1
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Dallalzadeh LO, Villatoro GA, Chen L, Sim MS, Movaghar M, Robbins SL, Karlin JN, Khitri MR, Velez FG, Korn BS, Demer JL, Rootman DB, Granet DB, Kikkawa DO. Teprotumumab for Thyroid Eye Disease-related Strabismus. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00336. [PMID: 38319994 DOI: 10.1097/iop.0000000000002611] [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: 02/08/2024]
Abstract
PURPOSE To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility. METHODS We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab. RESULTS Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation (p < 0.001), without significant change in mean horizontal deviation (p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye (p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion. CONCLUSIONS Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - George A Villatoro
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Lillian Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Myung S Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Mansoor Movaghar
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Shira L Robbins
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Justin N Karlin
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Monica R Khitri
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Federico G Velez
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
| | - Joseph L Demer
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, U.S.A.; and
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - David B Granet
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
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2
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Dallalzadeh LO, Ediriwickrema LS, Fung SE, Men CJ, Kossler AL, Kupcha AC, Mawn LA, Burkat CN, van Landingham SW, Conger JR, Simmons B, Pham C, Akella SS, Setabutr P, Ho T, Couch SM, Kim JS, Demirci H, Korn BS, Kikkawa DO, Liu CY. Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study. Orbit 2024; 43:41-48. [PMID: 36880205 DOI: 10.1080/01676830.2023.2186435] [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: 10/14/2022] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM). METHODS In this retrospective case-control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (-TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality. RESULTS Among eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality. CONCLUSIONS Patients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Lilangi S Ediriwickrema
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Sammie E Fung
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
| | - Clara J Men
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Andrea L Kossler
- Division of Oculoplastic and Orbital Surgery, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anna C Kupcha
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Louise A Mawn
- Division of Oculoplastics and Orbital Disease, Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Cat N Burkat
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Suzanne W van Landingham
- Oculoplastic, Orbital, & Cosmetic Facial Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Jordan R Conger
- Division of Ophthalmic Plastic and Reconstructive Surgery, Gavin Herbert Eye Institute, UC Irvine, Irvine, California, USA
| | - Brittany Simmons
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Chau Pham
- Division of Oculoplastic, Orbit, and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Sruti S Akella
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Pete Setabutr
- Oculoplastic and Reconstructive Surgery Service, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA
| | - Tiffany Ho
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Steven M Couch
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jane S Kim
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hakan Demirci
- Division of Eye Plastic, Orbital and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, California, USA
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Dallalzadeh LO, Qualliotine JR, Crawford KL, Liu CY, Kikkawa DO, Brumund KT, Orosco RK, Korn BS. Orbital floor reconstruction via autologous radial forearm free flap with palmaris longus tendon. Orbit 2024; 43:126-130. [PMID: 35666706 DOI: 10.1080/01676830.2022.2081986] [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: 03/28/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
We describe reconstruction of the orbital floor following suprastructure maxillectomy for resection of maxillary squamous cell carcinoma utilizing an osteocutaneous radial forearm free flap and palmaris longus tendon.
