DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2010
To report our short-term experience with bevacizumab in neovascular age-related macular degenerat... more To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy. Methods: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed. Results: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 µm at baseline to 278 µm at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed. Conclusion: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.
Purpose-The aim of this study is to determine the anatomic and visual outcomes following combined... more Purpose-The aim of this study is to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic macular hole (MH) without post-operative prone positioning (PPP). Materials and Methods-A retrospective chart review of 42 patients (47 eyes) with MH who underwent CPPLV was performed. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week. The main outcome measures included MH closure rate, best corrected post-operative Snellen visual acuity (BCVA), and procedure complications. Results-Anatomical closure was achieved in 44 eyes (93.6%). The average BCVA in these eyes improved from 20/203 at baseline to 20/91 post-operatively, with 28 (63.6%) having 20/40 or better. Twenty-eight (59.6%) of the 47 eyes had a BCVA of 20/40 or better post-operatively and 35 (74.5%) eyes improved by at least 2 Snellen lines. Post-operative retinal detachment (RD) was observed in 4 eyes (8.5%) and late reopening of the hole in 4 (9.1%). Discussion-The anatomical and visual outcomes and the RD rate of CPPLV with sulcus intraocular lens implantation without PPP are comparable to those of traditional MH surgery techniques. The main advantages include sparing the patient the inconvenience of PPP and eliminating the need for additional postvitrectomy cataract extraction procedure.
Choroidal neovascular membranes are a rare cause of decreased vision in children with optic nerve... more Choroidal neovascular membranes are a rare cause of decreased vision in children with optic nerve head drusen. We present a case of bilateral choroidal neovascular membranes associated with optic nerve head drusen in a 5-year-old boy who was successfully treated with a combination of focal laser photocoagulation and intravitreal bevacizumab.
Journal of Ophthalmic Inflammation and Infection, 2013
Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depig... more Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depigmentation associated with systemic fluoroquinolones and other antibiotics. Bilateral acute iris transillumination, which is associated with loss of the iris pigment epithelium and results in iris transillumination, differs from the previously described bilateral acute depigmentation of the iris, which is associated with atrophy of the iris stroma without transillumination. We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography imaging to highlight some observations about this syndrome. We interpret pharmacokinetic data to help explain why oral, but not topical, moxifloxacin may cause fluoroquinolone-associated uveitis.
ABSTRACT To report optical coherence tomography (OCT)-histologic correlations of two peripheral r... more ABSTRACT To report optical coherence tomography (OCT)-histologic correlations of two peripheral retinal lesions (PRLs) and to emphasize the feasibility of OCT imaging in fixed tissue specimens. We studied seven formalin-fixed human eyes two of which contained two common peripheral retinal lesions. OCT scans were performed through these lesions and the vitreous base area, and the images were correlated with corresponding histologic sections. Two PRLs including a retinal break and pars plana cysts in addition to the pars plicata and anterior vitreous were successfully imaged. Their optical characteristics correlated well with histology. OCT findings that may help differentiate the hyaloid face and vitreous skirt were also observed. The correlation between OCT images and corresponding histologic sections demonstrates the feasibility of OCT imaging in fixed tissue specimens. Optical characteristics of the vitreous noted in this study may be helpful in understanding disease processes involving the vitreomacular interface.
Retina-the Journal of Retinal and Vitreous Diseases, Apr 1, 2010
The purpose of this study was to report differentiating optical coherence tomography (OCT) findin... more The purpose of this study was to report differentiating optical coherence tomography (OCT) findings between postacute retinal arterial occlusion (PARAO) and nonacute optic neuropathy (NAON). Methods: A retrospective observational comparative study included 17 eyes with postacute permanent retinal arterial occlusion and 32 eyes with NAON whose assessment included a fast macular Status OCT. The macular OCT changes in the postacute phase of central retinal arterial occlusion and branch retinal arterial occlusion were, respectively, compared with those in diffuse and segmental NAON in an effort to establish differentiating features. The findings were used in the workup of four additional consecutive cases referred with suspected NAON. Results: Three main features differentiating PARAO from NAON were identified on macular OCT. Complete inner retinal atrophy with loss of the normal stratification of the inner retinal layers, loss of the normal foveal depression, and marked thinning of the involved retina were characteristic findings of PARAO and were absent even in the most severe cases of NAON. The involved retina was significantly thinner in PARAO compared with that in NAON (P Ͻ 0.05). These OCT features helped establish the diagnosis of PARAO in four additional consecutive cases referred with the misdiagnosis of NAON. Conclusion: The extent and pattern of inner retinal atrophy differentiate PARAO from NAON and help guide the systemic workup.
