Lin X.,Kresge Eye Institute
Current Opinion in Ophthalmology | Year: 2017
PURPOSE OF REVIEW: This article reviews current advancements in vitreoretinal surgical machines. RECENT FINDINGS: The most recent advancement in vitreoretinal surgical machines include 27-gauge vitrectomy probes, new cutter designs, higher cut rate, improved intraocular pressure control, new endoillumination technologies, and combined anterior/posterior segment capabilities. SUMMARY: With recent advancements in vitreoretinal surgical machines, surgical incisions have become less traumatic and fluidics control has led to a more controlled posterior segment vitrectomy. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
News Article | May 8, 2017
WESTPORT, CT, May 08, 2017-- "Patients considering cosmetic eyelid surgery or even non-surgical facial rejuvenation with BOTOX Cosmetic or tightening, volumizing gel fillers should work closely with their plastic surgeon to carefully share the results they are hoping to achieve in terms of their overall facial aesthetics," explained Cesar Sierra, M.D., a Fairfield County Cosmetic & Reconstructive Eye Plastic Surgeon."Probably because of too much advertising by cosmetic product companies as well as physicians and even spas and salons, we see many patients who schedule a consultation and simply state, "I am here for BOTOX or eyelid surgery" when in fact they haven't yet fully explored what they are hoping to achieve in terms of overall facial appearance," shared Dr. Sierra. "Taking the time to help patients identify both their areas of concern as well as the overall image they want to project is critical for each individual and varies a great deal. For many, our approach is to restore their natural, refreshed, youthful appearance by gently tightening, volumizing and lifting the delicate eye, facial features and chin. For men in particular, we often have to work in order maintain an energetic, masculine but softened ruggedness. Thorough discussion and expectation setting with each patient is the key to patient satisfaction. Sometimes patients want a blepharoplasty when we can confidently provide their desired look with non-surgical injectable treatments. In other instances patients request BOTOX for forehead wrinkles and slightly droopy eyelids when a minimally invasive invisible endoscopic brow lift will give them a smooth refreshed appearance for years to come. Understanding clear patient goals and expectations for the overall facial appearance lets us guide them in the best approach for satisfaction," explained Dr. Sierra.About Cesar Sierra, M.D., F.A.C.S.Cesar Sierra, M.D., F.A.C.S. is a cosmetic & reconstructive ophthalmic plastic surgeon practicing in Westport, Connecticut and holding an academic appointment at Yale University School of Medicine as Clinical Assistant Professor, Department of Ophthalmology where he teaches surgeons techniques of eye and facial plastic surgery. Dr. Sierra provides facial rejuvenation for men and women using non-surgical treatments & injections to minimize or eliminate the effects of aging. These include treatment for dark circles, eyelid bags, creases, folds, fine lines and wrinkles. His areas of surgical expertise include blepharoplasty "eyelifts" or cosmetic eyelid surgery for baggy, puffy eyelids, brow and minimally invasive endoscopic forehead surgery to lift troublesome areas. He has special expertise in eyelid surgery to correct ptosis or "droopy" eyelids, minimally invasive endoscopic tear duct surgery and repair of eyelids that unnaturally turn inward or outward as well as eyelid and orbital reconstruction after trauma or ocular tumor surgery.With a practice location at 125 Kings Highway N., Westport, Connecticut 06880 and comfortable, close to home ambulatory surgery center locations at Wilton Surgery Center, 195 Danbury Road, Wilton, Connecticut 06897 and the Surgery Center of Fairfield County, 112 Quarry Road, Trumbull, Connecticut 06611, Cesar Sierra, M.D., F.A.C.S. is conveniently located for patients from throughout southern Connecticut and Fairfield County, and Westchester and Dutchess County, New York.To learn more about facial rejuvenation, cosmetic eyelid surgery or other types of cosmetic and reconstructive eye plastic surgery visit http://www.cesarsierramd.com , Google+ or Facebook at http://www.facebook.com/cesarsierramd For additional information, contact:Natalie Devine, 125 Kings Highway N., Westport, Connecticut 06880, email@example.com , (P) 