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Affiliation(s)
- Liane O Dallalzadeh
- UC San Diego Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, La Jolla, CA, USA
| | | | | | - Catherine Y Liu
- UC San Diego Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, La Jolla, CA, USA
| | - Don O Kikkawa
- UC San Diego Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, La Jolla, CA, USA
- UC San Diego Department of Surgery, Division of Plastic and Reconstructive Surgery, La Jolla, CA, USA
| | - Kevin T Brumund
- Department of Otolaryngology, UC San Diego, La Jolla, CA, USA
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Ryan K Orosco
- Department of Otolaryngology, UC San Diego, La Jolla, CA, USA
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Bobby S Korn
- UC San Diego Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, La Jolla, CA, USA
- UC San Diego Department of Surgery, Division of Plastic and Reconstructive Surgery, La Jolla, CA, USA
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4
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Dallalzadeh LO, Ting M, Topilow N, Robbins SL, Liu CY, Burkat CN, Korn BS, Kikkawa DO. Teprotumumab-related Cutaneous Hypersensitivity Reactions. Ophthalmic Plast Reconstr Surg 2023; 39:e208-e210. [PMID: 37656913 DOI: 10.1097/iop.0000000000002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The authors report 4 cases of cutaneous hypersensitivity reactions developing in the course of teprotumumab treatment for thyroid eye disease. The onset of the cutaneous hypersensitivity reaction was also observed during the treatment course in all cases, between the second and fifth infusions. Teprotumumab-related cutaneous reactions suggest a possible immunogenic component of the monoclonal antibody and highlight the importance of close monitoring during treatment.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
| | - Michelle Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
| | - Nicole Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
| | - Shira L Robbins
- Division of Pediatric Ophthalmology and Adult Strabismus, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
| | - Cat N Burkat
- Division of Ophthalmic Facial Plastic Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, WI, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, CA, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, UC San Diego, La Jolla, CA, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, CA, U.S.A
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5
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Dallalzadeh LO, Robillard EG, Goodyear K, Khitri MR. Eyelid, Orbital, and Lacrimal Disorders in the Neonate. Neoreviews 2023; 24:e616-e625. [PMID: 37777617 DOI: 10.1542/neo.24-10-e616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Liane O Dallalzadeh
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
| | - Emily G Robillard
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Kendall Goodyear
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
| | - Monica R Khitri
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
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Abstract
We report two fatal cases of rhino-orbital-cerebral mucormycosis associated with COVID-19 infection. Both patients had pre-existing diabetes mellitus type 2, were treated with corticosteroids, and developed ketoacidosis. Both patients rapidly declined owing to rapid extension of the infection into the intracranial cavity. We postulate that additional risk factors for opportunistic fungal infection exist in COVID-19 patients including mechanical ventilation and Sars-CoV-2 induced immunosuppression. The ophthalmologist's role is particularly important in the early diagnosis of mucormycosis associated with COVID-19.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Daniel J Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
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7
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Dallalzadeh LO, Ang MJ, Beazer AP, Spencer DB, Afshari NA. Peripheral ulcerative keratitis secondary to severe hidradenitis suppurativa. Am J Ophthalmol Case Rep 2022; 25:101403. [PMID: 35198822 PMCID: PMC8844392 DOI: 10.1016/j.ajoc.2022.101403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe a unique case of peripheral ulcerative keratitis secondary to isolated, severe hidradenitis suppurativa (HS). Observation A 31-year-old male with HS presented with a red painful right eye with best corrected visual acuity of count fingers at 3 feet with peripheral corneal thinning, inferior descemetocele, and adjacent infiltrate. Work-up revealed negative corneal cultures and positive ANA, ANCA, and rheumatoid factor without other autoimmune or rheumatologic history or symptomatology. He was treated with topical corticosteroids with improvement until he was lost to follow-up before tumor necrosis factor-a inhibitor therapy could be started. Upon re-presentation, he was found to have corneal perforation. Conclusions and importance Coexistence of inflammatory eye disease and HS is known but rare, and most commonly manifests as anterior uveitis. Here we present a unique case of peripheral ulcerative keratitis secondary to HS and demonstrate the importance of ophthalmologists’ familiarly with this systemic disease and its variety of ocular manifestations.
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Affiliation(s)
- Liane O Dallalzadeh
- UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA, USA
| | - Michael J Ang
- UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA, USA
| | - Alex P Beazer
- UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA, USA
| | - Doran B Spencer
- UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA, USA
| | - Natalie A Afshari
- UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA, USA
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8
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Dallalzadeh LO, Brummel K, Robbins SL. Isolated bifid medial rectus muscle in adult-onset divergence insufficiency esotropia. J AAPOS 2021; 25:192-193. [PMID: 33932567 DOI: 10.1016/j.jaapos.2021.01.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/19/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
We present the case of a 77-year-old woman with adult-onset divergence insufficiency esotropia in which a bifid medial rectus muscle was identified intraoperatively. The patient had no past ocular, medical, syndromic, or traumatic history associated with this isolated horizontal rectus anomaly. Following identification of the bifid muscle, the original surgical plan was altered to asymmetric recession of the superior and inferior medical rectus heads.