Control issues We recently reviewed the article by Killer et al, titled 'Cerebrospinal fluid exch... more Control issues We recently reviewed the article by Killer et al, titled 'Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma' 1 in our weekly Glaucoma Journal Club at the Bascom Palmer Eye Institute. The article raises the interesting concept that a difference in cerebrospinal fluid (CSF) exchange between the subarachnoid space of the optic nerves and the basal cistern, measured using contrast-enhanced computed cisternography as a marker of ventricular CSF flow, may exist as a contributing factor in the development of normaltension glaucoma.
Purpose-To investigate intraocular pressure (IOP) control and corneal graft survival rates in eye... more Purpose-To investigate intraocular pressure (IOP) control and corneal graft survival rates in eyes with glaucoma drainage device (GDD) implantation and penetrating keratoplasty (PK) and 5 years of follow-up data. Design-Retrospective review. Methods-We performed a review of records of all patients who underwent both GDD placement and PK at our institution between January 1, 1988 and December 31, 2003. Twentyeight eyes of 27 patients were studied. Glaucoma outcome was assessed by postoperative IOP, number of glaucoma medications, and need for further glaucoma surgery. Corneal grafts were assessed for clarity. Results-All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ± 10.3 mm Hg on a mean of 2.6 ± 0.8 glaucoma medications. At 5-year follow-up, the mean IOP was 13.0 ± 5.9 mm Hg on a mean of 0.9 ± 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 96%, 86%, 79%, 75%, and 71% of eyes at 1, 2, 3, 4, and 5 years, respectively. Grafts remained clear in 96%, 82%, 75%, 57%, and 54% of eyes at 1, 2, 3, 4, and 5 years, respectively. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries. Conclusions-Our data suggests that GDD placement can provide glaucoma control in a high percentage (71%) of eyes with PK even at 5 years. Furthermore, the success of PK in eyes with GDD remains reasonable (54%) at 5 years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity.
Clinical and Experimental Ophthalmology, Aug 1, 2011
human-pathogenic microsporidia Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittafo... more human-pathogenic microsporidia Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittaforma corneae in water. Appl Environ Microbiol 1998; 64: 3332–5. 6. Lewis NL, Francis IC, Hawkins GS, Coroneo MT. Bilateral microsporidial keratoconjunctivitis in an immunocompetent non-contact lens wearer. Cornea 2003; 22: 374–6. 7. Das S, Sahu SK, Sharma S, Nayak SS, Kar S. Clinical trial of 0.02% polyhexamethylene biguanide versus placebo in the treatment of microsporidial keratoconjunctivitis. Am J Ophthalmol 2010; 150: 110–15.
Introduction: The Trabectome is a novel surgical device used in the treatment of open angle glauc... more Introduction: The Trabectome is a novel surgical device used in the treatment of open angle glaucoma that removes trabecular meshwork tissue to improve aqueous access to drainage channels. Little is known about the long-term consequences of permanently unroofing Schlemm canal. Eyes that have had previous surgery in the iridocorneal angle, specifically permanent removal of trabecular meshwork tissue, may have an increased propensity for blood reflux. Case Presentation: We present a case of a patient who had intraoperative blood reflux onto peripheral iris during trabeculectomy 11 months after Trabectome surgery. Discussion: Intraoperative blood reflux and resultant hyphema is strongly correlated with Trabectome surgery, but the literature does not reveal any cases of late postoperative blood reflux. In our patient, the absence of overlying angle structures, including the roof of Schlemm canal, may have allowed blood to reflux into the angle and onto peripheral iris during a sudden decrease in intraocular pressure in trabeculectomy surgery. Further studies to assess the consequences of permanent trabecular meshwork tissue removal may be warranted.