203-226-1696.Cesar Sierra, M.D. is a Cosmetic Eyelid, Orbital & Reconstructive Eye Plastic Surgeon who specializes exclusively in the eyelids and facial areas around the eyes. Dr. Sierra is trained as both an eye surgeon and cosmetic & reconstructive ophthalmic plastic surgeon. His areas of expertise include blepharoplasty "eyelifts" or cosmetic eyelid surgery for baggy, puffy eyelids, brow and forehead surgery to lift troublesome areas. He has special expertise in eyelid surgery to correct ptosis or "droopy" eyelids, minimally invasive endoscopic tear duct surgery and repair of eyelids that unnaturally turn inward or outward as well as eyelid and orbital reconstruction after trauma or ocular tumor surgery.In addition to surgery, Dr. Sierra provides facial rejuvenation for men and women using non surgical treatments & injections to minimize or eliminate the effects of aging. These include treatment for dark circles, eyelid bags, creases, folds, fine lines and wrinkles. His approach for women is to restore their natural, refreshed, youthful appearance by gently tightening, volumizing and lifting the delicate eye, facial features and chin. For men, Dr. Sierra strives to maintain an energetic, masculine but softened ruggedness. Depending on your areas of concern this may require BOTOX injections alone or in combination with gel fillers and tightening injections such as Juvederm, Restylane , Radiesse or Kybella to create the desired result.Dr. Sierra earned his Medical Degree from Universidad Central Del Caribe School of Medicine where he was elected a member of the Alpha Omega Alpha Medical Honor Society. He then completed a Residency in Ophthalmology at Yale-New Haven Hospital where he received the Marvin L. Sears Award for Clinical Excellence followed by an ASOPRS (American Society of Ophthalmic Reconstructive and Plastic Surgery) accredited Fellowship at Kresge Eye Institute & William Beaumont Hospital in greater Detroit, Michigan. He is certified by and a Diplomate of the American Board of Ophthalmology (ABO) and a Fellow of the American College of Surgeons. Dr. Sierra continues his dedication to the field of surgery by teaching surgeons procedures and techniques of cosmetic and reconstructive orbital and eye plastic surgery as an Assistant Clinical Professor of Ophthalmology at Yale School of Medicine in New Haven, Connecticut.Dr. Sierra is certified by and a Diplomate of the American Board of Ophthalmology (ABO), a member of the American Academy of Ophthalmology (AAO), the American College of Surgeons and Pan-American Association of Ophthalmology. He is an attending surgeon at Yale-New Haven Hospital, Bridgeport Hospital and Norwalk Hospital.SOURCE: Medical Management Services Group, L.L.C.
Sosne G.,Wayne State University |
Dunn S.P.,Michigan Cornea Consultants |
Kim C.,Kresge Eye Institute
Cornea | Year: 2015
Purpose: Standard therapies for severe dry eye are limited and fail to resolve the problem. The purpose of this study was to evaluate the safety and efficacy of Thymosin b4 eye drops (RGN-259) as a novel therapy forsevere dry eye disease (including that associated with graft vs. host disease). Methods: A small, multicenter,randomized, double-masked, placebo-controlled 56-day phase 2 clinical trial including a 28-day follow-up at 2US sites. Nine patients with severe dry eye were treated with either RGN-259 (0.1%) or vehicle control 6 times daily over a period of 28 days. Dry eye sign and symptom assessments, such as ocular discomfort (using the OSDI questionnaire) and corneal fluorescein staining (using the NEI workshop grading system), were evaluated at various time points. Results: Statistically significant differences in both symptom and sign assessments, wereseen at various time points throughout the study. Of particular note at day 56, the RGN-259-treated group (12 eyes) had 35.1% reduction of ocular discomfort compared with vehicle control (6 eyes) (P = 0.0141), and 59.1% reduction of total corneal fluorescein staining compared with vehicle control (P = 0.0108). Other improvements seen in the RGN-259-treated patients included tear film breakup time and increased tear volume production. Conclusions: In this small trial, RGN-259 eye drops were safe and well tolerated and met key efficacy objectives with statistically significant symptom and sign improvements, compared with vehicle control, at various time intervals, including 28-days posttreatment. © 2015 Wolters Kluwer Health, Inc. All rights reserved.
