huy
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
| | - Bruno Donnadieu
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
| | - François Mathey
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
| | - Astrid Muller
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
| | - Kathryn Colby
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
| | - Christopher J. Bardeen
- UCR-CNRS Joint Research Chemistry Laboratory, Department of Chemistry, University of California Riverside, Riverside, California 92521-0403
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Jurkunas UV, Bitar MS, Rawe I, Harris DL, Colby K, Joyce NC. Increased clusterin expression in Fuchs' endothelial dystrophy. Invest Ophthalmol Vis Sci 2008; 49:2946-55. [PMID: 18378577 DOI: 10.1167/iovs.07-1405] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the differential expression of the glycoprotein clusterin/apoJ (CLU) in normal and Fuchs' endothelial dystrophy (FED) corneal endothelium and to compare the expression of various forms of CLU in normal and FED tissue. METHODS FED and pseudophakic bullous keratopathy (PBK) corneal buttons were removed during transplantation, and normal corneas were obtained from tissue banks. Human corneal endothelial cells and Descemet's membrane (HCEC-DM) complex was dissected from the stroma. Proteins were separated on 2-D gels and subjected to comparative proteomic analysis. Relative expression of presecretory CLU (pre-sCLU), secretory (s)CLU, and nuclear (n)CLU were compared between normal and FED HCEC-DM by Western blot analysis. Expression of CLU mRNA was compared by using RT-PCR. Subcellular localization of CLU was compared in corneal wholemounts from normal eyes and eyes with FED by immunocytochemistry followed by confocal microscopy. RESULTS Proteomic analysis revealed an apparent increase in CLU expression in FED HCEC-DM compared with the normal control. Western blot analysis demonstrated that pre-sCLU protein expression was 5.2 times higher in FED than in normal samples (P = 3.52E-05), whereas the mature form modified for secretion (sCLU) was not significantly elevated (P = 0.092). Expression of nCLU protein was significantly elevated in FED (P = 0.013). RT-PCR analysis revealed that CLU mRNA was significantly increased (P = 0.002) in FED samples, but not in PBK samples. CLU also had a distinctive localization in FED samples with enhanced intracellular staining around the guttae and in the nuclei of endothelial cells. CONCLUSIONS CLU expression is markedly elevated in FED-affected tissue, pointing to a yet undiscovered form of dysregulation of endothelial cell function involved in FED pathogenesis.
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Affiliation(s)
- Ula V Jurkunas
- Schepens Eye Research Institute, Boston, Massachusetts, USA.
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Jurkunas UV, Rawe I, Bitar MS, Zhu C, Harris DL, Colby K, Joyce NC. Decreased expression of peroxiredoxins in Fuchs' endothelial dystrophy. Invest Ophthalmol Vis Sci 2008; 49:2956-63. [PMID: 18378575 DOI: 10.1167/iovs.07-1529] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare the relative expression of peroxiredoxin (Prx) proteins in normal human corneal endothelium with endothelium in corneas affected by Fuchs' endothelial dystrophy (FED) and between normal human endothelium and epithelial/stromal tissue. METHODS Human corneal endothelial cell-Descemet's membrane (HCEC-DM) complexes from normal and FED corneal buttons were dissected from the epithelium/stroma. For proteomic analysis, HCEC-DM protein extracts were separated by using two-dimensional gel electrophoresis. Relative differences in protein spot density was analyzed. Proteins of interest, including Prx isoforms, were identified by MALDI-TOF (matrix-assisted desorption ionization-time of flight) mass spectrometry. Western blot analysis compared the relative expression of Prx isoforms in normal and FED endothelium and between normal endothelium and normal epithelium/stroma. Expression of Prx-2 mRNA was compared by using real-time PCR. RESULTS Proteomic analysis identified differences in the relative expression of Prx isoforms between normal and FED endothelium. Western blot analysis confirmed that expression of Prx-2, -3, and -5 was significantly decreased (P < 0.05) in FED cells. Normal HCECs expressed significantly (P < 0.05) higher levels of Prx-2 and -3 than did the epithelium/stroma. Expression of Prx-5 was not significantly different (P > 0.05) in the endothelium versus the epithelium/stroma. Real-time PCR analysis revealed that Prx-2 mRNA was significantly decreased (P = 0.027) in FED samples. CONCLUSIONS Prx proteins were identified in human corneal endothelium. The fact that Prx-2 and -3 were expressed at significantly higher levels in HCEC-DM compared with the epithelium/stroma reflects the different physiologic activities of individual corneal cell types. Significantly decreased expression of Prx-2, -3, and -5 in FED may suggest an alteration in the ability of endothelial cells to withstand oxidant-induced damage and may be closely related to the pathogenesis of this disease.
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Affiliation(s)
- Ula V Jurkunas
- Schepens Eye Research Institute, Boston, Massachusetts, USA.
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Affiliation(s)
- Audrey S Chan
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Affiliation(s)
- Ula V Jurkunas
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Affiliation(s)
- Patrick C Yeh
- Massachusetts Ear and Eye Infirmary, Boston 02114, USA
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Affiliation(s)
- Shahzad I Mian
- Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA
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Affiliation(s)
- Kathryn Colby
- Massachusetts Eye and Ear Infirmary, 243 Charles St, Suite 808, Boston, MA 02114, USA.
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Abstract
Fuchs' endothelial dystrophy is a common disease that has been widely studied since its initial report in 1910 by Ernst Fuchs. Although its clinical course and pathologic characteristics are well described, the etiology and inheritance pattern are still ambiguous. Ongoing work is evaluating the role of mitochondrial DNA in the pathogenesis of FED. Significant advances in the surgical treatment of FED, in part utilizing some of the techniques of refractive surgery, are promising thus far. Larger case series are needed to fully assess the safety, efficacy and indications of these techniques. Indeed, the time is right to take "a fresh look at an aging disease" [9].
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Affiliation(s)
- Sheila Borboli
- Department Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Affiliation(s)
- K Colby
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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Affiliation(s)
- K Colby
- Department of Ophthalmology, Ophthalmic Education, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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