Eye & Contact Lens-science and Clinical Practice, 2011
Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba kera... more Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba keratitis. We report a case of isolated pseudodendritic fungal epithelial keratitis that occurred in an extended wear contact lens user. Methods: A 48-year-old woman was evaluated in our clinic for a 36-hour history of left eye pain. She wore extended wear soft contact lenses and frequently rinsed her eyes with tap water. Her left cornea had a paracentral 3-mm area of epithelium with raised ridges in a pseudodendritic pattern. The underlying corneal stroma was normal. A therapeutic and diagnostic corneal scraping of the lesion was performed and sent for Gomori methenamine silver (GMS) staining. The clinical concern was for epithelial acanthamoeba keratitis. Results: The GMS staining revealed septate fungal hyphae within sheets of corneal epithelium. The patient was started on frequent alternating natamycin (5%) and amphotericin B (0.15%) antifungal eyedrops and exhibited a rapid clinical response. Her keratitis completely resolved, and her vision returned to her baseline of 20/25. Corneal fungal cultures showed no growth. Conclusions: Our case is an extremely unusual presentation of fungal keratitis, which rarely presents as a pseudodendritic epithelial keratitis. There are two previous similar case reports initially misdiagnosed as acanthamoeba keratitis. Clinicians should be aware that isolated fungal epithelial keratitis can present as a distinct entity and should be considered in the differential diagnosis of pseudodendritic keratitis. The GMS staining is an excellent diagnostic test in a patient presenting with pseudodendritic keratitis because it allows rapid diagnosis of acanthamoeba and fungal infections.
DOAJ (DOAJ: Directory of Open Access Journals), Apr 1, 2010
To report our short-term experience with bevacizumab in neovascular age-related macular degenerat... more To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy. Methods: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed. Results: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 µm at baseline to 278 µm at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed. Conclusion: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.
Purpose-The aim of this study is to determine the anatomic and visual outcomes following combined... more Purpose-The aim of this study is to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic macular hole (MH) without post-operative prone positioning (PPP). Materials and Methods-A retrospective chart review of 42 patients (47 eyes) with MH who underwent CPPLV was performed. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week. The main outcome measures included MH closure rate, best corrected post-operative Snellen visual acuity (BCVA), and procedure complications. Results-Anatomical closure was achieved in 44 eyes (93.6%). The average BCVA in these eyes improved from 20/203 at baseline to 20/91 post-operatively, with 28 (63.6%) having 20/40 or better. Twenty-eight (59.6%) of the 47 eyes had a BCVA of 20/40 or better post-operatively and 35 (74.5%) eyes improved by at least 2 Snellen lines. Post-operative retinal detachment (RD) was observed in 4 eyes (8.5%) and late reopening of the hole in 4 (9.1%). Discussion-The anatomical and visual outcomes and the RD rate of CPPLV with sulcus intraocular lens implantation without PPP are comparable to those of traditional MH surgery techniques. The main advantages include sparing the patient the inconvenience of PPP and eliminating the need for additional postvitrectomy cataract extraction procedure.
Choroidal neovascular membranes are a rare cause of decreased vision in children with optic nerve... more Choroidal neovascular membranes are a rare cause of decreased vision in children with optic nerve head drusen. We present a case of bilateral choroidal neovascular membranes associated with optic nerve head drusen in a 5-year-old boy who was successfully treated with a combination of focal laser photocoagulation and intravitreal bevacizumab.