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Affiliation(s)
- Liane O Dallalzadeh
- Shiley Eye Institute, University of California, San Diego, La Jolla, California.
| | - Kirsta Brummel
- Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Shira L Robbins
- Shiley Eye Institute, University of California, San Diego, La Jolla, California
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9
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Abstract
Purpose: To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab.Methods: A retrospective series of patients with chronic thyroid eye disease (TED) and low clinical activity score (CAS) treated with teprotumumab infusion therapy. Inclusion criteria: adults over 18 years of age with TED for greater than 9 months and CAS of 1 or less. All patients included in the analyses completed a full series of eight infusions. Primary outcome measures included proptosis and eyelid retraction in both eyes. Secondary outcomes included CAS, reported adverse effects, and surgery post-treatment.Results: Nine patients met all inclusion criteria, seven females and two males with mean age of 50.2 years and TED diagnosis of 6.25 years. Three patients had a baseline CAS of 1 and 6 had a CAS of 0. Mean proptosis reduction in the worse eye was 4.0 ± 2.4 mm immediately post-treatment (p = .02). Five out of nine patients had extended follow-up (average 16.8 ± 5.1 weeks) with mean proptosis reduction of 4.2 ± 2.8 mm at last follow-up (p = .03). Mean reduction in eyelid retraction in the worse eye was 0.3 ± 1.6 mm post-treatment (p = .58) and 0.5 ± 0.9 mm at last follow-up (p = .30). Three patients reported infusion-related myalgias, two hair thinning, one exacerbated chronic tinnitus, and one hyperglycemia.Conclusions: We report clinically and statistically significant proptosis reduction in nine patients with chronic, low CAS TED treated with teprotumumab. Teprotumumab may be an effective treatment option for these patients.
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Affiliation(s)
- Daniel J Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
| | - Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
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10
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Abstract
We report two fatal cases of rhino-orbital-cerebral mucormycosis associated with COVID-19 infection. Both patients had pre-existing diabetes mellitus type 2, were treated with corticosteroids, and developed ketoacidosis. Both patients rapidly declined owing to rapid extension of the infection into the intracranial cavity. We postulate that additional risk factors for opportunistic fungal infection exist in COVID-19 patients including mechanical ventilation and Sars-CoV-2 induced immunosuppression. The ophthalmologist's role is particularly important in the early diagnosis of mucormycosis associated with COVID-19.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Daniel J Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
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11
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Hakimi AA, Lalehzarian SP, Lalehzarian AS, Dallalzadeh LO, Boodaie BD, Oggoian R, Hakim MA. The utility of a smartphone-enabled ophthalmoscope in pre-clinical fundoscopy training. Acta Ophthalmol 2019; 97:e327-e328. [PMID: 30302917 DOI: 10.1111/aos.13934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Amir A. Hakimi
- Chicago Medical School at Rosalind Franklin University of Medicine and Science North Chicago Illinois USA
| | - Simon P. Lalehzarian
- Chicago Medical School at Rosalind Franklin University of Medicine and Science North Chicago Illinois USA
| | - Aaron S. Lalehzarian
- Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science North Chicago Illinois USA
| | | | | | - Rosanne Oggoian
- Clinical Sciences Department Rosalind Franklin University of Medicine and Science North Chicago Illinois USA
| | - Melinda A. Hakim
- Department of Ophthalmology Cedars Sinai Medical Center Los Angeles California USA
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12
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Quinn GR, Severdija ON, Chang Y, Dallalzadeh LO, Singer DE. Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk. J Am Heart Assoc 2018; 7:JAHA.117.007537. [PMID: 29886417 PMCID: PMC6220538 DOI: 10.1161/jaha.117.007537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Guidelines for anticoagulation in atrial fibrillation (AF) assume that stroke risk scheme point scores correspond to fixed stroke rates. However, reported stroke rates vary widely across AF cohort studies, including studies from the same country. Reasons for this variation are unclear. This study compares methodologies used to assemble and analyze large AF cohorts worldwide and assesses potential bias in estimating stroke rates. Methods and Results From a previous systematic review of AF cohorts, we analyzed studies including at least 5000 patients. We assessed methods used to generate rates of ischemic stroke off anticoagulants, according to a structured inventory of database interrogation methods. Nine studies (497 578 total patients) met our criteria. Overall cohort stroke rates ranged from 0.45% to 7.03% per year. In bivariate study‐level analysis, multiple features were associated with higher stroke rates, including AF identified as inpatients versus outpatients (rate ratio 2.60, 95% confidence interval, 1.19, 5.68), and lack of clinical validation of outcome events (rate ratio 4.09, 95% confidence interval, 1.06, 15.70). European studies reported rates more than 4‐fold higher than North American studies. International Classification of Diseases (ICD) coding schemes for outcomes varied widely. Multiple high rate features coexisted in the same studies. Conclusions Among AF cohort studies, differences in the composition, method of assembly, determination of clinical features and outcomes, and analytic approach were strongly associated with reported stroke rates. Our study highlights the need for standardized and validated methodologies for AF cohort assembly and analysis to generate accurate stroke rates to better support anticoagulation guidelines for patients with AF.
