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New Philadelphia, Pennsylvania, United States

Milman T.,New York Eye and Ear Infirmary | Schear M.J.,New York Institute of Technology | Eagle Jr. R.C.,Wills Eye Hospital
Ophthalmology | Year: 2014

Purpose To determine the efficacy of adipophilin immunohistochemistry in the diagnosis of sebaceous carcinoma of the ocular adnexal region and to provide the guidelines for interpretation of this immunostain. Design Retrospective, histopathologic case series. Participants A total of 25 patients with sebaceous carcinoma, 21 patients with basal cell carcinoma, 22 patients with conjunctival squamous cell carcinoma, 9 patients with cutaneous squamous cell carcinoma, and 5 patients with conjunctival mucoepidermoid carcinoma. Methods Immunohistochemical staining for adipophilin was performed on paraffin-embedded tissues and correlated with hematoxylin-eosin, periodic acid-Schiff (PAS), and mucicarmine-stained preparations. Immunostaining was quantified by light microscopy and with a computerized image analysis system of scanned images. Statistical analysis was performed to compare immunostaining patterns within the tumor categories by stage and grade, between the different neoplasms, and for correlation between light microscopy observations and computerized image analysis. Main Outcome Measures Localization of adipophilin immunostain, intensity of immunostaining, percent of immunoreactive cells, percentages of vacuolar staining and granular staining, and vacuole size. Results Adipophilin expression was observed in 100% of sebaceous carcinomas, 100% of cutaneous squamous cell carcinomas, 95% of basal cell carcinomas, 73% of conjunctival squamous cell carcinomas, and 60% of mucoepidermoid carcinomas. Sebaceous carcinomas demonstrated significantly stronger adipophilin expression, a greater number of intracytoplasmic vacuoles, and larger vacuoles. The specificity and sensitivity of adipophilin immunostaining in the diagnosis of sebaceous carcinoma were both 100% when more than 5% of the staining occurred in vacuoles (<95% granular staining). The diagnostic sensitivity and specificity were 100% and 96%, respectively, when the staining was graded as moderately or strongly intense and were 92% and 85% when the vacuoles were greater than 1.5 μm in diameter. Conclusions Although upregulation of neoplastic steatogenesis is observed in both sebaceous and nonsebaceous carcinomas, the pattern and intensity of adipophilin immunostaining are helpful in distinguishing sebaceous carcinoma from other neoplasms with overlapping histology. © 2014 by the American Academy of Ophthalmology Published by Elsevier Inc. Source

Haller J.A.,Wills Eye Hospital
Survey of Ophthalmology | Year: 2014

Scientific collaboration between academia and industry has a long history in the United States and abroad. Initially U.S. companies took responsibility for patenting and licensing discoveries made in collaborating universities. A publicly funded "middle man", The Research Corporation, was the next paradigm and had the advantages of neutrality and centralization, but proved ultimately unworkable. More recently, universities have negotiated their own patenting and licensing activities. The ethical pitfalls of scientists and physicians dealing directly with industry stimulated much public discussion in the past decade, with a resultant backlash discouraging collaboration. I discuss this evolution, and recent developments with models of possible productive collaboration and rules of engagement. © 2014 Elsevier Inc. Source

Haller J.A.,Wills Eye Hospital | Stalmans P.,UZ Leuven | Benz M.S.,Retina Consultants of Houston | Gandorfer A.,Klinikum der LMU | And 3 more authors.
Ophthalmology | Year: 2015