Journal of Ophthalmic Inflammation and Infection, 2013
Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depig... more Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depigmentation associated with systemic fluoroquinolones and other antibiotics. Bilateral acute iris transillumination, which is associated with loss of the iris pigment epithelium and results in iris transillumination, differs from the previously described bilateral acute depigmentation of the iris, which is associated with atrophy of the iris stroma without transillumination. We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography imaging to highlight some observations about this syndrome. We interpret pharmacokinetic data to help explain why oral, but not topical, moxifloxacin may cause fluoroquinolone-associated uveitis.
ABSTRACT To report optical coherence tomography (OCT)-histologic correlations of two peripheral r... more ABSTRACT To report optical coherence tomography (OCT)-histologic correlations of two peripheral retinal lesions (PRLs) and to emphasize the feasibility of OCT imaging in fixed tissue specimens. We studied seven formalin-fixed human eyes two of which contained two common peripheral retinal lesions. OCT scans were performed through these lesions and the vitreous base area, and the images were correlated with corresponding histologic sections. Two PRLs including a retinal break and pars plana cysts in addition to the pars plicata and anterior vitreous were successfully imaged. Their optical characteristics correlated well with histology. OCT findings that may help differentiate the hyaloid face and vitreous skirt were also observed. The correlation between OCT images and corresponding histologic sections demonstrates the feasibility of OCT imaging in fixed tissue specimens. Optical characteristics of the vitreous noted in this study may be helpful in understanding disease processes involving the vitreomacular interface.
Retina-the Journal of Retinal and Vitreous Diseases, Apr 1, 2010
The purpose of this study was to report differentiating optical coherence tomography (OCT) findin... more The purpose of this study was to report differentiating optical coherence tomography (OCT) findings between postacute retinal arterial occlusion (PARAO) and nonacute optic neuropathy (NAON). Methods: A retrospective observational comparative study included 17 eyes with postacute permanent retinal arterial occlusion and 32 eyes with NAON whose assessment included a fast macular Status OCT. The macular OCT changes in the postacute phase of central retinal arterial occlusion and branch retinal arterial occlusion were, respectively, compared with those in diffuse and segmental NAON in an effort to establish differentiating features. The findings were used in the workup of four additional consecutive cases referred with suspected NAON. Results: Three main features differentiating PARAO from NAON were identified on macular OCT. Complete inner retinal atrophy with loss of the normal stratification of the inner retinal layers, loss of the normal foveal depression, and marked thinning of the involved retina were characteristic findings of PARAO and were absent even in the most severe cases of NAON. The involved retina was significantly thinner in PARAO compared with that in NAON (P Ͻ 0.05). These OCT features helped establish the diagnosis of PARAO in four additional consecutive cases referred with the misdiagnosis of NAON. Conclusion: The extent and pattern of inner retinal atrophy differentiate PARAO from NAON and help guide the systemic workup.
Control issues We recently reviewed the article by Killer et al, titled 'Cerebrospinal fluid exch... more Control issues We recently reviewed the article by Killer et al, titled 'Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma' 1 in our weekly Glaucoma Journal Club at the Bascom Palmer Eye Institute. The article raises the interesting concept that a difference in cerebrospinal fluid (CSF) exchange between the subarachnoid space of the optic nerves and the basal cistern, measured using contrast-enhanced computed cisternography as a marker of ventricular CSF flow, may exist as a contributing factor in the development of normaltension glaucoma.
Purpose-To investigate intraocular pressure (IOP) control and corneal graft survival rates in eye... more Purpose-To investigate intraocular pressure (IOP) control and corneal graft survival rates in eyes with glaucoma drainage device (GDD) implantation and penetrating keratoplasty (PK) and 5 years of follow-up data. Design-Retrospective review. Methods-We performed a review of records of all patients who underwent both GDD placement and PK at our institution between January 1, 1988 and December 31, 2003. Twentyeight eyes of 27 patients were studied. Glaucoma outcome was assessed by postoperative IOP, number of glaucoma medications, and need for further glaucoma surgery. Corneal grafts were assessed for clarity. Results-All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ± 10.3 mm Hg on a mean of 2.6 ± 0.8 glaucoma medications. At 5-year follow-up, the mean IOP was 13.0 ± 5.9 mm Hg on a mean of 0.9 ± 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 96%, 86%, 79%, 75%, and 71% of eyes at 1, 2, 3, 4, and 5 years, respectively. Grafts remained clear in 96%, 82%, 75%, 57%, and 54% of eyes at 1, 2, 3, 4, and 5 years, respectively. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries. Conclusions-Our data suggests that GDD placement can provide glaucoma control in a high percentage (71%) of eyes with PK even at 5 years. Furthermore, the success of PK in eyes with GDD remains reasonable (54%) at 5 years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity.
