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Skaat A.,The Goldschleger Eye Institute | Skaat A.,Tel Aviv University | Zadok D.,Tel Aviv University | Zadok D.,Assaf Harofeh Medical Center | And 11 more authors.
European Journal of Ophthalmology | Year: 2014

Purpose: To describe the antibacterial activity of treatment with riboflavin and ultraviolet A light (UVA) in cases of severe infectious keratitis. Methods: A retrospective analysis was performed of an interventional case series in which 6 eyes of 6 patients with severe infectious keratitis, all of whom were refractive to multidrug conventional therapy, were treated with riboflavin/UVA. The procedure was conducted according to the standardized protocol of corneal collagen crosslinking (CXL) for keratoconus. Best spectacle-corrected visual acuity and clinical outcomes were evaluated before and during the follow-up period. Results: Five of the 6 patients showed rapid reduction in symptoms and decreased infiltrate size after riboflavin/UVA photochemical therapy. Signs of infection and inflammation mostly resolved within 1 to 2 weeks after the treatment. Despite this therapy, one patient continued to deteriorate, and penetrating keratoplasty was performed. Conclusions: The adjunctive use of riboflavin/UVA photochemical therapy has a positive effect on refractory infectious keratitis. The treatment seems to be safe and effective and should be considered as part of the first-line therapy in severe cases of infectious keratitis. © 2013 Wichtig Editore.


PubMed | Tel Aviv Medical Center and The Goldschleger Eye Institute
Type: | Journal: Journal of ophthalmology | Year: 2016

Purpose. To investigate the value of optical coherence tomography (OCT) for differentiation between choroidal melanoma and metastasis based on characteristics of the anterior choroidal surface and the chorioretinal interface. Methods. This retrospective observational case series included 29 patients with untreated choroidal melanomas and 21 patients with untreated choroidal metastases. Regularity and lobularity characteristics of the anterior choroidal surface were evaluated in a masked manner. Retinal and retinal pigment epithelium (RPE) findings were documented as well. Results. OCT demonstrated a regular and smooth anterior choroidal surface in 89.7% of the eyes with melanoma and in 47.6% of the eyes with metastasis (p = 0.002; sensitivity = 89.7%; specificity = 52.4%). The anterior choroidal contour was lobulated in 81.0% of the eyes with metastasis versus 17.2% of the eyes with melanoma (p < 0.001; sensitivity = 82.8%; specificity = 81.0%). RPE thickness and neuroretinal characteristics (e.g., retinal thickness, the presence of cysts, and the presence of subretinal fluid) were similar in both choroidal tumors. Conclusion. OCT may serve as a noninvasive adjunctive tool for the differential diagnosis of choroidal tumors. Choroidal melanomas usually demonstrate regular surfaces on OCT, while choroidal metastases usually have an irregular and lobulated surface.


McKyton A.,Hebrew University of Jerusalem | Ben-Zion I.,The Goldschleger Eye Institute | Ben-Zion I.,Tel Aviv University | Doron R.,The Goldschleger Eye Institute | And 2 more authors.
Current Biology | Year: 2015

Visual object recognition develops during the first years of life [1]. But what if one is deprived of vision during early post-natal development? Shape information is extracted using both low-level cues (e.g.,intensity- or color-based contours) and more complex algorithms that are largely based on inference assumptions (e.g., illumination is from above, objects are often partially occluded) [2]. Previous studies, testing visual acuity using a 2D shape-identification task (Lea symbols), indicate that contour-based shape recognition can improve with visual experience, even after years of visual deprivation from birth [3]. We hypothesized that this may generalize to other low-level cues (shape, size, and color), but not to mid-level functions (e.g., 3D shape from shading) that might require prior visual knowledge. To that end, we studied a unique group of subjects in Ethiopia that suffered from an early manifestation of dense bilateral cataracts and were surgically treated only years later. Our results suggest that the newly sighted rapidly acquire the ability to recognize an odd element within an array, on the basis of color, size, or shape differences. However, they are generally unable to find the odd shape on the basis of illusory contours, shading, or occlusion relationships. Little recovery of these mid-level functions is seen within 1 year post-operation. We find that visual performance using low-level cues is relatively robust to prolonged deprivation from birth. However, the use of pictorial depth cues to infer 3D structure from the 2D retinal image is highly susceptible to early and prolonged visual deprivation. McKyton etal. show that early-onset blind children who regained sight only years later learn to discriminate between colors but fail to use 3D pictorial depth cues to recognize shape structure. The putative critical period for acquiring inference-based vision provides further incentive for early treatment of cataracts to restore functional vision. © 2015 Elsevier Ltd.