News Article | February 27, 2017
Scientists have identified another symptom of the Zika virus, this time focusing on the damage it causes to vision. A research team from the Wayne State University School of Medicine Department of Ophthalmology at the Kresge Eye Institute are the first to show that the Zika virus (ZIKV) can replicate in the eye’s retinal cells, causing severe tissue damage and even blindness in some cases. Ashok Kumar, Ph.D., a microbiologist and an assistant professor in the departments of Ophthalmology and of Anatomy and Cell Biology, led the research team in investigating whether Zika causes abnormalities in the eye. Zika is a significant emergent threat to global health, particularly during pregnancy. While it is not life-threatening, Zika has severe health implications beyond microcephaly—a condition where an infant’s head is significantly smaller than what is expected. According to Kumar, infants born with congenital Zika virus also have pathology in their eyes, ears, limbs and possibly other organs. Clinical studies show that Zika in the eye mainly impacts the retina—a layer of cells at the back of the eye that sends signals to the brain to visualize an object. “We studied the interaction of ZIKV with retinal cells. We observed that ZIKV can replicate and survive in retinal cells and ultimately kill them,” Kumar said in a statement. “Next, we tested whether ZIKV can cause retinal damage using an animal model. “To our surprise, we discovered that ZIKV infection of a mouse eye resulted in retinal lesions referred to as ‘chorioretinal atrophy’,” he added. “Interestingly, the ZIKV-infected mouse eyes showed some features of ZIKV-infected human eye. We believe we have a unique model to study molecular mechanisms of ocular ZIKV infection, and perhaps to test drugs or new anti-viral molecules to treat this blinding eye disease.” The eye is an immune-privileged organ, meaning Zika could hide there for months, Kumar said. The virus also has been shown to cause uveitis, another ophthalmic complication, in adults. More studies into the impact of Zika will continue. “Indeed, animal and human studies have shown the presence of ZIKV in tears, and there is ongoing research to determine how long, where and at what concentration the virus can survive in the eye,” Kumar said. “Similarly, we do not know the long-term impact of ZIKV-induced ocular abnormalities in infants born with congenital ZIKV infection. “Will they have a normal vision? What kind of vision rehab might they need? What about the social and economic impact in raising these children with a vision disability, if any?” Kumar’s team is now looking at how Zika modulates a cell to its advantage, while collaborating with another university to identify key genes and molecules that they think can attenuate Zika. The study was published in JCI Insight.
Qiu P.,Kresge Eye Institute |
Wheater M.K.,University of Detroit Mercy |
Qiu Y.,Kresge Eye Institute |
Qiu Y.,Dartmouth College |
Sosne G.,Wayne State University
FASEB Journal | Year: 2011
The mechanisms by which thymosin β 4 (Tβ4) regulates the inflammatory response to injury are poorly understood. Previously, we demonstrated that ectopic Tβ4 treatment inhibits injury-induced proinflammatory cytokine and chemokine production. We have also shown that Tβ4 suppresses TNF-α-mediated NF-κB activation. Herein, we present novel evidence that Tβ4 directly targets the NF-κB RelA/p65 subunit. We find that enforced expression of Tβ4 interferes with TNF-α-mediated NF-κB activation, as well as downstream IL-8 gene transcription. These activities are independent of the G-actin-binding properties of Tβ4. Tβ4 blocks RelA/p65 nuclear translocation and targeting to the cognate κB site in the proximal region of the IL-8 gene promoter. Tβ4 also inhibits the sensitizing effects of its intracellular binding partners, PINCH-1 and ILK, on NF-κB activity after TNF-α stimulation. The identification of a functional regulatory role by Tβ4 and the focal adhesion proteins PINCH-1 and ILK on NF-κB activity in this study opens a new window for scientific exploration of how Tβ4 modulates inflammation. In addition, the results of this study serve as a foundation for developing Tβ4 as a new anti-inflammatory therapy. © FASEB.