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Affiliation(s)
- Gene R Quinn
- Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA.,Alaska Heart and Vascular Institute, Anchorage, AK
| | - Olivia N Severdija
- Harvard Medical School, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yuchiao Chang
- Harvard Medical School, Boston, MA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Daniel E Singer
- Harvard Medical School, Boston, MA .,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
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Dallalzadeh LO, Go AS, Chang Y, Borowsky LH, Fang MC, Singer DE. Stability of High-Quality Warfarin Anticoagulation in a Community-Based Atrial Fibrillation Cohort: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. J Am Heart Assoc 2016; 5:JAHA.116.003482. [PMID: 27451456 PMCID: PMC5015384 DOI: 10.1161/jaha.116.003482] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Warfarin reduces ischemic stroke risk in atrial fibrillation (AF) but increases bleeding risk. Novel anticoagulants challenge warfarin as stroke-preventive therapy for AF. They are available at fixed doses but are more costly. Warfarin anticoagulation at a time in therapeutic range (TTR) ≥70% is similarly as effective and safe as novel anticoagulants. It is unclear whether AF patients with TTR ≥70% will remain stably anticoagulated and avoid the need to switch to a novel anticoagulant. We assessed stability of warfarin anticoagulation in AF patients with an initial TTR ≥70%. METHODS AND RESULTS Within the community-based Anticoagulation and Risk Factors in AF (ATRIA) cohort followed from 1996 to 2003, we identified 2841 new warfarin users who continued warfarin over 9 months. We excluded months 1 to 3 to achieve a stable dose. For the 987 patients with TTR ≥70% in an initial 6-month period (TTR1; months 4-9), we described the distribution of TTR2 (months 10-15) and assessed multivariable correlates of persistent TTR ≥70%. Of patients with TTR1 ≥70%, 57% persisted with TTR2 ≥70% and 16% deteriorated to TTR2 <50%. Only initial TTR1 ≥90% (adjusted odds ratio 1.47, 95% CI 1.07-2.01) independently predicted TTR2 ≥70%. Heart failure was moderately associated with marked deterioration (TTR2 <50%); adjusted odds ratio 1.45, 95% CI 1.00-2.10. CONCLUSIONS Nearly 60% of AF patients with high-quality TTR1 on warfarin maintained TTR ≥70% over the next 6 months. A minority deteriorated to very poor TTR. Patient features did not strongly predict TTR in the second 6-month period. Our analyses support watchful waiting for AF patients with initial high-quality warfarin anticoagulation before considering alternative anticoagulants.
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Affiliation(s)
| | - Alan S Go
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Yuchiao Chang
- Harvard Medical School, Boston, MA Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Leila H Borowsky
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, CA
| | - Daniel E Singer
- Harvard Medical School, Boston, MA Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
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14
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Dallalzadeh LO, Go AS, Chang Y, Borowsky LH, Fang MC, Singer DE. Abstract WP303: Stability of High-Quality Warfarin Anticoagulation in a Community-Based Atrial Fibrillation Cohort: The ATRIA Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp303] [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: 11/16/2022]
Abstract
Introduction:
Warfarin reduces stroke risk in atrial fibrillation (AF), but increases bleed risk. Frequent testing with dose adjustment is needed to maintain INR levels in the therapeutic range of 2.0-3.0. Novel anticoagulants (NOACs) now challenge warfarin as stroke-preventive therapy for AF. They are available at fixed doses but costlier. Warfarin anticoagulation at a time in therapeutic range (TTR) ≥70% is similarly effective and safe as NOACs. It is unclear whether AF patients with TTR ≥70% will remain stably anticoagulated and avoid the need to switch to a NOAC. We assessed stability of warfarin anticoagulation in AF patients with an initial TTR ≥70% primarily managed by anticoagulation clinics.