Clinical and Experimental Ophthalmology, Aug 1, 2011
human-pathogenic microsporidia Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittafo... more human-pathogenic microsporidia Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittaforma corneae in water. Appl Environ Microbiol 1998; 64: 3332–5. 6. Lewis NL, Francis IC, Hawkins GS, Coroneo MT. Bilateral microsporidial keratoconjunctivitis in an immunocompetent non-contact lens wearer. Cornea 2003; 22: 374–6. 7. Das S, Sahu SK, Sharma S, Nayak SS, Kar S. Clinical trial of 0.02% polyhexamethylene biguanide versus placebo in the treatment of microsporidial keratoconjunctivitis. Am J Ophthalmol 2010; 150: 110–15.
Introduction: The Trabectome is a novel surgical device used in the treatment of open angle glauc... more Introduction: The Trabectome is a novel surgical device used in the treatment of open angle glaucoma that removes trabecular meshwork tissue to improve aqueous access to drainage channels. Little is known about the long-term consequences of permanently unroofing Schlemm canal. Eyes that have had previous surgery in the iridocorneal angle, specifically permanent removal of trabecular meshwork tissue, may have an increased propensity for blood reflux. Case Presentation: We present a case of a patient who had intraoperative blood reflux onto peripheral iris during trabeculectomy 11 months after Trabectome surgery. Discussion: Intraoperative blood reflux and resultant hyphema is strongly correlated with Trabectome surgery, but the literature does not reveal any cases of late postoperative blood reflux. In our patient, the absence of overlying angle structures, including the roof of Schlemm canal, may have allowed blood to reflux into the angle and onto peripheral iris during a sudden decrease in intraocular pressure in trabeculectomy surgery. Further studies to assess the consequences of permanent trabecular meshwork tissue removal may be warranted.
Eye & Contact Lens-science and Clinical Practice, 2011
Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba kera... more Pseudodendritic keratitis in a contact lens wearer is generally associated with acanthamoeba keratitis. We report a case of isolated pseudodendritic fungal epithelial keratitis that occurred in an extended wear contact lens user. Methods: A 48-year-old woman was evaluated in our clinic for a 36-hour history of left eye pain. She wore extended wear soft contact lenses and frequently rinsed her eyes with tap water. Her left cornea had a paracentral 3-mm area of epithelium with raised ridges in a pseudodendritic pattern. The underlying corneal stroma was normal. A therapeutic and diagnostic corneal scraping of the lesion was performed and sent for Gomori methenamine silver (GMS) staining. The clinical concern was for epithelial acanthamoeba keratitis. Results: The GMS staining revealed septate fungal hyphae within sheets of corneal epithelium. The patient was started on frequent alternating natamycin (5%) and amphotericin B (0.15%) antifungal eyedrops and exhibited a rapid clinical response. Her keratitis completely resolved, and her vision returned to her baseline of 20/25. Corneal fungal cultures showed no growth. Conclusions: Our case is an extremely unusual presentation of fungal keratitis, which rarely presents as a pseudodendritic epithelial keratitis. There are two previous similar case reports initially misdiagnosed as acanthamoeba keratitis. Clinicians should be aware that isolated fungal epithelial keratitis can present as a distinct entity and should be considered in the differential diagnosis of pseudodendritic keratitis. The GMS staining is an excellent diagnostic test in a patient presenting with pseudodendritic keratitis because it allows rapid diagnosis of acanthamoeba and fungal infections.
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Papers by Robert Knape