Purpose: To evaluate the efficacy of a single intravitreal injection of ocriplasmin 125 μg across relevant subpopulations of patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction (VMT), including when associated with macular hole. Design: Two multicenter, randomized, placebo-controlled, double-masked, 6-month studies. Participants: A total of 652 randomized patients (464 receiving ocriplasmin; 188 receiving placebo). Methods: A single intravitreal injection of ocriplasmin 125 μg or placebo in the study eye. Main Outcome Measures: Prespecified subgroup analyses were conducted to evaluate the effects on the proportion of patients with nonsurgical resolution of focal VMA at day 28, nonsurgical full-thickness macular hole (FTMH) closure at month 6, and categoric improvement in best-corrected visual acuity (BCVA) at month 6. Results: Resolution of VMA at day 28 was achieved more often in younger patients (<65 years), eyes without epiretinal membrane, eyes with FTMH, phakic eyes, and eyes with a focal VMA ≤1500 μm. Eyes with FTMH width ≤250 μm were more likely to achieve nonsurgical FTMH closure. Categoric ≥2-line and ≥3-line improvement in BCVA occurred more often in younger patients (<65 years) and in patients with a lower baseline BCVA (<65 letters). Treatment differences in favor of ocriplasmin were generally observed across each subgroup of sub-populations studied. Conclusions: Subgroup analyses confirmed the positive effect of ocriplasmin across relevant subpopulations. © 2015 by the American Academy of Ophthalmology. Source

DeCroos F.C.,Wills Eye Hospital
Journal of medicine and life | Year: 2011

This work describes a series of patients with odontogenic orbital cellulitis (OOC), focusing on rate of abscess formation, need for surgical intervention, and imaging findings helpful for rapid diagnosis. Review of a current case and 22 patients with OOC from the scientific literature demonstrated periapical lucency as the most commonly (36.4%) reported finding on facial and orbital computerized tomography (CT) scan. Orbital abscess occurred in 72.7% of cases, and tooth extraction and/or abscess drainage was required in 95.5% of cases reviewed for control of infection. The current case presented with periapical lucency on CT scan, developed orbital abscess despite broad spectrum antibiotic therapy, and required multiple surgical interventions for disease resolution. Though our patient regained excellent vision, OOC often can result in severe vision loss. Periapical lucency on CT can help identify this atypical origin of cellulitis that is strongly associated with abscess formation and need for surgical intervention. Source

Samuelson T.W.,Minneapolis | Katz L.J.,Wills Eye Hospital | Wells J.M.,Glaukos | Duh Y.-J.,ClinReg Consulting Inc. | Giamporcaro J.E.,Glaukos
Ophthalmology | Year: 2011

Objective To assess the safety and efficacy of the iStent trabecular micro-bypass stent (Glaukos Corporation, Laguna Hills, CA) in combination with cataract surgery in subjects with mild to moderate open-angle glaucoma. Design Prospective, randomized, open-label, controlled, multicenter clinical trial. Participants A total of 240 eyes with mild to moderate open-angle glaucoma with intraocular pressure (IOP) ≤24 mmHg controlled on 1 to 3 medications were randomized to undergo cataract surgery with iStent implantation (treatment group) or cataract surgery only (control). Fifty additional subjects were enrolled to undergo cataract surgery with iStent implantation under protocol expansion. Data in this report are based on the first 240 eyes enrolled. Intervention Implantation of the iStent trabecular micro-bypass stent in conjunction with cataract surgery or cataract surgery only. Main Outcome Measures The primary efficacy measure was unmedicated IOP ≤21 mmHg at 1 year. A secondary measure was unmedicated IOP reduction <20% at 1 year. Safety measures included best-corrected visual acuity (BCVA), slit-lamp observations, complications, and adverse events. Results The study met the primary outcome, with 72% of treatment eyes versus 50% of control eyes achieving the criterion (P<0.001). At 1 year, IOP in both treatment groups was statistically significantly lower from baseline values. Sixty-six percent of treatment eyes versus 48% of control eyes achieved <20% IOP reduction without medication (P = 0.003). The overall incidence of adverse events was similar between groups with no unanticipated adverse device effects. Conclusions Pressure reduction on fewer medications was clinically and statistically significantly better 1 year after stent plus cataract surgery versus cataract surgery alone, with an overall safety profile similar to that of cataract surgery alone. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology. Source

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