Narala R.,Kresge Eye Institute
Retina | Year: 2016
PURPOSE:: To quantify photoreceptor volume changes after successful surgical repair of macula-off retinal detachment and to correlate these volumetric changes to postoperative best-corrected visual acuity (BCVA). METHODS:: Retrospective study of 15 eyes of 15 patients with macula-off retinal detachment who underwent successful surgical repair. A minimum of 4 optical coherence tomography scans that straddled the foveal center was used to quantify the central photoreceptor volume (central 1 mm). RESULTS:: Mean photoreceptor volume at the first postoperative visit was 0.451 mm, increasing to 0.523 mm at the final postoperative visit (P = 0.004). Mean BCVA improved from 1.13 ± 0.59 logarithm of the minimum angle of resolution units (∼20/270) preoperatively to 0.52 ± 0.42 logarithm of the minimum angle of resolution units (∼20/66) at the final postoperative visit (P = 0.001). Mean photoreceptor volume at either the initial or final visit demonstrated significant correlations with final postoperative BCVA (r = −0.670, P = 0.017 and r = −0.753, P = 0.005, respectively). Shorter time interval from diagnosis to surgery was significantly associated with greater mean final postoperative photoreceptor volume (r = −0.588, P = 0.021) and better mean final postoperative BCVA (r = 0.709, P = 0.003). CONCLUSION:: We observed a significant increase in photoreceptor volume after successful retinal detachment repair; photoreceptor volume was positively associated with BCVA and time to surgery. Our series emphasizes the importance of prompt surgical repair and shows that photoreceptor recovery and volumetric improvement correlate significantly with BCVA. © 2016 by Ophthalmic Communications Society, Inc.
Servat J.J.,Yale University |
Mears K.A.,Kresge Eye Institute |
Black E.H.,Kresge Eye Institute |
Huang J.J.,Yale University
Expert Opinion on Biological Therapy | Year: 2012
Introduction: The conventional treatment of uveitis includes corticosteroids and immunosuppressive agents, which are highly efficacious, but can be associated with serious systemic side effects. Over the last two decades, advances in the understanding of the pathogenesis of inflammatory diseases, as well as improved biotechnology, have enabled selective targeting of the chemical mediators of diseases. Recently, a new class of drugs called biologics, that target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. Areas covered: This article is a review and summary of the peer-reviewed evidence for biologic agents in the treatment of various forms of ocular inflammation and it focuses on the potential use of other biologic agents that have been tested in experimental autoimmune uveitis. Pubmed was used as our main tool for our literature search. Some additional references were taken from books written on the subject. Expert opinion: There are a wide variety of new and emerging biological agents currently being used in the treatment of uveitis which has expanded the therapeutic horizons far beyond previous limitations. © 2012 Informa UK, Ltd.
Madsen-Bouterse S.,Kresge Eye Institute |
Mohammad G.,Kresge Eye Institute |
Kowluru R.A.,Kresge Eye Institute
Investigative Ophthalmology and Visual Science | Year: 2010
Purpose. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) has been hypothesized as a mediator in the activation of multiple pathways implicated in the pathogenesis of diabetic retinopathy. The objective of this study was to understand the mechanism by which high glucose inactivates GAPDH in retinal microvascular cells. Methods. Bovine retinal endothelial cells (BRECs), transfected with GAPDH, were incubated in 20 mM glucose. The effect of the overexpression of GAPDH on its activity, apoptosis, and upstream signaling pathways, protein kinase C, and hexosamine pathways was determined. The effect of the inhibitors of nitration and ribosylation on GAPDH activity, its nuclear translocation and reversal of glucose insult was also evaluated. Results. High glucose decreased GAPDH activity, expression, and nuclear translocation. Overexpression of GAPDH prevented glucose-induced inhibition of its activity, nuclear translocation, apoptosis, and activation of protein kinase C and hexosamine pathways. Inhibitors of nitration and ribosylation ameliorated glucose-induced inhibition of GAPDH, and their addition during the normal glucose exposure that followed high glucose levels had a beneficial effect on GAPDH activity and the degree of nitration and ribosylation. Conclusions. In hyperglycemia, GAPDH in retinal microvascular cells is inhibited by its covalent modifications, and this activates multiple pathways implicated in the pathogenesis of diabetic retinopathy. The agents that can directly target modification of GAPDH have potential in inhibiting the development and in arresting the progression of diabetic retinopathy. © Association for Research in Vision and Ophthalmology.
