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New Philadelphia, PA, United States

Liu T.Y.A.,Columbia University | Shah A.R.,Scheie Eye Institute | Del Priore L.V.,Medical University of South Carolina
JAMA Ophthalmology | Year: 2013

Objective: To test the hypothesis that the natural history of choroidal neovascularization lesion size is uniform across prior randomized controlled clinical trials of exudative age-related macular degeneration (AMD), with apparent differences arising from different entry times of eyes into clinical trials. Methods: We conducted a retrospective metaanalysis of control eye data from 5 age-related macular degeneration trials (Treatment of Age-Related Macular Degeneration with Photodynamic Therapy; Verteporfin in Photodynamic Therapy; VEGF Inhibition Study in Ocular Neovascularization; Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration; and Phase 3b, Multicenter, Randomized, Double-masked, Sham Injection-controlled Study of the Efficacy and Safety of Ranibizumab in Subjects with Subfoveal Choroidal Neovascularization with or without Classic Choroidal Neovascularization Secondary to AMD Study), which were plotted on a double reciprocal plot of 1/ lesion size (disc area) vs 1/time (months after enrollment). To account for the different entry times, we introduced a horizontal translation factor to shift each data subset until r2 was maximized for the cumulative trend line. Results: Cumulative data for untreated control eyes fit a straight line on a double reciprocal plot (r2=0.98) after the introduction of horizontal translation factors. Our model predicts that a choroidal neovascular lesion will eventually enlarge to a size of 10.6 disc areas without treatment and that the lesion will reach half of its maximum size within 14.0 months after onset of exudation. The linear expansion rate of untreated lesions is approximately 26.0 μm per day for the smallest lesions and decreases gradually as the lesions enlarge. Conclusions: The pattern of choroidal neovascularization lesion size enlargement inAMDeyes is uniform across awide range of clinical trials, with apparent differences arising from different entry times of patients into various trials. The main determinant of choroidal neovascularization lesion size enlargement is the duration of exudative disease. © 2013 American Medical Association. All rights reserved. Source

Khairallah M.,University of Monastir | Accorinti M.,University of Rome La Sapienza | Muccioli C.,Federal University of Sao Paulo | Kahloun R.,University of Monastir | And 2 more authors.
Ocular Immunology and Inflammation | Year: 2012

Behçet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient "Silk Road" route in the Far East and Mediterranean basin. The eye is the most commonly involved organ in BD patients.The prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis. © 2012 Informa Healthcare USA, Inc. Source

Raber I.M.,Wills Eye Institute | Fintelmann R.,Wills Eye Institute | Chhabra S.,Wills Eye Institute | Ribeiro M.P.F.,Wills Eye Institute | And 2 more authors.
Cornea | Year: 2011

Purpose: To report a case series of eyes with posterior polymorphous corneal dystrophy and steep nonkeratoconic corneas. Methods: Retrospective, descriptive, nonrandomized case series. Results:: Thirty-five eyes of 18 patients (14 cases from 6 families and 4 isolated cases) with diffuse posterior polymorphous corneal dystrophy had mean topographic simulated keratometry readings of 52.21 diopters (D), with a range of 46.47 D to 59.86 D and an SD of 3.69 D, with no slit-lamp or topographic findings suggestive of keratoconus. Conclusions: The patients in this series demonstrate diffuse posterior polymorphous corneal dystrophy and nonkeratoconic steep corneas. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Bhoiwala D.L.,Scheie Eye Institute | Bhoiwala D.L.,Albany Medical College | Dunaief J.L.,Scheie Eye Institute
Survey of Ophthalmology | Year: 2016

Patients with beta (β)-thalassemia (β-TM: β-thalassemia major, β-TI: β-thalassemia intermedia) have a variety of complications that may affect all organs, including the eye. Ocular abnormalities include retinal pigment epithelial degeneration, angioid streaks, venous tortuosity, night blindness, visual field defects, decreased visual acuity, color vision abnormalities, and acute visual loss. Patients with β-thalassemia major are transfusion dependent and require iron chelation therapy to survive. Retinal degeneration may result from either retinal iron accumulation from transfusion-induced iron overload or retinal toxicity induced by iron chelation therapy. Some who were never treated with iron chelation therapy exhibited retinopathy, and others receiving iron chelation therapy had chelator-induced retinopathy. We will focus on retinal abnormalities present in individuals with β-thalassemia major viewed in light of new findings on the mechanisms and manifestations of retinal iron toxicity. © 2016 Elsevier Inc. Source

Mehta S.,Thomas Jefferson University | Linton M.M.,Scheie Eye Institute | Kempen J.H.,Scheie Eye Institute | Kempen J.H.,University of Pennsylvania
American Journal of Ophthalmology | Year: 2014

PURPOSE: To critically assess the evidence base regarding outcomes following cataract surgery in uveitic cases. DESIGN: Systematic evidence-based review and metaanalysis. METHODS: A comprehensive search query was performed on MEDLINE, EMBASE, CINHAL, and CENTRAL databases. Relevant publications were identified by reviewing query results and reference list searches. RESULTS: A total of 89 articles met eligibility criteria. Among uveitic eyes with quiet or mostly quiet uveitis before cataract surgery, 20/40 visual acuity or better (‡20/40) was achieved in 68% following phacoemulsification, 72% following extracapsular cataract extraction, and 40% following pars plana lensectomy. More eyes undergoing cataract surgery with intraocular lens (IOL) implantation than eyes left aphakic achieved ‡20/40 postoperatively (71% vs 52%). Eyes receiving acrylic IOLs or heparin-surface-modified (HSM) polymethylmethacrylate had better visual outcomes than those receiving non-HSM polymethylmethacrylate or silicone IOLs. Active uveitis at the time of cataract surgery was associated with worse visual outcomes. Compared with other uveitis cases, the proportion achieving 20/40 or better post cataract surgery was better for Fuchs heterochromic cyclitis cases and worse for uveitis related to Behçet disease, Vogt-Koyanagi-Harada disease, or sympathetic ophthalmia, and also posterior uveitis in general. CONCLUSION: Cataract surgery in eyes with uveitis resulted in normal range levels of visual acuity in most cases. The review suggests that preoperative control of uveitis, use of an acrylic or HSM IOL, and a diagnosis of Fuchs heterochromic cyclitis were associated with better outcomes. Posterior-involving uveitides tended to do worse, likely because of vision-limiting complications of uveitis. Average results may not be applicable to specific clinical scenarios. © 2014 by Elsevier All rights reserved. Source

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