Hypothesis:
AF patients who achieve TTR ≥70% in the first 6 months of warfarin therapy will maintain high TTR subsequently.
Methods:
Within the community-based ATRIA cohort of AF patients, we identified 2521 new warfarin users who continued warfarin therapy over 15 months. We excluded months 1-3 to achieve stable dose. For patients with TTR1 (months 4-9) ≥70% (TTR by Rosendaal method), we describe the distribution of TTR2 (months 10-15) and assess multivariable (logistic regression) correlates of persistent TTR ≥70%.
Results:
Of 1074 patients with TTR1 ≥70%, 57% (95%CI: 53-61%) persisted with TTR2 ≥70% (Figure). Of multiple patient features, only initial TTR1 ≥90%, aOR [95% CI]: 1.43 [1.05,1.93]); and heart failure aOR: 0.78 [0.57, 1.06]) independently predicted TTR2 ≥70%.
Conclusions:
Nearly 60% of AF patients with high quality initial 6-month TTR on warfarin will maintain TTR ≥70% over the next 6 months. A minority deteriorate to very poor TTR. Patient features do not strongly predict deterioration. Our analyses support watchful waiting for AF patients with initial high quality warfarin anticoagulation before switching to a NOAC.
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Affiliation(s)
| | - Alan S Go
- Div of Rsch, Kaiser Permanente Northern California, San Francisco, CA
| | - Yuchiao Chang
- Div of General Internal Medicine, Massachusetts General Hosp, Boston, MA
| | - Leila H Borowsky
- Div of General Internal Medicine, Massachusetts General Hosp, Boston, MA
| | - Margaret C Fang
- Dept of Medicine, Univ of California, San Francisco, San Francisco, CA
| | - Daniel E Singer
- General Internal Medicine, Massachusetts General Hosp, Boston, MA
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Ho VM, Dallalzadeh LO, Karathanasis N, Keles MF, Vangala S, Grogan T, Poirazi P, Martin KC. GluA2 mRNA distribution and regulation by miR-124 in hippocampal neurons. Mol Cell Neurosci 2014; 61:1-12. [PMID: 24784359 DOI: 10.1016/j.mcn.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 03/17/2014] [Accepted: 04/12/2014] [Indexed: 11/19/2022] Open
Abstract
AMPA-type glutamate receptors mediate fast, excitatory neurotransmission in the brain, and their concentrations at synapses are important determinants of synaptic strength. We investigated the post-transcriptional regulation of GluA2, the calcium-impermeable AMPA receptor subunit, by examining the subcellular distribution of its mRNA and evaluating its translational regulation by microRNA in cultured mouse hippocampal neurons. Using computational approaches, we identified a conserved microRNA-124 (miR-124) binding site in the 3'UTR of GluA2 and demonstrated that miR-124 regulated the translation of GluA2 mRNA reporters in a sequence-specific manner in luciferase assays. While we hypothesized that this regulation might occur in dendrites, our biochemical and fluorescent in situ hybridization (FISH) data indicate that GluA2 mRNA does not localize to dendrites or synapses of mouse hippocampal neurons. In contrast, we detected significant concentrations of miR-124 in dendrites. Overexpression of miR-124 in dissociated neurons results in a 30% knockdown of GluA2 protein, as measured by immunoblot and quantitative immunocytochemistry, without producing any changes in GluA2 mRNA concentrations. While total GluA2 concentrations are reduced, we did not detect any changes in the concentration of synaptic GluA2. We conclude from these results that miR-124 interacts with GluA2 mRNA in the cell body to downregulate translation. Our data support a model in which GluA2 is translated in the cell body and subsequently transported to neuronal dendrites and synapses, and suggest that synaptic GluA2 concentrations are modified primarily by regulated protein trafficking rather than by regulated local translation.
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Affiliation(s)
- Victoria M Ho
- Interdepartmental Program for Neuroscience, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA
| | - Liane O Dallalzadeh
- Interdepartmental Program for Neuroscience, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA
| | - Nestoras Karathanasis
- Department of Biology, University of Crete, Heraklion, Crete, Greece; Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - Mehmet F Keles
- Interdepartmental Program for Molecular, Cellular and Integrative Physiology, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Panayiota Poirazi
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - Kelsey C Martin
- Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA; Integrated Center for Learning and Memory, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1737, USA.
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