Kinori M.,The Goldschleger Eye Institute | Kinori M.,Sheba Medical Center | Kinori M.,Tel Aviv University | Bielorai B.,Tel Aviv University | And 7 more authors.
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Purpose: The purpose of the study was to evaluate whether hematopoietic stem cell transplantation (HSCT) without conditioning Total Body Irradiation (TBI) had lower or milder ocular complication rates in the pediatric population. Methods: This study included all children who underwent HSCT without conditioning TBI at the Chaim Sheba Medical Center between the years 2001 and 2008. All children had an ophthalmic evaluation prior to and every four months after HSCT. Results: Of the 33 children who initially comprised this study, ten did not complete the minimal follow-up of four months, and were, thus, excluded from the study. Follow-up of the remaining 23 children ranged from four to 117 months. Dry eye related to chronic graft-versus-host disease (cGVHD) developed in eight children (35 %). In three cases, an additional complication was observed : corneal abscess, herpes zoster ophthalmicus, and bilateral subcapsular cataract (one case each). Posterior segment or neuro-ophthalmological complications were not observed in any patient. Conclusion: In our study group, the preclusion of conditioning TBI before HSCT did not result in a decreased ocular complication rate compared to past publications, but complications were relatively mild and confined only to the anterior segment. © 2015, Springer-Verlag Berlin Heidelberg.


Wygnanski-Jaffe T.,The Goldschleger Eye Institute | Spierer A.,The Goldschleger Eye Institute | Melamed S.,The Goldschleger Eye Institute | Ben-Zion I.,The Goldschleger Eye Institute
European Journal of Ophthalmology | Year: 2014

Purpose: To report the effect of oral propranolol on intraocular pressure (IOP) in infants newly diagnosed with unilateral Sturge-Weber syndrome (SWS) glaucoma receiving no other treatment. Methods: This was a prospective, nonrandomized interventional case series. Four infants presenting with unilateral SWS glaucoma with no prior treatment were treated with oral propranolol at a dose of 2 mg/kg and followed thereafter. Results: Propranolol had a temporary IOP-lowering effect in 3 of 4 children after 1 week of treatment. This effect diminished thereafter and 3 of 4 children required additional medical or surgical treatment. Conclusions: Oral propranolol has a temporary effect on IOP in SWS glaucoma and is not effective as a single treatment in this syndrome, yet can serve to delay surgical treatment for a short period of time. In one case, the glaucoma was well-controlled on this medication. © 2014 Wichtig Publishing.


PubMed | The Goldschleger Eye Institute
Type: | Journal: Molecular vision | Year: 2011

To describe the clinical findings and genetic analysis in two brothers having a novel retinal disease characterized by an enhanced S-cone phenotype with normal rod function.Both patients underwent complete ophthalmologic examinations, including fundus photography, electroretinography (ERG), fluorescein angiography and optical coherence tomography (OCT). Mutation analysis of the following candidate genes was performed: nuclear receptor subfamily 2 group E member 3 (NR2E3), neural retina leucine zipper (NRL), nuclear receptor subfamily 1 group D member 1 (NR1D1), and thyroid hormone receptor beta (THRB).Spectral photopic ERG responses demonstrated enhanced S-cone function in both patients. Their scotopic b-wave ERG amplitude responses, however, were within normal limits. Their scotopic a-wave amplitude responses were within the lower limit of normal. The a- and b-wave latencies were normal for one sibling and on the upper limit of normal for the other. Peripheral retinal findings were normal. OCT showed flattening of the macular curvature and thinning of the photoreceptor layer. Mutation analysis of NR2E3, NRL, NR1D1, and THRB genes was negative.We describe what appears to be a previously unidentified familial retinal phenotype with enhanced S-cone function and well preserved rod system function in contrast to the severely reduced rod function seen in the enhanced S-cone syndrome (ESCS). Genetic analysis of candidate genes did not reveal the cause of disease. We postulate that the disease might be caused by mutation of another, as yet unidentified gene, which encodes a protein that functions as a negative inhibitor of rod and S-cone development.