Kowluru R.A.,Kresge Eye Institute
Investigative Ophthalmology and Visual Science | Year: 2010
PURPOSE. Diabetes activates a small molecular weight G-protein, H-Ras, in the retina and its capillary cells, and H-Ras activation is implicated in the apoptosis of retinal capillary cells. Matrix metalloproteinase (MMP)-9 is regulated by H-Ras, and in diabetes its activation is associated with increased vascular permeability. The goal of this study was to investigate the role of sustained activation of MMP-9 in the pathogenesis of diabetic retinopathy and to illustrate the mechanism through which it is upregulated in diabetes. METHODS. Retinal MMP-9 activation and its tissue inhibitor, TIMP-1, were quantified in streptozotocin-induced diabetic rats. Inhibition of H-Ras by simvastatin on diabetes-induced activation of H-Ras was evaluated. The mechanism by which diabetes regulates retinal MMP-9 was confirmed by determining the effect of genetic or pharmacologic regulation of H-Ras on its activation in retinal endothelial cells. RESULTS. In rats, MMP-9 was activated and expression of TIMP-1 was decreased in the retina and its microvasculature at both 2 months and 12 months of diabetes. In retinal endothelial cells, high glucose activated MMP-9, and inhibition of its activation (by pharmacologic inhibitor or siRNA) ameliorated accelerated apoptosis. Inhibition of H-Ras, both in diabetic rats (simvastatin) and in isolated endothelial cells (H-Ras siRNA), abrogated the activation of MMP-9 and prevented the reduction of TIMP-1. CONCLUSIONS. Hyperglycemia-induced activation of MMP-9 accelerates apoptosis of retinal capillary cells, a phenomenon that predicts the development of diabetic retinopathy, and the activation of MMP-9 is downstream of H-Ras. Characterizing the role of MMP-9 in the development of diabetic retinopathy will help explore novel molecular targets for future pharmacological interventions. © Association for Research in Vision and Ophthalmology.
Brown J.S.,Kresge Eye Institute |
Mahmoud T.H.,Kresge Eye Institute
Retina | Year: 2011
PURPOSE:: The purpose of this study was to provide further information about the risks of perioperative hemorrhage in diabetic vitrectomy in patients on anticoagulation. This may help us to better understand more about the fine balance between the risks of stopping anticoagulation versus continuation for intraocular surgery. METHODS:: A retrospective, comparative cohort study of all patients undergoing a diabetic pars plana vitrectomy by a single surgeon over a 30-month period at a single institution was conducted. RESULTS:: Ninety-seven eyes were included for analysis. Twenty-seven eyes remained on anticoagulation during the surgery. There were no perioperative complications related to the anticoagulation. Surgical intervention resulted in a significant increase in visual acuity in both groups. There was no difference in the incidence of postoperative vitreous hemorrhage or surgical reoperation between the two groups. Patients on anticoagulation had significantly worse postoperative vision compared with those not on anticoagulation (best-corrected visual acuity of 20/230 vs. 20/100, P = 0.03). CONCLUSION:: Patients undergoing diabetic vitrectomy, who are on anticoagulation or antiplatelet agents, do not exhibit a higher risk of intraoperative or postoperative vitreous hemorrhage. Anticoagulants and antiplatelets may be safely continued perioperatively to avoid complications secondary to their systemic disease. © The Ophthalmic Communications Society, Inc.