PubMed | The Goldschleger Eye Institute
Type: Case Reports | Journal: Seminars in ophthalmology | Year: 2016

We present a case of retained intraocular lens (IOL) haptic segment in the anterior chamber, diagnosed seven months following a reportedly uneventful cataract surgery due to manifestation of inferior corneal edema. Specular microscopy revealed low endothelial counts of 513/mm(2). Upon diagnosis, prompt surgical removal of the IOL haptic segment resulted in rapid resolution of the corneal edema within a week. Despite the clearing of the cornea, no improvement in the visual acuity occurred and cystoid macular edema was diagnosed and treated with topical anti-inflammatory agents and two intra-vitreal anti-VEGF injections, followed by complete resolution of ocular findings and improvement of the visual acuity.


PubMed | The Goldschleger Eye Institute
Type: Case Reports | Journal: Indian journal of ophthalmology | Year: 2012

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.


PubMed | The Goldschleger Eye Institute
Type: Journal Article | Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie | Year: 2015

The purpose of the study was to evaluate whether hematopoietic stem cell transplantation (HSCT) without conditioning Total Body Irradiation (TBI) had lower or milder ocular complication rates in the pediatric population.This study included all children who underwent HSCT without conditioning TBI at the Chaim Sheba Medical Center between the years 2001 and 2008. All children had an ophthalmic evaluation prior to and every four months after HSCT.Of the 33 children who initially comprised this study, ten did not complete the minimal follow-up of four months, and were, thus, excluded from the study. Follow-up of the remaining 23 children ranged from four to 117 months. Dry eye related to chronic graft-versus-host disease (cGVHD) developed in eight children (35 %). In three cases, an additional complication was observed : corneal abscess, herpes zoster ophthalmicus, and bilateral subcapsular cataract (one case each). Posterior segment or neuro-ophthalmological complications were not observed in any patient.In our study group, the preclusion of conditioning TBI before HSCT did not result in a decreased ocular complication rate compared to past publications, but complications were relatively mild and confined only to the anterior segment.


PubMed | Royal Melbourne Hospital and The Goldschleger Eye Institute
Type: Journal Article | Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie | Year: 2016

Rim-off lateral wall decompression may be associated with functional and cosmetic deficit. Our objective, therefore, was to describe the functional and cosmetic results of deep lateral orbital decompression with and without anterior rim repositioning for thyroid eye disease.In this retrospective comparative case series all consecutive thyroid eye disease patients who underwent deep lateral wall decompression at the Royal Victorian Eye and Ear Hospital between 1990-2007 and the Goldschleger Eye Institute, Sheba Medical Center between 2008-2011 were included. Patients were divided into two groups: the rim-on group in which the anterior lateral orbital rim was repositioned and the rim-off group in which it was left off. Main outcome measures were: proptosis reduction, postoperative oscillopsia and diplopia, presence of visible or palpable lateral orbit depression.One hundred and twelve patients who underwent 186 orbital decompressions were included in the final analysis. The average proptosis reduction for two- and three-wall decompressions ranged between 4.6-4.9mm in the rim-on and 4.6-5.7mm in the rim-off group respectively. The prevalence of postoperative oscillopsia was similar in both groups. The preoperative diplopia worsened in 17 patients (32.1%) in the rim-on group and in seven patients (12.3%) in the rim-off group (P=.02, chi-square test). None of the patients developed visible or palpable lateral orbit depression.Deep lateral orbital decompression without anterior rim repositioning may be an effective approach to enhance functional and cosmetic outcomes in thyroid eye disease patients without increasing the risk of lateral wall depression or postoperative oscillopsia.

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